bluuebunny/crossref_metadata_2025 huggingface dataset:
Case Report with Systematic Literature Review on Vascular Complications of BCG Intravesical Therapy for Bladder Cancer
Authors: King Brianna , Singh Dhanveer , Rathore Animesh , Flenner Ronald , Flemmer Mark
Published: October 2022

(1) Background: Intravesical instillation of therapeutic Bacillus Calmette-Guerin (BCG) is the standard of treatment for non-muscular invasive bladder cancer. Although the exact immunomodulatory effects of BCG therapy in non-muscular invasive bladder cancer (NMIBC) are still unclear, it has been considered a safe and effective treatment with the largest to-date report of complications citing minimal side effects, none of which included arterial involvement; (2) Methods: A systematic literature review was performed using PubMed, Cochrane, Medline, and Google Scholar from database inception to March 2021. Only eligible studies reporting aneurysm formation in adult patients with a history of BCG immunotherapy and no previous vascular pathology were included; (3) Results: A systematic literature review was conducted, highlighting 17 reports suggestive of BCG-induced mycotic aneurysm development. We added a case of a 78-year-old male, 30 months after last BCG-instillation, with a mycotic abdominal aneurysm yielding Mycobacterium tuberculosis with pyrazinamide resistance culture.; (4) Conclusions: Concluding results suggest a higher incidence of vascular complications from BCG intravesical therapy in the treatment of non-muscular invasive bladder cancer than previously reported. Recommendations are made to emphasize further research of this immunotherapy complication to facilitate the creation of guidelines for diagnosis and management of these patients.
Survival Rate after Palliative Surgery Alone for Symptomatic Spinal Metastases: A Prospective Cohort Study
Authors: Kakutani Kenichiro , Sakai Yoshitada , Zhang Zhongying , Yurube Takashi , Takeoka Yoshiki , Kanda Yutaro , Miyazaki Kunihiko , Ohnishi Hiroki , Matsuo Tomoya , Ryu Masao , Kuroshima Kohei , Kumagai Naotoshi , Hiranaka Yoshiaki , Hayashi Shinya , Hoshino Yuichi , Hara Hitomi , Kuroda Ryosuke
Published: October 2022

The effect of spine surgery for symptomatic spinal metastases (SSM) on patient prognosis remains unclear. This study aimed to reveal the prognosis of patients with SSM after spine surgery. One hundred twenty-two patients with SSM were enrolled in this prospective cohort study. The patients who received chemotherapy after enrollment were excluded. The decision of surgery depended on patient’s willingness; the final cohort comprised 31 and 24 patients in the surgery and non-surgery groups, respectively. The patients were evaluated by their performance status (PS), activities of daily living (ADL) and ambulatory status. Survival was evaluated by the Kaplan–Meier method. The PS, ADL and ambulation were significantly improved in the surgery group compared to non-surgery group. The median survival was significantly longer in the surgery group (5.17 months, 95% confidence interval (CI) 3.27 to 7.07) than in the non-surgery group (2.23 months, 95% CI 2.03 to 2.43; p = 0.003). Furthermore, the patients with a better PS, ADL and ambulatory status had a significantly longer survival. Surgery improved the PS, ADL, ambulation and survival of patients with SSM. In the management of SSM, spine surgery is not only palliative but may also prolong survival.
The Neuro-Ischaemic Charcot Foot: Prevalence, Characteristics and Severity of Peripheral Arterial Disease in Acute Charcot Neuro-Arthropathy
Authors: Meloni Marco , Ahluwalia Raju , Bellia Alfonso , Brocco Enrico , Di Venanzio Michela , Andreadi Aikaterini , Giurato Laura , Ruotolo Valeria , Di Daniele Nicola , Lauro Davide , Uccioli Luigi
Published: October 2022

The study aimed to evaluate the prevalence, characteristics and outcomes of patients affected by Charcot neuro-arthropathy (CN) and peripheral arterial disease (PAD) compared to CN without PAD. Consecutive patients presenting with an acute CN were included. The sample size was calculated by the power analysis by adopting the two-tailed tests of the null hypothesis with alfa = 0.05 and a value of beta = 0.10 as the second type error and, therefore, a test power equal to 90%. Seventy-six patients were identified. Twenty-four patients (31.6%) had neuro-ischaemic CN; they were older (66 vs. 57yrs), p = 0.03, had a longer diabetes duration (19 vs. 14yrs), p < 0.001, and more cases of end-stage-renal-disease (12.5 vs. 0%), p = 0.04 and ischaemic heart disease (58.3 vs. 15.4%), p < 0.0001 than neuropathic CN. Fifty patients (65.8%) had concomitant foot ulcers, 62.5% and 67.3% (p = 0.3), respectively, in CN with and without PAD. Neuro-ischaemic CN show arterial lesions of 2.9 vessels, and PAD was located predominantly below-the-knee (75%) but not below-the-ankle (16.7%). The outcomes for neuro-ischaemic and neuropathic CN patients were, respectively: wound healing (86.7 vs. 94.3%), p = 0.08; minor amputation (25 vs. 7.7%), p = 0.003; major amputation (8.3 vs. 1.9%), p = 0.001; hospitalization (75 vs. 23%), p = 0.0001. The study showed a frequent association between CN and PAD, leading to a neuro-ischaemic Charcot foot type. Neuro-ischaemic CN leaded to an increased risk of minor and major amputation and hospitalization, compared to neuropathic CN.
Validity and Test–Retest Reliability of the Spanish Version of the International Hip Outcome Tool (iHOT-12Sv)
Authors: González-de-la-Flor Ángel , López-de-Uralde-Villanueva Ibai , Valera-Calero Juan Antonio , Almazán-Polo Jaime , López-Marcos José Javier , Fernández-de-las-Peñas César , García-Fernández Pablo , Plaza-Manzano Gustavo
Published: October 2022

