bluuebunny/crossref_metadata_2025 huggingface dataset:
Ecological Livability Assessment of Urban Agglomerations in Guangdong-Hong Kong-Macao Greater Bay Area
Authors: Fan Zengzeng , Wang Yuanyang , Feng Yanchao
Published: December 2021

This paper proposes the “citizen-ecology-city” evaluation framework for urban ecological livability theoretically and studies the ecological livability of the Guangdong-Hong Kong-Macao Greater Bay Area (GBA) empirically. In addition, we analyze the factors of urban ecological livability in a spatial dynamic panel model. The results are as follows. (1) Ecological livability levels of Macao and Hong Kong are significantly higher than the nine cities in the PRD; (2) Shenzhen and Guangzhou lead the nine cities in the PRD, while Jiangmen and Zhaoqing perform poorly; (3) GBA cities can be divided into three categories: Macao, Hong Kong, Shenzhen, and Guangzhou in the first tier; Zhuhai, Foshan, and Dongguan in the second tier; Huizhou, Zhongshan, Jiangmen, and Zhaoqing in the third tier; and (4) The ecological livability of the GBA cities has a characteristic of spatial correlation. In terms of the international value, the three-dimensional evaluation framework can apply to other bay areas in the world.
Risk Assessment on Suicide Death and Attempt among Chinese Rural Youths Aged 15–34 Years
Authors: Sun Long , Zhang Jie , Lamis Dorian A. , Wang Yifan
Published: December 2021

Background: Although many suicide risk assessment tools are available in the world, their validity is not adequately assessed. In this study, we aimed to develop and evaluate a suicide risk assessment model among Chinese rural youths aged 15–34 years. Method: Subjects were 373 suicide deaths and 507 suicide attempters aged 15–34 years in three Chinese provinces (Shandong, Liaoning, and Hunan). Information about the community residents was also collected as the control groups. Social-demographic, social and psychological variables were examined for the suicides, suicide attempters, and community residents. Logistic regressions based on subjects from Shandong and Liaoning provinces were conducted to establish the suicide risk assessment models. Receiver operating characteristic (ROC) curves were drawn, and area under the ROC curves (AUC) were calculated to show how well the models separated the group being tested into those with and without suicide attempt or suicide. Results: The assessment model for suicide death included education years (OR = 0.773, p < 0.001), agricultural worker (OR = 2.091, p < 0.05), physical health (OR = 0.445, p < 0.05), family suicide history (OR = 6.858, p < 0.001), negative life events (OR = 1.340, p < 0.001), hopelessness (OR = 1.171, p < 0.001), impulsivity (OR = 1.151, p < 0.001), and mental disorder (OR = 8.384, p < 0.001). All these factors were also supported in the assessment model for suicide attempt, with an extension of very poor economic status (OR = 1.941, p < 0.01) and social interaction (OR = 0.855, p < 0.001). The AUC was 0.950 and 0.857 for the sample used to establish the assessment models of suicide death and attempt, respectively. The AUC was 0.967 and 0.942 for the sample used to verify the established assessment models of suicide death and attempt, respectively. Conclusions: Compared with some other assessment tools, the models for suicide death and attempt in the current study performed well among Chinese rural youths aged 15–34 years. A reliable suicide risk assessment approach, which includes multiple risk factors, should be evaluated in various cultures and populations.
Adolescents’ Attachment to Parents and Reactive–Proactive Aggression: The Mediating Role of Alexithymia
Authors: Mancinelli Elisa , Li Jian-Bin , Lis Adriana , Salcuni Silvia
Published: December 2021

Aggressive behaviors can serve different functions, which might be understood by distinguishing between reactive (RA) and proactive (PA) aggression. Few studies were conducted on adolescents’ family precursors and emotional processes associated with RA or PA. Accordingly, the current study compared RA and PA by evaluating their association with adolescents’ attachment to parents and alexithymia. N = 453 Italian adolescents aged 15–19 years (Mage = 16.48; SD = 0.69; 33.6% males) participated in the study filling in self-report measures. Results showed that PA and RA are significantly associated and that PA was higher among males. Moreover, four mediational models were performed to assess the influence of adolescents’ attachment to mothers vs. fathers on RA or PA, considering the mediating role of alexithymia. Gender was included as a covariate. Mediational models’ results showed a direct and indirect effect, through lower alexithymia, of adolescents’ attachment to mothers and fathers on RA. Differently, only attachment to mothers showed a direct effect on PA, while attachment to fathers only an indirect effect, mediated by lower alexithymia, on PA was shown. Findings support the greater relevance of emotional processes for RA while highlighting the differential contribution of adolescents’ attachment to mothers vs. fathers upon PA. Implications are discussed, and suggestions for future research are provided.
Tissue Distribution of Mercury and Its Relationship with Selenium in Atlantic Bluefin Tuna (Thunnus thynnus L.)
Authors: Belmonte Antonio , Muñoz Pilar , Santos-Echeandía Juan , Romero Diego
Published: December 2021

