bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Reattachment of Rare Proximal Adductor Avulsion Injury in a Female Athlete
Authors: Chang Alex , Zoland Mark , Bharam Srino
Published: September 2023

Case:

A 54-year-old female professional equestrian sustained a traumatic right groin injury with disabling groin pain. Magnetic resonance images indicated a proximal adductor avulsion injury with a 3.2-cm tendon retraction. Surgical reattachment of the fibrocartilage avulsion with suture anchor repair was subsequently performed.

Conclusion:

Adductor avulsion injuries have been rarely reported in female athletes. Patient-reported outcomes demonstrate a successful return to preinjury levels of daily function and sports performance after surgery for a female athlete. Surgical reattachment should be considered for the management of proximal adductor avulsion injuries in elite female athletes.
Surgical Decompression for Acute Axillary and Suprascapular Neuropathy
Authors: Wilson Seth B. , Wagner Daniel , Cvetanovich Gregory , Rauck Ryan C.
Published: September 2023

Case:

We present the case of a 25-year-old man, who sustained a ground level fall and presented with a left shoulder inferior labral tear with paralabral cyst and associated axillary nerve compression. He had electromyogram evidence of axillary and suprascapular nerve compression. Surgical decompression of the cyst, repair of the labrum, and suprascapular notch decompression relieved his previously progressive symptoms.

Conclusion:

This case demonstrates that individuals who have a paralabral cyst with acute, severe axillary neuropathy and suprascapular neuropathy can benefit from decompression of the paralabral cyst, repair of the labrum, and decompression of the suprascapular notch.
Persistence of Atypical Femoral Fracture 14 Years After Initial Diagnosis
Authors: Gerber Brett A. , Gibbons Kester , Egol Kenneth
Published: September 2023

Case:

A 75-year-old woman presented with left thigh pain 14 years after initial diagnosis of bilateral atypical femoral fractures secondary to chronic bisphosphonate use. New radiographic imaging and magnetic resonance imaging demonstrated bilateral incomplete femur fractures with surrounding marrow edema, cortical remodeling, and periosteal edema in a manner similar to that found 14 years earlier upon original diagnosis.

Conclusion:

Recurrence of pain 14 years after initial diagnosis supports consideration of initial surgical management of atypical femur fractures (AFFs), even in patients with nonoperative symptom improvement. Patients who decline surgical intervention should be informed that incomplete AFFs may become a chronic medical condition moving forward.
The multi-representational ability profile of physics students in the interactive multimedia assisted problem-based learning during the Covid-19 pandemic
Authors: Masrifah Masrifah , Amiroh Dewi
Published: September 2023

This study aims to analyze the multi-representation ability profile of physics students in the interactive multimedia assisted problem-based learning during the Covid-19 pandemic. This research is a qualitative descriptive study. This research involved 9 female teachers and 1 male teacher. Data on the multi-representation abilities of Physics teachers were obtained by using the 5 item multi-representation problem instrument in the form of representing image to verbal, verbal to mathematics, verbal to picture, table to graph, and mathematics to verbal. Meanwhile, researchers utilized interviews to gather information on the difficulties that prospective physics teachers had in working on multi-representational problems. The results of the analysis show that the multi-representation ability of prospective physics teachers is generally good. This can be seen from the average percentage obtained by 63%. However, there are two indicators that are still not good, namely verbal to mathematics representation and mathematics to verbal representation with an average percentage of 30% and 43% respectively. For this reason, it is necessary to make efforts to increase the multi-representational abilities of prospective physics teachers by using approaches, teaching materials, and learning media that are able to teach and present physics concepts in various forms of representation so that it is easier to understand the concepts presented.
Rasch modeling: Developing a critical thinking ability test for students on climate change material
Authors: Ridwan Irwan Muhammad , Kaniawati Ida , Suhandi Andi , Ramalis Taufik Ramlan , Mahmudah Ifa Rifatul , Vilmala Berry Kurnia
Published: September 2023

The goal of this study was to examine critical thinking skills on the topic of climate change. This study is quantitative in nature. The information was gathered by creating a 30-question test to assess the ability to think critically about climate change. Respondents were 52 physics education students from one of Tasikmalaya's campuses. Winstep software version 4.00 was utilized for data analysis. Rasch modeling was employed in this investigation. The results of the Rasch modeling study show a value of 0.38 for person reliability and 0.91 for item reliability, indicating that the instrument items manufactured are dependable. The raw variance value of 23.4% suggests that the standards for dichotomous data construct validity are met. The separation value of 3.15 supports this. It suggests that this item has a good answer distribution and can assess critical thinking skills on the topic of climate change. As a result, it can be used for study.
Exploration of physics teacher identity through life experience: A case study of science teacher with excellent achievement
Authors: Puspitaningtyas Ellen , Purwaningsih Endang , Handayanto Supriyono Koes
Published: September 2023

This research aims to explore the construction of teacher identity through life experiences. Data were collected from observation, interviews, and document analysis. The subject of this study was TN (a pseudonym), who is a science teacher with an excellent academic background. The results of this research indicate that, from the perspective of discourse identity, TN is a teacher who emphasizes contextual learning and student-centered learning. Based on the perspective of nature identity, kinesthetic learning and her fondness for mathematics have had a major influence on her interest in physics. Meanwhile, from the perspective of affinity identity, family and role models greatly influence TN's beliefs about learning and her decision to have a career as a teacher. From the perspective of institutional identity, formal institutions have a negative impact on the construction of TN’s identities, while informal institutions such as organizations have a positive influence on TN's physics interests and rhetorical skills.
Novel custom-made design and analysis of hydrogen PEM fuel cell for high endurance small UAV applications
Authors: Prajapati Soham , Thakar Parth S. , Markana Anilkumar
Published: September 2023

