bluuebunny/crossref_metadata_2025 huggingface dataset:
Investing in our planet: Examining retail investors' preference for green bond investment
Authors: Azad Shivam , Tulasi Devi S L , Mishra Anand Kumar
Published: March 2024

The green bond has emerged as an important financial instrument to advance environmentally friendly projects. While institutional investors have shown ample interest in green bonds, retail investors have lagged in their adoption. This study intends to examine the determinants of retail investors' attitude and intention toward green bond investment, utilizing the theory of planned behavior as the fundamental model and incorporating several context‐specific factors. Data from 506 Indian retail investors, representing the majority of Indian states and union territories (UTs), were collected through multi‐stage stratified random sampling. The PLS‐SEM method, coupled with artificial neural network (ANN) analysis and fuzzy set qualitative comparative analysis (fsQCA), was employed to test the hypothesized relationships, ensure the robustness of outcomes, and derive important practical insights. The findings suggest that intrinsic factors (perceived behavioral control and attitude) are superior predictors of investors' behavioral intentions relative to external factors (government policy support and social influence). Further, for green bonds to receive favorable evaluations from investors, they should display adequate financial cum environmental performance. Investors' attitude is significantly influenced by issuers' ratings and their willingness to pay premiums. Environmental concerns and perceived risk also influence investors' attitude toward green bonds, albeit with relatively lower strength. This study holds significance as it offers crucial implications for researchers, market participants, policymakers, and regulators involved in the development of the green bond market.
Evolution of the term “epicondyle of the femur”: Revisiting the anatomical and surgical literature
Authors: Kikuchi Keishiro , Holleman Gerrit T. , Cardona Juan J. , Lesser Emma R. , Kim Chung Yoh , Tabuchi Kosuke , Watanabe Koichi , Iwanaga Joe , Tubbs R. Shane
Published: March 2024

The femoral epicondyle is an anatomical bony landmark essential for surgeons and anatomists, but there are discrepancies between the two fields when using this term. In current orthopedic surgery, it commonly denotes the small bony prominence of the femoral condyle. Given the derivation, “epicondyle” should be a region projecting laterally from the articular surface rather than a point. These discrepancies in usage are found not only between the fields but also in the literature. This article reviews the narrative definition of “epicondyle of the femur” in surgery and the evolution of the term in anatomy. The outcomes of the review suggest a relationship between the differing perceptions of the epicondyle and the evolution of the term. In reports of studies related to the epicondyle, it is strongly recommended that the definition of the word is clearly stated, with an understanding of its evolution.
Unveiling the intriguing grape‐like mass: Uterine cervical adenosarcoma
Authors: Limaiem Faten , Ben Aissia Nizar
Published: March 2024

Key Clinical Message

Adenosarcoma of the uterine cervix should be considered in the evaluation of post‐menopausal bleeding, as it can be a potential underlying cause. Timely diagnosis and appropriate management are essential to optimize patient outcomes.

Adenosarcoma is a biphasic neoplasm comprising both a benign epithelial component and a typically low‐grade sarcomatous stromal component. Adenosarcoma mainly affects the endometrium (71%), with a lesser incidence in the cervix (2%). Herein, the authors report a case of adenosarcoma of the uterine cervix with distinct gross features.
Lower muscular strength is associated with greater liver fat content and higher serum liver enzymes—“The Sedentary's Liver” The Study of Health in Pomerania
Authors: Mayer Claudius , Ittermann Till , Schipf Sabine , Gross Stefan , Kim Simon , Schielke Jan , Bülow Robin , Kühn Jens‐Peter , Lerch Markus M. , Völzke Henry , Felix Stephan Burkhard , Bahls Martin , Targher Giovanni , Dörr Marcus , Markus Marcello Ricardo Paulista
Published: March 2024

We investigated the associations of low handgrip strength (HGS, i.e., a marker of muscular fitness) with liver fat content (LFC) and serum liver enzymes in a population‐based setting. We used data from 2700 participants (51.7% women), aged 21–90 years, from two independent cohorts of the population‐based Study of Health in Pomerania (SHIP‐START‐2 and SHIP‐TREND‐0). Cross‐sectional, multivariable adjusted regression models were performed to examine the associations of HGS with LFC, measured by magnetic resonance imaging and serum liver enzymes. We found significant inverse associations of HGS with both LFC and serum liver enzymes. Specifically, a 10‐kg lower HGS was associated with a 0.59% (95% confidence interval [CI]: 0.24–0.94; p = 0.001) higher LFC, a 0.051 µkatal/L (95% CI: 0.005–0.097; p = 0.031) higher gamma‐glutamyltransferase (GGT) concentration and a 0.010 µkatal/L (95% CI: 0.001–0.020; p = 0.023) higher aspartate aminotransferase (AST) concentration. The adjusted odds‐ratio for prevalent hepatic steatosis (defined by a MRI‐PDFF ≥5.1%) per 10‐kg lower HGS was 1.21 (95% CI: 1.04–1.40; p = 0.014). When considering only obese individuals, those with low HGS had a 1.58% (95% CI: 0.18–2.98; p = 0.027) higher mean LFC and higher chance of prevalent hepatic steatosis (adjusted OR 1.74, 95% CI: 1.15–2.62; p = 0.009) compared to individuals with high HGS. We found similar associations in individuals with overweight, but not in those with normal weight. Lower HGS was strongly associated with both higher LFC and higher serum GGT and AST concentrations. Future studies might clarify whether these findings reflect adverse effects of a sedentary lifestyle or aging on the liver.
Plug‐In Hybrid Electric Vehicle Energy Management with Clutch Engagement Control via Continuous‐Discrete Reinforcement Learning
Authors: Gong Changfu , Xu Jinming , Lin Yuan
Published: March 2024

