bluuebunny/crossref_metadata_2025 huggingface dataset:
Investigation of the mechanical behavior of rock-like material with two flaws subjected to biaxial compression
Authors: Lian Shuailong , Wan Wen , Zhao Yanlin , Wu Qiuhong , Du Can
Published: June 2024

The biaxial compression experiments of rock-like materials with two flaws are carried out under different flaw inclination angle, rock bridge ligament angle, lateral stress. The experimental studies show that crack propagation modes of rock-like material are as follows: wing crack through mode (Y mode), shear crack through mode (J mode), mixed crack through mode (wing shear JY mode), longitudinal extension of crack and transverse shear splitting. prefabricated fractured rock specimens have experienced the closing stage of prefabricated fractures, the elastic deformation stage, the generation and expansion of cracks (or plastic strengthening), and the residual loading stage. The peak strength of the specimen is increases with the increase of flaw inclination angle and lateral stress. With the increase of the rock bridge ligament angle, the failure of the rock bridge region changes from the shear crack failure to composite failure of shear crack and the wing type tensile crack failure, and then to the wing crack failure. With the increase of the lateral pressure, the failure of the specimen changes from the wing type tensile crack failure to the wing type and shear crack failure, and then to shear crack failure. The flaw inclination angle mainly changes the form of crack growth but does not effect on the failure modes. The counting number of acoustic emission events at the center of the sample is relative large, indicating that the cacks appear in the part of the rock bridge firstly. With the increasing of loads, the cracks of the rock bridge expanding constantly and connecting finally. The changes of acoustic emission event counts is consistent with the macroscopic damage form obtained from the experiments.
Ethanol consumption in non-human primates alters plasma markers of bone turnover but not tibia architecture
Authors: Zhakubayev Alibek , Sattgast Lara H. , Lewis Anne D. , Grant Kathleen A. , Turner Russell T. , Iwaniec Urszula T. , Benton Mary Lauren
Published: June 2024

Ethanol consumption is associated with positive, negative, and neutral effects on the skeletal system. Our previous work using a nonhuman primate model of voluntary ethanol consumption showed that chronic ethanol use has an impact on skeletal attributes, most notably on biochemical markers of bone turnover. However, these studies were limited by small sample sizes and resulting lack of statistical power. Here, we applied a machine learning framework to integrate data from 155 monkeys (100 ethanol and 55 controls) to identify the bone features associated with chronic ethanol use. Specifically, we analyzed the influence of ethanol consumption on biomarkers of bone turnover and cancellous and cortical bone architecture in tibia. We hypothesized that chronic ethanol use for 6 months to 2.5 years would result in measurable changes to cancellous features and the biochemical markers compared to control animals. We observed a decrease in bone turnover in monkeys exposed to ethanol; however, we did not find that ethanol consumption resulted in measurable changes in bone architecture.
RARRES1 identified by comprehensive bioinformatic analysis and experimental validation as a promising biomarker in Skin Cutaneous Melanoma
Authors: Liu Meng , Bai Ruimin , Zhang Guanfei , Liu Xinyi , Wang Ziyang , He Ke , Gan Xinyi , Zhou Xiaolin , Yin Pan , Zheng Yan , Wang Guorong
Published: June 2024

Skin cutaneous melanoma (SKCM) is a highly malignant form of skin cancer, known for its unfavorable prognosis and elevated mortality rate. RARRES1, a gene responsive to retinoic acid receptors, displays varied functions in various cancer types. However, the specific role and underlying mechanisms of RARRES1 in SKCM are still unclear. GSE15605 was utilized to analyze the expression of RARRES1 in SKCM. Subsequently, the TCGA and GEO databases were employed to investigate the relationships between RARRES1 and clinicopathological parameters, as well as the prognostic implications and diagnostic efficacy of RARRES1 in SKCM. GO, KEGG, and GSEA analyses were conducted to explore the potential functions of RARRES1. Furthermore, the associations between RARRES1 and immune infiltration were examined. Genomic alterations and promoter methylation levels of RARRES1 in SKCM were assessed using cBioPortal, UALCAN, and the GEO database. Finally, RARRES1 expression in SKCM was validated through immunohistochemistry, and its functional role in SKCM progression was elucidated via in vivo and in vitro experiments. We found that RARRES1 was downregulated in SKCM compared with normal tissues, and this low expression was associated with worse clinicopathological features and poor prognosis of SKCM. The diagnostic efficacy of RARRES1, as determined by ROC analysis, was 0.732. Through GO, KEGG, and GSEA enrichment analysis, we identified 30 correlated genes and pathways that were mainly enriched in the tumor immune microenvironment, proliferation, apoptosis, and autophagy. Additionally, RARRES1 expression was found to be positively related to the infiltration of various immune cells in SKCM, particularly macrophages and T helper cells, among others. Analysis of genomic alterations and promoter methylation revealed that shallow deletion and hypermethylation of the RARRES1 promoter could lead to reduced RARRES1 expression. IHC validation confirmed the downregulation of RARRES1 in SKCM. Moreover, overexpression of RARRES1 inhibited the proliferation and migration of A375 cells, promoted apoptosis, and inhibited autophagic flux. In the mouse xenograft model, RARRES1 overexpression also suppressed SKCM tumor growth. Collectively, these findings suggest that RARRES1 may function as a suppressor and could potentially serve as a prognostic biomarker and therapeutic target for SKCM.
Oocyte maturation, fertilization, and embryo development in vitro by green and chemical iron oxide nanoparticles: a comparative study
Authors: Nejadali Chaleshtari Shamim , Amini Elaheh , Baniasadi Farzaneh , Tavana Somayeh , Ghalamboran Mohammadreza
Published: June 2024

