bluuebunny/crossref_metadata_2025 huggingface dataset:
High return to sports rates after operative treatment of patella fractures
Authors: Pesch Sebastian , Greve Frederik , Zyskowski Michael , Müller Michael , Crönlein Moritz , Biberthaler Peter , Kirchhoff Chlodwig , Wurm Markus
Published: September 2023

Background

Patella fractures are relatively rare fractures and only little is known about the postoperative return to sports after patella fractures.

Methods

This retrospective study presents information on functional outcome after operative treatment of patella fractures as well as time until return to sports and patients’ complaints after open-reduction internal-fixation (ORIF) of patella fractures.

Results

Overall, 39 patients after ORIF of patella fractures were evaluated at our Level-I trauma center with a mean follow-up of 42 months. The mean time until return to sports was 7 ± 3.9 months. No significant difference was found for functional outcome with respect to body mass index (BMI) or age. Fracture consolidation was accomplished after a mean of 6.9 ± 2.9 months besides a relatively low complication rate of 5.1% (n = 2).

Conclusion

The results demonstrate a high return to sports rate of 90.3%. However, only 51.6% were able to perform sports on their pre-injury level or above.

Trial Registration The study was retrospectively registered at DRKS (No: DRKS00031146).
Influence of perioperative blood pressure regulation on postoperative delirium in patients undergoing head and neck free flap reconstruction
Authors: Ooms Mark , Schooß Ruth , Winnand Philipp , Heitzer Marius , Hölzle Frank , Bickenbach Johannes , Rieg Annette , Modabber Ali
Published: September 2023

Background

Postoperative delirium (POD) is a serious complication in patients undergoing microvascular head and neck reconstruction. Whether intraoperative and postoperative blood pressure regulation are risk factors for POD remains unclear. This study aimed to highlight the relationships between intraoperative and postoperative blood pressure regulation and POD in microvascular head and neck reconstruction.

Methods

Data from 433 patients who underwent microvascular head and neck reconstruction at our department of oral and maxillofacial surgery between 2011 and 2019 were retrospectively analyzed. The 55 patients with POD were matched with 55 patients without POD in terms of tracheotomy, flap type, and flap location, and the intraoperative and postoperative systolic and mean blood pressure values were compared between the two groups.

Results

Patients with POD showed lower intraoperative and postoperative minimum mean arterial pressure (MAP) values than patients without POD (60.0 mmHg vs. 65.0 mmHg, p < 0.001; and 56.0 mmHg vs. 62.0 mmHg, p < 0.001; respectively). A lower intraoperative minimum MAP value was identified as predictor for POD (odds ratio [OR] 1.246, 95% confidence interval [CI] 1.057–1.472, p = 0.009). The cut-off value for intraoperative MAP for predicting POD was  ≤ 62.5 mmHg (area under the curve [AUC] 0.822, 95% CI 0.744–0.900, p < 0.001).

Conclusions

Maintaining a stable intraoperative minimum MAP of  > 62.5 mmHg could help to reduce the incidence of POD in microvascular head and neck reconstruction.
Understanding the phenomenon of food waste valorisation from the perspective of supply chain actors engaged in it
Authors: Rao Madhura , Bast Aalt , de Boer Alie
Published: September 2023

The repurposing of surplus food and food processing by-products is a key aspect of the shift towards a circular bioeconomy. In the Netherlands, food supply chain actors are already working towards making better use of agri-food surpluses to improve food security and resource efficiency. By analysing the experiences of these actors, this study aims to identify the current state of the sector and highlight barriers and enablers of successful food waste valorisation. Based on a phenomenological analysis of 16 in-depth unstructured interviews with participants from the Netherlands, we empirically demonstrate that supply chain actors involved in food waste valorisation consider local embedding, societal perception, and food safety to be important aspects of their work. They often grapple with legislative and logistical uncertainties and face various ethical dilemmas such as having to pay for products that were once considered waste. Building on these findings, we propose that experienced professionals with a penchant for sustainability can play the role of ‘transition brokers’ as the food system moves towards a circular way of operating. We also posit that private standards and voluntary agreements could be a way for the sector to better manage the various bottlenecks that are characteristic of food waste valorisation endeavours.
Modelling acquired resistance to DOT1L inhibition exhibits the adaptive potential of KMT2A-rearranged acute lymphoblastic leukemia
Authors: Schneider Pauline , Crump Nicholas T. , Arentsen-Peters Susan T.C.J.M. , Smith Alastair L. , Hagelaar Rico , Adriaanse Fabienne R.S. , Bos Romy S. , de Jong Anja , Nierkens Stefan , Koopmans Bianca , Milne Thomas A. , Pieters Rob , Stam Ronald W.
Published: September 2023

In KMT2A-rearranged acute lymphoblastic leukemia (ALL), an aggressive malignancy, oncogenic KMT2A-fusion proteins inappropriately recruit DOT1L to promote leukemogenesis, highlighting DOT1L as an attractive therapeutic target. Unfortunately, treatment with the first-in-class DOT1L inhibitor pinometostat eventually leads to non-responsiveness. To understand this we established acquired pinometostat resistance in pediatric KMT2A::AFF1+ B-ALL cells. Interestingly, these cells became mostly independent of DOT1L-mediated H3K79 methylation, but still relied on the physical presence of DOT1L, HOXA9 and the KMT2A::AFF1 fusion. Moreover, these cells selectively lost the epigenetic regulation and expression of various KMT2A-fusion target genes such as PROM1/CD133, while other KMT2A::AFF1 target genes, including HOXA9 and CDK6 remained unaffected. Concomitantly, these pinometostat-resistant cells showed upregulation of several myeloid-associated genes, including CD33 and LILRB4/CD85k. Taken together, this model comprehensively shows the adaptive potential of KMT2A-rearranged ALL cells upon losing dependency on one of its main oncogenic properties.
Modification of an inpatient medical management protocol for pediatric Avoidant/Restrictive Food Intake Disorder: improving the standard of care
Authors: Gorrell Sasha , Vendlinski Siena S. , Thompson Arianna S. , Downey Amanda E. , Kramer Rachel , Hail Lisa , Clifton Sharon , Forsberg Sarah , Reilly Erin E. , Saunders Elizabeth , Buckelew Sara M. , Le Grange Daniel
Published: September 2023