Objective: To develop a Spanish version of the international Hip Outcome Tool questionnaire (iHOT-12Sv) for assessing the psychometric characteristics (internal consistency, convergent validity, test–retest reliability, and floor and ceiling effects) of this version in physically active patients with hip pain. Methods: After conducting the translation and transcultural adaptation, a consecutive sample of patients with labral tear injury and/or femoroacetabular impingement (Pincer or Cam type) were recruited in a Spanish Hospital. Patients completed the iHOT-12Sv and the Spanish version of the iHOT-33 and the Hip Outcome Score (HOS). Internal consistency was calculated using Cronbach’s alpha; convergent validity was evaluated using Spearman correlation coefficients (Rho) with iHOT-33 and HOS; test–retest reliability was examined using the intraclass correlation coefficient (ICC), standard error of measurement (SEM), and minimal detectable changes (MDC); and floor and ceiling effects were calculated as the percentage of patients who obtained the minimum and maximum score. Results: One hundred and fifty-three patients (64.7% males) participated in this study. Cronbach’s alpha of 0.92 revealed the excellent internal consistency. In addition, the iHOT-12Sv demonstrated strong to very strong correlations with the HOS (Rho ranged from 0.741 to 0.827; p < 0.001) and the iHOT-33 (Rho = 0.932; p < 0.001), respectively; acceptable test-retest reliability (ICC = 0.86 to 0.94); SEM = 6.21 and MDC = 17.22; and no floor or ceiling effects were found. Conclusions: The iHOT-12Sv can be used as a valid and reliable tool for clinical evaluation of physically active patients with hip pathology. However, the full version is preferable for research purposes aiming to assess changes in hip function.
Gynae-Oncology Surgeons’ Preparedness to Undertake Colorectal Procedures during Cytoreductive Surgery for Ovarian Cancer: A Cross Sectional Survey
Authors: Huddart Daniel , Rajkumar Savithri , Kolomainen Desiree , Mehra Gautam , Nath Rahul , Sayasneh Ahmad
Published: October 2022

Cytoreductive surgery for advanced ovarian cancer commonly involves bowel resection. Although UK gynaecological oncologists are trained in bowel surgery, the degree to which they perform bowel surgery independently varies nationally. A recent joint policy statement from the British Gynaecological Cancer Society (BGCS) emphasises the need for formalised colorectal support. An anonymous, online survey was emailed to BGCS members to assess the status of multidisciplinary working between UK gynaecological oncology and colorectal/general surgical teams. A total of 46 members responded (8.2% response rate). There was a large variety in the involvement of colorectal/general surgical teams in preoperative planning. A total of 13% of respondents had no formalised agreement for intraoperative support, 72.1% of respondents independently performed rectal peritoneal stripping and 60.5% independently performed small bowel resection. This was reduced to 27.9% for right hemicolectomy with primary anastomosis and 16.3% for left hemicolectomy with primary anastomosis. Respondents often involved colorectal support for post-operative complications. The majority of UK gynaecological oncologists involve colorectal/general surgical teams in bowel procedures, more commonly for large bowel procedures compared to small bowel and for left colon compared to right colon procedures. A total of 16.3% of respondents independently performed all surveyed bowel procedures. Future research should examine training and experience within these groups to address this disparity.
Purely Off-Clamp Partial Nephrectomy: Robotic Approach Better than Open Using a Pentafecta Outcome with Propensity Score Matching
Authors: Gandi Carlo , Totaro Angelo , Bientinesi Riccardo , Marino Filippo , Pierconti Francesco , Russo Andrea , Racioppi Marco , Bassi Pierfrancesco , Sacco Emilio
Published: October 2022

