bluuebunny/crossref_metadata_2025 huggingface dataset:
Improved performance and stability of perovskite solar modules by interface modulating with graphene oxide crosslinked CsPbBr3 quantum dots
Authors: Zhang Shujing , Guo Rui , Zeng Haipeng , Zhao Yang , Liu Xingyue , You Shuai , Li Min , Luo Long , Lira-Cantu Monica , Li Lin , Liu Fengxiang , Zheng Xin , Liao Guanglan , Li Xiong
Published: November 2021

A multifunctional interface modulator GO/(CsPbBr3 QD) composite decreases resistive losses of perovskite solar modules by enhanced charge transport and decreased carrier recombination, as well as inhibiting ion/molecule diffusion.
Self-powered seesaw structured spherical buoys based on a hybrid triboelectric–electromagnetic nanogenerator for sea surface wireless positioning
Authors: Hong Hongxin , Yang Xiya , Cui Hui , Zheng Duo , Wen Haiyang , Huang Ruiyuan , Liu Liqiang , Duan Jialong , Tang Qunwei
Published: November 2021

A self-powered seesaw-structured spherical triboelectric–electromagnetic hybrid nanogenerator buoy combining various working modes is presented for sea surface wireless positioning.
A niobium oxide with a shear structure and planar defects for high-power lithium ion batteries
Authors: Li Tongtong , Nam Gyutae , Liu Kuanting , Wang Jeng-Han , Zhao Bote , Ding Yong , Soule Luke , Avdeev Maxim , Luo Zheyu , Zhang Weilin , Yuan Tao , Jing Panpan , Kim Min Gyu , Song Yanyan , Liu Meilin
Published: November 2021

The micrometer-sized H-Nb2O5 could achieve fast lithium-ion storage by engineering its planar defects.
Ultrafine-grained Ni-rich layered cathode for advanced Li-ion batteries
Authors: Park Geon-Tae , Yoon Dae Ro , Kim Un-Hyuck , Namkoong Been , Lee Junghwa , Wang Melody M. , Lee Andrew C. , Gu X. Wendy , Chueh William C. , Yoon Chong S. , Sun Yang-Kook
Published: November 2021

The ultrafine-grained Ni-enriched Li[Ni0.95Co0.04Mo0.01]O2 (NCMo95) cathode achieved by inhibiting particle coarsening imparts the necessary mechanical toughness and significantly extends the battery life.
Facile access to template-shape-replicated nitrogen-rich mesoporous carbon nanospheres for highly efficient CO2 capture and contaminant removal
Authors: Shingdilwar Shashikant , Dolui Subrata , Kumar Devendra , Banerjee Sanjib
Published: November 2021

Novel nitrogen-rich mesoporous carbon nanospheres (NMCN) with high surface area and ordered pore geometry are prepared via a facile pathway for efficient CO2 capture and contaminant removal applications.
Is cannabidiolic acid an overlooked natural antioxidant? Insights from quantum chemistry calculations
Authors: Boulebd Houssem
Published: November 2021

The radical scavenging capacity of CBDA is moderate in lipid media but it is very important in water via the SET mechanism.
Heterogeneous copper-catalyzed synthesis of diaryl sulfones
Authors: Gong Xinchi , Shen Zhengqi , Wang Ganghu , Qu Lingling , Zhu Chunyin
Published: November 2021

A carbon-supported copper nanoparticle (Cu-NP) with high catalytic activity for the synthesis of diaryl sulfones is reported.
Catalytic asymmetric synthesis of α-stereogenic carboxylic acids: recent advances
Authors: Niu Rui , He Yi , Lin Jun-Bing
Published: November 2021

This review illustrates recent advances and further potential of catalytic asymmetric synthesis of α-stereogenic free carboxylic acids from racemic or prochiral precursors.
Synthesis of 5,7-diarylindolesviaSuzuki–Miyaura coupling in water
Authors: Elumalai Vijayaragavan , Hansen Jørn H.
Published: November 2021

Straightforward access to a range of novel, fluorescent 5,7-diarylindolesviaSuzuki–Miyaura coupling.
Asymmetric synthesis of functionalized 2,3-dihydrobenzofurans using salicyl N-phosphonyl imines facilitated by group-assisted purification (GAP) chemistry
Authors: Rouh Hossein , Tang Yao , Zhang Sai , Ali Ahmed I. M. , Unruh Daniel , Surowiec Kazimierz , Li Guigen
Published: November 2021

A new asymmetric method for the synthesis of highly functionalized 2,3-dihydrobenzofuranes in good to high yields and excellent diastereoselectivity via group-assisted purification (GAP) chemistry.
A multifunctional material with distinct mechanochromic and piezochromic properties: π-stacking in play
Authors: Ding Zeyang , Lu Tong , Bi Changjiang , Li Bao , Zhang Shi-Tong , Xu Weiqing , Jiang Shimei
Published: November 2021

Opposite emission variations under anisotropic shearing and isotropic pressure are observed, which are attributed to the destruction and reinforcement of molecular π–π interactions, respectively.
Anticipatory Completions in Conversations Between People Who Stutter and People Who Do Not Stutter
Authors: Kondrashov Sergey M. , Tetnowski John A.
Published: November 2021

Purpose:

The purpose of this study was to explore the following topics. (a) What are the specific stuttering moments that trigger anticipatory completions? (b) How do people who stutter (PWS) perceive anticipatory completions of their turn by people who do not stutter (PWNS)? (c) What are the expectations of PWS from PWNS in a conversation between them?

