bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical and genetic analysis in Chinese children with Alagille syndrome
Authors: Chen Ying , Sun Mei , Teng Xu
Published: July 2022

Background: Alagille syndrome (ALGS) is a multisystem disorder with changeable clinical penetrance. The genes responsible for this disease are JAGGED1 (JAG1) and NOTCH2. Clinical data of this disease is limited in China. The purpose of this study was to enrich the present data of Chinese children with Alagille syndrome by summarizing clinical characteristics and genetic variation of the cases. Case summary: From January 2011 to February 2022, 10 children were diagnosed with ALGS. The organs involved in ALGS were as follows: liver (10, 100%); heart (7, 70%); characteristic facial features (7, 70%); skeleton (4, 40%); brain (1,10%) and kidney (3, 30%). Four patients (40%) were underweight. The main clinical manifestations were cholestasis, heart disease, and facial features. The median total bilirubin, direct bilirubin, and total bile acid were 138.75 mmol/L (normal, 3.4–20.5 mmol/L), 107.25 mmol/L (normal, 0–8.6 mmol/L), and 110.65 mmol/L (normal, 0.5–10.0 mmol/L), respectively. The median value of gamma-glutamyltranspeptidase was 223 U/L (normal, 9–64 U/L). Six (60%) children had hypercholesteremia. Eight different JAG1 gene variations and one NOTCH2 gene pathogenic variant in the 10 Chinese ALGS patients were identified.Conclusion: Cholestasis was the most common initial presenting symptom in Chinese ALGS pediatric patients. Pathogenic variants in JAG1 and NOTCH2 are the primary mutations in Chinese children with ALGS, but we had our own unique variants spectrum. ALGS should be considered for cholestasis in infants and young children, especially those with multi-organ abnormalities.
Influence of Demographic and Socio-Economic Factors in Choosing Hospitalist Careers among US Medical Students
Authors: Rachoin Jean-Sebastien , Vilceanu M. Olguta , Franzblau Natali , Gordon Sabrina , Cerceo Elizabeth
Published: July 2022

Background: The subspecialty of Hospital Medicine (HM) has grown rapidly since the mid-1990s. Diversity and inclusion are often studied in the context of healthcare equity and leadership. However, little is known about the factors potentially associated with choosing this career path among US medical students. Methods: We analyzed the results of the Annual Association of American Medical Colleges Survey administered to Graduating medical students from US medical schools from 2018 to 2020.Results: We analyzed 46,614 questionnaires. 19.3% of respondents (N=8,977) intended to work as a HM (unchanged from 2018 to 2020), mostly combined with specialties in IM (31.5%), Pediatrics (14.6%), and Surgery (9.1%). Students interested in HM were significantly more likely to identify as female, LGB, Asian or Black/African-American, or Hispanic. Role models and the ability to do a fellowship were strong factors in choosing HM, as was higher average for educational debt (HM $170,000 vs. $155,000. Interest in higher salary and work/life balance negatively impacted the likelihood of choosing HM. There were significant differences between students who chose IM/HM and Pediatrics/HM. Conclusion: About one in five US medical students is interested in HM. The probability of choosing future HM careers is higher for students who identify as sexual or racial minorities, with a higher amount of educational debt, planning to enter a loan forgiveness program or are interested in doing a fellowship.
Assesment of Burnout & Stress Among Medical & Non-medical Students Age 18 Years and Above in Malaysia
Authors: Kyaw Thin Mon , Murthi Kavilan , Aveliar Vikneswary , Anadan Tilasini , Chelven Ashwini Avudima Kavi , Mun'em Fathiyah Abd , Kamal Sakina , Mazlan Nur Liyana
Published: July 2022

Background: According to World Health Organization, burnout is a syndrome resulting from work related stress which had not been well managed and this may lead to extreme health issues among people. Therefore, it’s important to learn how to prevent burnout and stress by addressing the factors associated with them. Objective: The objective was to assess the burnout and stress among Malaysian medical students & non-medical students age 18 years and above in Malaysia.Methods: A cross-sectional online survey was conducted by enrolling Malaysian adults aged 18 years and above. An online questionnaire was distributed with google form through multiple electronic platforms.Results: We found that most of the medical students have moderate level of burnout which was 28.3 % followed by high level of burnout which was 13.9%, no/low level burnout which was 5.8% and severe burnout which was 2.6%. Most of the non-medical students have moderate level of burnout which was 26.5 % followed by high level of burnout which was 16.8%. Furthermore, most of the both medical students and non-medical students having moderate level of stress which are 41.6% and 40.1% respectively.Conclusion: Overall, student’s mental health has been mostly triggered to stressful environment due to their academic sector mostly which led to more complication such as depression, anxiety and post-traumatic stress disorder.
Personal and sexual boundaries: The experiences of people with intellectual disabilities
Authors: Svae Gøril Brevik , Blixt Line , Søndenaa Erik
Published: July 2022

