bluuebunny/crossref_metadata_2025 huggingface dataset:
The effects of financial development and technological progress on environmental sustainability: Novel evidence from Asian countries
Authors: Nasreen Samia , Ishtiaq Faryal , Nghiem Xuan-Hoa
Published: January 2023

This research is an endeavor to improve the literature on ICT-financial development-environmental sustainability nexus by conducting an aggregated and disaggregated analysis on the role of financial development and ICT in attaining a sustainable environment. By employing a unique and comprehensive set of financial development and ICT indicators, this study offers an in-depth analysis of the role of financial development, ICT and especially their interactions in maintaining environmental sustainability in 30 Asian economies from 2006 to 2020. Results from two-step system GMM indicate that separately, both financial development and ICT are detrimental but together, their joint effects are beneficial to the environment. Several policy implications and recommendations are made to help policymakers to craft, design and implement appropriate policies to improve environmental quality.
JEL: C33; O33; Q43
Carvedilol as Primary and Secondary Prophylaxis to Prevent Variceal Hemorrhage in Patients With Hepatic Cirrhosis: a Systematic Review and Meta-analysis
Authors: Mariadi I Ketut , Daniella Dian , Paulus Ivana Beatrice , Somayana Gde , Sindhughosa Dwijo Anargha
Published: January 2023

Variceal bleeding is a medical emergency with mortality rate of 57%. After the first bleeding episode, the chance of a second bleeding is 70% in the first year. Carvedilol has been shown to have the added benefit of lowering hepatic venous pressure gradient (HVPG) but studies on its effectiveness as prophylaxis showed controversial results. The aim of this study was to assess the effectiveness and safety of carvedilol as primary and secondary prophylaxis of variceal bleeding in patients with liver cirrhosis. A comprehensive research was conducted using electronic databases, such as Google Scholar, PubMed, CENTRAL dan clinical trial.gov. We included studies from randomized controlled trials (RCTs). There were 17 studies included in the systematic review and 14 studies included in the analysis. As primary prophylaxis, carvedilol was as effective as EVL, (risk ratio [RR] 0.74, 95% confidence interval [CI] 0.37–1.49); p = 0.4) and propranolol (RR 0.76, 95% CI 0.27–2.14); p = 0.6). As secondary prophylaxis, carvedilol was more effective than placebo (RR 0.60, 95% CI 0.37–0.96); p = 0.03) and propranolol (RR 0.50, 95% CI 0.26–0.94); p = 0.03) and as effective as EVL (RR 1.11, 95% CI 0.76–1.63); p = 0.60) and non-selective beta-blocker (NSBB) + isosorbide mononitrate (ISMN) (RR 1.02, 95% CI 0.74–1.42); p = 0.88). There was no difference in side effects between carvedilol versus propranolol and EVL was even better than the NSBB + ISMN group (RR 0.35, 95% CI 0.15–0.80); p = 0.01). Carvedilol is as effective and safe as primary prophylaxis for variceal bleeding than propranolol and EVL. As secondary prophylaxis, carvedilol was as effective as EVL and NSBB + ISMN and more effective than placebo and propranolol, with fewer side effects.
Transcriptomic and functional analysis of ANGPTL4 overexpression in pancreatic cancer nominates targets that reverse chemoresistance
Authors: Gordon Emily R. , Wright Carter A. , James Mikayla , Cooper Sara J.
Published: January 2023

Background
Pancreatic ductal adenocarcinoma (PDAC) is one of the deadliest cancers based on five-year survival rates. Genes contributing to chemoresistance represent novel therapeutic targets that can improve treatment response. Increased expression of ANGPTL4 in tumors correlates with poor outcomes in pancreatic cancer.
Methods
We used statistical analysis of publicly available gene expression data (TCGA-PAAD) to test whether expression of ANGPTL4and its downstream targets, ITGB4 and APOL1, were correlated with patient survival. We measured the impact of ANGPTL4overexpression in a common pancreatic cancer cell line, MIA PaCa-2 cells, using CRISPRa for overexpression and DsiRNA for knockdown. We characterized global gene expression changes associated with high levels of ANGPTL4 and response to gemcitabine treatment using RNA-sequencing. Gemcitabine dose response curves were calculated on modified cell lines by measuring cell viability with CellTiter-Glo (Promega). Impacts on cell migration were measured using a time course scratch assay.
Results
We show that ANGPTL4 overexpression leads to in vitro resistance to gemcitabine and reduced survival times in patients. Overexpression of ANGPTL4 induces transcriptional signatures of tumor invasion and metastasis, proliferation and differentiation, and inhibition of apoptosis. Analyses revealed an overlapping signature of genes associated with both ANGPTL4activation and gemcitabine response. Increased expression of the genes in this signature in patient PDAC tissues was significantly associated with shorter patient survival. We identified 42 genes that were both co-regulated with ANGPTL4 and were responsive to gemcitabine treatment. ITGB4 and APOL1 were among these genes. Knockdown of either of these genes in cell lines overexpressing ANGPTL4 reversed the observed gemcitabine resistance and inhibited cellular migration associated with epithelial to mesenchymal transition (EMT) and ANGPTL4 overexpression.
Conclusions
These data suggest that ANGPTL4 promotes EMT and regulates the genes APOL1 and ITGB4. Importantly, we show that inhibition of both targets reverses chemoresistance and decreases migratory potential. Our findings have revealed a novel pathway regulating tumor response to treatment and suggest relevant therapeutic targets in pancreatic cancer.
Association of Hemoglobin-to-red blood cell distribution width ratio and risk of sarcopenia: a cross sectional study
Authors: Xi Lijuan , Zhou Jiajie , Xu Peirong , Zhang Yan , Tu Jiayuan , Sun Qiannan , Fang Fang
Published: January 2023

