bluuebunny/crossref_metadata_2025 huggingface dataset:
A gene expression assay based on chronic lymphocytic leukemia activation in the microenvironment to predict progression
Authors: Abrisqueta Pau , Medina Daniel , Villacampa Guillermo , Lu Junyan , Alcoceba Miguel , Carabia Julia , Boix Joan , Tazón-Vega Barbara , Iacoboni Gloria , Bobillo Sabela , Marín-Niebla Ana , González Marcos , Zenz Thorsten , Crespo Marta , Bosch Francesc
Published: August 2022

Several gene expression profiles with a strong correlation with patient outcomes have been previously described in chronic lymphocytic leukemia (CLL), although their applicability as biomarkers in clinical practice has been particularly limited. Here we describe the training and validation of a gene expression signature for predicting early progression in patients with CLL based on the analysis of 200 genes related to microenvironment signaling on the NanoString platform. In the training cohort (n = 154), the CLL15 assay containing a 15-gene signature was associated with the time to first treatment (TtFT) (hazard ratio [HR], 2.83; 95% CI, 2.17-3.68; P < .001). The prognostic value of the CLL15 score (HR, 1.71; 95% CI, 1.15-2.52; P = .007) was further confirmed in an external independent validation cohort (n = 112). Notably, the CLL15 score improved the prognostic capacity over IGHV mutational status and the International Prognostic Score for asymptomatic early-stage (IPS-E) CLL. In multivariate analysis, the CLL15 score (HR, 1.83; 95% CI, 1.32-2.56; P < .001) and the IPS-E CLL (HR, 2.23; 95% CI, 1.59-3.12; P < .001) were independently associated with TtFT. The newly developed and validated CLL15 assay successfully translated previous gene signatures such as the microenvironment signaling into a new gene expression–based assay with prognostic implications in CLL.
Prioritization of cancer driver gene with prize-collecting steiner tree by introducing an edge weighted strategy in the personalized gene interaction network
Authors: Zhang Shao-Wu , Wang Zhen-Nan , Li Yan , Guo Wei-Feng
Published: August 2022

Background

Cancer is a heterogeneous disease in which tumor genes cooperate as well as adapt and evolve to the changing conditions for individual patients. It is a meaningful task to discover the personalized cancer driver genes that can provide diagnosis and target drug for individual patients. However, most of existing methods mainly ranks potential personalized cancer driver genes by considering the patient-specific nodes information on the gene/protein interaction network. These methods ignore the personalized edge weight information in gene interaction network, leading to false positive results.

Results

In this work, we presented a novel algorithm (called PDGPCS) to predict the Personalized cancer Driver Genes based on the Prize-Collecting Steiner tree model by considering the personalized edge weight information. PDGPCS first constructs the personalized weighted gene interaction network by integrating the personalized gene expression data and prior known gene/protein interaction network knowledge. Then the gene mutation data and pathway data are integrated to quantify the impact of each mutant gene on every dysregulated pathway with the prize-collecting Steiner tree model. Finally, according to the mutant gene’s aggregated impact score on all dysregulated pathways, the mutant genes are ranked for prioritizing the personalized cancer driver genes. Experimental results on four TCGA cancer datasets show that PDGPCS has better performance than other personalized driver gene prediction methods. In addition, we verified that the personalized edge weight of gene interaction network can improve the prediction performance.

Conclusions

PDGPCS can more accurately identify the personalized driver genes and takes a step further toward personalized medicine and treatment. The source code of PDGPCS can be freely downloaded fromhttps://github.com/NWPU-903PR/PDGPCS.
Sedative effect of remimazolam combined with alfentanil in colonoscopic polypectomy: a prospective, randomized, controlled clinical trial
Authors: Xin Yueyang , Chu Tiantian , Wang Jinxu , Xu Aijun
Published: August 2022

Background

Remimazolam is a newer benzodiazepine with properties of rapid onset, short duration of action, and fast recovery. Our study was to evaluate the effects of different doses of remimazolam combined with alfentanil in colonoscopic polypectomy.

Methods

One hundred twenty patients were randomly divided into four groups: alfentanil and propofol (AP) group, alfentanil and remimazolam 0.1 mg/kg (AR1 group), 0.15 mg/kg (AR2 group), or 0.2 mg/kg (AR3 group). Patients in the four groups received alfentanil 10 μg/kg, followed by propofol 2 mg/kg and three dosages of remimazolam. Modified Observer's Assessment of Alertness and Sedation (MOAA/S) scale, heart rate (HR), oxygen saturation (SpO2), respiratory rate (RR), bispectral index (BIS) values and mean arterial pressure (MAP) were collected at intervals of 5 min and analyzed at different time points: before anesthesia (T0), 5 min (T1), 10 min (T2), 15 min after anesthesia (T3) and at the end of surgery (T4). The average MAP was calculated utilizing the average of all MAP values. The primary outcome was the success rate of sedation. Secondary outcomes included time to full alert and adverse events.

Results

The success rate of sedation was 100% among the four groups. The incidence of hypotension was significantly decreased (all P < 0.05) and the average MAP was higher in AR1-AR3 groups than AP group (all P < 0.001). None of the patients developed bradycardia or hypertension during surgery in all study groups. BIS values were higher (all P < 0.001) and the time to full alert was statistically shorter in AR1-AR3 groups (all P < 0.05) compared with the AP group. The MOAA/S score in AR1 was higher than AR2 (P < 0.05) and the AR3 group (P < 0.05) at T1 and BIS values in the AR1 group were significantly higher than AR3 group (P < 0.05) at T4.

