bluuebunny/crossref_metadata_2025 huggingface dataset:
Edge-Based Congestion-Aware Datacenter Load Balancing with Smart Probing
Authors: Bhutta Areeb Ahmed , Ahmed Hasnain
Published: October 2022

Data center networks employ multipath topologies for delivering high bisection bandwidth. Load balancing through these multiple paths reduces latency and improves throughput. Network fabric-based schemes need customized hardware and cannot be implemented on commodity hardware. The existing end-host-based solutions have shown performance better than equal-cost multi-path (ECMP) but they use active probing and uneven congestion signal (e.g. coarse-grained RTT or ECN) that degrades performance especially in asymmetric topologies. Therefore, most of these end-host solutions cannot accurately sense congestion. End-to-end latency can effectively provide accurate path congestion information and smart probing with the help of congestion window can reduce network overhead. In this paper, we propose an edge-based congestion-aware load-balancing solution with smart probing. We combine ECN and end-to-end latency to get more accurate congestion metric and with probabilistic approach we avoid congestion at the best available path. Furthermore, we employ congestion window trend to perform smart probing that will reduce network overhead by performing probing only when required. The proposed scheme is implemented in network simulator ns-3 and flow completion time is taken as the key performance metric. The results show that the proposed scheme not only outperformed ECMP, Clove and LetFlow but also improved the performance over Hermes and CONGA at least 10–30% by employing (i) an accurate congestion signal that effectively detects congestion and asymmetries, and (ii) smart probing to reduce network overhead.
Kidney function and the comparative effectiveness and safety of direct oral anticoagulants vs. warfarin in adults with atrial fibrillation: a multicenter observational study
Authors: Jun Min , Scaria Anish , Andrade Jason , Badve Sunil V , Birks Peter , Bota Sarah E , Campain Anna , Djurdjev Ognjenka , Garg Amit X , Ha Jeffrey , Harel Ziv , Hemmelgarn Brenda , Hockham Carinna , James Matthew T , Jardine Meg J , Levin Adeera , McArthur Eric , Ravani Pietro , Shao Selena , Sood Manish M , Tan Zhi , Tangri Navdeep , Whitlock Reid , Gallagher Martin
Published: October 2022

Aims

The aim of this study was to determine the comparative effectiveness and safety of direct oral anticoagulants (DOACs) and warfarin in adults with atrial fibrillation (AF) by level of kidney function.

Methods and results

We pooled findings from five retrospective cohorts (2011–18) across Australia and Canada of adults with; a new dispensation for a DOAC or warfarin, an AF diagnosis, and a measure of baseline estimated glomerular filtration rate (eGFR). The outcomes of interest, within 1 year from the cohort entry date, were: (1) the composite of all-cause death, first hospitalization for ischaemic stroke, or transient ischaemic attack (effectiveness), and (2) first hospitalization for major bleeding defined as an intracranial, upper or lower gastrointestinal, or other bleeding (safety). Cox models were used to examine the association of a DOAC vs. warfarin with outcomes, after 1:1 matching via a propensity score. Kidney function was categorized as eGFR ≥60, 45–59, 30–44, and <30 mL/min/1.73 m2. A total of 74 542 patients were included in the matched analysis. DOAC initiation was associated with greater or similar effectiveness compared with warfarin initiation across all eGFR categories [pooled HRs (95% CIs) for eGFR categories: 0.74(0.69–0.79), 0.76(0.54–1.07), 0.68(0.61–0.75) and 0.86(0.76–0.98)], respectively. DOAC initiation was associated with lower or similar risk of major bleeding than warfarin initiation [pooled HRs (95% CIs): 0.75(0.65–0.86), 0.81(0.65–1.01), 0.82(0.66–1.02), and 0.71(0.52–0.99), respectively). Associations between DOAC initiation, compared with warfarin initiation, and study outcomes were not modified by eGFR category.

Conclusion

DOAC use, compared with warfarin use, was associated with a lower or similar risk of all-cause death, ischaemic stroke, and transient ischaemic attack and also a lower or similar risk of major bleeding across all levels of kidney function.
Understanding surface wave modal content for high-resolution imaging of submarine sediments with distributed acoustic sensing
Authors: Viens Loïc , Perton Mathieu , Spica Zack J , Nishida Kiwamu , Yamada Tomoaki , Shinohara Masanao
Published: October 2022

Ocean bottom distributed acoustic sensing (OBDAS) is emerging as a new measurement method providing dense, high-fidelity and broad-band seismic observations from fibre-optic cables deployed offshore. In this study, we focus on 35.7 km of a linear telecommunication cable located offshore the Sanriku region, Japan, and apply seismic interferometry to obtain a high-resolution 2-D shear wave velocity (VS) model below the cable. We first show that the processing steps applied to 13 d of continuous data prior to computing cross-correlation functions (CCFs) impact the modal content of surface waves. Continuous data pre-processed with 1-bit normalization allow us to retrieve dispersion images with high Scholte-wave energy between 0.5 and 5 Hz, whereas spatial aliasing dominates dispersion images above 3 Hz for non-1-bit CCFs. Moreover, the number of receiver channels considered to compute dispersion images also greatly affects the resolution of extracted surface-wave modes. To better understand the remarkably rich modal nature of OBDAS data (i.e. up to 30 higher modes in some regions), we simulate Scholte-wave dispersion curves for stepwise linear VS gradient media. For soft marine sediments, simulations confirm that a large number of modes can be generated in gradient media. Based on pre-processing and theoretical considerations, we extract surface wave dispersion curves from 1-bit CCFs spanning over 400 channels (i.e. ∼2 km) along the array and invert them to image the subsurface. The 2-D velocity profile generally exhibits slow shear wave velocities near the ocean floor that gradually increase with depth. Lateral variations are also observed. Flat bathymetry regions, where sediments tend to accumulate, reveal a larger number of Scholte-wave modes and lower shallow velocity layers than regions with steeper bathymetry. We also compare and discuss the velocity model with that from a previous study and finally discuss the combined effect of bathymetry and shallow VS layers on earthquake wavefields. Our results provide new constraints on the shallow submarine structure in the area and further demonstrate the potential of OBDAS for high-resolution offshore geophysical prospecting.
The ultramarine simulation: properties of dark matter haloes before redshift 5.5
Authors: Wang Qiao , Gao Liang , Meng Chen
Published: October 2022

