bluuebunny/crossref_metadata_2025 huggingface dataset:
Can on-line gait training improve clinical practice? Study protocol for feasibility of an on-line educational intervention to improve clinician’s gait related decision-making in ambulant children and young people with cerebral palsy.
Authors: Hebda-Boon Anna , Shortland Adam P. , Birn-Jeffery Alexandra , Morrissey Dylan
Published: October 2023

Background: Instrumented gait analysis (IGA) is an assessment and research tool with proven impacts on clinical decision-making for the management of ambulant children and young people with cerebral palsy (CYPwCP) but is underused and variably understood by relevant clinicians. Clinicians’ difficulties in gaining expertise and confidence in using IGA are multifactorial and related to access for in-role decision-making, limited training opportunities and inability to translate this training into clinical practice.
Methods: The primary aim of this study is to test the feasibility of an educational intervention to advance clinicians’ application of gait analysis in CYPwCP, to inform a definitive trial. The secondary aim is to measure the effect that appropriate IGA training has on physiotherapists’ knowledge, skills, confidence and behaviours. This will be a two-arm feasibility randomised controlled trial with an experimental and control group. The 6-week on-line intervention uses a multicomponent approach grounded in behavioural change techniques. A repeated measures design will be adopted, whereby participants will complete outcome measures at baseline, immediately after the intervention and at 4-months. The primary outcome measures (trial feasibility related outcomes) are recruitment, retention and engagement. The secondary outcome measures (trial research-related outcomes) are knowledge, skills, confidence and practice change. Outcome measures will be collected via online questionnaires and during observed skill assessments. Analysis of data will utilise descriptive statistics, two-way mixed ANOVA model and qualitative content analysis.
Discussion: This study will determine feasibility of the definitive randomised control trial of educational intervention delivered to advance clinicians’ application of gait analysis in CYPwCP.
This study offers the shift in emphasis from regarding IGA as a tool to a focus on clinicians’ requirements for access, training and a well-defined role to optimise utilisation of IGA. The impact of this should be better engagement with IGA and clinical practice change. This study will contribute to a body of educational research into clinical education of healthcare professionals and IGA training offering insight into high levels of evaluation evidence including clinical behaviour change.
Trial registration: Protocol has been registered with the Open Science Framework (osf.io/nweq6) in June 2023
Heterogeneity of influenza infection at precise scale in Yinchuan, Northwest China,2012-2022: evidence from Joinpoint regression and spatiotemporal analysis
Authors: Zhang Lu , Li Yan , Ma Ning , Zhao Yi , Zhao Yu
Published: October 2023

Identifying high-risk regions and turning points of influenza with a precise spatiotemporal scale may provide effective prevention strategies. In this study, epidemiological characteristics and spatiotemporal clustering analysis at the township level were performed. A descriptive study and a Joinpoint regression analysis were used to explore the epidemiological characteristics and the time trend of influenza. Spatiotemporal autocorrelation and clustering analyses were carried out to explore the spatiotemporal distribution characteristics and aggregation. Furthermore, the hotspot regions were analyzed by spatiotemporal scan analysis. A total of 4025 influenza cases were reported in Yinchuan showing an overall increasing trend. The tendency of influenza in Yinchuan consisted of three stages: increased from 2012 to the first peak in 2019 (32.62/100,000) with a slight decrease in 2016; during 2019 and 2020, the trend was downwards; then it increased sharply again and reached another peak in 2022. The Joinpoint regression analysis found that there were 3 turning points from January 2012 to December 2022, namely January 2020, April 2020, and February 2022. The children under 10 displayed an upward trend and were statistically significant. The trend surface analysis indicated that there was a shifting trend from northern to central and southern. A significant positive spatial auto-correlation was observed at the township level and four high-incidence clusters of influenza were detected. These results suggested that children under 10 years old deserve more attention and the spatiotemporal distribution of high-risk regions of influenza in Yinchuan varies every year at the township level. Thus, more monitoring and resource allocation should be prone to the four high-incidence clusters, which may benefit the public health authorities to carry out the vaccination and health promotion timely.
Androgen deprivation induces neuroendocrine phenotypes in prostate cancer cells through CREB1/EZH2-mediated downregulation of REST
Authors: Li Wenliang , Zheng Dayong , Zhang Yan , Yang Sukjin , Su Ning , Bakhoum Michael , Zhang Guoliang , Naderinezhad Samira , Mao Zhengmei , Wang Zheng , Zhou Ting
Published: October 2023

Although effective initially, prolonged androgen deprivation therapy (ADT) promotes neuroendocrine differentiation (NED) and prostate cancer (PCa) progression. It is incompletely understood how ADT transcriptionally induces NE genes in PCa cells. CREB1 and REST are known to positively and negatively regulate neuronal gene expression in the brain, respectively. No direct link between these two master neuronal regulators has been elucidated in the NED of PCa. We show that REST mRNA is downregulated in NEPC cell and mouse models, as well as in patient samples. Phenotypically, REST overexpression increases ADT sensitivity, represses NE genes, inhibits colony formation in culture, and xenograft tumor growth of PCa cells. As expected, ADT downregulates REST in PCa cells in culture and in mouse xenografts. Interestingly, CREB1 signaling represses REST expression. In studying the largely unclear mechanism underlying transcriptional repression of REST by ADT, we found that REST is a direct target of EZH2 epigenetic repression. Finally, genetic rescue experiments demonstrated that ADT induces NED through EZH2’s repression of REST, which is enhanced by ADT-activated CREB signaling. In summary, our study has revealed a key pathway underlying NE gene upregulation by ADT, as well as established novel relationships between CREB1 and REST, and between EZH2 and REST, which may also have implications in other cancer types and in neurobiology.
A Non-Primordial Origin for the Widest Binaries in the Kuiper Belt
Authors: Campbell Hunter , Anderson Kalee , Kaib Nathan
Published: October 2023