Background

No guidelines currently exist that represent a standardization of care for Avoidant/Restrictive Food Intake Disorder (ARFID) on an inpatient service. Unique features of this diagnosis (e.g., sensory sensitivity contributing to involuntary emesis) suggest that established protocols that were developed for anorexia nervosa might be less effective for adolescents with ARFID. To inform improved inpatient medical stabilization and care for these patients, we first provide an overview of clinical characteristics for patients with ARFID who presented to a pediatric hospital for inpatient eating disorder care. We use these descriptives to outline the rationale for, and executions of, modifications to an inpatient protocol designed to flexibly meet the needs of this clinical population.

Methods

Chart review with descriptive statistics were conducted for patients who had received an ARFID diagnosis from March 2019 to March 2023 (N = 32, aged 9–23). We then present a case series (n = 3) of adolescents who either transitioned to a novel adjusted protocol from an original standard of care on the inpatient service, or who received only the standard protocol.

Results

The sample was aged M(SD) = 15.6 (3.3) years, 53% male, and a majority (69%) presented with the ARFID presentation specific to fear of negative consequences. On average, patients had deviated from their growth curve for just over two years and presented with mean 76% of their estimated body weight. Of those requiring nasogastric tube insertion during admission (n = 8, 25%), average duration of tube placement was 15 days. From within this sample, case series data suggest that the adjusted protocol will continue to have a positive impact on care trajectory among adolescents admitted for ARFID including improved weight gain, reduction of emesis, and improved food intake.

Conclusions

Findings demonstrate the likely need to tailor established medical inpatient protocols for those with ARFID given different symptom presentation and maintenance factors compared to patients with anorexia nervosa. Further research is warranted to explore the longer-term impact of protocol changes and to inform standardization of care for this high priority clinical population across care sites.
Climbing strategies of Taiwan climbers
Authors: Chen Po-Hao , Chung An-Ching , Lin Hung-Chih , Yang Sheng-Zehn
Published: September 2023

Background

The climbing strategies of lianas and herbaceous vines influence climber competition abilities and survival. The aim of this study was to investigate the climbing strategies of each plant species and observe their organs of origin.

Results

The results showed that all Taiwan climbers were approximately 555 species, accounting for 11% of the native flora. Among the 555 climbers, the twining stem type was the most common, with a total of 255 species (46%), the remaining climbing methods accounted for 300 species. Approximately twenty one climbing methods, including nine combination types, were exhibited, of which the most common type was the twining stem, followed by simple scrambling and twining tendrils. Most species of Fabaceae and Apocynaceae were twining stems in dextrorse, excluding Wisteriopsis reticulata and Alyxia taiwanensis, which were in sinistrorse. The prehensile branch of Fissistigma genus, Ventilago genus, and Dalbergia benthamii, originated from second-order or modified stems. In the simple scrambling type, some climbers were covered spines and prickles to attach the host, and the others were clinging to the supports or creeping on the ground without speculation. The hooks or grapnels of the genus Uncaria are derived from the branches, and a pair of curved hooks or a spine of Artabotrys hexapetalus are originated from the inflorescence to tightly attach to a host. The Piper genus use adhesive roots to climb their hosts. Among the genus Trichosanthes, only Trichosanthes homophylla exhibits a combination of twining modified shoots and adhesive roots. Gentianales includes four families with seven climbing mechanisms, while Fabales includes only Fabaceae, which presents six climbing methods.

Conclusions

The twining tendrils had nine organs of origin in Taiwan climber, that these opinions of originated organs might be available to the studies of convergent evolution. The data presented herein provide crucial basic information of the climber habits types and origin structures, which are available for terms standardization to improve field investigation. The terminologies would aid in the establishment of climber habits as commonly taxon-specific and the combination of two climber habits could be a characteristic of taxonomic value.
Empowerment and enablement and their associations with change in health-related quality of life after a supported osteoarthritis self-management programme – a prospective observational study
Authors: Åkesson Karin Sturesdotter , Sundén Anne , Stigmar Kjerstin , Eek Frida , Pawlikowska Teresa , Hansson Eva Ekvall
Published: September 2023

Background

Osteoarthritis is a leading cause of disability worldwide. Current treatment supports coping strategies to improve health-related quality of life (HRQoL). The need to predict response to treatment has been raised to personalise care. This study aims to examine change in HRQoL from baseline to three and nine months follow-up after participating in a Supported Osteoarthritis Self-Management Programme (SOASP) and to examine if empowerment and/or enablement were associated with change in HRQoL after a SOASP.

Methods

Patients participating in a SOASP were recruited consecutively between April 2016 and June 2018. The EQ-5D was used to measure HRQoL, the Swedish Rheumatic Disease Empowerment Scale (SWE-RES-23) (score range 1–5) to measure empowerment and the Patient Enablement Instrument (PEI) (score range 0–12) to measure enablement. The instruments were answered before (EQ-5D, SWE-RES-23) and after (EQ-5D, SWE-RES-23, PEI) the SOASP. A patient partner was involved in the research process to enhance the patient perspective. Changes in outcome were examined with paired sample t-test and standardized effect sizes (Cohen´s d). Multiple linear regression analysis was performed to assess potential associations.