Conclusions

Remimazolam combined with alfentanil have a non-inferior sedative effect than propofol during the colonoscopic polypectomy. Moreover, this combination of two short-acting drugs might be a safer alternative.

Trial registration

The clinical trial was registered on (16/05/2021, ChiCTR2100046492).
Efficacy of chitosan paste as intracanal medication against Enterococcus faecalis and Candida albicans biofilm compared with calcium hydroxide in an in vitro root canal infection model
Authors: Thienngern Pasika , Panichuttra Anchana , Ratisoontorn Chootima , Aumnate Chuanchom , Matangkasombut Oranart
Published: August 2022

Background

Enterococcus faecalis and Candida albicans are frequently found in persistent endodontic infection and could remain in dentinal tubules despite intracanal medication with calcium hydroxide (Ca(OH)2), a commonly used medication. Thus, an effective and safe antimicrobial medication against such refractory infection is necessary in endodontic retreatment, so we aimed to test the efficacy of chitosan paste against these microorganisms compared with Ca(OH)2 in root canals of extracted human teeth.

Methods

Thirty-six sterilized human root samples prepared from extracted premolars and upper maxillary incisors were infected with E. faecalis for 14 days, while 32 were infected with C. albicans for 48 h, for mature biofilm formation. The samples were assigned to 6 groups of intracanal medications: Group 1: no medication (negative control); Group 2: 20% Polyethylene glycol (PEG); Group 3: 20% Propylene glycol (PG); Group 4: Ca(OH)2; Group 5: Chitosan + PEG; and Group 6: Chitosan + PG. After 7 days, intracanal surface dentin was harvested using Protaper next, resuspended, serially diluted and spread on Brain–Heart-Infusion agar (for E. faecalis) and Yeast Extract-Peptone-Dextrose agar (for C. albicans) for colony count. Antimicrobial efficacy was determined as percentage of remaining colony forming unit (CFUs) relative to negative control and analyzed using One-way ANOVA and post-hoc Games-Howell test. The significance level was set at 0.05.

Results

For E. faecalis, chitosan + PG had significantly higher antibacterial activity than Ca(OH)2 (P = 0.039). Chitosan + PEG and chitosan + PG medication significantly reduced viable bacteria compared with negative control, PEG and PG (P = 0.001, 0.003, 0.024, respectively for chitosan + PEG; P = 0.002, 0.003, 0.014, respectively for chitosan + PG). For C.albicans, chitosan + PEG and chitosan + PG were not significantly different from Ca(OH)2. However, Chitosan + PEG and chitosan + PG, but not Ca(OH)2, showed a significantly lower level of remaining CFUs compared with negative control (P = 0.013 and 0.005, respectively).

Conclusion

Chitosan paste showed better efficacy in reducing viable E. faecalis biofilm when compared to Ca(OH)2 after 7-day intracanal medication in this in vitro root canal model. It could also significantly reduce viable C. albicans, but was not significantly different from Ca(OH)2.
The impact of simulation-based mastery learning, booster session timing and clinical exposure on confidence in intercostal drain insertion: a survey of internal medicine trainees in Scotland
Authors: Kerins Joanne , McCully Elisabeth , Stirling Suzanne Anderson , Smith Samantha Eve , Tiernan James , Tallentire Victoria Ruth
Published: August 2022

Background

Intercostal chest drain (ICD) insertion is a skill that medical trainees lack confidence in performing. This study explores the impact of a national programme of Simulation-Based Mastery Learning (SBML) on procedural confidence, including the impact of time intervals between booster sessions and interim clinical experience.

Methods

Internal Medicine Trainees in Scotland were surveyed about confidence and clinical experience with ICD insertion before and immediately after SBML and booster session. Data were matched and analysed using paired sample t-tests. Short interval and long interval groups were compared using Student’s unpaired t-test. The impact of interim clinical experience was assessed using Analysis of Variance.

Results

Mean confidence in ICD insertion rose following SBML, fell between initial and booster session, and increased again following booster session (P =  < 0.001). 33 of 74 trainees had successfully inserted an ICD between sessions. Fall in confidence was unaffected by the time interval between training sessions, but was mitigated by interim clinical experience.

Conclusions

SBML boosts trainee confidence in ICD insertion. However, there is evidence of confidence decay, possibly due to a lack of clinical experience between sessions. More research is needed to explore barriers to transfer of skills from simulated to real-world environments.
Single-cell genomic and transcriptomic landscapes of primary and metastatic colorectal cancer tumors
Authors: Wang Rui , Li Jingyun , Zhou Xin , Mao Yunuo , Wang Wendong , Gao Shuai , Wang Wei , Gao Yuan , Chen Kexuan , Yu Shuntai , Wu Xinglong , Wen Lu , Ge Hao , Fu Wei , Tang Fuchou
Published: August 2022

Background

Colorectal cancer (CRC) ranks as the second-leading cause of cancer-related death worldwide with metastases being the main cause of cancer-related death. Here, we investigated the genomic and transcriptomic alterations in matching adjacent normal tissues, primary tumors, and metastatic tumors of CRC patients.