Background: Previous research shows that people with intellectual disabilities have less knowledge about sexual health and are more vulnerable to victimisation. In cases of sexual abuse, they are likely to encounter the criminal justice system as vulnerable witnesses. Several challenges arise when people with intellectual disabilities are in communication with the criminal justice system We aimed to explore the perceptions, experiences and knowledge of people with intellectual disabilities regarding personal and sexual boundaries in order to map factors that can help prevent sexual abuse. Method: The study had a qualitative design. Data were collected from seven people with mild intellectual disabilities (28–40 years; 2 men, five women) through one-to-one interviews in specialised health care services for people with intellectual disabilities (SHCS). Some participants lived alone, and some lived with their families. Many received professional support services. Data were analysed using thematic analyses. Results: The interviews identified that the participants want to be in romantic relationships but consider sex to be unimportant. Many of them have had trouble finding someone to have a romantic relationship with. The participants were unsure about sexual consent related to sexual activity, though many could explain the concept of consent in other contexts. Many participants reported that they had experienced sexual abuse, including online sexual abuse. Those participants who had reported the sexual abuse had positive experiences obtaining assistance from the criminal justice system. Some participants reported trauma and fear related to the sexual abuse they had experienced. Conclusion: This study highlights the need for increased sexual education, including information about sexually abusive relationships, risks online and ways to get help. More attention should be given to the importance of trauma, and treatment after experiencing sexual abuse is needed.
Based annual classification of precipitation fallow period in dryland the Loess Plateau of China
Authors: Noor Hafeez , Min Sun , Ren Aixia , Gao Zhiqiang
Published: July 2022

In order to clarify the relationship between wheat yield and precipitation in dryland region, the annual classification method of precipitation in fallow period was summarized in this paper by analyzing precipitation, precipitation distribution and its relationship with yield in Wenxi Experimental Base of Shanxi Province and major meteorological stations on the Loess Plateau from 1983 to 2020.The results showed that the average precipitation during fallow period was 296mm (coefficient of variation CV = 10%), accounting for 58% (coefficient of variation CV = 6%) of annual precipitation in the upland region of the Loess Plateau. With the increase of precipitation in fallow period, the wheat yield in dryland increased logarithmically (Y = 2526.5 lnX-10148, R2 = 0.42, P < 0.05). The method of annual classification of precipitation in fallow period. Divide the year type by annual precipitation, wet year: Pi > Pm + 0.33δ; Pm-0.33 δ ≤ Pi ≤ Pm + 0.33δ; Dry years: Pi < Pm-0.33 δ, Pi is annual precipitation (mm); Pm is perennial average annual precipitation (mm); δ is mean variance of annual precipitation (mm). In total, 17 years were perennial, 7 years were wet and 13 years were dry. The years in which the proportion of perennial and humid fallow precipitation was lower than the multi-year average were defined as abnormal years, and the years in which the proportion of arid fallow precipitation was higher than the multi-year average were defined as abnormal years.
Clusters of comorbidities in fibrotic hypersensitivity pneumonitis
Authors: Prior Thomas Skovhus , Wälscher Julia , Gross Benjamin , Bendstrup Elisabeth , Kreuter Michael
Published: July 2022

Background: Hypersensitivity pneumonitis (HP) is a type of interstitial lung disease (ILD) with a variable disease course and prognosis ranging from inflammatory and self-limiting to irreversible and progressive pulmonary fibrosis. Comorbidities are common in HP and may have an impact on prognosis. Due to the heterogeneity of HP presentation and progression, the identification of specific phenotypes in relationship to disease course and outcome is essential. The aim of this study was to identify clusters of comorbidities which could represent phenotypes in fibrotic HP and examine their impact on prognosis. Methods: Patients diagnosed with fibrotic HP at a tertiary referral center for ILD were included. Comorbidities were systematically registered and clusters of comorbidities were identified using cluster analyses. Disease progression and survival was estimated for each cluster.Results: The cohort comprised 211 patients with 53.6% males, mean age 63.0, baseline FVC 72.7%, DLCO 44.1%. Median follow-up time was 1.8 years (IQR 0.7-3.9). Three clusters with distinct comorbidity profiles and clinical characteristics were identified. One cluster dominated by elder male patients with predominantly cardiovascular diseases was associated with more respiratory hospitalizations and a worse prognosis. Differences in pulmonary function or exercise capacity trajectories between clusters were not observed.Conclusions: Three clusters with distinct comorbidities were identified and could represent phenotypes in fibrotic HP not previously recognized. The worst prognosis was observed in a cluster dominated by elder males with cardiovascular diseases. Increased focus on prevention and treatment of comorbidities could potentially improve the prognosis of patients with fibrotic HP.
Electrochemically formed inverse opals of silver
Authors: Arabov Rustam I. , Komarova Maria Yu. , Knotko Alexander V. , Maslakov Konstantin I. , Martynova Natalia A. , Savilov Serguei V. , Grigorieva Anastasia V.
Published: July 2022

Silver inverse opals have been prepared electrochemically using a number of water-ethanol acidic or alkaline electrolytes. Opal matrices made of polystyrene microspheres of 420 nm diameter were used as templates. Compositions of electrolytes and conditions of syntheses have been optimized according to cyclic voltammetry and stability window of silver complexes during the experiments. Samples with the most uniform structure have been deposited from the iodous electrolyte. At the same time, the list percentage of surface admixtures observed for the opals formed from the rhodanide electrolyte using X-ray photoelectron spectroscopy (XPS). Reflectance optical spectra of the silver inverse opals measured with angles of incidence of 8 - 64° have shown various plasmon excitation modes in a visible spectral range according to the Bragg effect making the silver opals attractive for the Surface-Enhanced Raman Spectroscopy (SERS).
Effect of pinoresinol and vanillic acid isolated from Catalpa bignonioides on mouse myoblast proliferation via the Akt/mTOR signaling pathway
Authors: Kim Seo-Young , Kwon Sung-Pil , Park SeonJu , Cho Su-Hyeon , Oh Youngse , Kim Seung Hyun , Park Yoon Ho , Jung Hyun Suk , Lee Deug-chan , Jeong Hoibin , Kim Kil-Nam
Published: July 2022