Method:

In this qualitative study, the researchers used grounded theory to help analyze the collected data. The data sources were 26 observations, conversations, and interviews. A similar version could be used in the body of the text when the study is described.

Results:

Five out of six participants experienced anticipatory completions during stuttering moments. Hypothesis 1, “Anticipatory completions by PWNS occur at specific stuttering moments,” was accepted. Hypothesis 2, “PWS have negative perceptions and feelings of anticipatory completions by PWNS,” was not verified during interviews with three participants; therefore, the researchers revised Hypothesis 2 into “PWS do not always have negative perceptions and feelings of anticipatory completions by PWNS.” Five out of six participants expected PWNS to let them finish what they are saying; therefore, the researchers accepted Hypothesis 3, “PWS expect PWNS to let them finish what they are saying.”

Conclusion:

The main findings of this study include verification that the participants used anticipatory completions at specific stuttering moments and nonstuttering moments in one case, PWS do not always have negative perceptions and feelings about anticipatory completions by PWNS, and PWS expect PWNS to let them finish what they are saying.
Mafic mineralogy assemblages at the Chang’e-4 landing site: A combined laboratory and lunar in situ spectroscopic study
Authors: Liu C. , Liu L. , Chen J. , Cao H. , Qu H. , Qiao L. , Zhang J. , Qi X. , Lu X. , Xu R. , Wang Z. , He Z. , Ling Z.
Published: November 2021

Context.Chang’e-4 (CE-4) provides unprecedented information about lunar materials exposed by the South Pole-Aitken (SPA) basin. Diverse results have been obtained from previous interpretations of CE-4 visible and near-infrared (VNIR) spectra. Some studies suggest that materials at the CE-4 landing site are dominated by olivine and orthopyroxene, but others argue that only a small amount of olivine should be exposed at the CE-4 landing site.

Aims.Laboratory spectroscopy studies using the Engineering Model of CE-4 Visible and Near-infrared Imaging Spectrometer (VNIS) are critical in constraining the accurate mineral proportions and composition of soils and boulders at the CE-4 landing site.

Methods.VNIR spectra of nine lunar analogs – prepared by mixing orthopyroxene (OPX), clinopyroxene (CPX), olivine (OL), and plagioclase – were acquired using the CE-4 VNIS Engineering Model. The spectral indices model and modified Gaussian model were developed to estimate CPX/(CPX+OPX) and OL/(OL+CPX+OPX) and are applicable to the in situ spectra acquired by the Yutu-2 VNIS spectrometer.

Results.The lunar rocks and regolith at the CE-4 landing site excavated by the Finsen impact are CPX-rich with limited OL (CPX:OPX:OL = 56:29:17). The mineral chemistries of the four lunar rocks show Mid-Ca, Fe pyroxene, and Mid-Mg OL (Fo60−79), providing critical constraints for mineral compositions in the SPA compositional anomaly. These rocks exhibit high M1 intensity ratios, indicating that they were crystallized at a high temperature (980–1300 °C) and a rapid-cooling magmatic system produced by impact melt differentiation or volcanic resurfacing events.
Index of Mangrove Health Around the Ex-Bauxite Mining Area, Tanjungpinang City, Riau Islands Province
Authors: Azizah Diana , Hamidy Rasoel , Mubarak Mubarak , Efriyeldi Efriyeldi , Muzammil Wahyu , Lestari Febrianti , Murtini Sri
Published: November 2021

There are several former bauxite mining areas on Bintan Island which until now have been left open and not managed properly. In Tanjungpinang, the location of the former bauxite mine is located around the mangrove forest ecosystem. The impact of bauxite mining that changes the structure, texture, and physical of the soil can interfere with the development of the root system and the growth of surrounding plants, including mangroves. Therefore, it is necessary to know the health condition of mangroves around the former bauxite mining area. The method used is a cluster plot by calculating the percentage of tree damage based on organ location, type, and level of damage. The results of the analysis show that the health condition of the mangrove forest in Tanjungpinang City is healthy (50,9%); slightly damaged (40,4%) and moderately damaged (8,8%). The locations of the organs that suffered the most damage were roots, lower and upper stems, and leaves. The most common type of damage found roots submerged in red mud; stems and leaves covered with dust and red sand; termite; broken stem; roots break and die; broken shoots; and the leaves change color. The greatest severity is found between 10% and 20%.
Marine Pollution 73/ 78 IMO convention: a tool for sustainable marine resources in Kepulauan Riau Province
Authors: Zacky Abdurrahman , Akbar Dhani , Syakti Agung Dhamar
Published: November 2021

Annual sludge oil mitigation in Kepulauan Riau is one of the government’s efforts to comply with the results of the Convention of Marine Pollution (MARPOL) 73/ 78 IMO which is well-known as the basis of efforts to prevent pollution at ocean caused by economic activities at sea. This research aims to observe and evaluate the government effort to comply with the MARPOL 73/ 78 convention and its annual implementation response and mitigate illegal sludge oil activity in Kepulauan Riau Province. The data collection was carried out by sampling method to contaminated areas in Batam and Bintan as a locus of the research. Analysis of Green Theory, in the discipline of International Relations, conducted to provide a spotlight on environmental aspects in a sludge oil occurrence. The understanding of the concept of triangulation between environmental, economic, and state aspects is the basis for understanding the sludge oil issue, which is trying to be described through the perspective of global environmental ethics. It is shown that the overall efforts made by the government are in accordance with the MARPOL 73/78 and environmental analysis based on Green Theory. In conclusion, upcoming mitigation to be improved are appropriate budgeting, technology to response and prevent the occurrence, socialization and empowering coastal local communities, and optimizing regional collective responsibility and cooperation
Formulation of Seaweed (Sargassum polycystum) and Mangrove (Rhizophora apiculata) Leaf as Antimosquito Lotion
Authors: Apriliani Endah Putri , Sari Putri Raja Marwita , Apriandi Azwin
Published: November 2021

