bluuebunny/crossref_metadata_2025 huggingface dataset:
Oxidation in Retrieved, Never-Irradiated UHMWPE Bearings
Authors: Currier Barbara H. , Jevsevar Kori C. , Van Citters Douglas W.
Published: February 2023

Background:

Published analyses of never-irradiated, ethylene oxide (EtO)-sterilized tibial inserts and EtO- and gas plasma (GP)-sterilized acetabular ultra-high molecular weight polyethylene (UHMWPE) retrievals demonstrated minimal UHMWPE in vivo oxidation, whereas another analysis of EtO-sterilized acetabular liners found elevated oxidation linked with in vivo stresses. This study explored whether never-irradiated UHMWPE bearings are (1) oxidized by the in vivo environment, and (2) more likely to oxidize in higher-stress articulations (knee, ankle, shoulder).

Methods:

An institutional review board-approved retrieval archive was queried for never-irradiated, EtO- and GP-sterilized UHMWPE bearings received at revision from 2001 to 2021. A total of 193 EtO-sterilized and 112 GP-sterilized conventional UHMWPE retrievals were analyzed (0 to 25 years in vivo; 133 hip, 144 knee, 18 ankle, and 10 shoulder). Retrieved implants were evaluated for in vivo damage and analyzed for trans-vinylene and ketone content by Fourier transform infrared spectroscopy (FTIR). Twelve never-implanted EtO-sterilized tibial knee inserts, (shelf-aged 5 to 19 years) were non-oxidized controls. Mechanical properties of 3 never-implanted and 3 retrieved tibial inserts were evaluated by ASTM Type-V uniaxial tensile testing. Statistical analyses evaluated correlations between time in vivo and oxidation, and compared mean oxidation rates by articulation.

Results:

Burnishing was the most common clinical damage for all articulations. Eight retrievals exhibited oxidation-related fatigue damage. All retrievals were validated as never-irradiated (median trans-vinylene index [TVI] = 0.000). Maximum ketone oxidation in retrievals correlated with in vivo time (p < 0.001). Thirty-seven percent of retrievals exhibited UHMWPE (subsurface) oxidation, most frequently ankle, knee, and glenoid inserts. Tensile properties differed between retrieved and never-implanted inserts, changing with oxidation. The oxidation rate differed significantly among the articulations (p < 0.001).

Conclusions:

This study cohort confirmed the presence of in vivo oxidation in some non-irradiation-sterilized UHMWPE bearings, with higher-stress articulations (knee, ankle, shoulder) showing evidence of oxidation more frequently and having significantly higher oxidation rates than hips. Mechanical properties degraded by oxidation led to fatigue damage in 8 retrievals after a long duration in vivo.

Clinical Relevance:

Conventional EtO- or GP-sterilized UHMWPE bearings are at minimal risk for fatigue damage secondary to oxidation. However, higher stresses and longer time in vivo (more cycles of use) can lead to increased wear, oxidation, and fatigue damage.
Catastrophic Health Expenditure in Patients with Lower-Extremity Orthopaedic Trauma
Authors: Law Jody M. , Brody Madison , Cavanaugh Katherine E. , Dy Christopher J.
Published: February 2023

Background:

Health-care expenditures are a leading contributor to financial hardship in the United States. Traumatic orthopaedic injuries are unpredictable and result in substantial expense. Our objectives were to quantify the catastrophic health expenditure (CHE) risk of patients with orthopaedic trauma and to examine the impact of insurance status, socioeconomic status, sex, and race on CHE.

Methods:

We identified all isolated lower-extremity orthopaedic trauma cases at a safety-net, Level-1 trauma center from 2018 to 2020. We queried an institutional charge database to obtain total hospital charges, insurance status, and ZIP Code to determine out-of-pocket (OOP) expenditures. To evaluate financial hardship, we calculated the CHE risk as defined by the World Health Organization’s threshold of OOP expenditures, ≥40% of estimated household post-subsistence income.

Results:

In our cohort of 2,535 patients, 33% experienced a risk of CHE. A risk of CHE was experienced by 99% of patients who were uninsured, 35% of patients with private insurance, 2% of patients with Medicare, and 0% of patients with Medicaid. Multivariable regression modeling showed that patients who were uninsured were significantly more likely to experience a risk of CHE compared with patients with private insurance (odds ratio, 107.68 [95% confidence interval, 37.20 to 311.68]; p < 0.001).

Conclusions:

One-third of patients with lower-extremity orthopaedic trauma experience a risk of CHE, with patients who are uninsured facing a disproportionately higher risk of CHE compared with patients who are insured. Our results suggest that the expansion of public insurance options may provide substantial financial protection for those at the greatest risk for CHE.

Level of Evidence:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Comparison of Humeral-Head Replacement with Glenoid-Reaming Arthroplasty (Ream and Run) Versus Anatomic Total Shoulder Arthroplasty
Authors: Levins James , Molla Vadim , Adkins Jacob , Molino Janine , Pasarelli Emily , Paxton E. Scott , Green Andrew
Published: February 2023

Background:

Glenoid component failure is a major concern after anatomic total shoulder arthroplasty (aTSA). Ream and run (RnR) is an alternative procedure that may avoid glenoid-related complications. The purpose of this study was to compare outcomes of RnR versus aTSA in younger patients with advanced glenohumeral osteoarthritis.