We introduce the Ultramarine simulation, an extremely large N-body simulation of the structure formation and evolution to redshift 5.5 at which cosmic reionization was just completed. The simulation evolves 2.1 trillion particles within a 512 h−1 Mpc cube and has an unprecedented mass and force resolution for large volume simulations of this kind, 5.6 × 106 h−1 M⊙ and 1.2 h−1 kpc, respectively. We present some basic statistical results of the simulation, including the halo mass function, halo bias parameter as well as halo mass-concentration relation at high redshifts, and compare them with some existing representative models. We find excellent agreement with some models on the high redshift halo mass functions, but neither the halo bias factor nor halo mass-concentration relation. All halo bias models for comparison over-predicate high redshift halo bias by large factors, an accurate fit to our simulation is given. High redshift dark matter haloes still can be reasonably described with NFW model, the halo mass-concentration relations are monotonic, with more massive haloes having lower concentration, in disfavour of the upturn feature reported by some studies. The mass concentration relation has little evolution between $z$ = 5.5 to $z$ = 10, in contrast to strong evolution predicted by most existing models. In addition, concentration parameters of high redshift dark matter haloes are much lower than most model predictions.
The quantum character of the Scalar Field Dark Matter
Authors: Matos Tonatiuh
Published: October 2022

The scalar field dark matter (SFDM) model, also called Fuzzy, Wave, Bose–Einstein, and Ultra-light Dark Matter, has received a lot of attention because it has been able to provide simpler and more natural explanations for various features of galaxies, such as the number of satellite galaxies and the cusp-core problem. We recently showed that this model is able to explain the vast polar orbits of satellite galaxies around their host, the so-called VPO, and to explain the X-ray and gamma-ray emissions in the vacuum regions of our galaxy, that is, the Fermi Bubbles. In all these phenomena, the quantum character of SFDM has been crucial. In this work, we study the quantum effects of SFDM at the cosmological level, to see these effects not only at the galactic scale, but also at the cosmological scale. Using a convenient ansatz, we were able to integrate the perturbed equations to show that the shape of the SFDM haloes resembling atoms is a generic result. The main conclusion of this work is that quantum mechanics, the successful microworld theory, could also explain the dark side of the Cosmos.
Drinking on an empty stomach: a scoping review of the evidence on how consuming food with alcohol affects short-term outcomes
Authors: Ramsbottom Anna , Petticrew Mark , Huber Alexandra , van Schalkwyk May C I
Published: October 2022

Background

Alcohol is a leading risk factor for death worldwide. Governments issue official guidelines on reducing the short-term risks associated with alcohol as do alcohol industry-funded organizations. Both sources frequently recommend consuming food with alcohol, however, it is unclear what evidence these recommendations are based on. The aim of this scoping review was to map and summarize evidence on the short-term effects of consuming food and alcohol.

Methods

A scoping review, following PRISMA Extension for Scoping Reviews, searched CINAHL, Cochrane Library, Embase, Medline, PsychINFO and NICE Evidence Search (published inception to June 2021). Studies in English, investigating co-consumption of food and alcohol and reporting short-term health outcomes or acute effects, were included.

Results

Of the 15 246 studies identified, 10 met the inclusion criteria. There was little evidence on the effects of food co-consumption on most short-term alcohol-related outcomes. Included studies were low in quality and inconsistent in their reported outcomes.

Conclusions

Despite a weak and inconsistent evidence base, food co-consumption is often recommended by both official guidance and alcohol industry-funded sources. Food co-consumption as a harm reduction measure, while plausible, requires a stronger evidence base and more nuanced messaging due to the risk of encouraging heavier, sustained drinking.
MEASUREMENT OF THE CONCENTRATION OF 226RA, 232TH, 40K IN THE SOIL IN SETTLEMENTS ON THE COASTLINE OF LAKE VAN, TURKEY
Authors: Yorgun N Yıldız , Oto B , Gür F , Tarakçı M , Yıldız H Erzen , Kavaz E
Published: October 2022

