bluuebunny/crossref_metadata_2025 huggingface dataset:
Digital Entrepreneurship Behaviour
Authors: Edghiem Farag , George Nicholas
Published: May 2023

The entrepreneurship literature has recognised the impact of entrepreneurial behaviour and the contribution towards co-creating value by entrepreneurs within business communities. As such, entrepreneurs' behaviour within an online business community platform has been centre to recent academic debate marking contemporary digital transformation in multiple business sectors. A wide spectrum of entrepreneurship behaviour patterns may be unravelled to leverage value for business and to be influenced by dynamic determinants of online business communities. Given the paucity of research on this topic, this chapter intends to shed light on the behaviour patterns of digital entrepreneurs and the potential to co-create value within online business communities.
Improving the Business and IT Alignment Through Software Delivery Methodology
Authors: Yousfi SidAli Mohamed , Wood Bob
Published: May 2023

Business and IT alignment has been a critical issue for researchers, consultants, and practitioners seeking to improve demand and delivery management by executing business requirements in real-life systems that benefit end-users. Companies using IT to enable their business must improve their business and information technology alignment (BITA) by implementing best practices and frameworks. This study focuses on one area of improvement in the BITA model, which is project software delivery using Agile as a project management methodology. Agile methodology allows for collaboration and dynamic requirements, which benefits aligning businesspeople with IT delivery within the software development lifecycle (SDLC) framework.
Applying Digital Escape Rooms Infused With Cross-Cultural Management Theories in Higher Education
Authors: Meletiadou Eleni
Published: May 2023

In the last decade, there has been a shift from traditional passive face-to-face classroom models to the adoption of active learning methods, digitally enhanced learning, digital storytelling, escape rooms, and generally, approaches that promote experiential, peer/group, digital, game-based learning. Even though literature indicates that these teaching and assessment practices can transform the learning experience, digital educational escape rooms (DEERs) are a relatively new technique and there are not enough studies exploring the benefits and challenges they hold for university students. This chapter presents an implementation that addresses the lack of empirical evidence on the impact of DEERs on students in higher education (HE) settings by presenting an implementation of this approach with BA Business Management and HRM students at a Business School in the UK.
From Physical to Hybrid
Authors: Ampadu Ernest , Ottergren Elin
Published: May 2023

This study explores Swedish mathematics teachers teaching and assessing practices as different hybrid teaching methods were implemented. Data were collected from 51 teachers in the Stockholm region using an open-ended questionnaire. Teachers experienced a developmental leap involving both pedagogical adaptation and the use of technological tools when adapting to hybrid teaching. Quality dialogues, structure and learner autonomy, as well as the integrity of assessment practices were issues of major concern, as most students experienced online and hybrid learning for the first time with limited preparation. These adaptation processes led to an increase in transactional distance, which in turn affected students' autonomy and achievement. The results also show that the reliance on summative assessment became the new normal practice inconsistent with the Swedish way of teaching and assessing student learning. To enjoy the full advantages of hybrid teaching, there is a need to put measures in place to reduce the transactional distance to help improve students' autonomy and achievement.
Transformation of Teaching and Learning Through MOOCs in the Digital Era
Authors: Maheshkar Chandan
Published: May 2023

Technological interventions in teaching-learning practices have recently expanded the possibilities for e-learning. It has enabled learners to access wide-ranging educational choices virtually. MOOCs comprehensively refer to web-based study programs designed for a massive number of participants where teaching and learning take place through internet-enabled interactive tools and forums. People can connect via the internet to communicate and learn a particular course/subject matter is the sole idea of origin for MOOCs. This chapter presents a generalized framework for MOOCs that enables educators to design, develop, and deliver MOOCs in an effective way. Also, pedagogical underpinnings and issues affecting MOOCs have been described.
WebQuest as a Resource to Improve Motivation and Communicative Competence in English in Early Childhood Education
Authors: García Isabel María
Published: May 2023

In this chapter, the authors propose to use the WebQuest tool in order to improve the motivation and communicative competence in the English language of 5-year-old students. WebQuest is a research activity in which students work with information taken from the internet, which is based on learning by discovery and can be used at any stage and subject of education. Its use in early childhood education has multiple advantages. Among them, it increases the motivation, interest, and attention of the students to the subject, improving the understanding and acquisition of contents. Therefore, the authors present a WebQuest to bring P5 students closer to learn English in a fun, interesting, and motivating way. The goal of this WebQuest is for students to learn vocabulary related to the physical and natural environment so as to create a dictionary. This improvement in motivation will lead them to face the learning of the English language with a more positive attitude and to a better learning of it.
E-Learning Policy
Authors: Abdullahi Muhammad
Published: May 2023

Towards the end of 2019, the COVID-19 pandemic struck the world and affected the systems of operations of almost every nation. The situation was abrupt and sudden as it came when governments, teachers, and learners were unprepared. Yet, because it's a public health emergency, measures were put in place to avoid its spread. Despite the measures, the virus continued to spread at an alarming rate which led to tough measures such as curfews and closure of businesses and schools. It is against this background that this chapter examined the relationship between e-learning and COVID-19 with a view to understanding the level of electronic utilization in learning during the COVID-19 era. The chapter utilized conceptual analysis to reveal that many developed countries are utilizing ICT for research, teaching, and learning. However, less developed countries are left with little utilization in addition to the already existing poor governance and misappropriation of funds. It thus concluded that more investments must be made in the ICT sector and education, as well as building the capacity of teachers and students in e-learning.
Fractionation of Oil Palm Fiber Using Green Solvent for Lignin Separation
Authors: Yesika Yuana , Hudaya Tedi , Hawboldt Kelly Anne , Rusli Handajaya , Soetedjo Jenny Novianti Muliarahayu
Published: May 2023

