bluuebunny/crossref_metadata_2025 huggingface dataset:
Advances of exosomes in periodontitis treatment
Authors: Lin Hongbing , Chen Huishan , Zhao Xuetao , Ding Tong , Wang Yawei , Chen Zhen , Tian Yue , Zhang Peipei , Shen Yuqin
Published: June 2022

Periodontitis is an inflammatory disease initiated by dysbiosis of the local microbial community. Periodontitis can result in destruction of tooth-supporting tissue; however, overactivation of the host immune response is the main reason for alveolar bone loss. Periodontal tissue cells, immune cells, and even further activated osteoclasts and neutrophils play pro-inflammatory or anti-inflammatory roles. Traditional therapies for periodontitis are effective in reducing the microbial quantities and improving the clinical symptoms of periodontitis. However, these methods are non-selective, and it is still challenging to achieve an ideal treatment effect in clinics using the currently available treatments and approaches. Exosomes have shown promising potential in various preclinical and clinical studies, including in the diagnosis and treatment of periodontitis. Exos can be secreted by almost all types of cells, containing specific substances of cells: RNA, free fatty acids, proteins, surface receptors and cytokines. Exos act as local and systemic intercellular communication medium, play significant roles in various biological functions, and regulate physiological and pathological processes in numerous diseases. Exos-based periodontitis diagnosis and treatment strategies have been reported to obtain the potential to overcome the drawbacks of traditional therapies. This review focuses on the accumulating evidence from the last 5 years, indicating the therapeutic potential of the Exos in preclinical and clinical studies of periodontitis. Recent advances on Exos-based periodontitis diagnosis and treatment strategies, existing challenges, and prospect are summarized as guidance to improve the effectiveness of Exos on periodontitis in clinics.
Positive interaction between GPER and β-alanine in the dorsal root ganglion uncovers potential mechanisms: mediating continuous neuronal sensitization and neuroinflammation responses in neuropathic pain
Authors: Xu Zhenzhen , Xie Wanli , Feng Yiqi , Wang Yanting , Li Xia , Liu Jie , Xiong Yue , He Yuyao , Chen Lu , Liu Guoyang , Wu Qingping
Published: June 2022

Background

The pathogenesis of neuropathic pain and the reasons for the prolonged unhealing remain unknown. Increasing evidence suggests that sex oestrogen differences play a role in pain sensitivity, but few studies have focused on the oestrogen receptor which may be an important molecular component contributing to peripheral pain transduction. We aimed to investigate the impact of oestrogen receptors on the nociceptive neuronal response in the dorsal root ganglion (DRG) and spinal dorsal horn using a spared nerve injury (SNI) rat model of chronic pain.

Methods

We intrathecally (i.t.) administered a class of oestrogen receptor antagonists and agonists intrathecal (i.t.) administrated to male rats with SNI or normal rats to identify the main receptor. Moreover, we assessed genes identified through genomic metabolic analysis to determine the key metabolism point and elucidate potential mechanisms mediating continuous neuronal sensitization and neuroinflammatory responses in neuropathic pain. The excitability of DRG neurons was detected using the patch-clamp technique. Primary culture was used to extract microglia and DRG neurons, and siRNA transfection was used to silence receptor protein expression. Immunofluorescence, Western blotting, RT-PCR and behavioural testing were used to assess the expression, cellular distribution, and actions of the main receptor and its related signalling molecules.

Results

Increasing the expression and function of G protein-coupled oestrogen receptor (GPER), but not oestrogen receptor-α (ERα) and oestrogen receptor-β (ERβ), in the DRG neuron and microglia, but not the dorsal spinal cord, contributed to SNI-induced neuronal sensitization. Inhibiting GPER expression in the DRG alleviated SNI-induced pain behaviours and neuroinflammation by simultaneously downregulating iNOS, IL-1β and IL-6 expression and restoring GABAα2 expression. Additionally, the positive interaction between GPER and β-alanine and subsequent β-alanine accumulation enhances pain sensation and promotes chronic pain development.

Conclusion

GPER activation in the DRG induces a positive association between β-alanine with iNOS, IL-1β and IL-6 expression and represses GABAα2 involved in post-SNI neuropathic pain development. Blocking GPER and eliminating β-alanine in the DRG neurons and microglia may prevent neuropathic pain development.
Ethnobotany of medicinal plants used by the Yao people in Gongcheng County, Guangxi, China
Authors: Lu Zhaocen , Chen Hailing , Lin Chunrui , Ou Gui , Li Junsheng , Xu Weibin
Published: June 2022

Background

Gongcheng Yao Autonomous County (Gongcheng) is typical for the Yao people in northeastern Guangxi, southern China. The Yao people have a long history of using medicinal plants. In this study, we used ethnobotanical methods to collect traditional knowledge regarding herbal medicines in Gongcheng. Our study provides fundamental data for developing and applying local ethnic medicines and their protection.

Methods

Ethnobotanical data were collected from 103 villages in nine townships from 2014 to 2018 in Gongcheng. A total of 352 informants (279 male and 73 female) were interviewed through semi-structured interviews, key informant interviews, and guided field walks. All the informants were local inhabitants aged between 28 and 101 years of age, of which 40 key informants were selected based on the recommendations of knowledgeable elders and local medical institutions. The informant consensus factor (ICF) was used to evaluate the degree and importance of differences in medicinal plant species and calculated the relative frequencies of citation (RFC) for the recorded medicinal plants.

