bluuebunny/crossref_metadata_2025 huggingface dataset:
Turkiye in the Western Balkans Today: Numbers and Estimates
Authors: Arlyapova E. , Ponomareva E.
Published: August 2023

The article examines the outcomes of Turkish foreign policy towards the Western Balkans from the moment of its intensification, designated as the “Erdogan era”, up to date. As a period of development of Turkish-Balkan relations, it is characterized with the priority of economy over diplomacy and personal ties over institutional interaction. The article evaluates historiographical drift in the perception of Turkiye as an influencer in dependence on transformation of its general foreign policy and regional strategy. Negative assessments and connotations have prevailed in recent years: Turkiye has been analytically “separated” from the Western influential powers and referred to as a so-called Eastern power (along with Russia, China, and the Persian Gulf countries), recognized by western tradition as a nondemocratic force with malign influence in the region. The authors argue that this analytical construction does not correlate with the current Turkiye’s state of affairs in the region and its self-positioning in the changing world order. They point out that the Turkish authorities see and interpret Turkiye’s alleged challenge to the current international order as an intra-alliance opposition. Although often being called a “spoiler” of EU policy in the Western Balkans, indeed, Turkiye mostly remains in line with NATO, the EU and the US, still favoring Atlanticism and Europeanism in practical politics, despite severe criticism in public rhetoric used mainly for Turkish domestic consumption. The research pays special attention to Turkiye’s vulnerabilities. It evaluates achievements in the region with a focus on: low entry points in economy and politics of Turkish-Balkan relations; lack of interest and motivation of Turkish private business to explore the markets of the Western Balkans; inability to compete with the EU dominance in the foreign trade sector; incomparable capabilities of Turkiye with those of the leading “quintet” of external actors (China, EU, Russia, UK, and US) in the Western Balkans.
Armenian NPP in Focus of Geopolitical Interests in South Caucasus
Authors: Davtyan V. , Khachikyan S.
Published: August 2023

The present research paper studies the impact of geopolitical processes on the development of Armenian “peaceful atom”. Nuclear energy has a key role in diversifying the energy system and ensuring the energy security of Armenia. The presence of nuclear capacities in the territory of Armenia is a strategic priority, taking into account the complex interstate relations in the South Caucasus and the danger of Armenia’s involvement in regional conflicts. However, at present stage of development of nuclear energy, Armenia faces certain challenges. On the way to answering these challenges Armenia deals with complex geopolitical processes and regional trends in the development of nuclear energy. The results of the study show the impact of geopolitical processes and regional transformations on the development of Armenian “peaceful atom”. At present, all states of the region, except for Georgia, are implementing or planning national programs for the development of “peaceful atom”. Plans and actions aimed at the development of nuclear energy in the South Caucasus necessitate the importance of further development of Armenian “peaceful atom” in order to maintain the country’s competitiveness at regional level. At the same time, nuclear energy in Armenia becomes a place for the clash of interests of certain geopolitical actors and an area for their competition. While the Russian participation is of decisive importance for the functioning and the development of nuclear energy in Armenia, the USA and the EU try to weaken the Russian participation in this area by providing their vision for the the development of the industry and implementing their own projects in the Armenian energy sector. Тhe integration processes in the EAEU and the EU, in turn, create certain obstacles, opportunities and prospects for nuclear energy in Armenia and lead to the cooperation with international structures, regional and geopolitical actors.
European Gas Market Restructuring: Interests of Importing Countries and Gas Exporting Companies
Authors: Kopytin I.
Published: August 2023

The article focuses on the process of restructuring the natural gas market in Europe. It is shown that the transformation of the European gas market is taking place under the decisive influence of the political decision of the European Commission and the governments of the EU largest gas consuming countries, first, to reduce gas consumption as much as possible in the shortest time; second, to replace Russian gas with imports from alternative sources. As both tasks have the highest priority, the EU countries act within the framework of political, not market logic, regardless of significant economic costs. To hedge against very high gas prices EU introduced since 15 February 2023 the market correction mechanism, capping the price of gas from the above. It is also expected the mandatory filling of gas storage facilities to at least 90% of their capacity before the winter season since 2023 would pressure gas prices downwards. Natural gas exporting companies operate within a system of market coordinates and are ready to participate in the process of transforming the European natural gas market only to the extent that does not contradict their economic interests. The politicization of gas cooperation between the EU and the US at the interstate level cannot change the market behavior of companies. Given the uncertainty regarding the perspective demand for gas in Europe, gas exporting companies are interested in concluding long-term contracts for the export-import of gas on a “take or pay” basis. Europe’s unwillingness to massively engage into the long-term import-export contracts for LNG and readiness to bear additional costs in the form of elevated gas prices will allow companies in the short-term period to make high profits on the spot market.
Transatlantism in the Context of the Decline of Globalization: Discussions in the USA
Authors: Golub Y. , Shenin S.
Published: August 2023

