bluuebunny/crossref_metadata_2025 huggingface dataset:
A Protocol for the Diagnosis of Autism Spectrum Disorder Structured in Machine Learning and Verbal Decision Analysis
Authors: Andrade Evandro , Portela Samuel , Pinheiro Plácido Rogério , Nunes Luciano Comin , Filho Marum Simão , Costa Wagner Silva , Pinheiro Mirian Caliope Dantas
Published: March 2021

Autism Spectrum Disorder is a mental disorder that afflicts millions of people worldwide. It is estimated that one in 160 children has traces of autism, with five times the higher prevalence in boys. The protocols for detecting symptoms are diverse. However, the following are among the most used: the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), of the American Psychiatric Association; the Revised Autistic Diagnostic Observation Schedule (ADOS-R); the Autistic Diagnostic Interview (ADI); and the International Classification of Diseases, 10th edition (ICD-10), published by the World Health Organization (WHO) and adopted in Brazil by the Unified Health System (SUS). The application of machine learning models helps make the diagnostic process of Autism Spectrum Disorder more precise, reducing, in many cases, the number of criteria necessary for evaluation, denoting a form of attribute engineering (feature engineering) efficiency. This work proposes a hybrid approach based on machine learning algorithms’ composition to discover knowledge and concepts associated with the multicriteria method of decision support based on Verbal Decision Analysis to refine the results. Therefore, the study has the general objective of evaluating how the mentioned hybrid methodology proposal can make the protocol derived from ICD-10 more efficient, providing agility to diagnosing Autism Spectrum Disorder by observing a minor symptom. The study database covers thousands of cases of people who, once diagnosed, obtained government assistance in Brazil.
Integrating Kano Model, AHP, and QFD Methods for New Product Development Based on Text Mining, Intuitionistic Fuzzy Sets, and Customers Satisfaction
Authors: Li Ming , Zhang Jie
Published: March 2021

Online reviews are crucial to any online business that wants to increase sales on the Internet. Customer reviews have information about product attributes, customer requirements (CRs), and shopping experience; mining reviews provide the direction of decision-making for new product development and design (NPDD). Besides, the information of customer preference has vagueness and uncertainty, and the accuracy of decision-making information directly affects the success of NPDD. This paper proposed a methodology that integrates the Kano model (KM), analytic hierarchy process (AHP), and quality function deployment (QFD) methods with intuitionistic fuzzy set (IFS) to solve decision-making problems in NPDD. By the new method, the web crawler technology was first applied to e-commerce web sites to collect raw data, and the representative CRs were extracted through combining LDA model with Apriori algorithm. Second, the intuitionistic fuzzy Kano model (IFKM) is proposed to evaluate adjustment coefficient of CRs and Kano categories via customer preference membership functions. Thirdly, overall weights which contained emotional needs (ENs) and functional needs (FNs) are obtained via intuitionistic fuzzy analytic hierarchy process (IFAHP); thus, the adjusted weights are calculated from IFKM and IFAHP. Next, the intuitionistic fuzzy quality function deployment (IFQFD) is proposed to acquire engineering characteristics (ECs) of weights through combining competition benchmarks and based on technical benchmarks to make goals for a company’s NPDD. Finally, the method was applied to study vertical-configured air conditioner (VAC) as an example. The results showed that the application of text mining and IFS to improve CS is both reliable and scientific.
Further Results on the

p
,
k

−
Analogue of Hypergeometric Functions Associated with Fractional Calculus Operators
Authors: Hidan Muajebah , Boulaaras Salah Mahmoud , Cherif Bahri-Belkacem , Abdalla Mohamed
Published: March 2021

In a previous article, first and last researchers introduced an extension of the hypergeometric functions which is called “

p
,
k

-extended hypergeometric functions.” Motivated by this work, here, we derive several novel properties for these functions, including integral representations, derivative formula, k-Beta transform, Laplace and inverse Laplace transforms, and operators of fractional calculus. Relevant connections of some of the discussed results here with those presented in earlier references are outlined.
Null Controllability of a Four Stage and Age-Structured Population Dynamics Model
Authors: Traoré Amidou , Ainseba Bedr’Eddine , Traoré Oumar
Published: March 2021

This paper is devoted to study the null controllability properties of a population dynamics model with age structuring and nonlocal boundary conditions. More precisely, we consider a four-stage model with a second derivative with respect to the age variable. The null controllability is related to the extinction of eggs, larvae, and female population. Thus, we estimate a time

T

to bring eggs, larvae, and female subpopulation density to zero. Our method combines fixed point theorem and Carleman estimate. We end this work with numerical illustrations.
Algorithm of Underground Personnel Positioning Based on Improved Monte Carlo
Authors: Wu Bin
Published: March 2021

In order to improve the positioning accuracy of underground targets, especially the positioning accuracy of moving targets, an improved weighted Monte Carlo positioning algorithm is proposed. In the sampling initialization stage, the beacon node gradually constructs the sampling area according to the RSSI size and combines the Monte Carlo method to further narrow the range and improve the sampling success rate. In the filtering stage, refer to the sampling area at time and further improve the sample quality at t − 1 after two filterings. In the recollection stage, cooperate with invalid sample sets to reduce the number of recollections and weigh the final samples to improve the positioning accuracy of the nodes to be tested.
Application Analysis of Wearable Technology and Equipment Based on Artificial Intelligence in Volleyball
Authors: Dai Xianyan , Li Shangbin
Published: March 2021