Sarcopenia is a disease in which skeletal muscle decreases with age. Stimulating the proliferation and differentiation of muscle cells may help prevent sarcopenia. To discover effective natural substances enabling to treat muscle loss without side effects, we evaluated muscle growth with several compounds extracted from Catalpa bignonioides Walt. Among these compounds, pinoresinol and vanillic acid increased C2C12, a mouse myoblast cell line, proliferation the most without cytotoxicity. These substances activated the Akt/mammalian target of rapamycin (mTOR) pathway, which positively regulates the proliferation of muscle cells. In addition, they strongly bound to insulin-like growth factor 1 receptor (IGF-1R), which is an upstream of the Akt/mTOR pathway, indicating that both pinoresinol and vanillic acid stimulate myoblast proliferation through direct interaction with IGF-1R. These results suggest that pinoresinol and vanillic acid may improve the proliferation of skeletal muscle via IGF-1R/Akt/mTOR signaling and thus alleviate diseases such as sarcopenia.
Maximum Surgical Blood Order Schedule for flap reconstruction in oral and maxillofacial cancer patients
Authors: Zhao Yili , Li Xueer , Wang Yuepeng , Chen Yanhong , Li Dandan , Jiang Qiming , Wang Yan
Published: July 2022

Background: We established a MSBOS for flap reconstruction in oral and maxillofacial cancer patients.Method: We enrolled 2080 cases of oral and maxillofacial flap reconstruction from January 1, 2010, to December 31, 2021. Patient data were collected, including age, sex, BMI, preoperative Hb levels, ASA grade, T stage, flap type, tumor location, and bone flap. Scoring criteria were established based on a multivariate model of independent risk variables and their odds ratios. Two flap-type groups were divided into low-risk, intermediate-risk and high-risk groups by the scoring criteria, and analyzed using univariate and multivariate logistic regression. Perioperative transfusion analysis identified independent risk factors at various Hb levels. The cumulative percentage of patients requiring perioperative blood transfusion for each surgical procedure was calculated to establish the MSBOS.Results: 1) Regression analysis showed that BMI, tumor T staging, ASA grade, preoperative Hb level (male: Hb < 130 g/L, female: Hb < 120 g/L), and bone flap were independent risk factors for perioperative blood transfusion. 2) Regression analysis showed that independent risk factors for perioperative transfusion included the following: BMI, tumor T3-T4 stage, ASA Ⅲ, Ⅳ grade, and free flap/pediculated flap/bone flap in patients with different Hb levels; T3-T4 stage, ASA grade III-IV in mildly anemic patients; and ASA grade III-IV in moderately anemic patients. 3) A MSBOS was established for flap reconstruction in head and neck cancer patients.Conclusion: A MSBOS can guide preoperative blood preparation for head and neck cancer procedures, help optimize blood inventory, and save blood resources.
Effects of alcohol use disorder on biochemical and hematological parameters of adolescents
Authors: Anorue Eleazar Chukwuemeka , Joshua Parker Elijah , Anosike Chioma Assumpta , Nwaguma Benedict Chima
Published: July 2022

Background
Alcohol use disorder is becoming an increasing problem among adolescents. As a result, it has been reported that abuse of alcohol contributes to over 3 million deaths each year globally and is one of the world’s leading risk factors of morbidity, mortality and disability among adolescents.
Aim
Therefore, investigation was carried out to know the effects of alcohol use disorder on hematological and biochemical parameters of adolescents.
Method
The study was categorized into 3 groups comprising of non-drinkers (0g/day), low drinkers (≤ 46g/day), and high drinkers (≥ 46g/day).
Result
It was found that biochemical and hematological parameters of high drinkers (≥ 46g/day) were significantly lower (p < 0.05) compared to that of non-drinkers and low drinkers.
Conclusion
The results of this study suggest that alcohol use disorder can lead to anemia, vulnerability to infection, liver toxicity, kidney failure, and other pathophysiological conditions among adolescents given to high intake of alcohol.
TBC1D23 drives lymphatic metastasis in pancreatic ductal adenocarcinoma by altering EGFR cell surface dynamics and signaling
Authors: Shan Yan-Shen , Chao Ying-Jui , Wang Hao-Chen , Chen Yu-Lun , Hou Ya-Chin , Wang Chih-Jung , Shin Jyh-Wei
Published: July 2022

Rich in protein and adjacent to pancreatic cancer cells, pancreatic juice has been considered an attractive source to discover biomarkers for pancreatic ductal adenocarcinoma (PDAC). Here, we identified a novel biomarker, TBC1D23 in pancreatic juice of PDAC patients. High TBC1D23 expression was also observed in tumor tissues and sera, associated with lymphatic metastasis and shorter survival. TBC1D23 was strongly expressed in PDAC cell lines, and knocking down TBC1D23 reduced cell proliferation and migration in vitro and suppressed xenograft tumor growth and peritoneal metastasis in vivo. DNA microarray analysis identified the down-regulation of VEGF-C in TBC1D23 knockdown cells compared to control. Indeed, depletion of TBC1D23 decreased VEGF-C expression and secretion. Treatment with conditioned medium from PANC-1 cells promoted lymphangiogenesis in lymphatic endothelial cells, while this effect was counteracted by the VEGFR3 inhibitor MAZ51 or knockdown of TBC1D23, indicating that VEGF-C is a target gene of TBC1D23. Mechanistically, TBC1D23 could increase EGFR membrane distribution, enhance EGFR recycling, but inhibit EGFR endocytic degradation, suggesting that TBC1D23 up-regulates VEGF-C by maintaining EGFR capacity to transduce signals. This study clearly demonstrates the oncogenic role of TBC1D23 and EGFR/VEGF-C as its downstream signaling pathway for lymphatic metastasis.
Efficacy of Air Leak Test in Preventing Anastomotic Leaks After Rectal Excision: A Retrospective Case-Controlled Study
Authors: Song Seung Ho , Park Jun Seok , Choi Gyu-Seog , Park Soo Yeon , Kim Hye Jin , Lee Sung-Min , Na Dong-Hee , Jeong Min Hye
Published: July 2022