Background
The incidence rate of sarcopenia is high and it will lead to many adverse consequences. It is necessary to explore the influencing factors of sarcopenia and find out its inflammatory indicators.
Objectives
We aimed to explore the association between hemoglobin-to-red blood cell distribution width ratio (HRR) and the risk of sarcopenia from the large and diverse National Health and Nutrition Examination Survey (NHANES) 1999–2006, 2011–2018 population sample.
Methods
The general characteristics, disease related characteristics, diet and exercise characteristics, blood indicators, appendicular lean mass index, the peak isokinetic strength of the knee extensors, gait speed, combined grip strength and appendicular lean mass index extracted from the adult(18-79y) from the NHANES database. t test, two sample Kolmogorove-Smirnov test, Chi-square test, multiple linear regression analyses, binary logistic regression was used to assess the association between HRR and sarcopenia. The cut-off value invented by Budczies et al was used to found the cut-off value for the HRR to sarcopenia.
Results
A total sample of 28,531 participants were included in the study (50.85% males and 49.15% females). The prevance of sarcopenia is 23.87% (43.52% males and 56.48% females) and severe-sarcopenia is 18.13% (53.03% males and 46.97% females). HRR levels were significantly lower in sarcopenic people than non-sarcopenic people, and lower in severe-sarcopenia people than light-sarcopenia people(P < 0.05). HRR was significantly positive associated with appendicular lean mass index (ALMI), gait speed, peak isokinetic, and combined grip strength (P < 0.05). Regression analysis shows that HRR was independently associated with sarcopenia (P < 0.05).
Conclusions
This study first reveal that HRR is an independent risk factor for sarcopenia and the mechanism of HRR to sarcopenia is not clear. It is necessary to further explore the mechanism of HRR to sarcopenia in the future research.
Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness – a cross- sectional study
Authors: Moen Unni , Knapstad Mari Kalland , Goplen Frederik Kragerud , Nordahl Stein Helge Glad , Berge Jan Erik , Wilhelmsen Kjersti Thulin , Natvig Bård , Magnussen Liv Heide , Meldrum Dara
Published: January 2023

Background
The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain.
Methods
This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression.
Results
Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups.
Conclusion
Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.
The design of TXL-CAP study: a randomized, double-blind, placebo-controlled, multicenter Clinical Trial to assess Tongxinluo Capsule on Coronary Atherosclerotic Vulnerable Plaque
Authors: Yu Huaitao , Ti Yun , Qi Yan , Zhang Meng , Duan Dayue Darrel , Yao Chen , Jia Zhenhua , Zhang Yun , Ni Mei , Bu Peili
Published: January 2023

Background
Traditional Chinese medicine (TCM) Tongxinluo (TXL) capsules have been widely used in atherosclerosis treatment. Previous studies have demonstrated the TXL can retard the progression of atherosclerosis and reduce the incidence of cardiovascular events. In the present study (TXL-CAP trial), we aim to evaluate the efficacy of TXL on non-ST elevation acute coronary syndrome (NSTE-ACS) treatment.
Methods
This study is a randomized, double-blind, placebo-controlled, parallel-grouped multicenter clinical study and 220 patients diagnosed with NSTE-ACS will be enrolled. Patients will be randomized 1:1 to receive the TXL or placebo in addition to their standard treatment. The primary end point is the difference in the thickness of the fibrous cap of the target coronary artery plaque evaluated by OCT. The secondary observation indicators included the incidence of major adverse cardiovascular events (MACE), the proportion of patients with improved angina pectoris, Seattle angina pectoris questionnaire score, and serum levels of inflammatory cytokines (IL-1 β, IL-18, TNF- α).
Conclusion
The results of the TXL-CAP trial will provide clinical data for revealing whether TXL capsules stabilize vulnerable plaques in Chinese NSTE-ACS patients.
Trial registration:
The trial was registered at the Chinese Clinical Trial Registry on September 10, 2019 (http://www.chictr.org.cn). The registration Number was ChiCTR1900025842.
Sense of coherence in pregnancy: a systematic review of the literature.
Authors: Alcantara Joel , Myers Stephen , Emmanuel Elizabeth , Grace Sandra
Published: January 2023

