bluuebunny/crossref_metadata_2025 huggingface dataset:
The role of contractile dyssynchrony in pacing-induced cardiomyopathy: detailed assessment using index of contractile asymmetry
Authors: Fruelund Patricia Zerlang , Sommer Anders , Lundbye-Christensen Søren , Graff Claus , Søgaard Peter , Riahi Sam , Zaremba Tomas
Published: May 2023

Aims

The pathophysiological effects of chronic right ventricular pacing and the role of right ventricular lead position are not well understood. Therefore, we investigated the association between left ventricular contractile dyssynchrony and pacing-induced cardiomyopathy (PICM) in patients with chronic right ventricular pacing. Furthermore, we assessed the association between right ventricular lead location and left ventricular contractile dyssynchrony.

Methods

This was a retrospective study using data from 153 pacemaker patients with normal (≥ 50%) pre-implant left ventricular ejection fraction (LVEF). Baseline and follow-up echocardiograms were analyzed, and PICM was defined as LVEF < 50% with ≥ 10% decrease in LVEF after pacemaker implantation. Relative index of contractile asymmetry (rICA), a novel strain rate-based method, was calculated to quantify left ventricular contractile dyssynchrony between opposing walls in the three apical views. Right ventricular lead position was categorized into anterior septum, posterior septum, free wall, and apex based on contrast-enhanced cardiac computed tomography.

Results

Forty-seven (31%) developed PICM. Overall contractile dyssynchrony, measured by mean rICA, was higher in the PICM group compared with the non-PICM group (1.19 ± 0.21 vs. 1.03 ± 0.19, p < 0.001). Left ventricular anterior-inferior dyssynchrony, assessed in the apical two-chamber view, was independently associated with PICM (p < 0.001). Thirty-seven (24%) leads were implanted anterior septal, 11 (7.2%) posterior septal, 74 (48.4%) apical, and 31 (20.3%) free wall. Left ventricular anterior-inferior dyssynchrony was significantly different between the four pacing lead locations (p < 0.01) with the highest rICA observed in the posterior septal group (1.30 ± 0.37).

Conclusions

PICM is significantly associated increased contractile dyssynchrony assessed by rICA. This study suggests that especially left ventricular dyssynchrony in the anterior-inferior direction is associated with PICM, and pacing the right ventricular posterior septum resulted in the highest degree of anterior-inferior dyssynchrony. Quantification of left ventricular dyssynchrony by rICA provides important insights to the potential pathophysiology of PICM and the impact of right ventricular lead position.

Graphical Abstract
Motivation and job satisfaction of community health workers in Ethiopia: a mixed-methods approach
Authors: Ejigu Yohannes , Abera Netsanet , Haileselassie Werissaw , Berhanu Negalign , Haile Biniyam Tadesse , Nigatu Frehiwot , Tewfik Nurhan , Kiflie Yibeltal , Medhin Girmay , Walelign Fasil , Demissie Mekdes , Tigabu Setegn , Taddesse Daniel , Dadi Tegene Legese , Teklu Alula
Published: May 2023

Background

Ethiopia has been providing health care to its rural population since 2004 using female Community Health Workers called Health Extension Workers (HEWs). The HEWs are credited with several achievements in improving the country's health indicators. However, information about the HEWs' motivation and job satisfaction is limited. The aim of this study was to assess the HEWs' motivation and job satisfaction, as well as the factors that influence them.

Methods

A mixed-methods study was nested within a national health extension program assessment conducted from March 01 to May 31, 2019. A structured questionnaire which looked at motivation and satisfaction with Likert type single-question and multiple-item measures was used to collect quantitative data from 584 HEWs. Focus group discussion and in-depth interviews were used to gather qualitative data. Means and percentages were used to descriptively summarize important variables. Linear regression was used to identify factors associated with job satisfaction. The qualitative data was analysed thematically.

Results

Overall, 48.6% of HEWs were satisfied with their job, with a mean score of 2.5 out of 4.0. The result showed a high level of satisfaction with autonomy (72%), relationships with co-workers (67%), and recognition (56%). Low level of satisfaction was linked to pay and benefits (13%), opportunities for promotion (29%), and education (34%). Regression analysis showed that HEWs in the age category of 30 years and older had lower satisfaction scores as compared to HEWs in the age category of 18–24 years (adjusted β = − 7.71, 95% CI: − 14.42, − 0.99). The qualitative result revealed that desire to help their community, recognition or respect gained from the community, and achievement were the major motivating factors. In contrast, inadequate pay and benefit, limited education and career advancement opportunities, workload, work environment, limited supportive supervision, and absence of opportunity to change workplace were the demotivating factors.

Conclusions

The overall job satisfaction of HEWs was low; extrinsic factors, such as inadequate pay, limited education and career advancement opportunities were the major sources of demotivation. Policy makers and human resource managers should revise their human resource policies and guidelines to address the main sources of low level of job satisfaction and demotivation.
Exploring HIV/AIDS investigator perceptions of equity within research partnerships between low-and middle-income and high-income countries: a pilot survey
Authors: Modlin Chelsea E. , Kankaka Edward Nelson , Chang Larry W. , Sewankambo Nelson K. , Ali Joseph
Published: May 2023

Background

Recommendations for research partnerships between low- and middle-income countries (LMICs) and high-income countries (HICs) stress the importance of equity within the collaboration. However, there is limited knowledge of the practical challenges and successes involved in establishing equitable research practices. This study describes the results of a pilot survey assessing key issues on LMIC/HIC partnership equity within HIV/AIDS research collaborations and compares perspectives of these issues between LMIC- and HIC-based investigators.

