bluuebunny/crossref_metadata_2025 huggingface dataset:
Human cortical, muscular, and kinematic gait adaptation with novel use of an ankle exoskeleton
Authors: Song Seongmi , Haynes Courtney A. , Bradford J. Cortney
Published: March 2023

Walking with an exoskeleton is a complex task that requires human and machine integration. Previous studies focused on metabolic consumption, muscle activations, kinetic and kinematic changes, and adaption during exoskeleton-assisted walking. However, limited information is available on cortical changes and adaptations during walking with an exoskeleton. Our study aims to better understand human cortical responses and adaptation to walking with an ankle exoskeleton. We included healthy, novice users without prior exoskeleton experience and collected EEG (electroencephalography), EMG (electromyography), and full body motion capture while walking at a speed of 1.2m/s. When experiencing exoskeleton-assisted walking for the first time, subjects showed reduced joint range of motion and stride length along with increased step width, even while muscle activation was decreased. The cortical response also follows the decreased balance, showing theta power increase in the left prefrontal, right sensorimotor, and right somatosensory cortex. Over time, the results showed increased balance, greater reduction in muscle activity, and reduced cortical engagement while walking with exoskeleton assistance. Yet, we also observed adaptation to walking with exoskeleton frames over time. These findings could provide information to develop more effective and intuitive augmentation devices that are better able to integrate with human movements.
Fabrication of hydrophobic surface on eri silk/ wool fabric using nano silica extracted from rice husk
Authors: Borah Mamoni Probha , Kalita Binita Baishya , Jose Seiko , Baruah Sunita
Published: March 2023

Silica nano particles were synthesized from rice husk by alkali treatment followed by calcination. The nano particles were characterized with the aid of Fourier Transform Infrared Spectroscopy (FTIR), Scanning Electron Microscopy (SEM), Transmission Electron Microscopy (TEM) and X-ray Diffraction Spectroscopy (XRD). The eri silk / wool union fabric was coated with the nano silica by hydrothermal method for achieving hydrophobic surface. The SEM and XRD results inferred that the synthesized silica nano particles are spherical and amorphous in nature. SEM, EDX, and Atomic Absorption Spectroscopy (AAS) analyses qualitatively and quantitatively verified the presence of nano silica on the fabric. The nano silica treatment resulted in the enhancement of water contact angle upto 145○. The results are further confirmed by spray test and water absorbency analysis. The nano silica treated fabric possessed good fastness to dry cleaning and washing. The highest contact angle of 145○was observed with the treatment of union fabric with 7.5% nano silica. The AAS results showed 667 ppm of silica on the fabric. The physico-mechanical properties of the silica treated fabric marked marginal difference with the untreated fabric.
Diffuse reflectance spectroscopy for predicting age, species, and insecticide resistance of the malaria mosquito Anopheles gambiae s.l
Authors: Betancourth Mauro Pazmiño , Ochoa-Gutiérrez Victor , Ferguson Heather M. , González-Jiménez Mario , Wynne Klaas , Baldini Francesco , Childs David
Published: March 2023

Mid-infrared spectroscopy (MIRS) combined with machine learning analysis has shown potential for quick and efficient identification of mosquito species and age groups. However, current technology to collect spectra is destructive to the sample and does not allow targeting specific tissues of the mosquito, limiting the identification of other important biological traits such as insecticide resistance. Here, we assessed the use of a non-destructive approach of MIRS for vector surveillance, micro diffuse reflectance spectroscopy (µDRIFT) using mosquito legs to identify species, age and cuticular insecticide resistance within the Anopheles gambiae s.l. complex. These mosquitoes are the major vectors of malaria in Africa and the focus on surveillance in malaria control programs. Legs required significantly less scanning time and showed more spectral consistence compared to other mosquito tissues. Machine learning models were able to identify An. gambiae and An. coluzzii with an accuracy of 0.73, two ages groups (3 and 10 days old) with 0.77 accuracy and we obtained accuracy of 0.75 when identifying cuticular insecticide resistance. Our results highlight the potential of different mosquito tissues and µDRIFT as tools for biological trait identification on mosquitoes that transmit malaria. These results can guide new ways of identifying mosquito traits which can help the creation of innovative surveillance programs by adapting new technology into mosquito surveillance and control tools.
Adult-onset Alexander disease in people living with HIV and a novel mutation in GFAP
Authors: Guo Yongzheng , Peng Xiaorong , Zhou Xiaotang , Zhu Biao
Published: March 2023

Background: Alexander disease (AD) is a rare and fatal leukoencephalopathy that is diagnosed based on clinical symptoms, typical MRI findings, and mutations in the glial fibrillary acid protein (GFAP) gene. However, no case has been reported on adult-onset Alexander disease (AOAD) in people living with HIV (PLWH).
Case presentation: A 43-year-old male patient experienced a progressive gait disorder and generalized muscle weakness. He was diagnosed HIV-positive ten years ago with viral suppression. Conventional microbiological tests and Metagenomic next-generation sequencing in cerebrospinal fluid were negative. Brain T2-weighted image showed marked thinning of the medulla and upper cervical spinal cord (tadpole sign). A heterozygous 206A→T mutation was confirmed in GFAP exon 1. The patient’s family consisted of three generations with two affected individuals. The clinically affected mother (I.1) and unaffected sister (II.1) and daughter (III.1) had the 206A→T heterozygous mutation, whereas the remaining two siblings and son did not harbor the mutation.
Conclusions: In summary, this is the first report of AOAD in PLWH. AOAD should be considered in PLWH that exhibit uncommon neurological diseases.
Soil microbial dark matter explored from genome-resolved metagenomics
Authors: Ma Bin , Lu Caiyu , Wang Yiling , Yu Jingwen , Zhao Kankan , Xue Ran , Lv Xiaofei , Pan Ronghui , Zhang Jiabao , Zhu Yong-Guan , Xu Jianming
Published: March 2023