The article is devoted to the study of the role and place of transatlantic relations in American strategic plans. Amid a decline of globalization, the American approaches to the problem of interaction with Europe with the aim of forming a new international relations system are analyzed. As a part of its strategy of the world economy fragmentation, the administration of J. Biden plans to create a bloc of “friendly” countries, the foundation of which should be a strengthened transatlantic community. However, the leading American political and ideological groups disagree with many aspects of the administration’s plan to develop transatlantic relations. For example, the conservative democrats think than it is necessary to carry out reindustrialization by expanding functions of a State. The progressives demand to base the new transatlantism on the general transition to renewable energy and ideas of social equality. The moderate republicans propose to focus on deepening the European integration. The conservatives are confident that true transatlantic solidarity can be built only on the basis of center-right ideological unity. All the groups agree that it is necessary to stimulate the activity of the EU on the anti-Russian direction. Regarding the administration’s demand for Europe to sever relations with China, the progressives, conservative democrats and moderate republicans believe that the administration’s policy splits the transatlantic community. Although to some extent, most of the groups (except progressives) are concerned about protectionist measures on both sides of the Atlantic, it is still believed that such steps are permissible during the transitional stage of the restructuring of the world order. In general, the Biden administration’s policy receives only partial support for its transatlantic course, so quick consensus on the transatlantic future is unlikely.
Effect of Cuff-Inflation on Blood Pressure, Arousals, Sleep Efficiency, and Desaturations: Sub-Analysis of the VAST Pilot Study
Authors: Socrates Thenral , Krisai Philipp , Meienberg Andrea , Mayr Michael , Burkard Thilo , Vischer Annina Salome
Published: August 2023

The influence of cuff inflations on nighttime measurements during 24h ambulatory blood pressure (BP) measurements is unknown. We investigated the potential effect of cuff-inflations on asleep parameters using measurements taken simultaneously with a cuffless device using pulse-transit-time (PTT). On the first day of measurement, standard cuff-based 24h BP and cuf-fless measurements were simultaneously performed on right and left arms (CUFF/PTT-D). 1-2 days after the first measurement, the cuffless device was worn alone (PTT-D). Only data from the cuffless device was analyzed. The following mean asleep parameters were analyzed: systolic and diastolic BP, arousals, sleep efficiency, total arousals, arousal per hour and desaturations. 21 in-dividuals were prospectively enrolled. Mean (SD) age was 47(±15) years and 57% were female. Mean systolic asleep BP for the during CUFF/PTT-D and during PTT-D were 131(±21) and 131(±26) mmHg respectively. Mean diastolic asleep BP values during CUFF/PTT-D and during PTT-D were 80(±14) and 84(±14) mmHg respectively (p=0.860, p=0.100 respectively). Systolic and diastolic asleep mean difference was 0.1 (±18.0) and -3.6 (±9.8) mmHg, respectively. There were significantly more total arousals during PTT-D (p=0.042). There was no significant difference seen in sleep efficiency (p=0.339) or desaturations (p=0.896) between the two measurements. We could not show any significant impact from cuff inflations during asleep PTT-D measurements.
Current Status of Angiogenesis Inhibitors as Second-Line Treatment for Unresectable Colorectal Cancer
Authors: Otsu Satoshi , Hironaka Shuichi
Published: August 2023

Colorectal cancer is the third most common disease and the second most common cause of death in the world. The drug for second-line treatment depends on the drugs used in first-line treatment and biomarker status. As biomarkers, the RAS gene, BRAF gene, and dMMR/MSI-H, TMB-H, and HER2 statuses have been established in clinical practice, and the corresponding molecularly targeted therapeutic agents are selected based on biomarker status. Given the frequency of biomarkers, it is assumed that when patients move on to second-line treatment, an angiogenesis inhibitor is selected in many cases. For second-line treatment, three angiogenesis inhibitors, bevacizumab (BEV), ramucirumab (RAM), and aflibercept (AFL), are available, and one of them is combined with cytotoxic agents. These three angiogenesis inhibitors are known to inhibit angiogenesis through different mechanisms of action. Although no useful biomarkers are established for selecting angiogenesis inhibitors, previous biomarker studies have suggested that angiogenesis-related factors such as VEGF-A and VEGF-D might be predictors of therapeutic efficacy of angiogenesis inhibitors. These biomarkers are measured as protein levels in plasma and are considered to be hopeful biomarkers. We consider that the rationale for selecting among these three angiogenesis inhibitors should be clarified to benefit patients.
A Novel Symmetrical Active-Switched Coupled-Inductor High-Step-Up DC/DC Converter
Authors: Yang Sung-Pei , Chen Shin-Ju , Huang Chao-Ming , Tang Yao-Cheng , Chiu Cheng-Hsuan
Published: August 2023

This paper proposes a novel symmetrical active-switched coupled-inductor high-step-up DC/DC converter. A new active-switched coupled inductor is used to allow much higher voltage gain of the proposed converter. The symmetrical circuit structure of the proposed converter evenly divides large input currents and reduce input current ripple by operating in interleaved mode so power density is increased. The switches also have low voltage stress. The operating principle and design considerations for the converter topology are described. The proposed converter with an input voltage of 40 V, an output voltage of 400 V and an output of 1000 W at a switching frequency of 50 kHz is implemented. The simulations and experimental results are thus depicted to verify the theoretical analysis. The highest efficiency is 95.5% at 200 W measured by using a HIOKI 3390. Consequently, the proposed converter is suitable for renewable energy generation systems that require high power, high voltage gain and high efficiency.
Spatiotemporal Analysis and Multifactor Driving Mechanisms of Urban Blue Space in Beijing Using Remote Sensing
Authors: Chen Ya , Zhen Weina , Li Yu , Zhang Ninghui , Shi Yishao , Shi Donghui
Published: August 2023

