bluuebunny/crossref_metadata_2025 huggingface dataset:
Longitudinal NGAL and Cystatin C plasma profiles present a high level of heterogeneity in a mixed ICU population
Authors: Jou-Valencia Daniela , Volbeda Meint , Zijlstra Jan G , Kootstra-Ros Jenny E , Moser Jill , Meurs Matijs van , Koeze Jaqueline
Published: April 2023

Background
NGAL and Cystatin C (CysC) as biomarkers for the early detection of AKI are subject to both pathophysiological, as well as patient related heterogeneity. The aim of this study was to investigate the timeline of plasma levels of NGAL and CysC during the first seven days of ICU admission in a mixed ICU population and to relate these to AKI severity during ICU stay. Via these means we aimed to bring clarity to the previously reported heterogeneity of these renal biomarkers.
Methods
Prospective Observation Cohort. Consecutive patients admitted to adult ICU at an academic hospital in the Netherlands between 18-02-2014 and 31-03-2014 were included. Urine output, serum creatinine, plasma NGAL and CysC were recorded during the first seven days of ICU admission. Biomarker expression was analyzed based on KDIGO score and time of AKI diagnosis.
Results
335 patients were included, 110 met KDIGO criteria for AKI. NGAL and CysC plasma levels were higher in AKI patients compared to non-AKI, high variability in individual values resulted in 56% of AKI patients having a false negative, and 32% of non-AKI patients having a false positive. Individual biomarker levels were variable, and no pattern based on KDIGO score was observed.
Conclusions
Plasma NGAL and CysC as biomarkers for the early AKI detection are subject to pathophysiological, and patient related heterogeneity. Further understanding of individual biomarker profiles may help in their application amongst mixed ICU populations.
Trial Registration
The need for informed consent was waived by the Institutional Ethical Review Board of the University Medical Center Groningen (METc 2013 − 174) by Prof. dr. W.A. Kamps on May 17th 2013.
Spatial temporal analysis of the mangrove forest using the google earth engine cloud computing platform for Pichavaram, South East Coast of India
Authors: Rajendiren Nagarajan , Ram Sree , Vaithalingam Selvam , Shanmugam Punitha , Ramasamy Ramasubramanian , Suresh Madha
Published: April 2023

Coastal mangrove wetlands are constantly under pressure from increasing populations, rising sea levels, and other climate change impacts. Globally, mangrove cover has decreased by about 5,245 sq. km since 1996. However, quantifying mangroves is challenging due to the difficult terrain, and it can be time-consuming and costly. Fortunately, recent advances in remote sensing technology and machine learning algorithms enable managers to quickly and accurately quantify mangroves.The objective of this study is to use the Google Earth Engine (GEE) cloud computing facility and five decades of Landsat images to quantify mangroves. This study utilized the extensive Landsat archive images available through cloud computing facilities. The random forest classifier was used to classify satellite images for better accuracy. The study reveals that mangroves in Pichavaram Reserve Forest have increased by 104% from 1977 to 2021. It demonstrates that the massive dataset was processed quickly, efficiently, and cost-effectively on the GEE cloud platform without the need for sophisticated software or hardware
Prevalence and incidence of type 2 diabetes mellitus in patients with adrenal incidentalomas: A study of 709 cases
Authors: BROX-TORRECILLA NOEMI , Cano Ana M. García , Herrero Pablo Valderrábano , Tobar Alejandra Quintero , Morreale Héctor Francisco Escobar , Araujo-Castro Marta
Published: April 2023

Aim To evaluate the prevalence and incidence of type 2 diabetes in patients with nonfunctioning adrenal incidentalomas (NFAI) or adrenal incidentalomas (AI) with autonomous cortisol secretion (ACS).Methods In this single-center retrospective study, all patients with adrenal incidentalomas ≥ 1cm and ACS or NFAI studied between 2013–2020 were included. ACS was defined by a post-dexamethasone suppression test (DST) serum cortisol concentration ≥ 1.8µg/dl, in the absence of signs of hypercortisolism, and NFAI was defined as a DST < 1.8µg/dl without biochemical evidence of hypersecretion of other hormones.Results Inclusion criteria were met by 231 patients with ACS and 478 with NFAI. At diagnosis, type 2 diabetes was present in 24.3% of patients. No differences were found in the prevalence of diabetes (27.7% vs. 22.6%, P = 0.137) between patients with ACS and NFAI. However, fasting plasma glucose values and glycated haemoglobin levels were significantly higher in patients with ACS than with NFAI (112 ± 35.6 vs 105 ± 29mg/dl, P = 0.004; and 6.5 ± 1.4 vs. 6.1 ± 0.9%, P = 0.005, respectively). Furthermore, patients with type 2 diabetes had higher urinary free cortisol (P = 0.039) and late-night salivary cortisol levels (P = 0.010) than those without type 2 diabetes. After a median follow-up of 28 months, no differences were found in the incidence of diabetes between the groups (HR 1.17, 95% 0.52–2.64).Conclusion Type 2 diabetes was present in one fourth of our cohort. We found no differences in its prevalence or incidence between the groups. However, glycemic control might be worse among diabetic patients with ACS. Higher concentrations of urinary and salivary cortisol were found in patients with than without type 2 diabetes.
Use of light-weight foaming polylactic acid as a lung-equivalent material in 3D printed phantoms
Authors: Crowe Scott B , Maxwell Sarah K , Brar Harsimran , Yu Liting , Kairn Tanya
Published: April 2023