Soil contains a vast number of unidentified microbes, known as soil microbial dark matter. This is an important source of microbial biodiversity and genetic resources1,2, but has yet to be fully explored. In this study, we conducted the first large-scale excavation of soil microbial dark matter by reconstructing 40,039 metagenome-assembled genome bins (the SMAG catalog) from 3,463 soil metagenomes. We identified 16,530 of 21,077 species-level genome bins (SGBs) as unknown SGBs (uSGBs), which greatly expand archaeal and bacterial diversity across the tree of life. The uSGBs identified substantially increased the functional landscape and intra-species genome diversity of the soil microbiome, and provided large proportions of the 43,169 biosynthetic gene clusters and 8,544 CRISPR-Cas genes mined from the SMAG catalog. This suggests their potential for genetic resource exploitation. In addition, we determined that uSGBs contributed 84.6% of novel viral-host associations identified from the SMAG catalog. Our results demonstrate the richness of microbial dark matter in soil and highlight its potential. Furthermore, the SMAG catalog will serve as a valuable genomic database for understanding soil microbial biodiversity and exploiting novel genetic resources.
Association between Depression, Anemia And Physical activity Using Isotemporal Substitution Analysis
Authors: Nam Hee-kyoung , Park Jungmi , Cho Sung-il
Published: March 2023

Background:Depression is a leading cause of disability and mortality, with estimated number of deaths exceeding 2.2 million worldwide. We examined depression in relation to anemia and physical activity, both of which have an impact on depression mechanisms.Methods:This cross-sectional study used data from the Korean National Health and Nutrition Examination Survey was utilized including 18622 participants. Depression was measured by The Patient Health Questionnaire-9, and physical activity was assessed by the Global Physical Activity Questionnaire. Anemia was defined by World Health Organization criteria for blood hemoglobin levels. Isotemporal substitution model for physical activity was used to assess the effect of replacing each intensity level of physical activity. Logistic regression was applied to estimate the effects on depression.Results:Replacing sedentary behavior with moderate or vigorous physical activity was associated with a lower risk of depression in the anemic (OR: 0.875, 95% CI: 0.782–0.978) and non-anemic groups (OR: 0.943, 95% CI: 0.919–0.967). Depression risk was significantly reduced by replacing walking with moderate to vigorous physical activity in both anemic (OR: 0.877, 95% CI: 0.784–0.982) and non-anemic groups (OR: 0.951, 95% CI: 0.927–0.976).Conclusions:Moderate to vigorous physical activity had a protective effect against depression in both anemic and non-anemic groups. Physical activity should be performed to prevent depression in individuals with anemia.
The Benefits of Early Continuous Renal Replacement Therapy in Critically Ill Patients with Acute Kidney Injury at High-Altitude Areas: A Retrospective Multi-center Cohort Study
Authors: Wang Bowen , Peng Mengjia , Wei Hui , Liu Chang , Wang Juan , Jiang Liheng , Fang Fei , Wang Yuliang , Shen Yuandi
Published: March 2023

Severe hypoxia would aggravate the acute kidney injure (AKI) in high-altitude areas and continuous renal replacement therapy (CRRT) has been used to treat critically ill patients with AKI. However, the characteristics and outcomes of CRRT of critically ill patients with AKI in high altitude and the optimal timing of CRRT initiation are still unclear. 1,124 patients were diagnosed with AKI and treated with CRRT in ICU, involving high-altitude group (n = 648) and low-altitude group (n = 476). Compared with low-altitude group, patients with AKI in high altitude showed longer CRRT (4.8 vs. 3.7, P = 0.036) and more rapid progression of AKI stages (P < 0.01), but without any significance of minor or major bleeding episode (P > 0.05). Referring to the analysis of survival and kidney recovery curves, a higher mortality but a lower possibility of renal recovery was observed in high-altitude group (P < 0.001). However, in the high-altitude group, the survival rate of early CRRT initiation was significantly higher than that of delayed CRRT initiation (P < 0.001). The findings showed poorer clinical outcomes of patients undergoing CRRT for AKI in high altitude. CRRT at high altitude was unlikely to increase the adverse events. Moreover, early CRRT initiation might reduce the mortality and promote renal recovery in high-altitude patients.
Divergent brain regional atrophy and associated fiber disruption in amnestic and non-amnestic MCI
Authors: Chen Yaojing , Du Chao , Dang Mingxi , Chen Kewei , Zhang Zhanjun
Published: March 2023