In this study, the natural radioactivity level and its effects on the environment of Lake Van, which is the largest lake in Turkey, were investigated extensively. Initially, 254 soil samples have been collected from the districts (Tusba, Edremit, Gevas, Tatvan, Ahlat, Adilcevaz, Ercis) located around the coastline of Lake Van in eastern Turkey. A Na(TI) detector was used to detect activity concentrations of radium (226Ra), thorium (232Th) and potassium (40K) in each collected soil sample. The obtained average results were compared with available data from Turkey and international data base. The average activity in soil samples was measured as 28.0 ± 3.7–43.6 ± 2.2 Bq/kg for 226Ra, 27.3 ± 4.1–55.4 ± 4.8 Bq/kg for 232Th and 377 ± 42– 706 ± 40 Bq/kg for 40K. It was observed that the average concentrations of 226Ra, 232Th, 40K (43.6 ± 2.2, 55.4 ± 4.8, 706 ± 40 Bq/kg, respectively) for Tatvan district and (37.0 ± 3.5, 51.4 ± 4.2, 479 ± 41 Bq/kg, respectively) for Ahlat district were higher than both national and international average value. In addition, radiological effect parameters originating from terrestrial natural radionuclides for the study area; gamma dose rate (Dout), annual effective dose equivalent (AEDE), and lifetime cancer development probability (LCR) were calculated. The Dout, AEDE, LCR (83.0 ± 3.9 nGy/h, 0.102 ± 0.005 mSv/y, 0.36 ± 0.02 x 10–3, respectively) parameters in Tatvan district were found to be above the international allowable value.
BCR-ABL1 is a secondary event after JAK2V617F in a patient with essential thrombocythemia who develop chronic myeloid leukemia
Authors: Zhang Yanqing , Bi Hailiang , Wang Ying , Chen Long , Pan Jiaqi , Xu Ping , Wang Wei , Yang Shaobin
Published: October 2022

Several cases such as myeloproliferative neoplasms (MPN) with the coexistence of JAK2 and BCR-ABL have been reported. However, cases of transformation of essential thrombocythemia (ET) into chronic myeloid leukemia (CML) during the disease progression were rarely reported. Here, we report the case of a patient with JAK2 V617F- positive ET who subsequently acquired BCR–ABL1, which transformed the disease into CML after 10 years from the initial diagnosis. In this study, we dynamically monitored JAK2 V617F and BCR-ABL and observed multiple gene mutations, including IDH2, IDH1, ASXL1, KRAS, and RUNX1. It is important to be aware of this potentially clone evolution in disease progression.
Prognostic value of lymph node ratio in cervical cancer: A meta-analysis
Authors: Cui Haixia , Huang Yuan , Wen Weibo , Li Xiangdan , Xu Dongyuan , Liu Lan
Published: October 2022

Background:

The role of the lymph node ratio (LNR) in the existing tumor node metastasis classification system should be verified as one of the prognosis prediction factors. This work evaluated LNR’s performance in predicting cervical cancer (CC) prognosis through a meta-analysis.

Method:

Related studies were retrieved from the Cochrane Library, EMBASE, and PubMed databases. The language was restricted to English. The combined hazard ratios (HRs) were utilized to analyze the prognostic value of LNR.

Results.

Our study included 8 articles with 3325 subjects published after 2015. Based on our analysis, high LNR was the adverse prognostic factor for overall survival (OS, HR = 1.45; 95% CI = 1.23–1.73; P = .238) and disease-free survival (DFS, HR = 2.69; 95% CI = 1.98–3.66; P = .597) among the CC cases. Furthermore, as revealed by subgroup analysis, in CC patients, median LNR of about 0.0625 and 0.066 served as the prominent risk factor for DFS and OS.

Conclusions:

The current work illustrates that elevated LNR is related to the dismal prognosis of CC. More well-designed clinical studies are warranted for assessing whether LNR is a factor independently predicting the prognosis of CC.
Demographic and clinical characteristics of pediatric COVID-19 in Arkansas: March–December 2020
Authors: Sanders Sara C. , Taylor Maxwell D. , Filipek Jacob , Williford Dustin , Nguyen Cindy , Fisher Charalene R. , Scheffler Stephanie M. , Smith Emily S. , Martin Phoebe , Latch Rebecca L. , Snowden Jessica , Wu Chang L. , Cantu Rebecca M.
Published: October 2022

The COVID-19 pandemic reached the United States in early 2020 and spread rapidly across the country. This retrospective study describes the demographic and clinical characteristics of 308 children presenting to an Arkansas Children’s emergency department (ED) or admitted to an Arkansas Children’s hospital with COVID-19 in the first 10 months of the COVID-19 pandemic, prior to the emergence of clinically significant variants and available vaccinations. Adolescents aged 13 and older represented the largest proportion of this population. The most common presenting symptoms were fever, gastrointestinal symptoms, and upper respiratory symptoms. Patients with multisystem inflammatory syndrome in children (MIS-C) had a longer length of stay (LOS) than patients with acute COVID-19. Children from urban zip codes had lower odds of admission but were more likely to be readmitted after discharge. Nearly twenty percent of the study population incidentally tested positive for COVID-19. Despite lower mortality in children with COVID than in adults, morbidity and resource utilization are significant. With many Arkansas children living in rural areas and therefore far from pediatric hospitals, community hospitals should be prepared to evaluate children presenting with COVID-19 and to determine which children warrant transport to pediatric-specific facilities.
Aberrant expression of long non-coding RNAs in peripheral blood mononuclear cells response to tuberculosis in children
Authors: Zhong Xiaoling , Lei Shikun , Lin Jing-Wen , Ren Min , Shu Min
Published: October 2022