The 3D printing of lung-equivalent phantoms using conventional polylactic acid (PLA) filaments requires the use of low in-fill printing densities, which can produce substantial density heterogeneities from the air gaps within the resulting prints. Light-weight foaming PLA filaments produce microscopic air bubbles when heated to 3D printing temperatures. In this study, the expansion of foaming PLA filament was characterised for two 3D printers with different nozzle diameters, in order to optimise the printing flow rates required to achieve a low density print when printed at 100% in-fill printing density, without noticeable internal air gaps. Effective densities as low as 0.28 g cm− 3 where shown to be achievable with only microscopic air gaps. Light-weight foaming PLA filaments are a cost-effective method for achieving homogeneous lung-equivalency in 3D printed phantoms for use in radiotherapy imaging and dosimetry, featuring smaller air gaps than required to achieve low densities with conventional PLA filaments.
Deconcentration to improve regulation in low- and middle-income country health systems: Findings from research on regulation for doctors, nurses and midwives in Kenya and Uganda
Authors: McGivern Gerry , Wafula Francis , Seruwagi Gloria , Kiefer Tina , Musiega Anita , Nakidde Catherine , Ogira Dosila , Gill Mike , English Mike
Published: April 2023

Background: Regulating health professionals in Low- and Middle-Income Countries (LMICs) is a key challenge. While holding potential to improve professional practice and patient care, regulation is often weakly implemented and enforced across LMIC health systems, allowing poor practices to continue. Therefore, there is need to understand how regulation can be improved across resource constrained LMIC health systems.
Methods: We conducted mixed-methods research on health professional regulation in Uganda and Kenya (2019-2021), using qualitative interviews with national regulatory stakeholders, sub-national regulatory actors, ‘frontline’ doctors and nurses/midwives, and a bi-national survey.
Results: Due to resource constraints, Kenyan and Ugandan regulators were generally perceived to be ‘remote’ and ‘out of touch’ with ‘frontline’ professionals. Weak regulation was blamed for failing to address widespread malpractice and inadequate standards of health professional training. However, doctors and nurses/midwives were positive about online licencing and regulation where they had relationships with accessible regulators.
Conclusion: We propose an ambidextrous approach to regulatory improvement in resource constrained LMIC health systems; simultaneously deconcentrating regulatory monitoring and support to local level, to address frontline problems, while funding this using efficiency savings from developing and streamlining online regulatory administration.
Encouraging visual outcomes in children with idiopathic and JIA associated uveitis: a population-based study
Authors: Siiskonen Mira , Hirn Iida , Pesala Roosa , Ohtonen Pasi , Hautala Nina
Published: April 2023

Background: Pediatric uveitis is typically asymptomatic and may become chronic affecting ocular structures and vision. We evaluated clinical features and visual outcomes in children with either idiopathic uveitis (IU) or juvenile idiopathic arthritis associated uveitis (JIA-U). The effect of medication on uveitis activity is also analyzed.
Methods:A retrospective, population-based cohort study of children with uveitis in 2008-2017. The data included parameters for age, gender, age at diagnosis, laterality, chronicity, anatomical distribution, etiology, systemic association, uveitis activity, medication, and visual outcomes.
Results: A total of 119 patients aged <16 years with uveitis were included. Uveitis was IU in 23% and associated with JIA in 77% of cases. 37% of the patients in IU group and 65% in the JIA-U were girls (p=0.014). The mean age at first uveitis was 10.0 (SD 3.4) years in IU and 5.5 (SD 3.3) years in JIA-U (p<0.001). Anterior location of uveitis was noted in 74% in IU and 99% in JIA-U (p<0.001). Mostly, uveitis was chronic (59% in IU and 75% in JIA-U) and bilateral (56% in IU and 64% in JIA-U).
Topical corticosteroids were used by 89% and 100%, systemic corticosteroids by 30% and 27%, disease-modifying antirheumatic drugs (DMARDs) by 33% and 85% (p<0.001) of the patients in IU and JIA-U, respectively. Biologic disease-modifying antirheumatic drugs (bDMARDs) were more common in JIA-U (55% vs. 15% in IU, respectively, p<0.001).
Most of the patients had long-term bilateral and worse eye Snellen visual actuity >0.8 (84% and 70%, respectively). Only 5 patients (4%) had visual impairment in one, but none in both eyes. Uveitis activity by SUN classification was 0+ in 59% and 58%, 0.5+ in 37% and 28%, and 1+ in 4% and 14% in the IU and JIA-U, respectively (p=0.014). 92% of the patients treated with DMARDs and bDMARDs and with 1+ uveitis activity was in the JIA-U group.
Conclusions: Children with uveitis have good visual acuity and a low rate for visual impairment. In addition, modern treatment with DMARDs and biologic therapy seems to save vision.
A Structured Telephone Interview for collecting Geriatric health domains in Older People with HIV during COVID era
Authors: Ferrara Micol , Milic Jovana , Belli Michela , Venuta Maria , Micai Luca , Arsuffi Stefania , Minisci Davide , Fumarola Benedetta , Bonora Stefano , Focà Emanuele , Guaraldi Giovanni , Calcagno Andrea
Published: April 2023