Background: Understanding the pathological characteristics of various subtypes of mild cognitive impairment (MCI) is crucial for the differential diagnosis of dementia. The purpose of this study was to feature divergent symptom-deficit profiles in amnestic MCI (aMCI) and non-amnestic MCI (naMCI).
Methods: T1 and DTI MRI data from a total of 158 older adults with 50 normal controls, 56 aMCI and 52 naMCI were included. The voxel-wise gray matter volumes and the number of seed-based white matter fiber bundles were compared between these groups. Further, correlation and mediation analyses between the neuroimaging indices and cognitive performance indices were performed.
Results: The aMCI with specific memory abnormalities was characterized by volumetric atrophy of the left hippocampus but not by differences in linked white matter fiber bundles. Conversely, naMCI was characterized by altered volume of the right inferior frontal gyrus with significant damage to fiber bundles traversing the region in all three directions, not only affecting fibers around the atrophied area but also distant fibers. Mediation analyses of gray matter-white matter-cognition showed that gray matter atrophy affects the number of fiber bundles and further affects attention and executive function. Meanwhile, fiber bundle damage also affects gray matter volume, which further affects visual processing and language.
Conclusions: The divergent structural damage patterns of the MCI subtypes and cognitive dysfunctions highlights the importance of detailed differential diagnoses in the early stages of pathological neurodegenerative diseases to deepen understanding of dementia subtypes and inform targeted early clinical interventions.
Tongue Necrosis Secondary to Giant Cell Arteritis, Successfully Treated with Tocilizumab: A Case Report
Authors: Cho Young Min , Khoury Lara El , Paramo Jonathan , Horowitz Diane Michelle , Li Jian Yi , Kello Nina
Published: March 2023

Background: Giant Cell Arteritis (GCA) is a large vessel vasculitis that most commonly presents with headache, scalp tenderness, jaw claudication, and vision changes. Various other, less common, manifestations have been reported in the literature such as scalp and tongue necrosis. Though most patients respond to corticosteroids, some cases of GCA are refractory to the high doses of corticosteroids.
Case presentation: We present a 73-year-old female with GCA refractory to corticosteroids presenting with tongue necrosis. This patient significantly improved with a dose of tocilizumab, an IL-6 inhibitor.
Conclusion: To the best of our knowledge, this is the first case report of a patient with refractory GCA presenting with tongue necrosis that had rapid improvement with tocilizumab.
A novel quasi-zero-stiffness isolation platform via tunable positive and negative stiffness compensation mechanism
Authors: Chai Yuyang , Bian Jing , Li Meng
Published: March 2023

Various quasi-zero stiffness (QZS) systems with high-static and low-dynamic stiffness (HSLDS) have been applied extensively to attenuate low-frequency vibrations. However, in the majority of cases, the negative stiffness unit exhibits nonlinear stiffness behaviors, and the method of realizing QZS is limited to compensate the nonlinear negative stiffness through linear springs. Hence, a novel linkage anti-vibration structure (LAVS) via linear positive and negative stiffness compensation mechanism is proposed and studied for exploring its advantages in low-frequency vibration isolation. The LAVS is composed of a symmetric polygonal structure (SPS) and a vertical spring. The static stiffness behavior is first investigated, revealing the inherent positive and negative stiffness compensation mechanism of linear springs to the SPS. By tuning structural parameters, the linear spring can completely compensate the linear negative stiffness of the SPS to achieve enhanced QZS over a larger stroke. Numerical simulation is carried out to verify the theoretical result and demonstrates the effectiveness of the presented stiffness compensation mechanism. Based on the Lagrange principle, a dynamic equation is established and then solved via the multiple scales method to obtain the displacement transmissibility. The effects of key parameters such as the rod lengths, equilibrium points and damping factors on the amplitude-frequency characteristics and vibration transmissibility are analyzed. Compared with existing typical QZS and X-shaped isolation systems, the presented LAVS exhibits an enhanced QZS zone with a larger load capacity and can realize superb vibration isolation performance with guaranteed stable equilibrium. The proposed linear positive and negative stiffness compensation mechanism presents new insights for passive vibration isolation design in many engineering applications.
Infection by wMel Wolbachia alters female post-mating behaviors and physiology in the dengue vector mosquito Aedes aegypti
Authors: Avila Frank , Osorio Jessica , Villa-Arias Sara , Camargo Carolina , Ramírez-Sánchez Luis , Barrientos Luisa , Bedoya Carolina , Rúa-Uribe Guillermo , Dorus Steve , Alfonso-Parra Catalina
Published: March 2023