Methods

Survey participants were selected using clustered, random sampling and snowball sampling. Responses were compared between LMIC and HIC respondents using standard descriptive statistics. Qualitative respondent feedback was analyzed using a combination of exploratory and confirmatory thematic analysis.

Results

The majority of categories within four themes (research interests and resources; leadership, trust, and communication; cultural and ethical competence; representation and benefits) demonstrated relative consensus between LMIC and HIC respondents except for ‘lack of trust within the partnership’ which was rated as a more pronounced challenge by LMIC respondents. However, subcategories within some of the themes had significant differences between respondent groups including: equitable setting of the research agenda, compromise within a partnership, the role of regulatory bodies in monitoring partnerships for equity, and post-study access to research technology.

Conclusions

These efforts serve as a proof-of-concept survey characterizing contemporary issues around international research partnership equity. The frequency and severity of specific equity issues can be assessed, highlighting similarities versus differences in experiences between LMIC and HIC partners as potential targets for further discussion and evaluation.
Cost-effectiveness of surgical treatment of thumb carpometacarpal joint arthritis: a value of information study
Authors: Yoon Alfred P. , Hutton David W. , Chung Kevin C.
Published: May 2023

Background

Thumb carpometacarpal (CMC) joint arthritis is one of the most prevalent arthritic conditions commonly treated with trapeziectomy alone or trapeziectomy with ligament reconstruction and tendon interposition (LRTI). We evaluate the cost-effectiveness and value of perfect and sample information of trapeziectomy alone, LRTI, and non-operative treatment.

Methods

A societal perspective decision tree was modeled. To understand the value of future research in comparing quality-of-life after trapeziectomy, LRTI, and non-operative management we characterized uncertainty by fitting distributions to EQ-5D utility data published from the United Kingdom hand surgery registry. We used Monte Carlo simulation for the probabilistic sensitivity analysis and to evaluate the value of perfect and sample information.

Results

Both trapeziectomy alone and LRTI were cost-effective compared to non-operative management ($2,540 and $3,511/QALY respectively). Trapeziectomy alone (base case total cost $8,251, QALY 14.08) was dominant compared to LRTI (base case total cost $8,798, QALY 13.34). However, probabilistic sensitivity analysis suggested there is a 12.5% chance LRTI may be preferred at a willingness-to-pay of $50,000/QALY. Sensitivity analysis revealed postoperative utilities are the most influential factors in determining cost-effectiveness. The value of perfect information was approximately $1,503/person. A study evaluating the quality-of-life of 1,000 patients in each arm undergoing trapeziectomy alone or LRTI could provide an expected $1,117 of information value. With approximately 40,000 CMC arthroplasties performed each year in the U.S., the annual value is close to $45 million.

Conclusions

Trapeziectomy without LRTI appears to be the most cost-effective procedure in treating late-stage CMC arthritis and should be considered as first-line surgical treatment. There is substantial societal value in conducting additional research to better understand the relative quality-of-life improvements gained from these two common hand surgeries.
Amino acid metabolism regulated by lncRNAs: the propellant behind cancer metabolic reprogramming
Authors: Hu Qifan , Li Yutong , Li Dan , Yuan Yi , Wang Keru , Yao Lu , Cheng Zhujun , Han Tianyu
Published: May 2023

Metabolic reprogramming is one of the main characteristics of cancer cells and plays pivotal role in the proliferation and survival of cancer cells. Amino acid is one of the key nutrients for cancer cells and many studies have focused on the regulation of amino acid metabolism, including the genetic alteration, epigenetic modification, transcription, translation and post-translational modification of key enzymes in amino acid metabolism. Long non-coding RNAs (lncRNAs) are composed of a heterogeneous group of RNAs with transcripts of more than 200 nucleotides in length. LncRNAs can bind to biological molecules such as DNA, RNA and protein, regulating the transcription, translation and post-translational modification of target genes. Now, the functions of lncRNAs in cancer metabolism have aroused great research interest and significant progress has been made. This review focuses on how lncRNAs participate in the reprogramming of amino acid metabolism in cancer cells, especially glutamine, serine, arginine, aspartate, cysteine metabolism. This will help us to better understand the regulatory mechanism of cancer metabolic reprogramming and provide new ideas for the development of anti-cancer drugs.
Development of a compensation-aware virtual rehabilitation system for upper extremity rehabilitation in community-dwelling older adults with stroke
Authors: Luo Zhiqiang , Lim Audrey Ei-Ping , Durairaj Ponraj , Tan Kim Kiow , Verawaty Verawaty
Published: May 2023

Background

Compensatory movements are commonly observed in older adults with stroke during upper extremity (UE) motor rehabilitation, which could limit their motor recovery.

Aim

This study aims to develop a compensation-aware virtual rehabilitation system (VRS) that can detect compensatory movements and improve the outcome of UE rehabilitation in community-dwelling older adults with stroke.

Methods

The VRS development includes three main components: (1) the use of thresholds for determining compensatory movements, (2) the algorithm for processing the kinematic data stream from Kinect to detect compensation in real-time, and (3) the audio-visual feedback to assist older adults with stroke to be aware of the compensation. Two studies were conducted following the VRS development, where Study 1 identified the value of thresholds for determining compensatory movements in two planar motor exercises, and Study 2 provided preliminary validation for the developed VRS by comparing two groups undergoing VR training or conventional training (CT) in a community rehabilitation center.