Background
Elderly people living with HIV show a significant prevalence of multimorbidity, polypharmacy and frailty that increase the risk of disability. Telehealth has been suggested as a new tool to monitor people living with HIV in the COVID era, but its effectiveness in elderly is unknown. The aim of this study was two-fold: to explore feasibility of a telephone interview and its capability to collect relevant geriatric outcomes.
Methods
Assessed health domains included comorbidities, falls, urinary incontinence, antiretroviral drugs exposure and comedications (polypharmacy), and the following patient reported outcomes: quality of life, intrinsic capacity, and resilience.
Results
214 (70.6%) answered and completed the interview. During confinement period, 57 (26.7%) of people switched antiretroviral therapy : 119 (55.4%) to dual therapy regimens and 95 (44.6%) to triple regimens. Prevalence of geriatric syndromes were falls in 31 cases (14.7%), urinary incontinence in 48 cases (22.7%) and polypharmacy 122 cases (57.2%). Mean Health-related Quality of Life score was mildly impaired (0,88%) with good concordance of Helath-related Quality of Life self-perception in a visual analogue scale (8/10) (r=+0.348; p <0.01). Intrinsic capacity depicted impaired functional ability in multiple domains (0.737 ) and Resilience (CD-RISC) was suboptimal (0.6).
Conclusions
A structured telephone call was feasible in elderly people living with HIV and allowed to collect clinically meaningful geriatric health domains when face-to-face visits are not needed or discouraged.
Hybrid parameters for fluid identification using an improved quantum neural network in a tight reservoir
Authors: Luo Dejiang , Liang Yuan , Yang Yuanjun , Wang Xingyue
Published: April 2023

This paper proposes a fluid classifier for a tight reservoir using a quantum neural network (QNN). It is difficult to identify the fluid in tight reservoirs, and the manual interpretation of logging data, which is an important means to identify the fluid properties, has the disadvantages of a low recognition rate and non-intelligence, and an intelligent algorithm can better identify the fluid. For tight reservoirs, the logging response characteristics of different fluid properties and the sensitivity and relevance of well log parameter and rock physics parameters to fluid identification are analyzed, and different sets of input parameters for fluid identification are constructed. On the basis of quantum neural networks, a new method for combining sample quantum state descriptions, sensitivity analysis of input parameters, and wavelet activation functions for optimization is proposed. The results of identifying the dry layer, gas layer, and gas-water co-layer in the tight reservoir in the Sichuan Basin of China show that different input parameters and activation functions affect recognition performance. The proposed quantum neural network based on hybrid parameters and a wavelet activation function has higher fluid identification accuracy than the original quantum neural network model, indicating that this method is effective and warrants promotion and application.
Emergency Cervical Cerclage for Women with Cervical Dilatation after Laparoscopic Abdominal Cerclage: A case series report
Authors: Deng Songqing , Liang Yanchun , Wei Yajing , Wang Zi-lian , Shang Jianhong , Yao Shuzhong
Published: April 2023

Background: The aim of this study is to evaluate the feasibility and safety of emergency cervical cerclage (ECC) for women with cervical dilatation after laparoscopic abdominal cerclage (LAC) in second trimester.
Methods：Between October 2016 and May 2020 nine women underwent ECC. All women had showed cervical dilation with and without exposed unruptured fetal membranes after LAC in the second trimester. Patients’ characteristics were obtained from hospital’s medical record and we evaluated the prolongation of pregnancy, surgical data, and perinatal outcome.
Results: ECC was performed at 15+2 to 25+0 weeks of gestations. The median interval from cerclage to delivery was 5.81 weeks. Six patients got live birth, and the media gestation age for delivery was 26.71 weeks (18+3–31+5). Rate of preterm birth at < 28 weeks of gestation was 5/9 (55.56%). Chorioamnionitis and premature rupture of membranes (PPROM) were the major complications after ECC, which were detected in seven and six women, respectively.
Conclusion: ECC might be an alternative approach to prolong pregnancy for women with cervical dilatation after LAC in the absence of bleeding, infection, or uterine activity. Randomized controlled trial should be conducted to determine whether these potential benefits outweigh the perinatal morbidity of ECC in this population.
Evaluation of Core Coordination Strategies and Concept of Operations implemented during activation of Public Health Emergency Operations Center for COVID-19 Response in Pakistan
Authors: Tahir Majid Ali , Khan Mumtaz Ali , Ikram Aamer , Chaudhry Tamoor Hamid , Amir Afreenish , Tahir Muhammad , Haq Ijaz ul , Salam Arslan , Wali Sidra , Munir Wasay , Salman Muhammad , Zaki Shahbaz Ahmad
Published: April 2023

Background: Public health emergency management systems encountered difficulties in developing countries, especially in Pakistan. The COVID-19 pandemic was extremely challenging for different agencies, departments, and institutions in Pakistan. Public health emergency management depends on a well-established public health emergency operations center that could generate a coordinated response to escalated incidents. We conducted an assessment of public health emergency response and coordination implemented during the COVID-19 pandemic management at a strategic level in Pakistan.
Methods: This was mix-method study including qualitative and quantitative data collection processes implemented in 2022-23. Primary data was collected by using a structured questionnaire, and secondary data was collected by desk review. The agencies engaged in pandemic response at the national level in Pakistan were included in the assessment.
Results: The overall score of the emergency response coordination system during COVID-19 was 49% for all agencies. We found that agencies faced challenges in leadership, legislation, and financing issues during the pandemic response (44%). None of the agencies had a fully developed framework for joint planning and response system for health emergencies. Roles and responsibilities attached to designated agencies in response were relatively clear (55%) for most of the agencies.
Conclusion: An effective public health emergency response is based on multi-departmental coordination, resource mobilization, and correct information. Pakistan must proactively address these and other relevant challenges for future pandemic response.
Quantifying heat exposure reduction from adaptation and mitigation in 21st century US cities
Authors: Georgescu Matei , Broadbent Ashley , Krayenhoff Eric
Published: April 2023