An intraoperative air leak test (ALT) is commonly used to detect mechanical defects following a bowel anastomosis, although its efficacy is uncertain. This study aimed to evaluate the efficacy of ALT for preventing anastomotic leakage (AL) following rectal excision. We reviewed our database for patients with rectal cancers who had undergone curative surgery between January 2012 and January 2018. Patients were grouped according to whether or not an ALT was performed. Propensity score analyses were performed to compare outcomes for groups in a 1:1 case-matched cohort. In total, 1,191 patients underwent rectal excision; 438 (219 in each group) formed the case-matched cohort for analysis. The protective stoma rate was 16.0% and 14.6% in the ALT and the no-ALT groups, respectively (p = 0.791). In the ALT group, 2 patients (0.9%) showed a positive result and were treated with rectal tube drainage, resulting in no leakage. There was no significant between-group difference in postoperative AL rate (ALT group: 4.6%, no-ALT group: 4.1%, p = 1.000). ALT played a minimal role in preventing AL following rectal excision. Further studies are warranted to validate our results and clarify whether AL can be prevented with ALT or alternative methods.
PEDF inhibits non-small cell lung cancer proliferation by repressing autophagy through downregulating AMPK-ULK1 signaling
Authors: Miao Haoran , Hui Hongliang , Li Huaming , Lin Yangui , Li Dan , Luo Min , Jiang Bo , Zhang Yiqian
Published: July 2022

Background: Current investigations suggest that pigment epithelial factor (PEDF) can mediate progression of non-small cell lung cancer (NSCLC) by regulating autophagy. However, the underlying mechanisms associated with autophagy are still poorly known. This study aimed to investigate the relationship between PEDF-AMPK-ULK1 pathway and autophagy in NSCLCs.Methods: Intracellular autophagy was evaluated by some indicators, such as expression and activationof LC3-I, LC3-II and p62, distribution and number of autophagosomes observed by confocal microscopy. In addition, we also examined the activity and proliferative capacity of NSCLC cells under PEDF overexpression by CCK8, LDH assay and WB of related proteins. Results: The results show that PEDF could significantly inhibit NSCLC cell proliferation and cell viability, and increase LDH release and intercellular adhesion. Moreover, PEDF suppressed expression and activation of LC-3 and reduced the number and distribution of autophagosomes. PEDF-induced inhibition of autophagy showed a direct correlation with the suppressed proliferation capacity and cell viability of NSCLC cells. Western blot results showed that NSCLCs regulate autophagy through AMPK-ULK1 signaling pathway. PEDF can downregulate AMPK-ULK1 signaling pathway, and overexpression of AMPK or ULK1 can greatly reduce the inhibitory effect of PEDF on autophagy.Conclusions: PEDF could significantly inhibit the proliferative capacity and cell viability of NSCLCs, and the fundamental reason is that PEDF exerted an inhibitory function by regulating autophagy in NSCLCs. Finally, we elucidated that autophagy may be suppressed by inhibiting AMPK-ULK1 signaling pathway, thereby revealing a mechanism of lung cancer progression.
The Effects of Preoperative Anxiety Level in Patients with Nasogastric Tube Inserted on Postoperative Quality of Recovery and Pain undergoing Laparoscopic Cholecystectomy under General Anesthesia
Authors: Li Lifang , Cheng Zhangqin , Wang Liuyi , Zhang Yuhan , Su Yang , Wang Kai , Lu Xiaoxing , Wang Liwei
Published: July 2022