With the rapid development in Beijing, there is a critical need to explore the circumstance and reveal the mechanisms of precious urban natural resources. In this context, urban blue space has attracted more and more attention by driving microcirculation, cooling heat islands, and relaxing residential. We extracted the UBS at Beijing using remote sensing, explored the spatial and temporal development in the last two decades via USDA methods, uncovered the full spectrum of landscape patterns from an ecological perspective, and simulated the mechanisms of the UBS area and the landscape quantitatively. We found that: (1) The UBS area in Beijing increased with fluctuation from 2000 to 2020. (2) The spatial clustering has distributed stable with some subtle changes. (3)The ecological circumstance has improved in the last 21 years in Beijing, with the increasing habitat diversity and richness, while the inferior landscape fragmentation has indicated some severe challenges. (4) Natural factors impact urban blue space areas more than social ones, while both similarly influence the UBS landscape. (5) Vegetation circumstances and precipitation are the most important natural factors on both area and landscape of UBS, and population and artificial surface are the most important social factors.
Natural Biocontrol of Athelia rolfsii isolate INVEPAR-05 in Stevia rebaudiana Bertoni: Exploring the Biocontrol Potential of Native Trichoderma spp. Strains
Authors: Rodriguez-Paez Luis Alfonso , Jaraba-Navas Juan de Dios , Pineda-Rodriguez Yirlis Yadeth , Begambre-Hernandez Mauricio , Pompelli Marcelo F. , Jimenez-Ramirez Ana Melisa , Gil-Rocha Anselmo , Jarma-Orozco Alfredo , Combatt-Caballero Enrique , Aviña-Padilla Katia , Jamal Aftab , Oloriz-Ortega Maria Ileana , Rodríguez Novisel Veitía
Published: August 2023

Stevia rebaudiana (Bert.) is a natural sweetener with diterpenic glycosides, offering 300 times more sweetness than sucrose, and boasting low-calorie content, along with medicinal and therapeutic properties. To address a limited genetic diversity, a germplasm bank comprising 115 segregated lines of stevia was established in Colombia. Notwithstanding, the fungus Athelia rolfsii adversely impacted key stevia lines, leading to wilting and plant mortality. For this reason our study aimed to explore the biocontrol potential of native strains of Trichoderma spp., isolated from productive lots in Colombia's Cordoba department, as a solution to manage A. rolfsii. Soil samples underwent serial dilution technique (103 conidia.mL-1) to obtain Trichoderma spp. isolates, which were thoroughly morphologically and molecularly characterized. A total five native strains were identified through sequencing the PCR products using universal ITS primers, and comparisons with the GENBANK database confirmed their identity (OK310695.1, ON237703.1, ON238106.1, ON237737.1, and ON237923.1). Their biocontrol efficacy against A. rolfsii was evaluated using the dual culture technique. Remarkably, all strains exhibited significant biocontrol capacity against the A. rolfsii isolate INVEPAR-05 (OK271308.1), except for Trichoderma viride INVEPAR-T10 (ON237923.1). These findings suggest that Trichoderma spp. could be a potential option to manage the fungus in stevia.
A Machine Learning Model for Predicting Critical Minimum Foot Clearance (MFC) Heights
Authors: Asogwa Clement Ogugua , Nagano Hanatsu , Sarashina Eri , Begg Rezaul , Sankai Yoshiyuki
Published: August 2023

Tripping is the largest cause of falls and low swing foot ground clearance during the mid-swing phase, particularly at the critical gait event known as Minimum Foot Clearance (MFC) is the major risk factor for tripping-related falls. Intervention strategies to increase MFC height can be effective if applied in real-time based on feed-forward prediction. The current study investigated the capability of machine learning models to classify the MFC into various categories using toe-off kinematics data. Specifically, three MFC sub-categories (less than 1.5cm, between 1.5-2.0cm and higher than 2.0cm) were predicted applying machine learning approaches. A total of 18,490 swing phase gait cycles’ data were extracted from six healthy young adults, each walking for 5-minutes at a constant speed of 4km/h on a motorised treadmill. Both K-Nearest Neighbour (KNN) and Random-Forest were utilised for prediction based on the data from toe-off for five consecutive frames (0.025s duration). Foot kinematics data were obtained from inertial measurement unit attached to the mid-foot, recording tri-axial linear accelerations and angular velocities of the local coordinate. KNN and Random-Forest achieved 84% and 86% accuracy, respectively, in classifying MFC into the three sub-categories with run time of 0.39 seconds and 13.98 seconds respectively. The KNN-based model was found to be more effective if incorporated into an active exoskeleton as the intelligent system to control MFC based on the preceding gait event, toe-off due to its quicker computation time. The machine learning based prediction model shows promise for the prediction of critical MFC data indicating higher tripping risk.
Dose Effects of Flubendiamide and Thiodicarb Against Spodoptera Species Developing on Bt and Non-Bt Soybean
Authors: Godoy Daniela N. , Pretto Venicius E. , Almeida Poliana G. de , Weschenfelder Marlon A. G. , Warpechowski Luiz F. , Horikoshi Renato J. , Martinelli Samuel , Head Graham P. , Bernardi Oderlei
Published: August 2023