Today, while people’s satisfaction with materials is high, the pursuit of health has begun and sports are becoming increasingly important. Volleyball is a good physical and mental exercise, which helps improve the health of the body. However, excessive exercise usually leads to muscle strain and more serious accidents. Therefore, how to effectively prevent excessive fatigue and sports injuries becomes more and more important. In the past, some methods of exercise fatigue detection were mostly self-assessment through some indicators, which lacked real-time and accuracy. With the advancement of smart technology, in order to better detect sports fatigue, smart wearable technology and equipment are used in volleyball. Firstly, surface electromyography signals (sEMG) are collected through wearable technology and equipment. Secondly, the signal is preprocessed to extract features that are conducive to exercise fatigue assessment. Finally, a motion fatigue detection algorithm is designed to identify and classify features and evaluate the motion status in real-time. The simulation results show that it is feasible to collect ECG signals and EMG signals to detect exercise fatigue. The algorithm has good recognition performance, can evaluate exercise conditions in real-time, and prevent fatigue and injury during exercise.
Study on Stability of Shield Tunnel Excavation Face in Soil-Rock Composite Stratum
Authors: Sui Hongtao , Ma Chao , Dai Chunquan , Yang Tingzhi
Published: March 2021

In order to study the instability mode of shield excavation face in soil-rock composite stratum and determine the ultimate support pressure of excavation face, this paper selects two typical soil-rock composite strata and uses three-dimensional finite element software to study the failure development process of shield excavation face. Based on the principle of limit equilibrium, a calculation model of limit support pressure for soil-rock composite stratum is proposed and applied to practical engineering. It is found that the shape of “unloading loosening zone” is mainly determined by the properties of upper soil and the properties of lower rock mainly determine the scope and shape of “sliding instability zone.” With the increase of soil proportion coefficient, the ultimate bearing capacity increases nonlinearly and the growth rate decreases gradually. At the same time, the influence of overlying Earth pressure and soil cohesion cannot be ignored.
Anatomical Evaluation of Mandibular Molars in a Saudi Population: An In Vivo Cone-Beam Computed Tomography Study
Authors: Mashyakhy Mohammed , Jabali Ahmad , Alabsi Fatimah Saleem , AbuMelha Abdulaziz , Alkahtany Mazen , Bhandi Shilpa
Published: March 2021

Objective. This study assessed the canal configuration of mandibular molars according to Vertucci’s classification of a Saudi population using cone-beam computed tomography (CBCT). Methods. A total of 290 first and 367 second mandibular molars were analyzed. The CBCT images were evaluated in three sections to inspect the number of roots and canals and canal system. The data are presented as frequencies and percentages. The chi-squared test was used to assess differences between both sides. SPSS was used for analysis, with a significance level of α ≤ 0.05. Results. Among the first molars, 95.4% of the teeth had two roots, and 64.5% had three canals. Approximately 57.9% showed Vertucci type IV mesial roots. Between the second molars, 89.6% of teeth had two roots and 80.4% had three canals. The frequency of Vertucci type IV (39.4%) was the highest in mesial roots. The first molars showed a high prevalence of 3-rooted teeth (5.5%). Both the right and left sides showed teeth with similar external and internal anatomy

p
<
0.05

. Conclusion. Most of the mandibular first and second molars had two roots and three canals. In the first mandibular molars, similar to the second mandibular molars, the majority of the mesial canals had Vertucci type IV, while the distal canals had Vertucci type I.
Hybrid Numerical Simulation of Jet Blast Distance of a Departing Aircraft
Authors: He Xin , Chen Yaqing , Ma Yilong , Hu Dengfeng , Gao Haoran
Published: March 2021

A hybrid numerical simulation method was established by combining the Spalart-Allmaras (SA) turbulence model and detached eddy simulation (DES). Numerical simulations were carried out to model cold and hot spray conditions of a nozzle without considering the internal flow of an engine to determine jet conditions. Analysis results show that the calculated hot spray results more in line with the reality. The jet effect of a typical aircraft engine was simulated numerically to determine the distance influenced by the jet blast from a departing aircraft engine.
Comparison of the Effect of Three Irrigation Techniques and Root Canal Preparation Size on Sodium Hypochlorite Penetration into Root Canal Dentinal Tubules
Authors: Tungsawat Pakit , Arunrukthavorn Pondpun , Phuntusuntorn Phawinee , Opatragoon Suphakit , Sirirangsee Pharsiri , Inklub Surat
Published: March 2021

Objective. This study aims to compare the effects of conventional syringe irrigation (CSI), passive ultrasonic irrigation (PUI), and innovative sonic-powered irrigation (EDDY) on the penetration of sodium hypochlorite (NaOCl) solutions into root canal dentinal tubules at different levels of the root canal. Materials and Methods. One hundred ninety-two extracted first mandibular premolars of 17- to 25-year-old patients were decoronated 13 mm from the root apices and separated into two groups according to apical preparation sizes (APS) 25 and 40. The root canals were dried with a paper point and stained in crystal violet for 72 hours. Each APS group was separated into three groups according to irrigation techniques, as follows: CSI, PUI, and EDDY. Roots were perpendicularly resected to the long axis at three levels (coronal, middle, and apical). Photomicrographs were taken of all three cross-sections of each tooth under a stereomicroscope. The depth of the bleached zone was measured with ImageJ software. The data were analyzed by Welch’s analysis of variance and an independent t-test (p = 0.05). Results No penetration was found at the apical level in the CSI25, CSI40, and PUI25 groups. The EDDY25 and EDDY40 groups showed the most significant penetration at the middle and apical levels compared to the other groups (p < 0.05). Conclusions. Within the limitations of this study, irrigation techniques and APS affect the penetration depth of NaOCl into the root canal dentinal tubules. In terms of irrigation techniques, the penetration was deepest when EDDY was used, followed by PUI and CSI. In terms of APS, NaOCl penetrated deeper into APS40 than APS25. The use of the EDDY irrigation technique in APS25 can improve the penetration of NaOCl into root canal dentinal tubules at the apical level.
Megacystis-Microcolon-Intestinal Hypoperistalsis Syndrome (MMIHS): Series of 4 Cases Caused by Mutation of ACTG2 (Actin Gamma 2, Smooth Muscle) Gene
Authors: Ignasiak-Budzyńska Katarzyna , Danko Mikołaj , Książyk Janusz
Published: March 2021