Oxidative stress is considered one of the main challenges for in vitro maturation (IVM) and makes assisted reproductive technology (ART), including IVF and embryonic development less effective. Reducing free radicals via biocompatible nanoparticles (NPs) is one of the most promising approaches for developing IVM. We investigated the comparative effect of green and chemically synthesized iron oxide nanoparticles (IONPs) with an aqueous extract of date palm pollen (DPP) on oocyte parameters related to the IVM process. To this end, IONPs were synthesized by chemical (Ch-IONPs) and green methods (G-IONPs using DPP) and characterized. The mature oocyte quality of the Ch-IONPs and G-IONPs groups was evaluated by JC1 and Hoechst staining, Annexin V-FITC-Propidium Iodide, 2′, 7′-dichlorofluorescein diacetate, and dihydroethidium staining compared to the control group. Eventually, the mature oocytes were fertilized, promoted to blastocysts (BL), and evaluated in vitro. Compared with the control and G-IONPs groups, the Ch-IONPs-treated group produced more hydrogen peroxide and oxygen radicals. Compared with the Ch-IONPs group, the fertilization rate in the G-IONPs and control groups increased significantly. Finally, the G-IONPs and control groups exhibited a significant increase in the 2PN, 2-cell, 4-cell, 8-cell, compacted morula (CM), and BL rates compared with the Ch-IONPs group. Green synthesis of IONPs can reduce the toxicity of chemical IONPs during the IVM process. It can be concluded that G-IONPs encased with DPP compounds have the potential to protect against exogenous reactive oxygen species (ROS) production in an IVM medium, which can have a crucial effect on oocyte maturation and fertilization efficiency.
Dissecting the complexity of local and systemic circadian communication in plants
Authors: Mortada Mostafa , Xiong Lu , Mas Paloma
Published: June 2024

The plant circadian clock regulates daily and seasonal rhythms of key biological processes, from growth and development to metabolism and physiology. Recent circadian research is moving beyond whole plants to specific cells, tissues, and organs. In this review, we summarize our understanding of circadian organization in plants, with a focus on communication and synchronization between circadian oscillators, also known as circadian coupling. We describe the different strengths of intercellular coupling and highlight recent advances supporting interorgan communication. Experimental and mathematical evidence suggests that plants precisely balance both the circadian autonomy of individual cellular clocks and synchronization between neighboring cells and across distal tissues and organs. This complex organization has probably evolved to optimize the specific functions of each cell type, tissue, or organ while sustaining global circadian coordination. Circadian coordination may be essential for proper regulation of growth, development, and responses to specific environmental conditions.
Inhibition of thioredoxin reductase and upregulation of apoptosis genes for effective anti-tumor sono-chemotherapy using a meso-organosilica nanomedicine
Authors: Li Mengwen , Tian Yue , Wen Xiaoming , Fu Jingke , Gao Jianyong , Zhu Yingchun
Published: June 2024

Chemotherapy in combination with sonodynamic therapy is performed with CQ@MOS, leading to TrxR inhibition, severe ROS accumulation, pro-apoptotic gene upregulation in the JNK pathway, autophagy inhibition and tumor apoptosis.
Electronically modulated bimetallic telluride nanodendrites atop 2D nanosheets using a vanadium dopant enabling a bifunctional electrocatalyst for overall water splitting
Authors: Pathak Ishwor , Muthurasu Alagan , Acharya Debendra , Chhetri Kisan , Dahal Bipeen , Rosyara Yagya Raj , Kim Taewoo , Ko Tae Hoon , Kim Hak Yong
Published: June 2024

A bimetallic telluride heterojunction is electronically modulated by vanadium doping, resulting in remarkable catalytic activity for hydrogen evolution, oxygen evolution, and overall water-splitting.
Next-generation carbon molecule sieve membranes derived from polyimides and polymers of intrinsic microporosity for key energy intensive gas separations and carbon capture
Authors: Deng Min , Wei Jing , Ma Yulei , Qin Zikang , Song Jia , Yang Lin , Yao Lu , Jiang Wenju , Yi Shouliang , Li Nanwen , Dai Zhongde
Published: June 2024

The effects of pyrolysis protocols on the pore structure and gas separation performance of PI- and PIM-derived CMS membranes were systematically summarized and discussed, and the research progress in CO2 and olefin/paraffin separation was reviewed.
Hydrophilic amphibious open-cell macroporous sponge by Hofmeister effect induced nanofibrils
Authors: Chen Mengdie , Wang Yuhao , Yang Mohan , Zhang Lei , Wang Kai , Ye Dezhan , Zhan Yanhu , Li Xiao , Zhang Weiying , Jiang Xiancai
Published: June 2024

Hydrophilic macroporous sponge has been widely used in solar steam generation, catalysis, biosensing and other fields due to its high water transporting and adsorption ability.
Insights into the electronic structure of tin(ii) pyrochlore oxides with 5s2 lone pair states as transparent p-type oxide semiconductors
Authors: Shi Jueli , Sheng Ziqian , Zhuang Yong-Bin , Qi Dong-Chen , Zhang Kelvin H. L.
Published: June 2024

P-type oxide semiconductor is crucial for advanced electronics. This work reveals the development of tin(ii) pyrochlore oxides as transparent p-type oxide semiconductor through synergistic valence band modulation and crystal structural design.
Editorial
Authors: Jacobs Collin
Published: June 2024

