bluuebunny/crossref_metadata_2025 huggingface dataset:
Vacuum-assisted closure versus on-demand relaparotomy in patients with secondary peritonitis—the VACOR trial: protocol for a randomised controlled trial
Authors: Rajabaleyan Pooya , Michelsen Jens , Tange Holst Uffe , Möller Sören , Toft Palle , Luxhøi Jan , Buyukuslu Musa , Bohm Aske Mathias , Borly Lars , Sandblom Gabriel , Kobborg Martin , Aagaard Poulsen Kristian , Schou Løve Uffe , Ovesen Sophie , Grant Sølling Christoffer , Mørch Søndergaard Birgitte , Lund Lomholt Marianne , Ritz Møller Dorthe , Qvist Niels , Bremholm Ellebæk Mark ,   The VACOR study group, Michelsen Jens , Holst Uffe Tange , Möller Sören , Toft Palle , Luxhøi Jan , Buyukuslu Musa , Bohm Aske Mathias , Borly Lars , Sandblom Gabriel , Kobborg Martin , Poulsen Kristian Aagaard , Løve Uffe Schou , Ovesen Sophie , Sølling Christoffer Grant , Søndergaard Birgitte Mørch , Lomholt Marianne Lund , Møller Dorthe Ritz , Qvist Niels , Ellebæk Mark Bremholm
Published: May 2022

Background

Secondary peritonitis is a severe condition with a 20–32% reported mortality. The accepted treatment modalities are vacuum-assisted closure (VAC) or primary closure with relaparotomy on-demand (ROD). However, no randomised controlled trial has been completed to compare the two methods potential benefits and disadvantages.

Methods

This study will be a randomised controlled multicentre trial, including patients aged 18 years or older with purulent or faecal peritonitis confined to at least two of the four abdominal quadrants originating from the small intestine, colon, or rectum. Randomisation will be web-based to either primary closure with ROD or VAC in blocks of 2, 4, and 6. The primary endpoint is peritonitis-related complications within 30 or 90 days and one year after index operation. Secondary outcomes are comprehensive complication index (CCI) and mortality after 30 or 90 days and one year; quality of life assessment by (SF-36) after three and 12 months, the development of incisional hernia after 12 months assessed by clinical examination and CT-scanning and healthcare resource utilisation. With an estimated superiority of 15% in the primary outcome for VAC, 340 patients must be included. Hospitals in Denmark and Europe will be invited to participate.

Discussion

There is no robust evidence for choosing either open abdomen with VAC treatment or primary closure with relaparotomy on-demand in patients with secondary peritonitis. The present study has the potential to answer this important clinical question.

Trial Registration

The study protocol has been registered at clinicaltrials.gov (NCT03932461). Protocol version 1.0, 9 January 2022.
The prognostic significance of postoperative hyperbilirubinemia in cardiac surgery: systematic review and meta-analysis
Authors: Raveendran Dev , Penny-Dimri Jahan C. , Segal Reny , Smith Julian A. , Plummer Mark , Liu Zhengyang , Perry Luke A.
Published: May 2022

Background

Hyperbilirubinemia following cardiac surgery is a common phenomenon and is of emerging interest in prognostic factor research. This systematic review and meta-analysis evaluated the association between post-operative hyperbilirubinemia (PH) and mortality and morbidity in cardiac surgery patients.

Methods

Ovid Medline and Ovid Embase were searched from inception to July 2020 for studies evaluating the prognostic significance of PH following cardiac surgery. Maximally adjusted odds ratios (OR) with associated confidence intervals were obtained from each study and pooled using random effects inverse variance modelling to assess in-hospital mortality. Standardised mean differences were pooled to assess Intensive Care Unit (ICU) and hospital length of stay (LOS). Qualitative analysis was performed to assess ventilation requirements and long-term mortality. Meta-regression was used to assess inter- and intra-study heterogeneity.

Results

3251 studies satisfied the selection criteria, from which 12 studies incorporating 3876 participants were included. PH significantly predicted in-hospital mortality with a pooled OR of 7.29 (95% CI 3.53, 15.09). Multiple pre-defined covariates contributed to the prognostic significance of PH, however only aortic cross-clamp time (p < 0.0001) and number of transfusions (p = 0.0001) were significant effect modifiers. PH significantly predicted both ICU LOS (Mean difference 1.32 [95% CI 0.04–2.6]) and hospital LOS (Mean difference 1.79 [95% CI 0.36–3.21]). Qualitative analysis suggested PH is associated with increased post-operative ventilation requirements and reduced long-term survival rates.

Conclusions

Hyperbilirubinemia is a cost-effective, widely available prognostic marker of adverse outcomes following cardiac surgery, albeit with residual sources of heterogeneity.
Carbon dioxide and particulate emissions from the 2013 Tasmanian firestorm: implications for Australian carbon accounting
Authors: Ndalila Mercy N. , Williamson Grant J. , Bowman David M. J. S.
Published: May 2022

Background

Uncontrolled wildfires in Australian temperateEucalyptusforests produce significant smoke emissions, particularly carbon dioxide (CO2) and particulates. Emissions from fires in these ecosystems, however, have received less research attention than the fires in North American conifer forests or frequently burned Australian tropical savannas. Here, we use the 2013 Forcett–Dunalley fire that caused the first recorded pyrocumulonimbus event in Tasmania, to understand CO2and particulate matter (PM2.5) emissions from a severeEucalyptusforest fire. We investigate the spatial patterns of the two emissions using a fine scale mapping of vegetation and fire severity (50 m resolution), and utilising available emission factors suitable for Australian vegetation types. We compare the results with coarse-scale (28 km resolution) emissions estimates from Global Fire Emissions Database (GFED) to determine the reliability of the global model in emissions estimation.