Results

One hundred forty-three patients participated in baseline measurement. Mean EQ-5D-5 L index score increased significantly from baseline to three months corresponding to a standardised effect size (Cohen´s d) of d = 0.43, 95% CI [0.24, 0.63] (n = 109), and from baseline to nine months d = 0.19, 95% CI [0.01, 0.37] (n = 119). The average EQ VAS score increased significantly from baseline to three months corresponding to a standardised effect size of d = 0.26, 95% CI [0.07, 0.45] (n = 109), and from baseline to nine months d = 0.18, 95% CI [0.00, 0.36] (n = 119). Neither SWE-RES-23 nor PEI at three months follow-up nor the change in the SWE-RES-23 score from baseline to three months follow-up were associated with change in either EQ-5D-5 L index (p > 0.05) or the EQ VAS (p > 0.05).

Conclusions

Health-related quality of life increased after participating in a SOASP. Empowerment and enablement as measured with the SWE-RES-23 and the PEI were not associated with change in HRQoL among patients participating in a SOASP.

Trial registration

ClinicalTrials.gov. Identification number: NCT 02974036. First registration 28/11/2016, retrospectively registered.
The development and application of a two-step surveillance process for Healthy China Initiative based on wide coverage interagency data
Authors: Liu Lin , Lan Xiaomeng , Yang Yili , Luo Yuying , Zhang Xueli , Wang Xiuli , Pan Jay
Published: September 2023

Background

Healthy China is a nationwide health strategy aiming at improving health from diverse dimensions, and strengthening high-quality assessment is essential for its stimulation. However, there is limited evidence in the surveillance of the actual performance of the initiative at regional levels. This study innovatively proposes a two-step surveillance process which comprehensively monitors Healthy China Initiative based on regional realities, thus provides guidance for policymaking.

Methods

A flexible indicator system was firstly developed basing on Delphi survey and focus group discussions. And then the Analysis Hierarchical Process and the TOPSIS method were used to determine the weights of indicators and calculate comprehensive indexes as the surveillance outcomes. A pilot study was conducted in a typical area in China to verify the applicability of the process.

Results

Following the surveillance process and basing on the implementation of Healthy China Initiative in the target region, an indicator system comprised of 5 domains and 23 indicators with weights was first developed specifically for the pilot area. Then 1848 interagency data of the study area were collected from 8 provincial institutions/departments to calculate the indexes and ranks of the five domains which were health level, healthy living, disease prevention and control, health service, and healthy environment. The outcomes showed that Healthy China Initiative in the pilot area had been constantly improved since the strategy proposed, while there were still issues to be tackled such as the deficient monitoring mechanisms and unevenly development progress.

Conclusions

This study proposed a pragmatic surveillance process with indicators which could be tailored for specific context of target regions and produce meaningful surveillance outcomes to inform decision-making for policymakers, and also provided a theoretical foundation as well as empirical evidence for further health strategies and plannings assessment studies.
High performance strain sensor based on leather activated by micro-cracking conductive layer
Authors: Ma Jianzhong , Cheng Zhijie , Tan Sha , Zheng Tian , Zong Yan
Published: September 2023

Flexible strain sensors are capable to detect external force induced strain change owing to their unique ability to convert deformation into electrical signals. Generally, micro/nano patterning of conductive layer in strain sensor is an effective method to improve its sensitivity, however the sophisticated manipulation process is limited only in laboratory scale. In this report, a simple and scalable fabrication strategy was used to create micro-cracking conductive layer as an alternative patterning method to achieve high performance of strain sensor. In details, the sensor was fabricated using leather as the substrate to filtrated acidified multi-walled carbon nanotubes (a-MWCNTs)/layered double hydroxides (LDHs) suspension. During stretching process, micro-cracking structure emerged on the percolated a-MWCNTs/LDHs layer, causing a rise up of resistance according to increasing strain and generated a detectable electrical signal. The prepared sensor had a large detecting range (60%), high sensitivity (GF of 7238.92 at strain 30–60%), fast response (tensile response time of 270 ms), good stability and repeatability. The sensor also inherited the advantages of leather, such as biodegradability and good air permeability, and the introduction of a-MWCNTs/LDHs further enhanced its fire retardancy properties. These features ensured the sensor as an eco-friendly, comfortable and safe electronic device for human motion detection.

Graphical abstract
Addressing Domain Specificity in the Development of a Cell-Based Binding Assay for the Detection of Neutralizing Antibodies Against a CD47xPD-L1 Bispecific Antibody
Authors: Luong Michael , Wang Ying , Donnelly Brianna B. , Lepsy Christopher
Published: September 2023

PF-07257876 is a bispecific antibody being developed for the treatment of certain advanced or metastatic solid tumors. To support clinical development of PF-07257876, neutralizing antibody (NAb) assays were developed as part of a tiered immunogenicity testing approach. Because PF-07257876 targets both CD47 and PD-L1, determination of domain specificity of a NAb response may provide additional insight relating to PK, efficacy, and safety. Due to limitations of functional cell systems, two cell-based binding assays were developed using electrochemiluminescence to detect domain-specific NAb. While both NAb assays utilized a cell-based binding approach and shared certain requirements, such as sensitivity and tolerance to potentially interfering substances, the development of each assay faced unique challenges. Among the hurdles encountered, achieving drug tolerance while preserving domain specificity for CD47 proved particularly challenging. Consequently, a sample pretreatment procedure to isolate NAb from potentially interfering substances was necessary. The sample pretreatment procedure developed was based on a bead-extraction and acid dissociation (BEAD) approach. However, the use of the standard BEAD approach with whole drug to capture NAb resulted in loss of NAb detection under certain circumstances. Specifically, mock samples containing a mixture of NAb positive controls against both binding domains of the bispecific antibody produced false-negative results in the cell-based binding assay. An adaptation made to the standard BEAD approach restored domain-specific NAb detection, while also contributing to an assay sensitivity of 1 µg/mL in the presence of a clinically relevant drug tolerance level of up to 400 µg/mL.