Sehr geehrte Kolleginnen und Kollegen,

ich freue mich, Ihnen die zweite Ausgabe der IOK dieses Jahres präsentieren zu
dürfen. Als Thema für diese Ausgabe habe ich die klinische Kieferorthopädie gewählt.
Fallbeispiele aus diversen Arbeitsgruppen stellen die Möglichkeiten unseres Faches
dar. Medizinische Indikationen, digitale Diagnostik, individualisierte Planungen und
moderne Therapiekonzepte beschreiben die heutige Kieferorthopädie. Der Einsatz
moderner, Setup-basierter Apparaturen in kieferorthopädischen Fällen, deren
Behandlungsindikationen mehr als nur die Verbesserung der Ästhetik darstellen,
zeigen den Fortschritt unseres Faches. Von „A“ wie Aligner über „L“ wie Lingual bis
„Z“ wie Zentrik ist alles dabei. Die folgenden Beiträge der verschiedenen Autoren
sollen Ihnen Fallbespiele zu verschiedenen Themengebieten darstellen. Die zugehörige
Literatur unterstreicht die Evidenz der verwendeten Therapien im Kontext der
vorhandenen Wissenschaft.
Erwachsenenbehandlung einer Kl.II Malokklusion mit skelettal offenem
Biss und seitlichem Kreuzbiss – Kombination aus chirurgisch unterstützter
Gaumennahterweiterung und vollständig individualisierter
Lingualapparatur
Authors: Schneider Olina , Jacobs Collin
Published: June 2024

Der vorliegende Fallbericht beschreibt die Therapie und das Behandlungsergebnis
eines erwachsenen Patienten mit einer Angle-Klasse II – Malokklusion, einem
skelettal offenen Biss und einem seitlichen Kreuzbiss, welcher durch eine
vollständig individualisierte Lingualapparatur (WIN, DW Lingualsystems, Bad
Essen, Germany) in Verbindung mit einer chirurgisch unterstützten
Gaumennahterweiterung (GNE) behandelt wurde. Eine bilaterale Neutralokklusion
mit physiologischem Overjet und Overbite konnte ohne die primär geplante
Dysgnathie Operation erfolgreich eingestellt werden.
Die missverstandene Digitalisierung
Authors: Schwanenberg Jenni
Published: June 2024

Die Digitalisierung steht mehr denn je auf der politischen Agenda. In jedem
Unternehmen gibt es Digitalisierungsstrategien. Und so wird auch die
Hebammenschaft zunehmend damit konfrontiert. Doch wie ist Digitalisierung
eigentlich zu verstehen? Eine Analyse.
Post–Intensive Care Syndrome in Neurocritical Care Patients
Authors: Dangayach Neha S. , Kreitzer Natalie , Foreman Brandon , Tosto-Mancuso Jenna
Published: June 2024

Post–intensive care syndrome (PICS) refers to unintended consequences of critical care that manifest as new or worsening impairments in physical functioning, cognitive ability, or mental health. As intensive care unit (ICU) survival continues to improve, PICS is becoming increasingly recognized as a public health problem. Studies that focus on PICS have typically excluded patients with acute brain injuries and chronic neurodegenerative problems. However, patients who require neurocritical care undoubtedly suffer from impairments that overlap substantially with those encompassed by PICS. A major challenge is to distinguish between impairments related to brain injury and those that occur as a consequence of critical care. The general principles for the prevention and management of PICS and multidomain impairments in patients with moderate and severe neurological injuries are similar including the ICU liberation bundle, multidisciplinary team-based care throughout the continuum of care, and increasing awareness regarding the challenges of critical care survivorship among patients, families, and multidisciplinary team members. An extension of this concept, PICS-Family (PICS-F) refers to the mental health consequences of the intensive care experience for families and loved ones of ICU survivors. A dyadic approach to ICU survivorship with an emphasis on recognizing families and caregivers that may be at risk of developing PICS-F after neurocritical care illness can help improve outcomes for ICU survivors. In this review, we will summarize our current understanding of PICS and PICS-F, emerging literature on PICS in severe acute brain injury, strategies for preventing and treating PICS, and share our recommendations for future directions.
Hemostasis Testing in the Emergency Department: A Narrative Review
Authors: Thonon Henri , Van Nieuwenhove Michael , Thachil Jecko , Lippi Giuseppe , Hardy Michael , Mullier François
Published: June 2024

Routine laboratory screening is typically performed at initial evaluation of the vast majority of presentations to the emergency department (ED). These laboratory results are crucial to the diagnostic process, as they may influence up to 70% of clinical decisions. However, despite the usefulness of biological assessments, many tests performed are inappropriate or of doubtful clinical relevance. This overutilization rate of laboratory testing in hospitals, which represents a significant medical–economic burden, ranges from 20 to 67%, with coagulation tests at the top of the list. While reviews frequently focus on nonintensive care units, there are few published assessments of emergency-specific interventions or guidelines/guidance to date. The aim of this review is to highlight current recommendations for hemostasis evaluation in the emergency setting with a specific analysis of common situations leading to ED admissions, such as suspected venous thrombosis or severe bleeding. We revisit the evidence related to the assessment of patient's hemostatic capacity based on comprehensive history taking and physical examination as well as best practice recommendations for blood sample collection to ensure the reliability of results. This review also includes an examination of various currently available point of care tests and a comprehensive discussion on indications, limitations, and interpretation of these tests.
The effect of cadre–farmer relationship on farmers’ willingness to treat domestic waste: evidence from China
Authors: Jian Bei , Lin Ying , Li Qi , Xu Xiaoqian , Cao Yang , Liu Jiajia , Zhang Han , Qu Mei
Published: June 2024