Background Pregnancy is acknowledged as a time of physiological, social, and psychological challenges that may compromise a pregnant woman’s quality of life. Healthcare advocates have proposed a paradigm shift in maternity services towards a framework that includes the promotion and generation of health such as Antonovsky’s framework of salutogenesis. Central to salutogenesis are general resistance resources (GRRs) (i.e., assets and resources available to an individual) and sense of coherence (SOC) (i.e., a measure of their ability to mobilize their GRRs and manage physical, mental and social stressors). To begin to explore the role of SOC in pregnancy care, we critically analyzed, synthesized and summarized studies with quantitative measures of SOC during pregnancy. Methods A systematic review of the literature was performed using PubMed & Medline, Allied and Complementary Medicine (AMED), Cumulative Index to Nursing and Allied Health Literature (CINAHL) and PsychInfo between 1997 to 2022. Inclusion criteria for review were manuscripts: (1) of peer-reviewed primary investigation reports, (2) measuring SOC among pregnant women and (3) written in the English language. Manuscripts excluded were: (1) qualitative studies, (2) abstracts from conference proceedings and (3) dissertations from a Master or PhD degree. Quality assessment used the NIH National Heart, Lung, and Blood Institute Study Quality Assessment Tools. Our systematic review was guided by the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA). Results Our systematic review found 49 studies (i.e., prospective (n=29) and cross-sectional (n=17) cohorts) meeting inclusion criteria. Pregnant women (93% of subjects; n=27, 186) completed primarily the SOC-13 instrument along with 67 other patient reported outcomes (PROs) of mental and social health domains. Physical health measures were lacking. Overall, a low SOC score was associated with compromised health outcomes during pregnancy, labor and birth. Cause and effect inferences between measures of SOC and PROs remain largely unexplored. Conclusion The findings of this review are that low SOC is associated with poor prenatal health outcomes. Maternity care should focus on a more comprehensive approach that addresses not only morbidities and risks but also protective and stress resisting factors that promote health such as increasing a pregnant woman’s sense of coherence.
Serum cytokines in second trimester pregnancy and their relationship with preterm births in the Ribeirão Preto and São Luiz cohorts
Authors: Turra Suzana Eggers , Damaso Ênio Luis , Veiga Eduardo Carvalho de Arruda , Cardoso Viviane Cunha , Bettiol Heloisa , Cavalli Ricardo Carvalho
Published: January 2023

Objective: To evaluate the association between second trimester plasma cytokine levels in asymptomatic pregnant women and preterm births (PTB) in an attempt to identify a possible predictor of preterm birth.
Methods: Cohort case-control study including women with singleton pregnancies between 20 and 25 weeks and 6 days of gestation from two Brazilian cities. The patients were interviewed and venous blood samples were collected. The participants were again evaluated at birth. A total of 197 women with PTB comprised the case group. The control group was selected among term births (426 patients). Forty-one cytokines were compared between groups.
Results: When only spontaneous PTB were analyzed, GRO, sCD40L and MCP-1 levels were lower in the case group (p < 0.05). Logarithmic transformation was performed for cytokines with discrepant results, which showed increased levels of IL-2 in the group of spontaneous PTB (p < 0.05). In both analyses, the incidence of maternal smoking and of a history of preterm delivery differed significantly between the case and control groups. In multivariate analysis, only serum GRO levels differed between the case and control groups.
CONCLUSION: Lower second trimester serum levels of GRO in asymptomatic women are associated with a larger number of PTB. This finding may reflect a deficient maternal inflammatory response.
Sexual orientation knowledge and attitudes and its association with therapy services satisfaction among LGB Hispanic Puerto Ricans
Authors: Esteban Caleb , Francia-Martínez Margarita , Vázquez-Rivera Miguel , Crespo Frances , Bruno-Ortiz Taysha , Santiago-Ortiz Aquiria , Martínez-Taboas Alfonso
Published: January 2023

This study aimed to examine the difference in therapy satisfaction between LGB and heterosexual individuals, and to identify the association between therapy satisfaction and the perception of knowledge and attitudes of their last therapist among the LGB participants. Through an exploratory design with a comparative group, 125 participants were recruited online by availability. Results indicate that the participants’ sexual orientation has no significant relation on therapy satisfaction. However, there was a significant positive association between satisfaction with therapy and the therapist’s LGB knowledge and positive attitudes. This research highlights the importance for continuous education and curriculum efforts on LGB issues.
Using the integration of human resource management strategies at district level to improve workforce performance: analysis of workplan designs in three African countries
Authors: Martineau Tim , Mansour Wesam , Dieleman Marjolein , Akweongo Patricia , Amon Samuel , Chikaphupha Kingsley , Mubiri Paul , Raven Joanna
Published: January 2023