Methods:

This was a retrospective matched-cohort study of 110 patients who underwent aTSA and 57 patients who underwent RnR; patients were <66 years of age and had a minimum of 2 years of follow-up. Propensity matching was performed using 21 preoperative variables. Pre- and postoperative patient-reported outcome measures (PROMs) and health-related quality-of-life (HRQoL) scores, satisfaction with outcome, and revision data were analyzed. Mixed-effects models examined the association of preoperative variables with outcomes.

Results:

Thirty-nine patient pairs were matched. All patients were male, with a mean age of 58.6 ± 7.3 years and a mean follow-up 4.4 ± 2.3 years. The aTSA cohort had better final Simple Shoulder Test (SST) and American Shoulder and Elbow Surgeons (ASES) scores. However, in the mixed-effects model analysis, arthroplasty type was not associated with outcome. At 2 years postoperatively, a significantly greater percentage of aTSA patients achieved the substantial clinical benefit (SCB) for the ASES (100% versus 79.2%; p = 0.01) and the minimal clinically important difference (MCID) (89.7% versus 75%; p = 0.02) for the visual analog scale (VAS) for pain. At >5-year follow-up, there were no significant differences between the cohorts in the percentage who achieved the MCID, SCB, or patient acceptable symptom state (PASS) for the ASES, SST, and VAS for pain. Three patients underwent revision arthroplasty for pain after RnR, at a mean of 1.9 ± 1.7 years. Two patients underwent revision arthroplasty for glenoid loosening at 9.2 and 14 years after aTSA.

Conclusions:

RnR and aTSA had comparable outcomes in most analyses. The greater early revision rate after RnR should focus attention on optimizing patient selection and postoperative management. Revision for glenoid loosening is a concern among younger and active patients. Longer-term study is needed to better understand the relative benefits and disadvantages of these procedures.

Level of Evidence:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Short-Term Indwelling Foley Catheters Do Not Reduce the Risk of Postoperative Urinary Retention in Uncomplicated Primary THA and TKA
Authors: Weintraub Matthew T. , Yang JaeWon , Nam Denis , Greenspoon Joshua A. , DeBenedetti Anne , Karas Vasili , Mehta Neal , Della Valle Craig J.
Published: February 2023

Background:

The purpose of this randomized controlled trial was to determine whether a short-term Foley catheter (inserted in the operating room and removed upon arrival to the orthopaedic floor) would reduce the risk of postoperative urinary retention (POUR) in patients undergoing primary total hip (THA) and total knee arthroplasty (TKA).

Methods:

Three hundred and eighty-eight patients undergoing inpatient primary TKA (n = 228) or THA (n = 160) with spinal anesthesia were randomized to receive a short-term Foley catheter (n = 194) or no Foley (n = 194). There were 143 male and 245 female patients. The primary outcome was POUR, defined as requiring ≥2 straight catheterizations or the placement of an indwelling urinary catheter when indicated by retention of ≥450 mL on bladder scans. Secondary outcomes included urinary tract infections (UTIs) within 3 weeks and the need for ≥1 straight catheterization. A power analysis determined that 194 patients per group were required to detect a 7% minimal clinically important difference in POUR rates at 80% power and alpha of 0.05. Intention-to-treat and as-treated analyses were performed (2 patients received the non-allocated treatment). Outcomes were compared between the groups using univariate and multivariate analyses, with alpha < 0.05.

Results:

Nine patients developed POUR: 4 in the short-term Foley group and 5 in the control group (2.1% versus 2.6%; p = 1.00). Of those who developed POUR, 8 were male and 1 was female (88.9% versus 11.1%; p = 0.002). Twenty-four patients required ≥1 straight catheterization: 10 in the Foley group and 14 in the control group (5.2% versus 7.2%; p = 0.40). Four patients developed UTIs: 3 in the Foley group and 1 in the control group (1.5% versus 0.5%; p = 0.62) on intention-to-treat analysis, and 4 in the Foley group and none in the control group (2.1% versus 0.0%; p = 0.12) on as-treated analysis.

Conclusions:

The use of a short-term Foley catheter inserted in the operating room and removed on arrival to the orthopaedic floor does not decrease the rate of POUR.

Level of Evidence:

Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
Opportunities for International Orthopaedic Volunteerism
Authors: Brown Kelsey E. , Solaiman Rafat H. , Flores Michael J. , Nadone Haley , MacKechnie Madeline C. , Shearer David W. , Miclau Theodore
Published: February 2023

Background:

In low and middle-income countries (LMICs), there are often not enough orthopaedic surgeons to treat musculoskeletal conditions. International volunteerism is 1 way that the orthopaedic community seeks to meet this need. This study explored the opportunities available for orthopaedic surgeons to volunteer overseas as offered by nonprofit organizations in the United States and Canada.

Methods:

A systematic internet search was conducted using 2 distinct search strategies. A website was considered a “hit” if it was that of a U.S. or Canada-based nonprofit, volunteer, or non-governmental organization that had opportunities for international orthopaedic volunteerism. Duplicate hits were eliminated to identify distinct organizations. Data regarding the work and geographical reach of the organization, as well as changes to its volunteer programs as a result of COVID-19, were extracted from each hit.