Methods

We performed whole genome sequencing (WGS), multi-region whole exome sequencing (WES), simultaneous single-cell RNA-Seq, and single-cell targeted cDNA Sanger sequencing on matching adjacent normal tissues, primary tumors, and metastatic tumors from 12 metastatic colorectal cancer patients (n=84 for genomes,n=81 for exomes,n=9120 for single cells). Patient-derived tumor organoids were used to estimate the anti-tumor effects of a PPAR inhibitor, and self-renewal and differentiation ability of stem cell-like tumor cells.

Results

We found that the PPAR signaling pathway was prevalently and aberrantly activated in CRC tumors. Blocking of PPAR pathway both suppressed the growth and promoted the apoptosis of CRC organoids in vitro, indicating that aberrant activation of the PPAR signaling pathway plays a critical role in CRC tumorigenesis. Using matched samples from the same patient, distinct origins of the metastasized tumors between lymph node and liver were revealed, which was further verified by both copy number variation and mitochondrial mutation profiles at single-cell resolution. By combining single-cell RNA-Seq and single-cell point mutation identification by targeted cDNA Sanger sequencing, we revealed important phenotypic differences between cancer cells with and without critical point mutations (KRASandTP53) in the same patient in vivo at single-cell resolution.

Conclusions

Our data provides deep insights into how driver mutations interfere with the transcriptomic state of cancer cells in vivo at a single-cell resolution. Our findings offer novel knowledge on metastatic mechanisms as well as potential markers and therapeutic targets for CRC diagnosis and therapy. The high-precision single-cell RNA-seq dataset of matched adjacent normal tissues, primary tumors, and metastases from CRCs may serve as a rich resource for further studies.
Ulceroglandular form of tularemia after squirrel bite: a case report
Authors: Borgschulte Hannah Sophia , Jacob Daniela , Zeeh Jörg , Scholz Holger C. , Heuner Klaus
Published: August 2022

Background

The diagnosis of tularemia is not often considered in Germany as the disease is still rare in this country. Nonetheless, Francisella tularensis, the causative agent of tularemia, can infect numerous animal species and should, therefore, not be neglected as a dangerous pathogen. Tularemia can lead to massively swollen lymph nodes and might even be fatal without antibiotic treatment. To our knowledge, the case described here is the first report of the disease caused by a squirrel bite in Germany.

Case presentation

A 59-year-old German woman with a past medical history of hypothyroidism and cutaneous lupus erythematosus presented at the emergency room at St. Katharinen Hospital with ongoing symptoms and a swollen right elbow persisting despite antibiotic therapy with cefuroxime for 7 days after she had been bitten (right hand) by a wild squirrel (Eurasian red squirrel). After another 7 days of therapy with piperacillin/tazobactam, laboratory analysis using real-time polymerase chain reaction (PCR) confirmed the suspected diagnosis of tularemia on day 14. After starting the recommended antibiotic treatment with ciprofloxacin, the patient recovered rapidly.

Conclusion

This is the first report of a case of tularemia caused by a squirrel bite in Germany. A naturally infected squirrel has recently been reported in Switzerland for the first time. The number of human cases of tularemia has been increasing over the last years and, therefore, tularemia should be taken into consideration as a diagnosis, especially in a patient bitten by an animal who also presents with headache, increasing pain, lymphadenitis, and fever, as well as impaired wound healing. The pathogen can easily be identified by a specific real-time PCR assay of wound swabs and/or by antibody detection, for example by enzyme-linked immunosorbent assay (ELISA), if the incident dates back longer than 2 weeks.
Undifferentiated embryonal sarcoma of liver arising within mesenchymal hamartoma in a child "case report"
Authors: Mohamed Elshaimaa M. , Zeidan Mohamed , Gazzaz Tamadir Fadel , Abdullah Nouf S. , Abolyazid Sherif Maher , Elaryan Ahmed
Published: August 2022

Background

Primary pediatric liver tumors are scarce. Undifferentiated embryonal sarcoma of the liver (UESL) embraces nine to fifteen percent of the pediatric hepatic neoplasms. Mesenchymal hamartoma of the liver (MHL) is the second most prevalent benign pediatric hepatic neoplasm following infantile hemangioendothelioma.

Case presentation

A 6-year-old female child presented with vague diffuse abdominal pain and palpable right lumbar mass by clinical examination. The US showed a well-circumscribed large right hepatic complex multilocular cystic lesion with multiple internal septations and some turbid loculi. The constellation of CT and dynamic MRI findings raised the presence of atypical suspicious complex cystic hepatic mass lesion with hemorrhagic, calcific entities and internal soft tissue enhancement. The histopathological correlation proved UESL on the background of MHL.

Conclusions

A case of a pediatric hepatic complex cystic lesion, which had typical ultrasound features of MHL, however, CT and MRI had atypical suspicious criteria. Finally, our case is presented as UESL in the background of MHL based upon pathological diagnosis. The radiologists must be familiar with overlapped entities between MHL, UESL, and other differential diagnosis entities regarding pediatric hepatic neoplasms.
Overcoming Barriers in Neurosurgical Education: A Novel Approach to Practical Ventriculostomy Simulation
Authors: Amini Amir , Zeller Yannic , Stein Klaus-Peter , Hartmann Karl , Wartmann Thomas , Wex Cora , Mirzaee Elyas , Swiatek Vanessa M. , Saalfeld Sylvia , Haghikia Aiden , Dumitru Claudia A. , Sandalcioglu I. Erol , Neyazi Belal
Published: August 2022

BACKGROUND:

In the high-risk, high-stakes specialty of neurosurgery, traditional teaching methods often fail to provide young residents with the proficiency needed to perform complex procedures in stressful situations, with direct effects on patient outcomes. Physical simulators provide the freedom of focused, hands-on training in a more controlled environment. However, the adoption of simulators in neurosurgical training remains a challenge because of high acquisition costs, complex production processes, and lack of realism.