Globally invasive Aedes aegypti mosquitoes disseminate numerous arboviruses that impact human health. One promising method to control Ae. aegypti populations is transinfection with the intracellular bacterium Wolbachia pipientis, a symbiont that naturally infects ~40-52% of insects but is normally absent from Ae. aegypti. Transinfection of Ae. aegypti with the wMel Wolbachia strain induces cytoplasmic incompatibility, allowing infected individuals to rapidly invade native populations. Further, wMel Wolbachia-infected females display refractoriness to medically relevant arboviruses. Thus, wMel Wolbachia-infected Ae. aegypti are being released in several areas to replace native populations, thereby suppressing disease transmission by this species. Wolbachia is reported to have minimal effects on Ae. aegypti fertility, but its influence on other reproductive processes is unknown. Female insects undergo several post-mating physiological and behavioral changes required for optimal fertility. Post-mating responses (PMRs) in female insects are typically elicited by receipt of male seminal fluid proteins (SFPs) transferred with sperm during mating, but can be modified by other factors, such as adult age, nutritional status, and microbiome composition. To assess how Wolbachia infection influences Ae. aegypti female PMRs, we collected wMel Wolbachia-infected Ae. aegypti from the field in Medellín, Colombia and introduced the bacterium into our laboratory strain. We found that Wolbachia influences female fecundity, fertility, and re-mating incidence. Further, we observed that Wolbachia significantly extends longevity of virgin females. Changes in female PMRs are not due to defects in sperm transfer by infected males, or sperm storage by infected females. Using proteomic methods to examine the seminal proteome of infected males, we found that Wolbachia infection has a moderate effect on SFP composition. However, we identified 125 Wolbachia proteins that are paternally transferred to females by infected males. Surprisingly, the CI factor proteins (Cifs), were not detected in the ejaculates of Wolbachia-infected males. Our findings indicate that Wolbachia infection of Ae. aegypti alters female post-mating responses, potentially influencing control programs that utilize Wolbachia-infected individuals.
IKKε inhibition by amlexanox ameliorates high glucose-mediated endothelial senescence via the NF-κB/iNOS and AKT/eNOS signaling pathways
Authors: Wang Xianghong , He Qian , Zou Xiulan , Yao Kecheng
Published: March 2023

High glucose (HG)-induced endothelial cell senescence can induce atherosclerosis and is closely related to the vascular complications of diabetes. Amlexanox (AM), a selective IKKε inhibitor, can protect against metabolic diseases. This study examined how amlexanox inhibits endothelial senescence under high glucose conditions and explores its mechanisms of action .. HUVECs were incubated with HG (33 mmol/L), and then IKKε was targeted with shRNA lentivirus transfection or treatment with amlexanox. Cellular senescence indicators were examined by SA-β-gal staining, reactive oxygen species (ROS) measurement with dihydroethidium, and determining intracellular and serum levels of nitric oxide (NO). The levels of proteins related to the NF-κB/iNOS and AKT/eNOS pathways were assessed through Western blot analysis.. In this study, we found that high glucose promoted cell senescence, significantly increased ROS levels and decreased NO formation, and these effects were prevented by IKKε silencing and amlexanox treatment. In addition, high glucose decreased the phosphorylation of AKT/eNOS and increased the phosphorylation of NF-κB/iNOS in HUVECs, resulting in an imbalance in the p-eNOS/p-iNOS ratio. These trends were reversed by IKKε inhibition. Thus, amlexanox can target IKKε to alleviate HG-induced endothelial senescence by normalizing the NF-κB/iNOS and AKT/eNOS signaling pathways.
Inactive long prokaryotic Argonaute systems employ various effectors to confer immunity via abortive infection
Authors: Song Xinmi , Lei Sheng , Liu Shunhang , Liu Yanqiu , Fu Pan , Zeng Zhifeng , Yang Ke , Chen Yu , Li Ming , She Qunxin , Han Wenyuan
Published: March 2023

Argonaute proteins (Agos) bind short nucleic acids as guides and are directed by them to recognize target complementary nucleic acids. Prokaryotic Agos (pAgos) are extremely diverse, with potential functions in microbial defense. The functions and mechanisms of a group of full-length yet inactive pAgos, long-B pAgos, remain enigmatic. Here, we show that most long-B pAgos constitute cell suicide systems together with their various associated proteins, including nucleases, Sir2-domain-containing proteins and trans-membrane proteins, respectively. Among them, the long-B pAgo-nuclease system utilizes an RNA-programmed and target-recognition-activated collateral DNA cleavage activity to sense invaders and mediate genomic DNA degradation. This kills the infected cells and results in depletion of the invader from the cell population. The data indicate that the long-B pAgo systems induce cell death with various effector proteins after recognition of invading nucleic acids, corresponding to an immune response via abortive infection.
ezSingleCell: An integrated one-stop single-cell and spatial omics analysis platform for bench scientists
Authors: Chen Jinmiao , Sethi Raman , Ang Kok Siong , Li Mengwei , Long Yahui , Ling Jingjing
Published: March 2023

ezSingleCell is an interactive and easy-to-use application for the analysis and integration of multiple single-cell and spatial omics data types. It integrates the best-performing publicly available methods and in-house novel algorithms for in-depth data analysis, integration, and interactive data visualization. By integrating the relevant tools to form a complete analysis pipeline, we save users from the hassles of choosing among the enormous diversity of available methods, installing individual packages, and reformatting the data for different analysis steps. ezSingleCell takes input data in a variety of formats such as text files or Cell Ranger/ Space Ranger output and produces publication ready figures and tables. Users can customize the relevant parameters to ensure the quality and accuracy of their data analysis. Users can also download and store the R objects from ezSingleCell to perform additional offline analyses. ezSingleCell’s streamlined interface can analyze a standard scRNA-seq dataset containing 3000 cells in less than five mins. ezSingleCell is also accompanied by an in-depth manual and video tutorials to guide users. Overall, these features make ezSingleCell a convenient and easy web service for single cell and spatial analysis without requiring prior programming knowledge. ezSingleCell is available in two forms: an installation-free web application (https://immunesinglecell.org/ezsc/) or a software package with a shinyApp interface (https://github.com/JinmiaoChenLab/ezSingleCell2) that runs on a personal computer with a low memory requirement of 8 Gb RAM.
A case of robot-assisted radical nephroureterectomy (RANU) in a patient with horseshoe kidney
Authors: Shiode Ryo , Watanabe Ryuta , Toshio Kakuda , Suzuki Daiichiro , Nobumori Shota , Sugihara Naoya , Yamakawa Maki , Saiki Kaori , Kono Reina , Noda Terutaka , Nishimura Kenichi , Fukumoto Tetsuya , Miura Noriyoshi , Miyauchi Yuki , Kikugawa Tadahiko , Saika Takashi
Published: March 2023