The continued increase in the duration, frequency, and intensity of heat waves is especially problematic in cities, where more than half of the world’s population lives. We combine decadal scale regional climate modeling simulations with projections of urban expansion, emissions of greenhouse gases and population migration to examine the extent to which adaptation and mitigation strategies, in isolation and in tandem, can reduce population heat exposure across end-of-century US cities. We show that some cities respond more favorably to adaptation while others respond more favorably to mitigation. Our results indicate that the reduction in the number of extreme heat hours due to adaptation and mitigation varies during the daytime portion of the diurnal cycle but is largely independent of the hour of the day during nighttime. We emphasize the importance of adaptation and mitigation strategies through examination of their synergistic interaction to inform development of climate resilient urban development pathways.
Administration of bicarbonates through percutaneous gastrostomy with continuous nocturnal infusion in a patient with Kearns-Sayre disease: a life changing therapeutical paradigm
Authors: Traunero Arianna , Baldo Francesco , Magnolato Andrea , Leo Grazia Di , Barbi Egidio , Bruno Irene
Published: April 2023

Background Mitochondrial diseases (MDs) are systemic disorders that can affect multiple organs. Renal manifestations, including renal tubular acidosis, are common because kidneys are particularly vulnerable to energy deprivation. Treatment of MDs is often complex and electrolyte replacement can be difficult especially in pediatric patients, because large and repeated amounts of oral supplements are needed but are not well tolerated.Case presentation We describe the case of a girl affected by Kearns-Sayre disease with severe renal tubular acidosis. The management of her metabolic acidosis was challenging because she showed persistent low levels of serum bicarbonates despite a progressive incrementation of oral bicarbonates. Furthermore, as a result to the ingestion of large amounts of alkali, the girl developed an aversion to oral supplementation. After positioning a percutaneous gastrostomy (PEG) and starting enteral administration of bicarbonates (with daily boluses and continuous nocturnal infusion), she finally obtained an adequate electrolyte control, with a significant increase in her quality of life.Conclusions In MDs, the combination of nocturnal continuous enteral administration of alkali plus diurnal boluses may represent a valid solution to correct metabolic acidosis. It can also result in an improved patients’ quality of life, particularly in pediatric settings, where compliance to oral therapy is often lacking due to the large and repeated amounts of unpalatable bicarbonates solutions required.
Factors Affecting Capital Structure Decisions of Banks: A Systematic Review of Evidence from Commercial Banks of Ethiopia
Authors: Gofe Tesfaye Eresso , Asfaw Arega Seyoum
Published: April 2023

The present systematic literature review aims to analyze the literature on factors affecting capital structure decisions of commercial banks in Ethiopia to identify the existing gaps and the level of existing research in the field and to provide direction for future research. The review was conducted using 11 relevant and available scholarly studies that were published in any time period, mainly using open search engines and databases because of the shortage of studies for the specified review and lack of access to the known database. Different key words were used to identify the articles. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework was employed to analyze the research work on capital structure decisions. The inclusion and exclusion criteria were specified in the review protocol. The descriptive analysis was performed based on different parameters to arrive at conclusions. A citation analysis was also performed to recognize impactful authors and papers. The findings revealed that most of the variables of interest explored in the studies contradicted each other and the previous literature variables. The capital structure research studies were conducted by considering few variables, and most of the studies were not cited. The findings regarding the theories supported by factors affecting the capital structure decisions of commercial banks in Ethiopia were contradictory and not justified. The banking literature still doesn't cover the capital structure of banks very much. There is currently a lack of clarity regarding how banks determine their capital structure and what variables affect their corporate financing behaviour. Therefore, it is recommended that the concerned body conduct an in-depth study of the decisions banks make about their capital structure by identifying pertinent elements.
Infectious keratoconjunctivitis in semi-domesticated reindeer - a questionnaire-based study among reindeer herders in Norway and Sweden
Authors: Philippot Karin Wallin , Baron Jerome , Romano Javier Sánchez , Rautiainen Heidi , Frössling Jenny , Nymo Ingebjørg Helena , Persson Ylva , Omazic Anna , Tryland Morten
Published: April 2023