MMIHS, also known as Berdon’s syndrome, is a rare disease that belongs to primary causes of CIPOS (chronic intestinal pseudoobstruction syndrome). Clinical characteristics of MMIHS are differential, but we come across the following classic symptoms: disorders of intestinal peristalsis, microcolon, and megacystis. In this article, we present a series of 4 patients with Berdon’s syndrome, in whom we managed to identify the genetic causes of MMIHS. All infants showed clinical features of bowel obstruction and dysfunction of the urinary system after birth. Two of them also manifested disorders from other systems. The prognosis for these patients is poor, but a constant betterment of management in MMIHS, in which the leading role plays TPN (total parental nutrition), causes improvement of patients’ survival.
Tracheoesophageal Fistula in a COVID-19 Ventilated Patient: A Challenging Therapeutic Decision
Authors: Rosati Riccardo , De Nardi Paola , Dell’Acqua Antonio , Calvi Maria Rosa , Elmore Ugo , Scarparo Elena , Beretta Luigi
Published: March 2021

COVID-19 associated severe respiratory failure frequently requires admission to an intensive care unit, tracheal intubation, and mechanical ventilation. Among the risks of prolonged mechanical ventilation under these conditions, there is the development of tracheoesophageal fistula. We describe a case of a severe COVID-19 associated respiratory failure, who developed a tracheoesophageal fistula. We hypothesized that one of the mechanisms for tracheoesophageal fistula, along with other local and general risk factors, is the local infection due to the location of the virus itself in the tracheobronchial tree. The patient was managed successfully with surgical intervention. This case highlights the increased risk of this potentially life-threatening complication among the COVID-19 patient cohort and suggests a management strategy.
Dapagliflozin in Patients with Chronic Heart Failure: A Systematic Review and Meta-Analysis
Authors: Cai Ru-ping , Xu Yu-li , Su Qiang
Published: March 2021

Sodium-glucose cotransporter-2 (SGLT2) inhibitors represent newly developed oral antidiabetic drugs that are practiced for type 2 diabetes mellitus management and may decrease the risk of the first hospitalization in heart failure. The activity of SGLT2 inhibitors is not related to glucose, and the effectiveness and safety of SGLT2 inhibitors in individuals with chronic heart failure (CHF) remain unclear. We systematically retrieved PubMed, Cochrane Library, Embase, NCKI, VIP, Wanfang Data, and ClinicalTrials.gov records to identify eligible trials. The primary endpoints were cardiovascular death/hospitalization for heart failure (CV death/HHF), cardiovascular death, and hospitalization for heart failure. Secondary endpoints included hypoglycemia, volume depletion, urinary tract infection, left ventricular ejection fraction (LVEF), and NT-proBNP. Nine randomized controlled clinical trials were included. Dapagliflozin was reported to significantly decrease CV death/HHF (relative risk (RR): 0.75; 95% confidence interval (CI): 0.68–0.84), CV death (RR: 0.80; 95% CI: 0.68–0.93), and HHF (RR: 0.72; 95% CI: 0.63–0.83). There was no effect on hypoglycemia (RR: 0.69; 95% CI: 0.34–1.40), volume depletion (RR: 1.17; 95% CI: 0.97–1.41), urinary tract infection (RR: 0.82; 95% CI: 0.43–1.57), LVEF (WMD: 0.53; 95% CI: −4.04–5.09), or NT-proBNP (SMD: −0.66; 95% CI: −1.42–0.10). The risk of CV death/HHF, CV death, and HHF was lower among patients receiving dapagliflozin than patients receiving placebo.
Prediction of Short-Time Rainfall Based on Deep Learning
Authors: Sun Dechao , Wu Jiali , Huang Hong , Wang Renfang , Liang Feng , Xinhua Hong
Published: March 2021

Short-time heavy rainfall is a kind of sudden strong and heavy precipitation weather, which seriously threatens people’s life and property safety. Accurate precipitation nowcasting is of great significance for the government to make disaster prevention and mitigation decisions in time. In order to make high-resolution forecasts of regional rainfall, this paper proposes a convolutional 3D GRU (Conv3D-GRU) model to predict the future rainfall intensity over a relatively short period of time from the machine learning perspective. Firstly, the spatial features of radar echo maps with different heights are extracted by 3D convolution, and then, the radar echo maps on time series are coded and decoded by using GRU. Finally, the trained model is used to predict the radar echo maps in the next 1-2 hours. The experimental results show that the algorithm can effectively extract the temporal and spatial features of radar echo maps, reduce the error between the predicted value and the real value of rainfall, and improve the accuracy of short-term rainfall prediction.
The Ground Settlement and the Existing Pipeline Response Induced by the Nonsynchronous Construction of a Twin‐Tunnel
Authors: Sun Shicheng , Rong Chuanxin , Wang Houliang , Cui Linzhao , Shi Xin
Published: March 2021