The purpose of this paper is to propose a new methodology to devise a custom-made hydrogen-based proton exchange membrane fuel cell (\textcolor{red}{PEMFC}) system for a class of experimental fixed-wing small unmanned aerial vehicles (SUAVs). The proposed fuel cell provides three times higher flight endurance than the conventional battery-based powertrain. The chosen SUAV \textcolor{red}{represents} a class of high-altitude UAVs, having an operational altitude of 4500m \textcolor{red}{(14,760ft)}, cruising speed of 12-20 m/s (39.4 - 65.6 ft/s), take-off weight of 4 kg, wing-span of 1.61 m (5.28 ft) and battery-powered flight endurance of one hour. The characteristic parameters and design configurations of the fuel cell are determined by employing \textcolor{red}{the first} principles of electrochemistry and thermodynamics. Corresponding simulations are performed \textcolor{red}{using} popular development tools like MATLAB/Simulink. The vital results in the form of – polarization and power curves for fuel cell, against the current density are obtained, which are further narrowed down to meet the target power requirements for determining the size of the hydrogen storage tank. The paper also comments on the auxiliary systems and fuel cell powertrain for SUAVs. \textcolor{red}{Finally, the design efficiency of 54% for the fuel cell is achieved with respect to equivalent voltage for heating value with the calculated hydrogen storage tank size of 5.688 litres. This yields three times higher flight endurance as compared to the flight time found in literature for the same class of SUAVs. }
Wafer Defect Identification with Optimal Hyper-Parameter Tuning of Support Vector Machine using the Deep Feature of ResNet 101
Authors: Dash Shishir Prasad , Amat Rajat , Sethy Prabira , Behera Santi Kumari
Published: September 2023

As semiconductor processing technologies continue to advance, semiconductor wafers are becoming more densely packed and intricate, resulting in a higher incidence of surface imperfections. Therefore, it is crucial to detect these defects early and accurately classify them to pinpoint the root causes of the defects in the manufacturing process, ultimately leading to improved yield. Therefore, defect detection is critical in the industrial production of monocrystalline silicon. This study employs deep learning techniques to propose a framework for detecting defects on silicon wafers, focusing on optimizing the hyperparameters of support vector machines (SVM). Three methods were utilized to fine-tune the SVM parameters: Bayesian optimization, grid search, and random search techniques. This study demonstrates how selecting optimal values for SVM parameters can lead to better classification. Additionally, real manufacturing data were utilized to evaluate the performance of the proposed SVM classifier, with a comparison to state-of-the-art techniques in the field. By using deep features from ResNet 101 and a support vector machine, this work achieves 74.5% accuracy in identifying wafer defects without employing any optimization technique. However, the performance of the model was further improved by utilizing the random search optimization technique, which yielded the best result among the three optimization techniques tested, with an accuracy of 88.1%.
CBLL1 is hypomethylated and correlates with cortical thickness in transgender men before gender affirming hormone treatment
Authors: Fernández Rosa , Zubiaurre-Elorza Leire , Ojeda Natalia , Collet Sarah , Kiyar Meltem , T’Sjoen Guy , Mueller Sven C. , Guillamon Antonio , Pásaro Eduardo , Santisteban Andrea
Published: September 2023

Background:Gender identity refers to the consciousness of being a man, a woman or other condition. Generally, it is congruent with the sex assigned at birth; however, for some people, it is not. If the incongruity is distressing, it is defined as gender dysphoria (GD). Here, we measured whole-genome DNA methylation by the Illumina Infinium Human Methylation 850 array and report its correlation with cortical thickness (CTh) in 22 transgender men (TM) experiencing GD versus 25 cisgender men (CM) and 28 cisgender women (CW).
Results: With respect to the methylation analysis, TM vs.CW showed significant differences in methylation in 35 CpG sites, while 2,155 CpG sites were found when TM and CM were compared. With respect to correlation analysis, TM showed differences in the methylation degree of CBLL1 and DLG1 genes that correlated with global and left hemisphere CTh. Both genes were hypomethylated in TM compared to the cisgender groups. These genes are involved in neuronal myelination and CBLL1modulates alpha estrogen receptor transactivation through competitive interference with the estrogen receptor coactivators SRC1 and SRC2. Early onset TM showed a positive correlation between CBLL1and several cortical regions. Methylation of CBLL1 positively correlated with CTh in the frontal (left caudal middle frontal), temporal (right inferior temporal, left fusiform) and parietal cortices (left supramarginal and right paracentral).
Conclusions: This is the first study relating CBLL1 methylation with CTh in transgender persons and supports a neurodevelopmental hypothesis of gender identity.
Incidence of dislocation and associated risk factors in patients with a femoral neck fracture operated with an uncemented hemiarthroplasty
Authors: Olesen Britt Aaen , Närhi Susanne Faurholt , Jensen Thomas Giver , Overgaard Søren , Palm Henrik , Sørensen Michala Skovlund
Published: September 2023

