bluuebunny/crossref_metadata_2025 huggingface dataset:
A unique eukaryotic lineage of composite-like DNA transposons encoding a DDD/E transposase and a His-Me finger homing endonuclease
Authors: Kojima Kenji K. , Bao Weidong
Published: October 2022

Background

DNA transposons are ubiquitous components of eukaryotic genomes. A major group of them encode a DDD/E transposase and contain terminal inverted repeats (TIRs) of varying lengths. The Kolobok superfamily of DNA transposons has been found in a wide spectrum of organisms.

Results

Here we report a new Kolobok lineage, designated KolobokP. They were identified in 7 animal phyla (Mollusca, Phoronida, Annelida, Nemertea, Bryozoa, Chordata, and Echinodermata), and are especially rich in bivalves. Unlike other Kolobok families, KolobokP adopts a composite-like architecture: an internal region (INT) flanked by two long terminal direct repeats (LTDRs), which exhibit their own short terminal inverted repeats ranging up to 18 bps. The excision of LTDRs was strongly suggested. The LTDR lengths seem to be constrained to be either around 450-bp or around 660-bp. The internal region encodes a DDD/E transposase and a small His-Me finger nuclease, which likely originated from the homing endonuclease encoded by a group I intron from a eukaryotic species. The architecture of KolobokP resembles composite DNA transposons, usually observed in bacterial genomes, and long terminal repeat (LTR) retrotransposons. In addition to this monomeric LTDR-INT-LTDR structure, plenty of solo LTDRs and multimers represented as (LTDR-INT)n-LTDR are also observed. Our structural and phylogenetic analysis supported the birth of KolobokP in the late stage of the Kolobok evolution. We propose KolobokP families propagate themselves in two ways: the canonical transposition catalyzed by their transposase and the sequence-specific cleavage by their endonuclease followed by the multimerization through the unequal crossover.

Conclusions

The presence of homing endonuclease and long terminal direct repeats of KolobokP families suggest their unique dual replication mechanisms: transposition and induced unequal crossover.
Fractional order differential equations for chronic liver cirrhosis with frequent hospitalization
Authors: Dano Lemesa Bedjisa , Rao Koya Purnachandra , Keno Temesgen Duressa
Published: October 2022

Objective

Liver cirrhosis, which is considered as the terminal stage of liver diseases, has become life-threatening among non-communicable diseases in the world. Viral hepatitis (hepatitis B and C) is the major risk factor for the development and progression of chronic liver cirrhosis. The asymptomatic stage of cirrhosis is considered as the compensated cirrhosis whereas the symptomatic stage is considered as decompensated cirrhosis. The latter stage is characterized by complex disorder affecting multiple systems of liver organ with frequent hospitalization. In this paper, we formulate system of fractional differential equations of chronic liver cirrhosis with frequent hospitalization to investigate the dynamics of the disease. The fundamental properties including the existence of positive solutions, positively invariant set, and biological feasibility are discussed. We used generalized mean value theorem to establish the existence of positive solutions. The Adams-type predictor-evaluate-corrector-evaluate approach is used to present the numerical scheme the fractional erder model.

Results

Using the numerical scheme, we simulate the solutions of the fractional order model. The numerical simulations are carried out using MATLAB software to illustrate the analytic findings. The analysis reveals that the number of decompensated cirrhosis individuals decreases when the progression rate and the disease’s past states are considered.
Strategies to improve the quality of wheat- flour- bread chain in Iran: the perspective of different stakeholders
Authors: Bazhan Marjan , Shafiei Sabet Farnam
Published: October 2022

Objective

Bread constitutes a significant energy source and provides protein and some essential micronutrients to a large population worldwide, including Iran. So, its quality characteristics are important for health. This study aimed to identify the views and experiences of various stakeholders involved in the wheat- flour- bread chain about factors affecting the quality of this chain and strategies for its improvement in Iran.

Results

Main suggested strategies in the field of raw materials were managing and planning for the production of high-quality wheat, measuring the quality factors of grain before purchasing by the government, allocating wheat quotas to flour mills based on the quality of the flour produced, and aerating and storing flour in silos to reduce its moisture. Holding training courses for bakery workers, improving the economic situation of bakers, and standardizing bread-making devices were the most important strategies in the bakery field. Assigning a specific unified management apparatus to deal with bread issues was also an effective and essential strategy. Findings show the need to implement strategies in various fields to improve wheat- flour- bread chain quality. This study provides helpful information to guide policy decisions and planning to enhance bread quality and promote public health.
Comparison of [18F]-FDOPA PET and [123I]-FP-CIT SPECT acquired in clinical practice for assessing nigrostriatal degeneration in patients with a clinically uncertain parkinsonian syndrome
Authors: Wallert Elon , Letort Erwann , van der Zant Friso , Winogrodzka Ania , Berendse Henk , Beudel Martijn , de Bie Rob , Booij Jan , Raijmakers Pieter , van de Giessen Elsmarieke
Published: October 2022

Purpose

Two commonly used imaging techniques to aid in the diagnosis of neurodegenerative parkinsonian syndromes are dopamine transporter (DAT) imaging with [123I]-FP-CIT single-photon emission computed tomography (DAT-SPECT) and positron emission tomography with [18F]-FDOPA (FDOPA-PET). This paper provides a unique series of parkinsonian patients who received both FDOPA-PET and DAT-SPECT in routine clinical practice and compares the reported results to assess potential differences between these two imaging techniques.

