bluuebunny/crossref_metadata_2025 huggingface dataset:
Case of lichen planus with unusual features
Authors: Yogianti Flandiana , Pradipta Nabila Kirtti
Published: July 2021

A 25-year-old woman came with an itchy red rash on her back since 2 years ago. This lesion then extended to the abdomen, arms and legs. From the patient’s back, we found irregular linear hyperpigmented patches with some of the edges in the form of hyperpigmented plaques. On the abdomen, arms and legs, erythema-hyperpigmented plaque and patches were visible along the elevated edges with multiple scattered sizes. Lichen planus (LP) has several types based on various clinical manifestations. The diagnosis of LP can be made based on the clinical appearance and symptoms of pruritus. Many diseases can mimic other diseases so histopathology is used to make the diagnosis. Here, we report a case of LP with unusual features with diagnosis confirmed by histopathological examination. The patient was treated with oral and topical potent corticosteroids with good response.
Impact of type 2 diabetes and microvascular complications on mortality and cardiovascular outcomes in a multiethnic Asian population
Authors: Yap Jonathan , Anbalakan Kamalesh , Tay Wan Ting , Ting Daniel , Cheung Carol Yim , Sabanayagam Charumathi , Cheng Ching-Yu , Wong Tien-Yin , Yeo Khung Keong
Published: July 2021

Introduction

Diabetes mellitus is a growing public health epidemic in Asia. We examined the impact of type 2 diabetes, glycemic control and microvascular complications on mortality and cardiovascular outcomes in a multiethnic population-based cohort of Asians without prior cardiovascular disease.

Research design and methods

This was a prospective population-based cohort study in Singapore comprising participants from the three major Asian ethnic groups: Chinese, Malays and Indians, with baseline examination in 2004–2011. Participants with type 1 diabetes and those with cardiovascular disease at baseline were excluded. Type 2 diabetes, Hemoglobin A1c (HbA1c) levels and presence of microvascular complications (diabetic retinopathy and nephropathy) were defined at baseline. The primary outcome was all-cause mortality and major adverse cardiovascular events (MACEs), defined as a composite of cardiovascular mortality, myocardial infarction, stroke and revascularization, collected using a national registry.

Results

A total of 8541 subjects were included, of which 1890 had type 2 diabetes at baseline. Subjects were followed for a median of 6.4 (IQR 4.8–8.8) years. Diabetes was a significant predictor of mortality (adjusted HR 1.74, 95% CI 1.45 to 2.08, p<0.001) and MACE (adjusted HR 1.64, 95% CI 1.39 to 1.93, p<0.001). In those with diabetes, higher HbA1c levels were associated with increased MACE rates (adjusted HR (per 1% increase) 1.18, 95% CI 1.11 to 1.26, p<0.001) but not mortality (p=0.115). Subjects with two microvascular complications had significantly higher mortality and MACE compared with those with only either microvascular complication (adjusted p<0.05) and no microvascular complication (adjusted p<0.05).

Conclusion

Diabetes is a significant predictor of mortality and cardiovascular morbidity in Asian patients without prior cardiovascular disease. Among patients with type 2 diabetes, poorer glycemic control was associated with increased MACE but not mortality rates. Greater burden of microvascular complications identified a subset of patients with poorer outcomes.
Cost-effectiveness modelling of use of urea breath test for the management ofHelicobacter pylori-related dyspepsia and peptic ulcer in the UK
Authors: Pritchard D. Mark , Bornschein Jan , Beales Ian , Beresniak Ariel , Salhi Hocine , Malfertheiner Peter
Published: July 2021

Objective

Clinical data comparing diagnostic strategies in the management ofHelicobacter pylori-associated diseases are limited. Invasive and noninvasive diagnostic tests for detectingH. pyloriinfection are used in the clinical care of patients with dyspeptic symptoms. Modelling studies might help to identify the most cost-effective strategies. The objective of the study is to assess the cost-effectiveness of a ‘test-and-treat’ strategy with the urea breath test (UBT) compared with other strategies, in managing patients withH. pylori-associated dyspepsia and preventing peptic ulcer in the UK.

Design

Cost-effectiveness models compared four strategies: ‘test-and-treat’ with either UBT or faecal antigen test (FAT), ‘endoscopy-based strategy’ and ‘symptomatic treatment’. A probabilistic cost-effectiveness analysis was performed using a simulation model in order to identify probabilities and costs associated with relief of dyspepsia symptoms (over a 4-week time horizon) and with prevention of peptic ulcers (over a 10-year time horizon). Clinical and cost inputs to the model were derived from routine medical practice in the UK.

Results

For relief of dyspepsia symptoms, ‘test-and-treat’ strategies with either UBT (€526/success) and FAT (€518/success) were the most cost-effective strategies compared with ‘endoscopy-based strategy’ (€1317/success) and ‘symptomatic treatment’ (€1 029/success). For the prevention of peptic ulcers, ‘test-and-treat’ strategies with either UBT (€208/ulcer avoided/year) or FAT (€191/ulcer avoided/year) were the most cost-effective strategies compared with ‘endoscopy-based strategy’ (€717/ulcer avoided/year) and ‘symptomatic treatment’ (€651/ulcer avoided/year) (1 EUR=0,871487 GBP at the time of the study).