Mosquito repellent lotions generally use ingredients such as diethyltoluamide (DEET). DEET has been mixed by the manufacture of commercial mosquito repellent lotions and used by consumers without regard to the consequences if it is continuing used. Though many natural plants, especially marine plants can also provide the same benefits as a mosquito repellent. Therefore, in this study the aim was to make a lotion based on seaweed (Sargassum polycystum) and mangrove leaves (Rhizophora apiculata) as a mosquito repellent. The treatments in this study were 30% seaweed (L1), 30% mangrove leaf (L2), 15% seaweed, and 15% mangrove leaf (L3), and control (L0). The results showed that the effectiveness of the protective vover of anti-mosquito lotion S. polycystum (L1) was able to protect for 2 hours, (L2) mangrove leaf lotion was able to protect for 4 hours and S. polycycstum lotion and mangrove leaf R. apiculata (L3) were able to protect for 3 hours
An Analysis of Maritime Security Concept Based on International Safety Management (ISM) Code at The II Class Harbormaster and Port Authority (KSOP) Tanjungpinang
Authors: Simanjuntak Carry Anggun , Putra Risandi Dwirama , Yahya Glory Yolanda , Akbar Dhani , Riyadi Sayed Fauzan
Published: November 2021

The ISM Code’s objective is to improve safety and prevent accidents and pollution as regulated by the International Maritime Organization and has been ratified since 1994 by Indonesia and applies to each province, including the Riau Archipelago. The Riau Archipelago almost had 96% of the marine area as its territory and directly borders Singapore and Malaysia with high sea transportation activities and has a strategic role in international trade traffic. This study aimed to analyze the implementation of the ISM Code at KSOP II Class Tanjungpinang through the concept of maritime security. The research method used was the qualitative method. The data obtained were systematically compiled and analyzed qualitatively using the international regime effectiveness analysis. The concept of maritime security was used to answer the implementation of the ISM Code at II Class KSOP Office Tanjungpinang. The application of the ISM Code at II Class KSOP Office Tanjungpinang had to be considered to ensure safe sea transportation activities as regulated by IMO and legalized in each province of Indonesia. The results of this study were necessary to optimize each maritime actor’s function who had legal responsibilities. There were required changes in focus, understanding, and awareness of the importance of maritime security to optimize resources and tasks on an ongoing basis and emphasize preventive and repressive efforts. This assisted in preventing the recurrence of threats and violations of the law in the marine area directly adjacent to the Riau Archipelago.
Price negotiation and coordination in outsourcing supply chain under yield and demand uncertainties
Authors: Chen Zhiming , Chen Chongping
Published: November 2021

This paper considers the issues of pricing, lot-sizing decisions and coordination in a supply chain consisting of one original equipment manufacturer (OEM) and one contract manufacturer (CM). A Bayesian game accounting for asymmetric information is established to optimize the CM’s outsourcing price and the OEM’s selling price. A Stackelberg game incorporating yield and demand uncertainties is subsequently modelled to optimize the CM’s production quantity and the OEM’s order quantity. Finally, a shortage penalty with surplus purchase contract is proposed to coordinate the supply chain. It is found that the optimal outsourcing price is either the lower limit or the stationary point of the common price domain, while the optimal selling price is the upper limit. Whether the CM adopts a conservative or an aggressive production strategy depends on the threshold of the outsourcing price. Moreover, the coordination contract offers great flexibility in parameter selection. By setting the order quantity, penalty price and surplus purchase price properly, the supply chain can realize a win-win situation.
Proposed indicators for socio taqwa index indicator in Kelantan state Government
Authors: Fatinah Binti Mohd Azhar Nur , Nuri Al-Amin Endut Mohd , Ridhuan Tony Lim Abdullah Muhammad
Published: November 2021

The Kelantan state government has used the Developing with Islam policy to carry out its administration since 1990 in the state of kelantan. Various programs and changes have been implemented in 5 aspect which is in administration, shariah, economy, education and sociology. Since 1990, the Developing with Islam policy still ongoing. However, no comprehensive study has been conducted on all aspects of the Developing with Islam policy. Therefore, this study was conducted to produce appropriate indicators that will be used to see the effectiveness of the Developing with Islam policy in Kelantan. In this study paper will explain where these indicators are come from. By having this indicators, Kelantan state government can create an index and at the same time can evaluate the achievement of the policy since the policy was implemented. The result can help Kelantan state government to make improvement from time to time and become as a good example of Islamic state in Malaysia.
Digital Marketing Perspective in Cattle Business: Supply Chain Integrated Approach
Authors: Ariffin Ahmad Shabudin , Ramli Mona Fairuz , Ashari Hasbullah
Published: November 2021