Oil palm processing produces more than 70-wt% of its lignocellulosic content as by-product, the bulk of which is empty fruit bunches (EFB). EFB contains cellulose, hemicellulose, and lignin which makes it a potential source of bio-based chemicals. This research explores the utilization of ethanol as a potentially green, sustainable, and low-cost organic solvent (organosolv) for EFB fractionation. Organosolv processes target extraction of lignin (delignification). Conventional delignification use an acid hydrolysis process with lignin yields of approximately 18-wt%. In this study the EFB was treated in 2 stages, (1) soaking EFB for 1 hour followed by (2) delignification using ethanol as the organic solvent under variable process conditions. Temperature (140°C, 170°C), liquid-to-solid ratio (L/S-w/w) (6:1, 15:1), and wt%-ethanol (20-wt%, 50-wt%) were varied while residence time was constant at 30 minutes (experiments were run in duplicate). Data analysis using 2k Factorial Design Method showed the significant variables were temperature, L/S-ratio, wt%-ethanol, interaction of L/S ratio and temperature, temperature and %wt-ethanol interaction, and L/S-ratio and %wt-ethanol. The optimum operating conditions (170°C, 15:1, 20wt%-ethanol) produced a lignin yield of up to 31%wt. This preliminary study shows ethanol in an organosolv process is a potential delignification option.
Chest Radiography of Tuberculosis: Determination of Activity Using Deep Learning Algorithm
Authors: Choi Ye Ra , Yoon Soon Ho , Kim Jihang , Yoo Jin Young , Kim Hwiyoung , Jin Kwang Nam
Published: May 2023

Background: Inactive or old, healed tuberculosis (TB) on chest radiograph (CR) is often found in high TB incidence countries, and to avoid unnecessary evaluation and medication, differentiation from active TB is important. This study develops a deep learning (DL) model to estimate activity in a single chest radiographic analysis.Methods: A total of 3,824 active TB CRs from 511 individuals and 2,277 inactive TB CRs from 558 individuals were retrospectively collected. A pretrained convolutional neural network was fine-tuned to classify active and inactive TB. The model was pretrained with 8,964 pneumonia and 8,525 normal cases from the National Institute of Health (NIH) dataset. During the pretraining phase, the DL model learns the following tasks: pneumonia vs. normal, pneumonia vs. active TB, and active TB vs. normal. The performance of the DL model was validated using three external datasets. Receiver operating characteristic analyses were performed to evaluate the diagnostic performance to determine active TB by DL model and radiologists. Sensitivities and specificities for determining active TB were evaluated for both the DL model and radiologists.Results: The performance of the DL model showed area under the curve (AUC) values of 0.980 in internal validation, and 0.815 and 0.887 in external validation. The AUC values for the DL model, thoracic radiologist, and general radiologist, evaluated using one of the external validation datasets, were 0.815, 0.871, and 0.811, respectively.Conclusion: This DL-based algorithm showed potential as an effective diagnostic tool to identify TB activity, and could be useful for the follow-up of patients with inactive TB in high TB burden countries.
Morte, angoscia ed esperienza metafisica
Authors: Milanesi Paolo
Published: May 2023

L’autore muove la sua riflessione a partire dalla filosofia antica, intesa come esercizio spirituale di vita vissuta, e introduce il tema della morte che secondo Platone ed altri filosofi antichi rappresentava il morire alla propria individualità per accedere ad un pensiero vero ed entrare in contatto con l’universalità del tutto cosmico. Successivamente approdando al pensiero filosofico moderno, attraverso Heidegger, viene introdotto il tema dell’angoscia quale inevitabile viatico per accedere al ‘puro essere’ dell’essere umano o Esserci; e infine da qui, soprattutto appoggiandosi al pensiero di Elèmire Zolla prova ad indicare una strada che, superando l’angoscia e ‘perdendo’ la propria individualità identitaria, possa portare a identificarsi con l’’essere che semplicemente è’ nel mondo. In quest’ultimo passaggio viene individuato il possibile emergere dei diversi disturbi mentali in luogo di una possibile illuminazione, soprattutto se si è lasciati soli nella propria esperienza fenomenologico esistenziale.
Divenire genitori e divenire figli. Le nuove sfide della psicologia perinatale
Authors: Zanardi Martina
Published: May 2023

Non disponibile.
Phytochemistry, Pharmacology, and Clinical Applications of Centella asiatica (L.) Urban
Authors: Yan Zhong-Hong , Shi Xing-Yang , Jiang Hai
Published: May 2023