Partial nephrectomy (PN) is the gold standard treatment for localized renal masses. Robot-assisted PN (RAPN) has overcome laparoscopy’s technical limitations, greatly expanding the indications of minimally invasive PN, which is dominated by renal artery clamping in almost all published series. We compared off-clamp RAPN (OFFC-RAPN) with the open approach (OFFC-OPN) using propensity score (PS) matching. A favourable pentafecta outcome was defined as a combination of no positive surgical margins (PSM), no complications of Clavien–Dindo (CD) grade ≥ 3, post-operative eGFR loss <10%, length of hospital stay (LOS) ≤ 5 days and estimated blood loss (EBL) < 200 mL. A total of 340 consecutive patients were included. The PS-matched cohort included 142 patients: 71 matched pairs well-balanced for all covariates. The OFFC-RAPN group showed significantly shorter operative time (149.8 vs. 173.9 min, p = 0.003), lower EBL (182.1 vs. 329.3 mL, p = 0.001), and shorter LOS (5.8 vs. 6.9 days, p = 0.02), with a higher proportion of patients with LOS ≤ 5 days (57.7% vs. 23.9%, p < 0.001). No significant differences were found for PSM rate (2.8% vs. 8.4%, p = 0.27), CD > 2 complication rate (4.2% vs. 2.8%, p = 1.00) and mean ± SD eGFR change (−0.06 ± 0.3 vs. −0.8 ± 0.3, p = 0.5). Pentafecta was achieved in 56.3% and 21.1% in the OFFC-RAPN and OFFC-OPN series, respectively (p < 0.0001). On multivariable analysis, surgical approach and BMI proved to be independent predictors of achieving pentafecta. After adjusting for potential treatment selection bias, OFFC-RAPN outperformed OFFC-OPN for important peri-operative outcomes, without compromising oncological and functional safety.
Impact of Anemia Severity on the Outcome of an Aneurysmal Subarachnoid Hemorrhage
Authors: Said Maryam , Dinger Thiemo Florin , Gümüs Meltem , Rauschenbach Laurèl , Chihi Mehdi , Rodemerk Jan , Lenz Veronika , Oppong Marvin Darkwah , Uerschels Anne-Kathrin , Dammann Philipp , Wrede Karsten Henning , Sure Ulrich , Jabbarli Ramazan
Published: October 2022

Objective: Previous reports indicate a negative impact of anemia on the outcome of an aneurysmal subarachnoid hemorrhage (SAH). We aimed to identify the outcome-relevant severity of post-SAH anemia. Methods: SAH cases treated at our institution between 01/2005 and 06/2016 were included (n = 640). The onset, duration, and severity (nadir hemoglobin (nHB) level) of anemia during the initial hospital stay were recorded. Study endpoints were new cerebral infarctions, a poor outcome six months post-SAH (modified Rankin scale > 3), and in-hospital mortality. To assess independent associations with the study endpoints, different multivariable regression models were performed, adjusted for relevant patient and baseline SAH characteristics as well as anemia-associated clinical events during the SAH. Results: The rates of anemia were 83.3%, 67.7%, 40.0%, 15.9%, and 4.5% for an nHB < 11 g/dL, < 10 g/dL, < 9 g/dL, < 8 g/dL, and < 7 g/dL, respectively. The higher the anemia severity, the later was the onset (post-SAH days 2, 4, 5.4, 7.6 and 8, p < 0.0001) and the shorter the duration (8 days, 6 days, 4 days, 3 days, and 2 days, p < 0.0001) of anemia. In the final multivariable analysis, only an nHB < 9 g/dL was independently associated with all study endpoints: adjusted odds ratio 1.7/3.22/2.44 for cerebral infarctions/in-hospital mortality/poor outcome. The timing (post-SAH day 3.9 vs. 6, p = 0.001) and duration (3 vs. 5 days, p = 0.041) of anemia with an nHB < 9 g/dL showed inverse associations with the risk of in-hospital mortality, but not with other study endpoints. Conclusions: Anemia is very common in SAH patients affecting four of five individuals during their hospital stay. An nHB decline to < 9 g/dL was strongly associated with all study endpoints, independent of baseline characteristics and SAH-related clinical events. Our data encourage further prospective evaluations of the value of different transfusion strategies in the functional outcomes of SAH patients.
Explainable Preoperative Automated Machine Learning Prediction Model for Cardiac Surgery-Associated Acute Kidney Injury
Authors: Thongprayoon Charat , Pattharanitima Pattharawin , Kattah Andrea G. , Mao Michael A. , Keddis Mira T. , Dillon John J. , Kaewput Wisit , Tangpanithandee Supawit , Krisanapan Pajaree , Qureshi Fawad , Cheungpasitporn Wisit
Published: October 2022

Background: We aimed to develop and validate an automated machine learning (autoML) prediction model for cardiac surgery-associated acute kidney injury (CSA-AKI). Methods: Using 69 preoperative variables, we developed several models to predict post-operative AKI in adult patients undergoing cardiac surgery. Models included autoML and non-autoML types, including decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost), and artificial neural network (ANN), as well as a logistic regression prediction model. We then compared model performance using area under the receiver operating characteristic curve (AUROC) and assessed model calibration using Brier score on the independent testing dataset. Results: The incidence of CSA-AKI was 36%. Stacked ensemble autoML had the highest predictive performance among autoML models, and was chosen for comparison with other non-autoML and multivariable logistic regression models. The autoML had the highest AUROC (0.79), followed by RF (0.78), XGBoost (0.77), multivariable logistic regression (0.77), ANN (0.75), and DT (0.64). The autoML had comparable AUROC with RF and outperformed the other models. The autoML was well-calibrated. The Brier score for autoML, RF, DT, XGBoost, ANN, and multivariable logistic regression was 0.18, 0.18, 0.21, 0.19, 0.19, and 0.18, respectively. We applied SHAP and LIME algorithms to our autoML prediction model to extract an explanation of the variables that drive patient-specific predictions of CSA-AKI. Conclusion: We were able to present a preoperative autoML prediction model for CSA-AKI that provided high predictive performance that was comparable to RF and superior to other ML and multivariable logistic regression models. The novel approaches of the proposed explainable preoperative autoML prediction model for CSA-AKI may guide clinicians in advancing individualized medicine plans for patients under cardiac surgery.
Trans-Endothelial Migration of Memory T Cells Is Impaired in Alemtuzumab-Treated Multiple Sclerosis Patients
Authors: Nguyen Kristy , Juillard Pierre , Hawke Simon , Grau Georges E. , Marsh-Wakefield Felix
Published: October 2022