Results

The VRS could effectively detect all determined compensatory movements and timely trigger feedback in response to the detected compensatory movements. The VR participants showed significant improvements in Fugl-Meyer Assessment-Upper Extremity (FMA-UE, p = 0.045) and Wolf Motor Function Test (WMFT, p = 0.009). However, the VR and CT groups had no significant differences in outcome measures.

Conclusion

The VRS demonstrates the ability to detect compensation and the potential of assisting older adults with stroke to improve motor functions. Suggestions are given for further improvements of the VRS to support the older adult with stroke to reduce compensation.
Isolation and characterization of a novel phage belonging to a new genus against Vibrio parahaemolyticus
Authors: Chen Yubing , Li Wenqing , Shi Keming , Fang Zheng , Yang Yunlan , Zhang Rui
Published: May 2023

Background

Vibrio parahaemolyticus is a major foodborne pathogen that contaminates aquatic products and causes great economic losses to aquaculture. Because of the emergence of multidrug-resistant V. parahaemolyticus strains, bacteriophages are considered promising agents for their biocontrol as an alternative or supplement to antibiotics. In this study, a lytic vibriophage, vB_VpaM_R16F (R16F), infecting V. parahaemolyticus 1.1997T was isolated, characterized and evaluated for its biocontrol potential.

Methods

A vibriophage R16F was isolated from sewage from a seafood market with the double-layer agar method. R16F was studied by transmission electron microscopy, host range, sensitivity of phage particles to chloroform, one-step growth curve and lytic activity. The phage genome was sequenced and in-depth characterized, including phylogenetic and taxonomic analysis.

Results

R16F belongs to the myovirus morphotype and infects V. parahaemolyticus, but not nine other Vibrio spp. As characterized by determining its host range, one-step growth curve, and lytic activity, phage R16F was found to highly effective in lysing host cells with a short latent period (< 10 min) and a small burst size (13 plaque-forming units). R16F has a linear double-stranded DNA with genome size 139,011 bp and a G + C content of 35.21%. Phylogenetic and intergenomic nucleotide sequence similarity analysis revealed that R16F is distinct from currently known vibriophages and belongs to a novel genus. Several genes (e.g., encoding ultraviolet damage endonuclease and endolysin) that may enhance environmental competitiveness were found in the genome of R16F, while no antibiotic resistance- or virulence factor-related gene was detected.

Conclusions

In consideration of its biological and genetic properties, this newly discovered phage R16F belongs to a novel genus and may be a potential alternate biocontrol agent.
Breastfeeding and female labor force participation: the probability of survival of children in Nepal under 3 years old
Authors: Timilsina Kailash , Sawangdee Yothin , Bhandari Ravi , Tiwari Sirjana , Adhikari Ashmita
Published: May 2023

Background

The number of breastfeeding mothers participating in a labor force to generate income has been increasing in Nepal. In this regard, the study aims to assess the survival of Under 3 children in Nepal from the mother based on their labor force participation and breastfeeding status.

Methods

Data for the study were obtained from the Nepal Demographic and Health Survey 2016. The sample size of the study was 2,994 live births children, born in the last three years prior to the day of the interview. The robust hazard ratio and cox proportional hazard regression were conducted between dependent and independent variables with 95% confidence intervals (CIs) to conclude.

Results

From a total of 2,994 live births, 85 children died within 36 months of birth. More than 80% of the non-working mothers were breastfeeding their children. The findings shows that the survival of children under-3 is positively associated with the interaction with the mother’s work and breastfeeding status (Hazard Ratio 0.428, 95% CI 0.24, 0.75), family structure (Hazard Ratio 1.511; 95% CI 1.37, 1.655), relationship with the household head (Hazard Ratio 0.452; 95% CI 0.311, 0.65), wealth quintiles (Hazard Ratio 0.390; 95% CI 0.33, 0.46), caste (Hazard Ratio 0.652; 95% CI 0.60, 0.69), and religion (Hazard Ratio 2.015; 95% CI 1.09, 3.70) with model CI 95%, Log pseudo likelihood = -521.39236, prob. χ2 = 0.005 and time at risk = 52,748.

Conclusions

The highest rate of child survival was from the working mothers as well as continuing breastfeeding their children followed by mothers breastfeeding the child but not working, compared to mothers working but not breastfeeding the child, and mothers who were neither working nor breastfeeding their children respectively. This study provides clear evidence that breastfeeding is very important for the probability of survival of the child aged below 36 months and work of mother also have some positive impact on child survival. Employers should be encouraged to have a breastfeeding policy in the workplace through the establishment of a breastfeeding facility, and a flexible work schedule. At the same time government should also regulate the paid maternity leave and encourage societal support for the breastfeeding mothers.
A clinical experience-based Chinese herbal formula improves ethanol-induced drunken behavior and hepatic steatohepatitis in mice models
Authors: Gao Han , Li Zhen , Liu Yao , Zhao Yong-kang , Cheng Cheng , Qiu Feng , Gao Yuan , Lu Ya-wen , Song Xin-hua , Wang Jia-bo , Ma Zhi-tao
Published: May 2023

Background

Bao-Gan-Xing-Jiu-Wan (BGXJW) is a clinical experience-based Chinese herbal formula. Its efficacy, pharmacological safety, targeted function, process quality, and other aspects have met the evaluation standards and the latest requirements of preparations. It could prevent and alleviate the symptoms of drunkenness and alcoholic liver injury clinically. The present work aims to elucidate whether BGXJW could protect against drunkenness and alcoholic liver disease in mice and explore the associated mechanism.