Energy management strategy (EMS) is a key technology for plug‐in hybrid electric vehicles (PHEVs). The energy management of certain series–parallel PHEVs involves the control of continuous variables, such as engine torque, and discrete variables, such as clutch engagement/disengagement. Herein, a control‐oriented model is established for a series–parallel plug‐in hybrid system with clutch engagement control from the perspective of mixed‐integer programming. Subsequently, an EMS based on continuous‐discrete reinforcement learning (CDRL), which enables simultaneous output of continuous and discrete variables, is designed. During training, state‐of‐charge (SOC) randomization is introduced to ensure that the hybrid system exhibits optimal energy‐saving performance in both high and low SOC. Finally, the effectiveness of the proposed CDRL strategy is verified by comparing EMS based on charge‐depleting charge‐sustaining (CD‐CS) with rule‐based clutch engagement control and dynamic programming (DP). In the simulation results, it is shown that, under a high SOC, the CDRL strategy proposed in this article can improve energy efficiency by 8.3% compared to CD‐CS, and the energy consumption is just 6.6% higher than the global optimum based on DP, while under a low SOC, the numbers are 4.1% and 3.9%, respectively.
White adipose tissue distribution and amount are associated with increased white matter connectivity
Authors: Okudzhava Liana , Schulz Stephanie , Fischi‐Gomez Elda , Girard Gabriel , Machann Jürgen , Koch Philipp J. , Thiran Jean‐Philippe , Münte Thomas F. , Heldmann Marcus
Published: March 2024

Obesity represents a significant public health concern and is linked to various comorbidities and cognitive impairments. Previous research indicates that elevated body mass index (BMI) is associated with structural changes in white matter (WM). However, a deeper characterization of body composition is required, especially considering the links between abdominal obesity and metabolic dysfunction. This study aims to enhance our understanding of the relationship between obesity and WM connectivity by directly assessing the amount and distribution of fat tissue. Whole‐body magnetic resonance imaging (MRI) was employed to evaluate total adipose tissue (TAT), visceral adipose tissue (VAT), and subcutaneous adipose tissue (SAT), while MR liver spectroscopy measured liver fat content in 63 normal‐weight, overweight, and obese males. WM connectivity was quantified using microstructure‐informed tractography. Connectome‐based predictive modeling was used to predict body composition metrics based on WM connectomes. Our analysis revealed a positive dependency between BMI, TAT, SAT, and WM connectivity in brain regions involved in reward processing and appetite regulation, such as the insula, nucleus accumbens, and orbitofrontal cortex. Increased connectivity was also observed in cognitive control and inhibition networks, including the middle frontal gyrus and anterior cingulate cortex. No significant associations were found between WM connectivity and VAT or liver fat. Our findings suggest that altered neural communication between these brain regions may affect cognitive processes, emotional regulation, and reward perception in individuals with obesity, potentially contributing to weight gain. While our study did not identify a link between WM connectivity and VAT or liver fat, further investigation of the role of various fat depots and metabolic factors in brain networks is required to advance obesity prevention and treatment approaches.
Impact of goal‐directed hemodynamic therapy on perioperative outcomes in head and neck free flap surgery: A before‐and‐after pilot study
Authors: Philteos Justine , McCluskey Stuart A. , Emerson Sophia , Djaiani George , Goldstein David , Soussi Sabri
Published: March 2024

Background

Free flap reconstruction for head and neck cancer is associated with a high risk of perioperative complications. One of the modifiable risk factors associated with perioperative morbidity is intraoperative hypotension (IOH). The main aim of this pilot study is to determine if the intraoperative use of goal‐directed hemodynamic therapy (GDHT) is associated with a reduction in the number of IOH events in this population.

Methods

A before‐and‐after study design. The patients who had intraoperative GDHT were compared to patients from a previous period before the implementation of GDHT. The primary outcome was the number of IOH episodes defined as five or more successive minutes with a mean arterial pressure <65 mmHg. The secondary outcomes included major postoperative morbidity and 30‐day mortality.

Results

A total of 414 patients were included. These were divided into two groups. The control group (n = 346; January 1, 2018, to December 31, 2019), and the monitored group (n = 68; January 1, 2020, to May 1, 2021). The median intraoperative administered fluid volume was similar between the control and monitored groups (2250 interquartile range [IQR] [1607–3050] vs. 2210 IQR [1700–2807] mL). The monitored group was found to have an increased use of norepinephrine and dobutamine (respectively, 1.2% vs. 5.9% and 2.4% vs. 30.9%; p < 0.05). When adjusting for confounders (comorbidities, estimated blood loss, and duration of anesthesia) the incidence rate ratio (95% confidence interval) of number of IOH events was 0.94 (0.86–1.03), p = 0.24. The rate of postoperative flap and medical complications did not differ between the two groups.