Nearly one-third of objects occupying the most circular, coplanar Kuiper belt orbits (the cold classical belt) are binary companions revolving about one another as they orbit the Sun, and several percent of binaries are “ultra-wide” binaries (UWBs): ∼100-km companions spaced by tens of thousands of km. UWBs are dynamically fragile, and their existence is thought to constrain early solar system processes and conditions. However, we demonstrate that UWBs can attain their wide architectures well after the solar system’s earliest epochs when Neptune’s orbital migration implants the modern non-cold, or “kinetic,” Kuiper belt. During implantation, huge numbers of planetesimals cross the in-situ cold classical belt, and cold classical belt binaries suffer close encounters with them. Such encounters efficiently dissociate any existing UWBs and widen a small fraction of tighter binaries into UWB-like arrangements. Thus, today’s UWBs may not be primordial and may constrain the early solar system differently than previously surmised.
Modest geoengineering side effects predicted by an emulator
Authors: Bodai Tamas , Lembo Valerio , Aneesh Sundaresan , Ishuzu Miho , Franz Matthias O. , Chung Eui-Seok
Published: October 2023

It is common to speak about side effects of solar radiation management geoengineering considering that the forcing involved is different in nature from the anthropogenic greenhouse forcing. However, we argue that even if side effects are identified in terms of uncontrolled changes of climatic variables, they should scale with the geoengineering forcing magnitude. This would dictate a definition of side effects that takes a reference scenario where the same target is achieved, e.g. limiting the global mean surface temperature to an agreed maximum, without deploying geoengineering, but, say, by CO2 abatement only. We use a response theory based emulator, derived from new simulation output for the Max Planck Institute’s Earth system model, MPI-ESM, as well as the cGENIE carbon cycle model, in order to evaluate regional side effects regarding annual mean surface temperature and total precipitation in this sense. We find that the respective spatial patterns of the side effects bear the features as those known from the G2-type “cancellation” experiments of the Geo-MIP protocol – more so for temperature than precipitation. The former is governed by the effect of polar amplification, for which we provide now a succinct mathematical model, both for the greenhouse and geoengineering forcing, and explain the G2-type temperature pattern.
Traditional Eye Medicine and self-treatment in Rural Ethiopia
Authors: Sherief Sadik Taju , Sitotaw Munira Sherefedin , Girma Abonesh
Published: October 2023

Introduction: Traditional medicines are commonly used worldwide, especially in Africa—however, there is limited information on the prevalence and types of traditional eye medicine utilization in Ethiopia. The goal of this study was to determine the type and nature of traditional eye medicine use and practices related to self-medication for ophthalmic diseases in a rural Ethiopian population.Methods: A cross-sectional was conducted in six randomly selected primary health centers in rural Gurage Zone, Southern Ethiopia. Health-seeking behavior, use of self-medication, and traditional eye medicine were assessed in the population using a semi-structured questionnaire. Descriptive statistics and multivariable logistic regression analysis were computed to determine associated factors for using self-medication and traditional eye medicine.Result: Of the 814 participants interviewed, 487 (59.8%) reported using traditional eye medicine, mainly for combinations of symptoms of ocular redness, irritation, and eye discharge (95.5%). Besides, 604 (74.2%) participants reported self-treatment with tetracycline 1% eye ointment. Older age, females, low income, illiterate, and lack of access to media were risks for utilizing traditional eye medicine.Conclusion: The use of traditional eye medicine and self-treatment are common in this population. Regulatory legislation, public awareness, and making eye care are vital activities required to monitor such practices.
Study on the desalination and regeneration performance of PBA/AC electrode enhanced by membrane capacitor deionization
Authors: Wang Xiaobing , He Hao , Jiang Xiaoxue , Jin An , Li Dong , Gu Junfeng , Wang Lu
Published: October 2023

In this study, we investigate the desalination and regeneration performance of oilfield concentrated brine by the membrane capacitive deionization (MCDI) systems through batch experiments. Prussian blue analog (PBA) and active carbon (AC) electrodes is used in the MCDI cell. The influences of capacitive deionization on adsorption-desorption efficiency under optimal desorption conditions are analyzed. The experimental results show that the optimized operational parameters for achieving superior deionization regeneration performance in membrane capacitors comprise a voltage magnitude of -1.6 V, a desorption flow rate of 30 mL/min, and an electrode regeneration duration of 25 minutes. The MCDI system achieves a desorption amount of 45.87 mg/g, a remarkable regeneration rate of 99.23%, and an impressive desorption rate of 1.83 mg/(g·min) under the optimized operating conditions. The MCDI system demonstrates a desorption amount and regeneration rate that are 22.56 mg/g and 17.47% higher, respectively, compared to the Capacitive Deionization (CDI) system.
Pollution characteristics and source apportionment of Polycyclic Aromatic Hydrocarbons in atmospheric PM2.5 in Jinchang City
Authors: Wang Hong liang , Chu Run
Published: October 2023