Results

The fine scale inventory yielded total CO2emission of 1.125 ± 0.232 Tg and PM2.5emission of 0.022 ± 0.006 Tg, representing a loss of 56 t CO2ha−1and 1 t PM2.5 ha−1. The CO2emissions were comparable to GFED estimates, but GFED PM2.5estimates were lower by a factor of three. This study highlights the reliability of GFED for CO2but not PM2.5for estimating emissions fromEucalyptusforest fires. Our fine scale and GFED estimates showed that the Forcett–Dunalley fire produced 30% of 2013 fire carbon emissions in Tasmania, and 26–36% of mean annual fire emissions for the State, representing a significant single source of emissions.

Conclusions

Our analyses highlight the need for improved PM2.5emission factors specific to Australian vegetation, and better characterisation of fuel loads, particularly coarse fuel loads, to quantify wildfire particulate and greenhouse gas emissions more accurately. Current Australian carbon accountancy approach of excluding large wildfires from final GHG accounts likely exaggerates Tasmania’s claim to carbon neutrality; we therefore recommend that planned and unplanned emissions are included in the final national and state greenhouse gas accounting to international conventions. Advancing these issues is important given the trajectory of more frequent large fires driven by anthropogenic climate change.
Congenital hydrocephalus in a trisomy 9p gained child: a case report
Authors: Henningsen Mikkel Bak , Gulisano Helga Angela , Bjarkam Carsten Reidies
Published: May 2022

Background

Hydrocephalus caused by excessive liquor production due to choroid plexus hyperplasia is a rare condition that may necessitate unusual treatment paradigms. It can be seen in trisomy 9p where coexisting congenital heart disease additionally may complicate the therapeutic approach as illustrated in the current case report.

Case presentation

At 20 months of age, a Caucasian girl with trisomy 9 and family history of an older brother and twin sister having the same syndrome displayed sign of congenital hydrocephalus due to increasing head circumference. Magnetic resonance imaging revealed enlarged lateral ventricles and a prominent choroid plexus, and the girl was treated with a ventriculoperitoneal shunt, which 2 days later had to be replaced with a ventriculoatrial shunt as cerebrospinal fluid formation greatly exceeded the ability of the patient’s abdominal absorptive capability. At 16 years of age, the patient was diagnosed with cardiomyopathy and diminished ejection fraction. Some months later, she was admitted to the neurosurgical ward showing signs of shunt dysfunction due to a colloid cyst in the third ventricle. Cystic drainage through endoscopic puncture only helped temporarily. Revision of the shunt system showed occlusion of the ventricular drain, and replacement was merely temporary alleviating. Intracerebral pressure was significantly increased at around 30 mmHg, prompting externalization of the drain, and measurements revealed high cerebrospinal fluid production of 60–100 ml liquor per hour. Thus, endoscopic choroid plexus coagulation was performed bilaterally leading to an immediate decrease of daily cerebrospinal fluid formation to 20–30 ml liquor per hour, and these values where stabilized by pharmaceutical treatment with acetazolamide 100 mg/kg/day and furosemide 1 mg/kg/day. Subsequently a ventriculoperitoneal shunt was placed. Follow-up after 1 and 2 months displayed no signs of hydrocephalus or ascites.

Conclusions

High cerebrospinal fluid volume load and coexisting heart disease in children with trisomy 9p may call for endoscopic choroid plexus coagulation and pharmacological therapy to diminish the daily cerebrospinal fluid production to volumes that allow proper ventriculoperitoneal shunting.
Human-induced pluripotent stem cells-derived retinal pigmented epithelium, a new horizon for cells-based therapies for age-related macular degeneration
Authors: Dehghan Samaneh , Mirshahi Reza , Shoae-Hassani Alireza , Naseripour Masood
Published: May 2022

Retinal pigment epithelium (RPE) degeneration is the hallmark of age-related macular degeneration (AMD). AMD, as one of the most common causes of irreversible visual impairment worldwide, remains in need of an appropriate approach to restore retinal function. Wet AMD, which is characterized by neovascular formation, can be stabilized by currently available therapies, including laser photocoagulation, photodynamic therapy, and intraocular injections of anti-VEFG (anti-vascular endothelial growth factor) therapy or a combination of these modalities. Unlike wet AMD, there is no effective therapy for progressive dry (non-neovascular) AMD. However, stem cell-based therapies, a part of regenerative medicine, have shown promising results for retinal degenerative diseases such as AMD. The goal of RPE cell therapy is to return the normal structure and function of the retina by re-establishing its interaction with photoreceptors, which is essential to vision. Considering the limited source of naturally occurring RPE cells, recent progress in stem cell research has allowed the generation of RPE cells from human pluripotent cells, both embryonic stem cells (ESCs) and induced pluripotent stem cells (iPSC). Since iPSCs face neither ethical arguments nor significant immunological considerations when compared to ESCs, they open a new horizon for cell therapy of AMD. The current study aims to discuss AMD, review the protocols for making human iPSCs-derived RPEs, and summarize recent developments in the field of iPSC-derived RPEs cell therapy.
BHLHE40 promotes osteoclastogenesis and abnormal bone resorption via c-Fos/NFATc1
Authors: Zhang Yufeng , Yang Min , Zhang Sheng , Yang Zhiqiang , Zhu Yufan , Wang Yi , Chen Zhe , Lv Xuan , Huang Zan , Xie Yuanlong , Cai Lin
Published: May 2022

Background

Dysregulated osteoclast activity due to altered osteoclast differentiation causes multiple bone diseases. Osteoclasts are multinucleated giant cells derived from hematopoietic stem cells and play a major role in bone absorption. However, the mechanisms underlying the tight regulation of osteoclast differentiation in multiple pathophysiological status remain unknown.