We aimed to identify long non-coding RNAs (lncRNAs) aberrantly expressed in peripheral blood mononuclear cells (PBMCs) triggered by active tuberculosis (ATB), latent tuberculosis infection (LTBI), and healthy controls (HC). We examined lncRNAs expression in PBMCs isolated from children with ATB and LTBI, and from HC using RNA sequencing. Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analysis were used to explore the biological processes and signaling pathways of aberrantly expressed mRNAs. A total of 348 and 205 lncRNAs were differentially expressed in the ATB and LTBI groups, respectively, compared to the HC group. Compared to the LTBI group, 125 lncRNAs were differentially expressed in the ATB group. Compared to the HC group, 2317 mRNAs were differentially expressed in the ATB group, and 1093 mRNAs were differentially expressed in the LTBI group. Compared to the LTBI group, 2328 mRNAs were differentially expressed in the ATB group. The upregulated mRNAs were mainly enriched in neutrophil activation, neutrophil-mediated biological processes, and positive regulation of immune response in tuberculosis (TB), whereas the downregulated mRNAs were enriched in signaling pathways and structural processes, such as the Wnt signaling pathway and rDNA heterochromatin assembly. This is the first study on the differential expression of lncRNAs in PBMCs of children with TB. We identified significant differences in the expression profiles of lncRNAs and mRNAs in the PBMCs of children with ATB, LTBI, and HC, which has important implications for exploring lncRNAs as novel biomarkers for the diagnosis of TB. In addition, further experimental identification and validation of lncRNA roles could help elucidate the underlying mechanisms of Mycobacterium tuberculosis infection in children.
Management and treatment of ankle sprain according to clinical practice guidelines: A PRISMA systematic review
Authors: Ruiz-Sánchez Francisco J. , Ruiz-Muñoz María , Martín-Martín Jaime , Coheña-Jimenez Manuel , Perez-Belloso Ana J. , Pilar Romero-Galisteo Rita , Gónzalez-Sánchez Manuel
Published: October 2022

Background:

The lateral sprain of the ankle is a very frequent injury in the population in general, appearing in the emergency services frequently. The general objective was to review the current clinical practice guidelines (CPGs) on management and treatment of ankle sprains, assess their quality, analyze the levels of evidence and summarize the grades of recommendation.

Methods:

A systematic search of the literature in relevant databases with the search terms “ankle,” “sprain,” “practice guideline,” and “guideline” was carried out. There were included those guidelines that had the system of grades of recommendation and level of evidence concerning to management and treatment of ankle sprain. The quality of the guides was assessed using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) tool.

Results:

Seven clinical practice guides were included in this review. The AGREE II scores ranged from 42% to 100%, with only six CPGs explicitly declaring the use of a systematic methodology. Seventeen recommendations were extracted and summarized.

Discussion:

Six of the recommendations analyzed present enough evidence to be applied in clinical practice and are highly recommended for ankle sprain management: Ottawa rules, manual therapy, cryotherapy, functional supports, early ambulation, short term NSAIDs and rehabilitation.
CXCL2 acts as a prognostic biomarker and associated with immune infiltrates in stomach adenocarcinoma
Authors: Zhang Jingxin , Hou Wenji , Zuo Junbo , Huang Zhenhua , Ding Xin , Bu Xuefeng
Published: October 2022

Background:

STAD ranked 5th most common in the incidence of malignant tumors and 3rd most common in the death rate of cancer worldwide. CXC chemokines affect the biological progress of various tumors, resulting in therapeutic failure. The role of CXCL2 in STAD was still a mystery.

Methods:

The expression, prognostic value, and clinical function of CXCL2 were analyzed using several online bioinformatics tools and clinical tissues.

Results:

CXCL2 level was significantly upregulated in STAD tissues. Strong correlation was obtained between CXCL2 level and immune cells as well as immune biomarkers. High CXCL2 expression in STAD was correlated with a favorable prognosis. Further analysis revealed that CXCL2, pTNM stage and age were independent factors affecting the prognosis of STAD patients. A predictive nomogram indicated that the calibration plots for the 1-year, 3-year and 5-year OS rates were predicted relatively well compared with an ideal model in the entire cohort. Validation analysis revealed that CXCL2 expression was upregulated in STAD and high CXCL2 level had a better overall survival. CXCL2 was associated with resistance to numerous drugs or small molecules in STAD.

Conclusions:

We identified CXCL2 as a novel therapeutic target and associated with immune infiltration in STAD.
Comprehensive assessment of neurocognitive function, inflammation markers, and adiposity in treated HIV and control
Authors: Mouchati Christian , El Kamari Vanessa , Sattar Abdus , Yu Jiao , McComsey Grace A
Published: October 2022

To compare the neurocognitive scores between persons living with human immunodeficiency virus (PLWH) and persons without human immunodeficiency virus (HIV) and assess the relationship between neurocognition, HIV status and variables, inflammation, and body composition measures. Cross-sectional study involving 225 participants (126 PLWH on antiretroviral therapy [ART] and 99 persons without HIV). For the first time in HIV, we used Cognivue®, an food and drug administration (FDA)-approved computer-based test to assess cognitive function. The test was calibrated to individuals’ unique cognitive ability and measured 6 cognitive domains and 2 performance parameters. Markers of inflammation, immune activation, insulin resistance, and body fat composition (using dual-energy X-ray absorptiometry scan) were collected. Classical t tests, chi-square tests, and spearman correlations were used to compare and explore relationships between variables. Inverse probability weighting adjusted average treatment effect models were performed to evaluate the differences between PLWH and persons without HIV, adjusting for age, race, sex, and heroin use. Overall, 64% were male, 46% were Black, with a mean age of 43 years. Among PLWH, 83% had an undetectable HIV-1 RNA level (≤20 copies/mL). Compared persons without HIV, PLWH performed poorer across 4 domains: visuospatial (P = .035), executive function (P = .029), naming/language (P = .027), and abstraction (P = .018). In addition, PLWH had a significantly longer processing speed time compared to controls (1686.0 ms vs 1606.0 ms [P = .007]). In PLWH, lower cognitive testing domain scores were associated with higher inflammatory markers (high sensitivity C-reactive protein [hsCRP]) and with higher total fat and visceral adipose tissue (P < .05). Neurocognitive impairment (NCI) in HIV is associated with inflammation and total and central adiposity.
The relationship between the flexor and extensor muscle areas and the presence and degree of intervertebral disc degeneration in the cervical region
Authors: Yuksel Yavuz , Ergun Tarkan , Torun Ebru
Published: October 2022

Background:

This study aimed to investigate the relationship between the presence and degree of cervical intervertebral disc degeneration (IVDD) and the cervical region muscle areas.