Methods

We present 11 patients with a clinically uncertain parkinsonian syndrome (CUPS), who received both FDOPA-PET and DAT-SPECT. All patients received an FDOPA-PET scan and DAT-SPECT as part of routine clinical care.

Results

The median time between the F-DOPA-PET scan and DAT-SPECT scan was 6 months (range 0–15 months). There was a discrepancy in the reported results of the FDOPA-PET and DAT-SPECT scans in nine patients, including 7 patients whose FDOPA-PET scan was reportedly normal, whereas their DAT-SPECT scan was abnormal.

Conclusions

In this case series of CUPS patients, DAT-SPECT was more often rated as abnormal than FDOPA-PET. The striatal loss of FDOPA uptake can be less pronounced than that of DAT binding in CUPS patients in early disease stages. Consequently, the interpretation of FDOPA-PET scans in CUPS can sometimes be challenging in routine practice.
Risk of transmission of foot-and-mouth disease by wild animals: infection dynamics in Japanese wild boar following direct inoculation or contact exposure
Authors: Fukai Katsuhiko , Kawaguchi Rie , Nishi Tatsuya , Ikezawa Mitsutaka , Yamada Manabu , Seeyo Kingkarn Boonsuya , Morioka Kazuki
Published: October 2022

Understanding of disease dynamics and viral shedding in wild boar and of the potential for disease spreading within wild boar and domestic pig populations is critical for developing effective control and eradication measures for foot-and-mouth disease (FMD). Accordingly, we infected experimentally wild boar and domestic pigs with FMD virus (FMDV) strains O/TAI/315/2016 and A/MOG/2013, and studied their susceptibility and viral transmissibility in both populations. Similar to FMDV-infected pigs, wild boar inoculated with both viruses exhibited vesicular lesions on their feet, snout, tongue and lip, although they did not show lameness. Further, inoculated wild boar were equally capable of transmitting the virus to all of their contact animals. While all contact pigs developed vesicular lesions after contact with inoculated animals, in contrast, no wild boar when exposed to the same infected animals showed obvious clinical signs. These results will be useful for further understanding of the critical roles in occurring and sustaining an FMD outbreak, and will be useful for establishing epidemiological surveillance programs and effective countermeasures for wild boar.
Effects of exosomes derived from Trichinella spiralis infective larvae on intestinal epithelial barrier function
Authors: Wang Ruibiao , Zhang Yuheng , Zhen Jingbo , Zhang Jinpeng , Pang Zixuan , Song Xuewei , Lin Lihao , Sun Feng , Lu Yixin
Published: October 2022

Muscle larvae of Trichinella spiralis parasitize the host intestinal epithelium. The mechanisms of exosomes participating in the invasion of T. spiralis muscle larvae are unclear. Hence, the purpose of this study was to explore the effect of exosomes derived from T. spiralis infective larvae (TsExos) on the barrier function of porcine small intestinal epithelial cells (IPEC-J2). First, TsExos were successfully obtained, and their ingestion by epithelial cells was validated. Furthermore, the optimal induction condition was determined by the CCK8 kit, and we found that exposure to 150 μg/mL TsExos for 12/24 h decreased the viability of IPEC-J2 cells by 30%. Based on this outcome, the effects of TsExos on cell biological processes and tight junctions were studied. After coincubation of TsExos and IPEC-J2 cells, the results showed a significant increase in the content of FITC-dextran and in the levels of lactate dehydrogenase (LDH) and reactive oxygen species (ROS). The rate of apoptosis increased by 12.57%, and nuclear pyknosis and nuclear rupture were observed. After the cells were induced by TsExos, the expression of IL-1 was upregulated, but the expression of IL-10, TGF-β, TLR-5, MUC-1 and MUC-2 was downregulated. TsExo induction also led to a decrease in the levels of ZO-1, CLDN-3, and OCLN. In conclusion, TsExos are involved in several cellular biological processes, and they function by disrupting physiological and biochemical processes, hyperactivating innate immunity, and damaging tight junctions.
Adaptable waveform design for radar and jammer for multi-target using game theoretic strategies
Authors: Xin Fengming , Wang Yan , Sun Jiawen , Huang Yilin
Published: October 2022

In the environment of electronic warfare, the countermeasure between radar and jammer has become a hot issue. Finding the solution to optimal waveforms between them is very great significance. Aiming at the problem of multi-target detection in clutter environment, the authors propose the waveform optimization method based on signal-to-interference-plus-noise ratio (SINR) criterion for radar and jammer, respectively. When radar is the dominant player, the maxmin strategy is used to establish the optimization model to optimize the radar transmission waveform. When jammer is the dominant player, the minmax strategy is used to establish the optimization model to optimize the jammer waveform. When dealing with random multi-target, the authors also propose an adaptive weight method to solve the problem of summation of weighted multiple targets. Then, an improved method combined with Jensen’s inequality for radar and jammer is proposed, respectively, which could improve the detection performance of the radar system and reduce the computational complexity of maximum SINR-based method. The simulation results show that the proposed maximum SINR-based methods could adaptively allocate the transmission energy to improve the performance of the radar. The energy allocation of radar and jammer is slightly different under maxmin strategy and minmax strategy. The proposed improved methods could output the higher SINR than the maximum SINR-based methods. Both of the proposed methods could improve the performance of radar detecting targets.
Classification of audio signals using spectrogram surfaces and extrinsic distortion measures
Authors: Levy Jeremy , Naitsat Alexander , Zeevi Yehoshua Y.
Published: October 2022

