bluuebunny/crossref_metadata_2025 huggingface dataset:
Organic soil amendments and food security: Evidence from Cameroon
Authors: Tabe‐Ojong Martin Paul Jr. , Fabinin Akem Nina , Minkoua Nzié Jules René , Molua Ernest Lytia , Fonkeng Eltson Eteckji
Published: November 2022

Food insecurity remains a persistent policy issue in many developing countries. While socio‐political, epidemiological, climatic, and productivity‐related factors have received attention regarding food insecurity, a rarely considered factor is the changing quality of the soil, a natural resource base that has the potential of increasing or reducing vulnerability to food insecurity. The use of organic soil amendments may be socioeconomically and environmentally advantageous. This study examines the inherent relationship between the use of organic soil amendments and food security among smallholder farming households. Using the seemingly unrelated bivariate probit model and the recursive bivariate probit (RBP) model on nationally representative household‐level data from Cameroon, we find evidence that the use of organic soil amendments is positively associated with household food security. We also find the use of organic soil amendments to be associated with reduced levels of mild, moderate, and severe food insecurity. Empirical evidence is also suggestive of a positive association between crop diversification and food security. The results further show that households with larger farm sizes tend to use more organic soil amendments than households with smaller farms. Taken together, our findings confirm another pathway of improving food security with implications for the broad path toward achieving the UN Sustainable Development Goals (SDGs), particularly SDG 2 of ending hunger.
Lightweight and High Impact Polypropylene Foam Fabricated via Ultra‐Low Gas Pressure Injection Molding
Authors: Ma Wenyu , Weng Zhengsheng , Wu Minghui , Ren Qian , Wu Fei , Wang Long , Zheng Wenge
Published: November 2022

Foamed materials play an important role in a lightweight design. Foam injection molding (FIM) is an advanced and convenient way to fabricate lightweight structural materials. Recently, a new foam injection molding machine is developed, which only needs ultra‐low gas pressure to fabricate microcellular foam. As a universal plastic, polypropylene (PP) is widely used due to its good mechanical properties. But after foaming, the toughness of the PP tends to decrease. Herein, a lightweight and high‐impact polypropylene foam is fabricated via the new FIM technology with an ultra‐low nitrogen pressure of 6.5 MPa. PP/polyolefin elastomer (POE) foam with a tiny cell size of 4.13 µm and high cell density of 2.7 × 109  cm−3 is successfully obtained. Owing to the superior cellular structure, compared with the pure PP foam, after adding the POE component, the maximum impact performance is increased by 465%. In this work, an easy‐to‐industrialized method for preparing lightweight and high‐impact injection‐molded PP foams are presented.
Radio‐fluorogenic nanoclay gel dosimeters with reduced linear energy transfer dependence for carbon‐ion beam radiotherapy
Authors: Maeyama Takuya , Mochizuki Anri , Yoshida Kazuki , Fukunishi Nobuhisa , Ishikawa Kenichi L. , Fukuda Shigekazu
Published: November 2022

Purpose

The precise assessment of the dose distribution of high linear energy transfer (LET) radiation remains a challenge, because the signal of most dosimeters will be saturated due to the high ionization density. Such measurements are particularly important for heavy‐ion beam cancer therapy. On this basis, the present work examined the high LET effect associated with three‐dimensional gel dosimetry based on radiation‐induced chemical reactions. The purpose of this study was to create an ion beam radio‐fluorogenic gel dosimeter with a reduced effect of LET.

Methods

Nanoclay radio‐fluorogenic gel (NC‐RFG) dosimeters were prepared, typically containing 100 μM dihydrorhodamine 123 (DHR123) and 2.0 wt% nanoclay together with catalytic additives promoting Fenton or Fenton‐like reactions. The radiological properties of NC‐RFG dosimeters having different compositions in response to a carbon‐ion beam were investigated using a fluorescence gel scanner.

Results

An NC‐RFG dosimeter capable of generating a fluorescence intensity distribution reflecting the carbon‐ion beam dose profile was obtained. It was clarified that the reduction of the unfavorable LET dependence results from an acceleration of the reactions between DHR123 and H2O2, which is a molecular radiolysis product. The effects of varying the preparation conditions on the radiological properties of these gels were also examined. The optimum H2O2 catalyst was determined to include 1 mM Fe3+ ions, and the addition of 100 mM pyridine was also found to increase the sensitivity.

Conclusions

This technique allows the first‐ever evaluation of the depth–dose profile of a carbon‐ion beam at typical therapeutic levels of several Gy without LET effect.
Transurethral water vapor ablation of the prostate with the Rezūm system: Urodynamic findings
Authors: Martinelli Evangelista , Cindolo Luca , Grossi Francesco Saverio , Kuczyk Markus Antonius , Siena Giampaolo , Oelke Matthias
Published: November 2022

Aims

The efficacy of the transurethral convective interstitial radiofrequency water vapor thermal ablation of the prostate with the Rezūm system for the treatment of male lower urinary tract symptom due to benign prostatic hyperplasia is well proven.

The improvement of urodynamic parameters obtained from a simple uroflowmetry cannot measure the effect of water vapor injection on the bladder outlet obstruction.

Methods

This monocentric retrospective pilot study analyzes the data of pressure‐flow studies performed before and after 17 Rezūm procedures to answer the question whether thus obtained ablation of prostate tissue has a disobstructive effect on the bladder outlet.