Graphical Abstract
Increased Risk of Vertebral Fractures in Patients With Mild Autonomous Cortisol Secretion
Authors: Favero Vittoria , Eller-Vainicher Cristina , Morelli Valentina , Cairoli Elisa , Salcuni Antonio Stefano , Scillitani Alfredo , Corbetta Sabrina , Casa Silvia Della , Muscogiuri Giovanna , Persani Luca , Chiodini Iacopo
Published: September 2023

Context

The risk of vertebral fractures (VFx) in patients with adrenal incidentalomas (AI) and mild autonomous cortisol secretion (MACS) is debated.

Objective

To evaluate the VFx prevalence and incidence in patients with AI and MACS.

Methods

This cross-sectional and longitudinal study using retrospective data from 4 Italian endocrinology units included 444 patients (cross-sectional arm) and 126 patients (longitudinal arm, 24.9 ± 5.3 months follow-up) to evaluate prevalent and incident VFx, respectively, in patients with MACS (MACS-yes) and without MACS (MACS-no). The main outcome measures were serum cortisol after a 1-mg dexamethasone test (F-1mgDST), bone mineral density (BMD) by dual-energy x-ray absorptiometry at spine (LS) and femur (FN), and VFx presence by x-ray.

Results

Cross-sectional arm: 214 and 230 patients were MACS-yes and MACS-no, respectively, based on F-1mgDST >1.8 µg/dL (50 nmol/L). Patients with MACS had higher VFx prevalence (62.6%) than those without MACS (22.9%, P < .001); MACS was associated with prevalent VFx (odds ratio, 5.203; 95% CI, 3.361-8.055; P < .001; relative risk [RR] 2.07), regardless of age, body mass index, gender distribution, LS-BMD, and presence of type 2 diabetes mellitus (T2D). Longitudinal arm: 66 and 60 patients were MACS-no and MACS-yes, respectively. Patients without MACS showed higher number of incident VFx (36.4%) than patients without MACS (10.0%, P < .001); MACS was associated with the presence of an incident VFx (RR 4.561; 95% CI, 1.600-13.003; P = .005) regardless of age, LS-BMD, gender distribution, presence of prevalent VFx, and T2D. Results were confirmed in women and men when separately evaluated.

Conclusion

Women and men with AI and MACS are at higher risk of VFx.
Neuronal AR Regulates Glucose Homeostasis and Energy Expenditure in Lean Female Mice With Androgen Excess
Authors: Ubba Vaibhave , Joseph Serene , Awe Olubusayo , Jones Dustin , Dsilva Milan K , Feng Mingxiao , Wang Junjiang , Fu Xiaomin , Akbar Razeen J , Bodnar Brittany H , Hu Wenhui , Wang Hong , Yang Xiaofeng , Yang Ling , Yang Peixin , Ahima Rexford , Divall Sara , Wu Sheng
Published: September 2023

Hyperandrogenemia and polycystic ovary syndrome are a result of the imbalance of androgen levels in females. Androgen receptor (Ar) mediates the effect of androgen, and this study examines how neuronal Ar in the central nervous system mediates metabolism under normal and increased androgen conditions in female mice. The neuron-specific ARKO mouse (SynARKO) was created from female (Ar fl/wt; synapsin promoter driven Cre) and male (Ar fl/y) mice. A glucose tolerance test revealed impaired glucose tolerance that was partially alleviated in the SynARKO-dihydrotestosterone (DHT) mice compared with Con-DHT mice after 4 months of DHT treatment. Heat production and food intake was higher in Con-DHT mice than in Con-veh mice; these effects were not altered between SynARKO-veh and SynARKO-DHT mice, indicating that excess androgens may partially alter calorie intake and energy expenditure in females via the neuronal Ar. The pAkt/Akt activity was higher in the hypothalamus in Con-DHT mice than in Con-veh mice, and this effect was attenuated in SynARKO-DHT mice. Western blot studies show that markers of inflammation and microglia activation, such as NF-kB p-65 and IBA1, increased in the hypothalamus of Con-DHT mice compared with Con-veh. These studies suggest that neuronal Ar mediates the metabolic impacts of androgen excess in females.
Metastatic Merkel Cell Carcinoma Within a Cortisol-producing Adrenal Adenoma
Authors: Cutrone Lauren , Subauste Jose , Gomez-Sanchez Celso , Joiner Sarah
Published: September 2023

A 54-year-old man with hypertension, type 2 diabetes mellitus, and a history of Merkel cell carcinoma (MCC) of the right thigh presented to the emergency department with a 4-day history of right lower-quadrant abdominal pain associated with constipation and decreased appetite. Workup showed a heterogenous 6-cm right adrenal mass with macroscopic fat. Imaging was suggestive of benign pathology. Hormonal workup for the adrenal nodule led to the diagnosis of Cushing syndrome. The patient underwent a right adrenalectomy for Cushing syndrome with pathology revealing a 6.5-cm adrenocortical adenoma harboring a 2-cm, well-circumscribed neuroendocrine tumor consistent with metastatic MCC. Adrenal collision tumors are exceedingly rare. This case describes a collision tumor that has not previously been identified—a cortisol-producing adrenal adenoma and metastatic MCC.
A Case of Congenital Disorder of Glycosylation Type 1b Presenting as Hyperinsulinemic Hypoglycemia and Failure to Thrive
Authors: Rani Swati , Sahai Inderneel , Misra Madhusmita
Published: September 2023