Material and methods

We used acute-on-chronic (NIAAA) mice model to induce alcoholic steatosis, and alcohol binge-drinking model to reappear the drunk condition. BGXJW at indicated doses were administered by oral gavage respectively to analyze its effects on alcoholic liver injury and the associated molecular mechanisms.

Results

BGXJW had no cardiac, hepatic, renal, or intestinal toxicity in mice. Alcoholic liver injury and steatosis in the NIAAA mode were effectively prevented by BGXJW treatment. BGXJW increased the expression of alcohol metabolizing enzymes ADH, CYP2E1, and ALDH2 to enhance alcohol metabolism, inhibited steatosis through regulating lipid metabolism, counteracted alcohol-induced upregulation of lipid synthesis related proteins SREBP1, FASN, and SCD1, meanwhile it enhanced fatty acids β-oxidation related proteins PPAR-α and CPT1A. Alcohol taken enhanced pro-inflammatory TNF-α, IL-6 and down-regulated the anti-inflammatory IL-10 expression in the liver, which were also reversed by BGXJW administration. Moreover, BGXJW significantly decreased the blood ethanol concentration and alleviated drunkenness in the alcohol binge-drinking mice model.

Conclusions

BGXJW could effectively relieve drunkenness and prevent alcoholic liver disease by regulating lipid metabolism, inflammatory response, and alcohol metabolism.

Graphical Abstract
Effects of a peripherally acting µ-opioid receptor antagonist for the prevention of recurrent acute pancreatitis: study protocol for an investigator-initiated, randomized, placebo-controlled, double-blind clinical trial (PAMORA-RAP trial)
Authors: Cook Mathias E. , Knoph Cecilie S. , Fjelsted Camilla A. , Frøkjær Jens B. , Bilgrau Anders E. , Novovic Srdan , Jørgensen Maiken Thyregod , Mortensen Michael B. , Nielsen Liv B. J. , Hadi Amer , Berner-Hansen Mark , Rutkowski Wiktor , Vujasinovic Miroslav , Löhr Matthias , Drewes Asbjørn M. , Olesen Søren S.
Published: May 2023

Background

Acute and chronic pancreatitis constitute a continuum of inflammatory disease of the pancreas with an increasing incidence in most high-income countries. A subset of patients with a history of pancreatitis suffer from recurrence of acute pancreatitis attacks, which accelerate disease progression towards end-stage chronic pancreatitis with loss of exocrine and endocrine function. There is currently no available prophylactic treatment for recurrent acute pancreatitis apart from removing risk factors, which is not always possible. Pain is the primary symptom of acute pancreatitis, which induces the endogenous release of opioids. This may further be potentiated by opioid administration for pain management. Increased exposure to opioids leads to potentially harmful effects on the gastrointestinal tract, including, e.g. increased sphincter tones and decreased fluid secretion, which may impair pancreatic ductal clearance and elevate the risk for new pancreatitis attacks and accelerate disease progression. Peripherally acting µ-opioid receptor antagonists (PAMORAs) have been developed to counteract the adverse effects of opioids on the gastrointestinal tract. We hypothesize that the PAMORA naldemedine will reduce the risk of new pancreatitis attacks in patients with recurrent acute pancreatitis and hence decelerate disease progression.

Methods

The study is a double-blind, randomized controlled trial with allocation of patients to either 0.2 mg naldemedine daily or matching placebo for 12 months. A total of 120 outpatients will be enrolled from five specialist centres in Denmark and Sweden. The main inclusion criteria is a history of recurrent acute pancreatitis (minimum of two confirmed pancreatitis attacks). The primary endpoint is time to acute pancreatitis recurrence after randomization. Secondary outcomes include changes in quality of life, gastrointestinal symptom scores, new-onset diabetes, exocrine pancreatic insufficiency, disease severity, health care utilization, adherence to treatment, and frequency of adverse events. Exploratory outcomes are included for mechanistic linkage and include the progression of chronic pancreatitis-related findings on magnetic resonance imaging (MRI) and changes in circulating blood markers of inflammation and fibrosis.

Discussion

This study investigates if naldemedine can change the natural course of pancreatitis in patients with recurrent acute pancreatitis and improve patient outcomes.

Trial registration

EudraCT no. 2021–000069-34. ClinicalTrials.gov NCT04966559. Registered on July 8, 2021.
Detecting cervical esophagus with ultrasound on healthy voluntaries: learning curve
Authors: Reuter Paul-Georges , Ballouz Chris , Loeb Thomas , Petrovic Tomislav , Lapostolle Frédéric
Published: May 2023

Background

The objective of this study was to determine the learning curve of tracheal−esophageal ultrasound by prehospital medical and paramedical staff.

Methods

A single-center prospective study was carried out at a French EMS (SAMU 92). Volunteer participants first received a short theoretical training through e-learning, followed by two separate hands-on workshops on healthy volunteers, spaced one to two months apart. Learners were timed to obtain the tracheal–esophageal ultrasound target image 10 consecutive times. The first workshop was intended to perform a learning curve, and the second was to assess unlearning. The secondary objectives were to compare performance by profession and by previous ultrasound experience.