Results:

Of the 38 distinct organizations identified in the U.S. and Canada, the most common orthopaedic subspecialties represented were pediatrics (37%), hand (24%), and arthroplasty (18%). Foot and ankle (4 organizations; 11%), sports medicine (2 organizations; 5%), and oncology (1 organization; 3%) were the least represented subspecialities. The most common regions for volunteer trips included Latin America and the Caribbean, followed by West and East Africa. Twelve organizations (32%) were identified as having a religious affiliation. For most organizations, the trip duration was a minimum of 1 week. All volunteer organizations included operative or clinical experiences as part of their trips, and the majority of organizations (58%) reported that their trips included opportunities for training local surgeons. Many organizations (71%) reported having resumed trips after halting them during the COVID-19 pandemic.

Conclusions:

Many opportunities exist for orthopaedic surgeons to volunteer their time and skills abroad. Future directions for the improvement of international volunteer efforts among the orthopaedic community could include expanding the number of existing volunteer opportunities and assessing the ethics, safety, efficacy, and longevity of these programs.
The Effect of Proportion of Dioscorea alata and Wheat Flour on the Acceptability of Steamed Bolu
Authors: Naimah Siska Yulva , Ulilalbab Arya , Suprihartini Cucuk
Published: February 2023

Uwi tuber is functional food ingredients than can be flourished to become further food preparations. Uwi tuber is one of the recommended foodstuffs for diabetics with diabetes mellistusas alternative of first food. It is because uwi tuber has lower glicemix index compared to other foodstuffs, such as rice, corn, etc. Based on the potential of the uwi tuber, it is necessary to do further innovation in food processing, one of them is to be processed as another food such as steamed bolu which has low glicemix index. The purpose of this study is to know the effect of uwi tuber flour and wheat flour proportion toward acceptability of steamed bolu. This study was conducted at the Food Technology Laboratory of Nutrition Academy KaryaHusada Kediri on 29 February 2019 by using an experimental method with a Complete Randomized Design with 3 treatments and 3 times replications, namely P0uwi tuber flour : wheat flour (0% : 28%), P2uwi tuber flour : wheat flour (14% : 14%), P3uwi tuber flour : wheat flour (21% : 7%). Statistical analysis of organoleptic test uses Friedman Rank. According to organoleptic test that has been done, it is obtained steamed bolu in the propostion of uwi tuber flour : wheat flour (21% : 7%) can be accepted organoleptically. However, there is a need for research on the differences in handling during the pouring flour process as the basis production of steamed bolu.
Z-preference-based multi-criteria decision-making for design concept evaluation highlighting customer confidence attitude
Authors: Qi Jin
Published: February 2023

The aim of customer-oriented design concept evaluation (CDCE) is to select the best product design solution from the perspective of customer. Traditionally, most of CDCE methods mainly focus on the customer preference judgement but ignore the confidence attitude of customer, namely, the reliability of preference. However, the customer’s uncertain attitude means he is unsure about his decision and could probably change his mind. With the help of Z-number, more complete customer preference information is recorded (Z-preference). The main contribution of this paper is to propose a new Z-preference-based multi-criteria decision-making (MCDM) for CDCE method that retains the confidence coefficient α in evaluation value (Z-CDCE-α) to highlight the role of confidence attitude for CDCE, rather than simply translating Z-preference into a regular fuzzy preference value. By integrating with multiple information such as preference value, confidence coefficient α and the importance rating of design attribute, a novel ideal solution definition (ISD) strategy is put forward. For the re-defined ideal solutions, the distances of alternative to ideal solutions are deduced to get the priority degree δ to sort alternatives. According to the proposed ISD strategy of Z-CDCE-α, the best concept is that its important attribute values are preferred by customers with higher certainty or least preferred by customers with lower certainty, and the customers’ preferences and confidence attitudes for its less important attribute values are opposite. A case study and two comparison experiments are carried out to validate the reasonability and feasibility of Z-CDCE-α for CDCE by comparing with different evaluation values, ISD rules and MCDM models.
Soil decompacting potential and biomass production of Brachiaria genotypes
Authors: Serafim Milson Evaldo , Zeviani Walmes Marques , Barbosa Samara Martins , Severiano Eduardo da Costa , Costa Kátia Aparecida de Pinho , Romano Luciano Recart , Silva Bruno Montoani
Published: February 2023

Aims : Grasses of the Brachiariagenus are widely used as cover crops in no-tillage areas of the Brazilian Cerrado. The objective of this experiment was to study the ability of six Brachiaria genotypes to produce shoot biomass and root biomass, and the potential of the root system to perforate a 0.01m thick paraffin hardpan disk with 1.5 MPa soil penetration resistance at 30° C.
Methods: The plants were grown in PVC columns with a diameter of 0.1 m and a height of 0.7 m. The column was divided into an upper part measuring 0.25 m (top) and a lower part measuring 0.45 m (bottom). The paraffin disk was positioned between the two parts of the column as a physical barrier to be perforated by the roots. The columns were filled with peaty substrate. The Brachiaria genotypes cultivated were: Brachiaria brizanthacv. BRS Piatã, Brachiaria decumbenscv. Basilisk, Brachiaria brizanthacv. BRS Paiaguás, Brachiaria ruziziensis cv. Ruzizienses, Brachiaria brizantha cv. Xaraés and Brachiaria brizantha cv. Marandu.
Results: The cultivar Xaraes presented highest paraffin disk perforation capacity. Decumbens is the genotype with the lowest disk perforation capacity. The Ruziziensis cultivar is the genotype that accumulated the high root dry mass. Conclusions: The cover crop of Brachiaria implantation to reduce the physical limitations of the soil for root growth, in no-tillage, must consider the distinct potential of the genotype's root growth.
A natural experiment to assess how urban interventions in lower socioeconomic areas influence health behaviors: The UrbASanté study
Authors: Charreire Hélène , Conti Benoit , Bauchard Lucile , Cissé Ndèye Aïta , Perignon Marlène , Rollet Pascaline , Perrin Coline , Blanchard Sophie , Roda Céline , Feuillet Thierry , Madelin Malika , Dupuis Vincent , Evrard Anne-Sophie , Hellequin Anne-Peggy , Coll Isabelle , Larrue Corinne , Baudet-Michel Sophie , Vernouillet Gabrielle , Ntsame-Abegue Fernande , Fabre Isabelle , Méjean Caroline , Oppert Jean-Michel
Published: February 2023