An increase in Spodoptera species was reported in Bt soybean fields expressing Cry1Ac insecticidal proteins in Brazil, requiring additional management with chemical insecticides. Here, we evaluated the dose effects of flubendiamide and thiodicarb on Spodoptera cosmioides (Walker, 1858), Spodoptera eridania (Stoll, 1782), Spodoptera albula (Walker, 1857) and Spodoptera frugiperda (J. E. Smith, 1797) (Lepidoptera: Noctuidae) that survived on MON 87751 × MON 87708 × MON 87701 × MON 89788, expressing Cry1A.105, Cry2Ab2 and Cry1Ac; MON 87701 × MON 89788 soybean, expressing Cry1Ac; and non-Bt soybean. On unsprayed Cry1A.105/Cry2Ab2/Cry1Ac soybean, only S. frugiperda showed ~60% mortality after 10 d, whereas S. cosmioides, S. eridania and S. albula showed >81% mortality. Surviving larvae of all species on this Bt soybean showed >80% mortality when exposed to the field label dose of flubendiamide (70 mL/ha) or thiodicarb (400 g/ha) or at 50% of these doses. In contrast, all four species had <25% and <19% mortality on Cry1Ac and non-Bt soybean, respectively. Surviving S. cosmioides, S. eridania and S. albula on these soybean types presented >83% mortality post-exposure to both dose levels of flubendiamide and thiodicarb. Some S. frugiperda larvae surviving on Cry1Ac and non-Bt soybean sprayed with a 50% dose of either insecticide developed into adults. However, L1 larvae developing on Cry1Ac soybean leaves sprayed with flubendiamide and L2 larvae on this soybean sprayed with thiodicarb had a prolonged immature stage, and females lower fecundity, which are likely to impact its population growth on soybean.
Cytomegalovirus Infection after Allogeneic Hematopoietic Cell Transplantation under 100-day Letermovir Prophylaxis: a Real-world, 1-year Follow-up Study
Authors: Nho Dukhee , Lee Raeseok , Cho Sung-Yeon , Lee Dong-Gun , Kim Eun-Jin , Park Silvia , Lee Sung-Eun , Cho Byung-Sik , Kim Yoo-Jin , Lee Seok , Kim Hee-Je
Published: August 2023

Prevention and management of cytomegalovirus (CMV) reactivation is important to improve outcome of allogeneic hematopoietic cell transplantation (allo-HCT) recipients. The aim of this study was to analyze real-world data for incidence and characteristics of CMV infections until 1-year after allo-HCT under 100-day letermovir prophylaxis. A single-center retrospective study was conducted between November 2020 and October 2021. During the study period, 358 patients underwent allo-HCT, 306 of whom received letermovir prophylaxis. Cumulative incidence of clinically significant CMV infection (CS-CMVi) was 11.4%, 31.7%, and 36.9% at 14-weeks, 24-weeks, and 1-year post-HCT, respectively. In multivariate analysis, risk of CS-CMVi increased with graft-versus-host disease (GVHD) ≥ grade 2 (adjusted odds ratio 3.640 [2.036–6.510]; P < 0.001). One-year non-relapse mortality was significantly higher in letermovir breakthrough CS-CMVi patients than those with subclinical CMV reactivation who continued letermovir (P = 0.002). There were 18 (15.9%) refractory CMV infection in this study population. In summary, letermovir prophylaxis is effective in preventing CS-CMVi until day 100, which increased after cessation of letermovir. GVHD is still a significant risk factor in letermovir prophylaxis era. Further research is needed to establish individualized management strategies especially in patients with significant GVHD or letermovir breakthrough CS-CMVi.
Environmental Endocrinology: Parabens Hazardous Effects on HPT Axis
Authors: Azeredo Damáris Barcelos Cunha , Anselmo Denilson de Sousa , Soares Paula , Graceli Jones Bernardes , Magliano D'Angelo Carlo
Published: August 2023

Parabens are classified as endocrine disrupting compounds (EDCs), capable of interfering with the normal functioning of the thyroid, affecting the proper regulation of the biosynthesis of thyroid hormones (TH) which is controlled by hypothalamic-pituitary-thyroid axis (HPT). Given the crucial role of these hormones in health and the growing evidence of diseases related to thyroid dysfunction, this review looks at the effects of paraben exposure on the thyroid. In this study, we considered research carried out in vitro, in vivo, and epidemiological studies published between 1951 and 2023, which demonstrated an association between exposure to parabens and dysfunctions of the HPT axis. In humans, exposure to parabens appears to increase thyroid-stimulating hormone (TSH) levels, while in rodents, exposure decreases TSH levels. The effects on HT levels are also poorly described, as well as peripheral metabolism. Regardless, recent studies have shown different actions between different subtypes of parabens on the HPT axis, which allows us to speculate that the mechanism of action of these parabens is different. Furthermore, studies of exposure to parabens are more evident in women than in men. Therefore, future studies are needed to clarify the effects of exposure to parabens and their mechanisms of action on this axis.
Physicochemical and Sanitary Parameters of Raw Cow's Milk Intended for Consumption in the Amazonas Region, Peru
Authors: Frias Hugo , Murga Luis , Portocarrero-Villegas Segundo M , Arista-Ruiz Miguel Angel , Santillán Pinedo Llonar , Diaz Escobedo Heisen , Maraví César , Milla Pino Manuel Emilio , Culqui Vilca Janier , Alvarado Chuqui Wigoberto , Segura Portocarrero Gleni Tatiana , Saucedo-Uriarte José Américo , Bardales William
Published: August 2023