Shielding tunnel construction always has negative impacts on the surrounding buildings. Because of repeated disturbances caused by the construction, more attention should be paid to the impacts of the nonsynchronous construction of a twin‐tunnel. In this research, a three‐dimensional model was established to simulate the construction process of a twin‐tunnel in a section of the Hefei No. 4 metro line, and the calculation results were validated with the measured settlement data. Based on the model, the ground settlement and the existing pipeline responses were studied in detail. The results showed that, after the first tunnel (FT) construction, the settlement curves conformed to a Gaussian distribution. Additionally, after the second tunnel (ST) construction, the final settlement curves were no longer completely symmetrical. The influences of the twin‐tunnel space and the pipeline‐soil relative stiffness on the settlements were further studied. The results showed that the final settlement curves of the ground surface and the pipeline were mainly W‐shaped, U‐shaped, and V‐shaped. As the twin‐tunnel space increased and the pipeline‐soil relative stiffness decreased, the settlement curve gradually changed from V‐shaped to W‐shaped. C was defined as the ratio of two maximum settlements in the W‐shaped settlement curve. As the space increased, C started to decrease from 1 and then increased to 1.
Prediction of Intraformational Remaining Oil Distribution Based on Reservoir Heterogeneity: Application to the J‐Field
Authors: Zhang Jie , Fang Feifei , Wang Jie , Tian Yajie , Mo Fei , Li Qi , Li Sainan , Huang Xiaoliang , Yang Yi
Published: March 2021

At high water cut stage, the study of remaining oil distribution in water‐flooding reservoir is the basis of implementing potential‐tapping measures and enhancing oil recovery. At present, most of the oilfields in China have entered the stage of ultrahigh water cut. The reserves of the oilfields are highly developed, the situation of water flooding is extremely complex, and it is difficult to predict the distribution of the remaining oil, which seriously restricts the adjustment of the production measures, tapping the potential and improving the ultimate recovery rate. In view of aforementioned difficulties, this study puts forward a research approach to predict remaining oil distribution based on reservoir heterogeneity, which can quantitatively characterize reservoir heterogeneity. In order to avoid the drawback that a single parameter cannot fully describe the characteristics of pore structure, the composite index of pore structure (SQRT(K/Φ)) is introduced to study the pore microstructure. The composite index of pore structure is used to predict the distribution of remaining oil in the formation, and the results are basically consistent with those calculated by numerical simulation. It is concluded that the larger the fractal dimension of the composite index of pore structure is, the stronger the heterogeneity of reservoir is; the smaller the composite index of pore structure is, the smaller the recovery degree is. The composite index of pore structure is used to analyze and predict the distribution of remaining oil in the layer, which provides a new direction for the prediction method of remaining oil.
[Retracted] Effect and Repair Mechanism of Nano Ag Sponge Dressing Combined with Gelatin‐Bletilla Striata Gum/Salvia Miltiorrhiza on Refractory Orthopedic Wounds
Authors: Jiao Chuanjie , Deng Ming , Ma Yonggang , Hu Geliang
Published: March 2021

Objective. To explore the effect and mechanism of the sponge dressing on the healing of refractory orthopedic wound, and the gelatin‐Bletilla striata gum/Salvia miltiorrhiza nano Ag (GBS‐Ag) sponge dressing was prepared. Methods. GBS‐Ag sponge dressing was prepared by the freeze‐drying method. Twenty male SD rats were randomly divided into the control group (Ctrl group) and GBS‐Ag group, with 10 rats in each group, and the rats in the two groups were established a model of back wound infection. The Ctrl group was treated with gauze, while the GBS‐Ag group was treated with GBS‐Ag sponge dressing. Wound healing rate, blood immune indexes, Ag content in each organ, morphological changes of wound, and expression of transforming growth factor‐β1 (TGF‐β1) in wound transformation were detected in the two groups of rats. Results. The mechanical properties of GBS‐Ag sponge dressing were all in line with the standard, and it had good killing effect on the conventional strain after being incubated for 24 hours. Compared with the Ctrl group, the healing rate and lymphocyte percentage in the GBS‐Ag group were significantly increased on day 4 and day 10 (P < 0.05), while the total number of white blood cells and the percentage of neutrophils were significantly decreased (P < 0.05). Compared with Ctrl group, the Ag content in liver, spleen, and kidney of rats in the GBS‐Ag group was significantly increased (P < 0.05). The histological results showed that the Ctrl group lacked collagen fibers in the dermis, and the angiogenesis was not rich, accompanied by a large number of inflammatory cell infiltration. The epidermal repair of rats in the GBS‐Ag group was complete and partially keratinized, the dermis was rich in collagen fibers, with elastic fibers and new blood vessels, inflammatory cells were rare, and new hair follicles and thick‐walled blood vessels were also observed. The expression of TGF‐β1 protein in the wounds of rats in the GBS‐Ag group was higher than that of the Ctrl group. Conclusion. GBS‐Ag sponge dressing had multiple effects of sterilization and promoting wound healing, and its mechanism may be related to promoting the TGF‐β1 protein expression.
Foreign Body Ingestion Followed by Appendiceal Perforation
Authors: Qassim Sarah , Lairy Ali , Asfar Sami
Published: March 2021