OBJECTIVE:

To introduce an easily reproducible, cost-effective simulator for external ventricular drain placements through various ventriculostomy approaches with life-like tactile brain characteristics based on real patients' data.

METHODS:

Whole brain and skull reconstruction from patient's computed tomography and MRI data were achieved using freeware and a desktop 3-dimensional printer. Subsequently, a negative brain silicone mold was created. Based on neurosurgical expertise and rheological measurements of brain tissue, gelatin in various concentrations was tested to cast tactilely realistic brain simulants. A sample group of 16 neurosurgeons and medical students tested and evaluated the simulator in respect to realism, haptics, and general usage, scored on a 5-point Likert scale.

RESULTS:

We saw a rapid and significant improvement of accuracy among novice medical students. All participants deemed the simulator as highly realistic, effective, and superior to conventional training methods.

CONCLUSION:

We were able to demonstrate that building and implementing a high-fidelity simulator for one of the most important neurosurgical procedures as an effective educational and training tool is achievable in a timely manner and without extensive investments.
Efficacy and Safety of Subfascial Epidural Drainage Protocol After Intraoperative Durotomy in Posterior Thoracic and Lumbar Spine Surgery: Reoperation Prevention and Outcomes Among Drained and Undrained Cohorts
Authors: Wilson Christopher , McVeigh Luke , Williams Acacia , Acchiardo Joseph , Bradbury Jamie
Published: August 2022

BACKGROUND:

Persistent cerebrospinal fluid (CSF) egress after durotomy in posterior thoracic or lumbar spine surgery may cause devastating complications. Persistent CSF leaks may require reoperation, which confers additional cost and morbidity.

OBJECTIVE:

To evaluate the efficacy of our subfascial epidural drainage protocol in the setting of durotomy to prevent reoperation.

METHODS:

A retrospective cohort study of drained and undrained cohorts was completed to identify factors associated with reoperation for persistent CSF leak-related symptoms. The efficacy and safety of this 7-day subfascial epidural drainage protocol was assessed by comparing reoperation incidence, perioperative complications, rehabilitation necessity, and readmissions.

RESULTS:

In total, 156 patients underwent subfascial epidural drainage, and 14 were not drained. Subfascial drainage for up to 7 days was associated with a significantly lower incidence of reoperation than no drainage (3.3% vs 14%, respectively; P = .03). Perioperative complication incidence was similar between cohorts (12.8% vs 21.4%, respectively; P = .37), and length of stay was unchanged regardless of drainage (median 7 days). Subfascial drainage conferred a nearly 2-fold relative risk reduction in inpatient rehabilitation requirement (RR 0.55) and 3-fold relative risk reduction in 30-day (RR 0.31) and 90-day readmission (RR 0.36). Factors associated with reoperation among drained patients included drainage longer than 7 days, tobacco use, age younger than 50 years, and longer segment operations. Revision spine surgery was associated with reoperation among undrained patients.

CONCLUSION:

When followed after durotomy, our subfascial epidural drainage protocol results in fewer reoperations than in an undrained cohort without prohibitive cost and no added morbidity.
Extensive Symptomatic Thoracolumbar Epidural Lipomatosis Treated With Minimally Invasive Hemilaminectomies: Technical Case Report
Authors: Fuentes Angelica M. , Housley Steven B. , Starling Robert V. , Mullin Jeffrey P.
Published: August 2022

BACKGROUND AND IMPORTANCE:

Spinal epidural lipomatosis is a rare condition commonly associated with chronic corticosteroid use and obesity that involves deposition of adipose tissue in the epidural space of the spinal canal. This accumulation of adipose tissue may cause compression of the spinal cord and/or nerve roots and result in compressive symptoms such as myelopathy or radiculopathy. Spinal involvement is usually confined to either the thoracic or lumbar spine but can infrequently affect both regions. Depending on pre-existing conditions, treatment options include weight loss and discontinuation of exogenous steroid use, both of which have been shown to be effective therapeutic methods. Surgical decompression may be useful for appropriately selected patients in whom conservative therapy has failed or who experience acute neurological deterioration, although this is rarely indicated.

CLINICAL PRESENTATION:

In this study, we describe a patient receiving long-term corticosteroid therapy who presented with symptomatic epidural lipomatosis that involved the thoracic and lumbar spine. She was treated with decompression by continuous T3-L5 hemilaminectomies performed through 5 small incisions of alternating laterality. After surgery, the patient experienced clinical improvement and was able to return to her baseline.

CONCLUSION:

We illustrate a successful spinal decompression of extensive epidural lipomatosis through a less-invasive surgical approach using several small incisions to accomplish uninterrupted hemilaminectomies. This alternative approach to a standard continuous incision can be considered in cases of extensive spinal epidural lipomatosis in patients with multiple medical comorbidities in whom wound healing is believed to be an issue and for whom minimizing blood loss is crucial.
Comparison of Intraoperative Indocyanine Green Videoangiography vs Postoperative Catheter Angiography to Confirm Microsurgical Occlusion of Spinal Dorsal Intradural Arteriovenous Fistulas
Authors: Karahalios Katherine , Srinivasan Visish M. , Scherschinski Lea , DiDomenico Joseph D. , Catapano Joshua S. , Safaee Michael M. , Lawton Michael T.
Published: August 2022

BACKGROUND:

Dorsal intradural arteriovenous fistulas (DI-AVFs) represent 80% of spinal AVFs. Microsurgical clip occlusion is a durable treatment that uses preoperative and postoperative digital subtraction angiography (DSA) as standard practice. Intraoperative indocyanine green videoangiography (ICG-VA) is a valuable intraoperative adjunct in these cases. Intraoperative ICG-VA findings have not been compared with postoperative DSA findings.