Background
Several factors might be associated with risk of dislocating following uncemented hemiarthroplasty (HA) due to femoral neck fracture (FNF). Current evidence is limited with great variance in reported incidence of dislocation (1-15%).
Aim of this study was to identify the cumulative incidence of first-time dislocation following HA and to identify the associated risk factors.
Methods
We performed a retrospective cohort study of patients receiving an HA (BFX Biomet stem, posterior approach) at Copenhagen University Hospital, Bispebjerg, in 2010-2016. Patients were followed until death or end of study (dec 2018). Dislocation was identified by code extraction from the Danish National Patient Registry.
Variables included in the multivariate model was defined pre-analysis to include: age, sex and variables with a p-value <0.1 in univariate analysis. A regression model was fitted for 90 days dislocation as the assumption of proportional hazard rate (HR) was not met here after.
Results
We identified 772 stems and 58 stems suffered 90 dislocations during the observation period resulting in a 7% (CI 5-9) incidence of dislocation 90 days after index surgery. 55 of the 58 stems (95%) experienced the first dislocation within 90 days after surgery.
Only absence of dementia was identified as an independent protective factor in the cause-specific model (HR 0.46 (CI 0.23-0.89)) resulting in a 2.4-fold cumulative risk of experiencing a dislocation in case of dementia. Several other variables such as age, sex, various medical conditions, surgery delay and surgical experience were eliminated as statistical risk factors.
We found a decrease in survival probability for patients who experienced a dislocation during follow-up.
Conclusions
The incidence of first-time dislocation of HA (BFX Biomet stem, posterior approach) in patients with a hip fracture is found to be 7% 90 days after surgery. Due to the non-existing attribution bias, we claim it to be the true incidence. Dementia was among several variables identified as the only risk factor for dislocation.
In perspective, we may consider treating patients with cognitive impairment by other methods than HA.
The Study of Ketamine for Youth Depression (SKY-D): study protocol for a randomised controlled trial of low-dose ketamine for young people with major depressive disorder
Authors: Schwartz Orli , Amminger Paul , Baune Bernard T , Bedi Gillinder , Berk Michael , Cotton Sue M. , Daglas-Georgiou Rothanthi , Glozier Nick , Harrison Ben , Hermens Daniel F. , Jennings Emma , Lagopoulos Jim , Loo Colleen , Mallawaarachchi Sumudu , Martin Donel , Phelan Bethany , Read Nikki , Rodgers Anthony , Schmaal Lianne , Somogyi Andrew A. , Thurston Lily , Weller Amber , Davey Christopher G.
Published: September 2023

Background: Existing treatments for young people with severe depression have limited effectiveness. The aim of the Study of Ketamine for Youth Depression (SKY-D) trial is to determine whether a 4-week course of low-dose subcutaneous ketamine is an effective adjunct to treatment-as-usual in young people with major depressive disorder (MDD).
Methods: SKY-D is a double-masked, randomised controlled trial funded by the Australian Government’s National Health and Medical Research Council (NHMRC). Participants aged between 16 to 25 years (inclusive) with moderate-to-severe MDD will be randomised to receive either low-dose ketamine (intervention) or midazolam (active control) via subcutaneous injection once per week for four weeks. The primary outcome is change in depressive symptoms on the Montgomery-Åsberg Depression Rating Scale (MADRS) after four weeks of treatment. Further follow-up assessment will occur at 8 and 26 weeks from treatment commencement to determine whether treatment effects are sustained and to investigate safety outcomes.
Discussion: Results from this trial will be important in determining whether low-dose subcutaneous ketamine is an effective treatment for young people with moderate-to-severe MDD. This will be the largest randomised trial to investigate the effects of ketamine to treat depression in young people.
Trial registration: Australian and New Zealand Clinical Trials Registry ID: ACTRN12619000683134. Registered on May 7, 2019. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377513
Effect of heavy metal-sulfamethoxazole complexes on the sulfanilamide resistance gene sul1
Authors: Zhu Xianyi , Yang Yuezhu , Liu Lu , Gu Jing , Yang Guojun , Li Zhangliang , Wang Hua
Published: September 2023

Both heavy metals and antibiotics in the environment might be affecting the environmental behaviour of antibiotic resistance gene (ARGs). However, little attention has been paid to the effect of heavy metal-antibiotic complexes on the performance of ARGs. Therefore, in the present work, four heavy metals (Cu, Zn, Pb, Cd) and sulfamethoxazole (SMX) were selected as candidates to explore the effect of heavy metal-SMX complexes on the sulfanilamide resistance gene sul1. The results showed that Pb could inhibit the amplification of sul1, but Zn could stimulate it, as well as Cu and Cd stimulated the amplification of sul1 at low concentrations but inhibited at high concentrations (> 0.50 mg/L). Meanwhile, SMX could stimulate the amplification of sul1at high concentrations. Most importantly, it was discovered for the first time that the complexes of SMX with Pb, Zn, Cu, and Cd showed positive effects on the amplification of sul1 at ratios of 1:1, 1:1, 2:1, and 1:2, respectively, and the positive effects of the four complexes on sul1 were consistently higher than that of SMX or any of the heavy metals alone. These results reveal that heavy metal-antibiotic complexes could affect the existence and distribution of ARGs.
High-solution emission characters and health risks of volatile organic compounds for sprayers in automobile repair industries
Authors: Du Zhanxia , Li Hanbing , Nie Lei , Yao Zhen , Zhang Xinmin , Liu Yuting , Chen Sha
Published: September 2023