Representation of one-dimensional (1D) signals as surfaces and higher-dimensional manifolds reveals geometric structures that can enhance assessment of signal similarity and classification of large sets of signals. Motivated by this observation, we propose a novel robust algorithm for extraction of geometric features, by mapping the obtained geometric objects into a reference domain. This yields a set of highly descriptive features that are instrumental in feature engineering and in analysis of 1D signals. Two examples illustrate applications of our approach to well-structured audio signals: Lung sounds were chosen because of the interest in respiratory pathologies caused by the coronavirus and environmental conditions; accent detection was selected as a challenging speech analysis problem. Our approach outperformed baseline models under all measured metrics. It can be further extended by considering higher-dimensional distortion measures. We provide access to the code for those who are interested in other applications and different setups (Code:https://github.com/jeremy-levy/Classification-of-audio-signals-using-spectrogram-surfaces-and-extrinsic-distortion-measures).
Integrated sensing and communication in 6G: a prototype of high resolution multichannel THz sensing on portable device
Authors: Li Oupeng , He Jia , Zeng Kun , Yu Ziming , Du Xianfeng , Zhou Zhi , Liang Yuan , Wang Guangjian , Chen Yan , Zhu Peiying , Tong Wen , Lister David , Ibbetson Luke
Published: October 2022

6G is believed to go beyond communication and provide integrated sensing and computing capabilities for a vision of Connected Intelligence with everything connected, everything sensed, and everything intelligent. Integrated sensing and communication will play a vital role for the fusion of physical and cyber worlds. The exploration of higher frequency bands, larger bandwidth, and more advanced large antenna technologies is paving the way towards the goal. In particular, the study of THz opens the possibility to have high resolution sensing and imaging capability on a communication mobile device. In this paper, we take a step along this direction and justify such possibility by building a THz sensing prototype with millimeter level imaging resolution while considering the physical aperture constraint of typical mobile device.
Network abnormal traffic detection method based on fusion of chord similarity and multiple loss encoder
Authors: Lv Xiang , Han Dezhi , Li Dun , Xiao Lijun , Chang Chin-Chen
Published: October 2022

Fog computing, as a new distributed computing framework, extends the tasks originally done in the cloud data center to the edge of the network and brings more serious security challenges while providing convenience. Abnormal network traffic detection is an effective means to defense malicious behavior, can detect a variety of known attacks. Although the application of deep learning method in the field of network abnormal traffic detection is easier than traditional machine learning methods, there are still problems of poor recognition accuracy and false alarm rate. In this paper, we use the semi-supervised network anomaly detection model (NADLA) that combines the long-short-term memory neural network method and the self-encoder method to solve this problem. NADLA analyzes network traffic through the time characteristics and behavior characteristics of traffic, and optimizes the accuracy and false alarm rate of network traffic classification. In addition, we improved the preprocessing method to improve the sensitivity of the trained model to network abnormal traffic. The NADLA model is tested on NSL-KDD dataset, and the results show that the proposed model can improve the accuracy andF1-value of network anomaly traffic detection.
Development and validation of a drill attachment for faster and safer deployments of fin-mounted geolocators in large-bodied sharks
Authors: Heim Vital , Lüscher Daniel , Hottinger Jürgen , Ebert Dieter
Published: October 2022

Fin-mounted geolocators are widely used in marine studies to track animal movements and to design informed management strategies. However, the deployment protocols of such geolocators, which normally consist of drilling one to multiple holes using a template, can be challenging, and depending on the animal’s stress physiology and ocean conditions, speed and accuracy may be crucial. Here, we present the plans for a drill attachment allowing the template-free drilling of up to four holes simultaneously for a faster, more accurate and safer deployment of fin-mounted geolocators. The drill attachment was successfully tested on four great and two scalloped hammerheads, Sphyrna mokarran and Sphyrna lewini, which were all tagged with 4-bolt Smart Position and Temperature (SPOT) tags. The time required to secure the geolocators, from drill alignment to the complete fastening of the last bolt, ranged from 68 to 85 s (78.2 ± 10.9 s, mean ± SD). The new drill attachment further allowed the successful tagging of a great hammerhead alongside a research vessel in rough seas that would have made the deployment using traditional protocols more challenging. Simultaneously drilling four holes reduces the need to keep the animal’s fin steady for an extended period of time and thus makes the deployment of fin-mounted geolocators less dependent on the animal’s behavior and the weather conditions. As such, the 4-hole drill attachment makes the mounting process faster and more reliable and should reduce the stress experienced by the animal.
Identification of promising alfalfa varieties in conditions of the southern forest-steppe zone (Republic of Bashkortostan): a study of economic and biological characteristics
Authors: Kuznetsov Igor , Asylbaev Ilgiz , Dmitriev Alexey , Nizaeva Asiya , Shakirzyanov Anvar
Published: October 2022

Background

Alfalfa (Medicago sativa L.) is one of the most important forage crops, but its seed productivity varies from year to year due to weather conditions. Alfalfa is a forage crop rich in nutrients which makes it valuable. The present 5-year study aimed to identify the promising alfalfa varieties based on their economic and biological characteristics, such as high seed productivity, a high yield of forage mass, good quality, and stress resistance.