Conclusion

‘Test-and-treat’ strategies with either UBT or FAT are the most cost-effective medical approaches for the management ofH. pylori-associated dyspepsia and the prevention of peptic ulcer in the UK. A ‘test-and-treat’ strategy with UBT has comparable cost-effectiveness outcomes to the current standard of care using FAT in the UK.
Effect of a health system payment and quality improvement programme for tonsillectomy in Ontario, Canada: an interrupted time series analysis
Authors: Mahant Sanjay , Guan Jun , Zhang Jessie , Gandhi Sima , Propst Evan Jon , Guttmann Astrid
Published: July 2021

Background

Tonsillectomy is among the most common and cumulatively expensive surgical procedures in children, with known variations in quality of care. However, evidence on health system interventions to improve quality of care is limited. The Quality-Based Procedures (QBP) programme in Ontario, Canada, introduced fixed episode hospital payment per tonsillectomy and disseminated a perioperative care pathway. We determined the association of this payment and quality improvement programme with tonsillectomy quality of care.

Methods

Interrupted time series analysis of children undergoing elective tonsillectomy at community and children’s hospitals in Ontario in the QBP period (1 April 2014 to 31 December 2018) and the pre-QBP period (1 January 2009 to 31 January 2014) using health administrative data. We compared the age-standardised and sex-standardised rates for all-cause tonsillectomy-related revisits within 30 days, opioid prescription fills within 30 days and index tonsillectomy inpatient admission.

Results

111 411 children underwent tonsillectomy: 51 967 in the QBP period and 59 444 in the pre-QBP period (annual median number of hospitals, 86 (range 77–93)). Following QBP programme implementation, revisit rates decreased for all-cause tonsillectomy-related revisits (0.48 to −0.18 revisits per 1000 tonsillectomies per month; difference −0.66 revisits per 1000 tonsillectomies per month (95% CI −0.97 to −0.34); p<0.0001). Codeine prescription fill rate continued to decrease but at a slower rate (−4.81 to −0.11 prescriptions per 1000 tonsillectomies per month; difference 4.69 (95% CI 3.60 to 5.79) prescriptions per 1000 tonsillectomies per month; p<0.0001). The index tonsillectomy inpatient admission rate decreased (1.12 to 0.23 admissions per 1000 tonsillectomies per month; difference −0.89 (95% CI −1.33 to −0.44) admissions per 1000 tonsillectomies per month; p<0.0001).

Conclusions

The payment and quality improvement programme was associated with several improvements in quality of care. These findings may inform jurisdictions planning health system interventions to improve quality of care for tonsillectomy and other paediatric procedures.
Vision loss in giant cell arteritis
Authors: Donaldson Laura , Margolin Edward
Published: July 2021

Almost two-thirds of patients with giant cell arteritis (GCA) develop ocular symptoms and up to 30% suffer permanent visual loss. We review the three most common mechanisms for visual loss in GCA, describing the relevant ophthalmic arterial anatomy and emphasising how ophthalmoscopy holds the key to a rapid diagnosis. The short posterior ciliary arteries supply the optic nerve head, while the central retinal artery and its branches supply the inner retina. GCA has a predilection to affect branches of posterior ciliary arteries. The most common mechanism of visual loss in GCA is anterior arteritic optic neuropathy due to vasculitic involvement of short posterior ciliary arteries. The second most common cause of visual loss in GCA is central retinal artery occlusion. When a patient aged over 50 years has both anterior ischaemic optic neuropathy and a central retinal artery occlusion, the diagnosis is GCA until proven otherwise, and they should start treatment without delay. The least common culprit is posterior ischaemic optic neuropathy, resulting from vasculitic involvement of the ophthalmic artery and its pial branches. Here, the ophthalmoscopy is normal acutely, but MR imaging of the orbits usually shows restricted diffusion in the optic nerve.
Advancing undergraduate synthetic biology education: insights from a Canadian iGEM student perspective
Authors: Diep Patrick , Boucinha Austin , Kell Brayden , Yeung Bi-ru Amy , Chen Xingyu , Tsyplenkov Daniel , Serra Danielle , Escobar Andres , Gnanapragasam Ansley , Emond Christian A. , Sajtovich Victoria A. , Mahadevan Radhakrishnan , Kilkenny Dawn M. , Gini-Newman Garfield , Kaern Mads , Ingalls Brian
Published: July 2021

The last two decades have seen vigorous activity in synthetic biology research and the ever-increasing applications of these technologies. However, pedagogical research pertaining to teaching synthetic biology is scarce, especially when compared to other science and engineering disciplines. Within Canada, there are only three universities that offer synthetic biology programs, two of which are at the undergraduate level. Rather than taking place in formal academic settings, many Canadian undergraduate students are introduced to synthetic biology through participation in the annual International Genetically Engineered Machine (iGEM) competition. Although the iGEM competition has had a transformative impact on synthetic biology training in other nations, its impact in Canada has been relatively modest. Consequently, the iGEM competition remains a major setting for synthetic biology education in Canada. To promote further development of synthetic biology education, we surveyed undergraduate students from the Canadian iGEM design teams of 2019. We extracted insights from these data using qualitative analysis to provide recommendations for best teaching practices in synthetic biology undergraduate education, which we describe through our proposed Framework for Transdisciplinary Synthetic Biology Education (FTSBE).
Inoculating rhizome-propagated Sporobolus pumilus with a native mycorrhizal fungus increases salt marsh plant growth and survival
Authors: d’Entremont Tyler W. , López-Gutiérrez Juan C. , Walker Allison K.
Published: July 2021