The breakdown of the blood–brain barrier (BBB) and the trans-endothelial migration of lymphocytes are central events in the development of multiple sclerosis (MS). Autoreactive T cells are major players in MS pathogenesis, which are rapidly depleted following alemtuzumab treatment. This modulation, in turn, inhibits CNS inflammation, but alemtuzumab’s effect on T cell migration into the CNS has been less studied. Human brain endothelial cells were stimulated with pro-inflammatory cytokines to mimic an inflamed BBB in vitro. Peripheral blood mononuclear cells from healthy controls, untreated or alemtuzumab-treated patients with relapsing-remitting MS (RRMS) were added to the BBB model to assess their transmigratory capacity. Here, the migration of CD4+ effector memory T (TEM) and CD8+ central memory T (TCM) cells across the BBB was impaired in alemtuzumab-treated patients. Naïve T (Tnaïve) cells were unable to migrate across all groups. CD38 was lowly expressed on CD8+ TCM cells, particularly for RRMS patients, compared to CD8+ Tnaïve cells. CD62L expression was lower on CD4+ TEM cells than CD4+ Tnaïve cells and decreased further in alemtuzumab-treated patients. These data suggest that repopulated memory T cells are phenotypically different from naïve T cells, which may affect their transmigration across the BBB in vitro.
Cognitive Linguistics: Analysis of Mapping Knowledge Domains
Authors: Alduais Ahmed , Al-Khawlani Ammar , Almaghlouth Shrouq , Alfadda Hind
Published: October 2022

Language acquisition, processing, comprehension, and production encompass a complex mechanism. Particularly, the mechanisms by which we make sense of language, including perception, conceptualization, and processing, have been controversial topics among cognitive linguists and researchers in cognitive sciences. Cognitive processes such as attention, thought, perception, and memory play a significant role in meaningful human communication. This study aimed to apply the science mapping method to detect and visualize emerging trends and patterns in literature pertaining to cognitive linguistics. In order to accomplish this, eight bibliometric and eight scientometric indicators were used in conjunction with CiteSpace 5.8.R3 and VOSviewer 1.6.18 for scientometric analysis and data visualisation. The data were collected and triangulated from three databases, including 2380 from Scopus, 1732 from WOS, and 9911 from Lens from 1969 to 2022. Among the findings were the visualization of eight bibliometric indicators regarding the knowledge production size of cognitive linguistics based on year, country, university, journal, publisher, research area, authors, and cited documents. Second, we presented scientometric indicators with regard to cognitive linguistics development, including the most important authors in the field, co-citation networks, citation networks, sigma metrics to detect works with potential citation growth, and clusters to group related topics to cognitive linguistics. We conclude the study by emphasizing that cognitive linguistics has evolved from the micro level where it focused on studying cognitive aspects of language in relation to time, language, and modality dimensions, to the macro level, which examines cognitive processes and their relationship to the construction of meaningful communication using both sensation and perception.
Study on Fatigue Spectrum Analysis and Reliability Analysis of Multilayer Flexible Riser
Authors: Yu Jianxing , Wang Fucheng , Yu Yang , Li Haoda , Liu Xin , Sun Ruoke
Published: October 2022

Multilayer composite flexible risers have been widely used in engineering. However, this type of structure is complex, as there are influences between layers. Moreover, a range of uncertain factors need to be considered in fatigue analysis. Therefore, it is difficult to perform the fatigue analysis research of multilayer flexible risers. In this paper, the fatigue spectrum analysis and reliability analysis method of a nine-layer flexible riser structure are proposed, and a complete fatigue and reliability analysis process for multilayer structures is developed. The theoretical basis of the fatigue spectrum analysis method is introduced, and the calculation program is described. Finite element software is used to analyze the stress of the multilayer flexible riser under the influence of the upper platform structure movement and the ocean current. Moreover, the stress response of the riser structure of each layer is obtained. According to this, the irregular wave load is simulated by the method of random number simulation, and the stress response spectrum is formed. Then, the appropriate S-N curve is selected to calculate the fatigue damage degree of each layer, and the fatigue damage nephogram is displayed, so as to analyze the structural fatigue damage. Finally, the uncertainty in the process of fatigue damage calculation is analyzed. According to the results, the methods of multilayer riser analysis are summarized and the future research directions are put forward.
Principal Drivers of Fungal Communities Associated with Needles, Shoots, Roots and Adjacent Soil of Pinus sylvestris
Authors: Marčiulynienė Diana , Marčiulynas Adas , Mishcherikova Valeriia , Lynikienė Jūratė , Gedminas Artūras , Franic Iva , Menkis Audrius
Published: October 2022