Background:
Renal pelvic carcinoma occurring in a horseshoe kidney is rare. Further, there are few reports on robotic surgery in horseshoe kidneys. We report the case of a patient who underwent a robotic nephroureterectomy for right renal pelvic carcinoma in a horseshoe kidney.
Case presentation:
A 64-year-old male patient was diagnosed with right renal pelvic carcinoma (cT1N0M0) in a horseshoe kidney. Robot-assisted radical nephroureterectomy was performed using the da Vinci Xi® surgical system with imaging of the anatomical structures using 3D constructed imaging software (SYNAPSE VINCENT®). The isthmus was dissected using monopolar curved scissors, and the edge was coagulated using ball electrodes. The operating time was 6 h 31 min, and console time was 5 h 2 min. Blood loss was 185 mL. The surgery was performed without complications, and the patient was discharged after 8 days. The pathological diagnosis was invasive urothelial carcinoma (pT3, high-grade carcinoma with CIS) with a negative surgical margin.
Conclusion:
Robotic surgical procedures are safe in radical nephroureterectomy in a horseshoe kidney, and preoperative 3D construction images provide anatomical perception.
Extracorporeal Shockwave Therapy is an Effective Adjunctive Treatment for Late-Stage Breast Cancer-Related Lymphedema when Complex Decongestive Therapy is Not Enough
Authors: Wu Mu-Hsun , Huang Hung-Ya , Huang Ming-Hsuan , Hoe Zheng-Yu
Published: March 2023

Purpose:
Complex decongestive treatment (CDT) and extracorporeal shockwave therapy (ESWT) have been shown to be effective in the treatment of early-stage breast-cancer-related lymphedema (BCRL) but less so for later-stage. This study examined the effects of ESWT on late-stage BCRL (Stages IIb and III) as an adjunct treatment after prolonged CDT failed.
Patients and Methods:
11 female patients with BCRL who had undergone at least 6 months of CDT monotherapy without measurable effects received ESWT 3 times a week for 12 weeks with concurrent CDT. Limb circumference and the thicknesses of the skin, subcutaneous tissue, and muscle layers were measured using a measuring tape and ultrasound, respectively, in the most edematous regions of both the forearm and upper arm.
Results:
After the addition of ESWT to CDT, the mean circumference, thickness of the skin layer, and the thickness of the subcutaneous tissue layer of the affected limb decreased significantly (p < 0.05), while the mean thickness of muscle on the affected limb increased slightly but not significantly (forearm, p = 0.348; upper arm, p = 0.100). On the unaffected limb, no significant changes were measured (p > 0.05).
Conclusions:
ESWT as an adjunct treatment to CDT monotherapy after a period of 6 months showed significant reductions in distal and proximal upper limb circumference, skin layer thickness, and subcutaneous tissue layer thickness in patients suffering from prolonged late stage (IIb and III) BCRL, suggesting that the combination therapy was effective on severe BCRL and fibrotic lesions that could not be effectively treated by CDT alone.
Best Practice Guidance for Antibiotic Audit and Feedback interventions in Primary Care: a modified Delphi study from the Joint Programming Initiative on Antimicrobial Resistance - Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN)
Authors: Schwartz Kevin L. , Xu Alice X.T. , Alderson Sarah , Bjerrum Lars , Brehaut Jamie , Brown Benjamin C. , Bucher Heiner C. , De Sutter An , Francis Nick , Grimshaw Jeremy , Gunnarsson Ronny , Hoye Sigurd , Ivers Noah , Lecky Donna M. , Lindbaek Morten , Linder Jeffrey A. , Little Paul , Michalsen Benedikte Olsen , O’Connor Denise , Pulcini Celine , Sundvall Par-Daniel , Lundgren Pia Touboul , Verbakel Jan Y. , Verheij Theo J.
Published: March 2023

Background: Primary care is a critical partner for antimicrobial stewardship efforts given its high human antibiotic usage. Peer comparison audit and feedback (A&F) is often used to reduce inappropriate antibiotic prescribing. The design and implementation of A&F may impact its effectiveness. There are no best practice guidelines for peer comparison A&F in antibiotic prescribing in primary care.
Objective: To develop best practice guidelines for peer comparison A&F for antibiotic prescribing in primary care in high income countries by leveraging international expertise via the Joint Programming Initiative on Antimicrobial Resistance – Primary Care Antibiotic Audit and Feedback Network (JPIAMR-PAAN).
Methods: We used a modified Delphi process to achieve convergence of expert opinions on best practice statements for peer comparison A&F based on existing evidence and theory. Three rounds were performed, each with online surveys and virtual meetings to enable discussion and rating of each best practice statement. A five-point Likert scale was used to rate consensus with a median threshold score of 4 to indicate a consensus statement.
Results: The final set of guidelines include 13 best practice statements in four categories: general considerations (n=3), selecting feedback recipients (n=1), data and indicator selection (n=4), and feedback delivery (n=5).
Conclusion: We report an expert-derived best practice recommendations for designing and evaluating peer comparison A&F for antibiotic prescribing in primary care. These 13 statements can be used by A&F designers to optimize the impact of their quality improvement interventions, and improve antibiotic prescribing in primary care.
Dynamical Friction of Pulsars in Globular Clusters
Authors: Xie Yi
Published: March 2023