Background. Foreign body ingestion is very common among specific groups, especially children. However, appendicitis and perforated appendix caused by a foreign body is rare. Case summary. A 40-year-old female presented with abdominal pain in the right lower quadrant of 10 days duration after accidentally ingesting a drilling bit during a dental procedure. She had right iliac fossa tenderness on physical examination. X-ray showed a pointed long metal object in the right lower quadrant. A contrast-enhanced computed tomography scan of the abdomen revealed a pointed metal object in the pelvis with inconclusive location. Diagnostic laparoscopy showed an inflamed appendix with the tip of the metal object perforating it. Appendectomy was performed. Histopathology showed an inflamed appendix. Conclusion. Foreign bodies that cause appendicitis are rare. However, they may become lodged at any site of the gastrointestinal tract and cause inflammation or perforation. This is a bizarre case of foreign body-induced appendicitis with perforation.
Research on Determining the Inspection Point of Multirotor UAV Power Tower
Authors: Wang Hongxing , Zhou Hang , Liu Haoran , Huang Zheng , Feng Mingduan
Published: March 2021

During the inspection process of power pole towers, manual positioning is mainly used to select the shooting viewpoints of the drone, which leads to erroneous viewpoint selection and inaccurate shootings of inspected objects. Also, neglecting the effect of the sun’s backlight on photographs contributes to poor photo quality that does not meet inspection requirements. Aiming at the selection of shooting viewpoints during multirotor unmanned aerial vehicles’ inspection on power poles, this paper proposes an automatic positioning method that determines the shooting viewpoints by considering UAV performance, airborne camera parameters, and the size of objects to be measured. Considering the factors of sun illumination, we optimize the method to ensure the positions of the viewpoints and to ensure that the images can be clearly generated so that the observers can check the power pole towers through the images when shooting is also taken into consideration. Finally, the automatic calculation method of the related viewpoints is implemented in the Java language. Experiments show that the method can accurately obtain the positions of the drones’ viewpoints and reduce the number of viewpoints, which significantly improves the efficiency and quality of inspection shooting.
LINC00649 Facilitates the Cellular Process of Bladder Cancer Cells via Signaling Axis miR-16-5p/JARID2
Authors: Liu Yongsong , Huang Xiande , Guo Lijun , Luo Nengqin
Published: March 2021

Bladder cancer (BC), as one of the most common cancers around the world, begins in the inner side of the bladder and is inclined to spread to the remaining parts of the body. Extensive documents have shown that long noncoding RNAs function as stimuli in various cancer types. With regard to LINC00649, there is limited investigation on its role previously. In our research, we discovered that LINC00649 was considerably highly expressed in BC cells and the lack of LINC00649 would cause inactivity in cellular proliferation, migration, and invasion. miR-16-5p turned out to be competitively incorporated by LINC00649 in the upstream or JARID2 downstream. In BC cells, LINC00649 was found to bind with miR-16-5p to increase the expression of JARID2. Overly expressed JARID2 was found to reverse the LINC00649 shortage-mediated suppressive impacts on the cellular process of BC cells. Concisely, it was the first study on the molecular mechanism of LINC00649 in BC. This work detected that LINC00649 enhanced cell proliferation, migration, and invasion of BC cells by acting as a sponge of miR-16-5p and upregulating JARID2, providing novel insight into understating BC.
Tapering and Discontinuation of Thrombopoietin Receptor Agonist Therapy in Patients with Immune Thrombocytopenia: Results from a Modified Delphi Panel
Authors: Cooper Nichola , Hill Quentin A. , Grainger John , Westwood John-Paul , Bradbury Charlotte , Provan Drew , Thachil Jecko , Ramscar Nicholas , Roy Anuja
Published: March 2021

Background: Recent evidence suggests that in patients with immune thrombocytopenia (ITP) with a stable response on thrombopoietin receptor agonists, treatment may be tapered and/or discontinued. Objectives: The objective of this study was to provide a guide for tapering and discontinuation of TPO-RA therapy in patients with ITP, based on hematologist survey results, existing evidence, and expert consensus. Patients/Methods: UK hematologists completed a survey to characterize self-reported practice patterns related to TPO-RA tapering and discontinuation in patients with ITP. Using a modified Delphi panel approach, ITP experts developed consensus statements regarding the use of TPO-RA tapering and discontinuation. Results: Survey respondents estimated that 30–34% of their patients were suitable for tapering or discontinuation and that 29–35% of these patients required treatment re-initiation after an average treatment-free interval of 86–106 days. No clear predictors of patient suitability or response to tapering or discontinuation were identified. The ITP expert consensus was that approximately 30% of patients are eligible for tapering and discontinuation, which may be considered after 6–12 months for patients demonstrating an adequate treatment response (platelet count >50,000/µL at ≥75% of assessments in the preceding 6 months). Treatment re-initiation may be considered if the platelet count decreases or if the patient becomes symptomatic. Individual differences need to be taken into account when considering TPO-RA tapering or discontinuation. Conclusions: Tapering and discontinuation of TPO-RA therapy may be considered for certain patients with ITP. Further study is needed to better predict patients likely to achieve sustained off-treatment responses after tapering and discontinuation.
Evaluation of Risk Factors for Adverse Functional Outcomes after Radical Prostatectomy in Patients with Previous Transurethral Surgery of the Prostate
Authors: Tolle Julia , Knipper Sophie , Pose Randi , Tennstedt Pierre , Tilki Derya , Graefen Markus , Isbarn Hendrik
Published: March 2021