Centella asiatica, a traditional Chinese medicine belonging to the Umbelliferae family, was recorded in the Eastern Han Dynasty. Owing to its wide developmental prospects, many scholars have extensively explored C. asiatica and made significant progress in recent years. In this study, we summarize the phytochemistry, pharmacology, and clinical applications of C. asiatica (L.) Urban based on Google Scholar, PubMed, and CNKI databases. Triterpenes and their glycosides, flavonoids, terpenoids, and volatile oils occur in herbs. The pharmacological effects mainly comprise improving cognition and memory impairment in Alzheimer’s disease and anti-inflammation activity. Clinical applications include the treatment of chronic kidney diseases, malignant intestinal obstruction, radiation dermatitis, precancerous lesions, chronic prostatitis, Alzheimer’s disease, and other diseases. This review provides insights into the phytochemistry, pharmacology, and clinical applications of C. asiatica and summarizes the shortcomings of the research in recent years to provide a reference for future research.
An observational study of the correlation between Clinical/Etiological/Anatomical/Pathophysiological, Venous Clinical Severity Score, and heaviness/ache/swelling/throbbing/itching classifications for chronic venous insufficiency
Authors: Chen Xi , Zhao Yong-Feng , Han Yong-Feng , An Li , Yang Qian , Zhao Jun-Feng , Chi Yung-Wei , Liu Li-Wen
Published: May 2023

OBJECTIVE:

This study aimed to evaluate consecutive patients with chronic venous insufficiency (CVI) describing the relationship between Clinical/Etiological/Anatomical/Pathophysiological (CEAP) classification, leg heaviness/ache/swelling/throbbing/itching (HASTI) score, and Venous Clinical Severity Score (VCSS) and assessing the correlation between them.

MATERIALS AND METHODS:

The CEAP classification, HASTI, and VCSS of consecutive patients were recorded, and their correlations were evaluated.

RESULTS:

Four hundred eighty-four consecutive patients from March 2018 to March 2019 were studied. Significant correlations were detected between the HASTI and CEAP classification (F = 16.558, P < 0.001) and between VCSS and CEAP classification (F = 57.073, P < 0.001). The VCSS correlated more positively with CEAP (Spearman's correlation coefficient r = 0.740, P < 0.001) than HASTI (Spearman's correlation coefficient r = 0.536, P < 0.001). Using CEAP ≥2 as the cutoff, the areas under the receiver operating characteristics curve of the HASTI and VCSS were 0.694 and 0.774, respectively (P < 0.001 or both). The HASTI and VCSS cutoff values of 6.50 and 4.50, respectively, were identified as indicators of significant CVI with corresponding sensitivities of 63.8% and 78.7% and specificities of 65.6% and 47.0%, respectively.

CONCLUSION:

Increasing HASTI and VCSS corresponded to increasing CEAP class in patients with CVI. The result may be applicable for early screening of patients with CVI.
Right aberrant subclavian artery with Kommerell's diverticulum, hybrid treatment
Authors: Moniaci Diego , Corrado Federica , Maiorano Franceso , Pagliasso Elisa , Peretti Tania
Published: May 2023

Kommerell's diverticulum (KD) is a diverticular formation of the aortic arch located at the origin of an aberrant subclavian artery (ASA). KD is an extremely rare development abnormality of the aortic arch related to an ASA. KD is also known as “lusoria diverticulum” referring to the aneurysm dilatation of the descending aorta at the origin of ASA. This article reports one case of ASA with KD treated with a hybrid approach endovascular aortic repair with a custom-made endograft (Najuta® endograft) and bilateral axillary–carotid bypass with a 6-mm ePTFE graft. European Society for Vascular Surgery (ESVS) guidelines consider it eligible for treatment KD with a diameter ≥5.5 cm and aneurismatic ASA ≥3 cm. A standardized approach for any KD is unlikely to exist because the better treatment should be individualized and properly applied in an experienced vascular center able to offer all treatment strategies (open, endovascular, or hybrid). To date, the use of new techniques and the development of new materials have made possible ad endovascular approach to ASA with Kommerel's diverticulum.
Integrated High-Throughput Bioinformatics (Microarray, RNA-seq, and RNA Interaction) and qRT-PCR Investigation of BMPR1B Axis as a Potential Diagnostic Biomarker of Isfahan Breast Cancer
Authors: Azadeh Mansoureh , Salehzadeh Ali , Ghaedi Kamran , Talesh Sasani Soheila
Published: May 2023

Background:

According to the bioinformatics analyses and previous studies, bone morphogenetic protein receptor type 1B (BMPR1B) dysregulation could remarkably affect breast cancer (BC) status as a potential biomarker and tumor suppressor. Therefore, the analysis of the expression level of BMPR1B and other relevant biological factors such as microRNAs, long non-coding RNAs, downstream proteins in the relevant signaling pathways, and finding the accurate biological mechanism of BMPR1B could be helpful for a better understanding of BC pathogenicity and discovering the new treatment methods and drugs.

Materials and Methods:

R Studio software (4.0.2) was used for microarray data analyses. GSE31448 dataset was downloaded by GEOquery package and analyzed by limma package. STRING and miRWalk online databases and Cytoscape software were used for interaction analyses. Quantitative measurement of BMPR1B expression level was performed by qRT-PCR experiment.

Result:

Microarray and real-time PCR analysis revealed that BMPR1B has a significant downregulation in the transforming growth factor (TGF)-beta and bone morphogenic protein (BMP) signaling pathways in BC samples. BMPR1B is a potential diagnostic biomarker, regulated by hsa-miR-181a-5p. Also, BMPR1B regulates the function of BMP2, BMP6, SMAD4, SMAD5, and SMAD6 proteins.