Mercury (Hg) is an important heavy metal to consider in marine predators, while selenium (Se) has a natural antagonistic effect on this metal in fish. The Atlantic bluefin tuna (ABFT, Thunnus thynnus) is a pelagic top-level predator of the trophic web and their Hg muscular content is an object of concern in food safety. Nevertheless, little is known about levels of this metal in remaining tissues, which may be important as by-product source, and its relationship with Se. Thus, concentration of both elements in liver, kidney, brain, gill and bone, in addition to muscle, of ABFT were determined. The kidney was the tissue with the highest concentration of Hg (Total-Hg, THg) and Se, and the Se/THg concentration ratio was similar in all tissues, except bone and muscle. The Selenium Health Benefit Value (HBVSe) was positive in each specimen and tissue, indicating that the Se plays an important role against Hg not only in the muscle.
Effect of Soil Solution Properties and Cu2+ Co-Existence on the Adsorption of Sulfadiazine onto Paddy Soil
Authors: Xu Ziwen , Lv Shiquan , Hu Shuxiang , Chao Liang , Rong Fangxu , Wang Xin , Dong Mengyang , Liu Kai , Li Mingyue , Liu Aiju
Published: December 2021

Paddy soils are globally distributed and saturated with water long term, which is different from most terrestrial ecosystems. To better understand the environmental risks of antibiotics in paddy soils, this study chose sulfadiazine (SDZ) as a typical antibiotic. We investigated its adsorption behavior and the influence of soil solution properties, such as pH conditions, dissolved organic carbon (DOC), ionic concentrations (IC), and the co-existence of Cu2+. The results indicated that (1) changes in soil solution pH and IC lower the adsorption of SDZ in paddy soils. (2) Increase of DOC facilitated the adsorption of SDZ in paddy soils. (3) Cu2+ co-existence increased the adsorption of SDZ on organic components, but decreased the adsorption capacity of clay soil for SDZ. (4) Further FTIR and SEM analyses indicated that complexation may not be the only form of Cu2+ and SDZ co-adsorption in paddy soils. Based on the above results, it can be concluded that soil solution properties and co-existent cations determine the sorption behavior of SDZ in paddy soils.
Use of the Smart Lean Method to Conduct High-Quality Integrated Perioperative Management Prior to Hospitalization
Authors: Tsai Hung-Wen , Huang Su-Wen , Hung Yin-Lurn , Hsu Yu-Shan , Huang Chien-Chung
Published: December 2021

Background: competition in the healthcare market is becoming increasingly intense. Health technology continues to evolve, so hospitals and clinics need to strengthen hospital management techniques and also adopt a more patient-centered approach in order to provide high-quality healthcare services, including a more simplified process and shorter waiting times for examinations. The Lean and Six Sigma methodologies and smart technology were introduced and implemented into the integrated perioperative management (PERIO) processes for the purpose of decreasing pre-admission management waiting time, as well as increasing the completion rate and quality of pre-admission management for surgical patients in a 1576-bed medical center in central Taiwan. Methods: in order to improve hospital admission procedures for surgical patients by shortening process waiting times, simplifying admission processes, emphasizing a patient-centered approach, and providing the most efficient service process, the present study applied the DMAIC architecture of the Lean Six Sigma. This approach allowed the patients to save time on the hospital admission process. The current workflow used value flow mapping to identify wasted time caused by unnecessary walking and waiting during the hospital admission process. Therefore, we improved the process cycle for each patient by simultaneously selecting and controlling the process for the purpose of saving time. Results: the experimental results show that the percentage of Process Cycle Efficiency (PCE) increased from 35.42% to 42.47%, Value Added was reduced from 34 to 31 min, and Non-Value Added was reduced from 62 to 42 min. The satisfaction score of the 97 pre-implementation patients was 4.29 compared with 4.40 among the 328 post-implementation patients (p < 0.05). The LOS (Length of Stay) of 2660 pre-implementation patients was 2.49~3.31 days and for 304 after-implementation patients it was 1.16~1.57 days. Conclusions: by integrating different units and establishing standard perioperative management (PERIO) procedures, together with the support of the information systems, the time spent by patients on hospital admission procedures was shortened. These changes also improved the comprehensiveness of the preoperative preparations and the surgical safety of patients, thereby facilitating the provisions necessary for high-quality healthcare services. This in turn reduced the average length of hospital stays and increased the turnover of patients, benefiting the overall operations of the hospital.
The Chinese Mandarin Version of the Crisis Triage Rating Scale for Taiwanese with Mental Illness to Compulsory Hospitalization
Authors: Ting Shuo-Yen , Lan Tsuo-Hung , Shen Lih-Jong , Lin Chun-Yuan , Lee Shih-Kai , Ma Wei-Fen
Published: December 2021

Background: A controversial issue of the need to protect human rights and ensure public safety still remains a conflict in Taiwan. The purpose of this study was to translate the Crisis Triage Rating Scale to Chinese Mandarin (CMCTRS). Method: A cross-sectional design with convenient sampling was employed in this study. The CMCTRS was tested on 302 Taiwanese individuals with mental illness who were admitted to the emergency room (ER) of a psychiatric center. A higher score indicated a greater need for mandatory psychiatric admission. Psychiatrists rated the patients’ status according to three scale criteria and six action plans of recommendations. Results: Five specialists evaluated the content validity index to be 0.8. A total of 210 participants (69.5%) were deemed suitable for compulsory hospitalization or admission for observation in ER. The optimal cut-off score was 8, with a Youden Index of 1.46, a sensitivity of 0.748, and a specificity of 0.712 in deciding the need for hospitalization or observation. Conclusions: The CMCTRS exhibited an acceptable criterion validity with psychiatrists in a population of 302 patients at the ER of a psychiatric center. A cut-off point of 8 is recommended for determining hospitalization or a minimum 24 h stay at emergency for observation.
Preventing Childhood Obesity in Primary Schools: A Realist Review from UK Perspective
Authors: Ijaz Sharea , Nobles James , Johnson Laura , Moore Theresa , Savović Jelena , Jago Russell
Published: December 2021