The increasing automobile repair industries (ARIs) with spray facilities have become an important volatile organic compounds (VOCs) pollution source in China. However, the VOCs health risk assessment for long-term exposure in ARIs have not been well characterized. In this study, though sampled VOCs from 51 typical ARIs in Beijing, the relationship between emission patterns, average daily exposure concentrations (EC) and health risks were comprehensively analyzed with the health assessment method for spray operators, and the studies consider the health effects of the sprayers for five processes due to the difference in raw materials. Results showed that oxygen VOCs (OVOCs) and aromatics were the main VOCs components in solvent-based and water-based workshops, respectively. And ARIs operator's daily VOCs inhalation EC was 11.24-1460.70 µg·m− 3. The method of inhalation exposure health risk assessment was firstly used to evaluate carcinogenicity and non-carcinogenicity risk for sprayers in ARIs. The cumulative lifetime carcinogenic risk (LCR) for 24 sampled VOCs were within acceptable ranges, while the mean hazard index (HI) with 44 sampled VOCs was over 1. Among them, the LCR and HI of VOCs in solvent-based spraying workshops were 8.72E-12 to 5.66E-7 and 0.13 to 22.37, and ethanol had a high carcinogenic risk. Of these, the mean HI associated with aromatics were 6.45 to 9.64. Our study will provide the important references for the standard of VOCs occupational exposure health limits in ARIs.
Improved hydrolysis of sewage sludge by air-assisted non-thermal plasma for enhanced biomethane recovery
Authors: Vanegas Gerardo Oswaldo Ortiz , Kim Hyun-Woo
Published: September 2023

To resolve the slow hydrolysis of sewage sludge, various pre-treatment technologies have been assessed but high operating costs prevent active application. To mitigate the cost-effectiveness of pre-treatment and to promote anaerobic digestion (AD), this study investigates non-thermal plasma (NTP) technologies as an alternative. Experimental design under various contact time (CT) and temperature (T) conditions tests how NTP pre-treatment improves the methane conversion of organics in sewage sludge. By building a multi-response surface model (RSM) using a central composite design (CCD), optimal CT and T were revealed as 4.6 h and 45°C, respectively. This statistical optimization of NTP pre-treatment led to enhanced biochemical methane potential of 297 ± 46 mL CH4/g COD keeping the cost due to power consumption as low as 0.06 US$/L, which is comparable to those of other advanced oxidation processes (0.11 ~ 0.44 US$/L). The results demonstrate that accelerated hydrolysis of sewage sludge using non-thermal plasma pre-treatment might benefit better renewable energy recovery from sewage sludge.
Feasibility Analysis of Arterial CT Radiomics Model to Predict the Risk of Local and Metastatic Recurrence after Radical Cystectomy for Bladder Cancer
Authors: LV Huawang , Zhou Xiaozhou , Liu Yuan , Liu Yuting , Chen Zhiwen
Published: September 2023

Purpose
To construct a radiomics-clinical nomogram model for predicting the risk of local and metastatic recurrence within 3 years after radical cystectomy (RC) of bladder cancer (BCa) based on the radiomic features and important clinical risk factors for arterial computed tomography (CT) images and to evaluate its efficacy.
Methods
Preoperative CT datasets of 134 BCa patients (24 recurrent) who underwent RC were collected and divided into training (n = 93) and validation sets (n = 41). Radiomics features were extracted from a 1.5 mm CT layer thickness image in the arterial phase. A radiomics score (Rad-Score) model was constructed using the recursive feature elimination approach and a logistic regression model. Combined with important clinical factors, including gender, age, tumor size, tumor number and grade, pathologic T stage, lymph node stage and histology type of the archived lesion, and CT image signs, a radiomics-clinical nomogram was developed, and its performance was evaluated in the training and validation sets. Decision curve analyses (DCA) the potential clinical usefulness.
Results
The radiomics feature, consisting of five recurrence-related features, achieved good predictive results. The radiomics nomogram developed by combining two independent predictors, Rad-Score and pathologic T stage, was developed in the training set [AUC, 0.840; 95% confidence interval (CI), 0.743–0.937] and validation set (AUC, 0.883; 95% CI, 0.777–0.989). The calibration curve showed good agreement between the predicted probability of the radiomics-clinical model and the actual recurrence rate within 3 years after radical cystectomy for BCa. DCA show the clinical application value of the radiomics clinical model.
Conclusion
The radiomics clinical nomogram model constructed based on the radiomics features of arterial CT images and important clinical risk factors is potentially feasible for predicting the risk of recurrence within 3 years after RC for BCa.
Superparamagnetic Iron Oxide (SPIO) For Axillary Mapping in Patients with Ductal Carcinoma In Situ Undergoing Mastectomy: Single Institution Experience
Authors: Addae Jamin Kweku , Sweeting Raeshell Sharawn , Meszoely Ingrid Marie , McCaffrey Rachel Louise , Kauffmann Rondi Marie , Kelley Mark Carlton , Grau Ana Magdalena , Hewitt Kelly
Published: September 2023