Results

All the functional outcomes were consistently improved after the procedure, with a median flowrate increase of 5.1 ml/s (p = 0.0022) and a median postvoid residual urine (PVR) reduction of 100 ml (p = 0.0042). The prostate volume was reduced by 40% (p < 0.0001) and the median Bladder Outlet Obstruction Index (BOOI) reduction was 53.8 (p < 0.0001).

Conclusions

These data show that the possibility to significantly reduce the obstruction grade with even a single Rezūm procedure is concrete and seems to be independent from the degree of the obstruction grade.
Validation of the Spanish Acute Cystitis Symptoms Score (ACSS) in native Spanish‐speaking women of Europe and Latin America
Authors: Medina‐Polo José , Arrébola‐Pajares Ana , Corrales‐Riveros Juan Guillermo , Alidjanov Jakhongir F. , Lorenzo‐Gómez María F. , Tapia Ana‐María H. , Martínez‐Berganza María Lourdes , Ospina‐Galeano Irma A. , Padilla‐Fernández Bárbara , Pilatz Adrian , Naber Kurt G. , Wagenlehner Florian M.
Published: November 2022

Introduction and Objectives

The Acute Cystitis Symptom Score (ACSS) is a patient self‐reporting questionnaire for clinical diagnostics and patient‐reported outcome (PRO), which may assess the symptoms and the effect on the quality of life in women with acute cystitis (AC). The current study aimed to create a validated Spanish version of the ACSS questionnaire.

Material and Methods

The process of linguistic validation of the Spanish version of the ACSS consisted of the independent forward and backward translations, revision and reconciliation, and cognitive assessment. Clinical evaluation of the study version of the ACSS was carried out in clinics in Spain and Latin America. Statistical tests included the calculation of Cronbach's α, split‐half reliability, specificity, sensitivity, diagnostic odds ratio, positive and negative likelihood ratio, and area under the receiver‐operating characteristic curve (AUC).

Results

The study was performed on 132 patients [age (mean;SD) 45.0;17.8 years] with AC and 55 controls (44.5;12.2 years). Cronbach's α of the ACSS was 0.86, and the split‐half reliability was 0.82. The summary scores of the ACSS domains were significantly higher in patients than in controls, 16.0 and 2.0 (p < 0.001), respectively. The predefined cut‐off point of ≥6 for a summary score of the “Typical” domain resulted in a specificity of 83.6% and a sensitivity of 99.2% for the Spanish version of the ACSS. AUC was 0.91 [0.85; 0.97].

Conclusions

The validated Spanish ACSS questionnaire evaluates the symptoms and clinical outcomes of patients with AC. It can be used as a patient's self‐diagnosis of AC, as a PRO measure tool, and help to rule out other pathologies in patients with voiding syndrome.
Pitfalls in the interpretation of blood tests used to assess and monitor micronutrient nutrition status
Authors: Berger Mette M. , Talwar Dinesh , Shenkin Alan
Published: November 2022

Assessment of micronutrient (MN) status is of particular importance in patients who require medical nutrition therapy, especially those requiring parenteral nutrition. Blood testing is generally the only tool available in clinical settings to assess MN status. However, using plasma or serum concentration faces pitfalls mainly because of the impact of inflammation that diverts the MNs from the circulating compartment. This review aims to review the blood tests that are useful and provide information about how to integrate functional markers of status to reach a clinically relevant diagnosis. Most impacted, with a significant and proportional decrease in plasma concentrations, are iron, selenium, zinc, thiamin, folic acid, cobalamin, and vitamins A, C, and D; copper is the only MN for which the plasma concentration increases. Therefore, a surrogate marker of inflammation, C‐reactive protein, must always be determined simultaneously. Validated intracellular and functional tests are proposed to improve status assessment. A protocol is suggested for tests required both on commencing and during nutrition support. A timely turnaround of analysis is essential for results to be clinically useful. In some cases, the appropriate provision of MNs should be commenced before results have been obtained to confirm the clinical assessment. Laboratory tests of MN status are an area prone to misuse and misinterpretation. The appropriate use and interpretation of such tests are essential to ensure the correct management of nutrition problems.
Computational modeling studies reveal the origin of the binding preference of 3‐(3,4‐di hydroisoquinolin‐2(1H)‐ylsulfonyl)benzoic acids for AKR1C3 over its isoforms
Authors: Kong Xiaotian , Xing Enming , Wu Sijin , Zhuang Tony , Li Pui‐Kai , Li Chunhua , Cheng Xiaolin
Published: November 2022

As a key regulator for hormone activity, human aldo‐keto reductase family 1 member C3 (AKR1C3) plays crucial roles in the occurrence of various hormone‐dependent or independent malignancies. It is a promising target for treating castration‐resistant prostate cancer (CRPC). However, the development of AKR1C3 specific inhibitors remains challenging due to the high sequence similarity to its isoform AKR1C2. Here, we performed a combined in silico study to illuminate the inhibitory preference of 3‐(3,4‐dihydroisoquinolin‐2(1H)‐ylsulfonyl)benzoic acids for AKR1C3 over AKR1C2, of which compound 38 can achieve up to 5000‐fold anti‐AKR1C3 selectivity. Our umbrella sampling (US) simulations together with end‐point binding free energy calculation MM/GBSA uncover that the high inhibition selectivity originates from the different binding modes, namely “Inward” and “Outward,” of this compound series in AKR1C3 and AKR1C2, respectively. In AKR1C3/38, the tetrahydroquinoline moiety of 38 is accommodated inside the SP1 pocket and interacts favorably with surrounding residues, while, in AKR1C2/38, the SP1 pocket is too small to hold the bulky tetrahydroquinoline group that instead moves out of the pocket with 38 transitioning from an “Inward” to an “Outward” state. Further 3D‐QSAR and energy decomposition analyses suggest that SP1 in AKR1C3 prefers to bind with a rigid bicyclic moiety and the modification of the R3 group has important implication for the compound's activity. This work is the first attempt to elucidate the selectivity mechanism of inhibitors toward AKR1C3 at the atomic level, which is anticipated to propel the development of next‐generation AKR1C3 inhibitors with enhanced efficacy and reduced “off‐target” effect for CRPC therapy.
An Investigation of Reconfigurable Magnetomechanical Metamaterials
Authors: Galea Russell , Farrugia Pierre-Sandre , Dudek Krzysztof K. , Zammit Mangion Louis , Grima Joseph N. , Gatt Ruben
Published: November 2022