Polycyclic aromatic hydrocarbons (PAHs) are typical persistent organic pollutants with persistence, long-distance migration, bioaccumulation, and high toxicity. Due to their adverse effects on human health and the environment, they have been listed as a priority to be monitored and controlled. To explore the pollution characteristics and sources of polycyclic aromatic hydrocarbons (PAHs) in atmospheric PM2.5 in Jinchang City, the mass concentrations of PM2.5 and 16 types of priority polycyclic aromatic hydrocarbons (PAHs) were determined by gas chromatography-mass spectrometry (GC-MS). The HYSPLIT model was used to simulate the backward trajectory of the air masses, and the potential source contribution factor (PSCF) and the characteristic ratio methods were used to analyze the pollution characteristics and the source of PAHs respectively. The results indicated that ρ(PAHs) in atmospheric PM2.5 was in the order Winter [(86.40 ± 12.55) ng∙m− 3] > Spring [(71.82 ± 18.60) ng∙m− 3] > Autumn [(61.54 ± 17.48) ng∙m− 3] > Summer [(31.86 ± 7.64) ng∙m− 3]. Correlation analysis showed that the concentration of PAHs was highly significantly negatively correlated with temperature and humidity, but was significantly positively correlated with wind speed and pressure. Characteristic ratio analysis showed that the PAHs in PM2.5 atmosphere were mainly from automobile combustion and exhaust sources. The trajectory clustering and PSCF analysis showed that the airflows in southwestern and southern Inner Mongolia, as well as in the Hexi Corridor have a significant impact on the air quality in Jinchang City. The sources of PAHs in PM2.5 atmosphere in Jinchang are mainly from combustion sources and exhaust from motor vehicles. In winter, they mainly originate from burning of coal and biomass as well as oil combustion. The results of this study reveal that, the pollution characteristics and the sources of PAHs in Jinchang City are widely distributed especially in autumn and winter seasons, which may be related to meteorological conditions.
Prophylactic Cranial Irradiation (PCI) and Brain MRI Surveillance versus Brain MRISurveillance Alone in Patients with Limited-Stage Small Cell Lung Cancer Achieving Complete Remission (CR) of tumor after Chemoradiotherapy: a Multicenter Prospective Randomized Study
Authors: Chen Mengyuan , Li Runhua , Kong Yue , Shi Lei , Wang Jing , Wang Yuezhen , Xu Yujin , Ji Yongling , Hu Xiao
Published: October 2023

Background
Prophylactic cranial irradiation (PCI) is part of standard care in limited-stage small cell lung cancer (SCLC) at present. As evidence from retrospective studies increases, the benefits of PCI for limited-stage SCLC are being challenged.
Methods
A multicenter, prospective, randomized controlled study was designed. The key inclusion criteria were: histologically or cytologically confirmed small cell carcinoma, age ≥ 18 years, KPS ≥ 80, limited stage defined as tumor confined to one side of the chest including ipsilateral hilar, bilateral mediastinum, bilateral supraclavicular lymph nodes, patients have received definitive thoracic radiotherapy (regardless of the dose-fractionation of radiotherapy used) and chemotherapy, evaluated as complete remission (CR) of tumor 4–6 weeks after the completion of chemo-radiotherapy. Eligible patients will be randomly assigned to two arms: (1) PCI and brain MRI follow-up arm, receiving PCI (2.5Gy qd to a total dose of 25Gy in two weeks) followed by brain MRI follow-up once every three months for two years; (2) brain MRI surveillance alone arm, undergoing brain MRI surveillance once every three months for two years. The primary objective was to compare the 2-year brain metastasis-free survival (BMFS) rates between the two arms. Secondary objectives included 2-year overall survival (OS) rates, intra-cranial failure patterns, 2-year progression-free survival rates and neurotoxicity. In case of brain metastasis (BM) detected during follow-up, patients meeting the eligibility criteria will receive stereotactic radiosurgery (SRS).
Discussion
Based on our post hoc analysis of a prospective study, we hypothesize that in limited-stage SCLC patients with CR after definitive chemoradiotherapy, and ruling out of BM by MRI, it would be feasible to use brain MRI surveillance and omit PCI in these patients. If BM is detected during follow-up, treatment with SRS or whole brain radiotherapy (WBRT) does not appear to have a detrimental effect on OS. Additionally, this approach may reduce potential neurotoxicity associated with PCI.
The effect of physical exercise during radiotherapy on physical functioning in patients with head and neck cancer: a trial within cohorts, the VITAL study
Authors: Kriellaars Yvette , Vermaire Jorine Ariane , Beugeling Maaike , Poorter Robert , Drijvers Janneke , Speksnijder Caroline Margina
Published: October 2023