OBJECTIVE:

To assess the diagnostic value of intraoperative ICG-VA vs postoperative DSA for spinal DI-AVFs.

METHODS:

A multi-institutional database of vascular malformations was queried for all surgically managed cases of DI-AVF. Patients with both intraoperative ICG-VA and postoperative DSA were included. Demographic and radiologic data, intraoperative findings, and surgical outcomes data were retrospectively analyzed.

RESULTS:

Forty-five patients with DI-AVF were identified (male sex, 32; mean age, 61.9 [range, 26-85] years). All DI-AVFs were treated with interruption of the fistula with clip occlusion of the draining vein. Intraoperative ICG-VA showed complete obliteration in all patients. Postoperative DSA was performed for 40 patients and confirmed complete obliteration in all patients. The negative predictive value of ICG-VA confirming complete occlusion of the DI-AVFs was 100%. Eighteen patients (47%) experienced clinical improvement, and 16 (42%) experienced no change in condition.

CONCLUSION:

ICG-VA is useful for intraoperative identification of DI-AVFs and confirmation of complete microsurgical occlusion. Correlation between intraoperative ICG-VA and postoperative DSA findings demonstrates the diagnostic power of ICG-VA. This finding suggests that postoperative DSA is unnecessary when intraoperative ICG-VA confirms complete occlusion of the DI-AVF, which will spare patients the procedural risk and cost of this invasive procedure.
The relationship between magnesium deficiency and depression, and the effects of magnesium supplementation on depression symptoms – literature review
Authors: Białas Filip , Płaczek Alicja , Machaj Dominik , Baciur Patrycja , Skowrońska Katarzyna
Published: August 2022

Magnesium is a very important macronutrient in the human body. Its main storage is bones. The correct concentration of this macronutrient within the normal range is necessary for the proper functioning of the body. Deficiency of this element negatively affects the entire body. One of the symptoms of magnesium deficiency is depression and other psychiatric disorders. The factors explaining the mechanism of magnesium's antidepressant effect are not fully understood, however, a relationship between magnesium deficiency and the pathogenesis of depression has been demonstrated. Supplementation with preparations of this element improves the condition in ill people with depression. [3][6]
The influence of sleep disturbances on the development of insulin resistance - a literature review
Authors: Chmura Anna , Skowrońska Katarzyna , Karaś Anna , Baciur Patrycja , Białas Filip
Published: August 2022

Introduction and purpose of the work: Sleep is essential for the proper functioning of the body. Adequate quality and quantity of sleep affects metabolic processes, including glucose metabolism, as well as the sensitivity of tissues to insulin, the reduction of which is called insulin resistance. It leads to an increased production of glucose in order to maintain normal blood glucose levels. Insulin resistance is a modifiable risk factor of, inter alia, type 2 diabetes. The aim of this study is to summarize the current knowledge on the relationship between sleep deprivation and an increased risk of developing insulin resistance.

State of knowledge: Sleep undoubtedly has a strong influence on glucose metabolism and insulin sensitivity. Numerous studies show that even partial sleep deprivation lowers insulin sensitivity. The available literature shows that shift work and a shifted bedtime, combined with an insufficient amount of it, lead to a significant reduction in insulin sensitivity. The positive effect of increasing the time of night rest on the sensitivity of tissues to insulin may be an element of the prevention of diseases such as obesity or type 2 diabetes. Moreover, disturbances in sleep continuity lead to formation of insulin resistance. An example would be obstructive sleep apnea, the treatment of which affects metabolic processes.

Summary: Adequate sleep hygiene is an extremely important part of a healthy lifestyle. More research is needed on the relationship between sleep and the regulation of carbohydrate metabolism, due to the fact that the appropriate sleep-wake rhythm may give hope for improvement in health in people with metabolic disorders and may be an important protective factor for many diseases.
Point-of-care ultrasound of abdominal as an useful diagnostic tool for the general practitioner
Authors: Szwed Monika , Metelski Jakub , Metelska Aleksandra , Nieścior Hubert , Sereda Dominika , Piekarski Paweł
Published: August 2022

Introduction and purpose

Ultrasonography (US) is a safe, non-invasive and widespread diagnostic tool. Point-of-care ultrasound (POCUS) is more and more often used in a general practitioner’s (GP) office as an element complementing the medical and physical examination. The aim of the study is to present ultrasonography as a useful diagnostic tool in the practice of a general practitioner (GP).

Description of the state of knowledge

Abdominal pain and gastrointestinal infections are among the most common reasons for patients visiting their GPs. A point-of-care ultrasound examination enable the shortening of the time necessary to make a diagnosis as well as the fastest possible implementation of appropriate treatment. This is especially important in acute conditions such as cholecystitis, cholelithiasis, appendicitis or renal colic.Patients who underwent ultrasound examination during their GP visit gave them a better understanding of their health problem, increased their sense of securityand confidence in the diagnosis made by the doctor.