Herein, an experimental investigation of an accordion‐like system with embedded magnetic inclusion is carried out. It is shown that the way that this structure deforms when subjected to an external magnetic field depends on the magnetic moment of the embedded magnets and the length of the arms. Stacking of the accordion‐like system leads to the formation of hexagonal honeycombs that can have a negative, zero, and positive Poisson's ratio. Variation in the configuration attained depends on the relative positioning of the magnetic inclusion and the applied magnetic field. In particular, one of the hexagonal honeycomb arrangements is able to switch between a conventional and a re‐entrant configuration upon the reversal of the external magnetic field. For all structures considered, the dimensions can be controlled through the external magnetic field, allowing for a high degree of turnability. Furthermore, their behavior can be altered in real time. The practical implications of the results are of interest since they indicate that these structures can be adopted in numerous applications, such in the design of scaffoldings for deployable structures, actuators, variable pored sieves, and sound proofing systems.
Data‐driven predictive control for a class of uncertain control‐affine systems
Authors: Li Dan , Fooladivanda Dariush , Martínez Sonia
Published: November 2022

This article studies a data‐driven predictive control for a class of control‐affine systems which is subject to uncertainty. With the accessibility to finite sample measurements of the uncertain variables, we aim to find controls which are feasible and provide superior performance guarantees with high probability. This results into the formulation of a stochastic optimization problem (P), which is intractable due to the unknown distribution of the uncertainty variables. By developing a distributionally robust optimization framework, we present an equivalent and yet tractable reformulation of (P). Further, we propose an efficient algorithm that provides online suboptimal data‐driven solutions and guarantees performance with high probability. To illustrate the effectiveness of the proposed approach, we consider a highway speed‐limit control problem. We then develop a set of data‐driven speed controls that allow us to prevent traffic congestion with high probability. Finally, we employ the resulting control method on a traffic simulator to illustrate the effectiveness of this approach numerically.
Klebsiella-Induced Acute Infectious Purpura Fulminans in a Thai Woman: Case Report and Review of Literature
Authors: Temnithikul Bhakinai , Rungrunanghiranya Suthat , Limtanyakul Piyakan , Angkananard Teeranan , Wessagowit Vesarat
Published: November 2022

Purpura fulminans (PF) is an uncommon syndrome of acute purplish skin eruption characterized by coagulation of the microvasculature, which leads to purplish lesions and skin necrosis. There are three subtypes; idiopathic PF, neonatal PF and, the most common subtype, acute infectious PF (AIPF). Acute infectious PF is related to the thrombotic subtype of disseminated intravascular coagulation (DIC) and usually is superimposed on sepsis. This can rapidly lead to multi-organ failure from thrombotic occlusion of small and medium-sized blood vessels. We report a case of Klebsiella-induced AIPF in a 78-year-old Thai woman and also review other published cases.
Semitransparent Perovskite Solar Cells for Photovoltaic Application
Authors: Lou Junjie , Feng Jiangshan , Liu Shengzhong (Frank) , Qin Yong
Published: November 2022

Having a window that generates electricity when sunlight enters the room has long been a dream, and it is most likely to become reality with the advent of thin‐film perovskite solar cells (PSCs). As thin‐film solar cells, high‐efficiency PSCs have two significant advantages. One is that they can be flexible, and the other is that they can be semitransparent (ST). The power conversion efficiency (PCE) of PSCs is now over 25%; meanwhile, the PCE of ST‐PSCs is over 19% for devices formed using various fabrication processes and modification methods. Herein, the challenges leading to the deterioration of the PCE of ST‐PSCs are discussed along with their corresponding solutions. In detail, this review presents an overview of composition engineering, additive engineering, interface engineering, light management, and charge transport management, which are critical factors for fabricating high‐performance ST PSCs. Finally, new challenges and the outlook for future ST‐PSCs research are outlined.
Sandwiched Structure Design for Perovskite Solar Cells with Improved Folding and Environmental Stability
Authors: Lin Huang , Miao Renjie , Wang Haiqiao , Lai Huahang , Wang Weiyan , Song Weijie
Published: November 2022