Background
During the last ten years, twelve studies are published investigating physical exercise interventions (PEIs) for patients with head and neck cancer (HNC) during or after radiotherapy (RT), chemoradiation (CRT) or bioradiation (BRT). The overall conclusion is clear, PEIs for patients with HNC are safe and feasible. PEIs during or after RT, CRT or BRT ((C/B)RT) may maintain or improve physical function and quality of life (QoL). It is, however, necessary to do more research to underpin these effects. Besides, a cost-effectiveness analysis is missing. The aim of this study is to determine and compare physical performance, muscle strength, fatigue, QoL, body composition, nutritional status, physical activity, treatment tolerability of (C/B)RT, and healthcare related costs in patients with HNC with and without a 10 week exercise intervention during (C/B)RT.
Methods
This study based on a trial within cohorts (TwiCs) design will contain a prospective cohort with 112 patients. Half of the 112 patients will randomly be invited for an experimental 10 week PEI. Measurements are at baseline (M0), after 12 weeks (M1), 6 months (M2) and 12 months (M3). Statistical analyses will be performed for intention-to-treat and instrumental variable analysis using SPSS.
Discussion
This study is the first randomized study investigating the effect of PEI in a Dutch HNC population and it is the first study investigating the cost-effectiveness of PEI in HNC patients. A TwiCs design will be used. However, with this design, effect estimation can be more challenging.
Trial Registration
protocol is registered at clinicaltrials.gov with number NCT05988060.
Ectopic pregnancy following in vitro fertilization-embryo transfer: A retrospective diagnostic study to develop a predictive nomogram
Authors: He Sang , Xie Bing , Cao ShengHui , Luo Chen , Lin Jiao , Zhou ShunQiang , Chen XiaoYan , Huang XiangHong , Tan XiaoJun
Published: October 2023

Objective
This study aimed to investigate the risk factors associated with ectopic pregnancy (EP) following in vitro fertilization-embryo transfer (IVF-ET) to establish a model to predict the risk of EP.
Methods
This retrospective cohort study was conducted in our hospital between January 2010 and December 2020. The enrolled dataset was randomly divided into two: a training cohort (65%, N = 603) and validation cohort (35%, N = 331). Clinical characteristics and laboratory indexes were associated with EP following IVF-ET based on univariate and multivariate analyses, and nomograms for predicting EP were established. Discrimination and calibration were assessed using the concordance (C)-index and a calibration curve.
Results
Multivariate logistic regression analysis showed that female factors, previous ectopic pregnancy, high estrogen levels, frozen-thawed embryo transfer, and low human chorionic gonadotropin levels at 14 days post embryo transfer were risk factors for EP. Multivariate logistic regression analysis was used to develop the nomogram. A C-index of 0.819 and 0.882 in the training and validation cohorts respectively, indicated the model had reliable discrimination, and the calibration plot overlapped the diagonal reference line of perfect calibration, indicating effective calibration.
Conclusions
We developed and validated a nomogram for predicting the probability of EP that provides clinicians with a quantitative tool.
The causal association between inflammatory bowel disease and pancreatitis: a two-sample Mendelian randomization study
Authors: Gao Zetian , Zhang Xie , Cai Dihui , Song Yufei , Kang Jingyu , Zhang Qiubo
Published: October 2023

Background
Clinical studies showed a relationship between inflammatory bowel disease (IBD) and pancreatitis. This study employed a Mendelian randomization (MR) approach to determine whether there is a causal association between IBD and pancreatitis.
Methods
Genome-wide association study data on IBD were acquired from the International Inflammatory Bowel Disease Genetics Consortium. Summary statistics for acute pancreatitis (AP), chronic pancreatitis (CP), alcohol-induced acute pancreatitis (AAP), and alcohol-induced chronic pancreatitis (ACP) were from the FinnGen database. Inverse-variance weighting (IVW) was used to perform a two-sample MR analysis. Heterogeneity tests, horizontal pleiotropy tests, and sensitivity analyses were used to ensure the consistency and accuracy of our results.
Results
The incidence of AP in IBD populations was 1.063 times higher than in the control population (95% confidence interval [CI]: 1.008–1.121, IVW p = 0.023). The CP incidence in IBD populations was 1.075 times higher than in the comparative population (95% CI: 1.004–1.153, IVW p = 0.039). AP incidence in Crohn’s disease (CD) populations was 1.056 times higher than in the comparative population (95% CI: 1.010–1.105, IVW p = 0.017). The CP incidence in CD populations was approximately 1.070 times higher than in the comparative population (95% CI: 1.009–1.135, IVW p = 0.024). AP incidence in ulcerative colitis (UC) populations was 1.070 folds higher than in the general population (95% CI: 1.007–1.137, IVW p = 0.030), AAP incidence in UC populations was 1.189 times higher than in the general population (95% CI: 1.009–1.135, IVW p = 0.024).
Conclusion
IBD increases the risk of AP and CP. CD was related to AP and CP. UC had a causality with AP and AAP. Our research verified that IBD increased the risk of pancreatitis.
RETRACTED: Societal Benefits of Science: A study of the economic value of US Geological Survey landslide susceptibility maps in Puerto Rico
Authors: Lindley Sarah M , Pindilli Emily J , Huber Christopher
Published: October 2023

The authors have requested that this preprint be removed from Research Square.
Diagnostic Accuracy of Cognitive Screening Tools Validated for Older Adults in Iran: A Systematic Review and Meta-analysis
Authors: Kamalzadeh Leila , Tayyebi Gooya , Shariati Behnam , Shati Mohsen , Saeedi Vahid , Malakouti Seyed Kazem
Published: October 2023