The construction of an ecologically livable rural environment requires treating rural domestic waste. Farmers, as key participants in rural domestic waste disposal, can improve the rural environment by disposing of domestic waste in an environmentally friendly manner. Few studies have examined the cadre–farmer relationship and its impact on rural waste pollution. Using a questionnaire survey of farmers in Shaanxi Province, China, this study estimates the effect of cadre–farmer relationship on their willingness to treat domestic waste. The findings indicate that a positive cadre–farmer relationship significantly increases farmers’ willingness to treat domestic waste. This positive relationship can also strengthen the positive effects of institutional rules on waste treatment willingness. Further mechanism analysis shows that a good cadre–farmer relationship mobilizes farmers to protect the environment and to comply with national ecological laws and regulations, enhancing their willingness to treat domestic waste. These findings enrich research on rural domestic waste management.
Serum 25-Hydroxyvitamin D Is Associated With Prediabetes, Type 2 Diabetes Mellitus, and Insulin Resistance in Children: A Systematic Review and Dose-Response Meta-analysis of Epidemiologic Studies
Authors: Hajhashemy Zahra , Ziaei Rahele , Askari Gholamreza , Saneei Parvane
Published: June 2024

Context

Although several investigations have been conducted on the association between serum vitamin D levels and prediabetes and type 2 diabetes mellitus (T2DM) in children and adolescents, their findings are inconsistent.

Objective

We conducted a systematic review and dose-response meta-analysis to summarize this subject.

Data Sources

The electronic databases of ISI Web of Science, Scopus, PubMed, and motor engineering of Google Scholar were comprehensively searched up to May 2023.

Data Extraction

Epidemiologic studies that investigated the risk of hyperglycemia and insulin resistance in relation to serum 25-hydroxy vitamin D levels in children and adolescents were included.

Data Analysis

Twenty-two investigations, with a total of 38 622 participants, were systematically reviewed. Meta-analysis of 15 studies (n = 32 720 participants) showed that participants with the highest serum vitamin D levels had 42% lower risk of hyperglycemia, compared with those in the lowest category of serum vitamin D levels (relative risk [RR] = 0.58; 95%CI, 0.48, 0.71). Moreover, pooling 8 studies (n = 10 465 participants) illustrated that highest serum vitamin D level was associated with a 44% lower risk of insulin resistance compared with the lowest serum vitamin D level (RR = 0.56; 95%CI, 0.37, 0.83). Based on linear dose-response analysis, each 10 nmol/L increment in serum 25-hydroxy vitamin D was associated with a 6% decreased risk of hyperglycemia and insulin resistance in children. Furthermore, nonlinear dose-response analysis revealed that increasing serum vitamin D concentration from 40 nmol/L to sufficient values (>50 nmol/L) was associated with a decreasing trend in risk of hyperglycemia and insulin resistance.

Conclusion

This meta-analysis revealed inverse associations between serum vitamin D levels and hyperglycemia and insulin resistance in children and adolescents, in a dose-response manner. Increasing serum vitamin D concentration from 40 nmol/L to sufficient values (>50 nmol/L) was associated with a decreasing trend in hyperglycemia and insulin resistance risk. Systematic Review Registration: PROSPERO registration no. CRD42023458155.
Neoplatonism in Schelling’s Of the I and Letters
Authors: Fisher Naomi
Published: June 2024

This chapter details Schelling’s exposure to Neoplatonism in his early education and the way that Neoplatonic commitments are manifested in two of his early writings: Of the I as the Principle of Philosophy and Letters on Dogmatism and Criticism. This chapter argues that Schelling shares with certain Neoplatonists two fundamental commitments. First, Schelling is committed to two kinds of cognition: a lower, discursive kind and a higher, intuitive kind, which he terms intellectual intuition. Second, Schelling is committed to the triad of immanence, procession, and return as the basic grounding structure of the world. This structure is present in his early writings: All things remain immanent in the absolute, which is accessed in intellectual intuition. The absolute is that from which the world of finite things proceeds. Finally, it is that to which all things return, either through moral progress or through creative, artistic activity.
Conclusion
Authors: Fisher Naomi
Published: June 2024

This brief conclusion offers a summary of the major claims of the book and argues for their ongoing historical and philosophical relevance. This conclusion also examines the notion of progress at work in Schelling’s philosophy. Schelling draws on the resources of the past in order to address the idiosyncratic projects and problems of his own philosophical era. Schelling, in his attention to the tradition of Platonism, presents a model for engaging with past philosophy in order to make progress in the present. This conclusion accordingly offers a reflection on the ongoing relevance and resources of Schelling’s philosophy for our own age.
Debt Situation of SNGs in India
Authors: Dwivedi Hari Krishna
Published: June 2024

This chapter discusses the historical trend of debt accumulation in Indian states over the past forty years from 1982. The forty-year period can be broken into three phases, with the first being 1982–2003, during which there was a visible deterioration in the debt position of the states. The period from 2003 to 2015 witnessed the enactment and formalization on the FRBM regime in all the states which contributed to bringing the debt of most states under control. However, the period from 2015 has seen the situation worsening on account of multiple reasons such as the inclusion of the power sector debt under states’ ambit and increased borrowing to fight the Covid-19 pandemic. The trends in gross fiscal deficit and revenue deficit are covered to understand how states have accumulated debt over the years, and to get a better sense of the quality of the debt that states have been undertaking. An interstate comparison of the states’ debt position reveals that there are large differences between the states in terms of their indebtedness as a percentage of their gross state domestic product. Some of the reasons for the poor fiscal condition of the states are also discussed.
General Theory of Constructing Potential with Bound States in the Continuum
Authors: Kurino Mao , Takayanagi Kazuo
Published: June 2024