Discussion:

BMPR1B have a significant role in the development of BC by regulating the potential proteins' function, playing the diagnostic biomarker role, and regulation of TGF-beta and BMP signaling pathways. The high amount of BMPR1B protein helps in increasing the survival rate of the patients.
Comparative Evaluation of Captopril, Spironolactone, and Carvedilol Effect on Endothelial Function in Breast Cancer Women Undergoing Chemotherapy
Authors: Hashemi Jazi Seyed Mohammad , Tayebi Faranak , Teimouri-Jervekani Zahra , Mokarian Fariborz , Mehrzad Valiallah , Sadeghi Alireza
Published: May 2023

Background:

Breast cancer is the most prevalent malignancy in females which needs chemotherapy treatment. Studies demonstrated that anti-cancer agents used for chemotherapy in cancer patient causes endothelium dysfunction. Several researches showed the efficacy of angiotensin-converting enzyme inhibitors, Carvedilol and Spironolactone on improving endothelial function. This study aimed to evaluate the effect of the combination of Spironolactone, Carvedilol, and Captopril on endothelial function in breast cancer patients.

Materials and Methods:

This study is a prospective Randomized Clinical Trial in breast cancer patients who underwent chemotherapy. Patients were divided into two groups who received the combination of Captopril, Spironolactone, and Carvedilol or standard regimen for 3 months during chemotherapy. Before and after intervention, ejection fraction (EF), E/A ratio and e' and flow-mediated dilation (FMD) properties were calculated and then compared.

Results:

Fifty-eight patients with a mean age of 47.57 ± 9.46 years were evaluated. The mean FMD after the intervention is statistically different in case and controls (<0.001). E/A ratio and e' are not statistically different between groups after intervention. The mean EF was not statistically different between the two groups after intervention.

Conclusion:

Prescribing combination of Carvedilol, Spironolactone, and Captopril in breast cancer patients undergoing chemotherapy can improve endothelial function and may have beneficial effects on diastolic function.
Comparison of Antihypertensive Drugs Amlodipine and Perindopril on Blood Pressure Variability after Long-Term Treatment of Hypertension Induced by Apatinib and Bevacizumab
Authors: Zhao Weichao , Liu Lanbo , Chen Liqiang
Published: May 2023

The purpose of this study was to elucidate the therapeutic effect of different antihypertensive drugs (amlodipine and perindopril) on hypertension induced by apatinib and bevacizumab. Sixty patients with hypertension treated with apatinib or bevacizumab were selected and divided into two groups: one group was treated with amlodipine and the other group was treated with perindopril. Before and after treatment, the dynamic blood pressure (BP) measurement (systolic BP [SBP] and diastolic BP [DBP]), echocardiography (left ventricular end-diastolic diameter, interventricular septal thickness [IVST], left ventricular posterior wall thickness [LVPWT], and left atrial diameter [LAD]), and detection of nitric oxide (NO) content in venous blood were performed. In the amlodipine group, the 24hSBP, 24hSSD, 24hSCV, daytime mean SBP (dSBP), daytime mean SSD (dSSD), daytime mean SBP CV, night mean SBP (nSBP), night mean SSD, 24hDBP, 24hDSD, 24 h DBP CV, daytime mean DBP (dDBP), daytime mean DSD (dDSD), daytime mean DBP CV, night mean DBP (nDBP), LAD, and LAD index (LADi) after treatment were all lower than before treatment, while NO was higher than before treatment (all P < 0.05). In the perindopril group, the 24hSBP, dSBP, nSBP, 24hDBP, dDBP, nDBP, LAD, LADi, IVST, LVPWT, and left ventricular mass index (LVMI) after treatment were lower than before treatment, and NO level after treatment was higher than before treatment (all P < 0.05). After treatment, the 24hSBP, 24hSSD, dSBP, dSSD, nSBP, 24hDBP, 24hDSD, dDBP, dDSD, nDBP, night mean DSD, and NO were all lower while the LAD, LADi, IVST, LVPWT, and LVMI were higher in the amlodipine group than those in the perindopril group (all P < 0.05). Our study suggests that the SBP and DBP variability of amlodipine in the treatment of hypertension induced by apatinib and bevacizumab is slightly better than that of perindopril, but the effect of perindopril in improving endothelial function indices NO and echocardiographic data is better than that of amlodipine.
Comparative Study of Minimally Invasive Endoscopic Tympanoplasty with Microscopic Tympanoplasty
Authors: Verma Pankaj Kumar , Singh Charu , Kumar Shivesh , Rana Amit Kumar
Published: May 2023

Background:

Chronic suppurative otitis media (CSOM) is a disease of a low-socioeconomic group with high prevalence in India. Tympanoplasty is a common procedure done for CSOM. Hopkins endoscopes are now more popular for various ear surgeries due to better optics, portability, and cost-effectiveness. The objective was to compare the surgical outcome of minimally invasive endoscopic tympanoplasty and microscopic tympanoplasty.

Materials and Methods:

A prospective follow-up comparative study was performed on 60 patients who underwent tympanoplasty from January 2021 to December 2021. The subjects were divided equally and randomly into two groups (endoscopic group and microscopic group). Demographic data, perforation size of the tympanic membrane, pure-tone audiometry results preoperatively, and at the 8th week postoperatively, type of anesthesia used, average surgical time, postoperative morbidity, and graft uptake rate in both the groups were compared.

Results:

Graft uptake was 93% in the endoscopic group and 96% in the microscopic group. Postoperative morbidity was more in the microscopic group as compared to the endoscopic group. Average surgical time was less in the endoscopic group as compared to the microscopic group. Endoscopic tympanoplasty was done under local anesthesia and is economically more acceptable to the patient as compared to the microscopic group. The mean air–bone gap gain was 16.44 dB in the endoscopic group and 16.07 dB in the microscopic group.