Results

The study contributes information about the promising varieties of alfalfa characterized by high biomass and seed productivity. Varieties such as P-88044, U-73+149 and S-302 had stable seed/green mass yields regardless of climatic conditions; hence, they may be used for alfalfa selection in the southern forest-steppe regions of Bashkortostan.

Conclusions

The present findings can be used for alfalfa selection in the Republic of Bashkortostan (Russia). In addition, the results will be of interest to crop breeders across the globe.
On the introduction of intelligent alerting systems to reduce e-learning dropout: a case study
Authors: Luis Ricardo M. Meira Ferrão , Llamas-Nistal Martin , Iglesias Manuel J. Fernández
Published: October 2022

E-learning students have a tendency to get demotivated and easily dropout from online courses. Refining the learners’ involvement and reducing dropout rates in these e-learning based scenarios is the main drive of this study. This study also shares the results obtained and crafts a comparison with new and emerging commercial solutions. In a primary phase, the goal was to center the study and research made (background, state of the art, survey and interviews to uncover motives and behavior patterns). In an additional stage, the development, trails and validation of an operating prototype of an Intelligent Alerting System to grant and evaluate concepts, gather statistical data on its efficiency, explore and detect if course accomplishment rates did actually improve. The results measured the effectiveness of learning (accomplishment and dropout rates) before and after the application of the proposed solution. Finally, some related work is considered, as well as emerging commercial solutions are compared with the proposed solution.
Quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging to predict lymphovascular invasion and survival outcome in breast cancer
Authors: Lai Tianfu , Chen Xiaofeng , Yang Zhiqi , Huang Ruibin , Liao Yuting , Chen Xiangguang , Dai Zhuozhi
Published: October 2022

Background

Lymphovascular invasion (LVI) predicts a poor outcome of breast cancer (BC), but LVI can only be postoperatively diagnosed by histopathology. We aimed to determine whether quantitative parameters of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) can preoperatively predict LVI and clinical outcome of BC patients.

Methods

A total of 189 consecutive BC patients who underwent multiparametric MRI scans were retrospectively evaluated. Quantitative (Ktrans, Ve, Kep) and semiquantitative DCE-MRI parameters (W− in, W− out, TTP), and clinicopathological features were compared between LVI-positive and LVI-negative groups. All variables were calculated by using univariate logistic regression analysis to determine the predictors for LVI. Multivariate logistic regression was used to build a combined-predicted model for LVI-positive status. Receiver operating characteristic (ROC) curves evaluated the diagnostic efficiency of the model and Kaplan-Meier curves showed the relationships with the clinical outcomes. Multivariate analyses with a Cox proportional hazard model were used to analyze the hazard ratio (HR) for recurrence-free survival (RFS) and overall survival (OS).

Results

LVI-positive patients had a higher Kep value than LVI-negative patients (0.92 ± 0.30 vs. 0.81 ± 0.23, P = 0.012). N2 stage [odds ratio (OR) = 3.75, P = 0.018], N3 stage (OR = 4.28, P = 0.044), and Kep value (OR = 5.52, P = 0.016) were associated with LVI positivity. The combined-predicted LVI model that incorporated the N stage and Kep yielded an accuracy of 0.735 and a specificity of 0.801. The median RFS was significantly different between the LVI-positive and LVI-negative groups (31.5 vs. 34.0 months, P = 0.010) and between the combined-predicted LVI-positive and LVI-negative groups (31.8 vs. 32.0 months, P = 0.007). The median OS was not significantly different between the LVI-positive and LVI-negative groups (41.5 vs. 44.0 months, P = 0.270) and between the combined-predicted LVI-positive and LVI-negative groups (42.8 vs. 43.5 months, P = 0.970). LVI status (HR = 2.40), N2 (HR = 3.35), and the combined-predicted LVI model (HR = 1.61) were independently associated with disease recurrence.

Conclusion

The quantitative parameter of Kep could predict LVI. LVI status, N stage, and the combined-predicted LVI model were predictors of a poor RFS but not OS.
Subpleural emphysema as a rare initial manifestation of an iatrogenic tracheal penetration: a case report
Authors: Nakamura Minori , Iizuka Shuhei , Nakamura Toru
Published: October 2022

Background

Iatrogenic tracheal injury is a rare but potentially morbid condition and often poses a diagnostic challenge due to its rarity and the lack of specific clinical findings. Because a delayed diagnosis is associated with a higher mortality, a prompt diagnosis is essential. We report a case of an iatrogenic tracheal injury detected by subpleural emphysema as a rare initial manifestation.