The objective of this research was to evaluate the physicochemical and sanitary parameters of raw cow's milk intended for consumption in the Amazonas region, Peru. We sampled 31 collection centers and dairy processors. We evaluated physicochemical parameters (fat, protein, solids not fat, lactose, ash, pH, and density), somatic cell count, and microbiology (mesophilic aerobic bacteria and total coliforms) of raw milk. We applied an analysis of variance (α=0.05) and the comparison of means between the collection centers and livestock basins (p<0.05). In addition, we performed a cluster analysis, principal components and correlation. Depending on the collection center, we found differences in all the physicochemical parameters, somatic cell count and milk microbiology. In the livestock basin analysis, we found differences for somatic cells, fat, protein, solids, pH, coliforms and bacteria. The Jumbilla basin presented less somatic cells, less fat was found in the Levanto basin and higher protein in the Yambrasbamba basin. Lactose, ash, density, total coliforms and mesophilic aerobic bacteria did not vary according to basin. The cluster analysis yielded four groups, Group 1 is higher in ash and density, Group 2 and 3 are higher in fat, Group 3 with higher protein, but higher in total coliforms and mesophilic aerobic bacteria. Group 4 registered the highest pH and the lowest protein concentration. There was a positive correlation of fat with protein and solids not fat, lactose with solids not fat, ash with density. Negative correlations of somatic cells with fat and, protein and solids not fat with pH.
Spin Label Electron Paramagnetic Resonance Spectroscopy Reveals Effects of Wastewater Filter Membrane Coated with Titanium-Dioxide Nanoparticles on Bovine Serum Albumin
Authors: Sebők-Nagy Krisztina , Kóta Zoltán , Kincses András , Fazekas Ákos Ferenc , Dér András , László Zsuzsanna , Páli Tibor
Published: August 2023

Accumulation of proteins in filter membranes limits the efficiently of filtering technologies for cleaning wastewater. Efforts are ongoing to coat commercial filters with different materials (such as titanium-dioxide, TiO2) in order to reduce the fouling of the membrane. Beyond monitoring the desired effect of retention of biomolecules, it is demanding to understand what are the biophysical changes in water-soluble proteins caused by interacting with the new coated filter membranes, an aspect that has received little attention so far. Using spin label electron paramagnetic resonance (EPR), aided with native fluorescent spectroscopy and dynamic light scattering (DLS), here we report the changes in the structure and dynamics of bovine serum albumin (BSA) exposed to TiO2 (P25) nanoparticles or passing through commercial polyvinylidene fluoride (PVDF) membranes coated with the same nanoparticles. We have found that the filtering process and prolongued exposure to TiO2 nanoparticles had significant effects on different regions of BSA, and denaturation of the protein was not observed, neither with TiO2 nanoparticles nor by pressing through TiO2-coated filter membranes.
Exploration of the first-year university students’ metacognitive awareness about reading strategies
Authors: Zamborova Katarina , Klimova Blanka , Fronckova Katerina
Published: August 2023

There have been a vast number of studies on reading strategies from different angles performed at various age levels. However, the COVID-19 pandemic has brought a challenge to students´ lives, especially at the university level where they have to struggle with reading many materials online and offline. Therefore, this study investigated the levels of three different strategies of metacognitive awareness: global reading strategy, problem-solving strategy, and support reading strategy among 192 Slovak freshmen university students in a Business English class during the COVID-19 pandemic. The findings reveal that the students used problem-solving strategies the most, followed by global and support reading strategies the least. The results also indicate a difference between male and female students at individual levels of reading strategies. The study proposes a set of recommendations with an alliance of COVID-19 learning environment based on the results such as taking notes while reading and highlighting the most important information with an emphasis on details or showing the importance of previewing the text, asking questions/making predictions about the text, and most importantly paying attention to self-regulation practices in a new school environment.
Advancements in Understanding and Treating NAFLD: A Comprehensive Review of Metabolic-Associated Fatty Liver Disease and Emerging Therapies
Authors: Beiriger Jacob , Chauhan Kashyap , Khan Adnan , Shahzad Taha , Salinas Natalia , Zhang Peter , Chen Sarah , Nguyen Anh , Yan Brian , Bruckbauer John , Halegoua-DeMarzio Dina
Published: August 2023

This paper provides a comprehensive review of the current understanding of non-alcoholic fatty liver disease (NAFLD) and its progression to non-alcoholic steatohepatitis (NASH), focusing on key factors influencing its pathogenesis and emerging therapeutic strategies. The background highlights the growing prevalence of NAFLD and NASH, emphasizing their multifactorial nature. The methods section outlines the various contributors to NAFLD development, including genetic, dietary, and environmental factors. The results highlight the intricate interplay between these factors and their impact on hepatic lipid metabolism, inflammation, and insulin resistance. Genetic predisposition, dietary fat intake, and excessive fructose consumption are discussed as significant contributors to NAFLD progression. The conclusions emphasize the lack of a single therapeutic approach and underscore the need for combination strategies. Lifestyle interventions, particularly weight loss through diet and exercise, remain crucial, while pharmacological options like GLP-1 receptor agonists, obeticholic acid, lanifibranor, and resmetirom show promise but require further validation. Bariatric surgery and emerging endoscopic procedures offer potential in eligible patients. In sum, this review underscores the complexity of NAFLD and NASH, advocating for a multifaceted approach to address this increasingly prevalent and clinically relevant condition.
Time and Spatially Resolved Operando Small-Angle X-ray Scattering Measurements during Injection Moulding of Plastics
Authors: Mitchell Geoffrey R. , Arioli Matteo , Massano Anabela Pavia , Da Silva Daniel Pedra , Gameiro Fabio A. , Carreira Pedro , Malfois Marc , Matias Joao , Pascoal-Faria Paula Christina , Mateus Artur
Published: August 2023