Results

We included 32 participants with a mean age of 38 (± 10) years, consisting of 56% men. During the first workshop, the target image acquisition time was 20.4 [IQR: 10.6;41] seconds on the first try and 5.02 [3.72;7.5] seconds on the 10th (p < 0.0001). The image acquisition time during the second workshop was shorter compared to the first one (p = 0.016). In subgroup analyses, we found no significant difference between physicians and nurses (p = 0.055 at the first workshop and p = 0.164 at the second) or according to previous ultrasound experience (p = 0.054 at the first workshop and p = 0.176), counter to multivariate analysis (p = 0.02).

Conclusions

A short web-based learning completed by a hands-on workshop made it possible to obtain the ultrasound image in less than 10 s, regardless of the profession or previous experience in ultrasound.
Split monotone variational inclusion with errors for image-feature extraction with multiple-image blends problem
Authors: Tianchai Pattanapong
Published: May 2023

In this paper, we introduce a new iterative forward–backward splitting algorithm with errors for solving the split monotone variational inclusion problem of the sum of two monotone operators in real Hilbert spaces. We suggest and analyze this method under some mild appropriate conditions imposed on the parameters such that another strong convergence theorem for this problem is obtained. We also apply our main result to image-feature extraction with the multiple-image blends problem, the split minimization problem, and the convex minimization problem, and provide numerical experiments to illustrate the convergence behavior and show the effectiveness of the sequence constructed by the inertial technique.
Achieving reductions in the unmet need for contraception with postpartum family planning counselling in Ethiopia, 2019–2020: a national longitudinal study
Authors: Mruts Kalayu Brhane , Tessema Gizachew A , Kassaw Nigussie Assefa , Gebremedhin Amanuel Tesfay , Scott Jane A , Pereira Gavin
Published: May 2023

Background

An unmet need for contraception is associated with unintended pregnancy and adverse maternal and childhood outcomes. Family planning counselling is linked with reduced unmet need for contraception. However, evidence is lacking in Ethiopia on the impact of integrated family planning counselling on the unmet need for contraception. This study aimed to examine the association between family planning counselling and the unmet need for contraception in Ethiopia.

Methods

We used community-based prospective cohort study data from a nationally representative survey conducted by Performance Monitoring for Action Ethiopia between 2019 and 2020. Women who had received three maternal and child health (MCH) services (n = 769) - antenatal care (ANC), facility delivery and child immunisation - were included in this study. The primary exposure variable was family planning counselling provided during the different MCH services. A weighted modified Poisson regression model was used to estimate the adjusted relative risk (aRR) of the unmet need for contraception.

Results

The prevalence of family planning counselling during ANC, prior to discharge, and child immunisation was 22%, 28%, and 28%, respectively. Approximately one-third (34%) of the women had an unmet need for contraception. Family planning counselling prior to discharge from the facility was associated with reductions in the unmet need for contraception (aRR 0.88; 95% CI 0.67, 1.16). The risk of unmet need for contraception was 31% (aRR 0.69; 95% CI 0.48, 0.98) less likely among women who had received family planning counselling during child immunisation services. However, family planning counselling during ANC was associated with an increased unmet need for contraception (aRR 1.24; 95% CI 0.93, 1.64).

Conclusion

Strongest evidence was observed for moderate associations between reductions in the unmet need for contraception and family planning counselling during the provision of child immunisation services in Ethiopia.
Accurate gingival segmentation from 3D images with artificial intelligence: an animal pilot study
Authors: Yang Min , Li Chenshuang , Yang Wen , Chen Chider , Chung Chun-Hsi , Tanna Nipul , Zheng Zhong
Published: May 2023

Background

Gingival phenotype plays an important role in dental diagnosis and treatment planning. Traditionally, determining the gingival phenotype is done by manual probing of the gingival soft tissues, an invasive and time-consuming procedure. This study aims to evaluate the feasibility and accuracy of an alternatively novel, non-invasive technology based on the precise 3-dimension (3D) soft tissue reconstruction from intraoral scanning and cone beam computed tomography (CBCT) to predict the gingival biotype.

Methods

As a proof-of-concept, Yorkshire pig mandibles were scanned, and the CBCT data were fed into a deep-learning model to reconstruct the teeth and surrounding bone structure in 3D. By overlaying the CBCT scan with the intraoral scans, an accurate superposition was created and used for virtual measurements of the soft tissue thickness. Meanwhile, gingival thicknesses were also measured by a periodontal probe and digital caliper on the buccal and lingual sides at 3 mm apical to the gingival margin of the posterior teeth and compared with the virtual assessment at the same location. The data obtained from virtual and clinical measurements were compared by Wilcoxon matched-pairs signed-rank analysis, while their correlation was determined by Pearson’s r value. The Mann–Whitney U test was used for intergroup comparisons of the amount of difference.

Results

Among 108 investigated locations, the clinical and virtual measurements are strongly positively correlated (r = 0.9656, P < 0.0001), and only clinically insignificant differences (0.066 ± 0.223 mm) were observed between the two assessments. There is no difference in the agreement between the virtual and clinical measurements on sexually matured samples (0.087 ± 0.240 mm) and pre-pubertal samples (0.033 ± 0.195 mm). Noticeably, there is a greater agreement between the virtual and clinical measurements at the buccal sites (0.019 ± 0.233 mm) than at the lingual sites (0.116 ± 0.215 mm).