The plant- and soil-associated microbial communities are critical to plant health and their resilience to stressors, such as drought, pathogens, and pest outbreaks. A better understanding of the structure of microbial communities and how they are affected by different environmental factors is needed to predict and manage ecosystem responses to climate change. In this study, we carried out a country-wide analysis of fungal communities associated with Pinus sylvestris growing under different environmental conditions. Needle, shoot, root, mineral, and organic soil samples were collected at 30 sites. By interconnecting the high-throughput sequencing data, environmental variables, and soil chemical properties, we were able to identify key factors that drive the diversity and composition of fungal communities associated with P. sylvestris. The fungal species richness and community composition were also found to be highly dependent on the site and the substrate they colonize. The results demonstrated that different functional tissues and the rhizosphere soil of P. sylvestris are associated with diverse fungal communities, which are driven by a combination of climatic (temperature and precipitation) and edaphic factors (soil pH), and stand characteristics.
Current Issues in Fungal Infections and COVID-19
Authors: Fernández-Cruz Ana , Magira Eleni
Published: October 2022

The COVID-19 pandemic has brought up a new host for fungal invasive infections [...]
Cardiometabolic Risk after SARS-CoV-2 Virus Infection: A Retrospective Exploratory Analysis
Authors: Pires Rute , Pedrosa Miguel , Marques Maria , Goes Margarida , Oliveira Henrique , Godinho Hélder
Published: October 2022

Objective: The aim of this study is to characterize the cardiometabolic risk of individuals who were infected with the SARS-CoV-2 virus and subsequently admitted to a hospital in a major city in mainland Portugal. Methods: This is a retrospective exploratory study using a sample of 102 patients, with data analysis including descriptive statistics, nonparametric measures of association between variables based on Spearman’s rank-order correlation, a logistic regression model for predicting the likelihood that an individual might eventually pass away, and a multiple linear regression model to predict a likely increase in the number of days an infected patient remained in the hospital. Results: About 62.7% of the individuals required intensive care on the second day of hospitalization, remaining 14.2 days in the intensive care unit (ICU) on average. The likelihood that an individual might eventually pass away due to SARS-CoV-2 virus infection increases for the older than younger ones and increases even more if he/she suffers from cardiometabolic disorders such as obesity, especially cardiovascular disease. Older individuals and those with obesity and hypertension remained more days in the ICU. Conclusions: A later age and the prevalence of cardiometabolic disorders severely affect the care pathway of individuals infected with the SARS-CoV-2 virus.
Revisiting the Long-Run Dynamic Linkage between Dividends and Share Price with Advanced Panel Econometrics Techniques
Authors: Mohapatra Sudatta Bharati , Kar Nirmal Chandra
Published: October 2022

The log-linearized present value model (PVM) has been widely used in corporate finance to understand the long-run relationship between share price and dividends using panel data. However, the application of recently established panel econometric approaches that account for slope heterogeneity and cross-section dependency in the recent literature regarding the long-run link between share price and dividends in an Indian setting is limited. This paper re-examines the log-linearized PVM in an Indian setting using newly developed panel unit root, cointegration, and long-run dynamic estimation approaches. This study employed a panel dataset of 60 Bombay Stock Exchange (BSE)-listed Indian firms paying regular dividends for 28 years (1990–2017). The study found unit root, cointegration, and a long-run relationship between dividend and share price series for Indian firms during a 28-year sample period. By demonstrating the presence of a long-run link between share price and dividends, this paper contributes to the literature on the PVM, which is crucial in comprehending market rationality and share price behavior in India. This paper also discusses issues related to panel data, such as cross-section dependency and slope heterogeneity, as well as panel econometric approaches that can be applied in the appropriate settings.
Financial Literacy of Adults in Germany FILSA Study Results
Authors: Schuhen Michael , Kollmann Susanne , Seitz Minou , Mau Gunnar , Froitzheim Manuel
Published: October 2022

The steady growing of online financial services due to the vanishing of on-site banking offers is changing the socio-economic framework individuals make financial decisions in. Financial literacy as an essential part of basic education is therefore also subject to changes. In order to investigate the individual competence of the respondents with regard to financially determined life situations, a digital questionnaire survey with integrated simulation sequences was conducted. For this purpose, a testing instrument (FILSA—Financial Literacy Study of Adults) has been developed to measure the financial literacy of adults. The validity of the construct including its five content areas was tested and the relationships between the manifest exogenous variables and financial literacy were mapped in a structural equation model. It introduces the participants (N = 212) to various financial problems and offers specific aids for founded decision-making. The study’s evaluation system takes into account the participants’ individual behavior in three case studies as well as the impact of attitude and socio-demographic factors on their decisions and behaviors, such as gender, age, and their degree of internet affinity. FILSA examines how adults make decisions with regard to finances and what benefit or impact online tools and financial advisors have on the decision-making process. Furthermore, it is possible to develop concepts for self-learning that are comprised in online tools for decision-making.
The Consequences of a Switch to Free-to-Play for Overwatch and Its Esports League
Authors: Newham Thomas , Scelles Nicolas , Valenti Maurizio
Published: October 2022