We describe initial manifestations, approach to diagnosis, and treatment of a patient with congenital disorder of glycosylation type 1b (CDG 1b), previously managed as acetylcarnitine deficiency. A 9-year-old girl initially diagnosed with and treated for acetylcarnitine deficiency at an outside hospital presented with recurrent hypoglycemia, failure to thrive, poor weight gain, and short stature. She had discontinued levocarnitine therapy because of lack of response, and testing with us demonstrated a normal carnitine and acyl carnitine panel and hyperinsulinemic hypoglycemia during a diagnostic fast. Oral diazoxide and hydrochlorothiazide were initiated with resolution of hypoglycemia. She had iron deficiency anemia, but an upper gastrointestinal evaluation was normal. Genetic testing confirmed a diagnosis of CDG 1b caused by deficiency of mannose phosphate isomerase. Oral mannose was started with gradual reduction in and eventual discontinuation of the diazoxide dose. Hypoglycemia in the pediatric age group needs a systematic approach. It is important to raise awareness of CDG 1b, which can present as persistent hyperinsulinemic hypoglycemia. Mannose supplementation can ameliorate clinical symptoms and biochemical abnormalities.
External Beam Radiotherapy in Advanced Pheochromocytoma and Paraganglioma: An Observation of a Rare Abscopal Effect
Authors: Terakawa Aiko , Tanabe Akiyo , Nakayama Hidetsugu , Minamimoto Ryogo
Published: September 2023

Metastatic pheochromocytoma and paraganglioma are incurable, and effective treatment of systemic symptoms resulting from catecholamine excess and local symptoms from tumor growth are crucial to prolong survival and improve quality of life. We report the first case of metastatic pheochromocytoma wherein external beam radiotherapy (EBRT) demonstrated efficacy in both target and nontarget lesions, demonstrating the “abscopal effect.” EBRT reduced tumor volume and catecholamine secretion and improved catecholamine excess-related complications, including glycemic control. EBRT is an effective treatment option for metastatic pheochromocytoma and paraganglioma because of its minimal invasiveness, safety, and potential for the rare abscopal effect.
Primary Adenoma Arising From Two Ipsilateral Supernumerary Inferior Parathyroid Adenomas
Authors: Bolliet Marine , Katuwal Binit , Kolachalam Ramachandra
Published: September 2023

A single parathyroid adenoma is the most common cause of primary hyperparathyroidism (PHPT). However, multiple synchronous adenomas can be found at surgery. More uncommon are ipsilateral synchronous adenomas, and that combined with a supernumerary gland, is even more rare. Here we present a case of PHPT due to an ipsilateral double adenoma of the inferior parathyroid gland, which was supernumerary. The diagnosis was made preoperatively by ultrasonography; however, sestamibi scan showed only a single hyperfunctioning gland on the left side. This was further substantiated by the use of intraoperative parathyroid hormone (PTH) monitoring, wherein PTH levels decreased to less than 50% of preoperative values only after the complete removal of the second adenomatous gland. This case report highlights the importance of preoperative localization and intraoperative PTH monitoring in evaluating patients with PHPT in the setting of multiple synchronous parathyroid adenoma.
Cord Blood FGF-21 and GDF-15 Levels Are Affected by Maternal Exposure to Moderate to Severe Anemia and Malaria
Authors: Hjort Line , Wewer Albrechtsen Nicolai J , Minja Daniel , Rasmussen Christine , Møller Sofie Lykke , Lusingu John , Theander Thor , Bygbjerg Ib Christian , Schmiegelow Christentze , Grunnet Louise Groth
Published: September 2023

Context

Anemia and malaria are global health problems affecting >50% of pregnant women in sub-Saharan Africa and are associated with intrauterine growth restriction. The hormones fibroblast growth factor 21 (FGF-21) and growth differentiation factor 15 (GDF-15) are involved in metabolic regulation and are expressed in the placenta. No studies exist on FGF-21 and GDF-15 responses to exposures of malaria and anemia in pregnancy.

Objective and Methods

Using a prospective, longitudinal pregnancy and birth cohort of women with an average age of 26 years from a rural region in northeastern Tanzania, we examined if FGF-21 and GDF-15 levels in maternal blood at week 33 ± 2 (n = 301) and in cord blood at birth (n = 353), were associated with anemia and malaria exposure at different time points in pregnancy and with neonatal anthropometry.

Results

Among mothers at gestation week 33 ± 2, lower FGF-21 levels were observed after exposure to malaria in the first trimester, but not anemia, whereas GDF-15 levels at week 33 ± 2 were not associated with malaria nor anemia. In cord blood, moderate to severe anemia at any time point in pregnancy was associated with higher levels of FGF-21, whereas malaria exposure in the third trimester was associated with lower FGF-21 levels in cord blood. Negative associations were observed between cord blood FGF-21 and GDF-15 levels and neonatal skinfold thicknesses and birthweight.

Conclusion

Our results suggest that moderate to severe anemia throughout pregnancy associates with higher FGF-21 levels, and malaria in last trimester associates with lower FGF-21 levels, in the neonates, thereby potentially affecting the future cardiometabolic health of the child.
Persistent Deficits in Bone Quality in Treated Acromegaly: Evidence From Assessments of Microstructure
Authors: Kuker Adriana P , Agarwal Sanchita , Shane Elizabeth , Cohen Adi , Nickolas Thomas L , Stein Emily M , Reid Tirissa J , Hans Didier , Cremers Serge , Bruce Jeffrey N , Freda Pamela U
Published: September 2023

Purpose

Fractures are increased in patients with acromegaly, both before and after successful acromegaly treatment. Abnormalities of bone microstructure, which may underlie this fragility, are present in active acromegaly but to what extent these improve with acromegaly treatment or persist despite biochemical remission remains unclear. To examine these questions, we studied the effects of acromegaly treatment and remission on bone quality.

Methods

Sixty-five women and men with acromegaly were studied. Subgroups underwent assessments of areal bone mineral density by dual x-ray absorptiometry, trabecular bone score (TBS), and volumetric bone mineral density, microarchitecture, stiffness and failure load of the distal radius and tibia by high-resolution peripheral quantitative tomography in a longitudinal study before and after acromegaly treatment and in a cross-sectional study in which patients were compared to sex-, age-, and body mass index-matched healthy controls.