Pulsars are supposed to be powerful probes for the internal dynamics of the Galactic globular clusters (GCs). During the motion in the clusters, the pul-sars experience a drag force through dynamical friction (DF). We show that the effects of DF on the acceleration as well as the related timing parameters are significant for millisecond pulsars in the inner regions of core-collapsed clusters with high core densities. We also consider the influence of the IMBH that may exist in the center of a GC on the drag force, and found that it can improve dramatically the acceleration within its influenced region. The timing effects of the drag force may be used to increasing the accuracy of timing parameters, and may provide a unique tool to study the role of DF in GC dynamics.
Special-District Proliferation and Local Financial Condition: The Hidden Cost of the Externalized Service Responsibility
Authors: Park HyungGun
Published: March 2023

General-purpose governments have increasingly relied on creating special districts to provide specialized public services to subsections of their jurisdictions. There are many presumed advantages of pursuing this strategy, including displacing some of the own-source tax burden associated with providing such services with outside revenue sources. This goal is feasible, as special districts are usually formed across overlapping tax bases across multiple jurisdictions. However, this empirical analysis of 51,000 special district governments in the U.S., collected over the past four decades, finds that increased special district proliferation has generally resulted in decreased financial conditions of general-purpose governments. These empirical results demonstrate that claim public goods provision through special districts produces indirect financial stress on general-purpose governments that must then struggle to use less efficient methods for providing the same or similar services to their under-served citizens who are not covered by the special district.
Fiscal performance of West Bengal as a General Category States in India : Is it dynamics ?
Authors: Sardar Satchidananda Sardar Satchidananda
Published: March 2023

This study has tried to explore the fiscal performance of West Bengal and compare it with that of other general states in India. It is very important to be aware of the fiscal performance of a country or state. In 2003, India established the Fiscal Responsibility and Budget Management Act (FRBMA), a fiscal framework with principles to promote long-term macroeconomic stability. Achieving intergenerational justice in fiscal management is critical. All of these programs and laws attempt to boost revenue, lower the deficit, and ensure fiscal sustainability at the federal and state levels for both macroeconomic and microeconomic stability. In this paper, three indicators have been used for the calculation of fiscal performance: the Indicator of Deficit Index (IDI), the Own Revenue Effort Index (OREI) and the Debt and Expenditure Index (EDSI). The fiscal performance of West Bengal among the 17[1]general category states is not satisfactory; rather, it occupies the worst position among states and the performance did not improve over the period of time . Basically, this is due to low tax collection by the state and a higher amount of expenditure. Since the performance did not change significantly hence the fiscal performance of West Bengal is not dynamic.
[1] Although there are 18 general category states in India, I have considered 17 general category states because Telegana state was formed in 2013 . My study paper has tried to explore the fiscal performance of West Bengal from 2003–2004 to 2020–2021.
Compact Stars in κ(R, T) Gravity
Authors: Taşer Doğukan , Doğru Serta¸c Serkan
Published: March 2023

The study is to organized for investigation of a new solution for stellarobjects in κ(R, T ) theory. We investigate whether Krori-Barua modelproduces valid results in κ(R, T ) theory. We attain field equationsthrough Krori-Barua metric form related with geometry of inner space.From field equations, we obtain all unknown matter components κ(T ) =8πG−λT case in the theory. Constructed model is considered with someclass of compact stars such as 4U1820 − 30, SAXJ1808.4 − 3658and HerX − 1. To prove physical stability of constructed model, weinvestigate both normal and effective matter form behaviors by way ofsome physical conditions. It is found that all conditions are valid foreffective matter. Therefore, this study reveals consistency of both thecompact star model and the gravitation theory. But remarkable point isthat normal matter has to face with some problem in the κ(R, T ) theory.
A novel risk prediction nomogram for early death in patients with resected synchronous multiple primary colorectal cancer based on the SEER database
Authors: Zhang Xiangyu , Zhao Liang , Hu Yanpeng , Deng Kai , Ren Wanbo
Published: March 2023