Background
Mechanisms underlying the associations between changes in the urban environment and changes in health-related outcomes are complex and their study requires specific approaches. We describe the protocol of the interdisciplinary UrbASanté study, which aims to explore how urban interventions can modify environmental exposures (built, social, and food environments; air quality; noise), health-related behaviors, and self-reported health using a natural experiment approach.
Methods
The study is based on a natural experiment design using a before/after protocol with a control group to assess changes in environmental exposures, health-risk behaviors, and self-reported health outcomes of a resident adult population before and after the implementation of a time series of urban interventions in four contiguous neighborhoods in Paris (France). The changes in environmental exposures, health-related behaviors, and self-reported health outcomes of a resident adult population will be concurrently monitored in both intervention and control areas. We will develop a mixed-method framework combining substantial fieldwork with quantitative and qualitative analytical approaches. This study will make use of (i) data relating to exposures and health-related outcomes among all participants and in subsamples and (ii) interviews with residents regarding their perceptions of their neighborhoods and with key stakeholders regarding the urban change processing, and (iii) existing geodatabases and field observations to characterize the built, social, and food environments. The data collected will be analyzed with a focus on interrelationships between environmental exposures and health-related outcomes using appropriate approaches (e.g., interrupted time series, difference–in-differences method).
Discussion
Relying on a natural experiment approach, the research will provide new insights regarding issues such as close collaboration with urban/local stakeholders, recruitment and follow-up of participants, identification of control and intervention areas, timing of the planned urban interventions, and comparison of subjective and objective measurements. Through the collaborative work of a consortium ensuring complementarity between researchers from different disciplines and stakeholders, the UrbASanté study will provide evidence-based guidance for designing future urban planning and public health policies.
A machining partition method for local features with dimensional correlations of large cabin
Authors: Ma Jianwei , Sun Hechen , Yan Huiteng , Zhang Hongyuan , Tao Qiang , Jia Zhenyuan , Liu Wei
Published: February 2023

Integrated in-situ partition manufacturing mode of large cabins based on the mobile serial robots is adopted for machining tasks of outboard local features currently. However, the existing partition criteria of large-scale components only consider the geometric features and structure, ignoring the dimensional correlations of local features and the effective workspace of serial robots. This tends to cause that features with the same dimensional correlation are divided into different sub-regions, resulting in extra machining adjustment which reduces the machining efficiency. Aiming at the machining partition problem for local features of the large cabin, a machining partition method is proposed for local features with dimensional correlations of the large cabin based on clustering. Considering positions and dimensional correlations of local features, a multi-objective optimization model of partition based on clustering validity indexes is established to pre-solve partition schemes. To solve the reachable region of the large cabin, the effective workspace of serial robots is taken into account. With the reachable region as the constraint and the machining efficiency as the decision basis, the optimal partition scheme for local features of the large cabin is determined. The contrast validation is conducted on a reference cabin. The results indicate that the proposed method both satisfies the dimensional correlations of local features and the effective workspace of serial robots, which improves the machining efficiency. This research provides significant machining partition bases for robot machining in the integrated in-situ partition manufacturing mode of large cabins.
Angiogenesis-relevant lncRNA signature for osteosarcoma: prospects for prediction of clinical outcomes and immunotherapeutic efficacy
Authors: Chen Xianguo , Lin Zongjin , Chen Yiwei , Wang Xinwu , You Fengyuan
Published: February 2023

Objective: Angiogenesis is a highly adaptive and complex course, which is essential for tumor growth and metastases of osteosarcoma. Considering the regulatory functions of lncRNAs in angiogenesis, the current study attempted to propose an angiogenesis-relevant lncRNA signature for assisting precision medicine of osteosarcoma.
Methods: Transcriptome data of TARGET osteosarcomas and TCGA sarcoma (SARC) were acquired from the GDC. An angiogenesis-relevant lncRNA signature was defined utilizing LASSO approach. Somatic mutation was analyzed via Maftools. Immunotherapy response was inferred according to T cell-inflamed score, TIDE score and immune checkpoints. Angiogenesis-relevant lncRNAs were experimentally verified in osteoblasts hFOB1.19 and osteosarcoma cells (MG-63, U2OS, SJSA-1, HOS) utilizing RT-qPCR. In LINC01060-knockout cells, transwell and immunoblotting were conducted to investigate the invasion and angiogenesis.
Results: The angiogenesis-relevant lncRNA signature was established, and high-risk osteosarcomas presented worse overall survival and disease-free survival. It was proven that the risk score possessed the reliability and independency in prognosis prediction. Higher genetic mutation occurred in high-risk osteosarcomas. From higher expression of immune checkpoints, lower TIDE score and higher T cell-inflamed score, low-risk osteosarcomas were more likely to respond to immunotherapy. After experimental verification, AC004862.6, CYTOR, LINC01060, LINC02596, and LOC101928228 were up-regulated in osteosarcoma, and LINC01060-knockout MG-63 and U2OS cells presented impaired invasive capacity and reduced expression of angiogenic genes VEGFA, Angpt1, and Angpt2.
Conclusion: The angiogenesis-relevant lncRNA signature is a possible predictor of survival and immunotherapeutic response in osteosarcoma, and integrated transcriptome analysis coupled with clinical sample verification can facilitate biomarker discovery and clinical translation.
Super-enhancer-driven MLX mediates redox balance maintenance via SLC7A11 in osteosarcoma
Authors: Guo Weitang , Wang Xin , Lu Bing , Yu Jiaming , Xu Mingxian , Huang Renxuan , Chen Mingzhe , Yang Meiling , Zhao Wei , Zou Changye
Published: February 2023