Conclusion:

With minimally invasive endoscopic procedure, it is possible to get a similar graft uptake rate and hearing gain as compared with conventional microscopic procedure with the advantage of having less postoperative morbidity and lesser consumption of medical resources. Thereby making it a more cost-effective technique and can be easily performed in remote places.
Comparative Study between Anterior Tucking and Tunneling of Graft in Type-1 Tympanoplasty
Authors: Singh Gurchand , Chawla Achintya
Published: May 2023

Background:

Tympanoplasty is the surgical procedure performed to repair a perforated tympanic membrane, with or without reconstruction of the ossicles, with the aim of preventing reinfection and restoring hearing ability. There are various techniques to perform Type 1 tympanoplasty.

Aims and Objectives:

· To compare anterior tucking and tunneling of temporalis fascia graft in Type 1 tympanoplasty based on the clinical and audiological outcome. · To study the hearing outcome and graft uptake in anterior tucking technique and anterior tunneling technique in Type 1 tympanoplasty. · To compare the hearing outcome and graft uptake in anterior tucking versus anterior tunneling technique in Type 1 tympanoplasty.

Materials and Methods:

The study was carried out in the Department of Otorhinolaryngology (ENT), Maharishi Markandeshwar Institute of Medical Sciences and Research Hospital, Mullana over 2 years from September 2020 to September 2022. One hundred cases of inactive, chronic otitis media (COM) were included in this study and subjected to Type 1 tympanoplasty with 50 belonging to the anterior tucking technique (Group A) and 50 to the anterior tunneling technique (Group B).

Results:

The graft uptake rate was 96% in Group A (anterior tucking technique) and 98% in Group B (anterior tunneling technique). The average hearing gain in Group A was 9.94 dB and in Group B was 9.36. Chances of complications like residual perforation were found to be low (4% in Group A and 2% in Group B) in both techniques.

Conclusion:

In our study, we concluded that both the techniques of anterior tucking and anterior tunneling of temporalis fascia graft in Type 1 tympanoplasty surgery are equally effective to achieve intactness of graft and hearing improvement in patients of inactive, mucosal COM.
Unilateral Double-Barreled Internal Auditory Meatus with Severe Sensorineural Hearing Loss: A Diagnostic Challenge
Authors: Selvarajan G , Vaishnavi R , Anand P Mithun , Jeevanandham Balaji
Published: May 2023

Internal auditory meatus duplication is an exceedingly rare temporal bone anomaly. All of them being bilateral duplication or narrowing of internal auditory meatus with profound sensorineural hearing loss. We report a very rare case of unilateral double-barreled internal auditory meatus with severe sensorineural hearing loss without any inner ear anomalies in an adolescent, being benefited with an air-conduction hearing aid.
Laparoscopic radical transverse colectomy with transrectal specimen extraction: A novel natural orifice specimen extraction procedure: A case report
Authors: Lv Jingfang , Chen Haipeng , Guan Xu , Zhao Zhixun , Quan Jichuan , Zhang Xiaoqian , Liu Zheng , Jiang Zheng , Zheng Zhaoxu , Wang Xishan
Published: May 2023

Transverse colon cancer accounts for about 10% of all colonic cancers. The resection of cancers in the transverse colon is technically more challenging, compared with other cancer locations in the colon because the variable anatomy of the middle colic vessels demands excellent surgical skills and the anatomical location of the transverse colon is related to major organs. We report a novel laparoscopic technique for the first time used in surgery of transverse colon cancer which combines a total intracorporeal anastomosis with natural orifice specimen extraction to solve the problems of traditional laparoscopic surgery. A 48-year-old male patient, whose diagnosis was transverse colon adenocarcinoma, was admitted to the hospital. The surgery was performed in accordance with the procedure of totally laparoscopic right hemicolectomy and the specimen was extracted by opening the rectum. Natural orifice specimen extraction surgery has many advantages, including less pain, better cosmesis and minimising risks of complications and also has comparable long-term outcomes compared to conventional laparoscopic surgery.
Robotic excision of posterior mediastinal neurogenic tumours: Technique and surgical outcomes
Authors: Asaf Belal Bin , Bishnoi Sukhram , Vardhanpuri Harsh , Pulle Mohan Venkatesh , Kumar Arvind
Published: May 2023

Introduction:

Neurogenic tumours are the most common tumours of the posterior mediastinum and account for 75% of the tumours in this region. Till recently, open transthoracic approach has been the standard of care for their excision. Thoracoscopic excision of these tumours is being commonly employed because of lesser morbidity and shorter hospital stay. The robotic surgical system offers a potential advantage over conventional thoracoscopy. We herein report our technique and surgical outcomes of excision of posterior mediastinal tumours using the Da Vinci Robotic Surgical System.

Materials and Methods:

We retrospectively reviewed 20 patients who underwent Robotic Portal-Posterior Mediastinal Tumour (RP-PMT) Excision at our centre. The demographic data, clinical presentation, characteristics of the tumour, operative and post-operative variables including, total operative time, blood loss, conversion rate, duration of the chest tube, hospital stay and complications were noted.

Results:

Twenty patients underwent RP-PMT Excision and were included in the study. The median age was 41.2 years. The most frequent presentation was chest pain. Schwannoma was the most common histopathological diagnosis. There were two conversions. The total operative time was 110 min with an average blood loss of 30 mL. Two patients developed complications. The postoperative hospital stay was 2.4 days. With a median follow-up of 36 months (6–48 months), all except patients are recurrence-free, except the patient with malignant nerve sheath tumour who developed local recurrence.