Childhood obesity is a global public health concern. While evidence from a recent comprehensive Cochrane review indicates school-based interventions can prevent obesity, we still do not know how or for whom these work best. We aimed to identify the contextual and mechanistic factors associated with obesity prevention interventions implementable in primary schools. A realist synthesis following the Realist And Meta-narrative Evidence Syntheses–Evolving Standards (RAMESES) guidance was with eligible studies from the 2019 Cochrane review on interventions in primary schools. The initial programme theory was developed through expert consensus and stakeholder input and refined with data from included studies to produce a final programme theory including all of the context-mechanism-outcome configurations. We included 24 studies (71 documents) in our synthesis. We found that baseline standardised body mass index (BMIz) affects intervention mechanisms variably as a contextual factor. Girls, older children and those with higher parental education consistently benefitted more from school-based interventions. The key mechanisms associated with beneficial effect were sufficient intervention dose, environmental modification and the intervention components working together as a whole. Education alone was not associated with favourable outcomes. Future interventions should go beyond education and incorporate a sufficient dose to trigger change in BMIz. Contextual factors deserve consideration when commissioning interventions to avoid widening health inequalities.
Sustainable Land-Use Allocation Model at a Watershed Level under Uncertainty
Authors: Lu Yao , Zhou Min , Ou Guoliang , Zhang Zuo , He Li , Ma Yuxiang , Ma Chaonan , Tu Jiating , Li Siqi
Published: December 2021

Land-use allocation models can effectively support sustainable land use. A large number of studies solve the problems of land-use planning by constructing models, such as mathematical models and spatial analysis models. However, these models fail to fully and comprehensively consider three uncertain factors of land-use systems: randomness, interval and fuzziness. 33Therefore, through the study of the watershed land-use system, this paper develops a land-use allocation model considering the regional land–society–economy–environment system under uncertain conditions. On the basis of this model, an interval fuzzy two-stage random land-use allocation model (IFTSP-LUAM) combining social, economic and ecological factors is proposed to provide sustainable development strategies at the basin level. In addition, the proposed IFTSP-LUAM takes into account the above three uncertainties and multistage, multiobjective, dynamic, systematic and complex characteristics of typical land-use planning systems. The results showed that the model considers more socioeconomic and ecological factors and can effectively reflect the quantitative relationship between the increase in economic benefits and the decrease in environmental costs of a land-use system. The model was applied to land-use planning of Nansihu River Basin in Shandong Province. The results provided a series of suitable land-use patterns and environmental emission scenarios under uncertain conditions, which can help the watershed environmental protection bureau and watershed land-use decision-makers to formulate appropriate land-use policies, so as to balance social and economic development and ecological protection. The simulation results can provide support for an in-depth analysis of land-use patterns and the trade-off between economic development and ecological environment protection.
CSFF-Net: Scene Text Detection Based on Cross-Scale Feature Fusion
Authors: Li Yuan , Ibrayim Mayire , Hamdulla Askar
Published: December 2021

In the last years, methods for detecting text in real scenes have made significant progress with an increase in neural networks. However, due to the limitation of the receptive field of the central nervous system and the simple representation of text by using rectangular bounding boxes, the previous methods may be insufficient for working with more challenging instances of text. To solve this problem, this paper proposes a scene text detection network based on cross-scale feature fusion (CSFF-Net). The framework is based on the lightweight backbone network Resnet, and the feature learning is enhanced by embedding the depth weighted convolution module (DWCM) while retaining the original feature information extracted by CNN. At the same time, the 3D-Attention module is also introduced to merge the context information of adjacent areas, so as to refine the features in each spatial size. In addition, because the Feature Pyramid Network (FPN) cannot completely solve the interdependence problem by simple element-wise addition to process cross-layer information flow, this paper introduces a Cross-Level Feature Fusion Module (CLFFM) based on FPN, which is called Cross-Level Feature Pyramid Network (Cross-Level FPN). The proposed CLFFM can better handle cross-layer information flow and output detailed feature information, thus improving the accuracy of text region detection. Compared to the original network framework, the framework provides a more advanced performance in detecting text images of complex scenes, and extensive experiments on three challenging datasets validate the realizability of our approach.
A Comprehensive Review of the Coffee Leaf Miner Leucoptera coffeella (Lepidoptera: Lyonetiidae)—A Major Pest for the Coffee Crop in Brazil and Others Neotropical Countries
Authors: Dantas Juliana , Motta Isabela O. , Vidal Leonardo A. , Nascimento Eliza F. M. B. , Bilio João , Pupe Júlia M. , Veiga Adriano , Carvalho Carlos , Lopes Rogerio B. , Rocha Thales L. , Silva Luciano P. , Pujol-Luz José R. , Albuquerque Érika V. S.
Published: December 2021