Background: There is a worldwide shortage of health workers against WHO recommended staffing levels to achieve Universal Health Coverage. To improve the performance of the existing health workforce a set of integrated human resources (HR) strategies are needed to address the root causes of these shortages. The PERFORM2Scale project uses an action research approach to support district level management teams to develop appropriate workplans to address service delivery and workforce related problems using a set of integrated human resources strategies. This paper provides evidence of the feasibility of supporting managers at district level to design appropriate integrated workplans to address these problems.
Methods: The study used content analysis of problem trees and 43 workplans developed by 28 district health management teams (DHMT) across three countries between 2018-2021 to identify how appropriate basic planning principles and the use of integrated human resource and health systems strategies were used in the design of the workplans developed. Four categories of HR strategies were used for the analysis (availability, direction, competencies, rewards and sanctions) and the relationship between HR and wider health systems strategies was also examined.
Results: About half (49%) of the DHMTs selected service-delivery problems while others selected workforce performance (46%) or general management (5%) problems, yet all workplans addressed health workforce related causes through integrated workplans. Most DHMTs used a combination of strategies for improving direction and competencies. The use of strategies to improve availability and the use of rewards and sanctions was more common amongst DHMTs in Ghana; this may be related to availability of decision-space in these areas. Other planning considerations such as link between problem and strategy, inclusion of gender and use of indicators were evident in the design of the workplans.
Conclusions: The study has demonstrated that, with appropriate support using an action research approach, DHMTs are able to design workplans which include integrated HR strategies. This process will help districts to address workforce and other service delivery problems as well as improving ‘health workforce literacy' of DHMT members which will benefit the country more broadly if and when any of the team members is promoted.
Phytochemical profile of eleven peruvian Mentheae. Isolation of ursolic acid from Clinopodium revolutum (Ruiz & Pavon) Govaerts and analysis of the aqueous infusions
Authors: Serrano Carlos A. , Villena Gretty K. , Rodriguez Eric F. , Calsino Belea , Ludeña Michael , Ccana Gari V.
Published: January 2023

The profile of secondary metabolites in eleven Mentheae (Nepetoideae, Lamiaceae) from Peru by liquid chromatography associated with Orbitrap mass spectrometry, UHPLC-OT-MS is presented. Precursors of and salvianolic acids have been found, particularly rosmarinic acid, as well as a diversity of free and glycosylated flavonoids as main substances, 127 tentatively identified structures. In addition, a method to obtain ursolic acid from Clinopodium revolutum (R. & P.) Govaerts and a quantitative analysis for rosmarinic acid and triterpenic acids in aqueous infusions of these plants are presented.
The “wild west” of carbon offsets: Farmer perspectives on carbon markets incentivizing agricultural soil carbon sequestration
Authors: Strong Aaron , Barbato Clare
Published: January 2023

Climate change mitigation efforts to achieve net-zero emissions require not only decreasing current greenhouse gas emissions, but also the deployment of negative emissions technologies. Soil organic carbon sequestration in agricultural lands is one such negative emissions strategy, currently being incentivized predominantly through voluntary carbon offset markets. Here, through semi-structured interviews, we assess both conventional and organic farmer perspectives on soil carbon offset programs that have been created in the United States since 2017. The perspectives of farmers both participating and not participating in agricultural soil carbon markets were similar and consistent. Farmers in both groups expressed concerns about the convoluted, burdensome and unpredictable nature of receiving offset credits and emphasized that they were implementing practices for their own business interests and sustainability concerns, not the financial incentive of the generation of carbon credits. Based on our research, carbon offset credit payments for agricultural soil carbon sequestration are largely reaching farmers who were already implementing these beneficial practices or were already strongly interested in implementing these practices, and the payments for the offset credits are seen as a ‘gravy on top’, suggesting that these offset markets face strong challenges of ensuring true additionality essential to effective climate mitigation.
A rare Egyptian case report of rectal neuroendocrine tumour polyp
Authors: Badwei Nourhan , Mostafa Ahmed
Published: January 2023

Background: Neuroendocrine neoplasms NENs represent rare malignancies in the elderly group. They comprise a heterogeneous group including neuroendocrine tumors NETs, neuroendocrine carcinomas NECs and mixed neuroendocrine non-neuroendocrine neoplasms MiNENs.
Case presentation: A rare case of NET presenting as a bleeding rectal polyp.
Conclusion: we aimed to summarize the diagnostic approach for such a rare entity.
Predictive value of enhanced CT and pathological indicators in lymph node metastasis in patients with gastric cancer based on GEE model
Authors: Yang Ling , Ding Yingying , Zhang Dafu , Yang Guangjun , Dong Xingxiang , Zhang Zhiping , Zhang Caixia , Zhang Wenjie , Dai Youguo , Li Zhenhui
Published: January 2023