Salt marshes are ecosystems of significant ecological importance for coastal stability and fundamental roles in marine ecosystems. Salt marshes are declining due to anthropogenic and natural causes including sea level rise. Coastal restoration efforts have increased worldwide, but many fail in long-term coastal stability. We used a naturally occurring arbuscular mycorrhizal fungus (AMF) to test whether survival and early growth of the salt marsh grass Sporobolus pumilus (formerly Spartina patens) improved under simulated salt marsh conditions. Using a tidal mesocosm bench, we grew inoculated plants with varying AMF treatments under simulated tidal regimes to determine if AMF could aid in establishment of healthy Sporobolus communities. Rhizome-derived S. pumilus had greater survival and grew faster than seed-derived plants. Plants inoculated with propagated AMF consistently outperformed both sterile and native sediment controls in terms of plant survival and growth. Use of rhizome-derived Sporobolus inoculated with propagated Funneliformis geosporum showed the most promise in producing successful plant populations for salt marsh restoration. This may be due to plant life stage and improved plant nutrient status, allowing rhizome-derived plants to grow more quickly than seed-derived plants. Using these plants in future large-scale restoration may increase re-establishment of salt marsh ecosystems.
Binomial edge ideals of unicyclic graphs
Authors: Sarkar Rajib
Published: July 2021

Let [Formula: see text] be a connected graph on the vertex set [Formula: see text]. Then [Formula: see text]. In this paper, we prove that if [Formula: see text] is a unicyclic graph, then the depth of [Formula: see text] is bounded below by [Formula: see text]. Also, we characterize [Formula: see text] with [Formula: see text] and [Formula: see text]. We then compute one of the distinguished extremal Betti numbers of [Formula: see text]. If [Formula: see text] is obtained by attaching whiskers at some vertices of the cycle of length [Formula: see text], then we show that [Formula: see text]. Furthermore, we characterize [Formula: see text] with [Formula: see text], [Formula: see text] and [Formula: see text]. In each of these cases, we classify the uniqueness of the extremal Betti number of these graphs.
Human Rights Protection in UN Peace Operations: A Case Study of the Democratic Republic of the Congo
Authors: Khan Masrur Mahmud , Ahona Samwat Naiear , Chakma Subiggo
Published: July 2021

Despite the presence of UN peace operations for more than two decades, the human rights situation in the Democratic Republic of the Congo is still dire. This article illustrates the types of violations of human rights and hindrances to protect human rights in MONUSCO. Methodologically being a qualitative study, it is based on existing literature and key informant interviews. Killings of civilians, sexual and gender-based violence, child soldiers, war crimes and crimes against humanity are major types of human rights violations in the Democratic Republic of Congo. The study argues that due to structural challenges, like the bureaucratic structure of MONUSCO, inadequacy of budget and juristic limitation of the Peacekeeping Force, and operational challenges, like challenges in the protection of civilians and UN personnel, the paucity of logistics and manpower and also gender-based violence by some UN personnel and peacekeepers in MONUSCO, the UN forces failed to maintain and defend human rights properly.
Study of Au-Based and Au-Free Ohmic Contacts in AlGaN/GaN HEMTs by Recessed Patterns
Authors: You Xin-Rong , Chen Chih-Wei , Tzou Jerry , Hsin Yue-Ming
Published: July 2021

In this work, the effects of various recess depths and patterns in the ohmic contact of AlGaN/GaN HEMTs on device performance are investigated. In the studied device with a 22-nm Al0.23Ga0.77N barrier layer, as the recess depth and recess pattern are 5.5 nm and 1/3/5 μm, the Au-based (Ti/Al/Ni/Au) contact resistance of 0.89 Ω∙mm is achieved, which is 40% lower than that without recess. Compared to Au-based non-recessed ohmic contact AlGaN/GaN HEMTs (Au-based NROC AlGaN/GaN HEMTs), Au-based recessed ohmic contact AlGaN/GaN HEMTs (Au-based ROC AlGaN/GaN HEMTs) show a lower on-resistance and higher maximum drain current. Subsequently, the dynamic characteristics of AlGaN/GaN HEMTs were also observed. Through the pulse I–V measurement, both Au-based ROC and NROC AlGaN/GaN HEMTs exhibit severe current collapse. To improve the severe current collapse, Au-free ohmic contacts (Ti/Al/Ti) with low annealing temperature of 550 °C were adopted. The result shows that devices with Au-free ohmic contacts exhibit a significant improvement in current collapse.
Exercise‐Linked Irisin Prevents Mortality and Enhances Cognition in a Mice Model of Cerebral Ischemia by Regulating Klotho Expression
Authors: Jin Zhao , Zhang Zongze , Ke Jianjuan , Wang Yanlin , Wu Huisheng
Published: July 2021