The coffee leaf miner (CLM) Leucoptera coffeella moth is a major threat to coffee production. Insect damage is related to the feeding behavior of the larvae on the leaf. During the immature life stages, the insect feeds in the mesophyll triggering necrosis and causing loss of photosynthetic capacity, defoliation and significant yield loss to coffee crops. Chemical control is used to support the coffee production chain, though market requirements move toward conscious consumption claiming for more sustainable methods. In this overview, we discuss aspects about the CLM concerning biology, history, geographical distribution, economic impacts, and the most relevant control strategies in progress. Insights to develop an integrated approach for a safer and eco-friendly control of the CLM are discussed here, including bio-extracts, nanotechnology, pheromones, and tolerant cultivars.
Functional Response and Control Potential of Orius sauteri (Hemiptera: Anthocoridae) on Tea Thrips (Dendrothrips minowai Priesner)
Authors: Zhang Qiuping , Zhang Ruifang , Zhang Qiuqiu , Ji Dezhong , Zhou Xia , Jin Linhong
Published: December 2021

This study aimed to clarify the functional response and control potential of O. sauteri in relation to tea thrips. The functional response, interference response, and control potential of O. sauteri on adult tea thrips, in different insect stages and environment temperatures, were studied. The results showed that the predation of O. sauteri against tea thrips was positively correlated with prey density, while the effects of searching for O. sauteri on the adult tea thrips were negatively correlated with prey density. The predation effects of O. sauteri on tea thrips were also influenced by prey density, which indicated that there was an intra-specific interference response from predators to tea thrips. The population density of tea thrips was significantly decreased, and O. sauteri showed a remarkable ability to control them when the benefit-to-harm ratio was 3:100.
Fabrication and First Full Characterisation of Timing Properties of 3D Diamond Detectors
Authors: Anderlini Lucio , Bellini Marco , Corsi Chiara , Lagomarsino Stefano , Lucarelli Chiara , Passaleva Giovanni , Sciortino Silvio , Veltri Michele
Published: December 2021

Tracking detectors at future high luminosity hadron colliders are expected to be able to stand unprecedented levels of radiation as well as to efficiently reconstruct a huge number of tracks and primary vertices. To face the challenges posed by the radiation damage, new extremely radiation hard materials and sensor designs will be needed, while the track and vertex reconstruction problem can be significantly mitigated by the introduction of detectors with excellent timing capabilities. Indeed, the time coordinate provides extremely powerful information to disentangle overlapping tracks and hits in the harsh hadronic collision environment. Diamond 3D pixel sensors optimised for timing applications provide an appealing solution to the above problems as the 3D geometry enhances the already outstanding radiation hardness and allows to exploit the excellent timing properties of diamond. We report here the first full timing characterisation of 3D diamond sensors fabricated by electrode laser graphitisation in Florence. Results from a 270MeV pion beam test of a first prototype and from tests with a β source on a recently fabricated 55×55μm2 pitch sensor are discussed. First results on sensor simulation are also presented.
An LGAD-Based Full Active Target for the PIONEER Experiment
Authors: Mazza Simone Michele
Published: December 2021

PIONEER is a next-generation experiment to measure the charged pion branching ratios to electrons vs. muons Re/μ=Γπ+→e+ν(γ)Γπ+→μ+ν(γ) and pion beta decay (Pib) π+→π0eν. The pion to muon decay (π→μ→e) has four orders of magnitude higher probability than the pion to electron decay (π→eν). To achieve the necessary branching-ratio precision it is crucial to suppress the π→μ→e energy spectrum that overlaps with the low energy tail of π→eν. A high granularity active target (ATAR) is being designed to suppress the muon decay background sufficiently so that this tail can be directly measured. In addition, ATAR will provide detailed 4D tracking information to separate the energy deposits of the pion decay products in both position and time. This will suppress other significant systematic uncertainties (pulse pile-up, decay in flight of slow pions) to <0.01%, allowing the overall uncertainty in to be reduced to O (0.01%). The chosen technology for the ATAR is Low Gain Avalanche Detector (LGAD). These are thin silicon detectors (down to 50 μm in thickness or less) with moderate internal signal amplification and great time resolution. To achieve a 100% active region several emerging technologies are being evaluated, such as AC-LGADs and TI-LGADs. A dynamic range from MiP (positron) to several MeV (pion/muon) of deposited charge is expected, the detection and separation of close-by hits in such a wide dynamic range will be a main challenge. Furthermore, the compactness and the requirement of low inactive material of the ATAR present challenges for the readout system, forcing the amplifier chip and digitizer to be positioned away from the active region.
Long-Term Impact of Different Triple Combination Antihypertensive Medications on Blood Pressure Control, Metabolic Pattern and Incident Events: Data from the Brisighella Heart Study
Authors: Cicero Arrigo , Fogacci Federica , Rizzoli Elisabetta , D’Addato Sergio , Borghi Claudio
Published: December 2021