Purpose Unnecessary axillary surgery can potentially be avoided in patients with DCIS undergoing mastectomy. Current guidelines recommend upfront sentinel lymph node biopsy during the index operation due to the potential of upstaging to invasive cancer. This study reviews a single institution’s experience with de-escalating axillary surgery using superparamagnetic iron oxide dye for axillary mapping in patients undergoing mastectomy for DCIS.
Methods This is a retrospective single-institution cross-sectional study. All medical records of patients who underwent mastectomy for a diagnosis of DCIS from August 2021 to January 2023 were reviewed and patients who had SPIO injected at the time of the index mastectomy were included in the study. Descriptive statistics of demographics, clinical information, pathology results, and interval sentinel lymph node biopsy were performed.
Results A total of 41 participants underwent 45 mastectomies for DCIS. The median age of the participants was 58 years (IQR=17; range 25 to 76 years), and the majority of participants were female (97.8%). The most common indication for mastectomy was diffuse extent of disease (31.7%). On final pathology, 75.6% (34/45) of mastectomy specimens had DCIS without any type of invasion and 15.6% (7/45) had invasive cancer. Of the 7 cases with upgrade to invasive disease, 2 (28.6%) of them underwent interval sentinel lymph node biopsy. All Sentinel lymph nodes biopsied were negative for cancer.
Conclusion
The use of superparamagnetic iron oxide dye can prevent unnecessary axillary surgery in patients with DCIS undergoing mastectomy.
Principle-Guided Psychotherapy for Children and Adolescents (FIRST): Study Protocol for a Randomized Controlled Effectiveness Trial in Outpatient Clinics
Authors: Bailin Abby , Cho Evelyn , Sternberg Ariel , Evans Spencer C. , Hollinsaid Nathan L. , Bearman Sarah Kate , Weisz John R.
Published: September 2023

Background: Hundreds of youth psychotherapy randomized trials have generated scores of helpful empirically supported treatments (ESTs). However, the standardized structure of many ESTs and their focus on a single disorder or homogeneous cluster of problems may not be ideal for clinically referred youths who have comorbidity and whose treatment needs may shift from week to week. This concern has prompted development of flexible transdiagnostic, modular youth psychotherapies. One of these, designed for efficient training and implementation, is FIRST—a transdiagnostic intervention built on five empirically supported principles of change (i.e., feeling calm, increasing motivation, repairing thoughts, solving problems, and trying the opposite) and targeting common internalizing and externalizing youth mental health disorders and problems. FIRST has shown promise in improving youth mental health in three open trials. Now, in a more rigorous test, we seek to (1) conduct a randomized controlled trial comparing FIRST to usual care in real-world clinical practice settings; (2) examine a promising candidate mediator of change—regulation of negative emotions; and (3) explore variables that may influence clinicians’ treatment implementation.
Methods:This is an assessor-naïve randomized controlled effectiveness trial in youth outpatient community clinics in New England and Texas. Using double randomization, clinic-employed clinicians and treatment-referred youths (7–15 years old) are independently randomly allocated (1:1) to FIRST or usual care. We aim to recruit 212 youth participants, all referred through normal community pathways, with elevated symptoms of anxiety, depression, conduct problems, or post-traumatic stress. This study will test the effectiveness of FIRST compared to usual care on mental health outcomes, examine whether those outcomes are mediated by regulation of negative emotions, and explore clinician factors that may be associated with FIRST implementation and outcomes. Session recordings are coded to assess treatment fidelity.
Discussion: This study will evaluate the effectiveness of FIRST in youth community mental health settings, relative to the care usually provided in those settings. If FIRST is found to be effective, it could offer an efficient and practical method to increase use of empirically supported treatment principles in real-world practice contexts.
Trial registration: NIH Clinical Trials Registry, NCT04725721. Registered 27 January 2021, https://clinicaltrials.gov/ct2/show/study/NCT04725721
Prph2 mutant knock-in mice recapitulate all features of human central areolar choroidal dystrophy and reveals an aberrant synaptic remodelling and microglial activation
Authors: Cuenca Nicolas , Ruiz-Pastor María José , Sánchez-Sáez Xavier , Kutsyr Oksana , Albertos-Arranz Henar , Sánchez-Castilo Carla , Ortuño-Lizarán Isabel , Martínez-Gil Natalia , Vidal-Gil Lorena , Méndez Lucía , Sánchez-Martín Manuel , Maneu Victoria , Lax Pedro
Published: September 2023

Purpose Central areolar choroidal dystrophy is an inherited disorder characterized by progressive choriocapillaris atrophy and retinal degeneration, usually associated with mutations in the PRPH2 gene. We aimed to generate and characterize a mouse model with the p.Arg195Leu mutation previously described in patients.Methods Heterozygous (Prph2WT/KI) and homozygous (Prph2KI/KI) mice have been generated using the CRISPR/Cas9 system to introduce the Arg195Leu mutation. Retinal function was assessed by electroretinography and optomotor test at 1, 3, 6, 9, 12, and 20 months of age. The structural integrity of the retinas was evaluated at the same ages using optical coherence tomography. Immunofluorescence and transmission electron microscope images of the retina were also analyzed.Results Genetic sequencing confirmed that both Prph2WT/KI and Prph2KI/KI mice presented the p.Arg195Leu mutation. A progressive loss of retinal function was found in both mutant groups, with significantly reduced visual acuity from 3 months of age in Prph2KI/KI and from 6 months of age in Prph2WT/KI mice. Decreased amplitudes in the electroretinography responses were observed from 1 month of age in Prph2KI/KI and from 6 months of age in Prph2WT/KI. Morphological analysis of the retinas correlated with functional findings, showing a progressive decrease in retinal thickness of mutant mice, with earlier and more severe changes in the homozygous mutant mice. We corroborated the alteration of the outer segment structure, and we found changes in the synaptic connectivity in the outer plexiform layer as well as gliosis and signs of microglial activation.Conclusions The new Prph2WT/KI and Prph2KI/KI murine models show a pattern of retinal degeneration similar to that described in human patients with CACD and appear as good models to study the mechanisms involved in the onset and the progression of the disease, as well as to test the efficacy of new therapeutic strategies.
Endoscopic Iatrogenic Esophageal Perforation and Management: A Retrospective Outcome Analysis in the Modern Era
Authors: Montminy Eric , Jones Blake , Heller J. Christie , Attwell Augustin
Published: September 2023