Objectives
A predictive model was developed based on enhanced computed tomography (CT), laboratory test results, and pathological indicators to achieve the convenient and effective prediction of single lymph node metastasis (LNM) in gastric cancer.
Methods
Sixty-six consecutive patients (235 regional lymph nodes) with pathologically confirmed gastric cancer who underwent surgery at our hospital between December 2020 and November 2021 were retrospectively reviewed. They were randomly allocated to training (n = 38, number of lymph nodes = 119) and validation (n = 28, number of lymph nodes = 116) datasets. The clinical data, laboratory test results, enhanced CT characteristics, and pathological indicators from gastroscopy-guided needle biopsies were obtained. Multivariable logistic regression with generalised estimation equations (GEEs) was used to develop a predictive model for LNM in gastric cancer. The predictive performance of the model developed using the training and validation datasets was validated using receiver operating characteristic curves.
Results
Lymph node enhancement pattern, Ki67 level, and lymph node long-axis diameter were independent predictors of LNM in gastric cancer (p < 0.01). The GEE-logistic model was associated with LNM (p = 0.001). The area under the curve and accuracy of the model, with 95% confidence intervals, were 0.944 (0.890–0.998) and 0.897 (0.813–0.952), respectively, in the training dataset and 0.836 (0.751–0.921) and 0.798 (0.699–0.876), respectively, in the validation dataset.
Conclusion
The predictive model constructed based on lymph node enhancement pattern, Ki67 level, and lymph node long-axis diameter exhibited good performance in predicting LNM in gastric cancer and should aid the lymph node staging of gastric cancer and clinical decision-making.
Plating microstructure control by ultrasonic application to hot-dip galvanizing
Authors: Singh Selvaraj Manova Raja , Choi Yong bum , Koshiba Takuya , Hoshino Katsuya , Miyata Mai , Okumura Yusuke
Published: January 2023

The application of ultrasonic to molten metal has many effects, such as improving its wettability and fracturing the oxide layer. However, a few research studies have been done to apply ultrasound to the Hot-Dip Galvanizing plating method. This study focuses on improving the interfacial bonding strength and removing the oxide layer using ultrasonic waves. In this study, a high-tensile steel plate will be plated with ultrasonic waves, and the plated steel will be examined by microstructure observation and the mechanical properties of the interfacial bonding structure between SUS310S and Zn-Al alloy. It was confirmed that ultrasound waves affect the removal of impurities and pores between the SUS310S steel plate and the interface of the Zn-0.13 wt.% Al alloy during Hot-Dip galvanizing process. Furthermore, to observe the effect of ultrasonic waves on the removal of oxides, a kind of impurity, from the surface of SUS310S, an oxide layer having a thickness of 2 µm was deposited on the surface of SUS310S by Physical Vapor Deposition (PVD). When ultrasonic waves were applied to the oxide-coated SUS 310S surface for 60 seconds, a part of the oxide layer was fractured by the cavitation effect of ultrasonic.
Multi-scale Coefficients Fusion Strategy for Enhancement of SAM Image in Solder Joints Detection
Authors: Lu Xiangning , Wang Zengxiang , He Zhenzhi , Liao Guanglan , Shi Tielin
Published: January 2023

IC packaging technology becomes more complex with the increase of package density, and defect diagnosis of IC devices is getting more challenging. Scanning acoustic microscopy (SAM) is widely used in electronic industry. But the detection resolution is limited by the penetration depth of ultrasound. So it is of great necessity finding a way to improve the resolution and accuracy. A new strategy of multi-scale decomposition and fusion based on the wavelet transform has been proposed to enhance the image resolution in SAM detection. The original SAM image was subjected to wavelet decomposition at different scales. Two recombined images A and B were decomposed into a low frequency band (cAd1 and cAd2) and three high frequency bands (cHd1, cVd1, cDd1, and cHd2, cVd2, cDd2), which were then fused respectively based on the local area energy. The derived new coefficients were used to reconstruct a high resolution SAM image. A genetic algorithm modified back propagation network (GA-BP) was used for classifying the solder joints. The proposed scheme achieved highest recognition accuracy (97.16%) compared with other methods. The new strategy of image enhancement provides a stable and effective solution for SAM inspection of electronic devices.
Lebanese Population Knowledge, Attitudes, and Practice Regarding Cholera Disease and their Knowledge and Attitude Regarding the Cholera Vaccine Following an Outbreak in Lebanon
Authors: Jamaleddine Youssef , Tashjian Hagop , Mahmoud Mahmoud , Azzam Wael , Daher Amira , Salameh Pascale
Published: January 2023

The objective was to evaluate the knowledge, attitudes, and practices of the Lebanese population towards cholera and its vaccination. A cross-sectional study was conducted using a self-administered questionnaire among a sample of Lebanese residents. The questionnaire consisted of questions about the participants' demographics, knowledge, attitudes, and practice towards cholera and vaccination. The final sample size was 691 respondents. The proportion of female and male participants was 68.7% and 31.3%, respectively. The results showed that the majority had a good knowledge of cholera, with 97.4% identifying severe diarrhea as the main symptom. Young age, different governorate of residence, and higher education were associated with better knowledge. Most participants had positive attitude, which was correlated with being female and having children under the age of 5 in the same household. Regarding practices, the majority reported engaging in some form of cholera prevention, such as always cooking (90.8%) and washing (88.3%) food. Being older, female, and homemaker was associated with better practice. Most participants expressed good knowledge and a positive attitude towards the vaccine, with 55.5% indicating that they would surely be willing to be vaccinated if freely available. However, 14.2% participants rejected and expressed concerns about the vaccine. Higher cholera knowledge was significantly predictive of vaccination willingness (B = 0.091). In conclusion, this study has provided insights into the knowledge, attitudes, and practices of the Lebanese population towards cholera and its vaccination. The findings can be used to inform the development of public health interventions aimed at improving cholera prevention and control in Lebanon.
Technical Advantages of Modified Day Surgical Procedures for Penile Reconstructive Surgery During COVID-19
Authors: Yang Haoxuan , Fu Shengjie , Yang Mingxuan , Wang Yaxuan , Xue Wenyong , Du Lei , Ma Ziyue , Zhang Lin , Qi Jinchun
Published: January 2023