Background:
Synchronous multiple primary colorectal cancer (SMPCC) involves the simultaneous occurrence of 2 or more independent primary malignant tumors in the colon or rectum. Although SMPCC is rare, it results in a higher incidence of postoperative complications and mortality compared to patients with single primary colorectal cancer (SPCRC).
Methods:
The clinical factors and survival outcomes of SMPCC patients registered on the Surveillance, Epidemiology, and End Results (SEER) database between 2000 and 2017 were extracted. The patients were divided into the training and validation cohorts using a ratio of 7:3. Univariate and multivariate logistic regression analyses were used to identify the independent risk factors for early death. The performance of the nomogram was evaluated using the concordance index (C-index), calibration curves, and the area under the curve (AUC) of a receiver operating characteristics curve (ROC). A decision curve analysis (DCA) was used to evaluate the clinical utility of the model in relation to the standard TNM system.
Results:
A total of 4386 SMPCC patients were enrolled in the study and randomly assigned to the training (n = 3070) and validation (n = 1316) cohorts. The multivariate logistic analysis identified age, chemotherapy, radiotherapy, T stage, N stage, and M stage as independent risk factors for all-cause and cancer-specific early death. The marital status was associated with all-cause early death, and the tumor grade was associated with cancer-specific early death. In the training cohort, the nomogram achieved a C-index of 0.808 (95% CI, 0.784-0.832) and 0.843 (95% CI, 0.816-0.870) for all-cause and cancer-specific early death, respectively. Following validation, the C-index was 0.797 (95% CI, 0.758-0.837) for all-cause early death and 0.832 (95% CI, 0.789-0.875) for cancer-specific early death. The ROC and calibration curves indicated that the model had good stability and reliability. The DCA showed that the nomogram had a better clinical net value than the TNM staging system.
Conclusion:
Our nomogram can provide a simple and accurate tool for clinicians to predict the risk of early death in SMPCC patients undergoing surgery and could be used to optimize the treatment according to the patient's needs.
“I’d like accessibility analysis to help us shape the future”: Transportation practitioners and accessibility measurement
Authors: Rowangould Dana , Levine Kaylyn , Alcorn Louis , Karner Alex
Published: March 2023

Transportation agencies are becoming increasingly interested in measuring accessibility, or the ease with which people can reach desired destinations. In part, the concept is attractive because it reflects the primary purpose of a transportation system—to connect people to the opportunities they value. Academic researchers have identified a wide range of accessibility measures that vary widely in terms of their interpretability, data requirements, parameters, multimodalism, and relevance to different areas of transportation planning and decision-making. At the same time, new data and tools that facilitate and improve accessibility measurement are proliferating. Despite the promise of access measures, the landscape is vast and changing, which can be difficult for practitioners to navigate. In fact, the use of accessibility in practice is relatively limited, with only a small share of U.S. transportation agencies using these measures. In this paper, we draw from 45 interviews with transportation professionals and a follow-up survey to determine how U.S. transportation practitioners currently use accessibility measures, barriers to accessibility measurement, and opportunities to use accessibility measures moving forward. Our results point to a wide range of technical capacities and accessibility applications across agencies, a suite of considerations that influence whether and how accessibility measures are used, a desire among many practitioners to increase their use of accessibility, and barriers to doing so. We close with reflections on opportunities to expand and improve the use of accessibility measurement in practice to strengthen transportation decision making.
Spontaneous middle cerebral artery dissection: A series of six cases and literature review
Authors: Nounaka Yohei , Murai Yasuo , Shirokane Kazutaka , Matano Fumihiro , Koketsu Kenta , Nakae Ryuta , Watanabe Akira , Mizunari Takayuki , Morita Akio
Published: March 2023

Middle cerebral artery (MCA) dissection is rare, and various clinical presentations, including hemorrhage, ischemia, or comorbidities, and the changes in imaging findings over time hinder treatment decisions. The European Stroke Organization guidelines exclude MCA dissection. Few cases have been reported with no review of the relevant literature. Therefore, we reviewed the relevant literature and our own experience with non-traumatic MCA dissection cases to determine appropriate treatment strategies. At our institution and affiliated institutions, we encountered six cases of MCA dissection—five with infarction and one with hemorrhage. Two patients underwent revascularization, and one underwent an aneurysmectomy. We reviewed English and Japanese articles in PubMed and Medical Journal Web and summarized the results based on the relationships among age, sex, location, presence of an aneurysm, presence of angiography, history, treatment, and mode of onset. The clinical course, changes in imaging, treatment strategies, and prognosis were discussed. Eighty cases were included in the review. Cerebral aneurysms were more common distal to the M2 area (p=0.00) and were correlated with hemorrhage (p<0.001). Most hemorrhagic cases with aneurysms were treated surgically, while ischemic cases were treated with antithrombotic agents, and both had a similar neurological prognosis. There were some cases of rebleeding after antithrombotic therapy, especially in older adults.
Surgical treatment is recommended in cases of hemorrhage and confirmed aneurysms, particularly for lesions distal to the M2 area. Patients with aneurysm-associated ischemia should be followed-up, and antithrombotic treatment should be considered with particular care in older adults.
Alterations in the hepatocyte epigenetic landscape in steatosis
Authors: Schulz Marcel H. , Gasparoni Nina , Nordström Karl , Gasparoni Gilles , Laggai Stephan , Yang Xinyi , Sinha Anupam , Ebert Peter , Falk-Paulsen Maren , Kinkley Sarah , Chung Ho-Ryun , Rosenstiel Philip , Hengstler Jan G. , Walter Jörn , Kessler Sonja M. , Kiemer Alexandra K. , Maji Ranjan Kumar , Czepukojc Beate , Scherer Michael , Tierling Sascha
Published: March 2023