Introduction: A history of transurethral surgery of the prostate is generally considered as a risk factor of adverse functional outcomes after radical prostatectomy (RP). We tested whether the risk of postoperative urinary incontinence (UIC) and erectile dysfunction (ED) after RP could be further substantiated in such patients. Materials and Methods: We tested the effect of the following variables on UIC and ED rates 1 year after RP: residual prostate volume after transurethral desobstruction, the time from transurethral desobstruction to RP, the type of transurethral desobstruction (TURP vs. laser enucleation), age, and nerve-sparing surgery (yes vs. no). UIC was defined as usage of any pad except a safety pad. ED was defined as no sexual intercourse possible. Results: Overall, 216 patients treated with RP between 2010 and 2019 in a tertiary care center were evaluated. All patients had previously undergone transurethral desobstruction. Regarding UIC analyses, only time from transurethral desobstruction to RP significantly influenced UIC rates (p = 0.003). Regarding ED rates, none of the tested variables reached statistical significance. Conclusion: The risk of UIC and ED after RP is substantial in men who had previously undergone transurethral desobstruction. The time from transurethral desobstruction to RP significantly impacts on the postoperative UIC rates. This observation should be further explored in future studies.
Whether Adding Vitamin D to Tadalafil 5 mg Treatment Is Useful in Patients with Erectile Dysfunction and Vitamin D Deficiency?
Authors: Demirci Aykut , Çakan Murat , Topçuoğlu Murat
Published: March 2021

Introduction: Numerous factors such as endothelial disease and hormonal disorder cause the development of erectile dysfunction (ED). However, the relationship between vitamin D deficiency (VDD) and ED is unclear. Moreover, the benefit of vitamin D replacement on ED patients with VDD is uncertain. As far as we know, there is no study yet in the literature regarding the addition of vitamin D to phosphodiesterase type 5 inhibitors in the treatment of ED patients with VDD. In this study, we investigated whether adding vitamin D to daily tadalafil treatment would be beneficial in ED patients with VDD. Methods: A total of 111 patients with VDD accompanying ED were retrospectively evaluated between January 2016 and December 2019. Patients were divided into 2 groups according to the treatment they received. Group 1 (n = 58) was treated with daily oral tadalafil 5 mg, while group 2 (n = 53) received oral tadalafil 5 mg and 4,000 IU vitamin D3. Total International Index of Erectile Function-15 (IIEF-15) scores and vitamin D levels of the groups were compared at the end of the study. Results: The mean vitamin D level was increased statistically significant in group 2, but no difference was seen in group 1 (p < 0.001 and p > 0.05, respectively). There was a significant increase in median erectile function, orgasmic function, sexual desire, sexual satisfaction, and overall satisfaction scores in both groups (p < 0.001). However, the increase in median erectile function and sexual desire scores was significantly higher in group 2 compared to group 1 at the end of the study (p = 0.01 and p < 0.001, respectively). Conclusion: We found that adding vitamin D to 5 mg oral daily tadalafil treatment may have an additional positive effect on erectile function and sexual desire in ED patients with VDD.
Intratympanic Triamcinolone Acetonide as a Salvage Treatment for Idiopathic Sudden Sensorineural Hearing Loss
Authors: Andrianakis Alexandros , Moser Ulrich , Wolf Axel , Kiss Peter , Holzmeister Clemens , Tomazic Peter V. , Graupp Matthias
Published: March 2021

Introduction: Intratympanic steroid (ITS) injections represent an increasingly used salvage treatment option for patients with idiopathic sudden sensorineural hearing loss ­(ISSHL) after systemic treatment. The most effective corticosteroid for this treatment modality still remains unclear. Triamcinolone acetonide has been used for ITS treatment in various clinical settings. However, there are limited clinical data of its usage in the therapeutic management of ISSHL. The aim of this study was to determine the efficacy of intratympanic triamcinolone acetonide injections as a salvage treatment for ISSHL. Methods: We conducted a retrospective chart review on patients affected by ISSHL with insufficient hearing recovery after primary systemic corticosteroid therapy and who were treated with intratympanic triamcinolone acetonide as a salvage therapy between January 2014 and August 2019. The patients were divided into groups according to their degree of hearing recovery, and we evaluated potential predictors of hearing recovery. Audiometric results were then compared to historic studies using dexamethasone or methylprednisolone. Results: One-hundred and fifty-two patients received up to 3 intratympanic injections with triamcinolone acetonide at 1-week intervals. The mean hearing improvement due to ITS salvage treatment was 15.9 ± 18.9 dB. Complete hearing recovery was noted in 15 patients (9.9%), while 73 patients (48%) obtained partial recovery, and 64 patients (42.1%) had no recovery. Primary systemic treatment delay, hearing improvement by primary systemic treatment, and severity of initial hearing loss were identified as significant predictors of hearing improvement. The first of the 3 injections resulted in the greatest hearing improvement. Conclusion: The use of triamcinolone acetonide in ITS salvage treatment resulted in similar hearing improvements as the use of the commonly used corticosteroids, namely, dexamethasone and methylprednisolone. Longer treatment delays, lower hearing improvement by primary systemic treatment, and higher initial hearing loss are associated with poorer prognoses of hearing recovery.
A Complicated Case of COVID-19 and Hyperglycemic Hyperosmolar Syndrome in an Adolescent Male
Authors: Gohil Anisha , Malin Stefan , Abulebda Kamal , Hannon Tamara S.
Published: March 2021