Summary

Point-of-care ultrasound is an examination that is increasingly used by doctors working in primary care as a diagnostic tool ensuring earlier and more precise diagnosis. GP familiarization with ultrasound could reduce the number of incorrect referrals as well as improve the interpretation of the results. Performing the POCUS examination during a visit to the primary care physician allows GP to make a quick diagnosis and make a decision about conservative treatment, referral to the appropriate specialist or hospitalization.
Primary adrenal insufficiency - Addison's disease
Authors: Metelski Jakub , Metelska Aleksandra , Sereda Dominika , Nieścior Hubert , Szwed Monika
Published: August 2022

Introduction and purpose

Addison's syndrome is defined as primary adrenal insufficiency, the symptoms of which result from hormonal deficiencies: glucocorticosteroids, mineralocorticosteroids and androgens. Currently, autoimmunity is considered the most common cause of Addison's Syndrome. Antibodies are most often directed against the enzymes 21-hydroxylase and 17-hydroxylase involved in steroidogenesis.

The aim of the study is to present a typical clinical course, diagnostic path and current therapeutic options of Addison's syndrome.

Description of the state of knowledge

Currently, in developed countries, the number of cases is 100-140 people per million people. Initially, Addison's syndrome runs secretly. The clinical picture is closely correlated with the degree of adrenal cortex destruction. The most common symptoms include hypotonia, weight loss, weakness, salt craving, gastrointestinal disorders, and hyperpigmentation of the skin and mucous membranes. In extreme cases, adrenal crisis may develop, characterized by rapid clinical deterioration with hypotension, fever, vomiting, dehydration, and loss of consciousness.

Diagnostics uses the measurement of the concentration of morning cortisol and corticotropin (ACTH) in the blood, and in doubtful situations, additionally a stimulation test using synthetic ACTH.

Summary

A diagnosis of Addison's syndrome requires end-of-life hormonal substitution. For this purpose, hydrocortisone or prednisone and fludrocortisone are used. In stressful situations, the doses of glucocorticoids should be adequately increased. Patients with adrenal crisis require intensive fluid resuscitation to restore intravascular volume, correct hypoglycemia and electrolyte disturbances, and administer rapidly high doses of hydrocortisone.
Uygur Türkleri Üzerinde Dijital Gözetim
Authors: NARMANLIOĞLU Haldun , İYİGÜNGÖR Tuğçe
Published: August 2022

Çin Halk Cumhuriyeti tarafından Doğu Türkistan üzerinde kurulan baskıcı yönetimin en önemli unsurları arasında dijital gözetim teknolojileri bulunmaktadır. Çalışmanın amacı Çin’in sahip olduğu
teknoloji yoluyla Uygurlar üzerinde kurduğu dijital gözetimin ortaya konulmasıdır. Gözetimin ardında yatan felsefi ve ideolojik faktörlerin neler olduğu yine çalışmanın soruları arasındadır. Bu çerçevede Çin’in tarihi olarak ötekine bakışı ile Çinli olmayan milletleri yönetme politikaları ve Çin tarzı özerk yönetim anlayışı ele alınmıştır. Daha sonra sosyal düzen, devlete itaat ve hiyerarşi gibi prensiplere dayanan Konfüçyüsçü anlayışla kurulmuş dijital gözetim sistemi incelenmiştir. Bu amaçla Çin’in gözetleme odaklı teknolojik alt yapısı üzerine yapılmış akademik çalışmalar ve sivil toplum kuruluşlarının raporları taranmıştır. Çin hükümeti tarafından dünya kamuoyuna yapılan açıklamalar ile medyaya yansımış haber ve yorumlar incelenmiştir. Çalışmanın bulgularına göre dijital gözetim Çin’in Uygur politikasındaki en önemli araçlardan biridir. Doğu Türkistan, dijital gözetim yoluyla bir açık hava hapishanesine çevrilmiş, Uygurlara kendi kimliklerini yaşayabilecekleri serbest bir alan bırakılmamıştır.
Within-Field Variability in Nutrients for Site-Specific Agricultural Management in Irrigated Cornfield
Authors: Kumar Hemendra , Srivastava Puneet , Lamba Jasmeet , Ortiz Brenda V. , Way Thomas R , Sangha Laljeet , Takhellambam Bijoychandra S. , Morata Guilherme , Molinari Roberto
Published: August 2022

Highlights

Phosphorus and nitrogen in soil and plants varied during the growing season across the cornfield.

Spatial variability in nutrients caused spatial variability in plant growth and crop yield across the cornfield.

Hydrological characteristics and soil hydraulic properties were responsible for spatial variability in nutrients.

Need to consider spatial variability in nutrients in delineating management zones before adopting management practices.