We have recently introduced the possibility of performing operando small-angle X-ray scattering measurements using a novel industrially relevant injection moulding system for plastics. We show that useful time-resolving measurements can be performed with a time-cycle of 1s and we highlight the possible steps to reduce this to 0.5s. We show how we can use the transmission measurements to provide a time-marker when plastic first enters the mould cavity in the region probed by the incident X-ray beam. We show the opportunities provided by this experimental stage mounted on the NCD-SWEET beamline at ALBA to probe the reproducibility of the injection moulding system on different scales. The design of the equipment allows the development of the structure and the morphology to be evaluated in different parts of mould cavity and we evaluate any differences in a rectangular mould cavity. We identify future prospects for this equipment in terms of novel mould heating and cooling systems and the opportunities for quantitatively evaluating radical approaches to injection moulding technology.
Comparison of clinical and radiological outcomes for the anterior and medial approaches to open reduction in the treatment of bilateral developmental dysplasia of the hip. A systematic review protocol.
Authors: Jenner Edward , Chauhan Govind Singh , Burahee Abdus , Choudri Junaid , Gardner Adrian , Bache Edward
Published: August 2023

Background: Developmental dysplasia of the hip (DDH) affects 1–3% of newborns and 20% of cases are bilateral. The optimal surgical management strategy for patients with bilateral DDH who fail bracing, closed reduction or present too late for these methods to be used is unclear. There are proponents of both medial approach open reduction (MAOR) and anterior approach open reduction (AOR), however, there is little evidence to inform this debate.Methods: We will perform a systematic review designed according to the Preferred Reporting Items for Systematic review and Meta-Analysis Protocol. We will search the medical and scientific databases including the grey and difficult to locate literature. The Medical Subject Headings “developmental dysplasia of the hip”, “congenital dysplasia of the hip”, “congenital hip dislocation”, “developmental hip dislocation”, and their abbreviations, “DDH” and “CDH” will be used, along with the qualifier “bilateral”. Reviewers will independently screen records for inclusion and then independently extract data study design, population characteristics, details of operative intervention and outcomes from the selected records. Data will be synthesised and a metaanalysis performed if possible. If not possible we will analyse data according to Systematic Review without Meta-Analysis guidance. All studies will assessed for risk of bias. For each outcome measure a summary of findings will be presented in a table with the overall quality of the recommendation assessed using the Grading of Recommendations Assessment Development and Evaluation approach.Discussion: The decision to perform MAOR or AOR in patients with bilateral DDH who have failed conservative management is not well informed by the current literature. High quality, comparative studies are exceptionally challenging to perform for this patient population and likely to be extremely uncommon. A systematic review provides the best opportunity to deliver the highest possible quality of evidence for bilateral DDH surgical management.Systematic Review Registration: The protocol has been registered in the International Prospective Register of Systematic Reviews (PROSPERO ID - CRD42022362325).
Curcumin Loaded Mesoporous Silica Nanoparticles: Its Synthesis, Characterization, and Evaluation
Authors: Pathak Adarsh Kumar , Singh Bhuwanendra
Published: August 2023

Curcumin is a safe and natural therapeutic moiety. The aim of the study is to design and develop a molecule containing mesoporous silica nanoparticles loaded with curcumin. Curcumin-loaded mesoporous silica nanoparticles will be evaluated using physicochemical and analytical techniques. Fourier transform infrared analysis confirms the successful incorporation of the curcumin into the mesoporous silica cells, where the quaternary carbon has an absorption band at 1521.22 cm-1 and CH2 at 2858.4 cm-1. X-ray diffraction analysis confirms drug entrapment within the silica nanoparticle as well as there is no extra peak of drug in the final hexagonal channel of the loaded nanoparticle. Scanning electron microscopy and particle size analysis techniques have shown that the size of the unloaded and loaded particles is different. MCM-NPs-C-CUR were successfully synthesized and further research will be conducted to investigate their therapeutic profile.
Degradation of PET microplastic particles to monomers in human serum by PETase
Authors: Lopez-Lorenzo Ximena , Hueting David , Bosshard Eliott , Syrén Per-Olof
Published: August 2023