Osteosarcoma (OS) is a common type of bone tumor for which there has been limited therapeutic progress over the past three decades. The prevalence of transcriptional addiction in cancer cells emphasizes the biological significance and clinical relevance of super-enhancers. In this study, we found that Max-like protein X (MLX), a member of the Myc-MLX network, is driven by super-enhancers. Upregulation of MLX is predictive of poor prognosis in osteosarcoma. Knockdown of MLX impairs growth and metastasis of osteosarcoma in vivo and in vitro. Transcriptomic sequencing has revealed that MLX is involved in various metabolic pathways (e.g., lipid metabolism) and is capable of inducing metabolic reprogramming. More specifically, MLX regulates the glutamate/cystine antiporter SLC7A11 to promote extracellular cysteine uptake required for the biosynthesis of the essential antioxidant GSH, thereby detoxifying reactive oxygen species (ROS) and maintaining the redox balance of osteosarcoma cells. Importantly, sulfasalazine, an FDA-approved anti-inflammatory drug, can inhibit SLC7A11, disrupt redox balance, and induce massive ferroptosis, leading to impaired tumor growth in vivo. Taken together, this study reveals a novel mechanism whereby super-enhancer-driven MLX positively regulates SLC7A11 to meet the alleviated demand for cystine and maintain the redox balance, highlighting the feasibility and clinical promise of targeting SLC7A11 in osteosarcoma.
Impact of Topographic Localization of Corneal Ectasia on the Outcomes of Deep Anterior Lamellar Keratoplasty Employing Large (9 mm) Versus Conventional Diameter (8 mm) Grafts
Authors: Scorcia Vincenzo , Taloni Andrea , Rossi Costanza , Gioia Raffaella , Lucisano Andrea , Giannaccare Giuseppe
Published: February 2023

Objectives
Visual and topographic outcomes of large (9.0 mm) versus conventional (8.0 mm) deep anterior lamellar keratoplasty (DALK) for the treatment of keratoconus (KC) were compared in relation to the different localization of the corneal ectasia (within or beyond the central 8.0 mm).
Methods
This is a retrospective, comparative case series. Preoperatively, the topographic extension of the conus was calculated by measuring the distance from the geometric center of the cornea and the outermost point of the corneal ectasia (ectasia < 8.0 mm, group A; ectasia ≥ 8.0 mm, group B). DALK was performed using both small grafts (8.0 mm, group 1) and large grafts (9.0 mm, group 2). Best-corrected visual acuity and topographic astigmatism were evaluated preoperatively (T0) and postoperatively after complete suture removal (1 year, T1).
Results
Data from 224 eyes of 196 patients were evaluated. Topographic astigmatism improved in the entire series at T1 (4.94 ± 2.92 dioptres (D) [95% CI, 4.56–5.33] vs 4.19 ± 2.45 D [95% CI, 3.87–4.51], p = 0.001). There was no significant difference in postoperative topographic cylinder between group 1 and group 2 when considering eyes with corneal ectasia < 8.0 mm (group 1A, 4.15 ± 2.19 D [95% CI, 3.64–4.66] vs group 2A, 3.65 ± 2.13 D [95% CI, 2.92–4.38], p = 0.14); conversely, the difference was significant considering eyes with corneal ectasia ≥ 8.0 mm (group 1B, 4.74 ± 2.90 D [95% CI, 4.09–5.38] vs group 2B, 3.68 ± 1.94 D [95% CI, 3.10–4.26], p = 0.02).
Conclusions
Large 9.0-mm DALK provided better anatomical outcomes compared to conventional 8.0-mm DALK, particularly in eyes with corneal ectasia extending beyond the central 8.0 mm.
Effects of motor imagery based brain-computer interface on upper limb function and attention in stroke patients with hemiplegia: A randomized controlled trial
Authors: Liu Xiaolu , Zhang Wendong , Li Weibo , Zhang Shaohua , Lv Peiyuan , Yin Yu
Published: February 2023