Irisin, which can be released in the hippocampus after physical exercise, is demonstrated to have beneficial effects on neurovascular diseases. This study investigated the impact of exercise linked‐irisin on mortality and cognition in a mice model of cerebral ischemia and further explored its underlying mechanism. The cerebrospinal concentrations of irisin and klotho from ischemic stroke patients were measured with an enzyme‐linked immunosorbent assay (ELISA). The cognitive function of mice was evaluated by a series of behavioural experiments. The expressions of klotho, MnSOD, and FOXO3a in the hippocampus of mice were detected by Western blot. Superoxide production in the brain tissue of mice was evaluated with the dihydroethidium (DHE) dying. The results demonstrated that stroke patients showed a positive correlation between their CSF irisin concentration and klotho concentration. In addition, when mice subjected to cerebral ischemia, their cognitive function was impaired, the protein expressions of klotho, MnSOD, and FOXO3a downregulated, and the production of reactive oxygen species (ROS) increased compared with the sham group. After pretreatment with exogenous irisin, improved cognitive impairment, upregulated protein expressions of klotho, MnSOD, and FOXO3a, and reduced ROS generation were observed in mice with MCAO. However, the neuroprotective effects of irisin compromised with the evidence of severe cognitive impairment, decreased protein expressions of MnSOD and FOXO3a, and increased ROS production in klotho knockout mice. Thus, our results indicated that exercise‐linked irisin could prevent mortality and improve cognitive impairment after cerebral ischemia by regulating klotho expression.
Group Behavior Pattern Recognition Algorithm Based on Spatio-Temporal Graph Convolutional Networks
Authors: Chen Xinfang , Dinavahi Venkata
Published: July 2021

With the rapid growth of population, more diverse crowd activities, and the rapid development of socialization process, group scenes are becoming more common, so the demand for modeling, analyzing, and understanding group behavior data in video is increasing. Compared with the previous work on video content analysis, factors such as the increasing number of people in the group video and the more complex scene make the analysis of group behavior in video face great challenges. Therefore, a group behavior pattern recognition algorithm based on spatio-temporal graph convolutional network is proposed in this paper, aiming at group density analysis and group behavior recognition in the video. A crowd detection and location method based on density map regression-guided classification was designed. Finally, a crowd behavior analysis method based on density grade division was designed to complete crowd density analysis and video group behavior detection. In addition, this paper also proposes to extract spatio-temporal features of crowd posture and density by using the double-flow spatio-temporal map network model, so as to effectively capture the differentiated movement information among different groups. Experimental results on public datasets show that the proposed method has high accuracy and can effectively predict group behavior.
Haemophagocytic Lymphohistiocytosis with Leptospirosis: A Rare but Devastating Complication
Authors: Munasinghe B. M. , Arambepola A. G. , Pathirage N. , Fernando U. P. M. , Subramaniam N. , Nimalan S. , Gajanthan T.
Published: July 2021

Introduction. Secondary haemophagocytic lymphohistiocytosis (sHLH), often associated with an array of infections, malignancies, and autoimmune diseases, is rarely seen with leptospirosis, which carries a relatively poor prognosis even with modern state-of-the-art medical care. We describe a patient with leptospirosis complicated by sHLH who succumbed to illness following multiorgan dysfunction. Case Description. A 74-year-old farmer presented with high-grade, unsettling fever for a week. Muddy water exposure and suggestive symptoms prompted investigation and management in the line of leptospirosis (IV ceftriaxone was instituted, and later, MAT (microscopic agglutination test) became positive). Subsequently, he developed severe acute hypoxemia requiring mechanical ventilation and acute renal failure requiring renal replacement therapy. Bone marrow biopsy and markedly elevated serum ferritin and triglyceride levels done on day 10 (with unresolving fever, hepatosplenomegaly, and pancytopaenia) confirmed the diagnosis of HLH. The routine cultures, retroviral studies, CMV, dengue, hanta and mycoplasma antibodies, tuberculosis and COVID-19 PCR, and malaria screening were all normal. There was no improvement of hypoxemia following intravenous methylprednisolone. He died on day 15 despite escalating organ support. Conclusion. Leptospirosis is a common zoonotic disease in the tropics with significant morbidity and mortality. In the case of severe leptospirosis, overlapping clinical features with sHLH make the diagnosis of the latter challenging. No assessment tools are available to date to predict the risk of developing sHLH in a patient having leptospirosis. Outcome following sHLH due to leptospirosis still remains majorly ominous. A high index of suspicion and low threshold for specific investigations could possibly alter the outcome following such an occurrence.
Research on the Influence of Weak Interlayer in Open‐Pit Slope on Stability
Authors: Shuheng Zhong , Yinjun Miao
Published: July 2021

The weak interlayer in the slope meets with water threatening the overall stability of the slope. Sequestration location of the weak layer has an impact on the stability of the slope. Based on this, taking the south‐side slope of Fushun West Open‐Pit Mine as the background, the limit equilibrium method was used to study the influence of different depths and dip angles of weak interlayers on the factor‐of‐safety and sliding mode of the slope. After analyzing the effect, a bottom friction experiment was conducted to verify the theoretical results. The research results show that, as the buried depth of the weak layer becomes larger and the dip angle becomes smaller, the safety factor of the slope increases. Dip angle and depth both affect the sliding mode of the slope. This can provide a reference for study of the influence mechanism of weak interlayer on slope stability in multi‐weak‐layer slopes.
Design of Smart Classroom System Based on Internet of Things Technology and Smart Classroom
Authors: Zhang Mingbao , Li Xiang
Published: July 2021