Background: Nasogastric tube inserted before laparoscopic cholecystectomy is a preoperative common preparation, which is an invasive procedure and exacerbates the patient’s anxiety level. This prospective, observational, cohort study aimed to explore the effects of preoperative anxiety level in patients with nasogastric tube inserted on the postoperative quality of recovery and pain undergoing laparoscopic cholecystectomy, and analyze the correlation between preoperative anxiety level and the postoperative quality of recovery. Method: Patients with STAI-S＞40 were excluded the day before surgery. After entering the operating room, patients were assessed anxiety level using the Anxiety - Visual Analog Scale. The quality of recovery was assessed using 15 - items quality of recovery on postoperative day 1 and 2. The pain was evaluated with the Numerical Rating Scale. 17 cases were excluded, and a total of 80 patients were enrolled in this study.Results: Compared with the group N, Anxiety Visual Analog Scale scores were higher in the group Y (with nasogastric tube inserted) after entering the operating room (P < 0.001), 15 - items quality of recovery scores on postoperative day 1 in the group Y was lower than group N (without nasogastric tube inserted) (P < 0.001). Pain intensity was higher in group Y at 2, 4, 8, 12, 24 and 48h after surgery than in Group N (P < 0.050). Anxiety Visual Analog Scale scores were significantly and negatively correlated with the 15- items quality of recovery scores (r = -0.91, P < 0.001). Compared with group N, group Y had longer time to get out of bed and postoperative first flatus time (P < 0.001). The AIS scores were higher on the night after surgery in group Y than in group (P < 0.001). Conclusion: In summary, nasogastric tube inserted increases preoperative anxiety level, which is associated with lower postoperative quality of recovery and higher pain intensity after surgery, and affects the patient's emergence time and postoperative sleep quality. We can implement intervention measures according to patients' conditions to relieve patients' preoperative anxiety level, improve the postoperative quality of recovery, improve patients' satisfaction and speed up recovery.Trial registration: This prospective, observational, cohort study selected patients who underwent laparoscopic cholecystectomy at Xuzhou Central Hospital from April 2022 to June 2022. The study was approved by the Ethics Committee of Xuzhou Central Hospital (XZXY-LK-20220318-024) and registered on Clinicaltrials.gov (10/04/2022, ChiCTR2200058548).
Optimizing QTL introgression via stochastic simulations: an example of the IRRI rice breeding program
Authors: Platten John Damien , Fritsche-Neto Roberto
Published: July 2022

A key limitation in the ability of breeding programs to leverage benefits of major-gene marker-assisted selection is the availability of those genes in appropriate elite germplasm. In this context, our study compared three strategies to develop new recipients for QTL introgression (Background recovery (BG), Selective sweep (SS), and Breeding values (BV)) in a short-term breeding program (over five breeding cycles). Furthermore, we evaluated two different numbers of recipients (10 and 20) in the introgression process and how they influence the population performance and the QTL fixation over cycles. Finally, we used rice as a model of a self-pollinated crop and implemented stochastic simulations. Each strategy was simulated and replicated 40 times. Regardless of the selection strategy used, the QTL introgression resulted in substantial penalties in yield performance. However, introducing fewer new parents to the augmentation process minimized this effect. Conversely, the time required to achieve fixation of target QTLs showed substantial differences, with selection for BV during augmentation out-performing other methods. Overall, the BV_10 strategy (10 parents selected based on genomic estimated breeding values) displayed the best trade-off between reduced penalty from introducing new QTLs with a reasonable speed at which those QTLs can achieve fixation over subsequent breeding cycles.
Critical Appraisal of the National Institute for Health and Care Excellence (NICE) Guidelines for Spine Disorders using the Appraisal of Guidelines for Research and Evaluation II Instrument (AGREE II)
Authors: LIANG Ning , WU Sizhan , ROBERTS Simon , MAKARAM Navnit , Ngwayi James Reeves Mbori , PORTER Daniel
Published: July 2022

Introduction: Disorders of the spine (as defined by the musculoskeletal structures surrounding the spinal neural elements) require an evidence-based, approach to their care. This evaluation used the Appraisal of Guidelines for Research and Evaluation (AGREE) II instrument to evaluate the methodological quality of evidence-based guidelines on spine disorders published by The National Institute for Health and Care Excellence (NICE).Materials and methods: We systematically searched clinical guidelines on spine disorders published by NICE until December 2019. Four appraisers across three international centers independently evaluated the quality of eligible clinical guidelines using AGREE II. Mean AGREE II scores for each domain were calculated. In higher quality domains scores for individual items were analysed. The guidelines were grouped according to type and year of publication. Comparative statistics and intraclass correlation (ICC) calculations were performed.Results: A total of 37 guidelines published by NICE on spine disorders were identified. Mean scores for all six domains were as follows: Scope and Purpose (73.2%), Stakeholder Involvement (63.9%), Rigour of Development (68.1%), Clarity of Presentation (73.6%), Applicability (53.2%) and Editorial Independence (64.5%). The mean score for overall quality of all NICE spinal-related guidelines was 68.8% (95% CI: 62.3–75.3). Interventional Procedure Guidelines were evaluated as possessing significantly lower overall quality than other types (p = 0.007). Overall quality was significantly associated with year of publication (rs=0.476, p = 0.0029). Evaluator ICC for each guideline ranged from 0.39 to 0.95.Conclusions: NICE guidelines on spine disorders demonstrated acceptable or good quality across most domains. Despite deficiencies in the applicability domain, their quality has improved over time. We recommend use of NICE guidelines for assessment and treatment of spine disorders.
Dental caries prediction and the indication of pit and fissure sealant in children first permanent molars: a prospective study
Authors: Emmanuelli Bruno , Knorst Jessica Klöckner , Menegazzo Gabriele Rissotto , Mendes Fausto Medeiros , Ardenghi Thiago Machado
Published: July 2022