Introduction:
Iatrogenic esophageal perforation (IEP) is a severe adverse event (AE) of upper endoscopy procedures (UEPs) associated with morbidity. Management has shifted from surgery to endotherapy with clip placement (CP), self-expanding metal stent (SEMS), and vacuum therapy (VT). Limited analyses measure outcomes during contemporary interventional endoscopy periods.
Methods:
IEPs associated with EGD, upper EUS, small bowel enteroscopy (SBE), and ERCP at a 3-hospital academic center from January 2010 to December 2022 were identified retrospectively from a centralized AE database. Additional information was obtained from medical records. Statistical analysis was performed using Microsoft Excel and STATA.
Results:
Thirty-two IEPs from 26 EGDs, 4 EUS, 1 SBE, and 1 ERCP were identified. IEPs occurred mostly after dilation (bougie N = 7; balloon, N = 5) or foreign body removal (N = 6). Most IEPs occurred in the lower esophagus (N = 10) or gastroesophageal junction (N = 8). Diagnosis was made at a median 2 hours after the injury by endoscopy (N = 14), CT scan (N = 12), esophagram (N = 5), or x-ray (N = 1). Initial treatment included conservative therapy alone (N = 7), CP (N = 3), SEMS (N = 14), SEMS plus CP (N = 3), or surgery (N = 3). Eleven patients required additional treatment including repeat SEMS or adjustment (N = 4) or VT (N = 1). No surgical interventions were required after 2013. The median hospital stay was 3 days. Disposition included discharge to home (N = 25), long-term care facility (N = 2), 4 deaths (12.5% of IEPs), and 1 unknown.
Conclusions:
IEPs are rare and occur throughout the esophagus after any UEP. The majority are recognized immediately and managed with endotherapy, or rarely, surgery today. These characteristics likely explain the low mortality in this study.
Preoperative predictors of successful External Cephalic Version with breech presentation at term: a single centre experience
Authors: Duan Zhengrong , Chen Aner , Li Xiuxiu , He Xiaobo
Published: September 2023

Objective
To determine the factors associated with the external cephalic version (ECV) and evaluate the success rate ECV of at term in China.
Methods
207 consecutive patients who attempted ECV with a breech presentation at term were included from January 2017 to January 2023. Patients with a successful ECV were divided into the ECV success group. Patients who performed ECV but had a repeat breech presentation were divided into the ECV failure group. The factors for ECV success was carried out by multiple logistic regression analyses.
Results
The success rate of ECV was 68.6%(142/207) among 207 pregnancies with breech presentation at term. The reasons for failed ECV were not turning at all after four to five attempts(38/65, 58.5%), followed by fetal distress(7/65, 10.8%). Three predictive factors were identified and associated with a successful ECV: larger AFI, the use of tubutaline and lower HC/FL ratio.
Conclusions
This ECV prediction model based on a Chinese population to predict the success of ECV that is easy to use and incorporates a limited number of objective patient characteristics. The level of AFI, use of tubutaline, and ratio of HC/FL are independent determinants of the final presentation.
Relative anterior spinal overgrowth in mild and moderate adolescent idiopathic scoliosis: A retrospective study
Authors: Zhang Haoyang , Yao Benshun , Ye Xin , Li Shuailin , Pan Yingsen , Zhao Jinze , Shi Guoqing , Li Xiaoming , Lv Lijiang , Ying Xiaoming
Published: September 2023

Study design Retrospective study
Objective To determine whether the phenomenon of relative anterior spinal overgrowth (RASO) can occur regardless of scoliotic segments and scoliosis severity, and to clarify the regularity of vertebral body height changes in adolescent idiopathic scoliosis (AIS) patients.
Methods In total, 125 patients with AIS and 179 non-scoliotic adolescents were recruited for this study. The anterior vertebral body height (VBHa) and posterior vertebral body height (VBHp) were measured on lateral spine radiographs, and the VBHa/VBHp ratio was calculated. The ratios at the same levels between the two groups and different levels within the two groups were compared, as were the ratios among different segmental scolioses in the AIS group. The correlation between scoliosis severity and the ratio of the different vertebrae was subsequently analyzed.
Results Between T6 and L5, the VBHa/VBHp ratios were consistently higher in the AIS group than in the control group (P<0.001). Increasing trends were observed for the ratios of T7 to T10 and L1 to L5. There were no statistically significant differences among the ratios for different segmental scolioses at all levels. The Pearson coefficient for the analysis of the correlation between scoliosis severity and VBHa/VBHp ratios showed statistically significant positive correlations with T7 (P<0.05), T8 (P<0.05), and T11 (P<0.05), and negative correlations with L5 (P<0.05).
Conclusion The present study confirmed that RASO in patients with mild to moderate AIS is a generalized phenomenon regardless of the scoliosis severity and scoliotic segments. We speculate that the overgrowth on each vertebra is coordinated to maintain the integration of different vertebrae so that the spinal and truncal functions in patients with AIS can be maintained to the greatest extent possible.
Utilizing the Radiographic Union Score for Hip (RUSH) to Evaluate the Healing of Subtrochanteric Fractures after Intramedullary Fixation
Authors: Zhou Tian Jian , Jiang Song , Ren Jin Ke , Zhang Xuan , Liu Wang Xing , Yan Peng , Li Jian Wang , Zeng Tong , Xu Zhong Shi
Published: September 2023