Fatty liver disease or the buildup of fat in the liver, has been reported to affect the global population. This comes with an increased risk for the development of fibrosis, cirrhosis, and hepatocellular carcinoma. Yet, little is known about the effects of fat and alcohol diet towards epigenetic aging, with respect to changes in transcriptional and epigenomic profiles. In this study, we took up a multi-omics approach and integrated gene expression, methylation signals, and chromatin signals to study the epigenomic effects of a high-fat and alcohol-containing diet on mouse hepatocytes. We identified 4 relevant protein-protein interaction network clusters that were associated with relevant pathways that promote steatosis. Using a machine learning approach, we predict specific transcription factors that might be responsible to modulate the functionally relevant clusters. Finally, we discover 4 additional CpG loci and validate that aging related differential CpG methylation. Differential CpG methylation linked to aging showed minimal overlap with altered methylation in steatosis.
In silico construction and evaluation of anti-EGFR ScFv and IFN-β fusion protein as a novel immunocytokine for the treatment of HER1 positive breast cancer
Authors: Khan Muhammad Islam , Hassan Muhammad , Sohail Aamir , Ahmad Nadeem , Khan Idrees , Khan Mohsin Ahmad , Khan Muhammad Tahir
Published: March 2023

Context Human epidermal growth factor receptor 1 (HER1) positive breast cancer is characterized by overexpression of the HER1 receptor protein on cancer cells leading to aggressive disease and treatment resistance. Computational design can efficiently create immunocytokine that specifically target cancer cell antigens and modulate the immune response, making them a promising treatment for HER1-positive breast cancer.
Methods The current work involves computational tools to design a novel immunocytokine, including the anti-epidermal growth factor single-chain variable fragment (ScFv) against HER1 receptor with a connection to the functional part of a cytokine INF-β. The amino acid sequences of ScFv region of antibody and IFN-β were retrieved from gene bank (accession no. AFF61391.1) and (ABS89222.1) respectively, and fused together to form a chimeric protein, called ScFv-IFN-β fusion protein. Physicochemical properties and solubility were analyzed using ProtParam and SOLpro, respectively. The ScFv-IFN-β fusion protein was modeled in 3D using alpha-fold and refined with GalaxyRefine and assessed using PROCHECK and RAMPAGE. Allergenicity and mRNA stability were predicted using the AlgPred and RNAfold servers, respectively. Docking and molecular dynamic simulations were performed using HDOCK and iMOD servers, respectively. Our computational analysis predicted that the ScFv-IFN-β fusion protein is anticipated to exhibit solubility, possess a sturdy 3D structure, maintain stable mRNA structure, and effectively bind to both HER1 and IFN receptors, thus making it a suitable candidate for breast cancer treatment. The current findings appear encouraging and hold promise for future experimental investigations.
Asymptomatic Obstructive Ventilatory Defect is common among Rheumatoid Arthritis Patients
Authors: Hassan Asmaa M , Ali Ibrahim Abdelrhim , Osman Asim A
Published: March 2023

Background
Rheumatoid arthritis (RA) is a chronic inflammatory disease affecting about 0.5–2% of the population worldwide. Extra-articular involvement in RA is a common condition and can occur in up to 40% of patients. Pulmonary involvement is a common extra-articular manifestation and may affect parenchyma, pleura, airway, and vasculature. It occurs in 20 to 67% of RA patients and it is responsible for about 10–20% of mortality in RA patients. So evaluation of the patients with rheumatoid arthritis for any deterioration in their lung functions is essential to treat appropriately, improve their mobility and quality of life.
Objectives
The study aimed to evaluate the effect of RA on the pulmonary function tests (PFTs) among Sudanese RA patients attending Rheumatology clinics in Omdurman Military hospital.
Methods
This is an analytical cross-sectional hospital -based study conducted among Sudanese RA patients. The study included 32 RA patients who were not known to have any respiratory illnesses or chronic diseases. An interview questionnaire with personal data and brief medical history was filled by the investigator. Height and weight were measured and BMI was calculated. Forced Vital Capacity (FVC), Forced Expiratory Volume in 1 second (FEV1), and Peak Expiratory flow Rate (PEFR) were measure for each participant by digital spirometer. Matching from control group with similar age and height was performed and the results were compared with normal reference values for Sudanese subjects.. The tested data was analyzed using SPSS version 25, t-test was used to compare the statistical significant (P-value ≤ 0.05 was considered statistical significant).
Results
In this study, all the measured parameters of the PFTs in RA patients were lower than the published reference normal values for Sudanese subjects with significant P values. The mean of FEV1, FVC, FEV1/FVC ratio and PRFR in RA patients was found to be 1.8 ± ,3 L/min, 2,1 ± ,4 L/min, 87.1 ± 12,2% and 223.6 ± 86.2 L/min respectively in compared to 2,4 ± ,1 L/min, 2,7 ± ,1 L/min,90.81 ± 2.6% and 345.4 ± 86.2 L/min respectively in the control group (P Value 0.001, 0.001,0.05, and 0.001 respectively). There was no statistical significance correlation between PFT and duration of age, disease, and BMI. Obstructive ventilatory defect was seen in 78.1% (25) of patients. Restrictive ventilatory defect was seen in only 6.3% (2) of patients and 15.6% (5) showed normal pattern.
Conclusion
Pulmonary function abnormalities are common in asymptomatic rheumatoid patients which were found to be obstructive defect. Different pattern of pulmonary function abnormalities had a manifested in RA patients and the obstructive pattern represents the most common feature. Spirometry is indicated as a baseline assessment and for follow up of RA patient to enhance early detection and management of the pulmonary involvement.