Background
This systematic review aims to comprehensively assess the diagnostic accuracy of cognitive screening tools validated for older adults in Iran, providing evidence-based recommendations for clinicians and researchers.
Methods
Multiple databases were searched for cross-sectional research published until March 2033. Inclusion criteria encompassed paper and pencil cognitive screening tools used in Iranian seniors. Data extraction involved evaluating diagnostic accuracy measures, cognitive domains, and strengths/weaknesses of each test. A bivariate random-effects meta-analysis generated summary estimates with 95% CIs, and forest plots visually represented the findings.
Results
The review included 17 studies investigating 14 cognitive screening instruments. Diagnostic accuracy data were extracted for the Clock Drawing Test (CDT), Mini-Cog, short portable mental status questionnaire (SPMSQ), A Quick Test of Cognitive Speed (AQT), Quick Mild Cognitive Impairment (Qmci) screen, Rowland Universal Dementia Assessment (RUDAS), Picture-Based Memory Impairment Screen (PMIS), Abbreviated Mental Test Score (AMTS), Mini–Mental State Examination (MMSE), Modified Mini-Mental State Examination (3MS), Montreal Cognitive Assessment (MoCA), Addenbrooke’s Cognitive Examination (ACE)-III, Persian test of Elderly for Assessment of Cognition and Executive function (PEACE), and Rey Auditory Verbal Learning Test (RAVLT). Pooled values from the bivariate effect model for the MMSE showed a sensitivity of 0.97, specificity of 0.87, DOR of 242, LR + of 7.69, and LR- of 0.03.
Conclusion
The results showed that the ACE-III demonstrated the highest accuracy for dementia and mild cognitive impairment (MCI) in specialized care settings. However, the high risk of bias in many studies emphasizes the need for more rigorous validations in diverse clinical contexts and populations.
Fabrication of O‑enriched macroporous polymer for the efficient adsorption organic acid from aqueous solution
Authors: Fu Yuli , Zhong shihua , Lei Ting , Gong Hui , Su Shengpei
Published: October 2023

Herein, an oxygen-rich polymer, namely, β-CD-PS was gained according to one-step nucleophilic substitution, and it was used to adsorb organic acids from aqueous solution. The nucleophilic substitution brought abundant functional -OH groups (the oxygen contents were 9.04 wt%,) to the polymer, and increased the hydrogen bonding between the polymer and the adsorbate. The adsorption results showed that the capacities of organic acids on β-CD-PS were much greater than chloromethylated polystyrene (CMPS). The maximum adsorption capacities of salicylic acid (SA), pyrogallic acid (PA), β-naphthol (NAP), 1,1'-bi-2-naphthol (BNAP) and gallic acid (GA) were 407.47 mg/g, 312.42 mg/g, 246.39 mg/g, 320.75 mg/g and 254.40mg/g, respectively. Langmuir model was more fit for the adsorption of BNAP, PA, and GA, and Freundlich model was more suited to the adsorption of PHE, NAP, and SA. Thermodynamic analysis showed that the adsorption is a spontaneous process, furthermore, the exothermic occurred between the adsorption site and SA, NAP, and phenol (PHE) and the endothermic occurred between the adsorption site and BNAP, PA and GA. The adsorption kinetics results indicated that the time for the equilibrium of SA, PA, GA, and NAP was about 100 min, while BNAP required more time. Moreover, the adsorption of SA on β-CD-PS could achieve most adsorption at high concentrations and complete removal at low concentrations. The organic acids adsorbed on the polymer could be eluted by anhydrous alcohol and 0.01 mol/L NaOH. The β-CD-PS exhibited superior adsorption efficiency, reproducibility, and reusability, demonstrating their excellent performance for the adsorption of organic acids, and analysis of the adsorption mechanism revealed that the -OH groups played a significant role due to the strong hydrogen bonding interaction.
Comparison of three-dimensional imaging of the nose using three different 3D- photography systems
Authors: Ritschl Lucas M. , Classen Carolina , Kilbertus Paul , Eufinger Julia , Storck Katharina , Fichter Andreas M. , Wolff Klaus-Dietrich , Grill Florian D.
Published: October 2023

Objectives
New 3D technologies for superficial soft tissue changes, especially in plastic and reconstructive surgical procedures, can improve the planning and documentation of facial surgeries. The purpose of this study was to compare and determine the applicability and feasibility of three different 3D-photography systems in clinical practice imaging the nose.
Methods and materials
A total of 16 healthy non-operated noses were included in this prospective study. A plaster model of each nose was produced, digitized, and converted to an .stl mesh (= ground truth model). Three-dimensional images of each nose were then taken using Artec Space Spider (gold standard), Planmeca ProFace®, and the Bellus3D Dental Pro application. All resulting .stl files were aligned to the ground truth model using MeshLab software, and the root mean square error (RMSE), mean surface distance (MSD), and Hausdorff distance (HD) were calculated.
Results
The Artec Space Spider 3D-photography system showed significantly better results compared to the two other systems in regard to RMSE, MSD, and HD (each p < 0.001). There was no significant difference between Planmeca ProFace® and Bellus3D Dental Pro in terms of RMSE, MSD, and HD. Overall, all three camera systems showed a clinically acceptable deviation to the reference model (range: -1.23–1.57 mm).
Conclusions
The three evaluated 3D-photography systems were suitable for nose imaging in the clinical routine. While Artec Space Spider showed the highest accuracy, the Bellus3D Dental Pro app may be the most feasible option for everyday clinical use due to its portability, ease of use, and low cost. This study presents three different systems, allowing readers to extrapolate to other systems when planning to introduce 3D photography in the clinical routine.
A complex systems perspective on chronic aggression and self-injury: Case study of a woman with mild intellectual disability and borderline personality disorder
Authors: Hulsmans Daan H. G. , Otten Roy , Poelen Evelien A. P. , Vonderen Annemarie van , Daalmans Serena , Hasselman Fred , Olthof Merlijn , Lichtwarck-Aschoff Anna
Published: October 2023