More than 8 bton of plastic waste has been generated posing severe environmental consequences and health risks. Due to prolonged exposure, microplastic particles are found in human blood and other bodily fluids. Despite a lack of toxicity studies regarding microplastics, harmful effects for humans seem plausible and cannot be excluded. As small plastic particles readily translocate from the gut to body fluids, enzyme-based treatment of serum could constitute a promising futureavenue to clear synthetic polymers and their responding oligomers by their degradation into monomers of lower toxicity than the material they originate from. Still, whereas it is known that enzymatic depolymerization rate of synthetic polymers varies orders of magnitude depending on buffer and media composition, the activity of plastic degrading enzymes in serum was unknown. Here we report how an engineered PETase can expediently depolymerize crystalline microplastic-like particles of the commodity polymer polyethylene terephthalate (PET) into its non-toxic monomer terephthalic acid (TPA) alongside mono(2-hydroxyethyl) terephthalate (MHET) in human serum at 37°C. By developing an efficient method to depolymerize microplastics in vitro, our work takes a step closer to find a solution to the problem that microplastics in the bloodstream may pose in the future.
Effect of Surgery before and after Clerkship on the Attitude of Medical Students towards Surgery as a Future Career in Saudi Arabia.
Authors: Mashbari Hassan , Madkhali Abdullah , Hamithi Dalal , Hakami Fatimah , Alfaifi Ibrahim , Zogel Basem , Khubrani Fatimah , Mawkili Razan , Hakami Ibrahim , Arishi Abdulaziz
Published: August 2023

Background: It is becoming harder and harder to persuade talented medical students to choose carers in any of the medical specialties. According to studies, the majority of medical students make their final career decision while still in college. Various student and institution related aspects are crucial to the decision of specialization. Gender, age, marital status, prestige influence, surgical mentors, career potential, intellectual challenge, and clerkship experience are among the variables recognized as having a major impact on the decision to choose surgery as a career.
Methodology: Data was collected through an online self- administered questionnaire. The study is a questionnaire based- cross sectional study. Our target population of this study is medical students from 4th year and above, from Saudi Arabia.
Results: This study is conducted in Saudi Arabia with 835 participants, 62.4% were female, and 37.6% were male. The majority of respondents (83.2%) fell within the 18-25 age range. The largest representation of participants came from the Western region (29.7%), followed by the Southern region (27.4%). Regarding career aspirations, 60.5% were willing to pursue a career in surgery, while 39.5% expressed a negative inclination. Among medical students, general surgery showed no significant change in attitudes before and after a surgical clerkship, while other specialties remained largely unaffected. Factors influencing the choice of a surgical career included lifestyle concerns, perception of working hours, prestige, manual activity, intellectual challenge, research opportunities, work-life balance, financial considerations, and patient perception.
Conclusion: Our study indicated that a significant percentage of participants expressed a positive inclination towards pursuing a career in surgery. However, a surgical clerkship did not significantly influence the attitudes of medical students towards general surgery or other specialties. Factors such as lifestyle concerns, working hours, prestige, intellectual challenge, and financial considerations played crucial roles in shaping career choices among medical students.
Health care providers acceptance of default prescribing of TB preventive treatment for people living with HIV in Malawi: a qualitative study
Authors: De Groot Liza M , Shearer Kate , Sambani Clara , Kaonga Emmanuel , Nyirenda Rose , Mbendera Kuzani , Golub Jonathan E. , Hoffmann Christopher. J. , Mulder Christiaan
Published: August 2023

Background: Tuberculosis (TB) preventive treatment (TPT) substantially reduces the risk of developing active TB for people living with HIV (PLHIV). We utilized a novel implementation strategy based on choice architecture (CAT) which makes TPT prescribing the default option. Through CAT, health care workers (HCWs) need to “opt-out” when choosing not to prescribe TPT to PLHIV. We assessed the prospective, concurrent, and retrospective acceptability of TPT prescribing among HCWs in Malawi who worked in clinics participating in a cluster randomized trial of the CAT intervention.
Methods: 28 in-depth semi-structured interviews were conducted with HCWs from control (standard prescribing approach) and intervention (CAT approach) clinics. The CAT approach was facilitated in intervention clinics using a default prescribing module built into the point-of-care HIV Electronic Medical Record (EMR) system. An interview guide for the qualitative CAT assessment was developed based on the theoretical framework of acceptability and on the normalization process theory. Thematic analysis was used to code the data, using NVivo 12 software.
Results: We identified eight themes belonging to the three chronological constructs of acceptability. HCWs expressed no tension for changing the standard approach to TPT prescribing (prospective acceptability); however, those exposed to CAT described several advantages, including that it served as a
reminder to prescribe TPT and routinized TPT prescribing (concurrent acceptability). Some felt that CAT may reduce HCW´s autonomy and might lead to inappropriate TPT prescribing (retrospective acceptability).
Conclusions: The default prescribing module for TPT has now been incorporated into the point-of-care EMR system nationally in Malawi. This seems to fit the acceptability of the HCWs. Moving forward, it is important to train HCWs on how the EMR can be leveraged to determine who is eligible for TPT and who is not, while acknowledging the autonomy of HCWs.
The microenvironment dictates glycocalyx construction and immune surveillance
Authors: Tharp Kevin , Park Sangwoo , Timblin Greg , Richards Alicia , Twells Nicholas , Riley Nicholas , Peltan Egan , Shon Judy , Stevenson Erica , Tsui Kimberly , Palomba Francesco , Lefebvre Austin , Soens Ross , Ayad Nadia , Hoeve-Scott Johanna ten , Healy Kevin , Digman Michelle , Dillin Andrew , Bertozzi Carolyn , Swaney Danielle , Mahal Lara , Cantor Jason , Paszek Matthew , Weaver Valerie M. , Twells Nicholas
Published: August 2023