The aim of this study was to comparatively evaluate clinical, laboratory and hemodynamic effects on the long term of different triple combination antihypertensive medications in a well-characterized Italian cohort. We considered the data of a subset of Brisighella Heart Study (BHS) participants who were consecutively evaluated in three epidemiological surveys between 2012 and 2020. For the current analysis, we excluded normotensive subjects, patients treated with <3 or ≥3 antihypertensive drugs without taking angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), calcium-channel blockers (CCB) and/or thiazide/thiazide-like diuretics. The remaining participants were divided into three groups depending on whether they were treated with Perindopril/Amlodipine/Indapamide, ACE-inhibitors (other than perindopril)/CCBs/Thiazide or ARBs/CCBs/Thiazide, either with separate drugs or fixed pill combinations. A further group of age- and sex-matched volunteers was selected as control and included patients receiving other antihypertensive treatments. The long-term (8 years) effects of the different antihypertensive treatments were compared among the pre-defined groups. During the observation period, there was a trend towards increase in both systolic and diastolic blood pressure (BP) in all the investigated subgroups (p for trend <0.05), but in the subgroup of patients treated with Perindopril/Amlodipine/Indapamide, such increase was significantly lower than in the other groups (p < 0.05). The combination treatment with renin-angiotensin system (RAS) modulators, CCBs and thiazide/thiazide-like diuretics was associated with significantly lower diastolic BP (p < 0.05) and more strictly controlled lipid pattern than other triple combination of anti-hypertensive medications. Patients treated with Perindopril/Amlodipine/Indapamide did not experience any age-related increase in serum levels of total cholesterol. Moreover, during the follow up none of them developed type 2 diabetes, nor had a need for a greater number of antihypertensive drugs to improve BP control, mainly because of a more stable BP control. Based on our observations, combination treatment with RAS modulators, amlodipine and thiazides/thiazide-like diuretics is more effective than other triple antihypertensive medications for lowering the diastolic BP and has a better impact on serum lipids. Perindopril/Amlodipine/Indapamide is associated with more protective metabolic profile than any other considered combination antihypertensive medications.
Clinical Analysis of Persistent Subretinal Fluid after Pars Plana Vitrectomy in Macula with Diabetic Tractional Retinal Detachment
Authors: Kang Yong-Koo , Shin Jae-Pil
Published: December 2021

(1) Background: We analyzed the duration of persistent subretinal fluid (PSF) and the contributing factors of PSF after pars plana vitrectomy in patients who had a macula with diabetic tractional retinal detachment (TRD). (2) Methods: Forty eyes of 40 patients who had pars plana vitrectomy due to a macula with diabetic TRD, between 2014 and 2020, were retrospectively reviewed. The duration of PSF, as well as relevant ocular and systemic factors, was analyzed. (3) Results: The mean duration of PSF was 4.4 ± 4.7 months. The prevalence of PSF was 75.0% at 1 month, 50.0% at 3 months, 30.0% at 6 months and 10.0% at 12 months after surgery. Blood urea nitrogen, creatinine, and estimated glomerular filtration rate (eGFR) were significantly associated with the duration of PSF in the univariate analysis. In the multivariate analysis, only eGFR was significantly associated with the duration of PSF (β = −0.089, p = 0.030). (4) Conclusion: PSF may persist for more than 12 months in a macula with diabetic TRD after vitrectomy. Moreover, patients with impaired kidney function tended to have a delayed subretinal fluid absorption. Therefore, careful investigation of preoperative systemic conditions, especially kidney function, should be considered before TRD surgery in diabetic patients.
The Role of the Stromal Extracellular Matrix in the Development of Pterygium Pathology: An Update
Authors: Martín-López Javier , Pérez-Rico Consuelo , Benito-Martínez Selma , Pérez-Köhler Bárbara , Buján Julia , Pascual Gemma
Published: December 2021

Pterygium is a benign fibrovascular lesion of the bulbar conjunctiva with frequent involvement of the corneal limbus. Its pathogenesis has been mainly attributed to sun exposure to ultraviolet-B radiation. Obtained evidence has shown that it is a complex and multifactorial process which involves multiple mechanisms such as oxidative stress, dysregulation of cell cycle checkpoints, induction of inflammatory mediators and growth factors, angiogenic stimulation, extracellular matrix (ECM) disorders, and, most likely, viruses and hereditary changes. In this review, we aim to collect all authors’ experiences and our own, with respect to the study of fibroelastic ECM of pterygium. Collagen and elastin are intrinsic indicators of physiological and pathological states. Here, we focus on an in-depth analysis of collagen (types I and III), as well as the main constituents of elastic fibers (tropoelastin (TE), fibrillins (FBNs), and fibulins (FBLNs)) and the enzymes (lysyl oxidases (LOXs)) that carry out their assembly or crosslinking. All the studies established that changes in the fibroelastic ECM occur in pterygium, based on the following facts: An increase in the synthesis and deposition of an immature form of collagen type III, which showed the process of tissue remodeling. An increase in protein levels in most of the constituents necessary for the development of elastic fibers, except FBLN4, whose biological roles are critical in the binding of the enzyme LOX, as well as FBN1 for the development of stable elastin. There was gene overexpression of TE, FBN1, FBLN5, and LOXL1, while the expression of LOX and FBLN2 and -4 remained stable. In conclusion, collagen and elastin, as well as several constituents involved in elastic fiber assembly are overexpressed in human pterygium, thus, supporting the hypothesis that there is dysregulation in the synthesis and crosslinking of the fibroelastic component, constituting an important pathogenetic mechanism for the development of the disease.
The Definition, Assessment, and Prevalence of (Human Assumed) Central Sensitisation in Patients with Chronic Low Back Pain: A Systematic Review
Authors: Schuttert Ingrid , Timmerman Hans , Petersen Kristian K. , McPhee Megan E. , Arendt-Nielsen Lars , Reneman Michiel F. , Wolff André P.
Published: December 2021