Methods:

The magnetic resonance imaging (MRI) examination of the patients who were sent to our clinic for investigation of neck pain between 2019 and 2020 years were evaluated retrospectively. 143 Turkish women patients between 30 and 40 ages were examined in the study. The presence and degree of IVDD was evaluated for each patient. The areas of the cervical flexor and extensor paravertebral muscles were measured.

Results:

No cervical disc degeneration was present in 44 (30.76%) patients (grade 1). The cervical intervertebral disc degeneration was grade 2 in 28 (19.58%), grade-3 in 41 (28.67%), and grade 4 in 30 (20.97%) patients. In early stage degeneration (grade 2), an increase was observed in the area of all cervical paravertebral flexor and extensor muscles examined. As the degree of degeneration increased (grades 3 and 4), a decrease was observed in the areas of all muscles. Statistical significance was found for musculus (m) sternocleidomastoideus, m. levator scapulae, m. splenius capitis, m. semispinalis capitis, and m. multifidus muscles (P = .009, r = −0.261; P = .014, r = −0.248; P = .008, r = −0.267; P = .002, r = −0.307; P = .028, r = −0.222, respectively).

Conclusions:

IVDD is common in middle-aged females with neck pain. An increase in muscles areas is observed in the early stages of cervical disc degeneration but progressive decrease develops in all cervical paraspinal muscles areas as the degree of disc degeneration increases.
Factors affecting preventive behaviors of Alzheimer’s disease in family members of patients with Alzheimer’s disease
Authors: Kim JiEun , Kim Min Young , Kim Jung-Ae , Lee Youngeun
Published: October 2022

As genetic factors increase the risk of Alzheimer’s disease (AD), the families of dementia patients are at risk of AD. We aimed to evaluate the factors affecting preventive behaviors of AD in family members of AD patients. Using constructed questionnaire based on the Health Belief Model (HBM) theoretical framework, this cross-sectional study investigated factors influencing preventive behaviors of AD such the intention to take AD-preventive medicines, prior experience of taking cognitive function supplements, and AD-preventive lifestyle. 147 family members of AD patients were recruited through the Korea Alzheimer’s Caregiver Association. Out of 147 participants, 94.6% had intention to take AD-preventive medicines and 46.3% had experience of taking cognitive function supplements. The intention to take AD-preventive medicines were significantly influenced by self-efficacy (odds ratio [OR] 1.39, 95% confidence interval [CI] 1.03, 1.87) and dementia knowledge (OR 3.42, 95% CI 1.13, 10.39), whereas prior experience of cognitive function supplements was significantly associated with cue to action (OR 1.22, 95% CI 1.07, 1.40). AD-preventive lifestyle was significantly influenced by socio-demographics such as age, sex, and marital status, and the HBM factors such as perceived susceptibility, self-efficacy, and cue to action. Self-efficacy, cue to action, dementia knowledge, and perceived susceptibility were significantly associated with preventive behaviors of AD. Also, family members of dementia patients, who are at risk of dementia due to genetic factors, lifestyles, and environment factors, had high level of AD-preventive lifestyle and strong intention to take AD-preventive medicines. Further research could be suggested to understand AD-preventive behavior and intention to take AD-preventive medicines in general population.
Network-based pharmacological study of the mechanism of kaiyuzhongyutang in the treatment of tubal fimbria obstruction
Authors: Li Zaihong , Liu Xiangcheng , Wang Shengtan , Han Lizhen , Chen Pian , Zhong Tingting , Wang Bixia
Published: October 2022

To apply a network pharmacological approach to explore the targets and possible mechanisms of Kai Yu Zhong Yu Tang (KYZYT) in the treatment of tubal fimbria obstruction. The target information of KYZYT was extracted from TCMSP and HERB database. Genes related to tubal fimbria obstruction were searched using the GENECARD database. Target protein network maps (PPI) were drawn using string database analysis and Cytoscape 3.7.1 software. Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis and gene function analysis (GO) enrichment analysis were performed with the help of Perl language and biological program package in R language. To explore the multiple pharmacological mechanisms of action of KYZYT in the interventional treatment of tubal fimbria obstruction and to lay the foundation for further experimental validation. Through the collection and analysis of multiple databases, 355 biological targets of KYZYT were identified. 168 targets of tubal fimbria obstruction were obtained from disease database. The “drug-component” and “drug-target” networks of KYZYT were constructed, and the protein interaction network (PPI) of overlapping targets was analyzed to identify the key targets of the drug affecting the disease. In addition, KEGG pathway analysis and GO enrichment analysis were performed on the overlapping targets to explore the mechanism of KYZYT in the treatment of tubal fimbria obstruction. KYZYT has the characteristics of multi-component, multi-target and multi-pathway in the treatment of tubal fimbria obstruction, which provides new ideas and scientific basis for further clarification of the molecular mechanism.
Near-infrared fluorescence guided laparoscopic cholecystectomy in the spectrum of complicated gallstone disease
Authors: Gadiyaram Srikanth , Thota Ravi Kiran
Published: October 2022