Conclusion

In summary, the artificial intelligence-based virtual measurement proposed in this work provides an innovative technique potentially for accurately measuring soft tissue thickness using clinical routine 3D imaging systems, which will aid clinicians in generating a more comprehensive diagnosis with less invasive procedures and, in turn, optimize the treatment plans with more predictable outcomes.
Anti-inflammatory and antioxidative effects of gallic acid on experimental dry eye: in vitro and in vivo studies
Authors: Li Kexin , Gong Qianwen , Lu Bin , Huang Kaiyan , Tong Yixuan , Mutsvene Tinashe Emmanuel , Lin Meng , Xu Zhiqiang , Lu Fan , Li Xingyi , Hu Liang
Published: May 2023

Background

To investigate the anti-inflammatory and antioxidative effects of gallic acid (GA) on human corneal epithelial cells (HCECs) and RAW264.7 macrophages as well as its therapeutic effects in an experimental dry eye (EDE) mouse model.

Methods

A cell counting kit-8 (CCK-8) assay was used to test the cytotoxicity of GA. The effect of GA on cell migration was evaluated using a scratch wound healing assay. The anti-inflammatory and antioxidative effects of GA in vitro were tested using a hypertonic model (HCECs) and an inflammatory model (RAW264.7 cells). The in vivo biocompatibility of GA was detected by irritation tests in rabbits, whereas the preventive and therapeutic effect of GA in vivo was evaluated using a mouse model of EDE.

Results

In the range of 0–100 μM, GA showed no cytotoxicity in RAW264.7 cells or HCECs and did not delay the HCECs monolayer wound healing within 24 h. Ocular tolerance to GA in the in vivo irritation test was good after seven days. In terms of antioxidative activity, GA significantly reduced the intracellular reactive oxygen species (ROS) in lipopolysaccharide (LPS) activated RAW264.7 macrophages and HCECs exposed to hyperosmotic stress. Furthermore, after pre-treatment with GA, the expression levels of nuclear factor E2-related factor 2 (Nrf2), heme oxygenase-1 (HO-1), and NADPH quinone oxidoreductase-1 (NQO-1) were significantly upregulated in RAW264.7 macrophages. GA also exhibits excellent anti-inflammatory properties. This is mainly demonstrated by the ability of GA to effectively downregulate the nuclear transcription factor-κB (NF-κB) pathway in LPS-activated RAW264.7 macrophages and to reduce inflammatory factors, such as nitric oxide (NO), interleukin 6 (IL-6), and tumor necrosis factor alpha (TNF-α). In vivo efficacy testing results in a mouse model of EDE showed that GA can effectively prevent and inhibit the apoptosis of corneal epithelial cells (CECs), reduce inflammatory factors in the cornea and conjunctiva as well as protect goblet cells.

Conclusion

In vitro and in vivo results indicate that GA possesses potent anti-inflammatory and antioxidative properties with no apparent cytotoxicity within the range of 0–100 μM. It is a promising eye drop formulation for the effective prevention and treatment of dry eye disease (DED).
Changes in the posterior corneal surface after femtosecond laser-assisted lenticule intrastromal keratoplasty (LIKE) performed into a pocket (SMI-LIKE) or under a flap (FS-LIKE)
Authors: Liu Shengtao , Yu Lanhui , Zhao Yu , Zhou Xingtao
Published: May 2023

Background

To compare the changes in posterior corneal surface after small-incision lenticule intrastromal keratoplasty (SMI-LIKE) and femtosecond laser-assisted lenticule intrastromal keratoplasty (FS-LIKE) for hyperopia correction.

Methods

In this prospective comparative randomized study, 23 eyes with hyperopia were recruited. Eyes were categorized into two groups—SMI-LIKE group (11 eyes) and FS-LIKE group (12 eyes). Lenticules from myopia small incision lenticule extraction were implanted into a pocket (SMI-LIKE group) or at a depth of 100 µm under a flap (FS-LIKE group). Posterior corneal elevations in the center, mid-periphery, and periphery, as well as mean keratometry of the posterior corneal surface (Kmb) were measured using a Pentacam over a three-month follow-up.

Results

All surgeries were completed successfully and no complications occurred. At one day postoperatively, there was a slight backward change with SMI-LIKE and a forward change with FS-LIKE in the central region of the posterior corneal elevation. Conversely, the peripheral area showed forward displacement in SMI-LIKE and an apparent backward change in FS-LIKE. The mid-peripheral regions manifested a backward change after the procedure throughout the entire follow-up in both groups. Kmb exhibited flattening at one month postoperatively and subsequently returned to its original level at three months after SMI-LIKE while in FS-LIKE, Kmb steepened after lenticule implantation with a significant change noted at one day postoperatively (P = 0.001).

Conclusions

Posterior corneal surface after SMI-LIKE and FS-LIKE exhibited different change patterns in various corneal regions, with the most prominent change occurring at one day postoperatively during the three-month follow-up.

Trial registration: Chinese Clinical Trial Registry: ChiCTR-ONC-16008300. Registered on Apr 18th, 2016. http://www.chictr.org.cn/edit.aspx?pid=14090&htm=4
Association of antithrombotic therapy with postoperative rebleeding in patients with cerebral amyloid angiopathy
Authors: Yanagawa Taro , Sato Hiroki , Suzuki Kaima , Ooigawa Hidetoshi , Takao Masaki , Kurita Hiroki
Published: May 2023

Background

Cerebral amyloid angiopathy is a common cause of subcortical hemorrhage in older adults. Although open hematoma removal may be performed for severe subcortical hemorrhage, its safety in patients with cerebral amyloid angiopathy has not been established, and postoperative rebleeding may occur. Therefore, this study aimed to investigate factors associated with postoperative rebleeding.