Foldable perovskite solar cells (PSCs) have promising applications in self‐powered wearable and portable electronic devices. However, the folding stability requires further improvement through mitigating the strain in brittle layers under folding deformation. Herein, sandwich‐structured PSCs (SS‐PSCs) are constructed by coating a protection layer at the back of the device, to tune the neutral plane (NP) place into the brittle perovskite films. To accurately regulating the NP place, the effect of protective layer thickness on the strain distribution in PSCs is simulated. The SS‐PSCs are experimentally prepared using Al2O3/polyethylene terephthalate (PET) protection layer with optimum thickness, combined with ultrathin silver foldable electrodes. Benefitting from the water‐resisting Al2O3/PET, the SS‐PSCs demonstrate high environment stability which maintains 85.1% of original efficiency after 700 h in humidity of 50% ± 10%. More importantly, the SS‐PSCs exhibit excellent mechanical stability, which maintains >90% of the initial efficiency after bending with 4000 cycles at radius of 0.2 mm, and even 67.2% of the initial efficiency after 50 direct folding cycles. As far as it is known, it is one of the best mechanical stable devices. The findings pave the way for realizing not only foldable PSCs but also other foldable optoelectronic devices, such as sensors and organic light emitting devices.
Targeted Locus Amplification and Haplotyping
Authors: Lefferts Juliet W. , Boersma Vera , Hagemeijer Marne C. , Hajo Karima , Beekman Jeffrey M. , Splinter Erik
Published: November 2022

Targeted locus amplification (TLA) allows for the detection of all genetic variation (including structural variation) in a genomic region of interest. As TLA is based on proximity ligation, variants can be linked to each other, thereby enabling allelic phasing and the generation of haplotypes. This allows for the study of genetic variants in an allele-specific manner. Here, we provide a step-by-step protocol for TLA sample preparation and a complete bioinformatics pipeline for the allelic phasing of TLA data. Additionally, to illustrate the protocol, we show the ability of TLA to re-sequence and haplotype the complete cystic fibrosis transmembrane (CFTR) gene (> 200 kb in size) from patient-derived intestinal organoids.
Read-Based Phasing and Analysis of Phased Variants with WhatsHap
Authors: Martin Marcel , Ebert Peter , Marschall Tobias
Published: November 2022

WhatsHap is a command-line tool for phasing and phasing-related tasks. It allows to infer haplotypes in diploid and polyploid samples based on (preferably long) reads covering at least two heterozygous variants. It offers additional tools for working with phased variant calls such as computing statistics, comparing different phasings and assigning reads in alignment files to their haplotype.
Causal diamonds, cluster polytopes and scattering amplitudes
Authors: Arkani-Hamed N. , He S. , Salvatori G. , Thomas H.
Published: November 2022

Abstract

The “amplituhedron” for tree-level scattering amplitudes in the bi-adjoint ϕ3 theory is given by the ABHY associahedron in kinematic space, which has been generalized to give a realization for all finite-type cluster algebra polytopes, labelled by Dynkin diagrams. In this letter we identify a simple physical origin for these polytopes, associated with an interesting (1 + 1)-dimensional causal structure in kinematic space, along with solutions to the wave equation in this kinematic “spacetime” with a natural positivity property. The notion of time evolution in this kinematic spacetime can be abstracted away to a certain “walk”, associated with any acyclic quiver, remarkably yielding a finite cluster polytope for the case of Dynkin quivers. The $$ \mathcal{A} $$
A
n−3,$$ \mathcal{B} $$
B
n−1/$$ \mathcal{C} $$
C
n−1 and $$ \mathcal{D} $$
D
n polytopes are the amplituhedra for n-point tree amplitudes, one-loop tadpole diagrams, and full integrand of one-loop amplitudes. We also introduce a polytope $$ \overline{\mathcal{D}} $$

D
¯

n, which chops the $$ \mathcal{D} $$
D
n polytope in half along a symmetry plane, capturing one-loop amplitudes in a more efficient way.
Probability of Occurrence of Some Planar Random Quasi-homogeneous Vector Fields
Authors: Coll B. , Gasull A. , Prohens R.
Published: November 2022

The objective of this work is the study of the probability of occurrence of phase portraits in a family of planar quasi-homogeneous vector fields of quasi degree q,  that is a natural extension of planar linear vector fields, which correspond to $$q=1.$$

q
=
1
.

We obtain the exact values of the corresponding probabilities in terms of a simple one-variable definite integral that only depends on q. This integral is explicitly computable in the linear case, recovering known results, and it can be expressed in terms of either complete elliptic integrals or of generalized hypergeometric functions in the non-linear one. Moreover, it appears a remarkable phenomenon when q is even: the probability to have a center is positive, in contrast with what happens in the linear case, or also when q is odd, where this probability is zero.
Those who speak survive: the value of the verbal component of GCS in trauma
Authors: Cevik Arif Alper , Alao David Olukolade , Alyafei Eman , Abu-Zidan Fikri
Published: November 2022

Aim

To evaluate the value of the individual components of GCS in predicting the survival of trauma patients in the Emergency Department.

Methods

Trauma patients who were admitted for more than 24 h or died after arrival at Al-Ain Hospital from January 2014 to December 2017 were studied. Children < 16 years, elderly > 80 years, patients with facial injuries, those intubated in the ER, and those with missing primary outcomes were excluded. Demography, vital signs, Glasgow Coma Scale (GCS), GCS components, Injury Severity Score (ISS), head AIS, and death were compared between those who died and those who survived. Factors with a p value of < 0.1 were entered into a backward likelihood logistic regression model to define factors that predict death.

Results

A total of 2548 patients were studied, out of whom 11 (0.4%) died. The verbal component of GCS (p < 0.001) and the ISS (p = 0.047) were the only significant predictors for death in the logistic regression model. The AUC (95% CI) of the GCS-VR was 0.763 (0.58–0.95), p = 0.003. The best point of GCS-VR that predicted survival was 5, having a sensitivity of 97%, a specificity of 54.5%, positive predictive value of 99. 8%, negative predictive value of 7.3%, and likelihood ratio of 2.13.