Background
Prompt identification of fracture healing is crucial for medical decision-making and clinical research. This study aims to assess the effectiveness of the Radiographic Union Score for Hip (RUSH) in subtrochanteric fractures and determine the optimal scoring threshold for fracture healing.
Methods
We obtained 94 sets of X-ray films from the postoperative follow-up of 35 patients who underwent intramedullary nail fixation for subtrochanteric fractures. Six orthopedic surgeons evaluated the imaging data and determined fracture healing based on subjective judgment. They then scored the X-ray images using the RUSH form. After four weeks, the same observers reevaluated 47 randomly selected sets of radiographs. Subsequently, Subsequently, the observers and study designer conducted a consensus meeting where they agreed on whether the fractures had healed. We used Fleiss kappa to evaluate agreement among observers based on subjective impressions, and the intraclass correlation coefficient assessed RUSH score consistency. Regression analysis examined the relationship between scores and fracture healing consensus using a receiver operator characteristic (ROC) curve.
Results
Based on overall impressions, the agreement level among orthopedic surgeons for determining the healing status of subtrochanteric fractures was moderate (Kappa = 0.564, 95% CI: 0.511–0.616). However, utilizing the RUSH scoring system can improve the consistency to a substantial level of agreement (ICC = 0.748, 95% CI: 0.663–0.817). Regarding intraobserver reliability, there were significant differences among orthopedic surgeons in judging fracture healing based on overall impressions. However, using the RUSH scoring form, the attending group achieved better intraobserver consistency than the resident group. Regression analysis and ROC curve analysis revealed a strong correlation between the RUSH total score, cortical bone score, cancellous bone score, and consensus on fracture healing. The AUC values are 0.769 (95% CI: 0.670–0.868), 0.779 (95% CI: 0.681–0.876), and 0.771 (95% CI: 0.674–0.867), respectively.
Conclusions
Our study highlights the effectiveness of the RUSH scoring system in enhancing interobserver agreement and intraobserver consistency when evaluating subtrochanteric fracture healing in orthopedic surgeons. We propose a cutoff value of 21 for determining fracture healing by simplifying the system to include eight cortical bone-related items.
Morphologic and morphometric bilateral analysis and sexual dimorphism in sciatic nerves of adults: an anatomic investigation of cadaveric specimens in Uganda with implications on sciatic nerve neuropathologies
Authors: Kegoye Eric Simidi , Ojewale Abdulfatai Olakunle , Ezekiel Winnie , Usman Ibe Michael , Aigbogun Eric Osamudiamwen , Adewale Adesanya Olamide , Fernandez Edgar Mario , Kasozi Keneth Iceland , Nalugo Halima , Echoru Isaac , Afodun Adam Moyosore , Kenganzi Ritah , Segun Okeniran Olatayo , Ssempijja Fred
Published: September 2023

Background
The Sciatic nerve (SN) depicts sex and side-associated dimorphic features that are of clinical relevancy. The study investigated the sex and side-related morphologic and morphometric variations of the nerve using cadavers.
Methods
A cross-sectional cadaveric study on 62 Ugandan cadavers were used. Continuous variables were reported using descriptive statistics and discrete variables were reported as percentages. Ordinary two-way ANOVA was used to compare the dimensions and percentages of patterns of the SN.
Results
The study identified six categories of exit patterns of the SN, type A (“Below and undivided”) occurred in a majority of cases (62.9%), a penta furcate branching pattern dominated the whole population, “Bifurcate” termination pattern was found in most SNs (90.3% and 87.1% for right and left limbs respectively) while the rest have the trifurcate termination pattern, with no side or sex-related variations. The average dimensions of SN were within normal ranges, and show no side-related differences but with a sex effect (are significantly higher in males than females), mean length of the SN in centimeters (length A: Males, right limbs = 30.58 ± 9.00; left limbs = 31.30 ± 6.20; Females, right = 26.07 ± 6.58; left = 26.30 ± 5.56), the mean level of termination of SN in centimeters (length B: Males, right = 8.5 ± 4; left = 8.2 ± 3.9; Females, right = 7.76 ± 3.8; left = 7.82 ± 3.5), mean SN diameters in millimeters: mean exit diameter (Males: right = 11.69 ± 1.92; left = 11.67 ± 2.16; Females, right = 8.41 ± 2.24; left = 9.28 ± 1.99), mean midthigh diameter (Males: right = 8.86 ± 1.56; left = 9.64 ± 1.88; Females, right = 7.12 ± 1.46; left = 8.28 ± 1.89), mean terminal end diameter (Males, right = 9.47 ± 2.07; left = 9.86 ± 2.32; Females, right = 7.5 ± 1.62; left = 8.4 ± 2.24).
Conclusions
Most SNs show normal anatomical characteristics with rare cases of sex-related dimorphism in the termination level and morphometry (length and diameter) of the nerve. The observed sexual dimorphisms in sciatic nerves are of great clinical and surgical interest and a warranty for more investigations in different populations, especially through the use of advanced techniques such as ultrasonographic anatomy techniques.
Efficacy and Safety of Raltitrexed plus Oxaliplatin Transvascular Intervention in the Treatment of Intermediate to Advanced Hepatocellular Carcinoma: A Single-arm Meta-analysis
Authors: Peng Yishan , Deng Jingduo , Chen Zhi , Yu Wenke , Yang Bin , Nie Yu , Cheng Yuan
Published: September 2023