Results

In the longitudinal study, significant increases in total, cortical, and trabecular densities at the radius and tibia and increased stiffness and failure load of the tibia occurred with acromegaly treatment. In the cross-sectional study, patients in biochemical remission after surgery had larger bones, lower trabecular and cortical volumetric density, and disrupted trabecular microarchitecture compared to controls. TBS did not change with acromegaly treatment but correlated with some microstructural parameters.

Conclusion

We show, for the first time, that volumetric bone mineral density and microarchitecture of the peripheral skeleton improve with acromegaly treatment but remain abnormal in patients in remission after surgery compared to controls. These abnormalities, known to be associated with fractures in other populations, may play a role in the pathogenesis of persistent fragility in treated acromegaly.
Maureen Warner-Lewis, Friend and Colleague
Authors: Pollard Velma
Published: September 2023

This essay is a brief personal tribute to Maureen Warner-Lewis, a committed scholar, a passionate researcher, and the author’s longtime friend.
Rejim İstikrarının İzlek Bağımlı Açıklaması: Mısır’da Kitlesel Ayaklanmalar, Ordu ve Siyasi İktidar
Authors: Kurt Veysel
Published: September 2023

Bu çalışmanın amacı, 2011 yılından itibaren Mısır’da yaşanan siyasal değişimi, ordunun etkisini merkeze alarak açıklamaktır. Mısır’da siyasal düzenin kurucu unsuru olarak ordunun tarihsel ve merkezî rolü, Mübarek sonrası yaşanan değişim sürecini de şekillendirmiştir. Nasır döneminden itibaren ordunun siyasal düzenle ilişkisi farklı formlara bürünmüş olsa da ordunun etkisi yapısal bir değişime uğramamıştır. Bu bağlamda rejim değişimi talebi ile Ocak 2011’de başlayan kitlesel protestolar ve sonrasında yaşanan siyasal değişim bir bütün olarak süreç analizine tabi tutulacaktır. Protestoların başlangıcından Mübarek’in devrilmesine, geçiş döneminden Mursi dönemine ve nihayet askerî darbeden siyasal düzenin yeniden şekillenmesine uzanan süreçte ordunun önemli bir ağırlık merkezi teşkil ettiği açıktır. Çalışma, “izlek bağımlılık (path dependency)” kavramından yola çıkarak Mübarek iktidarının devrilmesi ve serbest seçimlerin gerçekleşmesine rağmen Mısır’da neden bir rejim değişimi yaşanmadığı sorusuna cevap arayacaktır.
Sınır Sosyolojisi Perspektifinden Theo Angelopoulos’un “Sınır Üçlemesi”
Authors: Tekin Ferhat
Published: September 2023

Bu çalışmada Yunan yönetmen Theo Angelopoulos’un sınır üçlemesi olarak bilinen Leyleğin Geciken Adımı (1991), Ulis’in Bakışı (1995) ve Sonsuzluk ve Bir Gün (1998) adlı filmleri sınır sosyolojisi bağlamında ele alınmaktadır. Diğer birçok filmi çeşitli akademik çalışmalara konu edilmesine rağmen bu filmlerinin sosyoloji, özellikle de sınır sosyolojisi bağlamında incelenmediği görülmüştür. Özellikle günümüzde sınır, göç ve mültecilikle gittikçe daha yoğun bir biçimde karşılaşılıyor olması sınır üçlemesi üzerinde durulmayı gerektirmektedir. Çalışmada üçlemedeki başlıca temalar sınır sosyolojisi literatürü göz önünde bulundurularak belirlenmiştir. Bu çerçevede, modern sınırların böldüğü akraba topluluklardan sınırın şiddet biçimlerine, mültecilerin yaşam koşullarından ev sahibi toplumların onlara bakışına kadar birçok tema belirlenmiş ve ilgili literatür bağlamında yorumlanmıştır. Sonuç olarak sınır üçlemesinde; sınırların nasıl adaletsizliğin, şiddetin, dışlamanın, milliyetçi nefretin araçları ve birlikte yaşamanın önünde engeller olduğunu görmekteyiz. Dolayısıyla Angelopoulos’un sınıra, mülteciye ve yabancıya ne ulus-devletçi ne de ulus cemaatçi açıdan baktığını söyleyebiliriz.
Siyasette Epistemik Kriz ve Tevazu
Authors: Kılınç Yurdagül
Published: September 2023

Siyasette epistemik kriz, politik epistemoloji açısından değerlendirildiğinde bizi iki seçenek arasında bırakır: (i) Kamusal alanı, politik öznelerin her konuyu müzakere edebilecekleri ve uzlaşabilecekleri epistemik bir düzlem olarak tasarlamanın imkânsızlığından hareketle iyiye dair konuşmayı sınırlamak. Ya da (ii) kamusal alanda taraflar arasında epistemik güvenin imkânsızlığından hareketle minimuma razı olmak. İlk seçenek, öznelerin iyi ve iyi yaşama dair düşüncelerini müzakere konusu yapmanın çatışmalara yol açacağını iddia eder ve güvenlik açısından iyi hakkında sessiz kalınmasını önerir. İkinci seçenek, bireyler arasında karşılıklı epistemik güven sorunu giderilmediği sürece az ile yetinmenin daha makul bir tercih olacağına işaret eder. Ancak bu iki seçenekten hangisi seçilirse seçilsin siyaset alanının krizlerini derinleştiren epistemik kibir, epistemik adaletsizlik ve mitsel düşünce gibi epistemik kusurlardan uzaklaşmak mümkün değildir. Çünkü iyi düşüncesine dair bilgisizlik arttıkça epistemik kusurlar derinleşir. Epistemik kusurlar sadece bireyin bilişsel sürecini değil tüm siyaset alanını bozar. Bu çalışma politik aktörlerin epistemik tevazuyu entelektüel bir erdem olarak benimsemelerinin siyasette epistemik kusurları hafifleteceğini iddia etmektedir. Tevazu, politik aktörlerin epistemik kusurlarını fark etmelerini, bilgisiz bırakıldıkları konularda doğruyu aramaya devam etmelerini ve müzakere süreçlerinde karşılıklı güven sorununu aşarak iyi hakkında bilgi alışverişinde bulunmalarını kolaylaştıracaktır.
Argümanları, Gücü ve Sınırları ile Uluslararası İlişkilerde Kurumsal Hiyerarşi Teorisi
Authors: Taş Yetim Hüsna
Published: September 2023