Conclusion

In general trauma patients, acute trauma care professionals can use GCS-VR to predict survival when clinical condition permits instead of the total GCS score or ISS.
The role of REBOA in patients in traumatic cardiac arrest subsequent to hemorrhagic shock: a scoping review
Authors: Slot S. A. S. , van Oostendorp S. E. , Schoonmade L. J. , Geeraedts L. M. G.
Published: November 2022

Purpose

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a useful adjunct in treatment of patients in severe hemorrhagic shock. Hypothetically, REBOA could benefit patients in traumatic cardiac arrest (TCA) as balloon occlusion of the aorta increases afterload and may improve myocardial performance leading to return of spontaneous circulation (ROSC). This scoping review was conducted to examine the effect of REBOA on patients in TCA.

Methods

This scoping review was conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) Statement. PubMed, EMBASE.com and the Web of Science Core Collection were searched. Articles were included if they reported any data on patients that underwent REBOA and were in TCA. Of the included articles, data regarding SBP, ROSC and survival were extracted and summarized.

Results

Of 854 identified studies, 26 articles met criteria for inclusion. These identified a total of 785 patients in TCA that received REBOA (presumably less because of potential overlap in patients). This review shows REBOA elevates mean SBP in patients in TCA. The achievement of ROSC after REBOA deployment ranged from 18.2% to 67.7%. Survival to discharge ranged from 3.5% to 12.1%.

Conclusion

Overall, weak evidence is available on the use of REBOA in patients in TCA. This review, limited by selection bias, indicates that REBOA elevates SBP and may benefit ROSC and potentially survival to discharge in patients in TCA. Extensive further research is necessary to further clarify the role of REBOA during TCA.
Ten-year follow-up of a total knee prosthesis combining multi-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert shows long-lasting clinically relevant improvements in pain, stiffness, function and stability
Authors: Cosendey Killian , Eudier Antoine , Fleury Nicole , Pereira Luis C. , Favre Julien , Jolles Brigitte M.
Published: November 2022

Purpose

There is a paucity of data available on total knee prostheses combining dual-radius, ultra-congruency, posterior-stabilization and mobile-bearing insert. This prospective cohort study aimed to assess the clinical evolution of the FIRST® prosthesis (Symbios Orthopédie, Yverdon, CH), the earliest prosthesis with this particular design. It was hypothesized that the primary outcomes, evaluating pain, stiffness, function and stability, would improve following arthroplasty and remain improved during the follow-up period of 10 years.

Methods

All patients programmed for a total knee arthroplasty using a FIRST® prosthesis at our university hospital between 2006 and 2008 were invited to participate. Study knees were evaluated pre-operatively as well as one, five and ten years post-operatively. Patients filled out questionnaires at each evaluation point and had a radiographic assessment at the five-year and ten-year follow-ups. Primary outcomes were the total, pain, stiffness and function measures of the Western Ontario and McMaster Universities Osteoarthritis questionnaire (WOMAC) and the knee and function measures of the Knee Society Score (KSS). Friedman and Wilcoxon’s rank-sum tests were used to compare measures across time points.

Results

Hundred and twenty four prostheses were included (baseline demographics: 69.9 ± 8.3 years old, 28.1 ± 4.3 kg/m2, 54% male) and 68 could be followed during ten years. Five prostheses underwent a revision. All other prostheses lost at follow-up were lost for reasons unrelated to the prosthesis. All primary measures reported statistically and clinically significant improvements between baseline and the three follow-up evaluations. Statistically significant improvements at the three follow-up evaluations were also observed for most secondary measures. There was no implant loosening. At ten-year follow-up, radiolucent lines were observed in 2.9% femoral implants and 1.5% tibial implants.

Conclusion

The positive results observed in all domains of assessment and the small revision rate demonstrated an effective functioning of the FIRST® prosthesis during the ten-year follow-up period. The results, globally similar to those previously published for other prosthesis designs, encourage the development of assistive methods to select the most appropriate designs on an individual basis.

Level of evidence

IV, prospective cohort study.
Artificial Intelligence for Pre‐operative Diagnosis of Malignant Thyroid Nodules Based on Sonographic Features and Cytology Category
Authors: Jassal Karishma , Koohestani Afsanesh , Kiu Andrew , Strong April , Ravintharan Nandhini , Yeung Meei , Grodski Simon , Serpell Jonathan W. , Lee James C.
Published: November 2022

Background

Current diagnosis and classification of thyroid nodules are susceptible to subjective factors. Despite widespread use of ultrasonography (USG) and fine needle aspiration cytology (FNAC) to assess thyroid nodules, the interpretation of results is nuanced and requires specialist endocrine surgery input. Using readily available pre‐operative data, the aims of this study were to develop artificial intelligence (AI) models to classify nodules into likely benign or malignant and to compare the diagnostic performance of the models.

Methods

Patients undergoing surgery for thyroid nodules between 2010 and 2020 were recruited from our institution's database into training and testing groups. Demographics, serum TSH level, cytology, ultrasonography features and histopathology data were extracted. The training group USG images were re‐reviewed by a study radiologist experienced in thyroid USG, who reported the relevant features and supplemented with data extracted from existing reports to reduce sampling bias. Testing group USG features were extracted solely from existing reports to reflect real‐life practice of a non‐thyroid specialist. We developed four AI models based on classification algorithms (k‐Nearest Neighbour, Support Vector Machine, Decision Tree, Naïve Bayes) and evaluated their diagnostic performance of thyroid malignancy.