Conclusions

Even though the use of vasopressors/inotropes was higher in the monitored group, the number of IOH episodes and postoperative morbidity and mortality were similar between the two groups. Further change in hemodynamic management will require the use of specific blood pressure targets in the GDHT fluid algorithm.
Metformin and other anti‐diabetic medication use and breast cancer incidence in the Nurses' Health Studies
Authors: Wang Tengteng , Chai Boyang , Chen Wendy Y. , Holmes Michelle D. , Erdrich Jennifer , Hu Frank B. , Rosner Bernard A. , Tamimi Rulla M. , Willett Walter C. , Kang Jae H. , Eliassen A. Heather
Published: March 2024

We aimed to examine the association between the use of metformin and other anti‐diabetic medications and breast cancer incidence within two large prospective cohort studies. We followed 185,181 women who participated in the Nurses' Health Study (NHS; 1994–2016) and the NHSII (1995–2017), with baseline corresponding to the date metformin was approved for type 2 diabetes (T2D) treatment in the US Information on T2D diagnosis, anti‐diabetes medications, and other covariates was self‐reported at baseline and repeatedly assessed by follow‐up questionnaires every 2 years. Breast cancer cases were self‐reported and confirmed by medical record review. Hazard ratios (HRs) and 95% confidence intervals (CIs) for the association between medication use and breast cancer were estimated using Cox proportional hazards regression models, adjusting for breast cancer risk factors. During 3,324,881 person‐years of follow‐up, we ascertained 9,192 incident invasive breast cancer cases, of which 451 were among women with T2D. Compared with women without T2D (n = 169,263), neither metformin use (HR = 0.97; 95% CI = 0.81–1.15) nor other anti‐diabetic medications use (HR = 1.11; 95% CI = 0.90–1.36) associated with significantly lower breast cancer incidence. Among women with T2D (n = 15,918), compared with metformin never users, metformin ever use was not significantly inversely associated with breast cancer (HR = 0.92; 95% CI = 0.74–1.15). Although we observed that past use of metformin was inversely associated with breast cancer in the T2D population (HR = 0.67; 95% CI = 0.48–0.94), current use (HR = 1.01; 95% CI = 0.80–1.27) and longer duration of metformin use were not associated with breast cancer (each 2‐year interval: HR = 1.01; 95% CI = 0.95–1.07). Overall, metformin use was not associated with the risk of developing breast cancer among the overall cohort population or among women with T2D.
Cervical ripening balloon compared with vaginal dinoprostone for cervical ripening in obese women at term: A prospective cohort study
Authors: Ducarme Guillaume , Gilman Serena , Sauvee Margot , Planche Lucie
Published: March 2024

Objective

To evaluate vaginal delivery in obese women who underwent cervical ripening at term using a dinoprostone vaginal insert or a cervical ripening balloon (CRB), and to assess maternal and neonatal morbidity according to the method.

Methods

A prospective cohort study including obese women with a live singleton fetus in cephalic presentation who required cervical ripening at term (≥37 weeks) for maternal and/or fetal disease using a dinoprostone vaginal insert or a CRB. The primary outcome was vaginal delivery. Secondary outcomes were a favorable cervix (Bishop score >6) after 24 h, the time from device insertion to delivery, and composite maternal and neonatal morbidity.

Results

In total, 135 consecutive women were analyzed (107 CRB, 79.3%; 28 dinoprostone vaginal insert, 20.7%). Vaginal delivery (86 [80.4%] after CRB vs 19 [67.9%] after dinoprostone vaginal insert; P = 0.248), favorable cervix within 24 h after device placement (52 [48.6%] vs 17 [60.7%]; P = 0.264), and maternal morbidity (12 [11.2%] vs 4 [14.3%]; P = 0.646) were similar between the groups. The time from device insertion to delivery also did not differ between the groups. Neonatal morbidity was significantly higher after the dinoprostone vaginal insert (11 [39.3%] vs 20 [18.7%]; P = 0.030). Cervical ripening using the dinoprostone vaginal insert, compared with the CRB, was significantly associated with neonatal morbidity (adjusted odds ratio 4.00, 95% confidence interval 1.34–12.5), but not with maternal morbidity (adjusted odds ratio 1.23, 95% confidence interval 0.30–4.38).

Conclusions

Vaginal delivery, a favorable cervix after 24 h, the time from device insertion to delivery, and maternal morbidity did not significantly differ between the CRB and the dinoprostone vaginal insert for cervical ripening in obese women at term. Nevertheless, neonatal morbidity was significantly associated with the dinoprostone vaginal insert, compared with the CRB, among obese women who required cervical ripening at term.
Photocurable extracellular matrix sealant for cessation of venous hemorrhage
Authors: Schepers Luke E. , Martindale Brooke L. , Berman Alycia G. , Cebull Hannah L. , Van Alstine William , Hollingshead Sydney E. , Novak Tyler , Goergen Craig J.
Published: March 2024