Case presentation

A 75-year-old woman was diagnosed with stage IA2 right lung cancer. During the surgery, visceral subpleural emphysema developed along the lung surface up to the interlobar fissure followed by subcutaneous emphysema in the anterior neck. Suspecting a tracheal injury, we aborted the surgery. Fiberoptic bronchoscopy revealed a longitudinal laceration on the membranous part of the distal trachea without esophageal involvement, consistent with a level II injury. Conservative management was chosen and she had a successful recovery.

Conclusions

Iatrogenic tracheal injury could initially manifest as visceral subpleural emphysema. Once subpleural emphysema is observed during surgery, a prompt diagnostic workup of the tracheal injury should be performed.
Indirect cholecystoduodenal fistula via hepatoduodenal ligament secondary to gangrenous cholecystitis: a case report
Authors: Fukuda Yasunari , Michiura Toshiya , Ito Daisaku , Takahashi Tomohiro , Tokuyama Shinji , Morishita Hiromu , Nuta Junya , Miyazaki Yasuaki , Hayashi Nobuyasu , Yamabe Kazuo
Published: October 2022

Background

Cholecystoduodenal fistula is an infrequent complication of gallbladder diseases. In the majority of cases, the fistula is formed by direct communication between the gallbladder and duodenum due to gallstone impaction in the gallbladder neck. We herein report a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis.

Case presentation

An 80-year-old woman suspected of having emphysematous cholecystitis by a previous doctor was referred to our hospital for urgent surgery. The initial diagnosis based on additional examinations was gangrenous cholecystitis penetrating the hepatoduodenal ligament. Since she did not complain of signs of peritonitis and was taking an anticoagulant medicine, we avoided surgery and selected percutaneous gallbladder drainage (PTGBD) instead. Contrast imaging of the PTGBD tube and upper endoscopy identified the indirect cholecystoduodenal fistula via the hepatoduodenal ligament. Despite repeated attempts at endoscopic fistula closure using clips, the fistula did not close successfully. We therefore performed laparoscopic cholecystectomy and fistula closure. The postoperative clinical course was uneventful, and she left the hospital on postoperative day 15. The resected gallbladder contained small black stones, and a histological examination revealed gangrenous cholecystitis with no malignant signatures.

Conclusion

We encountered a rare case of indirect cholecystoduodenal fistula via the hepatoduodenal ligament secondary to gangrenous cholecystitis that was successfully treated by laparoscopic cholecystectomy and fistula closure. It is important to recognize the possible formation of indirect cholecystoduodenal fistula in cases of gangrenous cholecystitis penetrating the hepatoduodenal ligament.
Laparoscopic hepatectomy for hepatocellular carcinoma in a patient with congenital factor V deficiency: a case report
Authors: Seki Takaomi , Tsukagoshi Mariko , Harimoto Norifumi , Araki Kenichiro , Watanabe Akira , Ishii Norihiro , Hagiwara Kei , Hoshino Kouki , Muranushi Ryo , Kakizaki Satoru , Ogawa Yoshiyuki , Handa Hiroshi , Shirabe Ken
Published: October 2022

Background

Factor V (FV) deficiency is an extremely rare disease, with an incidence of 1 in 1 million. The bleeding symptoms are mild, and the prognosis is good; however, the safety of surgical treatment is unclear, because there are few available reports. Herein, we report a case of hepatocellular carcinoma with congenital FV deficiency in a patient who safely underwent laparoscopic hepatectomy.

Case presentation

A 79-year-old man, diagnosed with hepatocellular carcinoma of liver segment 5, with type C cirrhosis and sustained virological response visited our hospital. He had congenital FV deficiency, and blood tests showed coagulation deficiencies with an FV activity of < 2.6%, prothrombin time activity of 11%, and activated partial thromboplastin time of 100.3 s. Surgery and radiofrequency ablation were considered for treatment. Since the tumor was in contact with the Glissonean pedicle 5 + 6, surgery was judged to be superior from the viewpoint of safety and curability. After discussing the safety of the surgery with a hematologist, it was determined that the operation could be performed safely by transfusing sufficient fresh frozen plasma (FFP). Laparoscopic hepatic segment 5 + 6 subsegmental resection was performed with FFP transfusion, fluid restriction, airway pressure control, and central venous pressure reduction to control the bleeding. Bleeding was minimized during the transection of the liver parenchyma and no bleeding tendency was observed. The operative time was 445 min, and the amount of intraoperative bleeding was 171 mL. No complications, such as postoperative bleeding, were observed, and the patient was discharged on the eighth postoperative day.

Conclusions

Liver surgery can be performed safely in FV-deficient patients with strict coagulation capacity monitoring and appropriate transfusion of FFP. Preoperative evaluation of cardiac function to determine tolerance to high doses of FFP and ingenuity of surgery and intraoperative management to minimize blood loss are important.
The influence of a virtual reality entertainment program on depressive symptoms and sedentary behaviour in inpatient stroke survivors: a research protocol for a pilot randomized controlled trial
Authors: Rash Isabelle , Helgason Megan , Jansons Donna , Mitchell Lindsay , Sakakibara Brodie M.
Published: October 2022

Background

Sedentary behaviour among stroke inpatients may be due to high rates of depressive symptoms after stroke. Thus, efforts to address depressive symptoms among stroke inpatients are warranted to in turn lessen sedentary behaviour. Despite evidence that virtual reality (VR) is emerging as a method to help with depression, the use of VR to improve depression among inpatient stroke survivors has yet to be studied. In this paper, we report on the protocol investigating the feasibility of a VR entertainment system at improving depressive symptoms among stroke survivors receiving inpatient rehabilitation.