Methods

Out of 145 consecutive patients who had undergone craniotomy for surgical removal of subcortical intracerebral hemorrhage between April 2010 and August 2019 at a single institution in Japan, we examined 109 patients with subcortical hemorrhage who met the inclusion criteria. After excluding 30 patients whose tissue samples were unsuitable for the study, the final study cohort comprised 79 patients.

Results

Of the 79 patients, 50 (63%) were diagnosed with cerebral amyloid angiopathy (cerebral amyloid angiopathy group) and 29 (37%) were not diagnosed with noncerebral amyloid angiopathy (noncerebral amyloid angiopathy group). Postoperative rebleeding occurred in 12 patients (24%) in the cerebral amyloid angiopathy group and in 2 patients (7%) in the noncerebral amyloid angiopathy group. Preoperative prothrombin time–international normalized ratio and intraoperative bleeding volume were significantly associated with postoperative rebleeding in the cerebral amyloid angiopathy group (odds ratio = 42.4, 95% confidence interval = 1.14–1578; p = 0.042 and odds ratio = 1.005, 95% confidence interval = 1.001–1.008; p = 0.007, respectively).

Conclusions

Patients with cerebral amyloid angiopathy-related cerebral hemorrhage who are receiving antithrombotic therapy, particularly warfarin therapy, are at a high risk of postoperative rebleeding.

Trial registration

Registry and Registration Number of the study: 19–220, 2019/12/23, retrospectively registered.
Leave-one-out cross-validation, penalization, and differential bias of some prediction model performance measures—a simulation study
Authors: Geroldinger Angelika , Lusa Lara , Nold Mariana , Heinze Georg
Published: May 2023

Background

The performance of models for binary outcomes can be described by measures such as the concordance statistic (c-statistic, area under the curve), the discrimination slope, or the Brier score. At internal validation, data resampling techniques, e.g., cross-validation, are frequently employed to correct for optimism in these model performance criteria. Especially with small samples or rare events, leave-one-out cross-validation is a popular choice.

Methods

Using simulations and a real data example, we compared the effect of different resampling techniques on the estimation of c-statistics, discrimination slopes, and Brier scores for three estimators of logistic regression models, including the maximum likelihood and two maximum penalized likelihood estimators.

Results

Our simulation study confirms earlier studies reporting that leave-one-out cross-validated c-statistics can be strongly biased towards zero. In addition, our study reveals that this bias is even more pronounced for model estimators shrinking estimated probabilities towards the observed event fraction, such as ridge regression. Leave-one-out cross-validation also provided pessimistic estimates of the discrimination slope but nearly unbiased estimates of the Brier score.

Conclusions

We recommend to use leave-pair-out cross-validation, fivefold cross-validation with repetitions, the enhanced or the .632+ bootstrap to estimate c-statistics, and leave-pair-out or fivefold cross-validation to estimate discrimination slopes.
Comparison of clinical features, disease activity, treatment and outcomes between late-onset and early-onset patients with systemic lupus erythematosus. A sex- and year at diagnosis-matched controlled study
Authors: Mongkolchaiarunya Jarukit , Wongthanee Antika , Kasitanon Nuntana , Louthrenoo Worawit
Published: May 2023

Background

Several studies have compared the clinical features and outcomes of late- and early-onset systemic lupus erythematosus (SLE) patients. However, these previous studies were uncontrolled. The current study aimed to compare late- and early-onset SLE patients while controlling for sex and year at diagnosis (± 1 year).

Methods

The medical records of SLE patients in a lupus cohort from January 1994 to June 2020 were reviewed. Late-onset patients were identified as those with an age at diagnosis ≥ 50 years. The early-onset patients (age at diagnosis < 50 years) were matched by sex and year at diagnosis with the late-onset patients at a ratio of 2:1. Clinical manifestations, disease activity (mSLEDAI-2K), organ damage scores, treatment, and mortality were compared between the two groups.

Results

The study comprised 62 and 124 late- and early-onset patients, respectively, with a mean follow-up duration of 5 years. At disease onset, when comparing the early-onset patients with the late-onset patients, the latter group had a higher prevalence rate of serositis (37.0% vs. 14.5%, p < 0.001) and hemolytic anemia (50.0% vs. 33.9%, p = 0.034) but lower prevalence rate of malar rash (14.5% vs. 37.1%, p = 0.001), arthritis (41.9% vs. 62.1%, p = 0.009), leukopenia (32.3% vs. 50.0%, p = 0.022) and lymphopenia (50.0% vs. 66.1%, p = 0.034). The groups had similar SLE disease activity (7.41 vs. 7.50), but the late-onset group had higher organ damage scores (0.37 vs. 0.02, p < 0.001). The rates of treatment with corticosteroids, antimalarial drugs, or immunosuppressive drugs were not different. At their last visit, the late-onset patients still had the same pattern of clinically significant differences except for arthritis; additionally, the late-onset group had a lower rate of nephritis (53.2% vs. 74.2%, p = 0.008). They also had a lower level of disease activity (0.41 vs. 0.57, p = 0.006) and received fewer antimalarials (67.7% vs. 85.5%, p = 0.023) and immunosuppressive drugs (61.3% vs. 78.2%, p = 0.044), but they had higher organ damage scores (1.37 vs. 0.47, p < 0.001) and higher mortality rates/100-person year (3.2 vs. 1.1, p = 0.015). After adjusting for disease duration and baseline clinical variables, the late-onset patients only had lower rate of nephritis (p = 0.002), but still received fewer immunosuppressive drugs (p = 0.005) and had a higher mortality rate (p = 0.037).