Results

We showed that Bhlhe40 upregulation is tightly associated with osteoclast differentiation and osteoporosis. Functionally, Bhlhe40 promoted osteoclast differentiation in vitro, and Bhlhe40 deficiency led to increased bone mass and decreased osteoclast differentiation in vivo. Moreover, Bhlhe40 deficient mice resisted estrogen deficiency and aging-induced osteoporosis. Mechanism study showed that the increase in bone mass due to Bhlhe40 deficiency was a cell intrinsic defect in osteoclast differentiation in these mice. BHLHE40 upregulated the gene expression of Fos and Nfatc1 by directly binding to their promoter regions. Notably, inhibition of Fos/Nfatc1 abrogated the enhanced osteoclast differentiation induced by BHLHE40 overexpression.

Conclusions

Our research reveals a novel Bhlhe40/c-Fos/Nfatc1 axis involved in regulating osteoclastogenesis and shows that osteoporosis caused by estrogen deficiency and aging can be rescued by regulating Bhlhe40 in mice. This may help in the development of a new strategy for the treatment of osteoporosis.
Bridging treatment prior to liver transplantation for hepatocellular carcinoma: radioembolization or transarterial chemoembolization?
Authors: Benkö Tamás , König Julia , Theysohn Jens M. , Schotten Clemens , Saner Fuat H. , Treckmann Jürgen , Radunz Sonia
Published: May 2022

Background

In hepatocellular carcinoma (HCC) patients, intraarterial therapies are regularly employed as a bridge to liver transplantation to prevent tumor progression during waiting time. Objective of this study was to compare HCC recurrence after liver transplantation following TACE or radioembolization bridging treatment.

Methods

We retrospectively analyzed prospectively collected data on 131 consecutive HCC patients who underwent liver transplantation between January 2007 and December 2017 at our liver transplant center (radioembolizationn = 44, TACEn = 87). Multivariable logistic regression and cox proportional hazard regression models were used to evaluate factors associated with tumor recurrence and post-transplant survival.

Results

Between groups, patients were comparable with regards to age and gender. In the radioembolization group, Milan criteria for HCC were met significantly less frequently (20.5% vs. 65.5%,p < 0.0001). Patients in the radioembolization group required significantly fewer intraarterial treatments (1 [1–2] vs. 1 [1–7],p = 0.0007). On explant specimen, tumor differentiation, microvascular invasion and tumor necrosis were comparable between the groups. HCC recurrence and overall survival were similar between the groups. Multivariable analysis detected increasing recipient age, male gender, complete tumor necrosis and absence of microvascular invasion being independently associated with decreased odds for HCC recurrence. Increasing model of end-stage liver disease (MELD) score and tumor recurrence were independently associated with increased odds of post-transplant death.

Conclusions

Intraarterial bridging treatment leading to tumor necrosis may not only prevent waitlist drop-out but also facilitate long-term successful liver transplantation in HCC patients. Both radioembolization and TACE represent potent treatment strategies.
Hydrocephalus and the neuro-intensivist: CSF hydrodynamics at the bedside
Authors: Papaioannou Vasilios , Czosnyka Zofia , Czosnyka Marek
Published: May 2022

Hydrocephalus (HCP) is far more complicated than a simple disorder of cerebrospinal fluid (CSF) circulation. HCP is a common complication in patients with subarachnoid hemorrhage (SAH) and after craniectomy. Clinical measurement in HCP is mainly related to intracranial pressure (ICP) and cerebral blood flow. The ability to obtain quantitative variables that describe CSF dynamics at the bedside before potential shunting may support clinical intuition with a description of CSF dysfunction and differentiation between normal pressure hydrocephalus and brain atrophy. This review discusses the advanced research on HCP and how CSF is generated, stored and absorbed within the context of a mathematical model developed by Marmarou. Then, we proceed to explain the main quantification analysis of CSF dynamics using infusion techniques for deciding on definitive treatment. We consider that such descriptions of multiple parameters of measurements need to be significantly appreciated by the caring neuro-intensivist, for better understanding of the complex pathophysiology and clinical management and finally, improve of the prognosis of these patients with HCP.
Ethical principles of renal therapy rationing in Senegal
Authors: Faye Fatoumata Mbagnick , Audibert Martine
Published: May 2022

Background

Since 2012, Senegal has conducted a national program to cover renal therapy (dialysis) expenses in public hospitals and social security-approved centers. Given the increasing demand for dialysis, national guidelines recommend explicit rationing through waiting lists, and hospitals have committees to determine whom to enroll. While national recommendations are known, criteria applied in hospitals to register patients remain unclear. Our study analyzes social justice principles used to ration renal therapy in government-owned centers and highlights inequalities caused by low access to treatment.

Methods

We conduct a multivariate logit regression analysis using data collected from patients in public and private centers to identify which socioeconomic or sociodemographic factors determine enrollment. Based on the average marginal effects of these factors on program enrollment, we hypothesize the justice principles applied (or not) in hospitals.

Results

We find that the duration of illness, insurance distribution, age, education, and involvement in patient associations influence program access. The duration of illness is the most robust predictor regardless of socioeconomic factors, which suggests the predominant application of egalitarian principles, notably the first-come-first-served rule. However, our findings indicate that the most impoverished patients do not have access to free dialysis.