Smart classroom teaching is one of the new teaching methods. With the support of technology, teaching is carried out with the help of smart teaching tools to enhance teacher-student communication, enhance students’ learning autonomy, and provide new ideas for the realization of students’ deep learning. How to promote the overall intelligence of the teaching environment so that the teaching equipment can be used more efficiently and managed more effectively has become the main concern of schools. This article mainly studies the smart classroom system based on the Internet of Things technology and smart classroom. For temperature detection, we mainly use the DS18B20 chip to detect the temperature in the classroom. For the light intensity of the classroom, we use a photoresistor to collect the light data, and after amplification by the amplifier, the A/D sampling process of the single-chip microcomputer is used to obtain the light intensity, combined with the clock module to distinguish the influence of the classroom light. The data collection adopts the method of directly observing the source data, and the data format has not undergone secondary conversion, which ensures the accuracy of the source data. This test uses the USR-TCP232 network debugging assistant to debug the data collection. To optimize the safety and reliability of the system, dual-computer backup switching is adopted on the hardware, and process monitoring and management strategies are adopted on the software. At the same time, the amount of data interaction in the smart classroom is relatively large, so it is necessary to build a highly available cluster server, so that the system not only has a certain degree of stability, but also can quickly respond to users’ access requests. We can calculate that the average transmission time is about 10 ms, and 99.9% of the data transmission delay is less than 30 ms. The results show that the Internet of Things and smart classroom provide great convenience for future smart campus construction, daily teaching, and campus management and can also provide reference for the construction of smart classrooms in other universities.
Analysis of Vertical Load Transfer Mechanism of Assembled Lattice Diaphragm Wall in Collapsible Loess Area
Authors: Xia Mingtan , Zhang Xudong , Yang Gengshe , Hui Liu , Ye Wanjun
Published: July 2021

Based on analysis of the formation mechanism and characteristics of the negative friction in collapsible loess areas, this study investigates the load transfer law of a wall‐soil system under a vertical load, establishes the vertical bearing model of a lattice diaphragm wall, and analyzes the vertical bearing capacity of an assembled latticed diaphragm wall (ALDW) in a loess area. The factors influencing the vertical bearing characteristics of the ALDW in a loess area are analyzed. The vertical bearing mechanism of the lattice diaphragm wall in the loess area is investigated. The failure modes of the ALDW in the loess area are mainly shear failure of the soil around the wall and failure of the wall‐soil interface. In the generation and development of negative friction, there is always a point where the relative displacement of the wall‐soil interface is zero at a certain depth below the ground; at this point, the wall and soil are relative to each other. The collapsibility of loess, settlement of the wall and surrounding soil, and rate and method of immersion are the factors affecting the lattice diaphragm wall. The conclusions of this study provide a reference for the design and construction of ALDWs in loess areas.
Mechanical Characteristics of Asphalt Pavement Pothole Maintenance
Authors: Zhao Fengjun , Tang Yuhang , Wu Jianjun , Huang Zhi , Gao Mingyue , Long Yanliang
Published: July 2021

Traditionally, potholes are mainly paved for maintenance, and the asphalt mixture needs to be compacted. But due to the construction quality problem, the compacting degree of asphalt mixture may not be enough and the void ratio of asphalt mixture may not meet the requirements, resulting in the premature damage of the potholes after repair. If the repair material can be prefabricated, this problem will be well solved. So, based on the structure form of the prefabricated rapid maintenance of asphalt pavement, this paper aims to determine the most unfavorable loading position in pothole repair, which was established by the ANSYS software with the finite element model. The results show that the most unfavorable loading position of tensile stress for patch materials and joint filling material is C1-1 (A2-2) and the most unfavorable loading position of shear stress for joint filling material and leveling layer is B2-1 and C1-5. Subsequently, the influences of the material modulus, size, thickness, and modulus of the old pavement material on the potholes are calculated by using the finite element model under the most unfavorable loading position.
Some Bounds on Bond Incident Degree Indices with Some Parameters
Authors: Rizwan Muhammad , Bhatti Akhlaq Ahmad , Javaid Muhammad , Jarad Fahd
Published: July 2021

It is considered that there is a fascinating issue in theoretical chemistry to predict the physicochemical and structural properties of the chemical compounds in the molecular graphs. These properties of chemical compounds (boiling points, melting points, molar refraction, acentric factor, octanol-water partition coefficient, and motor octane number) are modeled by topological indices which are more applicable and well-used graph-theoretic tools for the studies of quantitative structure-property relationships (QSPRs) and quantitative structure-activity relationships (QSARs) in the subject of cheminformatics. The

π

-electron energy of a molecular graph was calculated by adding squares of degrees (valencies) of its vertices (nodes). This computational result, afterwards, was named the first Zagreb index, and in the field of molecular graph theory, it turned out to be a well-swotted topological index. In 2011, Vukicevic introduced the variable sum exdeg index which is famous for predicting the octanol-water partition coefficient of certain chemical compounds such as octane isomers, polyaromatic hydrocarbons (PAH), polychlorobiphenyls (PCB), and phenethylamines (Phenet). In this paper, we characterized the conjugated trees and conjugated unicyclic graphs for variable sum exdeg index in different intervals of real numbers. We also investigated the maximum value of SEIa for bicyclic graphs depending on

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.
Language and Communication Impact of Hypertension: A Qualitative Study
Authors: Amponsem-Boateng Cecilia , Oppong Timothy Bonney , Zhang Weidong , Abdulai Tanko , Boakye-Yiadom Jonathan , Wang Lianke , Duodu Kyere Emmanuel Kumi
Published: July 2021