Objectives: To evaluate predictors for caries incidence on first permanent molars and to assess the accuracy and efficiency of these predictors for the indication of pit and fissure sealants.Methods: This 7-y cohort study started in 2010 with a sample of 639 children (1–5 years) from Southern Brazil. Dental caries was assessed using the ICDAS. Maternal education, family income, parental perception on child oral health and severe dental caries experience were collected at baseline and used to test the prediction of dental caries. Predictive values, accuracy and efficiency were estimated for each possible predictor.Results: About 449 children were re-assessed at follow-up (70.3% retention rate). Low family income and poor parental perception of child oral health were moderately accurate in correctly identifying sound children who would not need to receive pit and fissure sealant. However, all the adopted criteria have lower accuracy incorrectly identifying children who later developed dental caries in first permanent molars. Conclusions: Distal and intermediate factors were relatively accurate in determining caries risk incidence on children's first permanent molars. The criteria adopted were more accurate in identifying sound children than those who need to receive pit and fissure sealant.Clinical relevance: Our findings reinforce the idea that investing in strategies that take into account common risk factors still represents the best option for dental caries prevention. However, adopting only these parameters is not enough to indicate pit and fissure sealants.
Ethyl loflazepate as a treatment for patients with idiopathic and psychogenic dysgeusia
Authors: Sakata Ken-ichiro , Hato Hiroyuki , Sato Jun , Iori Takashi , Ohga Noritaka , Watanabe Haruhisa , Yamazaki Yutaka , Kitagawa Yoshimasa
Published: July 2022

Background
Ethyl loflazepate (EL) is a benzodiazepine derivative that has been reported to activate the gustatory cortex. Our department routinely uses EL as a first-line treatment for idiopathic and psychogenic taste disorders, although little has been reported in the literature with respect to patient outcomes, so we conducted a retrospective study examining its safety and efficacy.
Methods
Between 2008 and 2020, 49 patients (14 males and 35 females; mean age, 62.1 years) were diagnosed with taste disorders and received EL as their only treatment for > 14 days. Severity of taste disorder was evaluated using the paper disc method by Sakai et al [7], and treatment efficacy was evaluated using the Visual Analog Scale, wherein patients gave subjective ratings for their symptoms (reductions by > 50% after administration of EL for 4 weeks were defined as improvements).
Results
Results showed that the improvement rates for patients with idiopathic and psychogenic taste disorders were 55% and 70%, respectively. Additionally, the majority (78%) improved within 2 weeks, and side effects were mild (seven cases with drowsiness and one case with dizziness).
Conclusions
We conclude that EL is an appropriate first-line medication for patients with idiopathic and psychogenic taste disorders.
Review on the strategies for enhancing mechanical properties of bacterial cellulose
Authors: Wang Yun-Ya , Zhao Xue-Qing , Li Dong-Mei , Wu Ya-Mei , Wahid Fazli , Xie Yan-Yan , Zhong Cheng
Published: July 2022

Bacterial cellulose (BC) is a pure biopolymer with abundant sources. BC has been used in wound dressings, artificial blood vessels, bone tissue engineering, and other applications because of its microporosity, excellent water retention, thermal stability, and biocompatibility. Despite this, the mechanical qualities of dehydrated BC are poor, and its strength and toughness are insufficient for the application. The mechanical properties of BC are influenced by the three-dimensional (3D) nano-network structure, which includes porosity, pore diameter, and the ordered arrangement of fibers, among other factors. Essentially, the quantity and kind of cross-linking in the 3D network play a critical role in improving mechanical characteristics. Selection and modification of production strains, surface chemical modification, physical mixing with reinforcement, and improving the ordered arrangement of fibers are some of the tactics discussed in this review for improving the mechanical properties of BC. Various improvement methods and their effects on mechanical characteristics are addressed.
WITHDRAWN: Factors affecting delayed displacement of clavicle fractures in polytrauma patients:a retrospective cohort study
Authors: Lee Doo-Hyung , Han Kyeong-Jin , Cho Jae-Ho , Kim Tae Hun , Yoon Ha Seung , Choi Wan-Sun
Published: July 2022

Background: The tendency toward conservative treatment for clavicle fractures in polytrauma patients may be related to certain characteristics of polytrauma patients. The purpose of this study was to analyze the factors that could affect delayed displacement of fractures during conservative treatment for clavicle fracture in polytrauma patients. Methods: From January 2013 to April 2017, 178 polytrauma patients with an ISS of 16 or more and a clavicle fracture were enrolled from a single trauma center. Of these patients, 79 who had an initial displacement of fractures of less than 100% of the clavicle diameter and initially underwent conservative treatment were included. We analyzed the risk factors that could affect delayed displacement of clavicle fracture by performing a regression analysis of the following factors: patients’ demographic characteristics, location of fracture, presence of comminuted fracture, duration of the intensive care unit stay, ventilator care, initial consciousness level, combined upper extremity injuries, rib fractures of the ipsilateral side, brain injury, and spinal cord injury.Results: A total of 31 patients had delayed displacement of clavicle fracture. The univariable and multivariable logistic regression analyses showed that the statistically significant risk factors for delayed displacement of clavicle fractures were the presence of comminuted fracture and middle third shaft clavicle fracture. Other factors were not statistically related to delayed displacement.Conclusion: Polytrauma patients with clavicle fractures are more likely to develop delayed displacement if there is a presence of comminuted fracture or middle third clavicle fracture. However, polytrauma-related factors did not reduce the risk of delayed displacement of clavicle fractures in polytrauma patients. Level of Evidence: III, retrospective cohort study
Robust Statistics and Cluster Analysis in NDT for Multi-Parameter Signals
Authors: Underhill P. R. , Krause T. W.
Published: July 2022