Conclusions

Although the national dialysis program aims to improve access to costly life-sustaining treatment, the first-come-first-served strategy is designed to suit patients who live longer, that is, those who can seek dialysis care in a private center. The program does not address inequalities in access, especially for the most impoverished patients recently diagnosed with end-stage kidney disease.
Fertility decline and the emergence of excess female survival in post-reproductive ages in Italy
Authors: Salinari Gianbattista , De Santis Gustavo , Zarulli Virginia , Giuliani Cristina , Franceschi Claudio , Breschi Marco
Published: May 2022

In Italy, at least in the cohorts born up to the beginning of the twentieth century, women’s mortality in post-reproductive ages was influenced by fertility, with large progenies (and, to a lesser extent, childlessness) leading to markedly lower survival chances. This relationship proved strong enough to affect the female-to-male ratio in old age as fertility declined. In this paper, we show that various measures of extra female survival at high ages are closely connected to the fertility transition in Italy, and to its peculiar historical and geographical evolution.
Effects of experience on recognition of speech produced with a face mask
Authors: Crinnion Anne Marie , Toscano Joseph C. , Toscano Cheyenne M.
Published: May 2022

Over the past two years, face masks have been a critical tool for preventing the spread of COVID-19. While previous studies have examined the effects of masks on speech recognition, much of this work was conducted early in the pandemic. Given that human listeners are able to adapt to a wide variety of novel contexts in speech perception, an open question concerns the extent to which listeners have adapted to masked speech during the pandemic. In order to evaluate this, we replicated Toscano and Toscano (PLOS ONE 16(2):e0246842, 2021), looking at the effects of several types of face masks on speech recognition in different levels of multi-talker babble noise. We also examined the effects of listeners’ self-reported frequency of encounters with masked speech and the effects of the implementation of public mask mandates on speech recognition. Overall, we found that listeners’ performance in the current experiment (with data collected in 2021) was similar to that of listeners in Toscano and Toscano (with data collected in 2020) and that performance did not differ based on mask experience. These findings suggest that listeners may have already adapted to masked speech by the time data were collected in 2020, are unable to adapt to masked speech, require additional context to be able to adapt, or that talkers also changed their productions over time. Implications for theories of perceptual learning in speech are discussed.
Chromosomal studies on drug resistance genes in extended spectrum β-lactamases producing-Klebsiella pneumoniae isolated from equine
Authors: Fawzy Nehal M. , Abd Elmawgoud Shaimaa R. A. , El-Shafii Soumaya S. A. , Farag Azza N. , Osman Kamelia M.
Published: May 2022

Background

K. pneumoniae is one of the most virulent and multidrug resistant bacteria, of great concern in both human and veterinary medicine. Studies conducted on the drug resistance of Klebsiella pneumoniae in equine are lack in Egypt.

Results

The distribution pattern of ten drug resistance genes were investigated and analyzed among fifteen Klebsiella isolates (previously isolated, identified and antibiogram tested). The targeted determinant genes were coded on the chromosomes, conferring the resistance against β-lactams, carbapenems, fluoroquinolones and aminoglycosides, in addition to the gene determinants of porin protein and efflux pump. The study revealed an incidence rate of 86.7, 100, 23, 7.7, 0, 0, 73.3, 40, 100 and 0% for the genes blaCTX-M, blaTEM, blaKPC, blaNDM-1, blaVIM, qnrB, qnrS, aadA1, AcrAB and ompK35 respectively. The Extended Spectrum β-lactamase-production coding genes were detected in all strains with at least one of their genes. In addition, the efflux pump codding gene and mutation in porin protein gene, which are two important co-factors in the drug resistance mechanism were also detected in all strains. By investigating the association of the drug resistance determinants within a single strain, it was showed that 40% (6/15) of the strains harbored 5 associated genes, 27.7% (4/15) harbored 6 associated genes, 13.3% (2/15) harbored 4 and 7 genes as well and finally only 1 isolate harbored 3 determinants, with complete absence of strains having sole existence of one gene or even two. Pareto chart elucidated that the association of β-lactamases, AcrAB and Qnr with the mutation of the porin protein was the most existed (26.7%). Interestingly, the sequencing results of the CTX-M PCR amplicons were typed as OXY-5 (50%), CTX-M-15 (40%) and CTX-M-27 (10%).

Conclusions

The current study represented the first record of the drug resistance genes’ predominance and their association among the K. pneumoniae strains; recovered from equine in Egypt, offering a helpful guide for scientists seeking new alternatives other-than antibiotics.
Early rehabilitation program and weaning outcomes in critically ill chronic obstructed airway disease patients: a randomized trial
Authors: Shaaban Lamiaa , Abdeen Ashraf , Saleh Hend Mohamed , Mahran Safaa A. , Farghaly Shereen
Published: May 2022

Background

To compare the effectiveness of early rehabilitation program on mechanical ventilated COPD patient in RICU to those using current usual care regarding diaphragm function and weaning outcomes.

Methods

The study was a randomized controlled trial. It included 108 newly admitted COPD patients to RICU, Chest Department, Assiut University Hospital, Egypt, in the period from June 2018 to May 2020. They were divided into two groups: group Ι received the usual care plus pulmonary rehabilitation program, and group II received the usual care alone. The outcomes (MV duration, rates of successful weaning, diaphragm function, and lengths of hospital and ICU stay) were recorded and evaluated. The data was analyzed using Student t-test, Mann–Whitney U-test, Wilcoxon signed-rank test, chi-square (χ2) test or Fisher Exact test, receiver operating characteristics (ROC) curve, and logistic regression analysis.