Central sensitisation is assumed to be one of the underlying mechanisms for chronic low back pain. Because central sensitisation is not directly assessable in humans, the term ‘human assumed central sensitisation’ (HACS) is suggested. The objectives were to investigate what definitions for HACS have been used, to evaluate the methods to assess HACS, to assess the validity of those methods, and to estimate the prevalence of HACS. Database search resulted in 34 included studies. Forty different definition references were used to define HACS. This review uncovered twenty quantitative methods to assess HACS, including four questionnaires and sixteen quantitative sensory testing measures. The prevalence of HACS in patients with chronic low back pain was estimated in three studies. The current systematic review highlights that multiple definitions, assessment methods, and prevalence estimates are stated in the literature regarding HACS in patients with chronic low back pain. Most of the assessment methods of HACS are not validated but have been tested for reliability and repeatability. Given the lack of a gold standard to assess HACS, an initial grading system is proposed to standardize clinical and research assessments of HACS in patients with a chronic low back.
Electrocardiographic Predictors of Primary Ventricular Fibrillation and 30-Day Mortality in Patients Presenting with ST-Segment Elevation Myocardial Infarction
Authors: Cipriani Alberto , D’Amico Gianpiero , Brunetti Giulia , Vescovo Giovanni Maria , Donato Filippo , Gambato Marco , Dall’Aglio Pietro Bernardo , Cardaioli Francesco , Previato Martina , Martini Nicolò , Perazzolo Marra Martina , Iliceto Sabino , Cacciavillani Luisa , Corrado Domenico , Zorzi Alessandro
Published: December 2021

Primary ventricular fibrillation (PVF) may occur in the early phase of ST-elevation myocardial infarction (STEMI) prior to primary percutaneous coronary intervention (PCI). Multiple electrocardiographic STEMI patterns are associated with PVF and short-term mortality including the tombstone, Lambda, and triangular QRS-ST-T waveform (TW). We aimed to compare the predictive value of different electrocardiographic STEMI patterns for PVF and 30-day mortality. We included a consecutive cohort of 407 STEMI patients (75% males, median age 66 years) presenting within 12 h of symptoms onset. At first medical contact, 14 (3%) showed the TW or Lambda ECG patterns, which were combined in a single group (TW-Lambda pattern) characterized by giant R-wave and downsloping ST-segment. PVF prior to primary PCI occurred in 39 (10%) patients, significantly more often in patients with the TW-Lambda pattern than those without (50% vs. 8%, p < 0.001). For the multivariable analysis, Killip class ≥3 (OR 6.19, 95% CI 2.37–16.1, p < 0.001) and TW-Lambda pattern (OR 9.64, 95% CI 2.99–31.0, p < 0.001) remained as independent predictors of PVF. Thirty-day mortality was also higher in patients with the TW-Lambda pattern than in those without (43% vs. 6%, p < 0.001). However, only LVEF (OR 0.86, 95% CI 0.82–0.90, p < 0.001) and PVF (OR 4.61, 95% CI 1.49–14.3, p = 0.042) remained independent predictors of mortality. A mediation analysis showed that the effect of TW-Lambda pattern on mortality was mediated mainly via the reduced LVEF. In conclusion, among patients presenting with STEMI, the electrocardiographic TW-Lambda pattern was associated with both PVF before PCI and 30-day mortality. Therefore, this ECG pattern may be useful for early risk stratification of STEMI.
Efficacy of Pulsatile Flow Perfusion in Adult Cardiac Surgery: Hemodynamic Energy and Vascular Reactivity
Authors: Dodonov Mikhail , Onorati Francesco , Luciani Giovanni Battista , Francica Alessandra , Tessari Maddalena , Menon Tiziano , Gottin Leonardo , Milano Aldo Domenico , Faggian Giuseppe
Published: December 2021

Background: The role of pulsatile (PP) versus non-pulsatile (NP) flow during a cardiopulmonary bypass (CPB) is still debated. This study’s aim was to analyze hemodynamic effects, endothelial reactivity and erythrocytes response during a CPB with PP or NP. Methods: Fifty-two patients undergoing an aortic valve replacement were prospectively randomized for surgery with either PP or NP flow. Pulsatility was evaluated in terms of energy equivalent pressure (EEP) and surplus hemodynamic energy (SHE). Systemic (SVRi) and pulmonary (PVRi) vascular resistances, endothelial markers levels and erythrocyte nitric-oxide synthase (eNOS) activity were collected at different perioperative time-points. Results: In the PP group, the resultant EEP was 7.3% higher than the mean arterial pressure (MAP), which corresponded to 5150 ± 2291 ergs/cm3 of SHE. In the NP group, the EEP and MAP were equal; no SHE was produced. The PP group showed lower SVRi during clamp-time (p = 0.06) and lower PVRi after protamine administration and during first postoperative hours (p = 0.02). Lower SVRi required a higher dosage of norepinephrine in the PP group (p = 0.02). Erythrocyte eNOS activity results were higher in the PP patients (p = 0.04). Renal function was better preserved in the PP group (p = 0.001), whereas other perioperative variables were comparable between the groups. Conclusions: A PP flow during a CPB results in significantly lower SVRi, PVRi and increased eNOS production. The clinical impact of increased perioperative vasopressor requirements in the PP group deserves further evaluation.
Analgesic Efficacy and Safety of Local Infiltration Following Lumbar Decompression Surgery: A Systematic Review of Randomized Controlled Trials
Authors: Tsaousi Georgia , Tsitsopoulos Parmenion P. , Pourzitaki Chryssa , Palaska Eleftheria , Badenes Rafael , Bilotta Federico
Published: December 2021