Videogames and their business models have evolved significantly over time, with consumers preferring a shift towards free-to-play (F2P) without any initial purchase, as evidenced in the popularity of Fortnite, Warzone and others. The aim of this research is to establish the viability of a switch from a buy-to-play (B2P) to a F2P model for the game Overwatch and the impact on its associated esports. The relevant literature within the subject area was identified. A framework was then developed to determine whether a switch to F2P would be successful for Overwatch, based on the criteria seen as significant within the literature identified. These criteria represent a mix of quantitative and qualitative approaches, and a mix of styles, with some being more descriptive with biographical elements of the author’s experience, and others being more analytical. The main conclusion drawn from the analysis undertaken is that Overwatch would be well suited for a switch to F2P. The sequel to Overwatch, Overwatch 2, is due to release in the near future, which would have opened the possibility of Overwatch being free, while Overwatch 2 is paid. However, Overwatch 1 is confirmed to be shutting down completely. It is also concluded there would be a likely increase in player numbers, and that a switch to F2P is likely to improve the problematic esports scene associated with Overwatch.
Sulphur Contents in Arable Soils from Four Agro-Ecological Zones of Ghana
Authors: Neina Dora , Adolph Barbara
Published: October 2022

There is limited data on Sulphur (S) contents in arable soils for appropriate fertilizer recommendations in Ghana. Five study areas in a reconnaissance survey (RS), followed by an in-depth study of two areas comprising farms of different durations of cultivation, were investigated for the current total S and sulphate contents. Basic soil properties were measured using standard laboratory procedures. Total S and sulphate contents were determined using LECO instrument dry combustion and HPLC, respectively. The results showed wide variations in total S contents from 31 to 603 mg kg−1 in the Guinea Savannah (GS) zone. The mean trend was Forest > Forest-Transition (F-S) > north Guinea Savannah (nGS) > Deciduous Forest (DF) > south Guinea Savannah (sGS) in the RS sites, with a similar trend in the main study sites. Sulphate contents ranged from 5 to 25 mg kg−1, constituting 0.8 to 37% of the total S. The mean percent trend was sGS = DF > Forest > nGS > F-S. Soil organic carbon (SOC) was the major predictor of total S along with pedogenic minerals. Total S and crystalline pedogenic minerals predicted the sulphate contents. The results highlight the need for ecologically-based S fertilizer programmes to boost crop yields.
Resources or Capital?—The Quality Improvement Mechanism of Precision Poverty Alleviation by Land Elements
Authors: Zhang Dongsheng , Yang Ming , Wang Ziyou
Published: October 2022

With China facing the challenges of fragmentation, multidimensionality, and the dynamics of relative poverty under the present situation, more attention is being paid to the role of land in poverty alleviation. In order to improve the quality of precision in poverty alleviation, it is urgent to clarify the micromechanisms of precision poverty alleviation methods that utilize land elements. On the basis of panel data from 29 provinces from 2010 to 2016, this research uses a panel vector autoregressive model to empirically analyze the mechanisms of interaction among land resource endowment, land capital endowment, and rural poverty. The research results show that the improvement of land resource endowment has had a relatively prominent effect on short-term poverty reduction, while the improvement of land capital endowment has had a relatively longer-term effect on the improvement of rural poverty. Land capital endowment and rural poverty can constitute a positive, cumulative circular effect, which can play a sustainable role in improving poverty. The increase in land resource endowment has a positive effect on land capital endowment, but excessive increases in land capital endowment were found to have a negative effect on land resource endowment. Therefore, the implementation of land element resource-based and capital-based poverty alleviation policies can distinguish between shorter-term and relatively longer-term goals, enabling a more accurate improvement of the quality of poverty alleviation. At the same time, this approach is more sustainable, since it makes full use of the circular effect constituted by land capital endowment and rural poverty. However, attention should be paid to preventing damages to land resource endowment, which can be caused by the excessive capitalization of land.
How Urban Expansion Triggers Spatio-Temporal Differentiation of Systemic Risk in Suburban Rural Areas: A Case Study of Tianjin, China
Authors: Tian Jian , Zeng Suiping , Zeng Jian , Wang Sen
Published: October 2022

Rapid urban expansion has strongly impacted rural development in China’s suburbs. The increasing probability of socio-ecosystem hazards, such as the shrinking and fragmentation of ecological space, the outflow of labor force, the disintegration of traditional society, and the decline in collective economy has become a systemic risk restricting the sustainable development of rural areas in the suburbs. At present, the influence of urban expansion on rural systemic risk in the suburbs is not clear, which is not conducive to putting forward differentiated and targeted strategies for rural revitalization. Therefore, in this study, we propose the ecological, industrial, social, and livelihood elements of rural systemic risk in the suburbs and construct a multi-dimensional risk resistance analysis framework involving functionality, stability, and sustainability. Taking 93 villages in the western suburbs of Tianjin as an example, and using spatial econometric methods such as remote sensing interpretation, GIS analysis, multiple linear regression, and random forest model testing, we analyze the relationship between external transportation construction, urban employment attraction, construction of land growth, rural risk factors, and the dimension of risk resistance. Finally, the influence of urban expansion on the spatial–temporal differentiation of rural systemic risk and the risk management strategy are discussed. The results show that the difference in the urban expansion intensities is the main factor of the spatial differentiation of rural systemic risk in the suburbs. With the acceleration of the land replacement rate between urban and rural areas, the proportion of urban construction of land is increasing, leading to various degrees of change in the rural land use pattern and the ecological security pattern. Meanwhile, because of the urban employment attraction, part of the rural labor force continues to decrease, leading to the spatial differentiation of rural industrial risks and social risks aggravated. Precise risk management strategies are put forward according to the systemic risks in different types of villages. In villages with a high proportion of urban construction land and inefficient land consolidation, ecological restoration projects should be carried out. For villages severely divided by transit roads, internal spatial connections should be strengthened by constructing public transport. For villages with good accessibility, the allocation of rural non-agricultural industries and service facilities should be strengthened to mitigate the impact of urban expansion on the rural social structure. From the perspective of risk management, the research results will provide a basis for making decisions regarding rural public policymaking and spatial resource allocation in the suburbs of developing countries.
Study on Functional Zoning Method of National Park Based on MCDA: The Case of the Proposed “Ailaoshan-Wuliangshan” National Park
Authors: Liu Junze , Huang Xiaoyuan , Guo Huijun , Zhang Zhuoya , Li Xiaona , Ge Mengxiao
Published: October 2022