Results

One-hundred and eight COPD patients were included. Early rehabilitation program for COPD patients in the ICU shortened the duration of their MV, increases the rates of successful weaning and decreases 30-day mortality, and shortened the duration of their ICU and hospital stays, as compared to COPD patients who received usual care.

Conclusions

Management of COPD patients with early rehabilitation program is associated with better outcome with improvement of the quality of life of COPD patients.

Trial registration

Clinical trial.gov: NCT03253380
Incels, violence and mental disorder: a narrative review with recommendations for best practice in risk assessment and clinical intervention
Authors: Broyd Josephine , Boniface Lauren , Parsons Damon , Murphy David , Hafferty Jonathan D
Published: May 2022

In recent years, mass violence associated with men who identify as involuntary celibates (incels) has been of increasing concern. Incels engage in an online community where misogyny and incitements to violence against women are prevalent, often owing to the belief that women are denying them a ‘right’ to sex. Indeed, inceldom can be considered a form of extremism. Information released about the prepetrators of incel-associated violence consistently suggests that mental disorder is a contributory factor and may increase vulnerability to engaging with the incel community. Depression, autism and personality disorder are particularly relevant. To date, there has been little research into the mental health of incels and how, in some, this contributes to violence. This article considers the associations between mental disorder and inceldom, including the risk factors for incel-related violence, and makes recommendations for best practice in risk assessment and clinical intervention.
Catalytic Synthesis of Oxazolidinones from a Chitin-Derived Sugar Alcohol
Authors: Sagawa Takuya , Kobayashi Hirokazu , Murata Chinatsu , Shichibu Yukatsu , Konishi Katsuaki , Hashizume Mineo , Fukuoka Atsushi
Published: May 2022

Chitin is an abundant marine biomass that contains nitrogen atoms in its monomer units. Therefore, it is an attractive feedstock for the production of renewable organonitrogen compounds. The hydrolytic hydrogenation of chitin produces 2-acetamide-2-deoxysorbitol (ADS), which is a potential platform chemical in chitin-based biorefinery. In this work, we report the catalytic conversion of ADS to oxazolidinones named 2,3-OX and 1,2-OX. Of the two isomers, 2,3-OX possesses specific chirality suited for the application of antibiotic agents, naturally derived from ADS. This work demonstrates that a ubiquitous base catalyst, KHCO3, selectively gives 2,3-OX in 84% yield, 12 times more preferential than 1,2-OX under kinetic control. DFT calculations show that inner-molecular hydrogen bonds formed in the transition states specifically reduce the energy barrier for the 2,3-OX formation, thus giving this isomer selectively. We also found that the addition of boron compounds slightly shifts the selectivity towards 1,2-OX.
Hierarchically Porous Carbon from Phoenix dactylifera Seed for High-Performance Supercapacitor Applications
Authors: Shrestha Rekha Goswami , Maji Subrata , Mallick Aabhash Kumar , Jha Abhimanyu , Man Shrestha Rajeshwar , Rajbhandari Rinita , Hill Jonathan P , Ariga Katsuhiko , Shrestha Lok Kumar
Published: May 2022

Large surface area hierarchically nanoporous activated carbons are prepared by KOH activation and high temperature carbonization of agricultural waste, Phoenix dactylifera (date) seeds. The nanoporous activated carbon obtained by this method has excellent surface porosity with very large surface area, typically 2383.2 m2 g−1, and large pore volume (1.76 cm3 g−1) due to their interconnected micro- and mesoporous structure. The hierarchically nanoporous material of this activated carbon leads to excellent electrochemical charge storage capability for their application as supercapacitor electrode materials. In a three-electrode cell, an optimum carbon sample exhibited high specific capacitance ca. 386 F g−1 at a current density of 1 A g−1 with excellent retention of specific capacitance (63%) at a very high current density of 50 A g−1. Cyclic stability is also excellent with 98% specific capacitance retention after 10,000 charge-discharge cycles. These hierarchical nanoporous activated carbons derived from agricultural waste materials have sufficient potential for use as electrode materials in commercial, and advanced supercapacitors.
Safety and efficacy of combining afatinib and whole-brain radiation therapy in treating brain metastases from EGFR-mutated NSCLC: a case report and literature review
Authors: Marampon Francesco , Gelibter Alain J , Cicco Pier Rodolfo , Parisi Martina , Serpone Maria , De Felice Francesca , Bulzonetti Nadia , Musio Daniela , Cortesi Enrico , Tombolini Vincenzo
Published: May 2022

Combining EGFR-tyrosine kinase inhibitors (TKIs) to whole brain radiation therapy (WBRT) has been shown to be more effective than EGFR-TKIs or WBRT alone in treating brain metastases (BMs) from EGFR-mutated Non Small-Cell Lung Cancer (NSCLC). However, despite the combination results well tolerated, EGFR-TKIs are often discontinued before WBRT, to reduce the risk of possible side effects, potentially resulting in reduced treatment efficacy and possible progression of intra- and extra-cranial disease. Afatinib, an irreversible inhibitor of EGFR-TK, has been shown to radiosensitize NSCLC in pre-clinical models and, compared to the other EGFR-TKIs, more efficiently penetrates the blood-brain barrier. However, nowadays, only two case reports describe the therapeutic efficiency and safety of combining afatinib with WBRT. Herein, we report on a 58-year-old woman patient with symptomatic BMs from NSLCL, treated with afatinib and concomitant WBRT, 30 Gy in 10 fractions. Treatment induced a remarkable and persistent radiological regression of BMs and the disappearance of neurological symptoms. However, the patient experienced severe skin toxicity of G3, corresponding to the irradiation area. Toxicity was successfully treated pharmacologically, and the patient did not experience any BMs-related symptoms for the next 10 months. She died of COVID-19-related respiratory failure. The association of afatinib with WBRT appears to be a successful strategy in the control of BMs from EGFR-mutated NSCLC. However, it should be considered that the combination could be responsible for serious dermatological toxicity.
Ο εικονογραφικός κύκλος του βίου του Αγίου Νικολάου στη μεταβυζαντινή τέχνη, 16ος-18ος αιώνας
Authors: Βουγιουκλάκη Πηνελόπη
Published: May 2022