Hemorrhage is the second leading cause of death in patients under 46 years of age in the United States. Cessation of hemorrhage prevents hemorrhagic shock and tissue hypoxia. Controlling the bleed via direct pressure or tourniquet is often the first line of defense, but long‐term care requires staples, hemostatic agents, or sealants that seal the vessel and restore blood flow. Here, we compare a new photocurable extracellular matrix sealant (pcECM) with low, medium, and high crosslink density formulations to a commercially available fibrin‐based sealant, TISSEEL®. pcECM has potential uses in surgical and remote settings due to room temperature storage conditions and fast preparation time. Here, we determine if pcECM sealant can stop venous hemorrhage in a murine model, adhere to the wound site in vivo throughout the wound‐healing process, and has the mechanical properties necessary for stopping hemorrhage. Adjusting pcECM crosslinking density significantly affected viscosity, swelling, burst strength, tensile strength, and elasticity of the sealant. 3‐Dimensional ultrasound volume segmentations showed pcECM degrades to 17 ± 8% of its initial implant volume by day 28. Initially, local hemodynamic changes were observed, but returned close to baseline levels by day 28. Acute inflammation was observed near the puncture site in pcECM implanted mice, and we observed inflammatory markers at the 14‐day explant for both sealants. pcECM and fibrin sealant successfully sealed the vessel in all cases, and consistently degraded over 14–28 days. pcECM is a durable sealant with tunable mechanical properties and possible uses in hemorrhage control and other surgical procedures.
Improving osseointegration and antimicrobial properties of titanium implants with black phosphorus nanosheets‐hydroxyapatite composite coatings for vascularized bone regeneration
Authors: Ma Shilong , Sun Ruize , Wang Yuhui , Wei Yan , Xu Haofeng , Liu Xuanyu , Liang Ziwei , Zhao Liqin , Hu Yinchun , Lian Xiaojie , Guo Meiqing , Huang Di
Published: March 2024

For decades, titanium implants have shown impressive advantages in bone repair. However, the preparation of implants with excellent antimicrobial properties as well as better osseointegration ability remains difficult for clinical application. In this study, black phosphorus nanosheets (BPNSs) were doped into hydroxyapatite (HA) coatings using electrophoretic deposition. The coatings' surface morphology, roughness, water contact angle, photothermal properties, and antibacterial properties were investigated. The BP/HA coating exhibited a surface roughness of 59.1 nm, providing an ideal substrate for cell attachment and growth. The water contact angle on the BP/HA coating was measured to be approximately 8.55°, indicating its hydrophilic nature. The BPNSs demonstrated efficient photothermal conversion, with a temperature increase of 42.2°C under laser irradiation. The BP/HA composite coating exhibited a significant reduction in bacterial growth, with inhibition rates of 95.6% and 96.1% against Staphylococcus aureus and Escherichia coli. In addition, the cytocompatibility of the composite coating was evaluated by cell adhesion, CCK8 and AM/PI staining; the effect of the composite coating in promoting angiogenesis was assessed by scratch assay, transwell assay, and protein blotting; and the osteoinductivity of the composite coating was evaluated by alkaline phosphatase assay, alizarin red staining, and Western blot. The results showed that the BP/HA composite coating exhibited superior performance in promoting biological functions such as cell proliferation and adhesion, antibacterial activity, osteogenic differentiation, and angiogenesis, and had potential applications in vascularized bone regeneration.
Pharmacokinetics and Safety of Firsocostat, an Acetyl‐Coenzyme A Carboxylase Inhibitor, in Participants with Mild, Moderate, and Severe Hepatic Impairment
Authors: Younis Islam R. , Nelson Cara , Weber Elijah J. , Qin Ann R. , Watkins Timothy R. , Othman Ahmed A.
Published: March 2024

Firsocostat is an oral, liver‐targeted inhibitor of acetyl‐coenzyme A carboxylase in development for the treatment of metabolic dysfunction‐associated steatohepatitis. Hepatic organic anion transporting polypeptides play a significant role in the disposition of firsocostat with minimal contributions from uridine diphospho‐glucuronosyltransferase and cytochrome P450 3A enzymes. This phase 1 study evaluated the pharmacokinetics and safety of firsocostat in participants with mild, moderate, or severe hepatic impairment. Participants with stable mild, moderate, or severe hepatic impairment (Child–Pugh A, B, or C, respectively [n = 10 per cohort]) and healthy matched controls with normal hepatic function (n = 10 per cohort) received a single oral dose of firsocostat (20 mg for mild and moderate hepatic impairment; 5 mg for severe hepatic impairment) with intensive pharmacokinetic sampling over 96 h. Safety was monitored throughout the study. Firsocostat plasma exposure (AUCinf) was 83%, 8.7‐fold, and 30‐fold higher in participants with mild, moderate, and severe hepatic impairment, respectively, relative to matched controls. Firsocostat was generally well tolerated, and all reported adverse events were mild in nature. Dose adjustment is not necessary for the administration of firsocostat in patients with mild hepatic impairment. However, based on the observed increases in firsocostat exposure, dose adjustment should be considered for patients with moderate or severe hepatic impairment, and additional safety and efficacy data from future clinical trials will further inform dose adjustment.
Discovery of novel heterocyclic derivatives containing oxadiazolone or pyrimidinone cores as DPP‐4 inhibitors
Authors: Feitosa Sidney Gustavo Diniz , Lins Ilária Martina Silva , Maciel Larissa Gonçalves , dos Anjos Janaína Versiani
Published: March 2024