Background
The incidence of primary hepatocellular carcinoma (HCC) has remained high worldwide, and patients with advanced unresectable HCC are not in the minority. Previous studies have shown that oxaliplatin plus raltitrexed via Hepatic Arterial Infusion Chemotherapy(HAIC) can prolong Overall Survival(OS) and Progression-Free Survival(PFS) in patients with advanced HCC. However, almost all studies on this regimen for advanced HCC were non-randomized controlled trials and had all sample sizes, which may lead to a lack of validity of the results obtained. Therefore, the aim of this meta-analysis was to evaluate the efficacy and safety of raltitrexed plus oxaliplatin transvascular intervention in patients with intermediate to advanced HCC.
Methods
To find relevant studies, we extracted metrics including Overall Remission Rate(ORR), median OS(mOS), median PFS(mPFS), and Adverse Events(AEs) by systematically searching Pubmed, Embase, Cochrane Library and Web of Science data bases for further analysis.
Results
Seven studies involving 419 patients were finally included. In terms of efficacy against tumors, the ORR across studies combined was 55.9%(95%CI = 46.1%-65.7%), the mPFS and mOS of 5.68 months and 12.47 months. The most common adverse reactions were elevated ALT (incidence: 49.2%, ≥Grade III: 4.6%), abdominal pain (incidence: 47.8%, ≥Grade III: 2.2%) and fever (incidence: 42.9%). The most common adverse event greater than grade 3 was AST elevation, with an incidence of 12.8%.
Conclusion
The results of this analysis suggested that raltitrexed plus oxaliplatin transvascular intervention has good efficacy and safety in patients with intermediate and advanced HCC, but larger and multicenter clinical trials are still needed to confirm this fact.
Registration Information
This meta-analysis has completed registration with PROSPERO, the registration number is CRD42023421097.
Immuno-antioxidative reno-modulatory effectiveness of Echinacea purpurea extract against bifenthrin-induced renal poisoning
Authors: Abdel-Wahhab Khaled , Elqattan Ghada , Hassan Laila , Sayed Rehab , El-Sahra Doaa , Mannaa Fathia
Published: September 2023

Echinacea purpurea is a precious medicinal herb. Many civilizations utilize it as a natural medicine. Its extracts provide antifungal, antiviral, antibacterial, and antioxidative activities and are utilized for treating the common cold in addition to respiratory and urinary illnesses. Using male albino rats (160-200g), an in vivo study was conducted to examine the ameliorative potential and investigate the anti-inflammatory, antioxidant, and chemical detoxifying activities of Echinacea purpurea ethanolic extract (EEE) against bifenthrin-induced renal injury. The animals were divided into four groups and orally treated for 30 days as follows: normal control; animals were treated with EEE (465 mg/kg/day) dissolved in water; healthy animals were given bifenthrin (7mg/kg/day) dissolved in olive oil and the last group was administered EEE one-hour prior bifenthrin intoxication. It was noticed that the administration of the animals with bifenthrin caused significant elevations in serum values of ALAT, ASAT, urea, creatinine, the renal inflammatory and apoptotic markers (IL-1β, TNF-α, IFN-γ and caspase-3), and the oxidative stress and antioxidant markers in kidney (MDA and NO) while, renal GSH, GPx, and SOD values showed about two-fold decrement in compared to normal control. EEE treatment resulted in a considerable restoring of all these parameters to near the control values. Moreover, the extract improved the histological architecture of the kidney. It was concluded that Echinacea purpurea extract has ameliorative potential and chemo-preventive efficacy against bifenthrin-induced renal injury, as well as the significant role of its anti-inflammatory, antioxidant, and chemical detoxifying activities.
Investigation of the creatine biosynthesis negative feedback loop via creatine mediated control of arginine:glycine amidinotransferase expression in human HAP1 cells implies an intracellular creatine sensing mechanism
Authors: Tropak Michael B. , Tkachyova Ilona , Gu Ray , Lee Alex , Schulze Andreas
Published: September 2023

Cellular homeostasis of creatine (CT), integral part of the energy buffering and -transducing system connecting intracellular sites of ATP production and -utilization, comprises of mechanisms that increase CT, i.e., biosynthesis and cellular uptake, and CT-lowering processes, such as export and non-enzymatic conversion to creatinine. The negative feedback loop by which CT controls its biosynthesis via suppression of the rate-limiting enzyme arginine:glycine amidinotransferase (AGAT) is not well understood. We have used CRISPR to tag the C-terminus of AGAT with a nanoluc luciferase (NLuc) reporter in HAP1 cells. A biphasic decay of AGAT-NLuc in response to increasing extracellular CT was observed, whereas the decrease in AGAT-NLuc expression was directly proportional to the rise in intracellular CT levels with an approximate IC50 of 1–2 mM. CRISPR generated HAP1 CT transporter (CrT) null cells and HAP1 CrT null cells stably expressing a CrT-GFP fusion protein further demonstrated that the biphasic response to extracellular CT is mediated by a high-affinity (Km 9–10 µM) CrT dependent, saturable mechanism and a CrT independent, unsaturable uptake process. The direct response to intracellular CT suggests the existence of an intracellular CT sensing system enabling a dynamic cell response to changing CT concentration that is relevant for cellular CT homeostasis.