Αντικείμενο της διατριβής αποτελεί ο εικονογραφικός κύκλος του βίου του αγίου Νικολάου στη μεταβυζαντινή ζωγραφική στον ελλαδικό χώρο και τα Βαλκάνια. Στην έρευνα περιλαμβάνονται παραστάσεις σε τοιχογραφίες εκκλησιών, φορητές εικόνες, χαρακτικά και ανθίβολα. Συνολικά, καταγράφονται και εξετάζονται περισσότερες από χίλιες επτακόσιες παραστάσεις σε διακόσιους είκοσι δύο εικονογραφημένους κύκλους του αγίου, στους οποίους εικονογραφούνται πενήντα τουλάχιστον επεισόδια-θαύματα του βίου του, που αναπτύσσονται σε περισσότερες από ογδόντα αυτοτελείς σκηνές. Ο εξαιρετικά μεγάλος αριθμός των εξεταζομένων παραστάσεων επέβαλλε τη διάρθρωση της διατριβής σε τρεις τόμους. Ο πρώτος τόμος περιλαμβάνει τη μελέτη των κύκλων και των σκηνών. Στην εισαγωγή παρουσιάζεται η ιστορία της έρευνας για τον βίο του αγίου Νικολάου και για την εικονογραφία του κύκλου του στη βυζαντινή και τη μεταβυζαντινή τέχνη. Περιλαμβάνεται επίσης, αναλυτικός πίνακας των ελληνικών πηγών που είχαν ρόλο στη διαμόρφωση και εξέλιξη της εικονογραφίας του κύκλου του αγίου. Στη συνέχεια η μελέτη διαρθρώνεται σε δύο κεφάλαια.Στο πρώτο και εκτενέστερο κεφάλαιο γίνεται η εικονογραφική ανάλυση των επεισοδίων που απεικονίζονται στους μεταβυζαντινούς κύκλους του αγίου. Διακρίνονται έξι κατηγορίες σκηνών: α. Σκηνές από την παιδική ηλικία του αγίου β. Χειροτονίες γ. σκηνές που σχετίζονται με την επικράτηση του χριστιανισμού και της ορθοδοξίας δ. Θαύματα ε. ο κύκλος της Κοίμησης του αγίου και στ. αδιάγνωστες σκηνές. Ειδικότερα, τα θαύματα ταξινομούνται σε τρεις ομάδες: Διάφορα θαύματα, Ναυτικά θαύματα, Θαύματα ίασης. Στο δεύτερο κεφάλαιο με βάση την εικονογραφική ανάλυση των επεισοδίων που προηγήθηκε γίνεται μία συνολική θεώρηση του εικονογραφικού κύκλου του αγίου Νικολάου στη μεταβυζαντινή εποχή. Ειδικότερα, εξετάζεται η εξέλιξη του εικονογραφικού κύκλου κατά χρονική περίοδο και κατά γεωγραφική περιοχή. Στα συμπεράσματα, συνοψίζονται γενικές παρατηρήσεις για την εικονογραφική εξέλιξη των σκηνών του βίου του αγίου, τη σύνθεση του εικονογραφικού κύκλου και τέλος την επιλογή των σκηνών. Ο δεύτερος τόμος περιλαμβάνει τον αναλυτικό κατάλογο των παραστάσεων του εικονογραφικού κύκλου του βίου του αγίου Νικολάου στον ελλαδικό χώρο και στα Βαλκάνια κατά την εξεταζόμενη περίοδο, με τη σχετική βιβλιογραφία. Ο κατάλογος διαιρέθηκε σε τέσσερα μέρη για την καλύτερη διαχείριση του υλικού και περιλαμβάνει: α. 106 κύκλους σε τοιχογραφίες διαφορετικών ναών β. 105 κύκλους σε φορητές εικόνες γ. 7 κύκλους σε χαρακτικά δ. 4 κύκλους σε ανθίβολα. H παρουσίαση σε κάθε ενότητα γίνεται κατά γεωγραφική περιοχή και κατά χρονολογική σειρά. Ο τρίτος τόμος περιλαμβάνει τους πίνακες.
Chronic obstructive pulmonary disease patients' quality of life and its related factors: A cross-sectional study of the Jordanian population
Authors: Assaf Enas A , Badarneh Angham , Saifan Ahmad , Al-Yateem Nabeel
Published: May 2022

Background: Chronic Obstructive Pulmonary Disease (COPD) is the third leading cause of death globally, mostly in low- and middle-income countries. It is estimated that 6.5% of Jordanians under 50 and 37.5% of those over 70 years of age are affected. The country's air pollution levels surpass recommended levels, increasing the disease incidence and burden on individuals and the health system. COPD is a long-term, severe, and exhausting condition. In Jordan, patients are highly dependent and frequent users of the healthcare services; therefore, their Quality of Life (QoL) is highly influenced by the health care they receive. The QoL of COPD patients must be studied to devise interventions that can help patients cope with this disease and for healthcare systems to improve their service. 