Conclusion:

Our study demonstrates the feasibility and safety of robotic surgery for posterior mediastinal neurogenic tumours with good surgical outcomes.
Laparoscopic versus open surgical management in elderly patients with rectal cancer aged 70 and older
Authors: Li Xiaolong , Zhang Hengwei , Hou Xudong
Published: May 2023

Background:

This retrospective study aimed to compare the short- and long-term surgical outcomes of laparoscopic surgery versus open surgery in elderly patients with rectal cancer.

Patients and Methods:

Elderly patients (≥70 years old) with rectal cancer who received radical surgery were retrospectively analysed. Patients were matched (1:1 ratio) using propensity score matching (PSM), with age, sex, body mass index, American Society of Anesthesiologists score and tumour-node-metastasis staging included as covariates. Baseline characteristics, post-operative complications, short- and long-term surgical outcomes and overall survival (OS) were compared between the two matched groups.

Results:

Sixty-one pairs were selected after PSM. Patients with laparoscopic surgery had a longer duration of operation time, lower estimated blood loss, shorter duration of post-operative analgesics administered, time to first flatus, time to first oral diet and post-operative hospitalisation stay than those observed in patients with open surgery (All P < 0.05). The incidence of post-operative complications in the open surgery group was numerically higher than that occurred in the laparoscopic surgery group (30.6% vs. 17.7%). Median OS was 67.0 months (95% confidence interval [CI], 62.2–71.8) in the laparoscopic surgery group and 65.0 months (95% CI, 59.9–70.1) in the open surgery group, however, Kaplan–Meier curves indicated that no significant differences in OS (Log-rank test, P = 0.535) were noted between the two matched groups.

Conclusions:

Compared with the open surgery, laparoscopic surgery had the advantages of less trauma and faster recovery, and provided similar long-term prognostic outcome in elderly patients with rectal cancer.
Influence of Systolic Blood Pressure on Outcomes in Nigerians with Peripartum Cardiomyopathy
Authors: Sa′idu H , Balarabe SA , Ishaq NA , Adamu UG , Mohammed IY , Oboirien I , Umuerri EM , Mankwe AC , Shidali VY , Njoku P , Dodiyi-Manuel S , Olunuga T , Josephs V , Mbakwem AC , Okolie H , Talle MA , Isa MS , Adebayo RA , Tukur J , Isezuo SA , Umar H , Shehu MN , Ogah OS , Karaye KM
Published: May 2023

Background:

The relationship between blood pressure (BP) trajectories and outcomes in patients with peripartum cardiomyopathy (PPCM) is not clear. Aim: The study aimed to assess the clinical features and outcomes (all-cause mortality and unrecovered left ventricular [LV] systolic function) of PPCM patients grouped according to their baseline systolic BP (SBP).

Patients and Methods:

PPCM patients presenting to 14 tertiary hospitals in Nigeria were consecutively recruited between June 2017 and March 2018 and then followed up till March 2019. SBP at first presentation was used to categorize the patients into seven groups: <90, 90–99, 100–109, 110–119, 120–129, 130–139, and ≥140 mmHg. Unrecovered LV systolic function was defined as echocardiographic LV ejection fraction (LVEF) below 55% at the last profiling.

Results:

Two hundred and twenty-seven patients were recruited and followed up for a median of 18 months. Of these, 4.0% had <90 mmHg, 16.3% had 90–99 mmHg, 24.7% had 100–109 mmHg, 24.7% had 110–119 mmHg, 18.5% had 120–129 mmHg, 7.5% had 130–139 mmHg, and 4.4% had ≥140 mmHg of SBP at presentation. The highest frequency of all-cause mortality was recorded among patients with SBP ≤90 mmHg (30.8%) followed by those with 90–99 mmHg (20.5%) (P = 0.076), while unrecovered LV systolic function did not differ significantly between the groups (P = 0.659). In a Cox proportional regression model for all-cause mortality, SBP <90 mmHg had a hazard ratio (HR) of 4.00 (95% confidence interval [CI] 1.49–10.78, P = 0.006), LVEF had an HR of 0.94 (95% CI 0.91–0.98, P = 0.003, B = 0.06%), and use of angiotensin-converting enzyme or angiotensin receptor and/or β-receptor blockers had an HR of 1.71 (95% CI 0.93–3.16, P = 0.085). However, SBP was not associated with LV function recovery.

Conclusion:

In our cohort of PPCM patients, one-fifth was hypotensive at presentation. SBP <90 mmHg at presentation was associated with a four-fold higher risk of all-cause mortality during a median follow-up of 18 months.
An Effective Artificial Testing Model to Reliability Experiments for Electronic Apex Locator Devices Used in Endodontic Practice
Authors: Özdemir O
Published: May 2023

Background and Aim:

This experimental study aimed to investigate the reliability of using electronic apex locator devices to determine the working length of artificial root canals.

Materials and Methods:

The experiments were performed using resin endoblocks and mandibular canine teeth (n = 20/group). After the same working length of root canal samples was provided, the teeth and artificial root canals were embedded in an alginate mold. The measurements with Root ZX® and Propex Pixi® apex locators were performed and recorded. The data were analyzed using SPSS software (SPSS V23; IBM Corp., Armonk, New York, USA) and the variance was set at P < 0.05.