Methods

In this single-blind randomized controlled trial, 30 inpatient stroke survivors from the rehabilitation unit at Kelowna General Hospital will be randomized to either (1) intervention: 3 times per week of VR entertainment for duration of inpatient rehabilitation or (2) control: usual care. Individuals will be included if they have a confirmed diagnosis of stroke, are 19 years of age or older, able to provide informed consent, have physician clearance to participate in the study (medically stable or fit), or are able to understand English. Outcome measures to address depressive symptoms (primary outcome), sedentary behaviour, motivation, anxiety, stress, and happiness (secondary outcome) will be administered at two timepoints: (1) baseline (T1) and (2) post-intervention (T2). Study analyses will consider study feasibility indicators and clinical (statistical) outcomes. Means and standard deviations (for continuous variables) and frequencies and proportions (for categorical variables) will be used to summarize the variables. Feasibility indicators will be dichotomized into either ‘success’ if they meet the a priori criteria, or ‘revise’ if they do not meet the criteria. Intervention effects post-intervention (T2) for the primary and secondary clinical outcomes will be estimated using linear regression including baseline (T1) controlling for age and sex.

Discussion

The results of this trial will add to our understanding of depression and sedentary behaviour among individuals receiving inpatient stroke rehabilitation as well as the feasibility of a VR entertainment program to improve depressive symptoms, which will in turn may lessen sedentary behaviour in inpatient stroke survivors.

Trial registration

ClinicalTrials.gov Identifier: NCT04011202
. First posted July 8, 2019 (study postponed from March 2020 to July 2021 due to COVID-19).
Subaxial cervical spine ligamentous instability anterior versus posterior fixation: prospective nonrandomized study
Authors: Moawad Ahmed M. , El-Sawy Medhat M.
Published: October 2022

Background

The goals of cervical internal fixation are to provide immediate stability to control an unstable segment and to improve bony union. Early cervical fixation methods preferred a posterior approach and consisted of simple wire and cancellous bone graft. Later, anterior, and posterior fixation became recent additions to surgeon’s armamentarium.

Objectives

Comparing between anterior and posterior fixation in cervical subaxial ligamentous subluxation regarding the applicability, safety, and clinical efficacy in achieving stability and enhancing bony union. Also cost-related variables are studied.

Methods

This prospective clinical and radiographic analysis was performed on 40 patients with cervical subaxial ligamentous subluxation. Half of these patients were treated with anterior cervical fixation and interlocking screws with inter-body cage fusion. The other half was treated by posterior fixation with lateral mass fixation and inter-facet bone fusion.

Results

There were 27 male and 13 female patients with mean age 37.4 years. The level of cervical dislocation was C4–5 in four, C5–6 in 14, C6–7 in 20 and more than one level in two patients. Closed reduction was achieved in 33 patients while open reduction through the posterior approach was done in four cases and through anterior approach in other three cases. Statistically significant difference between the two groups was found for estimated blood loss and operating room time with better results in the anterior group. There were no perioperative deaths in both groups. Regarding surgery-related complications, there was injury to a cervical root during posterior fixation in two cases. There was no statistical difference between the two groups regarding the length of the hospital stay. The mean hospital stay was 7 days. Positioning of the plate and screws in all cases was satisfactory. All patients were followed up for at least 6 months. Mean follow-up period was 13 months. Vertebral body alignment (radiological stability) was achieved in all cases with anterior fixation while one case with posterior fixation showed delayed subluxation. Solid bony cage fusion was found in 85% with anterior fixation and solid bony fusion in 70% with lateral mass fixation.

Conclusions

Although some of the literature have indicated that posterior fixation in ligamentous cervical subaxial injury is more solid than anterior fixation, yet most of these studies were done on cadaver subjects so eliminating any bony fusion, long-term stability, and hardware failure. This study proved that anterior cervical fixation is not only safer and simple procedure than posterior fixation, but also it restores the cervical stability better than the posterior fixation.
THC degradation does not impair the accuracy of THC doses aerosolized by the metered-dose SyqeAir inhaler: a 24-month stability trial
Authors: Aviram Joshua , Atzmony Daniella , Frenklakh Anna , Kroll Asaf , Zaks Ilana , Hazekamp Arno
Published: October 2022

Background

Although the worldwide use of medical cannabis (MC) is on the rise, there is insufficient data regarding the long-term stability of phytocannabinoids in the plant material under different storage conditions. Specifically, there is insufficient data on the effect of storage conditions on the availability of (-)-∆9-trans-tetrahydrocannabinol (THC) in vaporized cannabis. The Syqe inhaler delivers metered doses of phytocannabinoids by inhalation and utilizes accurate quantities of ground cannabis inflorescence packaged in tamper-proof cartridges. We aimed to assess the stability of phytocannabinoids in ground cannabis before and after packaging in Syqe cartridges as well as the reproducibility of THC delivery in the aerosolized dose.