Method: A cross-sectional correlational study of 200 COPD patients. The Arabic WHO Quality of Life Questionnaire Short Form was used to collect data.  

Results: The mean COPD patient QoL score was 10.66 (SD=1.58), showing poor QoL perception. The physical domain had the lowest perceived QoL (10.232, SD=1.912), while the environmental domain had the highest (10.948, SD=1.636). Unmarried, non-smokers, and employed had better QoL (M=11.04, M=10.92, M=12.04). Age categories 50-61 exhibited greater mean QoL than age category 61 or higher (M=11.44, M=10.84, M=10.08). Private health services are characterized by short waiting times, availability of different diagnostic and treatment services, and skilled staff was related to better QoL. 

Conclusions: QoL for COPD patients seems to be an area requiring urgent attention from Health service providers and planners. Patients should be adequately supported and cared for to have a good QoL. In Jordan, COPD patients' QoL is highly influenced by lack of physical activity, emotional distress, and anxiety. Therefore, better health care services is needed to address all these areas adequately.
Massive Open Online Course (MOOC) Opportunities in Health Education (HE) in a mandatory social isolation context
Authors: Dolores-Maldonado Gandy , Cañari-Casaño Jorge L. , Montero-Romainville Rosalia , Malaga German
Published: May 2022

Background: Routine care for prevention and health promotion has reduced significantly due to the Covid-19 pandemic and mandatory social isolation measures. In this context, it is necessary to identify and describe Massive Open Online Courses (MOOCs) that provide opportunities for health education, promotion, and prevention aimed at the general population. The study is a systematic review of MOOCs on health education, health promotion, and prevention for the general population in a pandemic context.

Methods: We developed a search for MOOC courses aimed at the general population on health education, health promotion, and prevention in different available MOOC platforms. We executed a descriptive analysis of the main characteristics of the selected MOOCs. Terms such as healthy living, physical activity, healthy eating, mental health, and variants aimed at the general population were explored. We did not include advanced or specialized studies aimed only at professionals that required prior knowledge. A descriptive analysis of the main characteristics of the selected MOOCs was performed.

Results: There were 117 MOOCs chosen on health education, promotion, and prevention for the general population. Coursera (40.3%) was the platform that offered the highest quantity of MOOCs; more than half of the MOOCs were in English (52.9%). The median (interquartile range) duration of the selected MOOCs was 11 (6–15) hours. The predominant themes were "Health promotion" (43%) and "Food and nutrition" (31%), and the origin was mainly from Europe (37.8%).

Conclusions: Potentially MOOCs could improve access to massive open online public health courses. Adaptation to different languages and topics needed for each context could increase access to important health promotion messages, even outside of "times of pandemic and enforced social isolation".
Improving learning by playing with an app: The FantaTraining® experience with anesthesia trainees.
Authors: Gibiino Giovanni , Capogna Emanuele , Velardo Matteo , Del Vecchio Angelica , Ingrassia Pier Luigi , Capogna Giorgio
Published: May 2022

Background: FantaTraining® is an app that simulates a football league. Each participant represents a team, and the game is played with the opposing team by answering a questionnaire. In the intervals between games, participants can practice by consulting the educational material (films, short texts, or slides) in the app. Various prizes are offered to the winners of the championship. In this study, we aimed to evaluate whether the use of the FantaTraining® app could improve the learning of anesthesia trainees registered in an online obstetric anesthesia course.

Methods: The study involved 282 trainees in anesthesia, from five Italian universities, registered in the Online Obstetric Anesthesia Course (OOAC) who were given the app. They were randomly allocated into two groups according to whether the app had been enabled to allow the participant to play the league (study group, n=137), or not (control group, n=145). All the trainees underwent entry and final tests, consisting of the same 40 multiple choice questions, respectively before and after completing the OOAC course.

Results: There were no differences in the scores obtained in the pre-course test between the groups. The mean score obtained in the final test was significantly greater than that obtained in the entry one in both groups (P<0.05) but the final test score obtained by the participants of the study group was significantly greater than that obtained by the control group. (P<0.001), regardless of the university of origin and year of specialization. Trainees stated that the app had helped their study, improving understanding and motivation, without increasing the intensity of study.

Conclusions: Using the FantaTraining® app greatly improved trainees’ final exam performance after the online obstetric anesthesia course. The FantaTraining® app seems a promising tool to improve learning outcomes by strengthening learning behaviors and attitudes towards learning.
Understanding the implementation of telepractice in speech and language services using a mixed-methods approach
Authors: Shankar Varsha , Ramkumar Vidya , Kumar Shuba
Published: May 2022

Background: Telepractice emerged as a solution to overcome the challenges of access issues in the delivery of healthcare. Telepractice in speech language pathology (SLP) has existed for nearly a decade yet there is a significant knowledge gap with respect to the factors influencing the implementation of telepractice as a routine or long-term, sustained effort. This mixed-methods study aimed to identify implementation factors that influence the provision of telepractice in SLP services.

Method: A mixed-methods study consisting of a scoping review and semi-structured interviews (SSI) was carried out. Articles that described telepractice in SLP were included based on an operational definition of implementation and a set of inclusion criteria.

Results: Data was extracted from 11 studies that were mapped to nine projects in telepractice in SLP. The broad focus areas identified included diagnostics and evaluation, therapeutics and comprehensive assessment, management and follow-up care services. Synchronous/ real-time telepractice methods were always used for the provision of diagnostic testing or when providing therapy services using video conferencing. The ‘professional-facilitator-patient’ model was used most commonly followed by the ‘professional-patient’ model.  Barriers for long-term sustainability included inadequate initial capital investment, lack of reimbursement and payment options, low internet speed and bandwidth, resistance and hesitancy to use telepractice from the patient’s end, lack of organizational policies and uniform regulations. Sustainable source of funding, having a dedicated team of professionals and technicians with clear roles and responsibilities, and inclusion of systematic planning facilitated implementation. 