Objective The modified day surgical procedure was compared with traditional inpatient procedures and standard day surgical procedures to explore the technical advantages of the modified day surgical procedures during COVID-19.
Methods The clinical data of 135 children who underwent the day operation (the day group) and 101 children who underwent the traditional inpatient procedures (the inpatient group) were collected in the Second Hospital of Hebei Medical University during COVID-19. The patients' satisfaction surveys were divided into three groups: standard process group, modified process group, and inpatient group. The standard and modified process groups form the day surgical group. The degree of satisfaction among the groups was compared.
Results The average ages of the inpatient and day surgical groups were 8.92 years old and 11.85 years old, respectively. There was no significant difference between these two groups in operation time, bleeding volume, and postoperative complications (P>0.05). Compared with the inpatient group, the average inpatient time and the hospitalization cost of the day group decreased by 69% and 27%, respectively (P < 0.05). The patient's family members in the modified procedure group had the highest satisfaction among the three groups.
Conclusion The penile reconstructive plastic performed by modified day surgical procedures has advantages over the standard and traditional inpatient surgical procedures during COVID-19. The modified day surgical procedure benefits hospitals and patients, which is suitable for being popularized on a large scale during COVID-19.
Optimum Adaptive Bandwidth Selection Method of Local Fitting in Kernel Regression Analysis for Non-uniform Data
Authors: Patil Mahendra Deoraji , Sarate G. G.
Published: January 2023

Selection of a global bandwidth is common in kernel regression. On the other hand, the point wise choice of a local bandwidth can lead to better results in kernel regression because it has direct effect on smoothing of the signal. These smoothing bandwidths affect the filtering capacity of any signals and systems. It shows the higher adaptability to number of analysis varying from various problems in one-dimensional to multidimensional as well as different class of engineering branches of human-machine interactions. In this paper, we have proposed a new method called optimum adaptive local bandwidth selection method (OALB) depending on bias-variance optimization ratio. It is based on Stankovic optimization of bias-variance of the signal [3]. The bandwidth is calculated independently for every points based on intersection of confidence interval.
Alcohol consumption may be associated with postoperative delirium in the elderly: the PNDABLE study
Authors: Wu Xiaoyue , Zhang Ning , Zhou Bin , Liu Siyu , Wang Fei , Wang Jiahan , Tang Xinhui , Lin Xu , Wang Bin , Bi Yanlin
Published: January 2023

Objectives: The aim of this study was to reveal the relationship between alcohol consumption and Postoperative delirium (POD) in the elderly.
Methods: A total of 284 patients were enrolled in this study (mean age was 69.38 (65-90) years and 7.1% were female). Those who had measurements of CSF Aβ40, Aβ42，P-tau, and tau protein and drinking characteristics were included from the Perioperative Neurocognitive Disorder And Biomarker Lifestyle (PNDABLE ) study. Mini-Mental State Examination (MMSE) was used to assess preoperative mental status of patients. POD was diagnosed using the Confusion Assessment Method (CAM) and assessed for severity using the Memorial Delirium Assessment Scale (MDAS). The two independent samples t-test was used for comparison between the two groups. Logistic regression analysis was utilized to explore the association of alcohol consumption with POD. What’s more, We also performed sensitivity analysis by adding corrected confounders and the results were almost unchanged. Linear regression analysis was used to study the relationship between alcohol consumption and CSF biomarkers. Mediation analyses with 10000 bootstrapped iterations were used to explore the mediation effects. A two-factor ANOVA was used to explore the impact of gender and alcohol consumption on CSF biomarkers. Finally, we constructed the receiver operating characteristic (ROC) curve and the nomogram model to evaluate the efficacy of alcohol consumption and CSF biomarkers in predicting POD.
Result: The incidence of POD was 17.5% (44/252). Logistic regression showed that alcohol consumption (OR = 1.016, 95%CI 1.009-1.024, P < 0.001) is a risk factor for POD. In particular, alcohol consumption >24 g (heavy) is more likely to cause POD. What’s more, Aβ42 is a protective factor for POD (OR = 0.993, 95%CI 0.989-0.997, P < 0.05) and P-Tau was a risk factor for POD (OR = 1.093, 95%CI 1.022-1.168, P < 0.05). Linear regression analysis revealed that alcohol consumption was negatively associated with CSF Aβ42 (β = -0.638, P < 0.001) in POD patients. The two independent samples t-test showed that the non-postoperative delirium (NPOD) group had higher Aβ42 levels than the POD group; the POD group had more alcohol consumption than the NPOD group (P < 0.001). Mediation analyses show that alcohol consumption is likely to mediate POD through Aβ42 (proportion:14.21%) partially. ROC curve showed that alcohol consumption (AUC=0.904; P<0.001) exhibited a relative better discriminatory ability in POD prediction compared to Aβ42 (AUC=0.798; P<0.001). The calibration curve indicated good prediction of the nomogram(P=0.797).
Conclusion: Alcohol consumption is a risk factor for POD (particularly for those with >24 g a day on average) in the elderly, and contributes to POD through the mediation of Aβ42.
Association between Low-density Lipoprotein Cholesterol and Sudden Cardiac Arrest in People with Diabetes Mellitus
Authors: Kim Yun Gi , Jeong Joo Hee , Han Kyung-Do , Roh Seung-Young , Min Kyongjin , Lee Hyoung Seok , Choi Yun Young , Shim Jaemin , Choi Jong-Il , Kim Young-Hoon
Published: January 2023