Methods

Ground MC inflorescence was stored under different temperature and humidity conditions, before or after being packaged in Syqe cartridges. Concentrations of the major phytocannabinoids therein were analyzed at different time points using ultra-high performance liquid chromatography (U-HPLC). THC doses aerosolized via the Syqe inhaler were evaluated using cartridges stored for up to 2 years at 25°C. Every vapor chip contains 13.5±0.9 mg of ground MC powder.

Results

No significant changes were observed in phytocannabinoid concentrations in ground cannabis inflorescence after 3 months of bulk storage in a polypropylene container and sealed in an aluminum foil pouch at 5°C. In contrast, significant changes in phytocannabinoid concentrations were found when ground inflorescence was stored in the cartridges at 25°C for 2 years. Specifically, CBGA, THCA, and total THC concentrations decreased from 0.097±0.023, 2.7±0.3, and 2.80±0.16 mg/chip at baseline to 0.044±0.007 (55% decrease), 1.50±0.27 (44% decrease), and 2.20±0.083 (21% decrease) mg/chip following 2 years, respectively, while CBN and THC concentrations increased from 0.005±0.005 and 0.44±0.11 mg/chip at baseline to 0.14±0.006 (2700% increase) and 0.88±0.22 (100% increase) mg/chip following 2 years, respectively. Storage at 30°C revealed a steeper change in phytocannabinoid concentrations within an even shorter period. Despite the significant change of relative cannabinoid composition within the cartridge, the actual THC dose present in the aerosol remained relatively stable throughout this period and within the dosage range of 500mcg±25% required for pharmaceutical-grade inhalers.

Conclusions

MC powder in Syqe cartridges may be stored at room temperature for at least 2 years after production without affecting the aerosolized THC dose delivered to patients by more than ±25%. Future studies should analyze additional phytocannabinoids and terpenes in the cannabis inflorescence and assess the stability of different cannabis cultivars following storage in Syqe cartridges.
CD44+/CD24- Expression as predictors of ovarian cancer chemoresistance: immunohistochemistry and flow cytometry study
Authors: Sihombing Unedo Hence Markus , Andrijono Andrijono , Purwoto Gatot , Gandamihardja Supriadi , Harahap Alida R. , Rustamadji Primariadewi , Kekalih Aria , Widyawati Retno , Fuady Dzicky Rifqi
Published: October 2022

Background

The conventional standard treatment for ovarian cancer is not very effective, and the disease is fatal for women. Cancer Stem Cells (CSCs) that express CD44+/CD24- can contribute to chemoresistance and a poor prognosis. We seek to investigate the expression of CSCs (CD44+/CD24-) in ovarian cancer and their predictive significance.

Methods

The ambispective cohort was performed on 64 patients (32 patients in each group) at four hospitals (Cipto Mangunkusumo, Tarakan, Fatmawati, and Dharmais Hospital). Debulking surgery was performed on the patients, followed by histopathological analysis. The patients had six rounds of chemotherapy and were under monitoring for six months. The therapeutic responses were evaluated using the RECIST criteria (Response Criteria in Solid Tumors) and categorized as chemoresistant or chemosensitive. Using immunohistochemistry, we directly assess the CSCs from ovarian cancer tissue and using flow cytometry to assess the CSCs from the blood.

Results

High CSCs expression and ovarian cancer chemoresistance were significantly related in both trials (p 0.05). A better outcome was obtained using CD44+/CD24- immunohistochemistry.

Conclusions

We conclude that there is a substantial association between high CSCs expression and chemoresistance in ovarian cancer and that CSCs immunohistochemistry has a higher predictive value.
The mechanics of implementation strategies and measures: advancing the study of implementation mechanisms
Authors: Lewis Cara C. , Klasnja Predrag , Lyon Aaron R. , Powell Byron J. , Lengnick-Hall Rebecca , Buchanan Gretchen , Meza Rosemary D. , Chan Michelle C. , Boynton Marcella H. , Weiner Bryan J.
Published: October 2022

Background

There is a fundamental gap in understanding the causal mechanisms by which strategies for implementing evidence-based practices address local barriers to effective, appropriate service delivery. Until this gap is addressed, scientific knowledge and practical guidance about which implementation strategies to use in which contexts will remain elusive. This research project aims to identify plausible strategy-mechanism linkages, develop causal models for mechanism evaluation, produce measures needed to evaluate such linkages, and make these models, methods, and measures available in a user-friendly website. The specific aims are as follows: (1) build a database of strategy-mechanism linkages and associated causal pathway diagrams, (2) develop psychometrically strong, pragmatic measures of mechanisms, and (3) develop and disseminate a website of implementation mechanisms knowledge for use by diverse stakeholders.

Methods

For the first aim, a combination of qualitative inquiry, expert panel methods, and causal pathway diagramming will be used to identify and confirm plausible strategy-mechanism linkages and articulate moderators, preconditions, and proximal and distal outcomes associated with those linkages. For the second aim, rapid-cycle measure development and testing methods will be employed to create reliable, valid, pragmatic measures of six mechanisms of common strategies for which no high-quality measures exist. For the third aim, we will develop a user-friendly website and searchable database that incorporates user-centered design, disseminating the final product using social marketing principles.