Conclusion: In general, telepractice in SLP was not explicitly guided by implementation science or framework. The use of implementation frameworks ensures systematic planning and feasibility assessment to inform the scale-up of implementation. Therefore, it would be worthwhile for program implementers to consider these aspects when exploring telepractice services.
Protocol: Mapping social networks, social influence and sexual health among youth in rural KwaZulu-Natal, the Sixhumene cohort study
Authors: Nxumalo Vuyiswa , Nxumalo Siyabonga , Smit Theresa , Khoza Thandeka , Mdaba Fikile , Khumalo Thulile , Cislaghi Beniamino , McGrath Nuala , Seeley Janet , Shahmanesh Maryam , Harling Guy
Published: May 2022

Background: Sexual behaviour and sexually transmitted infections are strongly affected by social connections, and interventions are often adapted more readily when diffused through social networks. However, evidence on how young people acquire ideas and change behaviour through the influence of important social contacts is not well understood in high-HIV-prevalence settings, with the result that past peer-led HIV-prevention interventions have had limited success.

Methods: We therefore designed a cohort study (named Sixhumene or ‘we are connected’) to follow young people in three rural and small-town communities in uMkhanyakude district, KwaZulu-Natal, South Africa, and the people that these youth identify as important in their lives. We will interview them five times over three years, at each visit collecting information on their socioeconomic, social and sexual health lives, and testing them for HIV and herpes simplex virus 2 (HSV-2). We will use this information to understand how these young people’s sexual health decisions are formed. This will include evaluating how poor sexual health outcomes are correlated across social networks, how youth mimic the attitudes and behaviours of those around them, who is at greatest risk of acquiring HIV and HSV-2, and who might be most influential within communities and thus best able to promote protective interventions.

Discussion: The information gathered through this study will allow us to describe social connection and influence spread through these real-world social networks, and how this leads to sexual health outcomes. Sixhumene will provide vital inputs for mathematical models of communities and spreading processes, as well as inform the development of effective interventions to protect the sexual health of community members through appropriate targeting with optimised messaging requiring fewer resources.
The effect and therapeutic compliance of adjuvant therapy in patients with cholangiocarcinoma after R0 resection: a retrospective study
Authors: Jeong Han Taek , Lee Joonkee , Jo Hyeong Ho , Kim Ho Gak , Han Jimin
Published: May 2022

Background: This study aimed to compare clinical outcomes between surveillance and adjuvant therapy (AT) groups after R0 resection for cholangiocarcinoma (CCA). Methods: A total of 154 patients who underwent R0 resection for CCA at the Daegu Catholic University Medical Center between January 2010 and December 2019 were included. Overall survival (OS) and progression-free survival (PFS) were analyzed.Results: The median follow-up duration was 899 days. There were 109 patients in the AT group and 45 patients in the surveillance group. The patients in the AT group were younger (67 years vs. 74 years, p<0.001) and included more males (64.2% vs. 46.7%, p=0.044). The proportion of patients with stage III CCA was larger in the AT group than in the surveillance group (13.8% vs. 2.2%, p=0.005). In addition, AT did not improve OS (5-year OS rate, 69.3% in the AT group vs. 64.2% in the surveillance group, p=0.806) or PFS (5-year PFS rate, 42.6% in the AT group vs. 48.9% in the surveillance group, p=0.113). In multivariate analysis using the Cox proportional hazards model, stage III CCA (hazard ratio [HR], 10.81; 95% confidence interval [CI], 2.92–40.00; p<0.001) was a significant predictor of OS. American Society of Anesthesiologists classification II (HR, 0.50; 95% CI, 0.31–0.81; p=0.005), and American Joint Committee on Cancer stages II (HR, 3.14; 95% CI, 1.25–7.89; p=0.015) and III (HR, 8.08; 95% CI, 2.80–23.32; p<0.001) were independent predictors of PFS. Conclusion: AT after R0 resection for CCA did not improve OS or PFS.
Esculturas romanas de Asido (Medina Sidonia, Cádiz)
Authors: Beltrán Fortes José , Loza Azuaga María Luisa , Montañés Caballero Salvador
Published: May 2022

El estudio de la escultura es un tema "clásico" en arqueología de época romana, que se justifica por la importancia de los significados que aquélla tuvo en la antigüedad y que sirven para la caracterización histórica de las sociedades que la produjeron. De ahí la riqueza de tales estudios, realizados desde enfoques muy variados: el análisis de los materiales, de los talleres y técnicas de producción, del comercio de piezas, de la iconografía, del estilo, de las reutilizaciones, etc. En el caso de la actual localidad de Medina Sidonia (Cádiz), la antigua colonia romana de Asido, destaca no sólo la cantidad de piezas conservadas, sino la calidad y singularidad de muchas de ellas. Sobresale, especialmente, la estatuaria imperial de época augustea y julio-claudia, que conforma uno de los ciclos dinásticos mejor documentados de la Bética, con tres diferentes localizaciones en el paisaje urbano de la colonia: un santuario en la "acrópolis", el foro, y el posible teatro. Esta monografía, coeditada por el Servicio de Publicaciones de la Universidad de Cádiz y la Editorial Universidad de Sevilla, se organiza en dos partes: el catálogo de piezas y el estudio conjunto resultante de su análisis. El Ayuntamiento de Medina Sidonia ha colaborado en esta edición.