Objective: To investigate the effects of motor imagery-based brain-computer interface training (MI-BCI) on upper limb function and attention in stroke patients with hemiplegia.
Methods: Stroke patients with impairment of upper extremity function and decreased attention were randomly assigned to the conventional rehabilitation group or the BCI group (1:1 ratio). BCI group performed 20 minutes of MI-BCI training five times a week for 3 weeks (15 sessions) in addition to conventional rehabilitation. The primary outcome measures were the changes in Fugl-Meyer Motor Function Assessment for Upper Extremities (FMA-UE) and Attention Network Test (ANT) from baseline to 3 weeks.
Results: A total of 60 people participated in the study, and about 93% of the patients completed the allocated training. Compared with the conventional rehabilitation group, among those in the BCI group, FMA-UE was increased by 8.0 points (95%CI, 5.0 to 10.0; P<0.001). Alert network response time (32.4ms; 95%CI, 58.4 to 85.6; P<0.001), orienting network response (5.6ms; 95%CI, 29.8 to 55.8; P=0.010), and corrects number (8.0; 95%CI, 17.0 to 28.0; P<0.001) also increased in the BCI group compared with the conventional rehabilitation group. Additionally, the executive control network response time (-105.9ms; 95%CI, -68.3 to -23.6; P=0.002), the total average response time (-244.8ms; 95%CI, -155.8 to -66.2; P=0.002), and total time (-122.0ms; 95%CI, -80.0 to -35.0; P=0.001) were reduced in the BCI group compared with the conventional rehabilitation group.
Conclusion: MI-BCI combined with conventional rehabilitation training could better enhance upper limb motor function and attention in stroke patients. This training method may be feasible and suitable for individuals with stroke.
Trial registration: This study was registered in the Chinese Clinical Trial Registry with Portal Number ChiCTR2100050430(27/08/2021).
Treatment of the Insensitive Munitions Compound, 3-Nitro-1,2,4-Triazol-5-one (NTO), in Flow Through Columns Packed with Zero-Valent Iron
Authors: Yu Youngjae , Root Robert A. , Sierra-Alvarez Reyes , Chorover Jon , Field Jim A.
Published: February 2023

The need for effective technologies to remediate the insensitive munitions compound 3-nitro-1,2,4-triazol-5-one (NTO) is emerging due to the increasing use by the U.S. Army and environmental concerns about the toxicity and aqueous mobility of NTO. Reductive treatment is essential for the complete degradation of NTO to environmentally safe products. The objective of this study is to investigate the feasibility of applying zero-valent iron (ZVI) in a continuous-flow packed bed reactor as an effective NTO remediation technology. The ZVI-packed columns treated an acidic influent (pH 3.0) or a circumneutral influent (pH 6.0) for six months (ca. 11000 pore volumes, PVs). Both columns effectively reduced NTO to the amine product, 3-amino-1,2,4-triazol-5-one (ATO). The column treating the pH-3.0 influent exhibited prolonged longevity in reducing NTO, treating 11-fold more PVs than the column treating pH-6.0 influent until the breakthrough point (defined as when only 85% of NTO was removed). The exhausted columns (defined as when only 10% of NTO was removed) regained the NTO reducing capacity by reactivation using 1 M HCl, fully removing NTO. After the experiment, solid phase analysis of the packed-bed material showed that ZVI was oxidized to iron (oxyhydr)oxide minerals such as magnetite, lepidocrocite, and goethite during NTO treatment. This is the first report on the reduction of NTO and the concomitant oxidation of ZVI in continuous-flow column experiments. The evidence indicates that treatment in a ZVI-packed bed reactor is an effective approach for the removal of NTO.
Assessing the suitability of lakes and reservoirs for recreation using Landsat 8 Water Clarity
Authors: Keith Darryl J. , Salls Wilson , Schaeffer Blake A. , Werdell P. Jeremy
Published: February 2023

Water clarity has long been used as a visual indicator of the condition of water quality. The clarity of waters is generally valued for aesthetic and recreational purposes. Water clarity is often assessed using a Secchi disk, attached to a measured line and lowered to a depth where it can be no longer seen. We have applied an approach which uses atmospherically corrected Landsat 8 data to estimate water clarity in freshwater bodies by using the Quasi-Analytical Algorithm (QAA) and Contrast Theory to predict Secchi depths for more than 270 lakes and ponds across the continental US. We found that incorporating Landsat 8 spectral data into methodologies created to retrieve the inherent optical properties (IOP) of coastal waters was effective at predicting in-situ measures of the clarity of inland lakes. The predicted Secchi depths were used to evaluate the recreational suitability for swimming and recreation using an assessment framework developed from public perception of water clarity. Results showed approximately 90 percent of the waterbodies in our dataset were classified as “marginally suitable to suitable” with less than 10 percent classed as “eminently suitable” to “totally unsuitable – unsuitable”. The implications are that satellites engineered for terrestrial applications can be successfully used with traditional ocean color algorithms and methods to measure the water quality of freshwater environments. Further, operational land-based satellite sensors have the temporal repeat cycles, spectral resolution, wavebands, and signal-to-noise ratios to be repurposed to monitor water quality for public use and trophic status of complex inland waters.
Psycho-social and health predictors of loneliness in older primary care patients and mediating mechanisms linking comorbidities and loneliness
Authors: Ljiljana Majnarić Trtica , Mile Volarić , Tomislav Kurevija , Silvio Mihaljević , Zdravka Krivdić , Wittlinger Thomas
Published: February 2023