ICG fluorescence (ICGF) guidance during laparoscopic cholecystectomy (LC) is gaining wider acceptance. While the accruing data largely addresses ICGF guidance during LC in patients with uncomplicated gallstone disease (UGS) and acute cholecystitis, there is a paucity of data related for complicated gall stone disease (CGS) such as choledocholithiasis, bilio-enteric fistula, remnant gall bladder, etc. The purpose of this study was to evaluate the role of ICGF during LC in the spectrum of CGS with state of the art 4 chip camera system. Retrospective review from a prospectively maintained database of all patients who underwent ICGF guided LC during the period June 1st, 2019 till December 30th, 2021 formed part of the study. Clinical profile and findings on ICGF during LC for CGS were studied. The data was studied to evaluate the potential roles of ICGF during LC for CGS. Of 68 patients, there were 29 males and 39 females. Among them were 32 and 36 in the uncomplicated and complicated gallstone disease groups, respectively. ICGF showed CBD visualization in 67(98.5%) and cystic duct in 62(91%). ICGF guidance helped in management of CGS, prior to, during and after completion of LC. It had novel application in patients undergoing CBD exploration. In our small series of patients with CGS, ICGF guidance enabled a LC and laparoscopic subtotal cholecystectomy in 94% and 6% of patients respectively. The study highlights potential roles and advantages with ICGF guided laparoscopic management for CBD stones, bilioenteric fistula, completion cholecystectomy and cystic duct stones. Large scale multicenter prospective studies are required to clarify the role of ICGF in the wide spectrum of CGS.
Risk factor stratification for postoperative delirium: A retrospective database study
Authors: Vacas Susana , Grogan Tristan , Cheng Drew , Hofer Ira
Published: October 2022

Postoperative delirium (POD) is a disturbing reality for patients and their families. Absence of easy-to-use and accurate risk scores prompted us to retrospectively extract data from the electronic health records (EHR) to identify clinical factors associated with POD. We seek to create a multivariate nomogram to predict the risk of POD based upon the most significant clinical factors.

Methods:

The EHR of 32734 patients >18 years of age undergoing surgery and had POD assessment were reviewed. Patient characteristics and study variables were summarized between delirium groups. We constructed univariate logistic regression models for POD using each study variable to estimate odds ratios (OR) and constructed a multivariable logistic regression model with stepwise variable selection. In order to create a clinically useful/implementable tool we created a nomogram to predict risk of delirium.

Results:

Overall, we found a rate of POD of 3.7% across our study population. The Model achieved an AUC of the ROC curve of 0.83 (95% CI 0.82–0.84). We found that age, increased American Society of Anesthesiologists (ASA) score (ASA 3–4 OR 2.81, CI 1.49–5.28, P < .001), depression (OR 1.28, CI 1.12–1.47, P < .001), postoperative benzodiazepine use (OR 3.52, CI 3.06–4.06, P < .001) and urgent cases (Urgent OR 3.51, CI 2.92–4.21, P < .001; Emergent OR 3.99, CI 3.21–4.96, P < .001; Critically Emergent OR 5.30, CI 3.53–7.96, P < .001) were associated with POD.

Discussion:

We were able to distinguish the contribution of individual risk factors to the development of POD. We created a clinically useful easy-to-use tool that has the potential to accurately identify those at high-risk of delirium, a first step to prevent POD.
Ustekinumab is effective against ulcerative colitis with intestinal stenosis: A case report
Authors: Liu Ailing , Guo Jing , Liu Hua , Xu Yonghong , Wu Jun , Mao Tao , Tian Zibin , Ding Xueli
Published: October 2022

Rationale:

Intestinal stricture and obstruction are rare complications of ulcerative colitis (UC). Currently, there are only a few studies on the treatment of UC with intestinal stenosis, however there are no reports on the treatment of UC with benign intestinal stenosis with ustekinumab (UST).

Patient concerns:

A 22-year-old woman was admitted to our hospital due to a 3-year history of recurrent bloody mucous in stool with intermittent abdominal pain and distension developed in the past month. She was steroid-dependent and had developed a secondary loss of response to infliximab.

Diagnoses:

She was diagnosed with UC combined with incomplete intestinal obstruction due to stenosis. The stricture had a mixed pattern with both inflammatory and fibrotic components, with the former covering a larger section of the intestine.

Interventions:

The patient was given UST for 56 weeks.

Outcomes:

The patient’s symptoms subsided after treatment with UST. The ulcers healed, and the stenosis was reduced.

Lessons:

UST is effective against UC with benign intestinal stenosis. It is thought that UST inhibits the production of transforming growth factor-β and interleukin-17, leading to the suppression of myofibroblast proliferation, ultimately alleviating intestinal stenosis.
Vascular photobiomodulation in the treatment of children with temporomandibular disorders: Study protocol for a randomized, controlled, blind, clinical trial
Authors: Sertaje María Roxana Ferreira , Gonçalves Marcela Leticia Leal , Gomes Andréa Oliver , Bruno Laura Hermida , Fossati Ana Laura , Viarengo Natalia Osorio , Santos Elaine Marcilio , Sobral Ana Paula Taboada , Mesquita-Ferrari Raquel Agnelli , Fernandes Kristianne Porta Santos , Horliana Anna Carolina Ratto Tempestini , Motta Lara Jansiski , Bussadori Sandra Kalil
Published: October 2022

Background:

This study aims to verify if the use of intravascular laser irradiation of blood (ILIB) influences the reduction of pain and increases the range of motion in opening and closing of the mouth in children and adolescents with temporomandibular disorders (TMD).