Emerging data demonstrate that comorbid conditions and older age are contributing factors to COVID-19 severity in children. Studies involving youth with COVID-19 and diabetes are lacking. We report the case of a critically ill adolescent male with obesity, type 2 diabetes, and COVID-19 who presented with hyperglycemic hyperosmolar syndrome (HHS). This case highlights a challenge for clinicians in distinguishing severe complications of COVID-19 from those seen in HHS. Youth with obesity and type 2 diabetes may represent a high-risk group for severe COVID-19 disease, an entity that to date has been well-recognized in adults but remains rare in children and adolescents.
Gamma Knife Stereotactic Radiosurgery for Conjunctival Squamous Cell Carcinoma Invading the Anterior Orbit: A Case Series
Authors: Bata Bashar M. , Radatz Matthias W.R. , Salvi Sachin M.
Published: March 2021

Introduction: The aim of the study was to report our experience in the use of Gamma Knife Stereotactic Radiosurgery (GKSTRS) for conjunctival squamous cell carcinoma (SCC) invading the orbit, as an alternative to exenteration surgery. Patients and Methods: Patients who had GKSTRS for conjunctival SCC invading the orbit but sparing the bone (AJCC eighth ed. T4a) with a minimum of 1-year follow-up were included. Treatment failure was defined as no decrease in tumour size 3 months post-treatment, or further growth during the follow-up period. Patients were followed up 3-monthly for 2 years and 6-monthly afterwards with a minimum of yearly MR Imaging of orbit. Results: Six patients met the inclusion criteria. MR imaging was used to identify the extent of orbital involvement of SCC. Stereotactic radiosurgery utilizing the Leksell Gamma Knife® Perfexion was delivered in a single session in which patients received 18–20 Gy to the 45–50% isodose. The median follow-up was 29 months. Four patients responded to the treatment and had no evidence of recurrence at their most recent follow-up. The treatment failed in 2 patients, in 1 of whom the tumour was larger and extended deeper into the orbit. The other patient developed a recurrence away from the treated area at 9 months, suggesting a multifocal disease. Both patients had poorly differentiated SCC. Conclusion: GKSTRS is a potential alternative to orbital exenteration surgery for conjunctival SCC extending into the anterior orbit in a selected group of patients refusing orbital exenteration or has a second blind eye. Nevertheless, the disease is more likely to recur than with exenteration surgery, hence lifelong monitoring and low threshold for surgical intervention or retreatment is prudent.
Swinging and Rocking: Two Millennia of Debating the Cradle
Authors: Obladen Michael
Published: March 2021

In most societies, devices evolved to enhance the mother’s working capacity. This article depicts the cradle’s development in some countries and delineates the scientific debate that led to its demise in the 19th century. A few basic forms of infant cots survived the centuries from antiquity: the carrying board, trough, hammock, sling, transverse rockers, and forward rockers. Romans discerned 2 types: the cuna stood on the floor and was moveable by wooden rockers. Lecti pensiles were suspended beds. Cradleboards of Native Americans revealed remarkable variety of shapes and decorations. The cradle’s hood was a 16th century development, intended to protect the baby’s face from flies, sunlight, and the evil eye. Already in the second century CE, Galen mentioned controversies about rocking. A fervent debate began in the 18th century. Propagators reasoned that rocking perpetuates habitual fetal movement, exercises the child, and avoids the need for somniferous drugs. Opponents claimed that rocking is dangerous, producing an unnatural sleep harmful to the brain, and impeding milk digestion. In the 20th century, cradles were replaced by pushchairs and prams, but they did not disappear. Despite centuries of debate, robust studies have never been conducted, and it remains unclear whether rocking has any benefit or harm for the infant.
Glottic Malignant Fibrous Histiocytoma: A Case Report and Literature Review
Authors: Aljariri Adham A. , Alsaleh Abdulrahman R. , Al-Enazi Hussain A. , Haider Hasan A. , Petkar Mahir , Rahman Waheed , Nashwan Abdulqadir Jeprel
Published: March 2021

Pleomorphic sarcoma of the larynx is a rare variant of laryngeal cancer. We present the case of a 59-year-old male patient who has been smoking for 40 years. He presented with signs and symptoms of an obstructive glottic mass. The diagnostic workup pointed to a malignant pathology; the histopathology report confirmed the diagnosis of glottic undifferentiated pleomorphic sarcoma (malignant fibrous histiocytoma).
Stunning Response with Low-Dose Enzalutamide after Abiraterone Acetate Failure in a Patient Diagnosed with Metastatic Castration-Resistant Prostate Cancer: A Case Report
Authors: Rossi Luigi , Cimino Giuseppe , Gozzi Elisa , Sinjari Marsela , Brandi Martina , Ceddia Serena , Cosimati Antonella , Raimondi Lucrezia , Fontana Antonella , Filippi Luca , Bagni Oreste , Spinelli Gian Paolo
Published: March 2021

We report a case of an elderly patient with metastatic castration-resistant prostate cancer, initially treated with abiraterone acetate (1,000 mg/day) combined with LH-RH antagonist, prednisone (10 mg/day), and zoledronic acid to manage bone metastases. In consideration of his poor performance status, radiological and biochemical progression of the disease, we decided to switch abiraterone to enzalutamide (160 mg/day). Due to adverse events, we reduced enzalutamide to a dose of 80 mg/day. Currently, the disease is under control despite the use of a low dose of enzalutamide.
Metastasis of Osteosarcoma to the Abdomen: A Report of Two Cases and a Review of the Literature
Authors: Serpico Robert , Brown Jeffrey , Blank Alan , Jones Kevin , Randall R. Lor , Groundland John
Published: March 2021