Type 2 diabetes is a chronic disease characterized by insulin resistance and alterations in incretin secretion, such as the glucagon‐like peptide‐1 (GLP‐1) hormone. GLP‐1 plays a crucial role in signaling insulin production in the pancreas, with its activity regulated by the dipeptidyl peptidase 4 (DPP‐4) enzyme. DPP‐4 presents an intriguing strategy for controlling type 2 diabetes. This study focuses on synthesizing 22 novel oxadiazolone and pyrimidinone derivatives, in vitro DPP‐4 inhibition, and elucidating binding modes through molecular docking simulations. Nine compounds showed promising inhibitory activity, with IC50 values ranging from 0.3 to 1.86 mM. Molecular docking simulations revealed interactions between these compounds and critical residues in the enzyme's active site, such as Arg125, Glu206, Ser630, and His740. This investigation introduces a new class of DPP‐4 inhibitors, providing insights into the design of more potent molecules as potential candidates for combating type 2 diabetes. The findings contribute to developing innovative therapeutics for managing this prevalent metabolic disorder.
Assessment of model projections of climate‐change induced extreme storms on the south‐east coast of Australia
Authors: Zhu Wenjun , Wang Xiao Hua , Peirson William , Salcedo‐Castro Julio
Published: March 2024

General circulation models (GCMs) and their downscaled regional‐scale equivalents have been important tools for climate‐change studies. However, there has been limited assessment of the performance of GCMs and downscaled models in simulating extreme storms in temperate coastal environments. This study assesses the model characterization of extreme storms on the heavily populated coast of south‐east Australia. Twenty‐year average recurrence interval (ARI) storm intensities derived from generalized extreme value (GEV) distributions based on observed and large‐scale atmospheric model data are compared. Changes in extreme storms from past climate to a high‐emission future scenario are also investigated. Simulations of storm minimum surface pressures compared favourably with measured data. Both the GCMs and downscaled models reproduced the observed decrease with increasing latitude along the coast in the 20 year ARI of minimum surface pressure. Both indicated that the minimum storm surface pressure should change negligibly in a high‐emission future. Although the models underestimated the maximum daily precipitation significantly, models are improving significantly with CMIP epoch and downscaling. In the high‐emission future scenario, the GCMs and NARCliM projected the 20 year ARI maximum daily precipitation would increase in the order of 25%. GCMs and the corresponding downscaled products presently do not represent the extreme value distributions of historical wind speed data well, overestimating at smaller values of ARI and significantly underestimating in larger values of ARI. Significant changes in the magnitude of the 20 year ARI maximum daily‐average onshore wind speed are not projected for the high‐emission future.
Distraction osteogenesis in combined sequential use of external fixation and nailing (lengthening and then nailing): An experimental study in rabbits
Authors: Shchepkina Elena A. , Solomin Leonid N. , Lebedkov Ivan V. , Netylko Georgy I. , Anisimova Larisa O. , Sheridan Gerard A. , Robert Rozbruch S. , Trushnikov Vladislav V.
Published: March 2024

Limb lengthening relies on the process of distraction osteogenesis. The active periosteal bone formation has been detected in clinical practice with a lengthening and then nail (LATN) technique but has not been confirmed by experimental studies to date. The aim of this study is to compare the tissue regeneration of the distraction regenerate during tibial lengthening in rabbits using a LATN technique. This study was performed on 54 mature rabbits of the Soviet Chinchilla breed, which were divided into three groups of 18 animals. In group 1 (control), the tibia was lengthened in an external fixator. In group 2, the LATN technique was modeled and in group 3, lengthening over nail (LON) was modeled. The total duration of the experiment was 45 days. On the 10th, 15th, 20th, 30th, and 45th day X‐ray, computed tomography and morphological studies were performed. In the experimental groups (2 and 3), a more pronounced periosteal bone formation in the area of regenerate was noted when compared to group 1. In group 2 (LATN), wide cortical plates were formed from the intermediate and periosteal areas. In this group, the maximum densitometric density values were noted. Endosteal bone formation was preserved in all groups. The LON and LATN techniques, when compared with the classical Ilizarov lengthening, do not demonstrate any deficiency in the tissue regeneration of the bone tissue at the regenerate sites. The most powerful bone structures are formed with the sequential use of the external fixation and nailing (LATN).
Nutrition considerations for patients with persistent critical illness: A narrative review
Authors: Viner Smith Elizabeth , Lambell Kate , Tatucu‐Babet Oana A. , Ridley Emma , Chapple Lee‐anne
Published: March 2024

Critically ill patients experience high rates of malnutrition and significant muscle loss during their intensive care unit (ICU) admission, impacting recovery. Nutrition is likely to play an important role in mitigating the development and progression of malnutrition and muscle loss observed in ICU, yet definitive clinical trials of nutrition interventions in ICU have failed to show benefit. As improvements in the quality of medical care mean that sicker patients are able to survive the initial insult, combined with an aging and increasingly comorbid population, it is anticipated that ICU length of stay will continue to increase. This review aims to discuss nutrition considerations unique to critically ill patients who have persistent critical illness, defined as an ICU stay of >10 days. A discussion of nutrition concepts relevant to patients with persistent critical illness will include energy and protein metabolism, prescription, and delivery; monitoring of nutrition at the bedside; and the role of the healthcare team in optimizing nutrition support.
Tailored chitosan integration in diatomaceous earth particles as a scaffold for fructosyltransferase immobilization in fructo‐oligosaccharide production
Authors: Zhao Zishen , Xiao Ziqun , Jiang Bo , Chen Jingjing
Published: March 2024

BACKGROUND

Fructo‐oligosaccharide (FOS) belongs to the group of short inulin‐type fructans and is one of the most important non‐digestible bifid‐oligosaccharides capable of biotransforming sucrose using fructosyltransferase (FTase). However, there are no immobilized FTase products that can be successfully used industrially. In this study, diatomite was subjected to extrusion, sintering and granulation to form diatomaceous earth particles that were further modified via chitosan aminomethylation for modification. FTase derived from Aspergillus oryzae was successfully immobilized on the modified support via covalent binding.