This systematic review aims to appraise available clinical evidence on the efficacy and safety of wound infiltration with adjuvants to local anesthetics (LAs) for pain control after lumbar spine surgery. A database search was conducted to identify randomized controlled trials (RCTs) pertinent to wound infiltration with analgesics or miscellaneous drugs adjunctive to LAs compared with sole LAs or placebo. The outcomes of interest were postoperative rescue analgesic consumption, pain intensity, time to first analgesic request, and the occurrence of adverse events. Twelve double-blind RCTs enrolling 925 patients were selected for qualitative analysis. Most studies were of moderate-to-good methodological quality. Dexmedetomidine reduced analgesic requirements and pain intensity within 24 h postoperatively, while prolonged pain relief was reported by one RCT involving adjunctive clonidine. Data on local magnesium seem promising yet difficult to interpret. No clear analgesic superiority could be attributed to steroids. Τramadol co-infiltration was equally effective as sole tramadol but superior to LAs. No serious adverse events were reported. Due to methodological inconsistencies and lack of robust data, no definite conclusions could be drawn on the analgesic effect of local infiltrates in patients undergoing lumbar surgery. The probable positive analgesic efficacy of adjunctive dexmedetomidine and magnesium needs further evaluation.
Control of Low-Density Lipoprotein Cholesterol in Secondary Prevention of Coronary Artery Disease in Real-Life Practice: The DAUSSET Study in French Cardiologists
Authors: Ferrières Jean , Roubille François , Farnier Michel , Jourdain Patrick , Angoulvant Denis , Boccara Franck , Danchin Nicolas
Published: December 2021

Introduction: Patients with established coronary artery disease (CAD) are at very high risk for cardiovascular events. Methods: The DAUSSET study is a national, multicenter, non-interventional study that included very high-risk CAD patients followed by French cardiologists. It aimed to describe real-life clinical practices for low-density lipoprotein (LDL) cholesterol control in the secondary prevention of CAD. Results: A total of 912 patients (mean age, 65.4 years; men, 76.1%; myocardial infarction, 69.4%; first episode, 80.1%) were analyzed. The LDL cholesterol goal was 70 mg/dL in most cases (84.9%). The LDL cholesterol goal <70 mg/dL was achieved in 41.7% of patients. Of the 894 (98.0%) patients who received lipid-lowering therapy, 81.2% had been treated more intensively after the cardiac event, 27.0% had been treated less intensively and 13.1% had been maintained. Participating cardiologists were very satisfied or satisfied with treatment response in 72.6% of patients. Moderate satisfaction or dissatisfaction with lipid-lowering therapy was related to not achieving objectives (100%), treatment inefficacy (53.7%), treatment intolerance (23.4%) and poor adherence (12.3%). Conclusion: These real-world results show that lipid control in very high-risk patients remains insufficient. More than half of the patients did not achieve the LDL cholesterol goal. Prevention of cardiovascular events in these very high-risk patients could be further improved by better education and more intensive lipid-lowering therapy.
Remote Hospital Care for Recovering COVID-19 Patients Using Telemedicine: A Randomised Controlled Trial
Authors: van Goor Harriët M. R. , Breteler Martine J. M. , van Loon Kim , de Hond Titus A. P. , Reitsma Johannes B. , Zwart Dorien L. M. , Kalkman Cornelis J. , Kaasjager Karin A. H.
Published: December 2021

Background: To ensure availability of hospital beds and improve COVID-19 patients’ well-being during the ongoing pandemic, hospital care could be offered at home. Retrospective studies show promising results of deploying remote hospital care to reduce the number of days spent in the hospital, but the beneficial effect has yet to be established. Methods: We conducted a single centre, randomised trial from January to June 2021, including hospitalised COVID-19 patients who were in the recovery stage of the disease. Hospital care for the intervention group was transitioned to the patient’s home, including oxygen therapy, medication and remote monitoring. The control group received in-hospital care as usual. The primary endpoint was the number of hospital-free days during the 30 days following randomisation. Secondary endpoints included health care consumption during the follow-up period and mortality. Results: A total of 62 patients were randomised (31 control, 31 intervention). The mean difference in hospital-free days was 1.7 (26.7 control vs. 28.4 intervention, 95% CI of difference −0.5 to 4.2, p = 0.112). In the intervention group, the index hospital length of stay was 1.6 days shorter (95% CI −2.4 to −0.8, p < 0.001), but the total duration of care under hospital responsibility was 4.1 days longer (95% CI 0.5 to 7.7, p = 0.028). Conclusion: Remote hospital care for recovering COVID-19 patients is feasible. However, we could not demonstrate an increase in hospital-free days in the 30 days following randomisation. Optimising the intervention, timing, and identification of patients who will benefit most from remote hospital care could improve the impact of this intervention.
Measuring Resilience in Women with Endometriosis
Authors: Lubián-López Daniel María , Moya-Bejarano Davinia , Butrón-Hinojo Carmen Aisha , Marín-Sánchez Pilar , Blasco-Alonso Marta , Jiménez-López Jesús Salvador , Villegas-Muñoz Emilia , González-Mesa Ernesto
Published: December 2021