Two cases of primary distal femur osteosarcoma with subsequent metastasis to the abdomen are presented. In both cases, the development of abdominal metastasis was quickly followed by patient decline and death. A review of the literature was performed, assessing the presentation and survival of patients with osteosarcoma metastasized to the abdomen. As illustrated by the current cases and the literature review, abdominal metastasis in osteosarcoma is often a late manifestation and terminal prognostic indicator. Nonetheless, early detection and prompt intervention of this less common site of disease metastasis may improve patient care and palliative therapy.
Hipertensión pulmonar aguda de la primera infancia, sensible a la tiamina (TRAPHEI): Serie de casos y revisión clínica
Authors: Panigrahy Nalinikanta , Chirla Dinesh Kumar , Shetty Rakshay , Shaikh Farhan A.R.  , Kumar Poddutoor Preetham , Madappa Rajeshwari , Lingan Anand , Lakshminrusimha Satyan
Published: March 2021

La hipertensión pulmonar persistente del neonato (PPHN) es un síndrome de alta resistencia vascular pulmonar (RVP), observado comúnmente en todo el mundo durante el periodo neonatal inmediato. Recientemente, varios reportes de casos en la India han descrito la ocurrencia de hipertensión pulmonar grave en infantes en el periodo posneonatal. Típicamente, en estos casos se presenta dificultad respiratoria en infantes de 1–6 meses de edad, amamantados por madres con una dieta basada en arroz blanco. Los factores predisponentes incluyen infecciones del tracto respiratorio, como laringotraqueobronquitis con cambio en la voz, que conducen a hipertensión pulmonar, dilatación de la aurícula y el ventrículo derechos, edema pulmonar y hepatomegalia. La mortalidad es alta si no se aplica una terapia específica. La asistencia respiratoria, tratamiento con vasodilatadores pulmonares, inotrópicos, diuréticos y la infusión de tiamina han mejorado el pronóstico de estos infantes. En esta revisión se describen cuatro pacientes típicos con hipertensión pulmonar aguda de la primera infancia, sensible a la tiamina (TRAPHEI), debida a la deficiencia de esta vitamina, y se discute su fisiopatología, sus características clínicas, sus criterios diagnósticos y las opciones terapéuticas disponibles.
The impact of peer assisted learning on mentors’ academic life and communication skill in medical faculty: A systematic review
Authors: Zoraya Sabrina Intan , Florettira Mutiara Tri , Syakurah Rizma Adlia , Azhar Abdillah Adipatria B. , Okparasta Andika , Irfani Tri Hari
Published: March 2021

Peer assisted learning (PAL) was initiated to support the first-year students. In medical faculty, first-year students often find starting new academic life challenging. The impact from the peer mentors’ aspect is not widely explore. The aim of this study was to review studies that reported the impact of PAL programs on peer mentors in medical faculty, particularly on their academic life and communication skill. The DOAJ, PubMed Central, SciELO, and Science Direct databases advanced search used to conduct a systematic literature searching. Systematic search was performed according to preferred reporting items for systematic reviews and meta-analysis (PRISMA) checklist recommendations. Five studies were included. All of the reviewed studies shown the impact of PAL programs on mentors’ academic life. Three studies have shown both the impact of PAL programs on mentors on their academic life and communication skill. Studies in this review have shown positive impacts on mentors’ academic life and communication skill. Good communication skills, empathy, leadership and teaching skills will promote individual abilities and skills as a doctor, be it as a practitioner, or as an educator.
Cost‐Effectiveness of Coronary Artery Bypass Grafting and Percutaneous Coronary Intervention in Patients With Chronic Kidney Disease and Acute Coronary Syndromes in the US Medicare Program
Authors: Reynolds Matthew R. , Gong Tingting , Li Shuling , Herzog Charles A. , Charytan David M.
Published: March 2021

Background

Coronary revascularization provides important long‐term clinical benefits to patients with high‐risk presentations of coronary artery disease, including those with chronic kidney disease. The cost‐effectiveness of coronary interventions in this setting is not known.

Methods and Results

We developed a Markov cohort simulation model to assess the cost‐effectiveness of percutaneous coronary intervention (PCI) and coronary artery bypass grafting (CABG) in patients with chronic kidney disease who were hospitalized with acute myocardial infarction or unstable angina. Model inputs were primarily drawn from a sample of 14 300 patients identified using the Medicare 20% sample. Survival, quality‐adjusted life‐years, costs, and cost‐effectiveness were projected over a 20‐year time horizon. Multivariable models indicated higher 30‐day mortality and end‐stage renal disease with both PCI and CABG, and higher stroke with CABG, relative to medical therapy. However, the model projected long‐term gains of 0.72 quality‐adjusted life‐years (0.97 life‐years) for PCI compared with medical therapy, and 0.93 quality‐adjusted life‐years (1.32 life‐years) for CABG compared with PCI. Incorporation of long‐term costs resulted in incremental cost‐effectiveness ratios of $65 326 per quality‐adjusted life‐year gained for PCI versus medical therapy, and $101 565 for CABG versus PCI. Results were robust to changes in input parameters but strongly influenced by the background costs of the population, and the time horizon.

Conclusions

For patients with chronic kidney disease and high‐risk coronary artery disease presentations, PCI and CABG were both associated with markedly increased costs as well as gains in quality‐adjusted life expectancy, with incremental cost‐effectiveness ratios indicating intermediate value in health economic terms.