Background The effects of climate change, loss of pastureland to other land usage and presence of large carnivores are the main reasons for the increase in supplementary feeding of semi-domesticated reindeer (Rangifer tarandus tarandus) in Fennoscandia over the last decades. Feeding might expose reindeer to stress and increased animal-to-animal contact, leading to an increased risk of infectious disease transmission, like infectious keratoconjunctivitis (IKC). As it can develop rapidly and be very painful, IKC is described as an important animal welfare concern and a potential source of economic loss. The aim of this study was to investigate the current presence of IKC and potential associations between IKC and supplementary feeding through an online questionnaire survey, distributed among reindeer herders in Norway and Sweden in 2021.Results: Infectious keratoconjunctivitis was common, with 54 (71%) of the 76 herders that responded having observed clinical signs during the past 10 years. These signs were mainly observed as increased lacrimation, causing “wet cheeks”, but also as keratitis and conjunctivitis. Winter, followed by autumn, were the seasons in which IKC was observed most. The herders reported several measures, such as slaughter and isolation of affected reindeer, to counteract the spread of disease. The herding year 2019/2020 was associated with reports of outbreaks of IKC in herds as well as being the herding year where most herders (80%) had performed supplementary feeding. A significant association was found between IKC and feeding performed in an enclosure (odds ratio = 15.20), while feeding on free range areas had a non-significant, negative, relationship with the appearance of IKC outbreaks (odds ratio = 0.29). Finally, there was a trend in the data suggesting that IKC affected calves especially.Conclusions: Infectious keratoconjunctivitis is a common disease, mainly observed in winter and autumn. It has mild to moderately severe clinical signs. Our results imply that IKC is associated with stress and feeding situations and that calves might be more susceptible than adults, however, this needs to be confirmed with further studies, preferably on an individual animal level.
EU carbon prices signal high policy credibility and farsighted actors
Authors: Sitarz Joanna , Pahle Michael , Osorio Sebastian , Luderer Gunnar , Pietzcker Robert
Published: April 2023

The EU emissions trading system (EU ETS) is a key driver behind Europe’s decarbonization. Coinciding with two major reforms to tighten the cap, prices have increased tenfold between 2017 and 2021 to 80 €/tCO2 and above, completely changing the investment decisions in electricity and industry sectors. But can price movements be explained through these reforms alone? We here argue that the emission cap changes are not sufficient to explain the price jumps and offer a more comprehensive explanation: Our results suggest that the price increase was strongly driven by actors becoming more farsighted when policymakers signaled high long-term commitment to climate targets by implementing ambitious reforms. With these assumptions, our model reproduces the historic price path and shows present prices to be consistent with EU reduction targets. To underline the role of credibility, we test what would happen if a crisis undermines policy credibility such that actors become myopic again, demonstrating that carbon prices could plummet and endanger the energy transition.
Disruptions to HIV Services Due to the COVID Pandemic in the USA: A State-Level Stakeholder Perspective
Authors: Pinto Rogério , Hall Evan , Im Vitalis , Lee Carol Ann , Park Sunggeun (Ethan)
Published: April 2023

Background: The United States envisions a 90% reduction in HIV infections by 2030. However, the COVID-19 pandemic disrupted the HIV continuum and disproportionately affected access to social and health services for people at the highest vulnerability. This study shows how COVID disrupted the HIV continuum in the state of Michigan, how stakeholders handled disruptions, and key recommendations. As a case study, this study adds to the literature about preparedness for future pandemics.
Methods: We used semi-structured interviews with 33 statewide Michigan HIV/AIDS Council members—practitioners, researchers, community representatives guiding service planning, improvement, and resource allocations. We asked: (1) how the COVID-19 pandemic disrupted the HIV continuum; (2) how disruptions were handled; and (3) recommendation to help address disruptions now and in the future. Using thematic analysis, we coded the interviews. We measured group cohesiveness as a proxy for how individual opinions reflected those of the Council as a group.
Results: We found a high degree of cohesiveness among participants. Participants agreed that the pandemic disrupted all HIV continuum services (e.g., HIV testing, PrEP education, referrals to primary care, etcetera) offered by community organizations, hospital clinics, and health departmentsacross the state. In response, they developed online and curbside services to maintain HIV continuum services, abate social isolation, and address structural issues like lack of food and public transportation. We organized results in four categories: (1) HIV continuum disruptions (e.g., “Housing for women and children who are fleeing a legal situation”); (2) Responses to disruptions (e.g., “Some of them, we would say, hey, weather permitting, we’ll come out to your car”); (3) Minoritized groups disproportionately affected (e.g., “Especially in my community, to get people if there's ever a vaccine, Black people are going to be the last people to take it”); and Recommendations (below).
Conclusions: The pandemic unsettled and further exacerbated every aspect of HIV service provisions. The main recommendation was to overhaul communication systems between government and organizations offering HIV services to mitigate disruptions and improve the chances of achieving a 90% reduction.
The anterior transmuscular intrapelvic approach for the treatment of acetabular fractures - a new anterior surgical strategy
Authors: Lippross Sebastian , Wehrenpfennig Clara , Wedel Thilo , Seekamp Andreas , Osmonov Daniar , Moradi Babak , Fitschen-Oestern Stefanie , Finn Joerg , Klueter Tim , Kurz Bodo , Alkatout Ibrahim
Published: April 2023