RESULTS

The immobilized enzyme activity was 503 IU g−1 at an enzyme concentration of 0.6 mg mL−1, immobilization pH of 7.0 and contact time of 3 h. Additionally, the immobilization yield was 56.91%. Notably, the immobilized enzyme was more stable under acidic conditions. Moreover, the half‐life of the immobilized enzyme was 20.80 and 10.96 times as long as that of the free enzyme at 45 and 60 °C, respectively. The results show good reusability, as evidenced by the 84.77% retention of original enzyme activity after eight cycles. Additionally, the column transit time of the substrate was 35.56 min when the immobilized enzyme was applied in a packed‐bed reactor. Furthermore, a consistently high FOS production yield of 60.68% was achieved and maintained over the 15‐day monitoring period.

CONCLUSIONS

Our results suggest that immobilized FTase is a viable candidate for continuous FOS production on an industrial scale. © 2024 Society of Chemical Industry.
Preparation and characterization of zein–caseinate–pectin complex nanoparticles for encapsulation of curcumin: pectin extracted by high‐speed shearing from passion fruit (Passiflora edulis f. flavicarpa) peel
Authors: Li Xiefei , Lin Yupeng , Huang Yumeng , Li Xin , An Fengping , Song Hongbo , Huang Qun
Published: March 2024

BACKGROUND

Pectin extracted by high‐speed shearing from passion fruit peel (HSSP) is a potentially excellent wall material for encapsulating curcumin, which has multiple advantages over pectin prepared by heated water extraction. HSSP was used to fabricate complex nanoparticles of zein–sodium caseinate–pectin for encapsulation of curcumin in this study. The influence of heating on the physicochemical properties of the composite nanoparticles was also investigated, as well as the effect of composite nanoparticles on the encapsulation efficiency, antioxidant activity and release characteristics of curcumin.

RESULTS

The nanoparticles were formed through electrostatic interactions, hydrogen bonds and hydrophobic interactions between the proteins and HSSP. A temperature of 50 °C was more favorable for generating compact and small‐sized nanoparticles, which could effectively improve the encapsulation efficiency and functional properties. Moreover, compared to other pectin used in the study, the nanoparticles prepared with HSSP showed the best functionality with a particle size of 234.28 ± 0.85 nm, encapsulation rate of 90.22 ± 0.54%, free radical scavenging rate of 78.97% and strongest protective capacity in simulated gastric fluid and intestinal release effect.

CONCLUSION

Zein–sodium caseinate–HSSP is effective for encapsulating and delivering hydrophobic bioactive substances such as curcumin, which has potential applications in the functional food and pharmaceutical industries. © 2024 Society of Chemical Industry.
Computer‐Aided Diagnosis of Maxillary Sinus Anomalies: Validation and Clinical Correlation
Authors: Bhattacharya Debayan , Becker Benjamin Tobias , Behrendt Finn , Beyersdorff Dirk , Petersen Elina , Petersen Marvin , Cheng Bastian , Eggert Dennis , Betz Christian , Schlaefer Alexander , Hoffmann Anna Sophie
Published: March 2024

Objective

Computer aided diagnostics (CAD) systems can automate the differentiation of maxillary sinus (MS) with and without opacification, simplifying the typically laborious process and aiding in clinical insight discovery within large cohorts.

Methods

This study uses Hamburg City Health Study (HCHS) a large, prospective, long‐term, population‐based cohort study of participants between 45 and 74 years of age. We develop a CAD system using an ensemble of 3D Convolutional Neural Network (CNN) to analyze cranial MRIs, distinguishing MS with opacifications (polyps, cysts, mucosal thickening) from MS without opacifications. The system is used to find correlations of participants with and without MS opacifications with clinical data (smoking, alcohol, BMI, asthma, bronchitis, sex, age, leukocyte count, C‐reactive protein, allergies).

Results

The evaluation metrics of CAD system (Area Under Receiver Operator Characteristic: 0.95, sensitivity: 0.85, specificity: 0.90) demonstrated the effectiveness of our approach. MS with opacification group exhibited higher alcohol consumption, higher BMI, higher incidence of intrinsic asthma and extrinsic asthma. Male sex had higher prevalence of MS opacifications. Participants with MS opacifications had higher incidence of hay fever and house dust allergy but lower incidence of bee/wasp venom allergy.

Conclusion

The study demonstrates a 3D CNN's ability to distinguish MS with and without opacifications, improving automated diagnosis and aiding in correlating clinical data in population studies.

Level of Evidence

3 Laryngoscope, 134:3927–3934, 2024
Pain control is comparable between opioid versus non‐opioid management after otolaryngology procedures
Authors: Sarathy Ashwini , An Clemens , Bever Ty , Callas Peter , Fujii Mayo H. , Sajisevi Mirabelle
Published: March 2024

Objective

The current study aims to measure patient‐reported satisfaction with pain control using opioid and non‐opioid medications after undergoing the following otolaryngology procedures: parathyroidectomy, thyroid lobectomy, total thyroidectomy, and bilateral tonsillectomy.

Materials and Methods

A prospective cohort study was performed at an academic medical center that included a telephone questionnaire and chart review. Opioid prescriptions, usage, and patient‐reported pain outcomes were recorded. Bivariate analyses were used to compare opioid and non‐opioid users.