Efforts to identify anti-cancer therapeutics and understand tumor-immune interactions are built with in vitro models that do not match the microenvironmental characteristics of human tissues. Using in vitro models which mimic the physical properties of healthy or cancerous tissues and a physiologically relevant culture medium, we demonstrate that the chemical and physical properties of the microenvironment regulate the composition and topology of the glycocalyx. Remarkably, we find that cancer and age-related changes in the physical properties of the microenvironment are sufficient to adjust immune surveillance via the topology of the glycocalyx, a previously unknown phenomenon observable only with a physiologically relevant culture medium.
Large common bile duct stones in high-risk elderly patients: Immediate endoscopic stone removal or elective stone removal? A single-center retrospective study
Authors: Meng Ke , Zhang Daya , Chen De-xin , Liu Wen-jing , Fang Kai-xuan , Chen Shengxin , Wu Lang , Li Ming-yang
Published: August 2023

Background and objective
: For high-risk elderly patients with chronic diseases, endoscopic stone removal for large common bile duct stones is associated with a high risk of adverse events and incomplete stone removal. The aim of this study was to investigate whether the treatment strategy of short-term biliary plastic stent placement followed by elective endoscopic stone removal is more effective and safer than immediate endoscopic stone removal.
Methods
The data of 262 high-risk elderly patients who received endoscopic retrograde cholangiopancreatography (ERCP) for large common bile duct (CBD) stones from 2017 to 2022 were retrospectively analyzed. The patients were divided into group A (immediate stone removal) and group B (stent drainage + elective stone removal). The baseline data of the 2 groups were matched 1:1 by propensity score matching. The stone clearance rate, ERCP procedure time, total hospital stay, and procedure-related adverse events were compared between the matched groups. In group B, stone size before and after stent placement, hospital stay, procedure time and adverse events of two ERCPs were compared.
Results
A total of 57 pairs of patients were successfully matched between the 2 groups. The stone clearance rate in group B was higher than that in group A (89.5% vs. 75.3, P = 0.049). The total hospital stay in group B was longer than that in group A (11.86 ± 3.912 d vs. 19.14 ± 3.176 d, P <0.001). The total adverse event rate in group A was higher than that in group B (29.8% vs. 12.3%, P = 0.005). The incidence of cholangitis/cholecystitis after ERCP was significantly higher in group A than in group B (7.0% vs. 0.9% P = 0.029). There was no significant difference in the incidence of post-ERCP pancreatitis, bleeding, pneumonia, and cardio-cerebrovascular events between the 2 groups. There were no perforation cases in either group. After plastic biliary stent placement in group B, the stone size was significantly smaller than before stent placement (1.59 ± 0.544 cm vs. 1.95 ± 0.543 cm, P < 0.001), and there was no significant difference in the total adverse event incidence between the two ERCP procedures (18.8% vs. 10.9%, P = 0.214).
Conclusion
For high-risk elderly patients with large CBD stones, the treatment strategy involving temporary placement of plastic stent and elective endoscopic stone removal is safer and more effective than immediate stone removal.
Positive family history and girl sex might increase the risk of failure of abduction treatment in developmental dysplasia of the hip
Authors: Lankinen Vilma , Helminen Mika , Bakti Karim , Välipakka Jarmo , Laivuori Hannele , Hyvärinen Anna
Published: August 2023

Background. Known risk factors of DDH include female sex, family history and breech presentation. Abduction treatment fails more often with severe forms of DDH. Risk factors´ effects on abduction treatment failure are not well established.
Material and methods. The children with DDH diagnosis treated in Tampere University hospital in the years 1998-2018 were retrospectively identified. Only the children with early evaluation (maximum 2 weeks of age) of pediatric surgeon or pediatric surgery resident were included in the analysis. Total of 761 children were included.
Results. Family history of DDH and girl sex were associated with more severe forms of DDH, characterized by alpha angles under 50 degrees and/or major instability in dynamic ultrasound at one month of age.
Conclusion. Family history of DDH and female sex increase the risk of more severe forms of DDH and thereby might increase the risk of abduction treatment failure.
Acute bilateral blindness due to diffuse outer retinopathy following clear lens exchange: A case report
Authors: Gürtler Nicolas , Bughin Alice , Vaclavik Veronika , Kaisari Eirini , Guex-Crosier Yan
Published: August 2023

Background: As the trend of refractive lens exchange for presbyopia continues to grow, our case report shows the first occurrence of an acute bilateral outer retinopathy following uncomplicated sequential clear lens extraction in an otherwise healthy individual.
Case presentation: A 54-year-old male without significant medical history benefited from a sequential bilateral lens exchange for presbyopia. He then experienced a rapid vision loss in both eyes, accompanied by photopsias and myodesopsias, with symptoms appearing respectively 4 and 3 weeks after the surgeries. Multimodal imaging revealed a fulminant outer retinopathy, leading to a total loss of light perception within a few days. Immediate intravenous corticoid therapy was administered, permitting to recover a small area of central visual function in both eyes, enabling shape and color distinction. The primary diagnostic hypothesis is a presumed autoimmune retinopathy, triggered by the cataract extraction, while an alternative diagnosis could be a toxic reaction secondary to the use of intracameral cefuroxime and lidocaine during the surgery.
Conclusion: In this report, the authors describe the first recorded instance of outer retinopathy following cataract surgery. This occurrence raises the possibility of auto-immunization leading to retinal atrophy and vision loss as a potential outcome after undergoing cataract surgery.