Population aging is the global demographic trend in EU countries in the last decades. Aging is associated with unfavorable sociodemographic factors such as widowhood, lower physical and mental functioning, and fewer possibilities for social participation. All these factors have been found to be associated with loneliness – a feeling of social isolation. Living with feeling of loneliness may, in turn, have negative implications on quality of life, physical and mental health, and mortality, of elderly individuals. The aim was to assess associations of feeling of loneliness with sociodemographic and psycho-social characteristics and comorbidities of older individuals from the general population. The sample consisted of 189 (58% F) older individuals (> 50 years) (mean ± SD, 78.47 ± 6.65), attenders in Primary Health Care. Apart from sociodemographic characteristics and comorbidities, participants were described by psychological characteristics, assessed by a set of standard questionnaires, including: UCLA loneliness scale, MSPSS (Multidimensional Scale of Perceived Social Support), GAS (Geriatric Anxiety Scale), GDS (Geriatric Depression Scale), ADL (Activities of Daily Living), IADL (Instrumental Activities of Daily Living), GSE (General Self-Efficacy) and ERQ (Emotional Regulation Questionnaire). The effect of particular blocks of factors on status loneliness was assessed by the hierarchical regression model. We also analyzed if any of psychological characteristics mediate associations between comorbidities and loneliness, when controlling for sociodemographic characteristics. The results indicated that older individuals who lived alone, had difficulties in relations with their family members, suffered from depression, and had lower level of education, felt much lonely. Individuals who were generally engaged in hobbies, were less lonely. The level of comorbidity was shown to be associated with loneliness, with some diagnoses contributing more than some others. Some psychological traits can lessen feeling of loneliness, while anxiety and depression make it worsen. Mediation analysis informed us on how to help patients with comorbidities to feel less lonely, including interventions such as those that can reduce anxiety and depression, improve cognitive abilities and emotional regulation, and enhance social support.
Neutral lipid storage disease with myopathy and myotonia associated to pathogenic variants on PNPLA2 and CLCN1 genes: case report.
Authors: Landim João Igor Dantas , Ribeiro Ian Silva , de Oliveira Eduardo Braga , Freitas Hermany Capistrano , de Brito Lara Albuquerque , Maia Isaac Holanda Mendes , Távora Daniel Gurgel Fernandes , Rodrigues Cleonisio Leite
Published: February 2023

Background:
Neutral lipid storage disease with myopathy (NLSD-M) is an autosomal recessive disease that manifests itself around the 3rd to 4th decade with chronic myopathy of proximal predominance in the shoulder girdle. Clinical myotonia is uncommon. We will report a rare case associated with pathogenic mutations on PNPLA2 and CLCN1 genes with a mixed phenotype of NLSD-M and a subclinical form of Thomsen’s congenital myotonia.
Case presentation:
We describe a patient with chronic proximal myopathy, very subtle clinical myotonia and electrical myotonia on electromyography (EMG). Serum laboratory analysis disclosure hyperCKemia (CK 1280 mg/dL). A blood smear analysis showed Jordan’s anomaly, a hallmark of NLSD-M. A genetic panel was collected using the NGS technique, which identified two pathogenic variants on genes supporting two different diagnosis: NLSD-M and Thomsen congenital myotonia, whose association has not been previously described.
Conclusions:
Although uncommon, it is important to remember the possibility of association of pathogenic mutations to explain a specific neuromuscular disease phenotype. The use of a range complementary methods, including myopathy genetic panels, may be essential to diagnostic definition in such cases.
Does quadriceps strength asymmetry is able to predict functional decline, gait abnormalities and falls in community-dwelling older adults? A cohort study
Authors: MARQUES NISE RIBEIRO , Brando Natalia Dias , Santos Giovanny Viegas dos
Published: February 2023

Introduction.
Aging and articular degenerative inflammatory diseases, such as osteoarthritis, decline quadriceps strength. The reduction on quadriceps strength usually is asymmetric, and it may leads to an inefficient pattern to absolve ground reaction forces on the weaker limb during walking.
Objective.
The present study aimed to identify the ability quadriceps strength asymmetry to predict gait abnormalities, functional decline and falls prevalence in community-dwelling older adults.
Methods.
Participated of this study 52 older adults who live on a community-dwelling setting. The participants were separated into two groups according having or not knee extensor muscles strength asymmetry. Strength asymmetry was considered when the difference of strength between right and left maximal quadriceps maximal strength is higher than 20%. Twenty-four participants composed the strength asymmetry group and twenty-eight participants composed the control group. For the data collection: participants answered a characterization form; performed Short Physical Performance Battery and 400-m walking tests; three maximal isometric voluntary knee extensors contraction of right and left legs were recorded; and gait kinematics data was collected. The follow-up of the study was conducted after six months. A multivariate analysis of variance was used to compare the parameters, stepwise test was used to identify the predictive parameters and a ROC curve was used to determine the sensitive and specificity. The significant level was set at p < 0.05.
Results.
The quadriceps strength asymmetry was 28.9% in the group with strength asymmetry and the control group have 15% of quadriceps asymmetry. A strength asymmetry of 25% was able to predict functional a decline on the 400-m walking test (sensitivity = 78% and specificity = 82%); falls prevalence (sensitivity = 76,9% and specificity = 96,1%); and gait abnormalities, such as increased stance and stride time variability (sensitivity = 68% and specificity = 80%; and sensitivity = 71% and specificity = 84%, respectively).
Conclusion.
Quadriceps strength asymmetry higher than 25% may predict falls prevalence in community-dwelling older adults. Also, the quadriceps strength asymmetry predicts a functional decline, and temporal and spatial gait abnormalities those could reduce gait performance, promote early fatigue, and increase the risk of falls in older adults.
Identifying key genes related to the peritubular capillary rarefaction in renal interstitial fibrosis by bioinformatics
Authors: Zhang Yu , Shi Chuanbing , Yang Yiqiong , Huang Jing , Hu Xiuxiu , Ni Haifeng , Li Li , Cheng Zhengyuan , Chen Pingsheng
Published: February 2023