Results

Of the 107 total patients undergoing otolaryngology procedures included in the study, 49 (45.8%) used an opioid for pain management postoperatively and 58 (54.2%) did not. Among the 81 patients who underwent endocrine procedures (parathyroidectomy, total thyroidectomy/lobectomy), most patients reported being “very satisfied” or “satisfied” with pain control whether they used opioids (n = 27/30, 90%) or not (n = 50/51, 98%). Of the 26 patients who underwent bilateral tonsillectomy, 19 (73%) were prescribed opioids and among these, most (n = 17/19, 89%) reported they were “very satisfied” or “satisfied” with pain control. In the non‐opioid usage group, all patients (n = 7/7, 100%) reported they were “satisfied” with pain control. There was no statistically significant difference in patient‐reported satisfaction with pain control between opioid and non‐opioid users for any of the procedures listed.

Conclusion

The results of our study suggest that patients who did not use opioids have a similar level of satisfaction with pain control compared to those using opioids after thyroid, parathyroid and tonsillectomy surgeries. Considering the magnitude of the opioid crisis, providers should reassess the need for opioid prescriptions following certain ENT procedures.

Level of Evidence

IV.
Acute myeloid leukemia: An unusual manifestation of the trachea
Authors: Celidonio Joseph , Bahethi Rohini , Malhotra Raj , Yan Kenneth
Published: March 2024

Objective(s)

Hematologic malignancy involving the trachea is rare. It is even less common for tracheal involvement to be the initial manifestation of this disease. We present a case report highlighting an unusual diagnosis of acute myeloid leukemia (AML) that first presented with prominent tracheal manifestations. There have been only three other published case reports of extramedullary AML with involvement of the trachea.

Methods

We discuss direct laryngoscopy and bronchoscopy findings, including pinkish‐white irregular lesions, which were similar to findings described in the available literature for tracheal AML.

Results

Laboratory findings from our case are reported, including peripheral smear demonstrating 57% blasts and bone marrow biopsy confirming the diagnosis of AML, and the relevance of these findings is discussed.

Conclusion

In patients with unusual airway lesions, laboratory testing and a comprehensive airway evaluation including biopsy are necessary to narrow the differential diagnosis.

Level of Evidence

5.
Financing and ordering decisions in a risk‐averse dual‐channel supply chain: Interactive impacts of revenue sharing rate and dividend proportion
Authors: Zhen Zhiyuan , Jiang Lan , Yu Yue
Published: March 2024

The paper studies a dual‐channel supply chain in which the capital‐constrained retailer operating the reselling channel is risk‐averse, whereas both the supplier and the platform operating the direct retail channel exhibit risk‐neutral. The traditional retailer chooses supplier financing (SF), platform investment (PI), or non‐financing (NF) to meet uncertain demand. Examining three scenarios using CVaR, we find financing equilibrium determined by interactive impacts of dividend proportion and revenue sharing rate. Adjusting the latter achieves Pareto improvement among supply chain members, explaining why platforms invest in traditional retailers. Extending the model introduces a portfolio financing approach, combining SF and PI.
Newly launched mental health provider blends novel and traditional treatments
Authors: Enos Gary
Published: March 2024

A New York City‐based outpatient mental health treatment provider that opened for business in January is establishing a care model that seeks to integrate new clinical approaches with the tried‐and‐true.
Suicide prevention bills, 988 crisis funding top AFSP priorities
Authors: Canady Valerie A.
Published: March 2024

Reflecting on a number of concerns and issues impacting communities nationally, the American Foundation for Suicide Prevention (AFSP) is pushing for suicide prevention and mental health bills to become law, among them, more investments in the 988 Suicide & Crisis Lifeline system and educating communities about lethal means safety.
Comparison of environmental DNA and underwater visual count surveys for detecting juvenile Coho Salmon in small rivers
Authors: Shaffer Jason T. , Kinziger Andrew P. , Bjorkstedt Eric P. , Buchheister Andre
Published: March 2024

Objective

This study compares the probability of detecting juvenile Coho Salmon Oncorhynchus kisutch using both environmental DNA (eDNA) techniques and underwater visual count (UVC) surveys in northern California rivers. Here, UVC surveys commonly have detection probabilities (p) surpassing 0.90, providing an ideal setting to examine the performance of newer eDNA methods. We also evaluate the potential for using eDNA concentrations to predict the count of Coho Salmon within pool habitats.

Methods

We conducted paired eDNA and UVC surveys in 96 pools across 25 stream reaches within the Smith River basin, California. Method-specific p and the effect of environmental covariates were estimated using multiscale occupancy modeling. We used generalized linear models to evaluate the relationship of fish counts to eDNA concentrations and habitat covariates.

Result

The eDNA and UVC methods showed a high degree of agreement in detecting the presence of Coho Salmon within a pool (93% agreement) and survey reach (80% agreement). Detection probabilities for eDNA (peDNA) and for UVC (pUVC) were similar and high at median levels of pool residual depth and contributing basin area (peDNA = 91%, pUVC = 89%). Contributing basin area (a proxy for discharge) had a strong, negative effect that was more pronounced for peDNA than for pUVC (e.g., in the largest basins, peDNA = 34% whereas pUVC = 77%). We did not find eDNA concentrations to be a good predictor of Coho Salmon counts in small pools.