Uluslararası sistemi ve devletlerarası ilişkileri anarşi formülasyonuyla açıklayan uluslararası ilişkiler teorileri son yıllarda ciddi bir meydan okumayla karşı karşıyadır. Bu meydan okumanın öncüsü olan hiyerarşi teorisi devletlerarası ilişkilerin ve dünya politikasının hiyerarşi ve anarşinin birlikte var olduğu melez bir yapıyla yönetildiğini belirtmektedir. İkinci Dünya Savaşı’na kadar sömürge ve imparatorluk şeklindeki resmi hiyerarşik sistemlere ev sahipliği yapan uluslararası arenaya Savaş sonrası dönem itibariyle büyük devletlerin küçük devletlerin egemenliklerini dolaylı yollarla kontrolleri altına aldıkları gayri resmi hiyerarşiler hâkim olmaya başlamıştır. Bu argümanlardan hareket eden hiyerarşi teorisi hiyerarşinin dünya siyasetindeki görünümünü, doğasını, dünya politikası ve aktörler üzerindeki etkilerini ortaya çıkarmak için ilişkisel otorite (relational authority) kavramını geliştirmiştir. Bu çalışma hiyerarşiyi, egemen devletlerarasında gerçekleştirilen pazarlıklar sonucunda inşa edilen bir ast-üst ilişkisi olarak tanımlayan ve literatürde kurumsal hiyerarşi (institutional hierarchy) teorisi olarak da isimlendirilen bu kavramın güçlü yönlerini ve sınırlarını araştırmaktadır. Bu amaçla çalışma kurumsal hiyerarşi teorisinin argümanlarına değindikten sonra bu argümanların üç güçlü yönünü ve beş temel sınırını tespit etmektedir.
Emvolio - A battery operated portable refrigerator preserves biochemical and haematological integrity of biological samples in preclinical studies
Authors: Maity Swastika , Aakriti Jaya , Manandhar Suman , Anchan Sharad B , Bhat Ashlesh , Shetty Mayur U , Nayak Yogendra
Published: September 2023

Background: Emvolio is a non-medical device, indigenously developed portable refrigeration for maintaining the internal temperature 2–8˚C. The Indian Patent Office has granted patent for applications such as preservation and transport of medicines, vaccines, food, beverages, dairy etc. Further, use of Emvolio can be utilized in transport and store biologicals to preserve their biochemical and cellular integrity.  The objective of this study was to evaluate the biochemical and haematological integrity of biological samples such as rat blood, serum and liver.

Methods: The steady temperature was maintained inside the Emvolio, and it was compared to that of thermocol and polypropylene boxes aided with frozen gel packs. The blood and liver samples were isolated from Wistar rats and kept in Emvolio, thermocol and polypropylene boxes for 10 hrs, and the temperature was monitored. The blood parameters, namely red blood cells (RBC), white blood cells (WBC), platelets, haematocrit, haemoglobin, mean corpuscular volume (MCV), mean corpuscular haemoglobin concentration (MCHC) and red cell distribution width (RDW), serum parameters like alanine transaminase, alkaline phosphatase, total protein, albumin, creatine kinase, blood urea nitrogen and liver parameters like superoxide dismutase (SOD), glutathione (GSH), catalase were estimated and compared.

Results: Emvolio maintained a constant inner temperature range of 2–8˚C, whereas a significant temperature variation was seen in thermocol and polypropylene boxes. There was no significant deviation in the parameters tested when samples were kept in Emvolio for six hours compared to the zero hour readings. In contrast, there was a significant deviation among the parameters for the samples kept in thermocol and polypropylene boxes for six hours compared to zero hour parameters.

Conclusions: Emvolio maintained constant temperature and preserved the biological integrity of rat blood, serum and liver. Thus, Emvolio can be efficiently used as a biological sample carrier, especially in preclinical studies.
The role of IL-6, ferritin, and coagulopathy in Covid-19 clinical progression
Authors: Harahap Alvin Tagor , Irawan Cosphiadi , Susilo Adityo , Harimurti Kuntjoro , Gathmyr Dewi , Shatri Hamzah , Lubis Anna Mira , Nainggolan Leonard , Abdullah Murdani
Published: September 2023

Background 

In Covid-19 infection, the release of pro-inflammatory mediators in the setting of cytokine storm, primarily interleukin-6 (IL-6), has been hypothesized to induce pulmonary intravascular thrombosis and eventually systemic coagulopathy. However, the relationship between IL-6 and coagulopathy remains unclear in Covid-19 progression. We aimed to investigate the correlation of IL-6 with D-dimer, fibrinogen, prothrombin time (PT), and ferritin. Furthermore, we also analysed the changes of those parameters in relation with progression of Covid-19 disease.

Methods 

A prospective cohort study was conducted in moderate and severe Covid-19 patients from June 2020 to January 2021. A serial evaluation of IL-6, D-dimer, fibrinogen, ferritin, and PT was performed and correlated with the patient's condition at admission and on the 14th day. The outcomes (improvement, worsening, or discharged patients) were recorded during the study.