The Malaysian economy has experienced robust economic growth over the past few decades, averaging around 6 per cent a year since 2000. With competitive pressure for resources from non-agriculture sectors, there is likely to be an inadequate capacity to increase agricultural production. Attaining agriculture business performance continued relevance remains demanding in the Eleventh Malaysia Plan. Anchored in the supply chain management philosophy, this paper highlights cattle businesses and the interrelated elements of supply chain integration and a digital marketing perspective. The cattle meat industry in Malaysia is gradually transforming from unorganized backyard farming into organized farming. However, the supply chains are still characterized by inefficiencies, diseconomies of scale, lack of investments, and inadequate arrangement. Therefore, to improve the efficiency and economy of scale, added value chain is required. One form of value creation is technology adoption. The digital marketing part of technology currently leads to the adoption new business policies in agriculture production. Policies and procedures also need to be eased to facilitate investments to increase production. This paper concludes that, in many important ways, the Malaysian Government still sees food security as a public obligation, especially in the case of protein-based products, and is working attentively to increase food security for its citizens.
Stock Performance Comparison between Green Innovation Sharia Companies and Green Innovation Non-Sharia Companies: Evidence from Indonesia Stock Exchange
Authors: Nurhayadi Yadi , Wijiharjono N. , Al-Azizah Ummu S. , Johl Satirenjit K. , Shamim A. , Kaur Shireenjit
Published: November 2021

This Research is about comparison between sharia companies and non-sharia companies in the stock market. Several previous studies have shown that in the stock market, the stock performance of sharia companies is better to that of non-sharia companies. Then this research increases the qualification of the companies to become companies that have implemented green innovation technology. This qualification is applied to companies listed in the Sri-Kehati index on the Indonesia Stock Exchange. Through bivariate and multivariate analysis, the results showed that the stock performance of non-sharia companies was better than those of sharia companies. Bivariate analysis show that the positive gradient of non-sharia trendline (168.37) is bigger than sharia trendline (11.633). The coefficient of determination between non-sharia stocks and Sri-Kehati index (86.41%) is bigger than between sharia stocks and Sri-Kehati index (26.46%). Multivariate analysis obtained a multiple linear regression equation of 1 2 yˆ =117.187 + 0.0081x1 + 0.014397 x2. This equation shows that the variable coefficient of the value of sharia stocks is smaller than the coefficient of the variable value of non-sharia stocks. These facts are based on research on Sri-Kehati index data from 2016 to 2019. The results of this study indicate that investors prefer to invest in shares in non-sharia companies than in sharia companies. The results also indicate that increasing the qualifications of a sharia company to become a company that applies green innovation technology will not necessarily increase its share value. Is upgrading the qualification of a sharia company to a sharia company that applies green innovation technology a mistake? Meanwhile, Indonesia is a country with the largest Muslim population in the world.
The Impact of Transformational Leadership on Job Satisfaction and Employee Turnover Intentions: A Conceptual Review
Authors: Gan Evelyn , Voon Mung Ling
Published: November 2021

All employees deserve a decent working environment in order to be productive in their work. High employee turnover has adverse effects on economic growth as companies incur additional costs and experience drop in productivity. Hence, identifying the factors that reduce employee turnover intention is in line with Sustainable Development Goals. This review paper aims to improve our understanding of the relationship between transformational leadership style and job satisfaction, and examines their impact on reducing employee turnover intention. The literature review has proved that transformational leadership and job satisfaction greatly influence an employee’s decision to leave or stay with his or her organisation. Based on the literature, this paper also provides recommendations for future research areas that would provide valuable information in helping organisations reduce employee turnover intention, and ultimately employee turnover.
The Moderating Role of Consumer Characteristics on E-Loyalty in E-banking business: A Multigroup Analysis
Authors: Aziza Chaima , Kassim Norizan Mohd
Published: November 2021

Noticing the recent development in internet banking in different parts of the world has resulted in increasing online transactions without visiting the bank. Thus, this study investigates the importance of antecedents of e-loyalty—shared value, information quality, system quality, service quality, trust, attraction, and satisfaction— in using e-banking services and the role of consumer characteristics (gender, age, and level of education) as a moderator was analyzed as well. A survey questionnaire was distributed conveniently via online and face-to-face to customers in Muscat and Nizwa to gain important insights on how customer loyalty in the e-banking business is constructed. A total of 228 usable questionnaires were collected and analyzed using descriptive statistics, multigroup analysis, and structural equation modelling to test the hypotheses. Results of the analyses indicated that e-loyalty is found to be positively influenced by satisfaction, which later influenced by trust, attraction, shared value, information quality, system quality, service quality. The moderating role of gender, age, and level of education was supported by the data. The paper concludes some implications and limitations of the results are discussed. Besides, investigating which factors are important in driving customers using online banking, this study provides a deeper understanding of keeping customers online and loyal to a particular service provider. Specifically, the service providers need to focus on the importance of gender, age, and level of education in moderating the construction of e-loyalty in using e-banking services. This study provides new insights by adding attraction as an antecedent of customer satisfaction and the moderating role of consumer characteristics in using e-banking services.
Irregularity in Plantar Fascia, Muscle Edema and Tendon Thickness in
Patients with High-Risk for Diabetic Foot
Authors: Korkmaz Busra Yurumez , Akturk Mujde , Ucar Murat , Altınova Alev Eroglu , Can Mehmet Ali , Arslan Emre , Tokgoz Nil , Toruner Fusun
Published: November 2021

Aim To investigate the alterations in the plantar fascia (PF), intrinsic
muscles, and tendons in the feet of patients at high risk for developing
diabetic foot.

Methods The healthy feet of 22 patients with type 2 diabetes, who had
developed diabetic foot ulcers on a single foot without any pathology on the
contralateral extremity, and those of 22 healthy volunteers were evaluated by
magnetic resonance imaging. The volume of the Achilles tendon (AT), the surface
area of the PF, the thickness of AT, flexor hallucis longus, flexor digitorum
longus, tibialis posterior, and peroneus longus tendons, irregularity in the PF,
and edema of intrinsic foot muscles were examined.