In a national park master plan, functional zoning plays a key role in developing differentiated zoning controls that achieve multiple park construction objectives. In this study, a geographical attribute code and basic zoning elements are developed for the proposed “Ailaoshan-Wuliangshan” National Park, followed by the development of spatial multi-criteria sets and weight sets to determine the suitability of the land. Next, we use a clustering algorithm and conflict unit prioritization to allocate space for multi-target units to get the preliminary zoning schemes, and then identify stable units and unstable units through sensitivity analysis. Ultimately, the functional zoning of the National Park was determined. According to the results, the proposed “Ailaoshan-Wuliangshan” National Park can be divided into nine types of 164 landscape units; the highest land suitability values of each zone showed the traits of differentiation and aggregation in spatial distribution; there are 97 stable units and 67 unstable units; approximately 62.83% and 37.17% of the total park area can be divided into core conservation area (primary sensitive area and secondary sensitive area) and general control area (ecological activity area and ecological control area). By implementing a comprehensive assessment and decision-making process, the defined functional zones are precise and simple to recognize on the ground, and they adhere to the area proportions needed by national standards. Furthermore, the functional zoning is clustered, which avoids the fragmentation of the zoning results causing difficulties in management, and serves as a point of reference for the functional zoning approaches used in other proposed national parks in China.
Analysing the Policy Delivery System and Effects on Territorial Disparities in Italy: The Mechanisms of Territorial Targeting in the EU Rural Development Programmes 2014–2020
Authors: Mantino Francesco , De Fano Giovanna , Asaro Gianluca
Published: October 2022

This study aims to answer the following research questions: (a) to what extent do EU rural development supports for investments address territorial differences of rural areas, especially concerning the differences between rich and intensive areas, on one hand, and marginal and peripheral rural areas on the other hand; (b) how does present governance and the delivery system of measures supporting rural investments contribute to the financial support of marginal and peripheral rural areas? To respond to these questions, the research examined 747 calls for tender in all Italian regions related to 16 types of investment measures and a global amount of EUR 67 billion Euros and 49,410 representative projects approved in 17 Italian regions during the period 2014–2020. Delivery mechanisms included the rules that have been set up to define recipient eligibility and selection criteria of the rural development programmes. The distributive effects of RDP investment support measures appear evidently uneven, especially in agricultural and agro-industrial competitiveness measures, which are mainly allocated in already dynamic and strongly competitive areas. Delivery mechanisms boost disparities when funds are allocated through the “open competition” approach. Instead, the modulation of territorial criteria in the implementation phase can provide effective results in terms of reducing disparities in fund allocation and outreaching the most lagging areas. There are two main novelties of this research: (a) the analysis of territorial criteria in the calls for tenders for investment support, and (b) the effects of these criteria on expenditure distribution at the municipal level (LAU2 in the EU nomenclature). This study has been carried out outside the formal methodological approaches promoted by the European Commission for RDP evaluation and might be considered a complementary approach to evaluation reporting activity. This study might provide two significant contributions to the debate on rural areas. First, a “combined” approach to the definition of rurality (mixing “structural” and “locational” approaches) might provide a better analytical framework in line with the evolution of the literature on rurality. Second, the delivery systems that put more emphasis on territorial targets, as they were presented in this study, might be an essential component of a place-based policy.
Childhood Obesity: A Potential Key Factor in the Development of Glioblastoma Multiforme
Authors: Sachdeva Punya , Ghosh Shampa , Ghosh Soumya , Han Sungsoo , Banerjee Juni , Bhaskar Rakesh , Sinha Jitendra Kumar
Published: October 2022

Glioblastoma multiforme (GBM) is a malignant primary tumor type of the central nervous system (CNS). This type of brain tumor is rare and is responsible for 12–15% of all brain tumors. The typical survival rate of GBM is only 12 to 14 months. GBM has a poor and unsatisfactory prognosis despite advances in research and therapeutic interventions via neurosurgery, radiation, and chemotherapy. The molecular heterogeneity, aggressive nature, and occurrence of drug-resistant cancer stem cells in GB restricts the therapeutic efficacy. Interestingly, the CNS tumors in children are the second most usual and persistent type of solid tumor. Since numerous research studies has shown the association between obesity and cancer, childhood obesity is one of the potential reasons behind the development of CNS tumors, including GBM. Obesity in children has almost reached epidemic rates in both developed and developing countries, harming children’s physical and mental health. Obese children are more likely to face obesity as adults and develop non-communicable diseases such as diabetes and cardiovascular disease as compared to adults with normal weight. However, the actual origin and cause of obesity are difficult to be pointed out, as it is assumed to be a disorder with numerous causes such as environmental factors, lifestyle, and cultural background. In this narrative review article, we discuss the various molecular and genetic drivers of obesity that can be targeted as potential contributing factors to fight the development of GBM in children.
Challenges and Pitfalls in CT-Angiography Evaluation of Carotid Bulb Stenosis: Is It Time for a Reappraisal?
Authors: Pierro Antonio , Modugno Pietro , Iezzi Roberto , Cilla Savino
Published: October 2022