Results 

Of 374 patients, 73 study subjects (61 severe and 12 moderate Covid-19) were included in this study. A total of 35 out of 61 severe illness and one out of 12 moderate illness subjects had experienced worsening. Spearman-rank correlation of IL-6 with with ferritin, D-dimer, fibrinogen, and PT was 0.08 ( p=0.5), −0.13 ( p=0.27), 0.01 ( p=0.91), and 0.03 ( p=0.77), respectively. In ROC analysis, D-dimer (74,77%) and IL-6 (71,32%) were the highest among other variables (>60%).

Conclusions 

In Covid-19 patients, there was a correlation between elevated IL-6 and D-dimer levels with clinical deterioration. There was no correlation between elevated IL-6 levels with ferritin, D-dimer, fibrinogen, and PT levels. In conclusion, changes in IL-6 and D-dimer can be independent predictor of disease progression in moderate and severe Covid-19 patients.
Effectiveness of multi-component modular intervention among adults with prehypertension in a village of Dakshina Kannada district - a community-based interventional study – protocol
Authors: Feren Neneh , Thapar Rekha , Unnikrishnan B , Mithra Prasanna , Kumar Nithin , Holla Ramesh , BB Darshan , Kotian Himani
Published: September 2023

Introduction: The Joint National Committee (JNC 7) report on Prevention, Detection, Evaluation, and Treatment of Hypertension, defined "prehypertension," as individuals with a Systolic Blood Pressure (SBP) in the range of 120–139 mmHg and a (diastolic blood pressure) DBP of 80–89 mmHg. Prehypertension is directly linked with hypertension which is a precursor of CVDs. Owing to its high conversion rate to hypertension, it is important to identify individuals with blood pressures in this category and bring about lifestyle modifications in them that can prevent them from being hypertensive and from developing cardiovascular diseases later in life.

Methods: This randomized controlled trial will be done among the selected pre-hypertensive adults of all genders residing in Kateel Gram panchayat, Dakshina Kannada district, Karnataka. A baseline survey will be done initially to assess the level of prehypertension among the study population. To study the effectiveness of the intervention, 142 individuals will be randomly allocated using block randomization technique to intervention and control groups. A multi-component module (educational intervention) will be developed, validated, and administered to participants in the intervention group, while the control group receives standard care. Each participant will then be followed up once in four months till the end of the study period of one year to assess for changes in SBP, DBP, WHR, BMI, stress levels, and usage of tobacco and alcohol.

Ethics and dissemination: Institutional Ethics Committee approval was obtained from Kasturba Medical College in Mangalore, India.  

The plans for dissemination of findings include presenting at scientific conferences and publishing in scholarly journals.
Comparative evaluation of accuracy of cranial prosthesis designed by four different workflow protocols analysed by software
Authors: Jain Ritul , Kale Pisulkar Sweta
Published: September 2023

Cranioplasty aims to reconstruct skull defects from tumours, congenital anomalies, decompressive craniectomies, and fractures in a cosmetically acceptable manner. Since the 1970s, polymethyl methacrylate (PMMA) prostheses have been manually prefabricated using a variety of techniques. However, more recent computer-aided design and computer-aided manufacturing (CAD/CAM) techniques appear to have eclipsed these older methods. These techniques essentially involve using imaging from the patient's cranial defect and prefabricating the PMMA prosthesis using a 3D printer. The traditional methods for producing prostheses require a number of intricate stages, can be extremely stressful for the patient, and their success depends on the expertise of the maxillofacial team. Although there have been advances in digital fabrication for prosthetics, there are still some constraints that prevent a full transition to digital fabrication for the final stages of prosthesis construction. Advance training and modification of current treatment procedures are required due to the introduction of new technologies and methods in the field of maxillofacial prosthodontics. The aim of this study is to compare and evaluate the accuracy of cranial prosthesis designed by conventional, digital and two hybrid workflows We will report on 10 consecutive patients who have undergone cranioplasty surgery or had trauma for an extensive skull defect. The final prosthesis will be analyzed using the software CloudCompare for its accuracy by using reverse engineering principle. The purpose of this research is to develop a hybrid protocol for fabricating a prosthesis that is both cost-effective and more dimensionally accurate than its conventional counterpart, thereby providing ease for both the patient and the maxillofacial team.
Prognostic value of C-reactive protein-to-albumin ratio in acute pancreatitis: a systematic review and meta-analysis
Authors: Mariadi I Ketut , Somayana Gde , Shalim Christina Permata , Sindhughosa Dwijo Anargha , Daniella Dian , Purwanta Made Lady Adelaida
Published: September 2023

Background: Acute pancreatitis (AP) is a common disorder and although most of the cases are mild, the mortality risk is high when it comes to severe AP. It is therefore important to determine the severity of AP as early as possible. This review aimed to determine the prognostic value of C-reactive protein-to-albumin ratio (CRP/alb ratio) in patients with AP.

Methods: We performed a systematic search on the electronic databases PubMed, Science Direct, and Cochrane Library up to January 2023. Studies reporting CRP/alb ratio on admission and its association with severity or mortality in AP patients were included. We calculated pooled mean difference (MD) and their 95% confidence intervals (CI) using a random-effects model. Quality assessment of the included studies was appraised using a Newcastle–Ottawa scale.

Results: A total of six studies comprising 2244 patients were included in this meta-analysis. Severe AP had higher CRP/alb ratio on admission than mild-moderate AP (pooled MD: 3.59; 95% CI: 2.51-4.68; p<0.00001). CRP/alb ratio was also significantly higher on non-survivor AP patients compared to survivor AP patients (pooled MD: 2.12; 95% CI: 0.43-3.8; p < 0.01).

Conclusion: High CRP/alb ratio can be used as an early predictor of poor prognosis in patients with AP.