Results Nineteen patients (86%) had irregularity in the PF,
whereas none of the healthy controls had any (p<0.001). Intrinsic muscle
edema was more common in the group with diabetes (p=0.006). The volume
of AT and the surface area of PF were decreased in patients with peripheral
arterial disease (PAD) (p<0.05). Patients with diabetes mellitus but
without PAD had a larger surface area of PF than that of controls
(p<0.05). There were no differences in the volume of AT, the surface
area of the PF, and other tendon thickness between the groups.

Conclusion Irregularity in the PF and muscle edema may indicate a high
risk for the diabetic foot. The presence of PAD may lead to regression in the
structure of AT and PF.
Central Ocular Motor Disorders: Clinical and Topographic Anatomical Diagnosis, Syndromes and Underlying Diseases
Authors: Strupp Michael Leo , Straumann Dominik , Helmchen Christoph
Published: November 2021

The key to the diagnosis of ocular motor disorders is a systematic clinical examination of the different types of eye movements, including eye position, spontaneous nystagmus, range of eye movements, smooth pursuit, saccades, gaze-holding function, vergence, optokinetic nystagmus, as well as testing of the function of the vestibulo-ocular reflex (VOR) and visual fixation suppression of the VOR. This is like a window which allows you to look into the brain stem and cerebellum even if imaging is normal. Relevant anatomical structures are the midbrain, pons, medulla, cerebellum and rarely the cortex. There is a simple clinical rule: vertical and torsional eye movements are generated in the midbrain, horizontal eye movements in the pons. For example, isolated dysfunction of vertical eye movements is due to a midbrain lesion affecting the rostral interstitial nucleus of the medial longitudinal fasciculus (riMLF), with impaired vertical saccades only or vertical gaze-evoked nystagmus due to dysfunction of the Interstitial nucleus of Cajal (INC). Lesions of the lateral medulla oblongata (Wallenberg syndrome) lead to typical findings: ocular tilt reaction, central fixation nystagmus and dysmetric saccades. The cerebellum is relevant for almost all types of eye movements; typical pathological findings are saccadic smooth pursuit, gaze-evoked nystagmus or dysmetric saccades. The time course of the development of symptoms and signs is important for the diagnosis of underlying diseases: acute: most likely stroke; subacute: inflammatory diseases, metabolic diseases like thiamine deficiencies; chronic progressive: inherited diseases like Niemann-Pick type C with typically initially vertical and then horizontal saccade palsy or degenerative diseases like progressive supranuclear palsy. Treatment depends on the underlying disease. In this article, we deal with central ocular motor disorders. In a second article, we focus on clinically relevant types of nystagmus such as downbeat, upbeat, fixation pendular, gaze-evoked, infantile or periodic alternating nystagmus. Therefore, these types of nystagmus will not be described here in detail.
Shear Wave Elastography Reveals a High Prevalence of NAFLD-related
Fibrosis even in Type 1 Diabetes
Authors: Meyer Gesine , Dauth Nina , Grimm Matthias , Herrmann Eva , Bojunga Joerg , Friedrich-Rust Mireen
Published: November 2021

Background The association between type 2 diabetes mellitus (T2DM) and
advanced stages of non-alcoholic fatty liver disease is well known. Some studies
indicate a relevant prevalence also in type 1 diabetes mellitus (T1DM), but so
far there is only limited data.

Objective To determine the prevalence of non-alcoholic fatty liver disease
(NAFLD)-related liver fibrosis in individuals with T1DM and compare to those
with type 2 diabetes.

Methods Diabetic patients from a single diabetes care centre were screened
for liver fibrosis by sonographic shear wave elastography (SWE). In addition,
all patients received laboratory evaluation including non-alcoholic fatty liver
fibrosis score and Fibrosis-4 Index.

Results Three hundred and forty patients were included in the study, of
these, 310 received SWE. Overall 254 patients (93 with type 1 and 161 with type
2 diabetes) had reliable measurements and were included in the final analysis.
In patients with type 1 diabetes, the prevalence of NAFLD-related liver fibrosis
was 16–21%, depending on the method of detection. Significant
liver fibrosis was observed in 30–46% of patients with type 2
diabetes.

Conclusions Our data revealed an unexpectedly high prevalence of
NAFLD-related liver fibrosis in patients with type 1 diabetes. To our knowledge,
this is one of the first studies using SWE to diagnose advanced NAFLD in type 1
diabetes in a non-preselected cohort. Considering the findings of our study,
regular screening for hepatic complications must be recommended for all diabetic
patients, even for those with type 1 diabetes.
Use of Homeopathic Arnica montana 30cH for Postoperative Analgesia in Female Dogs Undergoing Elective Ovariohysterectomy
Authors: Travagin David Ronald Parra , Balbueno Melina Castilho de Souza , Coelho Cidéli de Paula
Published: November 2021

Background Ovariohysterectomy (OH) is one of the most frequent elective surgical procedures in routine veterinary practice. Arnica montana is a well-known medicine in phytotherapy, with proven analgesic, anti-inflammatory, antiseptic, healing, antioxidant and immunomodulatory activity. However, there is still a shortage of studies on the action and effects of the homeopathic formulation of the medicine on animals. The aim of this study was to evaluate analgesia with Arnica montana 30cH during the postoperative period after elective OH.