Background. Hypertension (HTN) is the second main source of outpatient morbidity in Ghana, and the understanding of a disease is necessary for its prevention and management. Language and communication are contributing factors to HTN in Ghana. No studies have been conducted to assess knowledge/awareness of HTN (in the context of its understanding) among students in Ghana. Following a local name for HTN in Ghana, researchers interviewed students through a focus group to assess their understanding/perception (meaning, cause, and prevention) of the disease. Available literature has concerned itself with clients’ knowledge of their condition (diagnosis) rather than their comprehension of the true nature of what HTN is. The objective of this study is to assess the knowledge/awareness of HTN in the context of its understanding of the meaning, perception, causes, and prevention of hypertension among students of Ghana’s Senior High School (Second Cycle). Semistructured interviews with the use of the theme lists were employed. Focus group conversations and interviews were held in the local Akan (Twi) language, which was later translated, interpreted, and analyzed. Overall, 25 second-cycle students participated. 60% were between 15 and 17 years, 24% were ≥18 years, and 16% were <15 years of age. Males were 44% and females were 56%. Students gave diverse perceptions of their knowledge of HTN. The local language’s translation of HTN has influenced and affected its meaning/understanding among some, thus affecting their perception of causes and prevention.
Cluster-Based Antiphishing (CAP) Model for Smart Phones
Authors: Faisal Mohammad , Abed Sa’ed
Published: July 2021

Different types of connectivity are available on smartphones such as WiFi, infrared, Bluetooth, GPRS, GPS, and GSM. The ubiquitous computing features of smartphones make them a vital part of our lives. The boom in smartphone technology has unfortunately attracted hackers and crackers as well. Smartphones have become the ideal hub for malware, gray ware, and spyware writers to exploit smartphone vulnerabilities and insecure communication channels. For every security service introduced, there is simultaneously a counterattack to breach the security and vice versa. Until a new mechanism is discovered, the diverse classifications of technology mean that one security contrivance cannot be a remedy for phishing attacks in all circumstances. Therefore, a novel architecture for antiphishing is mandatory that can compensate web page protection and authentication from falsified web pages on smartphones. In this paper, we developed a cluster-based antiphishing (CAP) model, which is a lightweight scheme specifically for smartphones to save energy in portable devices. The model is significant in identifying, clustering, and preventing phishing attacks on smartphone platforms. Our CAP model detects and prevents illegal access to smartphones based on clustering data to legitimate/normal and illegitimate/abnormal. First, we evaluated our scheme with mathematical and algorithmic methods. Next, we conducted a real test bed to identify and counter phishing attacks on smartphones which provided 90% accuracy in the detection system as true positives and less than 9% of the results as true negative.
Congenital Malaria in a 2-Day-Old Neonate: A Case Report and Literature Review
Authors: Kajoba Dickson , Ivan Egesa Walufu , Jean Petit Habonimana , Omar Matan Muhiadin , Laker Goretty , Mugowa Waibi William , Asiimwe Daniel
Published: July 2021

Congenital malaria is the presence of malaria parasites in a blood smear obtained from a neonate usually within 24 hours to 7 days of life. It has for long been regarded a rare condition. However, recent data indicate that congenital malaria complicates around 35.9% of live births globally, 0–37% in Sub-Saharan Africa and about 4–6.1% in Eastern Uganda. We present a 2-day-old neonate who presented with fever, irritability, and failure to breastfeed. Laboratory tests indicated that the neonate had a positive Giemsa-stained peripheral smear for Plasmodium falciparum, with a positive malaria rapid diagnostic test (MRDT) for P. falciparum malaria. The mother had a negative peripheral film for malaria and a negative MRDT. The neonate was managed with intravenous artesunate with improvement.
Rauwolfia vomitoria Extract Represses Colorectal Cancer Cell Autophagy and Promotes Apoptosis
Authors: Wang Yu-Xuan , Lin Cheng , Cui Lu-Jia , Yang Wan-He , Li Qiu-Min , Liu Zhan-Ju , Miao Xin-Pu
Published: July 2021

Background: Colorectal cancer (CRC) is one of the most frequent digestive tract tumors in the world with an increasing incidence. Currently, surgical resection and chemotherapy are the main therapeutic options; however, their effects are limited by various adverse reactions. Rauwolfia vomitoria extract (Rau) has been shown to repress the progression of multiple human cancers; however, whether Rau plays a role in CRC remains undetermined. Methods: Influences of Rau treatment on HCT-116 and LoVo cells were estimated via MTT and colony formation experiments. Flow cytometry analysis was adopted to evaluate the apoptosis rate of HCT-116 and LoVo cells. Apoptosis-related proteins (Bcl-2, Bax, and caspase-3) and autophagy-related proteins (LC3 and P62) were assessed by Western blotting. Effects of Rau on autophagy of HCT-116 and LoVo cell were evaluated through GFP-LC3 analysis. In vivo xenograft tumor assay was conducted to further examine the role of Rau in CRC tumor growth. Results: Rau remarkably repressed HCT-116 and LoVo cell viability and promoted HCT-116 and LoVo cell apoptosis in vitro in a dose-dependent manner. Rau increased the expression of caspase-3 and Bax and decreased the expression of Bcl-2 in HCT-116 and LoVo cells. Moreover, Rau was demonstrated to decrease the LC3||/LC3| ratio and increase the level of P62 in HCT-116 and LoVo cells. In addition, we found that Rau repressed xenograft tumor growth and also repressed autophagy in vivo. Conclusion: Our findings revealed that Rau repressed CRC cell viability and autophagy in vitro and in vivo, suggesting that Rau might be a potent therapeutic agent of CRC.
Protein A Immunoadsorption Relieves Autoimmune Glial Fibrillary Acidic Protein Astrocytopathy after Unsuccessful Methylprednisolone Treatment
Authors: Qin Bing , Wu Ruizhen , Shu Yaqing , Wang Yuge , Yu Boguang , Sun Xiaobo , Qiu Wei
Published: July 2021