We aimed to perform an anatomical evaluation of the carotid bulb using CT-angiography, implement a new reliable index for carotid stenosis quantification and to assess the accuracy of relationship between NASCET and ECST methods in a large adult population. The cross-sectional areas of the healthy carotid at five levels were measured by two experienced radiologists. A regression analysis was performed in order to quantify the relationship between the areas of the carotid bulb at different carotid bulbar level. A new index (Regression indeX, RegX) for carotid stenosis quantification was proposed. Five different stenoses with different grade in three bulbar locations were simulated for all patients for a total of 1365 stenoses and were used for a direct comparison of the RegX, NASCET, and ECST methods. The results of this study demonstrated that the RegX index provided a consistent and accurate measure of carotid stenosis through the application of the ECST method, avoiding the limitations of NASCET method. Furthermore, our results strongly depart from the consolidated relationships between NASCET and ECST values used in clinical practice and reported in extensive medical literature. In particular, we highlighted that a major misdiagnosis in patient selection for CEA could be introduced because of the large underestimation of real stenosis degree provided by the NASCET method. A reappraisal of carotid stenosis patients’ work-up is evoked by the effectiveness of state-of-the-art noninvasive contemporary carotid imaging.
Cardiac Muscle Training—A New Way of Recognizing and Supporting Recovery for LVAD Patients in the Pediatric Population
Authors: Racolta Anca , Ahn Jae-Hyun Johannes , Kantzis Marinos , Milting Hendrik , Lauenroth Volker , Körperich Hermann , Sandica Eugen , Schubert Stephan , Laser Kai Thorsten
Published: October 2022

Patients with refractory heart failure due to chronic progressive cardiac myopathy (CM) may require mechanical circulatory support as a bridge to transplantation. A few patients can be weaned from support devices if recovery can be achieved. The identification of these patients is of great importance as recovery may be missed if the heart is unloaded by the ventricular assist device (VAD). Testing the load-bearing capacity of the supported left ventricle (LV) by temporarily and gradually reducing mechanical support during cardiac exercise can help identify responders and potentially aid the recovery process. An exercise training protocol was used in 3 patients (8 months, 18 months and 8 years old) with histological CM findings and myocarditis. They were monitored regularly using clinical information and functional imaging with VAD support. Echocardiographic examination included both conventional real-time 3D echocardiography (RT3DE) and speckle tracking (ST). A daily temporary reduction in pump rate (phase A) was followed by a permanent reduction in rate (phase B). Finally, pump stops of up to 30 min were performed once a week (phase C). The final decision on explantation was based on at least three pump stops. Two patients were weaned and successfully removed from the VAD. One of them was diagnosed with acute viral myocarditis. The other had chronic myocarditis with dilated myopathy and mild interstitial fibrosis. The noninvasive assessment of cardiac output and strain under different loading conditions during VAD therapy is feasible and helps identify candidates for weaning despite severe histological findings. The presented protocol, which incorporates new echocardiographic techniques for determining volume and deformation, can be of great help in positively guiding the process of individual recovery, which may be essential for selecting and increasing the number of patients to be weaned from VAD.
Regulation of Hepatocyte Nuclear Factor 4α Attenuated Lipotoxicity but Increased Bile Acid Toxicity in Non-Alcoholic Fatty Liver Disease
Authors: Roh Yoon Jin , Kim Yun , Lee Jae Sun , Oh Ju Hee , Lee Seung Min , Yoon Eileen Laurel , Lee Sung Ryol , Jun Dae Won
Published: October 2022

Hepatocyte nuclear factor 4 alpha (HNF4α) is a key master transcriptional factor for hepatic fat and bile acid metabolic pathways. We aimed to investigate the role of HNF4α in non-alcoholic fatty liver disease (NAFLD). The role of HNF4α was evaluated in free fatty acid–induced lipotoxicity and chenodeoxycholic acid (CDCA)-induced bile acid toxicity. Furthermore, the role of HNF4α was evaluated in a methionine choline deficiency (MCD)-diet-induced NAFLD model. The overexpression of HNF4α reduced intracellular lipid contents and attenuated palmitic acid (PA)-induced lipotoxicity. However, the protective effects of HNF4α were reversed when CDCA was used in a co-treatment with PA. HNF4α knockdown recovered cell death from bile acid toxicity. The inhibition of HNF4α decreased intrahepatic inflammation and the NAFLD activity score in the MCD model. Hepatic HNF4α inhibition can attenuate bile acid toxicity and be more effective as a therapeutic strategy in NAFLD patients; however, it is necessary to study the optimal timing of HNF4α inhibition.