The anterior ilioinguinal and the posterior Kocher-Langenbeck approach have long been the standard surgical approaches to the acetabulum. The last decade has witnessed the development of so-called intrapelvic approaches for anterior pathologies because they provide better exposure of the quadrilateral plate. Currently, the modified Stoppa approach and the pararectus approach are frequently used by surgeons for the treatment of acetabular fractures. We investigated an even more direct access to the entire anterior column and the quadrilateral plate via the abdominal wall muscles, between the incisions for the ilioinguinal and the pararectus approach.
After intensive study of anatomic specimens, a cadaver dissection was performed prior to clinical application. The approach was then used in 20 patients who were assessed retrospectively.
Postoperative CT scans showed that, according to the Matta scoring system, the quality of fracture reduction was “anatomical” (≤1 mm) in 12 (60%), “imperfect” (2-3 mm) in four (20%), and “poor” (>3 mm) in four (20%) patients. Numerous minor complications were observed; the majority of these had resolved at the time of discharge.
In conclusion, the anterior transmuscular intrapelvic approach (ATI) is a safe and effective alternative to the ilioinguinal and pararectal approaches, and may be regarded as an evolutionary advancement of traditional procedures.
A Nomogram for Individualized Preoperative Prediction of Microvascular Invasion Risk in Large Hepatocellular Carcinoma in Different Clinical Stages
Authors: Cao Momo , Gu Junming , Fang Feng , Xiao Shuai , Zuo Chaohui , Yang LianYue
Published: April 2023

Objective: To develop a nomogram to predict the risk of microvascular invasion (MVI) in patients with large hepatocellular carcinoma (LHCC) in different clinical stages.
Background:
Accurately predicting the risk of MVI in LHCC patients before surgery can helps us make appropriate clinical decisions. This study aimed to develop and validate a nomogram to preoperatively predict MVI risk of LHCC patients in different staging systems.
Methods
A total of 545 LHCC patients were assigned to training (n=358) and validation (n=187) cohorts. Univariate and multivariate analyses were used to reveal independent risk factors of MVI, which were then incorporated into the predictive nomogram. The C-index, calibration curves, and ROC curves were used to evaluate the accuracy of nomogram. Kaplan-Meier method and Log-rank test were used to analyze the LHCC patients’ survival time according to MVI status and nomogram prediction.
Results
Histopathologically identified MVI was found in 167 and 84 patients in the training cohort and validation cohorts. The independent preoperative factors associated with MVI were serum AFP level ≥ 400ng/L, platelet (PLT) < 140.5×109/L, neutrophil-to-lymphocyte ratio (NLR) ≥ 2.94, incomplete tumor capsule and multiple tumors. Based on our nomogram, we found the risk of MVI in LHCC patients with BCLC stage 0/A or TNM I/II was lower than BCLC stage B/C or TNM III.
Conclusions
This study developed and validated a nomogram to predict MVI risk in LHCC patients before surgery, which had well consistency with postoperative histopatholgy. The nomogram was also valuable for clinical classification and tumor staging in LHCC.
Prediction of Chatter Stability of Thin-walled Parts during High-speed Milling Considering Variation of Dynamic Characteristics based on Surface Roughness Measurement
Authors: DAMOUS Mohamed , ZEROUDI Nasreddine , CHELLIL Ahmed , IKKACHE Kamel
Published: April 2023

In high-speed milling, the machining system is affected by chatter resulting from the dynamic interaction between the tool and the part. Which can cause a harmful effect on the tool and the machined surface of the part. Chatter occurs more frequently for the milling of thin-walled parts due to their low stiffness. In addition, the dynamic characteristics of thin-walled parts vary along the tool path. The dynamics of the part is therefore the dominant factor that should be considered in the modeling and the study of milling process must be performed in 3D where the third dimension is the tool position. This paper studies the milling stability of Al 7075-T6 thin-walled parts during high-speed milling considering the variation of dynamic characteristics and develops three-dimensional stability lobe diagrams of the spindle speed, axial depth of cut and tool position. The dynamic equations of motion are solved numerically using semi-discretization method. Modal parameters of the tool and the part were extracted experimentally by model tests. Then, cutting tests were conducted to validate the established model by measuring the machined surface roughness which is used as criterion for detecting instability. The experimentally obtained results correspond well with the predicted stability limits. Moreover, influence of different cutting parameters on the machining stability along the tool path was investigated. It is found that the variable speed improves significantly the cutting process, and the best selection of feed per tooth impacts positively on the machined surface quality.
Comparison of antioxidant and anti-melanogenic activity of γ-oryzanol and gallic acid by inhibiting tyrosinase activity in B16F10 mouse melanoma cells
Authors: Andalib Mahdieh , Asnaashari Maryam , Emami Seyed Ahmad , Hadipour Elham , Tayarani-Najaran Zahra
Published: April 2023