Conclusion

This study demonstrates that eDNA methods yielded nearly identical results to UVC surveys in catchments <36 km2 and can provide a highly effective approach for determining the distribution of Coho Salmon. However, additional investigation is required before eDNA could be used to estimate relative abundance in small pools.
A framework for optimizing the acquisition protocol multishell diffusion‐weighted imaging for multimodel assessment
Authors: Ciceri Tommaso , De Luca Alberto , Agarwal Nivedita , Arrigoni Filippo , Peruzzo Denis
Published: March 2024

Complementary aspects of tissue microstructure can be studied with diffusion‐weighted imaging (DWI). However, there is no consensus on how to design a diffusion acquisition protocol for multiple models within a clinically feasible time. The purpose of this study is to provide a flexible framework that is able to optimize the shell acquisition protocol given a set of DWI models. Eleven healthy subjects underwent an extensive DWI acquisition protocol, including 15 candidate shells, ranging from 10 to 3500 s/mm2. The proposed framework aims to determine the optimized acquisition scheme (OAS) with a data‐driven procedure minimizing the squared error of model‐estimated parameters. We tested the proposed method over five heterogeneous DWI models exploiting both low and high b‐values (i.e., diffusion tensor imaging [DTI], free water, intra‐voxel incoherent motion [IVIM], diffusion kurtosis imaging [DKI], and neurite orientation dispersion and density imaging [NODDI]). A voxel‐level and region of interest (ROI)‐level analysis was conducted over the white matter and in 48 fiber bundles, respectively. Results showed that acquiring data for the five abovementioned models via OAS requires 14 min, compared with 35 min for the joint recommended acquisition protocol. The parameters derived from the reference acquisition scheme and the OAS are comparable in terms of estimated values, noise, and tissue contrast. Furthermore, the power analysis showed that the OAS retains the potential sensitivity to group‐level differences in the parameters of interest, with the exception of the free water model. Overall, there is a linear correspondence (R2 = 0.91) between OAS and reference‐derived parameters. In conclusion, the proposed framework optimizes the shell acquisition scheme for a given set of DWI models (i.e., DTI, free water, IVIM, DKI, and NODDI), combining low and high b‐values while saving acquisition time.
Non‐pharmacological strategies to reduce stress and anxiety in endovascular procedures: A scoping review
Authors: Mendes Francisco de Cassio de Oliveira , Santos Kauanny Vitoria Gurgel dos , Dantas Joyce Karolayne dos Santos , Araújo Sara Cristina Matias de , Teixeira Fernanda de Castro , Leal Karena Cristina da Silva , Dantas Daniele Vieira , Dantas Rodrigo Assis Neves
Published: March 2024

Aim

This study aimed to identify and map the production of knowledge on non‐pharmacological strategies to reduce stress and anxiety in patients undergoing endovascular procedures.

Design

Scoping review.

Methods

The review was performed using the PRISMA‐ScR guidelines. The searches were conducted in Scopus, PubMed, Web of Science, Wiley Online Library, BVS/BIREME, Lilacs, Gale Academic OneFile, SciELO, Cochrane Library, CAPES Catalog of Dissertations and Theses, Oswaldo Cruz Foundation Portal of Theses and Dissertations, and Theses and Dissertations from Latin America.

Results

Twenty‐two articles were selected. The articles were published from 2001 to 2022, mostly in Iran, and there was a predominance of randomized clinical trials. The Spielberger State‐Trait Anxiety Inventory was the most used instrument. The findings indicated that music therapy, educational guidelines or videos on the procedure, massage, psychological preparation and aromatherapy were the main non‐pharmacological therapies used to reduce anxiety and stress in patients undergoing vascular procedures.
Developing the questionnaire of general population knowledge, attitudes and practices towards the COVID‐19 outbreak
Authors: Namdar Areshtanab Hossein , Vahidi Maryam , Hosseinzadeh Mina , Khani Zahra
Published: March 2024

Aim

To develop the general population knowledge, attitudes and practices (KAP) questionnaire towards the COVID‐19 outbreak.

Design

A methodological study.

Methods

The general population KAP questionnaire items were designed using a literature review. A panel of experts was used to calculate content validity ratio (CVR) and content validity index (CVI). Construct validity was examined using exploratory factor analysis (EFA) and hypothesis testing. Internal consistency of the questionnaire was measured using Cronbach's α coefficient. Eight hundred forty‐seven patients referred to health centres in Tabriz, Iran completed the questionnaire in 2021.

Results

The developed questionnaire consisted of three parts, including knowledge, attitudes and practices. EFA identified three dimensions for the knowledge (ways of transmission and prevention, high‐risk groups, and symptoms and treatment), three dimensions for the attitudes (hope, fear and view of the vaccine) and three for the practices (adherence to personal and public hygiene, limiting their presence in society and protecting yourself in the community). The Kaiser–Meyer–Olkin index for knowledge, attitudes and practices was 0.733, 0.725 and 0.886, respectively, with a significant Bartlett's test of sphericity (p < 0.01). The hypotheses of knowledge and attitudes that are the related factors of practices were confirmed. Cronbach's α was 0.63, 0.74, 0.77, 0.1 and 0.85 for knowledge; fear, hope and view of the vaccine subscales of attitudes; and practices, respectively.

Patient or Public Contribution

The developed 47‐item questionnaire had acceptable validity and reliability. Thus, nurses can use it to assess the clients' KAP during the COVID‐19 outbreak. Also, nursing researchers can use this questionnaire in their descriptive and interventional studies.