Results:

There was no significant difference between the groups; mean distance from the actual working length using different apex locators (P = 0.633, P = 0.474), and endpoint positioning distributions (P = 0.591).

Conclusion:

The results indicate that the artificial model could be a laboratory method of determining the accuracy of apex locators and efficient calibration of devices before their clinical use.
Stakeholders' Perspectives on Internal Accountability Within a Sub-National Immunization Program
Authors: Ogbuabor DC , Ghasi N , Nwangwu N , Okenwa UJ , Ezenwaka U , Onwujekwe O
Published: May 2023

Background:

Weak accountability hinders the effectiveness of routine immunization (RI) systems in low- and middle-income countries, yet studies on accountability of immunization programs are scarce. Aim: The study explored stakeholders' perspectives on the functioning of internal accountability within the National Program on Immunization in Enugu State, southeast Nigeria.

Subjects and Methods:

We used semi-structured in-depth interviews to collect data from RI officials at state government, local government, and health facility levels (n = 35) in Enugu State between June and July 2021. We adopted maximum variation sampling to purposively select individuals with roles in immunization. The interview guide was developed based on an accountability framework with three dimensions—the axes of power, ability, and justice. Data were analyzed thematically using NVivo software (version 11). The major themes were role clarity, performance standards, supervision, data use, human resources, funding, motivation, sanctions, political influence, and community engagement.

Results:

Performance targets for immunization coverage and reporting timeline were not always met due to multiple accountability failures. Weaknesses in the formal rules that distribute roles among the immunization workforce comprise a lack of deployment letters, unavailability of job descriptions, and inadequate staff orientation. Local officials have a narrow decision space regarding staff posting, transfer, and discipline. Performance accountability was constrained by staff shortages, uneven staff distribution, absenteeism, infrequent supervision, weak data monitoring system, and underfunding. Despite being motivated by job recognition and accomplishments, low motivation from an insecure working environment and lack of financial incentives undermined the constructive agency of service delivery actors. The sanctions framework exists but is weakly enforced due to fear of victimization. Political commitment to the immunization program was low. Yet, political decision-makers interfered with staff recruitment, distribution, and discipline. Community engagement improved resource availability through paid volunteer health workers and maintenance of facilities. However, health facility committees were poorly resourced, non-functional, and lacked the power to sanction erring health workers.

Conclusions:

Immunization service delivery actors can be held accountable for program performance when there are sufficient formal instruments that provide roles and responsibilities, needed resources, motivated and supervised staff, an effective sanctions framework, genuine political participation, and strong community engagement.
Identification of a Novel Mutation in ALMS1 in a Chinese Patient with Monogenic Diabetic Syndrome by Whole-Exome Sequencing
Authors: Zhong Ming , Huang Ling-Ning , Zhang Song-Jing , Yan Sun-Jie
Published: May 2023

Alstrom syndrome (AS) is one type of monogenic diabetic syndromes caused by mutation in the ALMS1. Due to rare prevalence and overlaps of clinical symptoms, monogenic diabetes is often misdiagnosed. Here, we report a Chinese diabetes patient with poor blood glucose control and insulin resistance. With whole-exome sequencing (WES), this patient was classified into monogenic diabetes and diagnosed as AS with one novel gene mutation identified. This study highlights the clinical application of WES in the diagnosis of monogenic diabetes.
One-year results of switching to aflibercept for persistent diabetic macular edema resistant to bevacizumab
Authors: Abouhussein Mahmoud Alaa , Gomaa Amir Ramadan
Published: May 2023

PURPOSE:

The aim of this study is to evaluate the functional and anatomical effects of switching from bevacizumab to aflibercept in patients with persistent diabetic macular edema (DME) resistant to bevacizumab.

MATERIALS AND METHODS:

Patients with DME refractory to bevacizumab (1.25 mg/0.05 mL) were subsequently switched to aflibercept. The included patients received five loading doses of intravitreal aflibercept (2 mg/0.05 mL) given monthly. After the loading dose, aflibercept was injected every 2 months. The follow-up duration was 1 year.

RESULTS:

The study consisted of 37 eyes of 37 patients. The mean age of the participants was 56.81 ± 7.11 years. The mean central macular thickness at baseline was 428.32 ± 84.89 μm, which decreased significantly to 275.54 ± 50.24 μm (P < 0.003). There was a significant improvement in the mean best-corrected logMAR visual acuity from 0.627 ± 0.307 at baseline to 0.203 ± 0.235 (P < 0.017) at the end of follow-up.

CONCLUSIONS:

Aflibercept is effective in patients with persistent DME not responsive to bevacizumab.
Evaluation of Willingness to Accept COVID-19 Vaccine and Willingness to Pay among Pakistani Parents for Their Children Aged 5 to 11 Years: Findings and Implications
Authors: Hayat Khezar , Farooq Umer Muhammad , Mujtaba Hasan , Babar Kawish Ayesha , Azam Tahir Muhamad , Ullah Khan Faiz , Ullah Khan Farman , Omer Iqbal Muhammad , Hussain Talib , Ur Rehman Anees , Fang Yu
Published: May 2023