BackgroundChallenging behaviors like aggression and self-injury are dangerous for clients and staff in residential care. These behaviors are not well understood and therefore often labeled as “complex”. Yet it remains vague what this supposed complexity exactly entails at the individual level. The current case-study used a mixed-methods analytical strategy, inspired by complex systems theory, that consisted of three steps. First, we construed a holistic summary of the client’s relevant factors in her daily life. Second, we described her challenging behavioral trajectory by identifying stable phases. Third, instability and extraordinary events in her environment were evaluated as potential mechanisms for changes between different phases.Case presentationA woman, living at a residential facility, with mild intellectual disability and borderline personality disorder with a chronic pattern of aggressive and self-injurious incidents. She used ecological momentary assessments to daily self-rate challenging behaviors for 560 days.ConclusionsA qualitative summary of caretaker records revealed many internal and environmental factors relevant to her daily life. Her clinician narrowed these down to 11 staff hypothesized risk- and protective factors, such as reliving trauma, experiencing pain, receiving medical care, compliments or psychological therapy. The vast multitude of bivariate associations between these 11 factors and self-reported challenging behaviors were non-significant. These null-results indicate that challenging behaviors are not governed by mono-causal if-then relations, speaking to its complex nature. Despite this complexity there were patterns in the temporal ordering of incidents. Aggression and self-injury occurred on respectively 13% and 50% of the 560 days. On this timeline, we identified 11 distinct stable phases, that were alternating between four unique states: high levels of aggression and self-injury, average levels of aggression and self-injury, low levels of aggression and self-injury, and low aggression with high self-injury. Eight out of ten transitions between phases were either triggered by extraordinary events in her environment (event-induced) or preceded by increased fluctuations in her self-ratings (instability-induced), or a combination of these two. Desirable patterns emerged more often and were less easily malleable, indicating that when the participant experiences bad times, keeping in mind better times are ahead is as hopeful as it is realistic.
Single-cell RNA-seq Analysis Reveals the Wnt/Ca2+ Signaling Pathway with Inflammation, Apoptosis in Nucleus Pulposus Degeneration
Authors: Wang Peigeng , Li Zhencong , Ye Dongping
Published: October 2023

Background.Increasing studies have shown degeneration of nucleus pulposus cells (NPCs) as an critical part of the progression of intervertebral disc degeneration (IVDD). However, there are relatively few studies on single-cell transcriptome contrasts in human degenerated NPCs. Moreover, differences in Wnt/Ca2+signaling in human degenerated nucleus pulposus cells have not been elucidated. The aim of this study is to investigate the differential expression of Wnt/Ca2+signaling pathway between normal and degenerated nucleus pulposus cells in humans and try to investigate its mechanism.Methods.In this research, nucleus pulposus was isolated from normal and degenerated tissues for single-cell RNA sequencing (scRNA-seq). Cells were clustered unsupervised based on gene expression profiles and passed to tSNE/UMAP using the Seurat package for clustering and visualization to obtain the desired data.Results.The obtained cell data were clustered into five different chondrocytes clusters, which chondrocyte 4 and chondrocyte 5 mainly accounted for a high proportion in degenerated nucleus pulposus tissues, but rarely in normal nucleus pulposus tissues. Genes associated within the Wnt/Ca2+signaling pathway, such as Wnt5B, FZD1, PLC (PLCB1), CaN (PPP3CA) and NAFATC1 are mainly present in chondrocyte 3, chondrocyte 4 and chondrocyte 5 from degenerated nucleus pulposus tissues. In addition, as a receptor that activates Wnt signaling pathway, LRP5 is mainly highly expressed in chondrocyte 5 of degenerated nucleus pulposus cells. Six genes, ANGPTL4, PTGES, IGFBP3, GDF15, TRIB3 and TNFRSF10B, which are associated with apoptosis and inflammatory responses, and are widespread in chondrocyte 4 and chondrocyte 5, may be closely related to degenerative of nucleus pulposus cells.Conclusions.Single-cell RNA sequencing revealed differential expression of Wnt/Ca2+signaling in human normal and degenerated nucleus pulposus cells, and this differential expression may be closely related to the abundance of chondrocyte 4 and chondrocyte 5 in degenerated nucleus pulposus cells. In degenerated nucleus pulposus cells, LRP5 activate Wnt5B, which promotes nucleus pulposus cell apoptosis and inflammatory response by regulating the Wnt/Ca2+signaling pathway, thereby promoting disc degeneration. ANGPTL4, IGFBP3, PTGES in chondrocyte 4 and TRIB3, GDF15, TNFRSF10B in chondrocyte 5 may play an important role in this process．
Comparative Analysis of The Impact of Limitied Physical Activity on Lumbar Spinal Stenosis and Spondylolisthesis: A Retrospective Cohort Study between COVID-19 Pandemic Period and Control Period
Authors: Kim Jun-Hoe , Yebin Chegal , Kim Suhyun , Park Hangeul , Kim Young Rak , Kim Sum , Kim Kwangsoo , Lee Chang-Hyun , Kim Chi Heon , Chung Chun Kee
Published: October 2023