Results

In the training group (n = 857), 75% were female and 27% of cases were malignant. The testing group (n = 198) consisted of 77% females and 17% malignant cases. Mean age was 54.7 ± 16.2 years for the training group and 50.1 ± 17.4 years for the testing group. Following validation with the testing group, support vector machine classifier was found to perform best in predicting final histopathology with an accuracy of 89%, sensitivity 89%, specificity 83%, F‐score 94% and AUROC 0.86.

Conclusion

We have developed a first of its kind, pilot AI model that can accurately predict malignancy in thyroid nodules using USG features, FNAC, demographics and serum TSH. There is potential for a model like this to be used as a decision support tool in under‐resourced areas as well as by non‐thyroid specialists.
Energy expenditure and body composition in a hibernator, the alpine marmot
Authors: Ruf Thomas , Michel M. , Frey-Roos F. , Flatz S. , Tataruch F.
Published: November 2022

Visceral organs and tissues of 89 free-living alpine marmots (Marmota marmota) shot during a population control program in Switzerland, were collected. Between emergence from hibernation in April to July, the gastrointestinal tract (stomach to colon) gained 51% of mass and the liver mass increased by 24%. At the same time, the basal metabolic rate (BMR), determined with a portable oxygen analyzer, increased by 18%. The organ masses of the digestive system (stomach, small intestine, caecum, large intestine) were all significantly correlated with BMR. Interestingly, the mass of abdominal white adipose tissue (WAT) and of the remaining carcass (mainly skin and bones) were also significantly correlated with BMR. These results indicate that the gastrointestinal tract and organs involved in digestive function are metabolically expensive. They also show that it is costly to maintain even tissues with low metabolic rate such as WAT, especially if they are large. Heart and kidneys and especially brain and lungs did not explain a large proportion of the variance in BMR. Marmots increased the uptake of fat prior to hibernation, both by selective feeding and enhanced gastrointestinal capacity. Large fat reserves enable marmots to hibernate without food intake and to reproduce in spring, but at the cost of an elevated BMR. We predict that climate changes that disturb energy accumulation in summer, increase energy expenditure in winter, or delay the emergence from hibernation in spring, such as the occurrence of storms with increasing frequency, will increase mortality in alpine marmots.
Intake of prebiotic fibers and the risk of laryngeal cancer: the PrebiotiCa study
Authors: Turati Federica , Concina Federica , Bertuccio Paola , Fiori Federica , Parpinel Maria , Taborelli Martina , Rosato Valentina , Garavello Werner , Negri Eva , La Vecchia Carlo
Published: November 2022

Purpose

To evaluate whether the intake of specific fibers with prebiotic activity, e.g., inulin-type fructans (ITFs), fructo-oligosaccharides (FOSs), and galacto-oligosaccharides (GOSs), is associated with laryngeal cancer risk.

Methods

Within the PrebiotiCa study, we used data from a case–control study (Italy, 1992–2009) with 689 incident, histologically confirmed laryngeal cancer cases and 1605 controls. Six prebiotic molecules (ITFs, nystose [FOS], kestose [FOS], 1F-β-fructofuranosylnystose [FOS], raffinose [GOS] and stachyose [GOS]) were quantified in various foods via ad hoc conducted laboratory analyses. Subjects’ prebiotic fiber intake was calculated by multiplying food frequency questionnaire intake by the prebiotic content of each food item. The odds ratios (OR) of laryngeal cancer for prebiotic fiber intake were calculated using logistic regression models, including, among others, terms for tobacco, alcohol, and total energy intake.

Results

The intakes of kestose, raffinose and stachyose were inversely associated with laryngeal cancer, with ORs for the highest versus the lowest quartile of 0.70 (95% confidence interval, CI 0.50–0.99) for kestose, 0.65 (95% CI 0.45–0.93) for raffinose and 0.61 (95% CI 0.45–0.83) for stachyose. ITFs, nystose and 1F-β-fructofuranosylnystose were not associated with laryngeal cancer risk. Current smokers and heavy drinkers with medium–low intakes of such prebiotic fibers had, respectively, an over 15-fold increased risk versus never smokers with medium–high intakes and a five to sevenfold increased risk versus never/moderate drinkers with medium–high intakes.

Conclusion

Although disentangling the effects of the various components of fiber-rich foods is complex, our results support a favorable role of selected prebiotic fibers on laryngeal cancers risk.
Prevalence and determinants of Italian physicians’ burnout in the “post-COVID-19” era
Authors: Fiabane Elena , Margheritti Simona , Aiello Edoardo Nicolò , Magnone Stefano , Miglioretti Massimo , Gabanelli Paola , Giorgi Ines
Published: November 2022

Purpose

Several studies investigated prevalence and determinants of physicians’ burnout during the peak of the COVID-19 pandemic, but only a few during the chronic phase of the pandemic. This study thus aimed to examine this topic referring to the “post-COVID-19 era”, defined as a chronic and likely-to-be endemic status quo.

Methods

A cross-sectional, online survey (November 2021–January 2022) was addressed to physicians in Lombardia (Northern Italy). Besides socio-demographic and COVID-19-related data, measures of personal, work- and patient-related burnout (Copenhagen Burnout Inventory; CBI), depression (Patient Health Questionnaire-8), anxiety (General Anxiety Disorder-7), and self-efficacy (General Self-Efficacy Scale) were collected. Linear/generalized linear models were run to test associations/predictions of interest.