Endometriosis is a multifactorial disease with pathophysiological factors not yet well known; it also presents a wide symptomatic range that makes us think about the need for multidisciplinary management. It is a chronic disease in which there is no definitive treatment, and is associated in a large majority of cases with psychological pathology. Connecting comorbidities and multimorbidities on a neurobiological, neuropsychological, and pathophysiological level could significantly contribute to their more successful prevention and treatment. In our study, resilience is analyzed as an adjunctive measure in the management of endometriosis. Methods: A multi-centre, cross-sectional study was performed to analyse resilience levels in a sample of Spanish women suffering from endometriosis. CDRIS-25, CDRIS-10, BDI, the STAI, and the SF-36 Health Questionnaire were used for assessments. A representative group of 202 women with endometriosis was recruited by consecutive sampling. Exploratory and confirmatory factor analyses were performed for both resilience scales. Results: Mean CDRIS-25 and CDRIS-10 scores were 69.58 (SD 15.1) and 29.37 (SD 7.2), respectively. Women with adenomyosis and without signs of deep endometriosis showed the lowest scores. The best predictive model included women’s age, years of endometriosis evolution, number of pregnancies, and history of fertility problems as the best predictive factors. Conclusions: Women build resilience as the number of years of evolution of the disease increases. Symptoms such as dyspareunia and continued abdominal pain were more prevalent among less resilient women.
Evaluating the Effectiveness of Soft Tissue Therapy in the Treatment of Disorders and Postoperative Conditions of the Knee Joint—A Systematic Review
Authors: Jurecka Alicja , Papież Maciej , Skucińska Paulina , Gądek Artur
Published: December 2021

The term “soft tissue therapy” (STT) refers to mechanical methods of treatment involving passive kneading, pressing and stretching of pathologically tense tissues in supporting the process of recovery after surgery or trauma to the musculoskeletal system. The objective of this study was to review current scientific reports evaluating the effectiveness of the use of STT in patients with diseases or after surgical procedures of the knee joint. A systematic search of the popular scientific databases PubMed, Scopus and Embase was performed from inception to 15 October 2021. Eight articles met eligibility criteria and were included in the review. Six papers were related to disorders of the knee joint, while the remaining two studies were related to dysfunctions associated with the conditions after surgical intervention. The findings presented confirmed the effectiveness of STT in orthopaedic patients who showed an increase in lower limb functional parameters. The research has shown that the use of various methods of STT has a significant impact on increasing muscle activity and flexibility as well as increasing the range of motion in the knee joint. The physiotherapeutic methods used had a significant impact on reducing pain and increasing physical function and quality of life. The techniques used reduced the time to descend stairs in patients with knee osteoarthritis. This review summarises the effectiveness of STT as an important form of treatment for orthopaedic patients with various knee joint dysfunctions.
Specific versus Non-Specific Exercises for Chronic Neck or Shoulder Pain: A Systematic Review
Authors: Dueñas Lirios , Aguilar-Rodríguez Marta , Voogt Lennard , Lluch Enrique , Struyf Filip , Mertens Michel G. C. A. M. , Meulemeester Kayleigh De , Meeus Mira
Published: December 2021

The current systematic review aimed to compare the effect of injury-focused (specific) exercises versus more general (non-specific) exercises on pain in patients with chronic neck or shoulder pain. We searched PubMed, EMBASE, and Web of Science. Two reviewers screened and selected studies, extracted outcomes, assessed risk of bias, and rated the quality of evidence. A total of nine eligible studies, represented in 13 articles, were identified, with a considerable risk of bias. One article investigated the acute effect of single bouts of exercise on pain and reported an immediate pain reduction after non-specific exercise. Regarding short-term effects, seven out of the nine studies found no differences in pain between interventions, with inconsistent results among two other studies. Concerning the long-term effects, while pain reduction seems to be favored by specific exercises (two out of four articles), the best format is still unclear. Based on the acute effects, a single bout of non-specific exercise seems to be a better option for pain-relief for patients with chronic neck or shoulder pain. For short-term effects, there are no differences in pain between specific and non-specific exercises. Regarding long-term effects, specific exercises seem to be the best option. Nevertheless, more studies are warranted.
The Role of Extracellular Matrix in Skin Wound Healing
Authors: Potekaev Nikolai N. , Borzykh Olga B. , Medvedev German V. , Pushkin Denis V. , Petrova Marina M. , Petrov Artem V. , Dmitrenko Diana V. , Karpova Elena I. , Demina Olga M. , Shnayder Natalia A.
Published: December 2021

Impaired wound healing is one of the unsolved problems of modern medicine, affecting patients’ quality of life and causing serious economic losses. Impaired wound healing can manifest itself in the form of chronic skin wounds or hypertrophic scars. Research on the biology and physiology of skin wound healing disorders is actively continuing, but, unfortunately, a single understanding has not been developed. The attention of clinicians to the biological and physiological aspects of wound healing in the skin is necessary for the search for new and effective methods of prevention and treatment of its consequences. In addition, it is important to update knowledge about genetic and non-genetic factors predisposing to impaired wound healing in order to identify risk levels and develop personalized strategies for managing such patients. Wound healing is a very complex process involving several overlapping stages and involving many factors. This thematic review focuses on the extracellular matrix of the skin, in particular its role in wound healing. The authors analyzed the results of fundamental research in recent years, finding promising potential for their transition into real clinical practice.