Background
Dyslipidemia measured as low-density lipoprotein (LDL)-cholesterol is an established risk factor of cardiovascular disease, which is more pronounced in diabetes population. Less is known about the association of LDL-cholesterol level and sudden cardiac arrest (SCA) risk in diabetes mellitus patients. This study investigated the association of LDL-cholesterol level and SCA risk in diabetes population.
Methods
This study was based on Korean National Health Insurance Service database. Patients who received general examination from 2009 to 2012 and diagnosed as type 2 diabetes mellitus were analyzed. Primary outcome was defined as SCA event identified with International Classification of Disease code.
Results
A total of 2,602,577 patients were included, with total follow-up duration of 17,851,797 person*year. Mean follow-up duration was 6.86 years, and 26,341 SCA cases were identified. Overall incidence of SCA was highest in the lowest LDL-cholesterol group (< 70mg/dL) and decreased in a linear manner as LDL-cholesterol rises, till 160mg/dL. Adjustment of covariates resulted in U-shape association, with highest risk of SCA in the highest LDL-cholesterol group (≥ 160mg/dL) followed by lowest LDL-cholesterol group (< 70mg/dL). In subgroup analysis, U-shape association between SCA risk and LDL-cholesterol was more pronounced in male, non-obese people, and those who did not use statins.
Conclusions
In diabetes population, the association between SCA and LDL-cholesterol level was U-shaped with highest and lowest LDL-cholesterol group having higher risk of SCA than others. Paradoxically increased SCA risk in lower LDL-cholesterol population should be recognized and extended to clinical preventive measures.
Epigenetic age deacceleration in youth at familial risk for schizophrenia and bipolar disorder
Authors: Mas Sergi , Segura Alex , Serna Elena de la , Sugranyes Gisela , Baeza Inmaculada , Valli Isabel , Díaz-Caneja Covadonga , Martín-Martínez Nuria , Moreno Dolores , Gasso Patricia , Rodriguez Natalia , Castro-Fornieles Josefina
Published: January 2023

Epigenetic modifications occur sequentially during the lifespan, but their pace can be altered by external stimuli. The onset of schizophrenia and bipolar disorder is critically modulated by stressors that may alter the epigenetic pattern, a putative signature marker of exposure to environmental risk factors. In this study, we estimated the age-related epigenetic modifications to assess the differences between young individuals at familial high risk (FHR) and controls and their association with environmental stressors.
The sample included 117 individuals (6-17 years) at FHR (45%) and a control group (55%). Blood and saliva samples were used estimate the epigenetic age with six epigenetic clocks through methylation data. Environmental risk was measured with obstetric complications, socioeconomic statuses and recent stressful life events data.
For all epigenetic clocks except Horvath, estimated epigenetic ages were older than the chronological. Stratified analysis showed that Hannum epigenetic clock reported younger epigenetic age only in the FHR group. Epigenetic age was found deaccelerated in the FHR individuals in three epigenetic clocks. No effect of the environmental risk factors on the epigenetic age acceleration could be detected.
Epigenetic age asynchronicities were found in the young at high risk, suggesting that offspring of affected parents follow a slower pace of biological aging than the control group. It still remains unclear which environmental stressors orchestrate the changes in the methylation pattern. Further studies are needed to better characterize the molecular impact of environmental stressors before illness onset, which could be critical in the development of tools for personalized psychiatry.
Understanding the prevalence and manifestation of the anxiety and social difficulties experienced by children with Developmental Language Disorder.
Authors: Burnley Annabel , Clair Michelle St , Bedford Rachael , Wren Yvonne , Dack Charlotte
Published: January 2023