Discussion

Once strategy-mechanism linkages are identified using this multi-method approach, implementation scientists can use the searchable database to develop tailored implementation strategies and generate more robust evidence about which strategies work best in which contexts. Moreover, practitioners will be better able to select implementation strategies to address their specific implementation problems. New horizons in implementation strategy development, optimization, evaluation, and deployment are expected to be more attainable as a result of this research, which will lead to enhanced implementation of evidence-based interventions for cancer control, and ultimately improvements in patient outcomes.
Correlation of hearing outcome in otic capsule sparing temporal bone fractures using temporal bone sub-site classification: a cross-sectional descriptive study
Authors: Keshavamurthy Venkatesha Belur , Ajith K. M. , Maradi Nagaraj , Gupta Richa , Jain Suhani
Published: October 2022

Background

Head injury most commonly occur following road traffic accidents. Often hearing loss and other otological injuries are missed in view of serious head injury or other visible bodily injuries, leading to delayed recognition of problems. There is a need for early clinical and radiological indicators which can predict adverse outcome. Early diagnosis of otological injury during initial evaluation of the head injury has given some clues regarding the severity of hearing outcomes and such correlation has been attempted in this study. Two-year cross-sectional study involving head injury patients with radiological evidence of temporal bone fracture were assessed for hearing impairment.

Results

Thirty-seven patients who satisfied the inclusion criteria were assessed. Fifty-one percent patients had conductive hearing loss. 35.14% of the patients had involvement of mastoid, external auditory canal, and middle ear involvement. A weakly positive correlation was noted between otic capsule sparing fracture and hearing loss. (R value + 0.2064).

Conclusion

Weak correlation was observed between temporal bone sub-site classification and severity of hearing loss in otic capsule sparing temporal bone fractures.
Nasal steroid use and osteitis development in chronic rhinosinusitis with nasal polyps
Authors: Şimşek Sadullah , İşlek Akif
Published: October 2022

Objectives

Osteitis and tissue remodeling are inflammatory processes associated with the severity of chronic rhinosinusitis with nasal polyps (CRSwNP). Nasal steroids are the mainly recommended therapeutics in the treatment of the disease, and besides their beneficial effects, they may worsen osteitis via osteopenia. This study aimed to search for the coalescence of osteitis in CRSwNP and nasal steroid use (NSU).

Methods

A cross-sectional study was designed. Patients who underwent paranasal sinus computed tomography (PNSCT) imaging were queried, and the sino‐nasal outcome test-22 (SNOT-22) was completed. Regular NSU was defined as a continued treatment for 2 months in the last 6 months. The cumulative period of NSU during the last 6 months was determined and classified as no use or, for 1 to 3 months, or more than 3 months. Lund-MacKay scores (LMS) and Global Osteitis Scores (GOS) were calculated for 10 sinuses via PNSCT.

Results

Sixty-two patients were included in the study. The mean GOS score was 5.7 ± 1.7 points higher in patients with regular NSU (p = 0.002, 95% CI: 9.2–2.2, t-test). LMS and SNOT-22 scores also were significantly higher for patients with regular NSU (p = 0.036 and < 0.001 consecutively). The mean GOS score showed a significant increase according to the cumulative period of NSU (p < 0.001, one-way ANOVA test). Similarly, LMS and SNOT-22 scores were also significantly associated with the duration of total NSU. GOS score showed a significant positive high correlation with LMS and SNOT-22 scores (p < 0.001, r = 0.608 and r = 0.753 consecutively).

Conclusions

This association found between the severity of GOS and NSU is probably due to the severity of the disease. However, it may question the value of the NSU effect in the development of osteitis. The presence of NSU should be investigated in future histopathological studies.

Level of evidence

IV
A 10-year retrospective analysis of newborn hearing screening in a tertiary hospital in Malaysia
Authors: Mazlan Rafidah , Raman Kausallya , Abdullah Asma
Published: October 2022

Background

Universal newborn hearing screening (UNHS) has been widely adopted worldwide as a standard of care because it enables the detection of congenital hearing loss early in life. Therefore, the concepts of regular measurement of performance using pre-determined quality measures are recommended for continuous improvement of the program. This study aimed to evaluate and update the performance of a UNHS program by measuring the recommended quality measures between 2010 and 2019. A retrospective study analyzing data of 50569 babies screened between January 2010 and December 2019 was performed. The pre-determined quality measures of coverage rate, initial referral rate, return to follow-up rate, diagnosis rate, and age at diagnosis were measured.

Results

The average coverage rate was 95.5%, with all years achieving the recommended benchmark of ≥ 95% except 2014 (91.8%) and 2019 (89.5%). Generally, the initial referral rate (10%) exceeded the benchmark of ≤ 4%. The program only managed to reach the benchmark for initial referral rate in 2013, 2014, and 2015. Both quality indicators for return to follow-up and diagnosis rates also did not meet the ≥ 95% and ≥ 90% standards, respectively. The return to follow-up ranged from 62 to 72.7%, while the average diagnosis rate was 73.4% (60–100%). One hundred thirty-seven infants were diagnosed with hearing loss at a median age of 3.8 months (± 0.4 months), resulting in a prevalence of 0.27%.

Conclusion

The findings demonstrated an excellent coverage rate but unsatisfactory performance for other quality indicators. Hence, the current program needs to be revisited to remain relevant and effective.