We present a general theory of potentials that support bound states at positive energies (bound states in the continuum). On the theoretical side, we prove that, for systems described by nonlocal potentials of the form $V(r,r^{\prime })$, bound states at positive energies are as common as those at negative energies. At the same time, we show that a local potential of the form $V(r)$ rarely supports a positive-energy bound state. On the practical side, we show how to construct a (naturally nonlocal) potential that supports an arbitrary normalizable state at an arbitrary positive energy. We demonstrate our theory with numerical examples both in momentum and coordinate spaces with emphasis on the important role played by nonlocal potentials. Finally, we discuss how to observe bound states at positive energies, and where to search for nonlocal potentials that may support them.
The Afterlives of Mental Hygiene: Psychiatrizing Society in Socialist Yugoslavia
Authors: Savelli Mat
Published: June 2024

This article explores the ‘afterlives’ of the mental hygiene movement in Yugoslavia, by considering two periods of time (the immediate post-WWII period and the early 1960s onwards). Despite the favourable ideological conditions, during which authorities sought to refashion healthcare in the direction of social prophylaxis in order to build socialism, practitioners in the immediate post-war era did not embrace socially focussed psychiatry, instead retreating to focus on the clinic and the brain. From the early 1960s, however, many Yugoslav clinicians embraced the social psychiatry movement. In their work, they articulated the notion that improving the mental health of individuals could benefit society, and that refashioning society could equally prevent mental illness. This ‘second afterlife’ of mental hygiene thus proved much more successful than the first. Yet rather than seeing their discipline as a tool to support the state and its aims, social psychiatrists critiqued the conditions of life within socialist Yugoslavia.
Device-measured weekend catch-up sleep, mortality, and cardiovascular disease incidence in adults
Authors: Chaput Jean-Philippe , Biswas Raaj Kishore , Ahmadi Matthew , Cistulli Peter A , Rajaratnam Shantha M W , Hamer Mark , Stamatakis Emmanuel
Published: June 2024

Study Objective

Attempting to recover a sleep debt by extending sleep over the weekend is a common compensatory behavior in the population and is recommended by sleep-focused organizations. However, the purported benefits of catch-up sleep are based on a limited number of cross-sectional studies that relied on self-reported sleep. The objective of this study was to examine the association between accelerometer-derived weekend catch-up sleep and mortality and incident cardiovascular disease (CVD) in adults.

Methods

A prospective cohort study of UK adults who wore wrist-attached accelerometers was conducted. Weekend catch-up sleep was defined as a longer average sleep duration on weekends compared to weekdays. Participants were categorized into four groups: no weekend catch-up sleep (reference); > 0 to < 1 hour; ≥ 1 to < 2 hours; and ≥ 2 hours difference. Associations between weekend catch-up sleep and mortality and incident CVD were assessed using Cox proportional hazards regression, adjusted for potential confounders.

Results

A total of 73 513 participants (sample for mortality) and 70 518 participants (sample for CVD incidence) were included, with an average (SD) follow-up period of 8.0 (0.9) years. In multivariable-adjusted models, weekend catch-up sleep was not associated with mortality (≥ 2 hours group: hazard ratio [HR], 1.17 [95% CI: 0.97 to 1.41]) or incident CVD (HR, 1.05 [95% CI, 0.94 to 1.18]). Dose–response analyses treating catch-up sleep as a continuous measure or analyses restricted to adults sleeping less than 6 hours on weekdays at baseline were in agreement with these findings.

Conclusions

Weekend catch-up sleep was not associated with mortality or CVD incidence. These findings do not align with previous evidence and recommendations by sleep authorities suggesting that extending sleep over the weekend may offer protective health benefits.
Reducing Stimulant Prescribing Error: A Quality Improvement Initiative in Pediatric Outpatient Setting
Authors: Watthanathiraphapwong Natthaphon , Traipidok Pathrada , Charleowsak Pattra , Tassanakijpanich Nattaporn , Thongseiratch Therdpong
Published: June 2024

Objective:

To evaluate the impact of the Songklanagarind ADHD Multidisciplinary Assessment and Care Team for Quality Improvement (SAMATI) initiative on reducing stimulant prescribing errors in a pediatric outpatient setting.

Methods:

A retrospective study examined attention deficit hyperactivity disorder (ADHD) registry data from January 2017 to June 2023 to assess the impact of the SAMATI initiative, implemented in early 2020. This initiative, integrating multiple components such as audit and feedback, clinical pharmacist involvement, and Electronic Medical Record utilization, aimed to enhance ADHD medication management. Using interrupted time series and control chart analyses, the study evaluated the initiative's effect on reducing stimulant prescribing errors. Additionally, parental satisfaction was measured to gauge the initiative's overall success.

Results:

Out of 282 patients enrolled, 267 were included in the final analysis after exclusions. Post-intervention analysis showed significant reductions in various prescribing errors per thousand prescriptions: prescribing without concern drug-condition interaction (443 to 145, p < 0.001), prescribing without adequate monitoring (115 to 14, p < 0.001), lack of regular office visits (98 to 21, p = 0.007), and inappropriate dosage (66 to 14, p = 0.05). Medication errors severity classification also showed significant changes, with notable decreases in classes C and D errors. Parental satisfaction improved from 84% to 95%.