Background: Autoimmune glial fibrillary acidic protein (GFAP) astrocytopathy (GFAP-A) is a recently defined autoimmune inflammatory disease of the central nervous system in which GFAP IgG is present in the cerebrospinal fluid (CSF). Its primary clinical manifestation is meningoencephalitis, and it usually responds well to corticosteroids. Herein, we report a case of a patient with GFAP-A with initial symptoms of psychological and cognitive impairment, which did not respond to high-dose methylprednisolone therapy but was successfully treated with protein A immunoadsorption (PAIA) therapy. Methods: GFAP IgG was detected by indirect immunofluorescence assay. The patient’s data were analyzed retrospectively. Results: A 48-year-old man presented with anxiety, depression, cognitive decline, tremor, gait disturbance, and fecal and urine incontinence. Autoimmune GFAP-A was diagnosed based on the following: (1) T2-weighted and fluid-attenuated inversion recovery MRI findings of hypersensitive lesions in the subcortical and deep white matter of the brain, with multiple longitudinally extensive lesions in the cervical and chest regions of the spinal cord, and (2) high levels of GFAP IgG in the CSF. Clinical symptoms and abnormalities detected on neuroimaging worsened after administration of high-dose intravenous methylprednisolone (IVMP) and intravenous immunoglobulin (IVIG) but improved significantly after PAIA therapy. Conclusion: Psychological impairment can be the first sign of autoimmune GFAP-A. PAIA might be an effective treatment for patients with GFAP-A who respond poorly to conventional IVMP and IVIG therapy.
Clinical Value and Potential Target of miR-27a-3p in Pulpitis
Authors: Zhou Ming , Li Chaohong
Published: July 2021

Introduction: This study investigated the clinical values of miR-27a-3p for pulpitis patients, and its association with TLR4. Methods: Sixty-six patients with pulpitis and 34 cases without pulpitis were recruited; the pulp tissue and serum samples were collected from each participant. Real-time polymerase chain reaction was used for measurement of gene expression levels. The diagnosis values were assessed by the receiver operating characteristic curve. The target gene of miR-27a-3p was confirmed by the luciferase reporter assay. Results: MiR-27a-3p was downregulated in both serum and pulp tissue of pulpitis patients. MiR-27a-3p could distinguish pulpitis patients from healthy controls and might be a predictor for the development of irreversible pulpitis. A high level of TLR4 was also detected in both peripheral blood monocytes and pulp tissues from pulpitis patients and showed a negative association with the miR-27a-3p level. TLR4 was a direct target gene of miR-27a-3p. Discussion/Conclusion: MiR-27a-3p might be a promising biomarker for the diagnosis of pulpitis and predict the development of irreversible pulpitis. MiR-27a-3p might be involved in the pathogenesis of pulpitis via targeting TLR4.
Post-Progression Survival Influences Overall Survival among Patients with Advanced Non-Small Cell Lung Cancer Undergoing First-Line Pembrolizumab Monotherapy
Authors: Imai Hisao , Kishikawa Takayuki , Minemura Hiroyuki , Yamada Yutaka , Ibe Tatsuya , Mori Keita , Yamaguchi Ou , Mouri Atsuto , Hamamoto Yoichiro , Kanazawa Kenya , Kasai Takashi , Kaira Kyoichi , Kaburagi Takayuki , Minato Koichi , Kobayashi Kunihiko , Kagamu Hiroshi
Published: July 2021

Background: Among patients with non-small cell lung cancer (NSCLC), the impact of first-line treatment on overall survival (OS) may be influenced by subsequent therapies. Thus, using patient-level data, we assessed the relationships of progression-free survival (PFS) and post-progression survival (PPS) with OS among patients with high-programmed death-ligand 1 (PD-L1) expression undergoing first-line pembrolizumab monotherapy for NSCLC. Methods: We reviewed data from 133 patients with high PD-L1 expression undergoing first-line pembrolizumab monotherapy for NSCLC at 6 Japanese centers between February 2017 and December 2018. The correlations of PFS and PPS with OS were evaluated at the patient level. Results: Linear regression analyses and Spearman’s rank correlation coefficient revealed that PPS was strongly correlated with OS (r = 0.76, p < 0.05, R2 = 0.65), while PFS was only moderately correlated with OS (r = 0.71, p < 0.05, and R2 = 0.4). Furthermore, PPS was significantly associated with performance status at the end of pembrolizumab monotherapy, as well as the use of platinum-based combination chemotherapy after pembrolizumab monotherapy (both p < 0.05). Conclusions: Among patients with high PD-L1 expression undergoing first-line pembrolizumab monotherapy for NSCLC, PPS was more strongly correlated with OS, relative to the relationship between PFS and OS. Therefore, subsequent treatment appears to significantly influence OS in patients with disease progression following first-line pembrolizumab monotherapy.
Antineutrophil Cytoplasmic Autoantibody-Associated Vasculitis with Kidney Involvement in a Patient with AL Amyloidosis
Authors: Thoms Brendan L. , Agrawal Varun , Umyarova Elvira R. , Gibson Pamela C. , Solomon Richard J.
Published: July 2021