The beneficial effects of rice bran consumption must consider the synergic interaction of all these bioactive constituents.
Rice bran is abundant in gallic acid due to the tannins which upon hydrolysis yields gallic acid. Also, hydroxycinnamic acids such as ferulic, p-coumaric and caffeic acids were also found in the extracts. γ-Oryzanol comprises a mixture of ferulic acid esters and phytosterols (sterols and triterpenic alcohols). At least 10 steryl ferulates were determined in γ-oryzanol.
To better understand the mechanisms of the two important bioactive compounds of rice bran, we compared the antioxidant and anti melanogenic activities of gallic acid and γ-oryzanol for the treatment of disorders caused by hyperpigmentation. The antioxidant activity was measured by 2, 2′-diphenyl-1-picrylhydrazyl radical (DPPH) and ferric reducing antioxidant power (FRAP) methods. Then, its effects on viability, reactive oxygen species (ROS) production, mushroom tyrosinase and melanin content as well as amount of MITF and tyrosinase proteins was investigated on B16F10 murine melanoma cell line.
The antioxidant effects of were γ-oryzanol higher than gallic acid in DPPH and FRAP tests. Concentrations of 0.001 to 100 μM γ-oryzanol and gallic acid did not show significant cytotoxic effect at all concentrations after 24 and 48 h, and also reduced the amount of ROS, but did not have a significant effect in comparison with each other. In addition, the reduction of mushroom tyrosinase activity in γ-oryzanol was more than gallic acid and the concentrations of 10, 25, 50 and 100 μM showed significant effects. A decrease in melanin content was observed in different concentrations of γ-oryzanol and gallic acid, but this decrease in two compounds was not significant in comparison to each other. Finally, western blotting results showed that the decrease in the expression of MITF and tyrosinase proteins in γ-oryzanol is higher than in gallic acid, and this decrease was significant in concentrations of 01, 5 and 10 μM. According to the obtained results and the comparison of measured parameters between γ-oryzanol and gallic acid compounds, it can be concluded that γ-oryzanol has more antioxidant effects than gallic acid. In addition, γ-oryzanol shows higher inhibitory effects in the expression pathway of proteins involved in melanin synthesis in B16F10 cells.
According to the obtained results γ-oryzanol was superior to gallic acid in case of antioxidant and anti-melanogenic activity in B16F10 cells and may has higher potential in treating disorders caused by hyperpigmentation compared to gallic acid.
Impact of COVID-19 on selected essential public health services – lessons learned from a retrospective record review in the Free State, South Africa
Authors: Heunis Christo , Chikobvu Perpetual , Muteba Michel , Kigozi-Male N. Gladys , Engelbrecht Michelle C. , Mushori Providence
Published: April 2023

Background In an attempt to discern lessons to improve future pandemic responses, this study measured the effects of the COVID-19 pandemic on essential public health services (EPHSs) related to primary health care (PHC) and outpatient department (OPD) utilisation, antiretroviral treatment (ART) commencement, drug-susceptible tuberculosis (DS-TB) confirmation and treatment commencement, and Bacillus Calmette-Guérin (BCG) coverage, in the Free State province of South Africa during January 2019 to March 2021.
Methods A pre-post study design comparing EPHS performance between 2019 and 2020/21 was employed. Routinely collected data were analysed. An interrupted time series analysis was used to measure changes in service use and outcomes from January 2019 to March 2021. Median changes were compared using Wilcoxon sign ranked tests. A 5% statistical significance level was considered
Results Over the study period, the median values for the annual number of PHC visits was 1.8, 55.3% for unreferred OPD visits, 69.4% for ART commencement, 95.1% and 18.7% for DS-TB confirmation and treatment commencement respectively, and 93.7% for BCG coverage. While BCG coverage increased by 5.85% (p=0.0101), declines were observed in PHC utilisation (10.53%; p=0.0010), unreferred OPD visits (12.05%; p=0.0006), ART commencement (9.53%; p=0.0174), and DS-TB confirmation (5.24%; p≥0.050) and treatment commencement (3.80%; p≥0.050). Given the importance of PHC in addressing a new pandemic, along with the existing HIV and TB epidemics – as well as the entire quadruple burden of disease – in South Africa, the finding that the PHC utilisation rate statistically significantly decreased in the Free State post-COVID-19 commencement is particularly concerning.
Conclusions The lessons learned from this retrospective review attest to a measure of resilience in EPHS delivery in the Free State in as far as a significant hike in BCG vaccination over the study period, 2019-2020/21 was observed. As evidenced by a declines in PHC service utilisation, the decreased numbers of new patients commencing ART and lower confirmed DS-TB case and DS-TB treatment commencement rates, we also learned that EPHS delivery in the province was fragile.
Enabling giant thermopower by heterostructure engineering of hydrated vanadium pentoxide for zinc ion thermoelectrochemical cells
Authors: Zhang Xiaogang , Li Zhiwei , Xu Yinghong , Wu Langyuan , Cui Jiaxin , Dou Hui
Published: April 2023

Flexible power supply devices provide possibilities for wearable electronics in the Internet of Things. However, unsatisfying capacity or lifetime of typical batteries or capacitors seriously limit their practical applications. Different from conventional heat-to-electricity generators, zinc ion thermoelectrochemical cells has been a competitive candidate for the self-power supply solution, but the lack of promising cathode materials has restricted the achievement of promising performances. Herein, we propose an attractive cathode material by rational heterostructure engineering of hydrated vanadium pentoxide. Owing to the integration of thermodiffusion and thermoextraction effects, the thermopower is significantly improved from 9.1 mV K− 1 to 25.3 mV K− 1. Moreover, an impressive normalized power density of 2.7 mW m− 2 K− 2 is achieved in the quasi-solid-state cells. In addition, a wearable power supply constructed by three units can drive the commercial health monitoring system by harvesting body heat. This work demonstrates the effectiveness of electrodes design for wearable thermoelectric applications.
Endovascular retrograde tibial access for limb salvage in Chronic Limb-Threatening Ischemia: A Case Report
Authors: Isaza-Meza Mariana , Corso-Ramírez Julián Miguel , Flórez-Amaya Paula , Cabrales-Arévalo Jaime Ramón , Barrera-Carvajal Juan Guillermo
Published: April 2023