Vaccines are the most efficient and cost-effective tool to halt the transmission and prevention of COVID-19. The current study examined the willingness of parents to vaccinate their children against COVID-19. This was a cross-sectional study that used a questionnaire based on the Health Belief Model, previous history of COVID-19, willingness to accept, and willingness to pay for the COVID-19 vaccine. The questionnaire was administered among parents of children aged 5 to 11 years. Descriptive statistics, χ2 tests, and regression analysis were carried out for data analysis. A total of 474 respondents participated in this survey with a response rate of 67.7%. In our study, a majority of the respondents exhibited a willingness to accept the COVID-19 vaccine for their children (Definitely yes/Probably yes = 252, 53.2%); nevertheless, 229 (48.3%) respondents were unwilling to pay for it. More than three-quarters of the respondents were worried about the probability of COVID-19 infection in their children (n = 361, 76.2%) and were afraid of COVID-19-associated complications (n = 391, 82.5%). Likewise, most respondents showed their concerns regarding the effectiveness of the vaccine (n = 351, 74.1%), vaccine safety (n = 351, 74.1%), and the halal nature of the vaccine (n = 309, 65.2%). Respondents who were aged 40 to 50 years (odds ratio [OR]: 0.101, 95% CI: 0.38–0.268; P < 0.001), family income > 50,000 PKR (OR: 0.680, 95% CI: 0.321–1.442; P = 0.012), and location (OR: 0.324, 95% CI: 0.167–0.628; P = 0.001) were the factors that were likely to impact vaccine acceptance among parents. Education-based interventions are urgently required to improve COVID-19 vaccination acceptance among parents for their children.
Vaccine Refusal: A Major, Underestimated Obstacle for the Poliomyelitis Eradication Initiative
Authors: Seytre Bernard
Published: May 2023

In 1988, the WHO launched the Global Poliomyelitis Eradication Initiative with the goal of eradication by 2000. Not only has this goal, which has been repeatedly postponed, still not been achieved, but while the wild polio virus is still endemic in two Asian countries, a new epidemic caused by a vaccine-derived virus is spreading and is now affecting numerous developing and industrialized countries, including the United Kingdom and the United States. In addition to biological explanations for the failure of eradication, vaccination refusal by communities in mainly two regions of Africa and Asia has prevented mass vaccination campaigns from achieving their immunization coverage targets. The way these campaigns have been deployed has contributed to mistrust and hostility. The negative reactions of some communities, expressed from the first vaccination campaigns, were belatedly considered, which gave time for rumors to flourish and settle permanently. This failure underscores the importance of taking into account, before any vaccination campaign begins, the “health culture” of target populations—meaning their representations of the vaccines and the health authorities that promote vaccination, as well as their knowledge, fears, and hopes.
The Crown Pearl V2: an improved genome assembly of the European freshwater pearl mussel Margaritifera margaritifera (Linnaeus, 1758)
Authors: Gomes-dos-Santos André , Lopes-Lima Manuel , Machado André M. , Forest Thomas , Achaz Guillaume , Teixeira Amílcar , Prié Vincent , C. Castro L. Filipe , Froufe Elsa
Published: May 2023

Contiguous assemblies are fundamental to deciphering the composition of extant genomes. In molluscs, this is considerably challenging owing to the large size of their genomes, heterozygosity, and widespread repetitive content. Consequently, long-read sequencing technologies are fundamental for high contiguity and quality. The first genome assembly of Margaritifera margaritifera (Linnaeus, 1758) (Mollusca: Bivalvia: Unionida), a culturally relevant, widespread, and highly threatened species of freshwater mussels, was recently generated. However, the resulting genome is highly fragmented since the assembly relied on short-read approaches. Here, an improved reference genome assembly was generated using a combination of PacBio CLR long reads and Illumina paired-end short reads. This genome assembly is 2.4 Gb long, organized into 1,700 scaffolds with a contig N50 length of 3.4 Mbp. The ab initio gene prediction resulted in 48,314 protein-coding genes. Our new assembly is a substantial improvement and an essential resource for studying this species’ unique biological and evolutionary features, helping promote its conservation.
Japanese Medical Presence in the Territory of Construction and Operation of the Chinese Eastern Railway (1897-1922)
Authors: Gonchar Vladimir V. , Povolotsky Vladimir D.
Published: May 2023

The article examines Japanese medical practice in the territory of the Chinese Eastern Railway (CER or KVZhD) during its construction and operation. The archival material made it possible to find that the Japanese community was eager to take responsibility for providing medical care to its subjects independently. They achieved this by attracting national physicians whose activities were built on the principles of private medical practice.

The provision of medical care followed the principles of Western medicine, although traditional medicine methods were not excluded. The Russian authorities allowed Japanese doctors to maintain their practice in the Russian-controlled territories, but medical care was provided only to their compatriots, as well as to the Chinese and Korean population. However, the activities of Japanese doctors were treated with distrust and wariness in Russian society, both due to the migrants’ low level of education and due to the existing narrative about the so-called “Yellow Peril.”

Another aspect of the activities of Japanese physicians in Manchuria was the familiarization of the local population with European medicine methods. To achieve this, private, public, and charitable Japanese medical institutions were established. The difficult epidemiological situation in Manchuria, sanitary problems, socio-economic problems, requirements of Russian legislation, inter-faith divisions, and language barriers raised issues for the territorial communities’ leaders on increasing the availability and quality of health care for their compatriots. The initiatives and proposals of the Japanese community to open public hospitals in Manchuria, centralized medical examinations, strict sanitary procedures, and quarantine measures were supported by the Japanese central authorities. They were considered not only as elements of civilization and colonial ambitions but also as a means of social control not only over Japanese subjects.