Methods Thirty healthy female dogs, aged 1 to 3 years, weighing 7 to 14 kg, were selected at the Veterinary Hospital in Campo Mourão, Paraná, Brazil. The dogs underwent the surgical procedure with an anaesthetic protocol and analgesia that had the aim of maintaining the patient's wellbeing. After the procedure, they were randomly divided into three groups of 10. One group received Arnica montana 30cH; another received 5% hydroalcoholic solution; and the third group, 0.9% NaCl saline solution. All animals received four drops of the respective solution sublingually and under blinded conditions, every 10 minutes for 1 hour, after the inhalational anaesthetic had been withdrawn. The Glasgow Composite Measure Pain Scale was used to analyse the effect of therapy. Analysis of variance (ANOVA) followed by the Tukey test was used to evaluate the test data. Statistical differences were deemed significant when p ≤0.05.

Results The Arnica montana 30cH group maintained analgesia on average for 17.8 ± 3.6 hours, whilst the hydroalcoholic solution group did so for 5.1 ± 1.2 hours and the saline solution group for 4.1 ± 0.9 hours (p ≤0.05).

Conclusion These data demonstrate that Arnica montana 30cH presented a more significant analgesic effect than the control groups, thus indicating its potential for postoperative analgesia in dogs undergoing OH.
Abnormal Uterine Bleeding in Adolescence: When Menarche Reveals other Surprises
Authors: Gomes Helena , Abreu Bruna , Barros Liliana , Veríssimo Carlos
Published: November 2021

Introduction Abnormal uterine bleeding is more frequent in adolescence. Although, most commonly, it has a non-structural etiology, it may be due to any cause described.

Clinical case A 12-year-old adolescent, with no relevant personal history, menarche 1 month before, was observed in the emergency department for severe menstrual bleeding with progressive worsening, and hemodynamic repercussion in need of transfusion support. Physiological ovulatory dysfunction associated with possible previously unknown coagulopathy was considered to be the most likely diagnosis and medical treatment was initiated. Without response, the patient was submitted to sedated observation and uterine aspiration, which ultimately led to the diagnosis of a Burkitt Lymphoma.

Discussion Although structural causes, and particularly malignancy, whether gynecological or not, are a rare cause of abnormal uterine bleeding in this age group, they must be considered, thus enhancing the fastest and most appropriate treatment.
Incorporation of Fibrin, Platelets, and Red Blood Cells into a Coronary Thrombus in Time and Space
Authors: Maly Martin , Riedel Tomas , Stikarova Jana , Suttnar Jiri , Kotlin Roman , Hajsl Martin , Tousek Petr , Kaufmanova Jirina , Kucerka Ondrej , Weisel John W. , Dyr Jan E.
Published: November 2021

We describe the internal structure, spatial organization and dynamic formation of coronary artery thrombi from ST-segment elevation myocardial infarction patients. Scanning electron microscopy (SEM) revealed significant differences among four groups of patients (<2 hours; 2–6 hours; 6–12 hours, and >12 hours) related to the time of ischemia. Coronary artery thrombi from patients presenting less than 2 hours after the infarction were almost entirely composed of platelets, with small amounts of fibrin and red blood cells. In contrast, thrombi from late presenters (>12 hours) consisted of mainly platelets at the distal end, where clotting was initiated, with almost no platelets at the proximal end, while the red blood cell content went from low at the initiating end to more than 90% at the proximal end. Furthermore, fibrin was present mainly on the outside of the thrombi and older thrombi contained thicker fibers. The red blood cells in late thrombi were compressed to a close-packed, tessellated array of polyhedral structures, called polyhedrocytes. Moreover, there was redistribution from the originally homogeneous composition to fibrin and platelets to the outside, with polyhedrocytes on the interior. The presence of polyhedrocytes and the redistribution of components are signs of in vivo clot contraction (or retraction). These results suggest why later thrombi are resistant to fibrinolytic agents and other treatment modalities, since the close-packed polyhedrocytes form a nearly impermeable seal. Furthermore, it is of particular clinical significance that these findings suggest specific disparate therapies that will be most effective at different stages of thrombus development.
Biologic Augmentation during Meniscal Repair
Authors: Blough Christian L. , Bobba Christopher M. , DiBartola Alex C. , Everhart Joshua S. , Magnussen Robert A. , Kaeding Christopher , Flanigan David C.
Published: November 2021

We reviewed the literature regarding utility of biologic augmentation in meniscal repair. We hypothesized that the addition of biologic augmentation during meniscal repair improves postoperative knee function and reduces risk of repair failure. PubMed and Embase databases were systematically searched. Included studies were clinical studies in humans, published in English, and reported use of biologic augmentation techniques in addition to meniscal repair (including platelet-rich plasma [PRP], fibrin clot, bone marrow stimulation, meniscal wrapping, and bioscaffolds) for treatment of knee meniscal tears. Outcome measures included repair failure, repeat knee arthroscopic surgery, and magnetic resonance imaging), visual analog scale for pain, the International Knee Documentation Committee questionnaire, the Western Ontario and McMaster Universities Osteoarthritis Index Lysholm's Knee Scoring Scale, and the Knee Injury and Osteoarthritis Outcome Score. Study quality was assessed using the modified Coleman methodology score. Nineteen studies reported repair of 1,092 menisci including six studies that investigated fibrin clot augmentation, five studies that investigated PRP augmentation, three studies that investigated bone marrow stimulation augmentation, two studies that used meniscal wrapping augmentation, and three studies that used other techniques. The level of evidence ranged from I to IV and mean modified Coleman methodology score was 43 (range: 17–69), with higher scores noted in studies completed in recent years. PRP and bone marrow stimulation augmentation appear to decrease risk of failure in patients undergoing isolated meniscal repair but do not improve knee symptom scores. Fibrin clot and trephination augmentation techniques do not have sufficient evidence to support decreased failure risk at this time. Meniscal wrapping augmentation and scaffold implantation augmentation appear to be an attractive option to meniscectomy in complicated tears that are not candidates for repair alone, but further confirmatory studies are needed to support initial data. Evidence supporting augmentation of meniscal repair is limited at this time but suggests that the highest likelihood for effectiveness of augmentation is in the settings of isolated meniscal repair or meniscal repairs that would normally not be amenable to repair.
Pediatric Autoimmune Encephalitis in Sri Lanka: A Single-Center Experience over 7 Years
Authors: Wanigasinghe Jithangi , Anuradha K. W. D. A. , Chang Thashi
Published: November 2021