Non-Destructive testing (NDT) often involves acquisition of complex multi-parameter data in which the target flaw or structure condition can be difficult to identify. The use of robust cluster analysis, based on the Mahalanobis distance, to assess such data is examined here. The addition of robust estimates for the covariance matrix allows this approach to work in an unsupervised learning environment. Being unsupervised makes the approach very versatile and largely eliminates the requirement for large training sets such as are used by other artificial intelligence (AI) techniques such as artificial neural nets (ANN) or support vector machines (SVM). This is particularly helpful when there are numerous different environments, such as fasteners holding together the various components of an aircraft wing, each of which would require its own training set. It also eliminates issues related to changes in the performance of the instrument(s) between training set and real application. The concept of the partial Mahalanobis distance, which only uses information from eigenvectors associated with the defect under investigation, is introduced. The use of only that fraction of the signal that is relevant to the detection of the defects significantly increases the resolving power of the method. Robust cluster analysis can provide automatic defect identification on sample sizes as small as 50 or 60.
Assessing the role of venetoclax in combination with hypomethylating agents in higher risk myelodysplastic syndrome
Authors: Komrokji Rami , Singh Avani , Ali Najla Al , Chan Onyee , Padron Eric , Sweet Kendra , Kuykendall Andrew , Lancet Jeffrey , Sallman David
Published: July 2022

Hypomethylating agents (HMA) remain the backbone of therapy for treating higher risk myelodysplastic syndromes (HR-MDS), however less than 20% of these patients achieve a complete remission (CR). Preliminary data have reported promising higher response rate combining HMA with Venetoclax as first line therapy (1L) as well as activity in HMA failure MDS. We identified 1193 higher risk MDS patients who received HMA as 1L therapy for HR-MDS, 1158 patients received 1L HMA alone and 35 patients received 1L HMA/Venetoclax combination. The overall response rate was 77% for 1L HMA/Venetoclax compared to 40% for 1L HMA alone (p<0.005). Among patients with ASXL1 mutation, CR were 44% and 8% for combination and HMA alone, respectively (p <0.005). Among patients with TP53 mutation, the overall response rate (ORR) was 75% and 44% for 1L HMA/Venetoclax and HMA alone respectively (p=0.038). The OS was 21 months and 20 months for 1L HMA/Venetoclax and 1L HMA alone respectively (p=0.86). For 269 patients who proceeded to transplant, the 2-year survival rates were 91% and 51% for 1L HMA/Venetoclax and HMA alone, respectively. Overall HMA/Venetoclax results in higher responses in both frontline and HMA failure patients with favorable outcomes in HMA patients bridged to AHSCT.
In-situ high-temperature behaviour and breakdown conditions of uvite at room pressure
Authors: Ballirano Paolo , Celata Beatrice , Bosi Ferdinando
Published: July 2022

The thermal behaviour of an uvite from San Piero in Campo (Elba Island, Italy) was investigated at room pressure through in-situ High-Temperature X-Ray Powder Diffraction (HT-XRPD), until the breakdown conditions were reached. The variation of uvite structural parameters (unit-cell parameters and mean bond distances) was monitored together with site occupancies and we observed the thermally-induced Fe oxidation process counterbalanced by (OH)− deprotonation, which starts at 450°C and is completed at 650°C. The uvite breakdown reaction occurs between 800 and 900°C. The breakdown products were identified at room temperature by X-Ray Powder Diffraction (XRPD) and the breakdown reaction can be described by the following reaction: tourmaline → indialite + yuanfuliite + plagioclase + “boron-mullite” phase + hematite.
Trends in mortality in septic patients according to the different organ failure during 13 years
Authors: Lorencio Carolina , Yébenes Juan Carlos , Vela Emili , Clèries Montserrat , Sirvent Josep Mª , Bertolín Cristina Fuster , Reina Clara , Rodríguez Alejandro , Ruiz-Rodríguez Juan Carlos , Trenado Josep , Torné Elisabeth Esteban
Published: July 2022

Background: the incidence of sepsis can be estimated between 250 and 500 cases/100.000 people per year and is responsible for up to 6% of total hospital admissions. Identified as one of the most relevant global health problems, sepsis is the condition that generates the highest costs in the healthcare system. Important changes in the management of septic patients have been included in recent years, however, there is no information about how changes in the management of sepsis-associated organ failure have contributed to mortality.Methods: A retrospective analysis was conducted from hospital discharge records from the Minimum Basic Data Set Acute-Care Hospitals (CMBD-HA in Catalan language) for the Catalan Health System (CatSalut). CMBD-HA is a mandatory population-based register of admissions to all public and private acute-care hospitals in Catalonia. Sepsis was defined by the presence of infection and at least one organ dysfunction. Patients hospitalized with sepsis were detected, according ICD-9-CM codes used to identify acute organ dysfunction and infectious processes.Results: Of 9.875.635 discharges from all acute-care hospitals during the study period (2005-2017), 254.627 had sepsis (2,58%). The mean annual sepsis incidence in the population was 245,5 per 100.000 inhabitants/year. Multiorgan failure was present in 20,3% and bacteremia in 29,1% of cases. Renal was the most frequent organ failure (55,9%), followed by cardiovascular (23,9%). Hospital mortality during the study period was 20,8%, but decreases continuously from 25,7% in 2005 to 16,5% in 2017 (p<0,0001) whereas rates of multiorgan failure and bacteraemia remains unchanged. The most important reduction in mortality was observed in cases with cardiovascular failure (from 47,3% in 2005 to 29,9% in 2017) (p<0,0001). In the same way, mean mortality related to respiratory and renal failure in sepsis was decreased in last years (p<0,0001). Conclusions: The incidence of sepsis has been increasing in recent years in our country. However, hospital mortality has been significantly reduced. In septic patients, all organ failures except liver have shown a statistically significant reduction on associated mortality, with cardiovascular failure as the most relevant.
Soluble E-cadherin: A marker of genital epithelial disruption
Authors: Liu R , Armstrong E , Mohammadi A , Galiwango RM , Buchanan LB , Constable S , Huibner S , Perry MC , Prodger JL , Coburn B , Kaul R
Published: July 2022