Conclusion:

The SAMATI initiative significantly reduced stimulant prescribing errors and enhanced parental satisfaction in ADHD care management. This study demonstrates the potential of comprehensive quality improvement strategies in improving medication management in pediatric healthcare. Further research in diverse settings is warranted to confirm these findings.
Impact of an AI-based laparoscopic cholecystectomy coaching program on the surgical performance: a randomized controlled trial
Authors: Wu Shangdi , Tang Ming , Liu Jie , Qin Dian , Wang Yuxian , Zhai Siwei , Bi Enxu , Li Yichuan , Wang Chunrong , Xiong Yong , Li Guangkuo , Gao Fengwei , Cai Yunqiang , Gao Pan , Wu Zhong , Cai He , Liu Jian , Chen Yonghua , Fang Chihua , Yao Li , Jiang Jingwen , Peng Bing , Wu Hong , Li Ang , Wang Xin
Published: June 2024

Background:

Laparoscopic cholecystectomy (LC) is the gold standard for treating symptomatic gallstones but carries inherent risks like bile duct injury. While the critical view of safety (CVS) is advocated to mitigate bile duct injury, its real-world adoption is limited. Additionally, significant variations in surgeon performance impede procedural standardization, highlighting the need for a feasible, innovative, and effective training approach. The aim of this study is to develop an artificial intelligence (AI)-assisted coaching program for LC to enhance surgical education and improve surgeon’s performance.

Materials and methods:

The authors conducted a multicenter, randomized controlled trial from May 2022 to August 2023 to assess the impact of an AI-based coaching program, surgical coaching program, on novice performing LC. Surgeons and patients meeting specific inclusion criteria were randomly assigned to either a coaching group with AI-enhanced feedback or a self-learning group. The primary outcome was assessed using the Laparoscopic Cholecystectomy Rating Form, with secondary outcomes including surgical safety, efficiency, and adverse events. Statistical analyses were performed using SPSS, with significance set at a P-value less than 0.05.

Results:

Between May 2022 and August 2023, 22 surgeons were initially enrolled from 10 hospitals, with 18 completing the study. No demographic differences were noted between coaching and self-learning groups. In terms of surgical performance (Laparoscopic Cholecystectomy Rating Form scores), the coaching group showed significant improvement over time (31 to 40, P=0.008), outperforming the self-learning group by study end (40 vs 38, P=0.032). Significant improvements in CVS achievement were also noted in the coaching group (11% to 78%, P=0.021). Overall, the coaching program was well-received, outpacing traditional educational methods in both understanding and execution of CVS and participants in the intervention group expressed strong satisfaction with the program.

Conclusions:

The AI-assisted surgical coaching program effectively improved surgical performance and safety for novice surgeons in LC procedures. The model holds significant promise for advancing surgical education.
Robotic assisted common bile duct exploration for management of complex gallstone disease
Authors: Latif Javed , Mountjoy Poppy , Lewis Harrison , Bhatti Imran , Awan Altaf
Published: June 2024

Background:

Minimally invasive cholecystectomy and common bile duct exploration offers single-stage management for complex gallstone disease (cholelithiasis and choledocholithiasis). The Robotic platform presents benefits in improving operative precision, which has not been extensively evaluated in the acute setting of managing complex gallstone disease, as well as in performing transcholedochal or postcholecystectomy common bile duct exploration. The authors report an early series of emergent and expedited robotic-assisted cholecystectomy with common bile duct exploration (RC-CBDE) or robotic common bile duct exploration (R-CBDE) alone.

Material and Methods:

A retrospective analysis from a specialist unit in the United Kingdom was undertaken from April 2022 to September 2023, inclusive. All patients who underwent RC-CBDE or R-CBDE were included. Data was collated on patient demographics, perioperative investigations, intraoperative approach, and postoperative outcomes.

Results:

Twenty-three consecutive patients were identified. The median (IQR) age was 51 (33–66) years. Median (IQR) Charlson Comorbidity Index (CCI) was 1 (0–4). Five patients underwent operative intervention as an emergency and 18 on an expedited basis. Two patients underwent postcholecystectomy R-CBDE. Fourteen (61%) were transcholedochal and nine were transcystic (39%) CBDE. Median (IQR) bilirubin was 51 (34–253). Median (IQR) operative time was 176 (124–222) minutes. Median (IQR) postoperative length of stay was 2 (0–4) days. There were no bile leaks requiring intervention. The clearance rate of CBDS was 100%. No patients developed postoperative pancreatitis. One patient required intervention for port site hernia following RC-CBDE. One patient developed subhepatic collection postoperatively and required laparoscopic washout and placement of drains. No patients had retained stones after a 3-month follow-up.

Conclusion:

Early experience confirms that RC-CBDE and R-CBDE in feasible, safe, and effective treatment for complex gallstone disease. Integrated adjuncts (intraoperative robotic ultrasound – IORUS and Firefly – fluorescence guided surgery – FGS) and superior ergonomics of the robotic platform may assist in reducing the learning curve and increase wider uptake of this complex procedure.
The mediating effect of blood biomarkers in the associations between inflammatory bowel disease and incident psychiatric disorders: a prospective cohort study
Authors: Feng Jing , Wu Yanjun , Meng Meijun , Zeng Ruijie , Ma Yuying , Luo Dongling , Zhang Lijun , Zhang Yajie , Li Yang , Huang Wentao , Leung Felix W. , Duan Chongyang , Sha Weihong , Chen Hao
Published: June 2024

Background:

Despite the growing evidence of an association between inflammatory bowel disease (IBD) and psychiatric disorders, there has been limited research exploring the underlying mediating role of blood biomarkers on the gut-brain axis. This study aimed to examine the association between IBD and the risk of incident psychiatric disorders and investigate whether and how blood biomarkers mediate this association.