Results

Among the 958 respondents, burnout symptoms were clinically significant in 18.5% of them. Predictive models showed that female sex (OR = 0.73, 95% CI 0.42–1.27), younger age (OR = 0.94, 95% CI 0.59–1.48), shorter job tenure (OR = 1.01, 95% CI 0.62–1.65), trainee status (OR = 1.41, 95% CI 1.16–7.10), higher PHQ-8 (OR = 1.260, 95% CI 1.16–1.37), and GAD-7 scores (OR = 1.19, 95% CI 1.10–1.30) increased the risk to suffer from clinical burnout. COVID-19-related variables were mostly not related/associated to burnout levels.

Conclusion

In Italy, physicians’ burnout is moderately prevalent also in the chronic phase of the pandemic, with its determinants being more intrinsic than environmental. The development of effective interventions is needed to help physicians cope with the new challenges of their job.
Spatio-temporal statistical analysis of PM1 and PM2.5 concentrations and their key influencing factors at Guayaquil city, Ecuador
Authors: Rincon Gladys , Morantes Giobertti , Roa-López Heydi , Cornejo-Rodriguez Maria del Pilar , Jones Benjamin , Cremades Lázaro V.
Published: November 2022

Guayaquil, Ecuador, is in a tropical area on the equatorial Pacific Ocean coast of South America. Since 2008 the city has been increasing its population, vehicle fleet and manufacturing industries. Within the city there are various industrial and urban land uses sharing the same space. With regard to air quality there is a lack of government information on it. Therefore, the research’s aim was to investigate the spatio-temporal characteristics of PM1 and PM2.5 concentrations and their main influencing factors. For this, both PM fractions were sampled and a bivariate analysis (cross-correlation and Pearson's correlation), multivariate linear and logistic regression analysis was applied. Hourly and daily PM1 and PM2.5 were the dependent variables, and meteorological variables, occurrence of events and characteristics of land use were the independent variables. We found 48% exceedances of the PM2.5-24 h World Health Organization 2021 threshold’s, which questions the city’s air quality. The cross-correlation function and Pearson’s correlation analysis indicate that hourly and daily temperature, relative humidity, and wind speed have a complex nonlinear relationship with PM concentrations. Multivariate linear and logistic regression models for PM1-24 h showed that rain and the flat orography of cement plant sector decrease concentrations; while unusual PM emission events (traffic jams and vegetation-fires) increase them. The same models for PM2.5-24 h show that the dry season and the industrial sector (strong activity) increase the concentration of PM2.5-24 h, and the cement plant decrease them. Public policies and interventions should aim to regulate land uses while continuously monitoring emission sources, both regular and unusual.
Targeting the brain 5-HT7 receptor to prevent hypomyelination in a rodent model of perinatal white matter injuries
Authors: Bokobza Cindy , Jacquens Alice , Guenoun David , Bianco Blandine , Galland Anne , Pispisa Maxime , Cruz Alexandra , Zinni Manuela , Faivre Valérie , Roumier Anne , Lebon Sophie , Vitalis Tania , Csaba Zsolt , Le Charpentier Tifenn , Schwendimann Leslie , Young-Ten Pierrette , Degos Vincent , Monteiro Patricia , Dournaud Pascal , Gressens Pierre , Van Steenwinckel Juliette
Published: November 2022

Approximately 15 million babies are born prematurely every year and many will face lifetime motor and/or cognitive deficits. Children born prematurely are at higher risk of developing perinatal brain lesions, especially white matter injuries (WMI). Evidence in humans and rodents demonstrates that systemic inflammation-induced neuroinflammation, including microglial and astrocyte reactivity, is the prominent processes of WMI associated with preterm birth. Thus, a new challenge in the field of perinatal brain injuries is to develop new neuroprotective strategies to target neuroinflammation to prevent WMI. Serotonin (5-HT) and its receptors play an important role in inflammation, and emerging evidence indicates that 5-HT may regulate brain inflammation by the modulation of microglial reactivity and astrocyte functions. The present study is based on a mouse model of WMI induced by intraperitoneal (i.p.) injections of IL-1β during the first 5 days of life. In this model, certain key lesions of preterm brain injuries can be summarized by (i) systemic inflammation, (ii) pro-inflammatory microglial and astrocyte activation, and (iii) inhibition of oligodendrocyte maturation, leading to hypomyelination. We demonstrate that Htr7 mRNA (coding for the HTR7/5-HT7 receptor) is significantly overexpressed in the anterior cortex of IL-1β-exposed animals, suggesting it as a potential therapeutic target. LP-211 is a specific high-affinity HTR7 agonist that crosses the blood–brain barrier (BBB). When co-injected with IL-1β, LP-211 treatment prevented glial reactivity, the down-regulation of myelin-associated proteins, and the apparition of anxiety-like phenotypes. Thus, HTR7 may represent an innovative therapeutic target to protect the developing brain from preterm brain injuries.
Motor and non-motor improvements following short-term multidisciplinary day-clinic care in Parkinson´s disease
Authors: Krause Patricia , Berking Sara , Astalosch Melanie , Grünheid Raymond , Kühn Andrea A.
Published: November 2022

Background

Inpatient as well as outpatient care does often not meet PD-patients’ individual needs.

Introduction

Day-clinic concepts encompassing a multidisciplinary team as well as therapy adjustments accompanying everyday demands aim at filling this gap.