The genital epithelial barrier is a crucial first line of defence against HIV, and epithelial disruption may enhance HIV susceptibility. Assessment of genital epithelial integrity require biopsies, but their collection is not practical in many research settings. A validated biomarker of genital epithelial barrier integrity would therefore be useful. E-cadherin, an adhesion component of the cell-cell junction in epithelial tissues, may be released as soluble E-cadherin (sE-cad) upon epithelial trauma, and so we evaluated sE-cad as a marker of genital epithelial disruption. First, using an in vitro monolayer of immortalised endocervical epithelial cells, we demonstrate that sE-cad, IL-1β, and IL-1α levels are immediately increased after physical disruption, followed by a delayed increase in IL-6 levels compared to undisrupted controls. In vivo studies confirmed that sE-cad levels in cervicovaginal secretions were significantly elevated 6 hours after endocervical cytobrush sampling. Furthermore, the level of sE-cad in coronal sulcus swabs from Ugandan men was inversely correlated with the amount of membrane-bound E-cadherin within the overlying foreskin tissues. Our results validate the use of soluble E-cadherin as a marker of epithelial disruption and demonstrate that the processes of physical disruption and inflammation in the genital tract are strongly intertwined.
Evaluation of the prognostic factors for pediatric intestinal motility disorders: A single institution experience
Authors: Yano Keisuke , Muto Mitsuru , Sugita Koshiro , Murakami Masakazu , Onishi Shun , Harumatsu Toshio , Yamada Koji , Yamada Waka , Matsukubo Makoto , Kawano Takafumi , Kaji Tatsuru , Ieiri Satoshi
Published: July 2022

Purpose
To improve the life prognosis of patients with intestinal motility disorder (IMD), we explored predictors of survival.
Methods
We reviewed the medical records of IMD patients who required total parenteral nutrition (TPN) for four weeks or more at our institution from April 1984 to November 2021. We retrospectively evaluated the characteristics of patients with IMD as predictive factors.
Results
Fourteen patients were enrolled. They had high mortality rate (50%). The types of IMD were as follows: hypoganglionosis, extensive aganglionosis, and chronic idiopathic intestinal pseudo-obstruction. The mortality did not differ to a statistically significant extent among patients with three types of IMD. A significant difference was observed in the length of enterostomy between survivors and the non-survivors (p = 0.028). Cholestasis was a significant prognostic factor (p = 0.005). Intestinal failure associated liver disease (IFALD) was the cause of death in the short term. Catheter-related blood stream infection (CRBSI) and acute rejection after small bowel transplantation were causes of death in the long term.
Conclusion
IMD patients still have a high mortality rate and cholestasis predicts survival in IMD patients. Preventing or improving IFALD and CRBSI due to long-term TPN is important for reducing the mortality rate.
Real-life persistence of targeted therapy strategy in monotherapy versus combination therapy in patients with rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis
Authors: Exposito Lorena , Sánchez-Piedra Carlos , Vela-Casasempere Paloma , Moreno-Ramos Manuel José , Campos Cristina , Bohorquez Cristina , Manero Javier , Calvo-Gutiérrez Jerusalem , Rodríguez-Lozano Carlos , Ruiz-Montesino Dolores , Busquets Noemí , García-González Javier , Castrejón Isabel , Sanchez-Alonso Fernando , Bustabad Sagrario , Díaz-González Federico
Published: July 2022

Aim: To evaluate the persistence of the initial strategy of targeted therapy, with or without conventional synthetic (cs) disease-modifying antirheumatic drugs (DMARDs) (combination and monotherapy strategies, respectively) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS), under real-life conditions. Methods: This is a nested cohort study within BIOBADASER III, a prospective Spanish registry of patients with rheumatic diseases who are undergoing treatment with targeted therapy including biologics (b) and targeted synthetic (ts) DMARDs. The primary outcome was to determine the initial treatment strategy persistence; switching drugs within the same class, but maintaining the initial strategy (combination or monotherapy) was considered persistence. Bivariate comparisons and multivariate Cox proportional hazard models were used for the analyses.Results: A total of 2,589 patients were included in our study. In the multivariate model, compared to monotherapy, the combination therapy strategy was associated with shorter persistence in patients with RA (hazard ratio [HR] 1.58, 95% confidence interval [CI] 1.00 to 2.50, p=0.049), PsA-Axial (HR 3.00, 95% CI 1.35 to 6.70, p=0.007), PsA-Peripheral (HR 2.58, 95% CI 1.51 to 4.39, p<0.001) and AS (HR 16.77, 95% CI 7.37 to 38.16, p<0.001). Overall, the combination strategy was associated with an increased incidence of any adverse event (incidence rate ratio [IRR] 1.13, 95% CI 1.05-1.21) but not of serious adverse events (1.02, 95% CI 0.84-1.24) compared to monotherapy,Conclusion: In this real-life study, compared to monotherapy, the strategy of combining a b/tsDMARD with a csDMARD at the start of treatment is associated with lower persistence and worse tolerability in RA, PsA and especially in AS, suggesting that combination therapy should be avoided in AS and possibly PsA patients and used cautiously in RA patients.