Methods:

This prospective cohort study using data from the UK Biobank included participants without psychiatric diagnoses at baseline. The case-cohort consisted of participants with a hospital-based diagnosis of IBD at baseline. The primary outcome was all psychiatric disorders. Secondary outcomes included 11 major psychiatric disorders. Cox regression models estimated adjusted hazard ratios (HRs) for psychiatric outcomes. Causal mediation models investigated the potential mediation effects of blood biomarkers.

Results:

Among 491 131 participants, patients with IBD exhibited higher risks of overall psychiatric disorders (HR 1.23 [95% CI: 1.13–1.33]), substance misuse (1.23 [1.09–1.38]), depression (1.36 [1.22–1.52]), anxiety (1.15 [1.01–1.30]) and post-traumatic stress disorder (1.87 [1.00–3.51]) compared with non-IBD participants. The association with incident substance misuse was only among patients with Crohn’s disease (CD, 1.47 [1.23–1.76]), but not ulcerative colitis (UC, 1.01 [0.84–1.21]). Mediation analysis revealed 16, 14, 15, and 6 biomarkers partially mediated the associations for all psychiatric disorders, substance misuse, depression, and anxiety, respectively. Six blood markers showed the strongest mediating effects: neutrophil count (proportion mediated: 12.04%), C-reactive protein (10.29%), systemic immune-inflammatory index (8.94%), erythrocyte distribution width (16.51%), erythrocyte count (9.76%), and albumin (9.15%). Moreover, several blood mediators of CD identified in association with incident substance misuse may explain the risk discrepancy between IBD subtypes.

Conclusion:

The blood biomarkers of inflammation, blood oxygen-carrying capacity, and metabolism mediate the effect of IBD on the risk of psychiatric outcomes and could be considered as a therapeutic target.
Liver transplantation for Wilson disease: Current knowledge and future perspectives
Authors: Ferrarese Alberto , Cazzagon Nora , Burra Patrizia
Published: June 2024

Liver transplantation currently represents a therapeutic option for patients with Wilson disease presenting with end-stage liver disease or acute liver failure. Indeed, it has been associated with excellent postoperative survival curves in view of young age at transplant and absence of recurrence. Attention has shifted over the past decades to a wise expansion of indications for liver transplantation. Evidence has emerged supporting the transplantation of carefully selected patients with primarily neuropsychiatric symptoms and compensated cirrhosis. The rationale behind this approach is the potential for surgery to improve copper homeostasis and consequently ameliorate neuropsychiatric symptoms. However, several questions remain unanswered, such as how to establish thresholds for assessing pretransplant neuropsychiatric impairment, how to standardize preoperative neurological assessments, and how to define postoperative outcomes for patients meeting these specific criteria. Furthermore, a disease-specific approach will be proposed both for the liver transplant evaluation of candidates with Wilson disease and for patient care during the transplant waiting period, highlighting the peculiarities of this systemic disease.
Backwash Maneuver for HeartMate3 Inflow Thrombosis: Experience From Two Cases
Authors: Cholevas Nikolaos , Hoermandinger Christoph , Just Isabell Anna , Politis Nikolaos , Falk Volkmar , Potapov Evgenij , Schoenrath Felix
Published: June 2024

The ingested pump inflow thrombus, although rare, is a potentially life-threatening complication of left ventricular assist devices. During the last years, the backwash maneuver is considered an alternative method to pump replacement for the treatment of inflow thrombosis, showing high success rate in selected patients with HeartWare HVAD devices. However, that was not the case in our present report, in which we detail the application of this method in two HeartMate3 patients with ingested pump inflow thrombus. Washing out the thrombus was not feasible in either case, possibly due to mechanical aspects of the inflow part of the HeartMate3 pump. As a result, we remain skeptical regarding the use of the method in HeartMate3 patients with inflow thrombosis.
Efficacy and safety of ketamine wound infiltration for postoperative pain management: a systematic review, meta-analysis, and trial sequential analysis
Authors: Abate Semagn M. , Mergia Getachew , Basu Bivash , Gezahegn Mussie , Ayinie Animut
Published: June 2024

Background:

Postoperative pain has a huge impact on the patients, families, healthcare practitioners, and healthcare delivery. Pain management with opioid-based analgesics and blind techniques have certain limitations, and ultrasound-based regional analgesia necessitates resources and experience, but ketamine wound infiltration is innovative with few side effects. However, its effectiveness is still uncertain.

Methods:

A thorough search was carried out across various databases including PubMed/Medline, Cochrane, ScienceDirect, CINAHL, and LILACS, with no limitations on date or language. Only randomized trials comparing the effectiveness of ketamine wound infiltration for managing postoperative pain were considered for inclusion. Two authors independently conducted data extraction, and the quality of evidence was assessed using GRADEpro software. Trial sequential analysis (TSA) was utilized to ascertain the conclusiveness of the findings.

Results:

The review showed that the first analgesic request was higher in the control group as compared to ketamine standard mean difference (SMD)=1.68 (95% CI: 0.95–2.41). The TSA revealed that the cumulative Z-curve crosses both alpha-spending boundaries and reaches the required information size threshold, revealing strong power for current evidence. However, the quality of evidence was moderate.