Background:
Peripheral artery disease is a chronic disorder characterised by stenosis and/or occlusion of peripheral large and medium-sized arteries. It most commonly affects the lower limbs, causing claudication, and foot ulcers/gangrene, which if not treated correctly can lead to Chronic Limb-Threatening Ischemia. This condition requires revascularization to improve limb perfusion and limit the risk of amputation.
Case presentation:
We describe the case of a 76-year-old Latin American male who presented to the emergency department with ischemic rest pain and ulceration of the left limb. Angiotomography showed severe stenosis in the left common femoral, superficial femoral, and popliteal left arteries. Percutaneous angioplasty intervention was made to restore the blood flow and limb salvage. A retrograde approach was obtained via ultrasonography-guided tibial anterior artery puncture. The post-procedural course was uneventful. The retrograde puncture technique allowed adequate blood flow without complications. Follow-up 2 months later showed resolution of foot ulcer.
Conclusions:
There are still limited studies available to evaluate the effectiveness and long-term success of tibio-pedal access for revascularization, nevertheless, it shows a promising option for patients with poor surgical options in need of urgent intervention.
A brain neoplasm follow-up in a tertiary public hospital of northeast of Brazil: 2014-2016 data.
Authors: Maia Rafael Costa Lima , Junior Howard Lopes Ribeiro ,   Maria Claudia dos Santos Luciano3, Fiorenza Natália Gindri , Ferraz Clarissa Perdigão Mello , de Azevedo Orleancio Gomes Ripardo , Junior Edson , Filho Stelio Araujo , Sobrinho Osvaldo
Published: April 2023

Background. A brain neoplasm is a growth of abnormal cells in the brain. Brain tumors are dangerous because they can increase pressure on the brain and are associated to high mortality rates.
Methods. This study evaluated 669 patients; however, 42 patients were excluded from the study since they were diagnosed with conditions different from neoplasm. Thus, 627 were enrolled in the study. The patients were investigated for histologic type, localization, topography and laterality, the influence of early extubation and the diagnosis and management of hydrocephalus. All the patients enrolled on this study had diagnostic of at least brain dysplasia.
Results. Older patients (43±15.9) group significantly demonstrated the need for more urgency surgery compared to younger ones (30±14.6) (p<0.0001). Patients with previous surgery remained in the hospital, longer than patients that developed their first surgery (p=0.0171). This study demonstrated that the presence of hydrocephalus impacted in patients leading to increasing the duration of surgery (p<0.0001), length stay at intensive care unit (p=0.0023) and hospital (p<0.0001) respectively. This study found the early extubation protocol was associated to decreased duration of surgery (p<0.0001), also reduces length stay on intensive care unit (p<0.0001) and hospital stay (p<0.0001) respectively.
Conclusions. Low-grade gliomas were found in majority of females in the study, also, a male predominance among patients with craniopharyngioma. Early extubation was associated with a reduced duration of surgery and a shorter length of stay in the hospital and ICU. Hydrocephalus was associated with longer surgeries, increased length of stay in ICU and hospital.
Stat3 has a different role in axon growth during development than it does in axon regeneration after injury
Authors: Duan Qinwen , Zheng Hongfei , Qin Yanjun , Yan Jizhou , Wang Jian , Fan Chunxin
Published: April 2023

As a pleiotropic factor, signal transducer and activator of transcription 3 (STAT3) has been implicated in both neural development and regeneration. Here, we demonstrate that Stat3 plays distinct roles in PLL axon embryonic growth and regeneration using zebrafish posterior lateral line (PLL) axons. Mutation of stat3 rather than Jak/Stat inhibition resulted in PLL axons truncation during embryonic growth. We found that Stat3 was co-localized with mitochondria in PLL axon and the ATPase activity and mitochondrial membrane potential was decreased in stat3 mutant and mitochondria agonist partially rescued PLL axon growth in stat3 mutant indicating Stat3 regulated PLL axon growth through mitochondrial Stat3 function. By contrast, Jak/Stat signaling inhibitors retarded PLL axon regeneration and Schwann cell migration. Stat3 promotes PLL axon regeneration mainly through regulating Schwann cell migration via Jak/Stat signaling. We provide a new mechanism of Stat3 in axon growth and regeneration and suggest that Stat3 is a promising therapeutic target for neural regeneration.
Effect of chemotherapy on prognosis in patients with primary pancreatic signet ring cell carcinoma
Authors: Huang Kun , Yuan Xinzhu , Jiang Ning , Zhao Pingwu , Du Cheng-You
Published: April 2023

Objective Primary pancreatic signet ring cell carcinoma (PSRCC) is an extremely rare histologic variant of pancreatic cancer with a worse prognosis. The present study aimed to investigate the prognostic value of chemotherapy for patients with PSRCC.Methods Patients with PSRCC between 2000 and 2019 were identified Using the Surveillance Epidemiology and End Results (SEER) database. The main outcomes in our study were cancer-specific survival (CSS) and overall survival (OS). Patient baseline characteristics were compared using Pearson’s chi-square test. Kaplan-Meier analysis was used to generate the survival curves. Least absolute shrinkage and selection operator (lasso) as well as univariate and multivariate Cox regression models were used to analyze the prognostic variables on OS and CSS.Results A total of 588 patients with PSRCC were identified. Chemotherapy was an independent prognostic factor for OS and CSS, and significantly associated with OS (HR = 0.33, 95% CI = 0.27–0.40, P < 0.001) and CSS (HR = 0.32, 95% CI = 0.26–0.39, P < 0.001).Conclusions Patients with PSRCC can benefit from chemotherapy, so it should be recommended to patients with PSRCC, especially those not suitable for surgery.