BACKGROUND
The primary treatment for lumbar spinal stenosis (LSS) and spondylolisthesis (SPL) is conservative care, including exercise. Regarding exercise, physical activity has a different therapeutic role in the two diseases. We investigated the effect of physical inactivity on LSS and SPL by analyzing changes in hospital visits and medical costs during the COVID-19 pandemic period.
METHODS
We included first-visit patients diagnosed exclusively with LSS and SPL in 2017 and followed them up for two years before and after implementation of social distancing (SoD) policy. As controls, patients who first visited in 2015 and were followed for four years without SoD were analyzed. The common data model was employed to analyze each patient’s diagnostic codes and treatments. Hospital visits and medical costs were analyzed by regression discontinuity in time (RDiT) to control for temporal effects on dependent variables.
RESULTS
Among 33,484 patients, 2,615 LSS and 446 SPL were included. A significant decrease in hospital visits was observed in both the LSS (difference,-3.94 times/month·100 patients; p = 0.023) and SPL (difference,-3.44 times/month·100 patients; p = 0.026) groups after the SoD. This decrement was not observed in the data from the control. Concerning the medical cost, the LSS group showed a statistically significant decrease in median copayment (difference,-$45/month·patient; p < 0.001) after the SoD, while a significant change was not observed in the SPL group (difference,-$19/month·patient; p = 0.160).
CONCLUSION
After the implementation of SoD, both hospital visits and medical costs were reduced in only the LSS group. Limited physical activity due to SOD may reduce the medical demand for patients with LSS.
Mild cognitive impairment, Spirituality, and All-cause Mortality Among Older Adults in Mainland China: A Prospective Cohort Study
Authors: Xiong Mengyun , Ma Wanrui , Hu Xue , Tong Yan , He Zhehao , Lei Qiuhui , Koenig Harold G. , Wang Zhizhong
Published: October 2023

Background:
The association between spirituality, cognitive function, and risk of mortality is still unknown among older adults in mainland China.
Methods:
Data from a prospective cohort study of 4,705 community-dwelling older adults, including 915 with MCI, were analyzed. Measures included the Duke University Religion Index (DUREL), which assessed the spirituality of the
participants from years 2012 to 2016 (baseline). All-cause mortality records were linked with the National Cause of Death Surveillance System in the years 2017, 2019, and 2021. Cox proportional hazards regression modeling was used to estimate hazard ratios (HR) and 95% confidence intervals to assess the effects of MCI and spirituality on all-cause mortality. In addition, the interaction between spirituality and MCI in predicting all-cause mortality was examined using moderation modeling.
Results:
A total of 387 deaths were identified during an average follow-up time of 87.3 months (SD=20.8). MCI was associated with an increased risk of all-cause mortality (HR=2.07, 95%CI: 1.58-2.72), while high spirituality was associated with decreased risk of all-cause mortality (HR=0.65, 95%CI: 0.49-0.86). Interaction effect of MCI and spirituality on all-cause mortality after adjusting for covariates (Relative Excess Risk of Interaction=0.82; Attributable Proportion =0.27; Synergy Index=1.67) was found, participants with low spirituality and MCI had the highest risk of mortality (HR=3.30, 95%CI: 2.40~4.52).
Conclusions:
MCI predicted an increased risk of all-cause mortality among Chinese older adults, and spirituality predicted a reduced risk. The findings suggest that a spiritually-integrated community intervention program may reduce the risk of mortality in older adults with cognitive impairment.
Surgical outcomes of sinonasal malignancies among endoscopic surgery, open surgery and combined surgery: an 18-year experience
Authors: Promsopa Chakapan , Tangchawalit Tipmana , Kirtsreesakul Virat , Prapaisit Usaporn , Pitathawatchai Pittayapon
Published: October 2023

Objective
Sinonasal malignancies are complex neoplasms that necessitate careful surgical management. This study aimed to compare the outcomes of three surgical approaches: endoscopic surgery, open surgery, and a combination of both in treating sinonasal malignancies.
Results
Among the 59 patients included, there were 31 males and 28 females. The patients were separated into 3 groups: 13 patients underwent an endoscopic approach, 35 patients underwent an open approach, and 11 patients underwent a combined surgery. The 5-year overall survival rate was 50%. The 5-year disease-specific survival was 76%, 47% and 55% (p value = 0.066) for the endoscopic approach, combined surgery and open surgery groups, respectively, with no statistically significant differences among all approaches. The most frequent histotypes were squamous cell carcinoma (37%), salivary gland-type carcinoma (22%), esthesioneuroblastoma (11%), and adenocarcinoma (10%). Patients in the endoscopic approach group had the shortest length of hospital stay, with a statistically significant difference (p value < 0.001). Additionally, the overall 5-year survival in all 59 patients was 50%. The 5-year disease-specific survival was not significantly different among all groups (p value = 0.066), and there were no statistically significant relationships between surgical outcomes and survival when using multivariate regression analysis.
Capitella teleta gets left out: Possible evolutionary shift causes loss of left tissues rather than increased neural tissue from dominant-negative BMPR1
Authors: Webster Nicole B. , Meyer Néva P.
Published: October 2023