Methods:

This will be a blind, randomized, and controlled clinical trial, which will be carried out on children between 6 and 12 years of age who enter the Catholic University of Uruguay, Faculty of Health Sciences, Postgraduate School, for treatment. To be included, children must present temporomandibular disorders, based on the diagnostic criteria will be the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD). Forty-five participants will be randomized to three groups: Group 1—ILIB with 2 sessions of 20 minutes for 12 weeks (n = 15); Group 2—Placebo laser application with 2 sessions of 20 minutes for 12 weeks (n = 15); Group 3—Control with no treatment (n = 15). Irradiation will be performed by continuous and direct transcutaneous application to the radial artery, by means of a bracelet that inserts the laser beam. The laser to be used is infrared, power 100 mW ± 20%, wavelength 808 nm ± 10 nm, continuous application. RDC/TMD and pain evaluated through a visual analog scale will be the outcome measures.

Discussion:

Due to the low level of evidence, new studies are needed on the effect of ILIB in children with TMD.
Association between night sleep latency and hypertension: A cross-sectional study
Authors: Zhong Xia , Gou Fuyue , Jiao Huachen , Zhao Dongsheng , Teng Jing
Published: October 2022

Sleep disorders have been shown to increase the risk of hypertension, while the relationship between night sleep latency and hypertension is less well-known. We aimed to investigate the association between night sleep latency and hypertension, as well as related sleep factors by gender in the Chinese population. We conducted a cross-sectional study of the relationship between night sleep latency and hypertension. The sample size included 619 consecutive hospitalized patients (M/F: 302/317, 64.01 ± 12.27 years). T test, Chi-square test, and ANOVA were performed to analyze baseline data and intergroup comparisons. Spearman correlation analysis was performed to find the interrelationships. Multivariate logistic regression analysis was performed to adjust for covariables. The findings showed hypertension patients had longer night sleep latency (P < .001). After adjusting for confounding factors, night sleep latency was positively correlated with hypertension in both men and women (odds ratio: 1.065, 95% confidence interval: 1.044–1.087). Spearman correlation analysis suggested that night sleep latency was positively correlated with systolic blood pressure (r = 0.186, P < .001), diastolic blood pressure (r = 0.136, P < .001), sleep initiation time (r = 0.091, P = .023), and global Pittsburg Sleep Quality Index score (r = 0.371, P < .001), was negatively correlated with sleep duration (r = −0.186, P < .001), sleep time on weekdays (r = −0.183, P < .001), and sleep time on weekends (r = −0.179, P < .001). Longer night sleep latency was associated with an increased risk of hypertension in men and women, which might involve the pathological progression of hypertension along with other sleep factors.
Lipoma with osteocartilaginous metaplasia in infrapatellar fat pad: A case report and review of literature
Authors: Kim Segi , Ha Cheungsoo , Kwon Ah-Young , Choi Wonchul
Published: October 2022

Rationale:

Lipomas are tumors composed of mature adipocytes, originating from the mesoderm, and are the most common soft tissue tumor. According to the World Health Organization classification of human soft tissue and bone tumors, there are 14 types of benign tumors, including mature adipose tissue. Osteolipoma is known as the rarest subtype of lipoma.

Patient concerns:

A 63-year-old female presented to our hospital for the evaluation and treatment of a palpable mass with pain in the right knee.

Diagnosis:

The diagnosis was confirmed as lipoma with osteocartilaginous metaplasia.

Interventions:

Surgical removal of the tumor was performed.

Outcomes:

The main symptoms improved immediately after the surgery and recovered without any complications or recurrence until 2 years after surgery.

Lessons:

Lipoma with osteochondral degeneration is a rare variant of lipoma and it is important to differentiate it from other malignant tumors. Pathological confirmation should be performed after marginal resection of the mass.
Critical Care and Mechanical Ventilation Practices Surrounding Liver Transplantation in Children: A Multicenter Collaborative*
Authors: Maue Danielle K. , Martinez Mercedes , Alcamo Alicia , Beltramo Fernando , Betters Kristina , Nares Michael , Jeyapalan Asumthia , Zinter Matthew , Kamath Sameer , Ridall Leslie , Monde Alexandra , Resch Joseph , Kaushik Shubhi , Kang Elise , Mangus Richard S. , Pike Francis , Rowan Courtney M.
Published: October 2022

OBJECTIVES:

We aimed to determine which characteristics and management approaches were associated with postoperative invasive mechanical ventilation (IMV) and with a prolonged course of IMV in children post liver transplant as well as describing the utilization of critical care resources.

DESIGN:

Retrospective, multicenter, cohort study of children who underwent an isolated liver transplantation between January 2017 and December 2018.

SETTING:

Twelve U.S., pediatric, liver transplant centers.

PATIENTS:

Three hundred thirty children post liver transplant admitted to the ICU.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Six patients died in our cohort. The median length of PICU stay was 4.5 days (interquartile range [IQR], 2.9–8.2 d). Most patients were initially monitored with arterial catheters (96%), central venous pressures (95%), and liver ultrasound (93%). Anticoagulation (80%), blood product administration (52.4%), and vasoactive agents (23.0%) were commonly used therapies in the first 7 days. In multivariable logistic regression analysis, age (adjusted odds ratio [aOR] 0.9 [0.86–0.95]), open fascia (aOR 7.0 [95% CI, 2.6–18.9]), large center size (aOR 4.3 [95% CI 2.2–8.3]), and higher Model for End-Stage Liver Disease/Pediatric End-Stage Liver Disease scores (aOR 1.04 [95% CI, 1.01–1.06]) were associated with postoperative IMV. In multivariable logistic regression analysis, postoperative day 0 peak inspiratory pressure (PIP) (aOR 1.2 [95% CI, 1.1–1.3]), large center size (aOR 2.9 [95% CI, 1.6–5.4]), and age (aOR 0.89 [95% CI, 0.85–0.95]) were associated with length of IMV greater than 24 hours. Length of IMV greater than 24 hours was associated with bleeding complications (p = 0.03), infections (p = 0.03), graft loss (p = 0.02), and reoperation (p = 0.03).