Pediatric autoimmune encephalitis (AE) remains a diagnostic and therapeutic challenge in resource-poor settings. Minimizing delay in diagnosis and appropriate escalation of treatment will help reduce both the short- and long-term neurodisabilities. A retrospective observational study was performed on children consecutively diagnosed with possible AE and then prospectively followed up in a single tertiary care children's hospital in Sri Lanka. Serum and cerebrospinal fluid were tested for neuroglial surface-binding autoantibodies using cell-based assays in majority of these children. Twenty-five children (mean age 7.6 years, standard deviation = 4) were recruited. In these children, presenting symptom was psychiatric in 11 children (44%), seizures in 10 (40%), language regression in 2 (8%), and combination of psychosis and convulsions in 2 (8%). Psychiatric presentations were more common in older (>6 years) compared with young children (p = 0.001), while neurological presentations were more common in children aged ≤6 years (p = 0.001). N-methyl-D-aspartate receptor (NMDAR) antibodies were detected in 9 (45%) and unspecified voltage-gated potassium channel antibodies in 1 (5%) of the 20 tested. All received intravenous steroids and immunoglobulins; 19 (76%) plasma exchange; 7 (29%) rituximab. Complete/substantial improvement at 3 months occurred in 64%. Pediatric Cerebral Performance Category score at last review was 1 (normal function for age) in 43%. Higher proportion of younger children required less intense therapy and had better recovery (56%). Death (8%), incomplete recovery (71%), and relapses (8%) were more in older children. Clinical presentation and disease outcomes were different in children aged <6 years compared with older age group. NMDAR antibody encephalitis was the commonest AE syndrome identified in this cohort.
Pediatric Sciatic Neuropathy Secondary to Subacute Ischial Osteomyelitis: A Case Report
Authors: Cuérel Céline , Habre C. , Steiger Christina N. , DeMarco Giacomo , Tabard-Fougère Anne , Merlini Laura , Sahyoun Cyril , Dayer Romain O. , Ceroni Dimitri
Published: November 2021

Sciatic neuropathy (SN) is rarely encountered in the pediatric population. The causes of this mononeuropathy are either infectious, immune mediated, toxic, or infiltrative (tumoral). In this article, we presented the case of a 7.5-year-old male child who presented to the emergency department with a painful right lower limb. Magnetic resonance imaging confirmed the diagnosis of subacute osteomyelitis of the ischium, which extended toward the external hip rotators and infiltrated the tissues around the sciatic nerve. Treatment with intravenous antibiotics (flucloxacillin 50 mg/kg/d and gentamicin 10 mg/kg/d) rapidly improved the child's condition and relieved neurological symptoms within a few days. Traumatic and iatrogenic injuries are the most common causes for SN. To our knowledge, this presented case is the first to describe SN due to an infectious process following subacute osteomyelitis.
Comparison of Noninvasive Oscillometric and Intra-Arterial Blood Pressure Measurements in Children Admitted to the Pediatric Intensive Care Unit
Authors: Kaur Jaswinder , Bhargava Siddharth , Pooni Puneet Aulakh , Bhat Deepak , Dhooria Gurdeep S. , Arora Kamaldeep , Kakkar Shruti , Gill Karambir
Published: November 2021

Intra-arterial blood pressure (IABP) measurement, although considered the gold standard in critically ill children, is associated with certain risks and lacks widespread availability. This study was conducted to determine the differences and agreements between oscillometric non-invasive blood pressure (NIBP) and invasive IABP measurements in children. Inclusion criteria consisted of children (from 1 month to 18 years) admitted to the pediatric intensive care unit (PICU) of a teaching hospital who required arterial catheter insertion for blood pressure (BP) monitoring. The comparison between IABP and NIBP was studied using paired t-test, Bland–Altman analysis, and Pearson's correlation coefficient. In total, 4,447 pairs of simultaneously recorded hourly NIBP and IABP measurements were collected from 65 children. Mean differences between IABP and NIBP were −3.6 ± 12.85, −4.7 ± 9.3, and −3.12 ± 9.30 mm Hg for systolic, diastolic, and mean arterial BP, respectively (p < 0.001), with wide limits of agreement. NIBP significantly overestimated BP (p < 0.001) in all three BP states (hypotensive, normotensive, and hypertensive), except systolic blood pressure (SBP) during hypertension where IABP was significantly higher. The difference in SBP was most pronounced during hypotension. The difference in SBP was significant in children <10 years (p < 0.001), with the maximum difference being in infants. It was insignificant in adolescents (p = 0.28) and underweight children (p = 0.55). NIBP recorded significantly higher BP in all states of BP except SBP in the hypertensive state. SBP measured by NIBP tended to be the most reliable in adolescents and underweight children. NIBP was the most unreliable in infants, obese children, and during hypotension.
Anesthetic Management of Moyamoya Syndrome Secondary to Sickle Cell Anemia
Authors: Bithal Parmod K. , Jan Ravees , Pandey Ved P. , Ahmad Parvaiz
Published: November 2021