Abstract. The adoption of precision agricultural practices in Alabama has been increasing in recent years. Although challenging, understanding nutrient variability in agricultural fields is important for site-specific management. This study investigated phosphorus (P) and nitrogen (N) variability in an irrigated cornfield located in the Town Creek Watershed of Tennessee Valley Region of Alabama, USA during the 2019 growing season. Three different irrigation management zones (high yield-HY, moderate yield-MY, and low yield-LY) were delineated based on ten years of historical records of crop yield, soil texture, and measured topography using the Management Zone Analyst (MZA) software. The soil samples at 0 to 15 cm, 15 to 30 cm, and 30 to 60 cm depths were collected five different times during the 2019 growing season. Both manure and inorganic fertilizer were uniformly applied during the growing season. At all soil depths, HY and MY zones had higher soil nutrient concentrations than the field average nutrient concentration. However, the LY zone had below field average soil nutrient concentration in the entire soil profile. The plants (above-ground) in HY and MY zones had higher than average nutrient concentrations and the plants in the LY zone had lower than average nutrient concentrations throughout the cornfield. This site-specific nutrient variation in these zones was due to within-field terrain attributes, differences in soil properties, and surface runoff losses. A significant difference was recorded in the corn yield in the HY and LY zones of the field. Two extreme groups of nutrients were found in the cornfield similar to irrigation management zones (HY and LY). A zone with a higher yield also had higher soil and plant nutrients in the zone (HY), and a zone with a lower yield also had lower soil and plant nutrients in the zone (LY). Incorporating nutrient variability for site-specific management in management zone delineation can help with reducing nutrient application, nutrient loss, and improving yield. This study supports the adopting of precision agricultural management practices based on in-field nutrient variability. Keywords: Corn, Crop yield variability, Irrigation, Management zones, Nitrogen, Nutrient variability, Phosphorus, Site-specific management, Topographical wetness index (TWI).
Effect of N-Loaded Clinoptilolite on Soil Available Nutrients and Yield Under Water-Saving Irrigation
Authors: Sun Yang , Chen Hongyang , Wang Yanzhi , Li Yanqi , Gong Fuzheng , Wu Qi , Chi Daocai
Published: August 2022

Highlights

Clinoptilolite was used to adsorb ammonia from agricultural wastewater and as a nutrient carrier to cultivate crops.

Nitrogen-loaded clinoptilolite (NZ) prolonged the N supply time, which met the N demand for plant growth.

NZ under water-saving irrigation purified wastewater, saved irrigation water and increased grain yield.

Abstract. The extensive application of nitrogen (N) fertilizer causes soil acidification and increases the risk of water eutrophication, especially in irrigated areas. To reduce the eutrophication level of the water body and improve the soil fertility, clinoptilolite (Z) was used to adsorb N in simulated eutrophic water bodies, and then as a nutrient carrier to supplement the soil N source and promote the reuse of N. The results show that the NH4+-N loading process caused ion bonds to break inside the Z, which increased the contact area for ion adsorption. Z successfully reduced the NH4+-N concentration by 36.25% in the simulated N-rich water. The soil NH4+-N and NO3--N contents of N-loaded clinoptilolite (NZ) under alternate wet-dry irrigation (AWD) were higher during the critical growth period, which enhanced the soil N pool and replenished N in time. The NZ as a slow-release fertilizer prolonged the N supply time under AWD, which increased rice tillers by 13.68% and yield by 11.24% compared with control (without NZ amendment). In conclusion, the approach of NZ combined with AWD is beneficial to the rice growth and improvement of the soil-water environment in irrigated areas. Keywords: Ammonium Adsorption, Clinoptilolite, Nitrogen Releaser, Paddy Soil, Water-saving Irrigation.
Deep-learning based photon-efficient 3D and reflectivity imaging with a 64 × 64 single-photon avalanche detector array
Authors: Yang Xu , Tong ZiYi , Jiang PengFei , Xu Lu , Wu Long , Hu Jiemin , Yang Chenghua , Zhang Wei , Zhang Yong , Zhang Jianlong
Published: August 2022

A single photon avalanche diode (SPAD) is a high sensitivity detector that can work under weak echo signal conditions (≤1 photon per pixel). The measured digital signals can be used to invert the range and reflectivity images of the target with photon-efficient imaging reconstruction algorithm. However, the existing photon-efficient imaging reconstruction algorithms are susceptible to noise, which leads to poor quality of the reconstructed range and reflectivity images of target. In this paper, a non-local sparse attention encoder (NLSA-Encoder) neural network is proposed to extract the 3D information to reconstruct both the range and reflectivity images of target. The proposed network model can effectively reduce the influence of noise in feature extraction and maintain the capability of long-range correlation feature extraction. In addition, the network is optimized for reconstruction speed to achieve faster reconstruction without performance degradation, compared with other existing deep learning photon-efficient imaging reconstruction methods. The imaging performance is verified through numerical simulation, near-field indoor and far-field outdoor experiments with a 64 × 64 SPAD array. The experimental results show that the proposed network model can achieve better results in terms of the reconstruction quality of range and reflectivity images, as well as reconstruction speed.
Universal healthcare coverage and health service delivery before and during the COVID-19 pandemic: A difference-in-difference study of childhood immunization coverage from 195 countries
Authors: Kim Sooyoung , Headley Tyler Y. , Tozan Yesim
Published: August 2022

Background

Several studies have indicated that universal health coverage (UHC) improves health service utilization and outcomes in countries. These studies, however, have primarily assessed UHC’s peacetime impact, limiting our understanding of UHC’s potential protective effects during public health crises such as the Coronavirus Disease 2019 (COVID-19) pandemic. We empirically explored whether countries’ progress toward UHC is associated with differential COVID-19 impacts on childhood immunization coverage.