Renal interstitial fibrosis (RIF) is the prominent pathological characteristics of deteriorative chronic kidney disease (CKD), leading to peritubular capillary (PTC) rarefaction accompanied by obvious hypoxia. However, the underlying mechanisms remain elusive. To deal with this, we constructed a comparative transcriptome analysis of hypoxia and normoxia induced HK-2 cells model to discover total 572 differentially expressed genes (DEGs), which were involved in extensive biological processes. Moreover, these DEGs were uncovered to regulate RIF mainly through HIF-1 signaling pathway from KEGG enrichment. Hence, chip sequencing of HK-2 hypoxia was used to identify 2915 favorable genes modulated by HIF-1α through peak annotation. To translate bioinformatic data into credible clinical application, 43 intersections were then found via a combination of RNA sequencing and chip sequencing. In addition to angiogenesis of GO analysis, 2 candidates including VEGFA and BTG1 were finally recommended as novel targets by annotating their binding sites, which significantly interacted with HIF-1α. Our study provided ascendant insights into the molecular mechanism’s alterations of RIF, therefore paving the intervention therapeutics.
Digital advances in health education with fun health games for children
Authors: Efe Hacer , Topsakal Ünsal Umdu
Published: February 2023

Health education is a life-long process for every individual and improves the health and quality of life of the society and it is important to benefit from interactive digital learning environments in providing health education for the digital children of the new age. The aim of the study is to develop educational digital health games and to investigate the role of primary school students in health awareness. Accordingly, in this study, various educational digital health games were designed, developed and evaluated in many health areas, healthy daily life, dental health, hygiene/cleaning, diseases and coronavirus disease. The study is a design-based research and the ASSURE model, one of the design-based research types, was used in the study. The sample of the study consists of 12 primary school 4th grade students. In the study, semi-structured interview was used as data collection tool and content analysis was applied in the analysis. As a result of the study, it was found that educational digital health games improved the health awareness of primary school students and the students gave more and various correct answers after the implementation than before the implementation. Accordingly, educational digital health games can be used in health education for children.
Inhalable CAR-T Cell-Derived Exosomes as Paclitaxel Carriers for Treating Lung Cancer
Authors: Zheng Wei , Zhu Tianchuan , Tang Lantian , Li Zhijian , Jiang Guanmin , Huang Xi
Published: February 2023

Background
Non-small cell lung cancer (NSCLC) is a worldwide health threat with high annual morbidity and mortality. Chemotherapeutic drugs such as paclitaxel (PTX) have been widely applied clinically. However, systemic toxicity due to the non-specific circulation of PTX often leads to multi-organ damage, including to the liver and kidney. Thus, it is necessary to develop a novel strategy to enhance the targeted antitumor effects of PTX.
Methods
Here, we engineered exosomes derived from T cells expressing the chimeric antigen receptor (CAR-Exos), which targeted mesothelin (MSLN)-expressing Lewis lung cancer (MSLN-LLC) through the anti-MSLN single-chain variable fragment (scFv) of CAR-Exos. PTX was encapsulated into CAR-Exos (PTX@CAR-Exos) and administered via inhalation to an orthotopic lung cancer mouse model.
Results
Inhaled PTX@CAR-Exos accumulated within the tumor area, reduced tumor size, and prolonged survival with little toxicity. In addition, PTX@CAR-Exos reprogrammed the tumor microenvironment and reversed the immunosuppression, which was attributed to infiltrating CD8+ T cells and elevated IFN-γ and TNF-α levels.
Conclusions
Our study provides a nanovesicle-based delivery platform to promote the efficacy of chemotherapeutic drugs with fewer side effects. This novel strategy may ameliorate the present obstacles to the clinical treatment of lung cancer.
Fetal Testicular Teratoma: Report of a Prenatally Undiagnosed Case and Literature Review
Authors: Yue Qingxiong , Sha Yujia , Liu Yan
Published: February 2023

Background: Neonatal testicular teratoma is very rare. In addition, testicular teratoma diagnoses are usually missed during the relatively short neonatal period. We report the case of an infant with an undiagnosed testicular teratoma, who presented clinical signs during the prenatal and neonatal periods. We also reviewed the literature for ultrasonographic findings of prenatal and infancy testicular teratomas in an attempt to promote timely diagnoses and treatments for testicular teratomas.
Case presentation: A 29-year-old pregnant woman underwent a routine obstetric examination at 30w+2d of gestation. Doppler ultrasound examination revealed a cystic mass (30 × 26 × 26 mm) in the left lower abdomen of the fetus, next to the bladder. The inner wall of the cyst enveloped a heterogeneous hyperechoic solid mass of approximately 7 × 7 mm in size, without a blood flow signal. Regular ultrasound monitoring was continued during the pregnancy and neonatal periods. The infant underwent left testicular tumor resection at 10 months and 11 days after birth. The postoperative pathological result revealed a mature teratoma; after the treatment, the child presented no recurrences at the six-month follow-up visit.
Conclusions: Testicular teratomas should be suspected in fetuses with abdominal mixed cyst-solid or solid masses (especially in the presence of solid component calcifications) and an empty scrotum.