Conclusion:

Despite available evidence, the provision of a firm conclusion is less optimal with current evidence as the included studies were unpowered with low to very low quality of evidence.
Vendor-Specific Correction Software for Apparent Diffusion Coefficient Bias Due to Gradient Nonlinearity in Breast Diffusion-Weighted Imaging Using Ice-Water Phantom
Authors: Yoshida Tsukasa , Urikura Atsushi , Endo Masahiro
Published: June 2024

Objective

This study aimed to evaluate a vendor-specific correction software for apparent diffusion coefficient (ADC) bias due to gradient nonlinearity in breast diffusion-weighted magnetic resonance imaging using an ice-water phantom.

Methods

The phantom consists of 5 plastic tubes with a length of 100 mm and a diameter of 15 mm, filled with distilled water and immersed in an ice-water bath. Diffusion-weighted images were acquired by echo-planar imaging sequence on a 3.0-T scanner. ADC maps with and without correction were calculated using 4 b-values (0, 100, 600, and 800 s/mm2). The mean ADCs were measured using a rectangular profile with 5 × 40 pixels in the anterior-posterior (AP) and a square region of interest with 5 × 5 pixels in the right-left (RL) and superior-inferior (SI) directions on the ADC map. ADC was compared with and without correction using a paired t test. Additionally, ADC of the ice-water phantom was measured at the magnet isocenter.

Results

ADC increased in the AP and RL directions and decreased in the SI direction with increasing distance from the isocenter before correction. After the correction, ADC at the off-center positions in the AP, RL, and SI directions was reduced to within 5% of the expected value. There were significant differences in the ADC at the off-center positions without and with correction (P < 0.001); however, ADC at the magnet isocenter did not vary after correction (1.08 ± 0.02 × 10−3 mm2/s).

Conclusions

The vendor-specific software corrected the ADC bias due to gradient nonlinearity at the off-center positions in the AP, RL, and SI directions. Therefore, the software will contribute to the accurate ADC assessment in breast DWI.
Lowering Platelet Threshold to 20,000/μL for Fluoroscopy-Guided Lumbar Puncture Does Not Result in Observed Clinical Adverse Outcomes
Authors: Habib Ukasha , Buch Karen , Mehan William A.
Published: June 2024

Purpose

Fluoroscopic-guided lumbar puncture (FG-LP) is a common neuroradiologic procedure. Traditionally, a minimum platelet count (MPC) of 50,000/μL for this procedure has been required; however, we recently adopted a lower MPC threshold of 20,000/μL. The purpose of this study was to compare adverse events in patients undergoing FG-LP with MPCs above to those below the conventional 50,000/μL threshold.

Materials

This was an institutional review board–approved, retrospective study on adult patients with hematologic malignancy undergoing FG-LP in the neuroradiology division between May 2021 and December 2022, after lowering the minimal required MPC to 20,000/μL. Recorded data included indication for FG-LP, preprocedure and postprocedure MPC, need for and number of platelet transfusions within 24 hours of FG-LP, presence of traumatic tap, FG-LP-related complications, and any platelet transfusion–related adverse event. Patients were classified into 2 groups based on MPC: (1) those above 50,000/μL and (2) those below 50,000/μL. Descriptive statistics were used comparing these 2 groups.

Results

One hundred twenty-eight patients underwent FG-LP, with 46 having an MPC between 20,000 and 50,000/μL and 82 having an MPC above 50,000/μL. No postprocedural complications were encountered in either group. Traumatic taps occurred in 10/46 (22%)​ with MPC below 50,000/μL versus 10/82 (12%)​ in those with MPC above 50,000/μL. Forty of 46 patients (87%) were transfused with platelets within 24 hours prior to FG-LP. One patient developed a transfusion-related reaction.

Conclusion

Lowering the MPC threshold from 50,000/μL to 20,000/μL for FG-LP did not result in a higher incidence of spinal hematoma.
Protective Effects of Authenticity Against Depression, Suicide, and Burnout among Surgeons
Authors: Ockerman Kyle M , Mardourian Markos , Han Sabrina H , Sorice-Virk Sarah , Ching Jessica
Published: June 2024

BACKGROUND:

Physician burnout and poor mental health are highly prevalent issues within the surgical community. Authenticity, defined as the degree to which individuals align their actions with their true selves, has been identified as a potential factor facilitating positive mental health. This study explores the impact of authenticity on burnout, depression, and suicide among surgeons.

STUDY DESIGN:

Members of the department of surgery at a large academic medical center were sent an anonymous survey between April and May 2023. The survey evaluated authenticity using Authenticity Scale, depression using Patient Health Questionnaire, burnout using Copenhagen Burnout Inventory, and suicidality using Ask-Suicide Screening Questions (ASQ) tool.

RESULTS:

Of the 170 surgeons, 94 (55.3%) completed the survey. Higher Authentic Living Scores correlated with reduced burnout (r = −0.21, p = 0.047) and depression (r = −0.37, p = 0.0002). Conversely, higher Accepting External Influence (AEI) scores were associated with increased depression (r = 0.23, p = 0.023), and higher Authenticity Self-Alienation (ASA) scores were associated with increased burnout (r = 0.43, p < 0.0001) and depression (r = 0.48, p < 0.0001). Although authenticity domain scores were not significantly associated with ASQ, specific AEI and ASA questions indicated an elevated odds ratio (p = 0.029 and p = 0.010, respectively) of a positive ASQ. Authentic Living Score increased with advancement in professional rank (p = 0.007), whereas AEI (p = 0.0001), ASA (p = 0.003), depression (p = 0.014), and ASQ (p = 0.02) decreased.

CONCLUSIONS:

In this study, higher authenticity was associated with a lower likelihood of burnout and depression among surgeons. This study contributes valuable insights into the development of targeted intervention and support mechanisms aimed at promoting authenticity and mental health within the surgical profession.