Methods

This is a retrospective study on short-term effects of a 3 week multidisciplinary rehabilitation program in patients with Parkinson´s disease (PD) embedded in a specialized movement disorder day-clinic. We analyzed short-term outcome of motor and non-motor symptoms (NMS) in 143 PD-patients (mean age 65.3 ± 11.9 years; Hoehn-and-Yahr-score 2.6 ± 0.7) after 3 weeks with 7.4 ± 1.8 active days of interdisciplinary day-care treatment. Participants attended the day-clinic in groups of five patients at a time. Improvements were evaluated by comparison of standardized physical therapy assessments, disease specific scores for motor symptoms (MDS–UPDRS III), mood (BDI), quality of life (PDQ39, SF36), sleep (PDSS, ESS), impulsiveness (QUIP), apathy (SAS), cognition (MMST), as well as change in medication before and directly after the intervention.

Results

MDS–UPDRS motor score improved significantly by 22.9 ± 21.5% (p < 0.001) and was accompanied by a significant reduction of imbalance, immobility, and weakness ranging between 6% and 17% in standardized physical therapy tests. In addition, all disease-specific non-motor scales improved significantly.

Conclusions

A multidisciplinary day-clinic approach can support benefit on motor, non-motor symptoms and QoL in PD-patients. Given the increase in PD incidence and prevalence as well as the significant treatment effects shown here, more day-clinic treatment opportunities ought to be implemented to improve PD treatment adapted to everyday challenges while still reducing costs to the health care system.
Long-term outcomes after close rectal dissection and total mesorectal excision in ileal pouch-anal anastomosis for ulcerative colitis
Authors: Reijntjes M. A. , de Jong D. C. , Bartels S. , Wessels E. M. , Bocharewicz E. K. , Hompes R. , Buskens C. J. , d’Haens G. R. , Duijvestein M. , Bemelman W. A.
Published: November 2022

Background

During ileal pouch-anal anastomosis (IPAA) surgery for ulcerative colitis (UC), rectal dissection can be performed via close rectal dissection (CRD) or in a total mesorectal excision plane (TME). Although CRD should protect autonomic nerve function, this technique may be more challenging than TME. The aim of this study was to compare long-term outcomes of patients undergoing CRD and TME.

Methods

This single-centre retrospective cohort study included consecutive patients who underwent IPAA surgery for UC between January 2002 and October 2017. Primary outcomes were chronic pouch failure (PF) among patients who underwent CRD and TME and the association between CRD and developing chronic PF. Chronic PF was defined as a pouch-related complication occurring ≥ 3 months after primary IPAA surgery requiring redo pouch surgery, pouch excision or permanent defunctioning ileostomy. Secondary outcomes were risk factors and causes for chronic PF. Pouch function and quality of life were assessed via the Pouch dysfunction score and Cleveland global quality of life score.

Results

Out of 289 patients (155 males, median age 37 years [interquartile range 26.5–45.5 years]), 128 underwent CRD. There was a shorter median postoperative follow-up for CRD patients than for TME patients (3.7 vs 10.9 years, p < 0.01). Chronic PF occurred in 6 (4.7%) CRD patients and 20 (12.4%) TME patients. The failure-free pouch survival rate 3 years after IPAA surgery was comparable among CRD and TME patients (96.1% vs. 93.5%, p = 0.5). CRD was a no predictor for developing chronic PF on univariate analyses (HR 0.7 CI-95 0.3–2.0, p = 0.54). A lower proportion of CRD patients developed chronic PF due to a septic cause (1% vs 6%, p = 0.03).

Conclusions

Although differences in chronic PF among CRD and TME patients were not observed, a trend toward TME patients developing chronic pelvic sepsis was detected. Surgeons may consider performing CRD during IPAA surgery for UC.
Understanding altered contractile properties in advanced age: insights from a systematic muscle modelling approach
Authors: Mayfield Dean L. , Cronin Neil J. , Lichtwark Glen A.
Published: November 2022

Age-related alterations of skeletal muscle are numerous and present inconsistently, and the effect of their interaction on contractile performance can be nonintuitive. Hill-type muscle models predict muscle force according to well-characterised contractile phenomena. Coupled with simple, yet reasonably realistic activation dynamics, such models consist of parameters that are meaningfully linked to fundamental aspects of muscle excitation and contraction. We aimed to illustrate the utility of a muscle model for elucidating relevant mechanisms and predicting changes in output by simulating the individual and combined effects on isometric force of several known ageing-related adaptations. Simulating literature-informed reductions in free Ca2+ concentration and Ca2+ sensitivity generated predictions at odds qualitatively with the characteristic slowing of contraction speed. Conversely, incorporating slower Ca2+ removal or a fractional increase in type I fibre area emulated expected changes; the former was required to simulate slowing of the twitch measured experimentally. Slower Ca2+ removal more than compensated for force loss arising from a large reduction in Ca2+ sensitivity or moderate reduction in Ca2+ release, producing realistic age-related shifts in the force-frequency relationship. Consistent with empirical data, reductions in free Ca2+ concentration and Ca2+ sensitivity reduced maximum tetanic force only slightly, even when acting in concert, suggesting a modest contribution to lower specific force. Lower tendon stiffness and slower intrinsic shortening speed slowed and prolonged force development in a compliance-dependent manner without affecting force decay. This work demonstrates the advantages of muscle modelling for exploring sources of variation and identifying mechanisms underpinning the altered contractile properties of aged muscle.