Background
It is well-documented that children with Developmental Language Disorder (DLD) experience socio-emotional difficulties. Despite this, there is little consensus as to how these difficulties manifest. This study aims to understand their prevalence, and inform intervention development by understanding the relationships between them.
Methods
A mixed-methods, case-control study was conducted. First, an online survey was completed by 107 parents of either children with DLD (‘DLD sample’; n = 57), or typically developing children (‘typical sample’; n = 50), aged 6–12 years old. The online survey comprised of standardised psychosocial measures, binary psychosocial statements (generated from previous qualitative work) and both family stress and coping mechanisms. Two separate mediation models were run to understand the underlying mechanisms behind (1) anxiety, and (2) social frustration; separate correlation analyses were used to determine the relationships between other psychosocial and familial variables. Qualitative interviews were then carried out with a small subset of the survey respondents (n = 4).
Results
The DLD sample scored significantly higher on all psychosocial statements than the typical sample. Experiencing anxiety (80.7%, p < 0.05), requiring routine and sameness (75.4%, p < 0.001) and emotional dysregulation (75.4%; p < 0.001) were the most common difficulties for children with DLD. Family stress and coping mechanisms only correlated with the manifestation of psychosocial difficulties in the typical group, not the DLD group. ‘Intolerance of uncertainty’ was found to fully mediate the relationship between DLD diagnosis and symptoms of anxiety. Emotion regulation was found to moderately mediate the relationship between DLD diagnosis and social frustration.
Conclusions
Parents appear to cope well with their children’s complex psychosocial needs. Intervention focussing on intolerance of uncertainty and emotion dysregulation may help the management of psychosocial difficulties. Further research is needed to understand the children’s preference for routine.
Feasibility of Artificial Intelligence Assisted Quantitative Muscle Ultrasound in Carpal Tunnel Syndrome
Authors: Kim Sun Woong , Kim Sunwoo , Shin Dongik , Choi Jae Hyeong , Baek Seungjun , Yoon Joon Shik , Sim Jung Sub
Published: January 2023

Background: In case of focal neuropathy, the muscle fibers innervated by the corresponding nerves are replaced with fat or fibrous tissue due to denervation, which results in increased echo intensity (EI) on ultrasonography. EI analysis can be conducted quantitatively using gray scale analysis. Mean value of pixel brightness of muscle image defined as EI. However, the accuracy achieved by using this parameteralone to differentiate between normal and abnormal muscles is limited. Recently, attempts have been made to increase the accuracy using artificial intelligence (AI) in the analysis of muscle ultrasound images. CTS is the most common disease among focal neuropathy. In this study, we aimed to verify the utility of AI assisted quantitative analysis of muscle ultrasound in CTS.
Methods: This is retrospective study that used data from adult who underwent ultrasonographic examination of hand muscles. The patient with CTS confirmed by electromyography and subjects without CTS were included. Ultrasound images of the unaffected hands of patients or subjects without CTS were used as controls. Ultrasonography was performed by one physician in same sonographic settings. Both conventional quantitative grayscale analysis and machine learning (ML) analysis were performed for comparison.
Results: A total of 47 hands with CTS and 27 control hands were analyzed. On conventional quantitative analysis, mean EI ratio (i.e. mean thenar EI/mean hypothenar EI ratio) were significantly higher in the patient group than in the control group, and the AUC was 0.76 in ROC analysis. In the analysis using machine learning, the AUC was the highest for the linear support vector classifier (AUC=0.86). When recursive feature elimination was applied to the classifier, the AUC value improved to 0.89.
Conclusion: This study showed a significant increase in diagnostic accuracy when AI was used for quantitative analysis of muscle ultrasonography. If an analysis protocol using machine learning can be established and mounted on an ultrasound machine, a noninvasive and non-time-consuming muscle ultrasound examination can be conducted as an ancillary tool for diagnosis.
Taguchi grey relational analysis for parametric optimization of incremental forming process of bimetallic Steel-CP Titanium composite sheet
Authors: arfa henia , HASSINE HICHEM
Published: January 2023

Single point incremental forming (SPIF) remains a new technique of sheet metal forming process in which can produce various shapes from different sheet alloys in small series. However, when the SPIF parameters are not sufficiently chosen, some forms of incremental sheet forming part quality can be inacceptable. This work aims to optimize geometry properties and forming forces of Steel/CP-Ti bimetal sheet formed by SPIF. Three levels of step size, the specimen thickness and the wall angle have been considered as the input process parameters. The influential process parameters on the thinning rate, forming forces and the equivalent plastic deformation have been recognized using of statistical tool. In this idea, a new current method, Taguchi grey relational analysis has been used to numerical simulations results in order to optimize incremental forming process parameters. The Taguchi-based Grey optimization of the single point incremental forming process is given for the determination of approving a synthesis of optimal process parameters such as the wall angle, the initial thickness, and the step size tool. Moreover, the individual effect factor on the considered output (Thinning Rate, Fz and PPEQ) was resolute with Analysis of variance (ANOVA). The response table and the grey relational grade for each level of the process parameters has been established.