CONCLUSIONS:

Younger age, preoperative hospitalization, large center size, and open fascia are associated with use of IMV, and younger age, large center size, and postoperative day 0 PIP are associated with prolonged IMV on multivariable analysis. Longer IMV is associated with negative outcomes, making it an important clinical marker.
Breast Reconstruction Free Flap Failure
Authors: Kalmar Christopher L. , Drolet Brian C. , Kassis Salam , Thayer Wesley P. , Higdon Kent K. , Perdikis Galen
Published: October 2022

Background

Microvascular free tissue transfer is an increasingly popular modality for autologous tissue breast reconstruction. However, flap failure remains an ominous risk that continues to plague surgeons and patients even in the setting of meticulous surgical technique and monitoring. Venous and arterial thromboses are the leading causes of free flap failure. The purpose of this study was to determine whether thrombocytosis is associated with breast free flap failure.

Methods

A retrospective study was conducted of breast reconstruction with free flaps in North America between 2015 and 2020 using the National Surgical Quality Improvement Program database. Patient comorbidities and preoperative laboratory tests were used to determine risk factors for free flap failure.

Results

During the study interval, 7522 female patients underwent breast reconstruction with free flaps, and flap failure occurred in 2.7% patients (n = 203). In multivariate regression analysis, breast free flap failure was significantly higher in patients smoking cigarettes within the past year (P = 0.030; AOR, 1.7) and dyspnea on moderate exertion or at rest (P = 0.025; AOR, 2.6). Furthermore, each 50 K/mcL elevation in platelet count was independently associated with an increased odds of flap failure (P < 0.001; AOR, 1.2). Patients experienced significantly higher rates of flap failure with platelet counts greater than 250 K/mcL (P = 0.004), which remained significant through progressively increasing thresholds up to 450 K/mcL.

Conclusions

Platelet count greater than 250 K/mcL is associated with progressively increasing risk of free flap failure in breast reconstruction. Future studies of personalized patient anticoagulation protocols based on hemostatic metrics may improve free flap survival after autologous tissue breast reconstruction.
Dual-Innervated Free Gracilis Muscle Transfer for Facial Reanimation in Children
Authors: Deramo Paul J. , Seitz Allison J. , Shakir Sameer , Greives Matthew R. , Low David W. , Jackson Oksana A. , Nguyen Phuong D.
Published: October 2022

Background

Facial palsy may have deleterious effects for pediatric patients. The most common reconstruction is 2-stage free gracilis muscle transfer (FGMT) after cross-face nerve graft (CFNG). This requires a prolonged period from time of surgery to smile. New techniques using both a CFNG and motor nerve to masseter (MNM) as dual power sources in a single-stage surgery have been described in adults. Here, we examine our experience with this technique in children.

Methods

A retrospective study was performed examining patients who underwent dual-innervated single-stage FGMT at 2 pediatric hospitals from 2016 to 2019. Demographics, etiology, perioperative characteristics, time to mandibular and emotional smile, and Sunnybrook scores were recorded.

Results

Five patients met inclusion criteria with a mean age of 11.8 (range, 8–20). Two patients had congenital facial palsy while 3 had acquired facial palsy. Four patients (80%) received dual end-to-end neural coaptations of the CFNG and MNM to the obturator nerve. One (20%) had end-to-side coaptation of the CFNG to the obturator nerve and end-to-end of the MNM to the obturator nerve. The average time to mandibular smile was 103 ± 15.4 days. The average time to emotional smile was 245 ± 48.1 days. The preoperative Sunnybrook scale was 32 ± 7.5 and improved to 55.3 ± 20.6 at 8 months postoperatively.

Conclusions

Dual-innervated FGMT is effective for facial reanimation in children with unilateral facial palsy. Patients can harness a stronger motor source (MNM) and the component of an emotional stimulus (CFNG). This approach may be the new criterion standard pediatric facial reanimation.
Postoperative Clinical and Radiological Analysis of Deviated Noses
Authors: Altinel Dinçer , Serin Merdan , Toplu Gaye
Published: October 2022

Background

Anatomical deformities can greatly alter nasal function, which can be largely corrected during septoplasty and septorhinoplasty operations. In this study, we aimed to objectively measure the results of septoplasty surgeries of deviated noses with radiological analysis and compare the results with clinical evaluations.

Patients and Methods

Forty patients who were undergoing septorhinoplasty were included in the study. Patients were evaluated with preoperative and postoperative paranasal computed tomography scan measurements and satisfaction surveys.

Results

Preoperative and postoperative mean ± SD septal deviation angle measurements were 11.9 ± 5.3 degrees and 6.5 ± 3.1 degrees, respectively. Preoperative and postoperative mean ± SD septal deviation distance measurements were 7.3 ± 4 and 3 ± 1.3 mm, respectively. Preoperative and postoperative mean ± SD oblique conchal measurement on the deviated side was 17.3 ± 3.2 and 13.4 ± 2.8, respectively. Preoperative and postoperative mean ± SD patient satisfaction survey scores were 17 ± 1.9 and 4.5 ± 1.9 points, respectively.

Discussion

To obtain a nose with a greatly improved functional gains, especially in heavy deviated noses, is an important goal in septorhinoplasty surgery. It is essential to apply the technique that will benefit the patient. The most important success criterion seems to be the regression of the clinical complaints of the patients, which can be proven objectively with computed tomography scan measurements.