Background: The evolution of centralized nervous systems (CNSs) a fascinating and complex topic; further work is needed to understand the genetic and developmental homology between organisms with a CNS. Research into a limited number of species suggests that CNSs may be homologous across Bilateria. This hypothesis is based in part on similar functions of BMP signaling in establishing fates along the dorsal-ventral (D-V) axis including limiting neural specification to one region of ectoderm. From an evolutionary-developmental perspective, the best way to understand a system is to explore it in a wide range of organisms to create a full picture.
Methods: Here we expand our understanding of BMP signaling in Spiralia, the third major clade of bilaterians, by examining phenotypes after expression of a dominant-negative BMP Receptor 1 and after knock-out of the putative BMP antagonist Chordin-like using CRISPR/Cas9 gene editing in the annelid Capitella teleta (Pleistoannelida).
Results: Ectopic expression of the dominant-negative Cte-BMPR1 did not increase CNS tissue or alter overall D-V axis formation in the trunk. Instead, we observed a unique asymmetric phenotype: a distinct loss of left tissues including the left eye, brain, foregut, and trunk mesoderm. Adding ectopic BMP4 early during cleavage stages reversed the dominant-negative Cte-BMPR1 phenotype, leading to a similar loss or reduction of right tissues instead. Surprisingly, a similar asymmetric loss of left tissues was evident from CRISPR knock-out of Cte-Chordin-like but concentrated in the trunk rather than the episphere.
Conclusions: We further solidify the hypothesis that the function of BMP signaling during establishment of the D-V axis and CNS is fundamentally different in at least Pleistoannelida, possibly in Spiralia, and is not required for nervous system delimitation in this group. Our results support hypotheses of either multiple evolutionary origins of CNSs across Bilateria or divergence in the molecular mechanisms of CNS specification and D-V axis formation in annelids.
Long-term effects of sustained regular medication in hypertensive patients in Yunnan, China: a cohort study of 5 years follow up
Authors: Ma Min , Wang Huadan , Pang Linhong , Guo Zihong , Xia Yu , Sun Manli , Zhao Yajing , Shi Yi , Wu Xia , Song Junjie , Zhu Qiuyan , Duo Lin , Wang Zhongjie , Tang Mingjing , He Liping
Published: October 2023

Background The relationship between different grades of compliance to antihypertensive medication and blood pressure(BP) control rate remains unclear. The study underscores the relationship that long-term compliance with regular antihypertensive medication to improve rates of BP control.Methods Using 5-year follow-up data, hypertensive patients were categorized into "poor", "intermittent", and " sustained" groups according to tertiles of antihypertensive medication compliance, and the BP control rates of the three groups were compared.Then, the robust variance Poisson regression model estimated the association between three groups and the number of referrals. Kaplan-Meier calculated the cumulative risk of onset and survival probability of cardiovascular events from three medication compliance groups.Results A total of 1254 patients were enrolled and annual follow-up studies of 992, 1218, 1121, 1066 and 999 hypertensive patients were conducted from 2018 to 2022. From baseline to last follow-up, systolic BP declined from 154.69 ± 20.90 mmHg to 137.48 ± 12.44 mmHg and diastolic BP from 84.08 ± 12.80 mmHg to 79.50 ± 7.88 mmHg (p < 0.01). All three groups showed a significant improvement in BP control rates after management, especially the persistence group which reached 70% in 2022(p < 0.01). The number of referrals from the poor group was 11.5% higher than the sustained group (IRR = 1.115,95% CI:1.043 to1.193). The survival probability in the sustained group was the highest and kept at 0.950 at the end of 5 years.Conclusions Long-term high-grade compliance with antihypertensive medications significantly improves BP control rates and reduces the risk of cardiovascular disease (CVD) events and death.
Advancement Area Control Technology for High Mine Pressure Dynamic Disasters in Thick and Hard Roofs
Authors: Zheng Kaige
Published: October 2023

The western mining area exhibits the superimposed development of a thick and hard roof under the continental sedimentation of multiple ancient rivers. In this case, the fully mechanized caving working face with a large mining height has a high stope pressure, which induces rock burst, mine earthquake, and hurricane in the goaf. To determine the fracture evolution characteristics of overlying strata in a fully mechanized caving mining with a large mining hard roof height, this study investigated the disaster mechanism of hard roof strata that undergo a large “cantilever beam” collapse and produce fracture impact energy. The study was based on the cantilever beam fracture theory, and the UDEC discrete element numerical simulation was used. According to the concept of partition weakening control of a hard roof, an advance weakening technology for staged fracturing of a hard roof was proposed, a mechanical model for a reasonable hanging length of a hard roof was established, and a quantitative formula for determining a reasonable hanging length of a hard roof was developed. Fracturing models under different crustal stress conditions were analyzed, including the ellipsoid fracture network perpendicular to the direction of the working face, the horizontal fracture surface network perpendicular to the direction of the working face, and the near-linear fracture surface dominated by vertical fractures. The first and second models were effective governance models for hard roof disasters. The test was performed in a typical working face, and the results showed that the average periodic weighting step of the roof after fracturing weakening decreased from 18.7 m to 8.6 m, and the weighting strength decreased by 21.67%. These results indicate effective prevention and control of high-mining-pressure disasters in a thick and hard roof. The thick and hard roof was transformed into multiple small blocks by using open-hole staged hydraulic fracturing, resulting in significantly reduced accumulated energy and energy loss during fracturing. In this way, the partition and segmented controllable fracturing length collapse of the thick and hard roof was realized, facilitating the transfer and dissipation of the roof stress as well as the effective control of dynamic disasters. Under the fracturing effect, the caving pattern and breaking degree of the near-field, low-level thick and hard roof were effectively changed, resulting in an improved scope of the working face caving zone and increased gangue filling degree in the goaf. Hence, effective suppression of the far-field strata subsidence and surface subsidence was achieved. This study provides a technical model support for the synergistic control of high-mining-pressure dynamic disasters, mine earthquakes, and surface subsidence in hard roofs.