Moyamoya disease (MMD) is caused by stenosis or occlusion of internal carotid artery in brain, thereby reducing its blood supply. To augment blood flow, brain develops abnormal anastomotic vessels with deranged carbon dioxide reactivity and tendency to bleed. Moyamoya syndrome (MMS) is the name given to MMD when the latter results from secondary to some associated disease. Occurrence of MMS secondary to sickle cell anemia (SCA) presents unique challenges to neuroanesthesiologists. Management of various physiological parameters for cerebral revascularization surgery for MMD under general anesthesia necessitates vigilant and balanced control of various physiological variables, as the manipulation of a particular physiological variable for one pathology may adversely impact the same physiological variable for the associated disease, which will result in poor outcome of the patient. Therefore, optimum outcome of MMS is determined by a watchful balancing of various physiological parameters under anesthesia.
Effect of Sustained Uterine Compression versus Uterine Massage on Blood Loss after Vaginal Delivery: A Randomized Controlled Trial
Authors: Ghulmiyyah Labib M. , El-Husheimi Alaa , Usta Ihab M. , Colon-Aponte Cristina , Ghazeeri Ghina , Hobeika Elie , Mirza Fadi G. , Tamim Hani , Hamadeh Caroline , Nassar Anwar H.
Published: November 2021

Objective This study aimed to compare the effectiveness of sustained uterine compression versus uterine massage in reducing blood loos after a vaginal delivery.

Study Design This was a prospective randomized trial conducted at the American University of Beirut Medical Center (AUBMC) between October 2015 and October 2017. Inclusion criteria were women with a singleton pregnancy at ≥36 weeks of gestation, with less than three previous deliveries, who were candidates for vaginal delivery. Participants were randomized into two groups, a sustained uterine compression group (group 1) and a uterine massage group (group 2). Incidence of postpartum hemorrhage (blood loss of ≥500 mL) was the primary outcome. We assumed that the incidence of postpartum hemorrhage at our institution is similar to previously published studies. A total of 545 women were required in each arm to detect a reduction from 9.6 to 4.8% in the primary outcome (50% reduction) with a one-sided α of 0.05 and a power of 80%. Factoring in a 10% dropout rate. Secondary outcomes were admission to intensive care unit (ICU), postpartum complications, drop in hemoglobin, duration of hospital stay, maternal pain, use of uterotonics, or of surgical procedure for postpartum hemorrhage.

Results A total of 550 pregnant women were recruited, 273 in group 1 and 277 in group 2. There was no statistically significant difference in baseline characteristics between the two groups. Type of anesthesia, rate of episiotomy, lacerations, and mean birth weight were also equal between the groups. Incidence of the primary outcome was not different between the two groups (group 1: 15.5%, group 2: 15.4%; p = 0.98). There was no statistically significant difference in any of the secondary outcomes between the two groups, including drop in hemoglobin (p = 0.79).

Conclusion There was no difference in blood loss between sustained uterine compression and uterine massage after vaginal delivery.

Key Points
Idiopathic Polyhydramnios and Neonatal Morbidity at Term
Authors: Polnaszek Brock , Liang Brooke , Zhang Fan , Cahill Alison G. , Raghuraman Nandini , Young Omar M.
Published: November 2021

Objective Idiopathic polyhydramnios is among the most common etiologies of polyhydramnios. However, conflicting evidence exists regarding the relationship between polyhydramnios and neonatal morbidity. We investigated the association between pregnancies with and without idiopathic polyhydramnios and neonatal morbidity at term.

Study Design This is a retrospective cohort study of singleton, term (i.e., ≥370/7 weeks) pregnancies from 2014 to 2018. Pregnancies complicated by fetal anomalies, pregestational diabetes, and multifetal gestation were excluded. Pregnancies complicated by idiopathic polyhydramnios were defined by the deepest vertical pocket (DVP) ≥8 cm or amniotic fluid index (AFI) ≥24 cm after 20 weeks' gestation and were compared with women without polyhydramnios at time of delivery. These groups were matched 1:2 by gestational age within 7 days at delivery and maternal race. The primary outcome was a composite neonatal morbidity (neonatal death, respiratory morbidity, hypoxic–ischemic encephalopathy, therapeutic hypothermia, seizures, and umbilical artery pH < 7.10). Outcomes were compared between pregnancies with and without idiopathic polyhydramnios. Unadjusted and adjusted risk ratios were estimated using multivariable logistic regression.

Results Idiopathic polyhydramnios was diagnosed in 192 pregnancies and were matched to 384 pregnancies without polyhydramnios. After adjustment for obesity, women with pregnancies complicated by idiopathic polyhydramnios had an increased risk of composite neonatal morbidity 21.4 versus 5.5% (adjusted risk ratio [aRR] = 4.0, 95% confidence interval [CI]: 2.3–6.7). Term neonatal respiratory morbidity was the primary driver 20.3 versus 4.2%, (aRR = 4.8, 95% CI: 2.7–8.7) and included higher use of continuous positive airway pressure 19.8 versus 3.4%, p <0.01 and the need for supplemental oxygen at >12 hours of newborn life 6.8 versus 1.8%, p <0.01.

Conclusion Idiopathic polyhydramnios is associated with term neonatal respiratory morbidity at delivery and during the subsequent hours of newborn life, compared with pregnancies without idiopathic polyhydramnios. Further studies are needed to minimize neonatal morbidity at term.

Key Points