Conclusions

In this sex- and year at diagnosis-matched controlled study, after adjusting for disease duration and baseline clinical variables, the late-onset SLE patients had less renal involvement and received less aggressive treatment, but had a higher mortality rate than the early-onset patients.
DLP: towards active defense against backdoor attacks with decoupled learning process
Authors: Ying Zonghao , Wu Bin
Published: May 2023

Deep learning models are well known to be susceptible to backdoor attack, where the attacker only needs to provide a tampered dataset on which the triggers are injected. Models trained on the dataset will passively implant the backdoor, and triggers on the input can mislead the models during testing. Our study shows that the model shows different learning behaviors in clean and poisoned subsets during training. Based on this observation, we propose a general training pipeline to defend against backdoor attacks actively. Benign models can be trained from the unreliable dataset by decoupling the learning process into three stages, i.e., supervised learning, active unlearning, and active semi-supervised fine-tuning. The effectiveness of our approach has been shown in numerous experiments across various backdoor attacks and datasets.
Increasing trend toward joint-preserving procedures for hip osteonecrosis in the United States from 2010 to 2019
Authors: Ng Mitchell K. , Kobryn Andriy , Golub Ivan J. , Piuzzi Nicolas S. , Wong Che Hang Jason , Jones Lynne , Mont Michael A.
Published: May 2023

Introduction

The incidence of osteonecrosis of the femoral head is estimated at about 10 to 20,000 patients annually, and, when left untreated, 80% or more of cases progress to femoral head collapse. A series of joint-preserving procedures have been developed to prevent/delay the need for hip arthroplasty. The aim of this study was to provide a five-year update: (1) evaluating temporal trends of arthroplasty vs. joint-preservation techniques such as core decompression, bone grafting, osteotomies, and arthroscopy; (2) determining proportions of procedures in patients aged less than vs. over 50 years; and (3) quantifying rates of specific operative techniques.

Methods

A total of 10,334 patients diagnosed with osteonecrosis of the femoral head and having received hip surgery were identified from a nationwide database between 1 January 2010 and 31 December 2019, by using the International Classification of Disease, the Ninth/Tenth revision (ICD-9/10) codes. The percentage of patients managed by each operative procedure was calculated annually. To identify trends, patients were grouped by age under/over 50 years and divided into a joint-preserving and a non-joint-preserving (arthroplasty) group. Chi-squared tests were performed to compare the total number of procedures per year.

Results

Rates of arthroplasty far exceeded those for joint-preserving procedures. However, from 2015 to 2019, significantly more joint-preserving procedures were performed than in 2010 to 2014 (4.3% vs. 3.0%, P < 0.001). Significantly more joint-preserving procedures were performed in patients aged < 50 years relative to those ≥ 50 years (7.56% vs. 1.86%, P < 0.001). Overall, total hip arthroplasty was the most common procedure (9,814; 94.97%) relative to core decompression (331; 3.20%), hemiarthroplasty/resurfacing (102; 0.99%), bone grafting (48; 0.46%), and osteotomy (5; 0.05%).

Conclusion

Management of patients who have osteonecrosis of the femoral head continues to be predominantly arthroplasty procedures, specifically, total hip arthroplasty. Our findings suggest a small, but significant trend toward increased joint-preserving procedures, especially in patients under 50 years. In particular, the proportion of patients receiving core decompression has increased significantly from 2015 to 2019 relative to prior years.
Would a complete electrophysiological study allow us to make a correct diagnosis? Case report
Authors: Chávez-González Elibet , Carmona-Puerta Raimundo , Rodríguez-González Fernando , Cruz-Elizundia Juan Miguel , Torres-Acosta Cynthia
Published: May 2023

Background

Oblique course of some left accessory pathways is rare An incomplete electrophysiological study may confuse us between an oblique accessory pathway or the presence of two accessory pathways. The proximity of all atrial and ventricular electrograms, at each pole of the catheter, within the coronary sinus may be a novel finding.

Case presentation

A 68-year-old woman patient presented arrhythmias with hypotension requiring electrical cardioversion. Her electrocardiogram (ECG) was interpreted as atrial fibrillation by accessory pathway. We performed with the protocol of ablation stablished in our laboratory: two punctures on the right femoral vein with placement of introducers (8F and 7F) by Seldigner technique and one puncture on the left femoral vein (7F). The study was performed with BIOTRONIK technology (Multicath study catheter), a non-deflectable 7F quadripolar catheter with 2 mm tip electrode to record the His electrogram, a non-deflectable decapolar catheter with 5 pairs of coronary sinus (CS) electrodes. Accessory pathway mapping was performed in right and left cavities and within the CS. All electrograms into CS showed short AV from proximal to distal CS. Finally, ablation of two accessory pathway recordings was achieved at two distant epicardial points within the CS.

Conclusions

Ablation at two distant sites, one on the ventricular side and the other on the mitral annulus, suggests the presence of an oblique accessory pathway and at the same time the differential diagnosis of the presence of two accessory pathways. In our point of view according the above, we consider this is a very rare case of oblique AP with epicardial trajectory. The sequence of electrograms (in this case) along the CS has not been seen before in the literature reviewed. It is important, regardless of the urgency, to follow diagnostic and therapeutic protocols in invasive electrophysiology.