Antineutrophil cytoplasmic autoantibody (ANCA) vasculitis has occasionally been associated with other systemic glomerulonephritis, such as anti-glomerular basement membrane disease. Here, we report the first clinical case of ANCA-associated crescentic glomerulonephritis with AL amyloidosis. An 81-years-old gentleman presented to the hospital with acute kidney injury (serum creatinine 4.7 mg/dL) on a background of chronic kidney disease and volume overload. Autoimmune serology was remarkable for p-ANCA and myeloperoxidase positivity. A renal biopsy confirmed pauci-immune glomerulonephritis and lambda light-chain amyloid deposition (confirmed on liquid chromatography and tandem mass spectrometry). The patient was initially managed with rituximab and subsequently transitioned to bortezomib-based chemotherapy but died due to decompensated heart failure. This case report promotes greater awareness of the unusual presentation of amyloidosis and guides future research and treatment.
Reproducible Naevus Counts Using 3D Total Body Photography and Convolutional Neural Networks
Authors: Betz-Stablein Brigid , D’Alessandro Brian , Koh Uyen , Plasmeijer Elsemieke , Janda Monika , Menzies Scott W. , Hofmann-Wellenhof Rainer , Green Adele C. , Soyer H. Peter
Published: July 2021

Background: The number of naevi on a person is the strongest risk factor for melanoma; however, naevus counting is highly variable due to lack of consistent methodology and lack of inter-rater agreement. Machine learning has been shown to be a valuable tool for image classification in dermatology. Objectives: To test whether automated, reproducible naevus counts are possible through the combination of convolutional neural networks (CNN) and three-dimensional (3D) total body imaging. Methods: Total body images from a study of naevi in the general population were used for the training (82 subjects, 57,742 lesions) and testing (10 subjects; 4,868 lesions) datasets for the development of a CNN. Lesions were labelled as naevi, or not (“non-naevi”), by a senior dermatologist as the gold standard. Performance of the CNN was assessed using sensitivity, specificity, and Cohen’s kappa, and evaluated at the lesion level and person level. Results: Lesion-level analysis comparing the automated counts to the gold standard showed a sensitivity and specificity of 79% (76–83%) and 91% (90–92%), respectively, for lesions ≥2 mm, and 84% (75–91%) and 91% (88–94%) for lesions ≥5 mm. Cohen’s kappa was 0.56 (0.53–0.59) indicating moderate agreement for naevi ≥2 mm, and substantial agreement (0.72, 0.63–0.80) for naevi ≥5 mm. For the 10 individuals in the test set, person-level agreement was assessed as categories with 70% agreement between the automated and gold standard counts. Agreement was lower in subjects with numerous seborrhoeic keratoses. Conclusion: Automated naevus counts with reasonable agreement to those of an expert clinician are possible through the combination of 3D total body photography and CNNs. Such an algorithm may provide a faster, reproducible method over the traditional in person total body naevus counts.
Role of Liver Resection for Hepatocellular Carcinoma with Vascular Invasion: Emerging Evidence from Western Countries
Authors: Kokudo Norihiro , Kokudo Takashi , Hasegawa Kiyoshi
Published: July 2021

Patients with advanced hepatocellular carcinoma (HCC) with macrovascular invasion, that is, tumor thrombosis in the portal vein or hepatic vein, are generally considered not eligible for liver resection in Western countries, and only systemic therapy is recommended. However, there is a subgroup of patients who can survive long after surgical treatment despite having a very advanced stage of the disease. Some Asian surgical centers and a few Western surgical centers have been using surgery to treat BCLC stage C HCC as long as it is operable, and those centers have reported acceptable outcomes. In this issue of Liver Cancer, Govalan et al. report on the superiority of surgical resection over other treatments for patients with vascular invasion based on data from the National Cancer Database. This is a first report analyzing a large set of contemporary US cohort data, and its findings may catch the attention of many hepatologists in Western countries who are hesitant about sending eligible patients to surgeons. In this era of advanced systemic therapy using molecular targeted agents and immuno-check point inhibitors, a combination of promising systemic therapy and surgery may be a future path to improve survival for patients with this very advanced disease.
The Importance of the Posterolateral Area of the Diaphragm Muscle for Palpation and for the Treatment of Manual Osteopathic Medicine
Authors: Bordoni Bruno , Walkowski Stevan , Escher Allan , Ducoux Bruno
Published: July 2021

The eupneic act in healthy subjects involves a coordinated combination of functional anatomy and neurological activation. Neurologically, a central pattern generator, the components of which are distributed between the brainstem and the spinal cord, are hypothesized to drive the process and are modeled mathematically. A functionally anatomical approach is easier to understand although just as complex. Osteopathic manipulative treatment (OMT) is part of osteopathic medicine, which has many manual techniques to approach the human body, trying to improve the patient’s homeostatic response. The principle on which OMT is based is the stimulation of self-healing processes, researching the intrinsic physiological mechanisms of the person, taking into consideration not only the physical aspect, but also the emotional one and the context in which the patient lives. This article reviews how the diaphragm muscle moves, with a brief discussion on anatomy and the respiratory neural network. The goal is to highlight the critical issues of OMT on the correct positioning of the hands on the posterolateral area of the diaphragm around the diaphragm, trying to respect the existing scientific anatomical-physiological data, and laying a solid foundation for improving the data obtainable from future research. The correctness of the position of the operator’s hands in this area allows a more effective palpatory perception and, consequently, a probably more incisive result on the respiratory function.