Methods and findings

Using a quasi-experimental difference-in-difference (DiD) methodology, we quantified the relationship between UHC and childhood immunization coverage before and during the COVID-19 pandemic. The analysis considered 195 World Health Organization (WHO) member states and their ability to provision 12 out of 14 childhood vaccines between 2010 and 2020 as an outcome. We used the 2019 UHC Service Coverage Index (UHC SCI) to divide countries into a “high UHC index” group (UHC SCI ≥80) and the rest. All analyses included potential confounders including the calendar year, countries’ income group per the World Bank classification, countries’ geographical region as defined by WHO, and countries’ preparedness for an epidemic/pandemic as represented by the Global Health Security Index 2019. For robustness, we replicated the analysis using a lower cutoff value of 50 for the UHC index. A total of 20,230 country-year observations were included in the study. The DiD estimators indicated that countries with a high UHC index (UHC SCI ≥80, n = 35) had a 2.70% smaller reduction in childhood immunization coverage during the pandemic year of 2020 as compared to the countries with UHC index less than 80 (DiD coefficient 2.70; 95% CI: 0.75, 4.65; p-value = 0.007). This relationship, however, became statistically nonsignificant at the lower cutoff value of UHC SCI <50 (n = 60). The study’s primary limitation was scarce data availability, which restricted our ability to account for confounders and to test our hypothesis for other relevant outcomes.

Conclusions

We observed that countries with greater progress toward UHC were associated with significantly smaller declines in childhood immunization coverage during the pandemic. This identified association may potentially provide support for the importance of UHC in building health system resilience. Our findings strongly suggest that policymakers should continue to advocate for achieving UHC in coming years.
Health extension workers contribution on tuberculosis case notification in Tigray region, Northern Ethiopia: A concurrent mixed method study
Authors: Gebretnsae Hailay , Hadgu Tsegay , Ayele Brhane Gebrekidan , Abraha Alemnesh , Gebre-egziabher Equbay , Woldu Mulugeta , Wellay Tsegay , Gebrekidan Gebregziabher Berihu , Gebregziabher Measho Gebreslassie
Published: August 2022

Background

Despite the emphasis placed on Community Based Tuberculosis Care (CBTC) implementation by Health Extension Workers (HEWs) within the National Tuberculosis Program (NTP) in Ethiopia, there is little evidence on contribution of HEWs on TB case notification. Therefore, this study aimed to describe the contribution of HEWs on TB case notification and its associated factors in Tigray region, Northern Ethiopia.

Methods

A concurrent mixed method (quantitative and qualitative) cross-sectional study design was conducted in three randomly selected districts in Tigray region, Northern Ethiopia. Quantitative data were collected using a pre-tested semi-structured questionnaire. Qualitative data were collected using Focused Group Discussions (FGDs) and Key Informant Interviews (KIIs) to further describe the community participation and presumptive TB identification and referral system. For the quantitative data, binary logistic regression analysis was done and all variables with P-value of < 0.25 in bivariate analysis were included in the multi-variable model to see predictors of HEWs contribution to TB notification. The qualitative data were thematically analyzed using Atlas.ti version 7.

Results

In this study, a total of 68 HEWs were included. From March 1, 2017 to February 28, 2018, a total of 427 TB cases notified in the study areas and one-third (34%) of them were notified by the HEWs referral. Provision of Community Based-Directly Observed Treatment Short course (CB–DOTS) (Adjusted Odds Ratio (AOR) = 3.63, 95% Confidence Interval (CI) = 1.18–11.19) and involvement of community volunteers on CBTC (AOR = 3.31, 95% CI = 1.10–10.09) were significantly associated with the contribution of HEWs on TB case notification. The qualitative findings indicated that high workload of HEWs, inaccessibility of TB diagnostic services at nearby health facilities, and transportation and investigation costs were identified as factors affecting for presumptive TB referral by HEWs.

Conclusions

Provision of CB-DOTS and involvement of community volunteers in CBTC activities should be strengthened to improve the HEWs contribution on TB case notification. Additionally, HEWs should be empowered and further interventions of TB diagnostic services at diagnostic health facilities are needed to improve presumptive TB referral by HEWs.
Using the Global Trigger Tool in surgical and neurosurgical patients: A feasibility study
Authors: Brösterhaus Mareen , Hammer Antje , Gruber Rosalie , Kalina Steffen , Grau Stefan , Roeth Anjali A. , Ashmawy Hany , Groß Thomas , Binnebösel Marcel , Knoefel Wolfram Trudo , Manser Tanja
Published: August 2022

Background

The Global Trigger Tool (GTT) has become a worldwide used method for estimating adverse events through a retrospective patient record review. However, little is known about the facilitators and the challenges in the GTT-implementation process. Thus, this study followed two aims: First, to apply a comprehensive set of feasibility criteria to qualitatively and systematically assess the GTT-implementation process in three departments of German university hospitals. Second, to identify the facilitators and the obstacles met in the GTT-implementation process and to derive recommendations for supporting other hospitals in implementing the GTT in clinical practice.

Methods

The study used a qualitative documentary method based on process documentation, with written and verbal feedback from the reviewer, as well as evaluating the study sites during the implementation process. The study was conducted in three departments, each in a different German university hospital. The authors applied a comprehensive set of 22 feasibility criteria assessing the level of challenge in GTT implementation. The results were synthesized and they focused on the facilitators and the challenges.

Results

Of these 22 feasibility criteria, nine were assessed as a low-level challenge, eleven regarded as a moderate-level challenge, and two with a problematic level of challenge. In particular, the lack of time and staff resources, the quality of the information in the patient records, organizational procedures, and local issues, posed major challenges in the implementation process. By contrast, the use of local coordinators and an external expert made important contributions to the GTT implementation.

Conclusions

Considering the facilitators and the obstacles beforehand may help with the implementation of the GTT in routine practice. In particular, early and effective planning can reduce or prevent critical challenges in terms of time, staff resources, and organizational aspects.