Results

Data from 352 local healers were collected for the study. The Guanyin and Sanjiang townships had the highest distribution of per capita healers (Pch), while the Gongcheng, Lianhua, and Ping'an townships were relatively lower. Of the 352 local healers, more than half were older than 60 years of age and therefore faced the problem of suitable successors and potential loss of traditional medicinal knowledge. There are 12 types of diseases treated by local healers in the study area, and most of the types had a high ICF value. The highest ICF (0.80) was reported for digestive system disease, followed by urinary system disease (0.78) and nervous system disease (0.77). Traumatic injury and orthopedics, digestive system, and rheumatic disease are the most common ailments. The RFC value calculated in 33 medicinal plant species (with an FC of more than 5) ranged from 0.024 to 0.056. The higher RFC values included Kadsura longipedunculata, Schefflera heptaphylla, Plantago asiatica, etc. The most commonly used medicinal method was decoction; plasters, creams, and some form of moxibustion and cupping skills were locally practiced, but only rarely. The local healers used 306 medicinal plant species (116 families and 255 genera). Herbal plants were most commonly used among these, with whole plants and roots being favored.

Conclusion

The Yao people are highly skilled at using medicinal plants to treat various diseases in Gongcheng. Their treatment methods are varied, convenient, and efficient. Due to the impact of urbanization and economic development, knowledge of traditional medicine is under threat, with declining numbers of local healers and a lack of suitable successors. In order to protect and inherit Yao's traditional medicinal knowledge, it is necessary to educate young healers and to protect biodiversity.
Urgent need to expand syringe services programs in South Carolina and beyond
Authors: Pham Quang , Burrows Marc , Litwin Alain
Published: June 2022

Opioid related overdose deaths in the United States claimed over 100,000 thousand lives during the 12-month period ending in April 2021, an increase of 28.5% from the previous period. Syringe services programs (SSPs) are an evidence-based harm reduction strategy that have been shown to be effective in reducing opioid overdose deaths and infectious complications and increasing rates of entry into recovery programs. Ignoring this evidence, South Carolina (SC) and several states have yet to legalize SSPs. In the absence of full legalization, the operation of SSPs in SC faces many barriers. Despite these barriers, Challenges Inc. has been successful in playing a critical role in preventing opioid overdoses through naloxone and fentanyl test strip distribution, reducing infectious complications by providing clean needles, treating individuals with hepatitis C and HIV, and helping patients remain in sustained recovery from opioids. In order for SSPs to function at their full potential to curb the rising tides of opioid overdose deaths and related health complications, policymakers in SC and similar states need to urgently legalize them.
Parallelogram flap versus homodigital island flap in the treatment of fingertip defects with bone exposure: a prospective controlled study
Authors: Zhang Yingkai , Wang Yao , He Xianwei , Zhou Jiaqi , Cai Guoping , Wu Rongbo
Published: June 2022

Purpose

A modified local transposition flap (we call it “parallelogram flap”) surgery was performed for fingertip injuries. This study aimed to compare the clinical effects of parallelogram flap and homodigital island flaps in fingertip reconstruction.

Methods

The study collected patients who underwent parallelogram transposition flaps and homodigital island flaps to repair fingertip defects from 2019 to 2021. 150 cases (150 fingers) were included in our study. All operations were performed by one surgical team. Record the operation time, two-point discrimination (2PD), Total Active Movement (TAM) and the MHQ (Michigan Hand Questionnaire) of the injured fingers to evaluate the therapeutic effect.

Results

All parallelogram (Group A) and homodigital island flap (Group B) had survived postoperatively. The operative duration of Group A (31.2 ± 3.3 min) is shorter than Group B (97.8 ± 6.1 min) (P < 0.05). At the 6-month follow-up, there was no difference with the two-point discrimination (2PD) of the palmar part of the flaps and the Total Active Movement (TAM) of injured figures in Group A and Group B. The MHQ summary scores in Group A (94.29 ± 3.14) were much higher than in Group B (91.73 ± 3.41) (P < 0.05). Evaluation of the MHQ subscale performance showed that the overall hand function, activities of daily living, work performance and pain score had no differences(P > 0.05), but aesthetics (92.15 ± 7.16) and satisfaction (92.45 ± 5.61) score in Group A was higher than aesthetics (86.56 ± 5.60) and satisfaction (86.72 ± 8.21) score in Group B (P < 0.05 for both).

Conclusions

The reconstruction using parallelogram flaps is a easier and more versatile treatment with better functions, less morbidity and better aesthetics. This method is a better choice for reconstruction of fingertip injury.
A height-weight formula to measure body fat in childhood obesity
Authors: Licenziati Maria Rosaria , Ballarin Giada , Iannuzzo Gabriella , Lonardo Maria Serena , Di Vincenzo Olivia , Iannuzzi Arcangelo , Valerio Giuliana
Published: June 2022

Background

The assessment of body composition is central in diagnosis and treatment of paediatric obesity, but a criterion method is not feasible in clinical practice. Even the use of bioelectrical impedance analysis (BIA) is limited in children. Body mass index (BMI) Z-score is frequently used as a proxy index of body composition, but it does not discriminate between fat mass and fat-free mass. We aimed to assess the extent to which fat mass and percentage of body fat estimated by a height-weight equation agreed with a BIA equation in youths with obesity from South Italy. Furthermore, we investigated the correlation between BMI Z-score and fat mass or percentage of body mass estimated by these two models.

Methods

One-hundred-seventy-four youths with obesity (52.3% males, mean age 10.8 ± 1.9) were enrolled in this cross-sectional study. Fat mass and percentage of body fat were calculated according to a height-weight based prediction model and to a BIA prediction model.

Results

According to Bland–Altman statistics, mean differences were relatively small for both fat mass (+ 0.65 kg) and percentage of body fat (+ 1.27%) with an overestimation at lower mean values; the majority of values fell within the limits of agreement. BMI Z-score was significantly associated with both fat mass and percentage of body fat, regardless of the method, but the strength of correlation was higher when the height-weight equation was considered (r = 0.82; p < 0.001).

Conclusions

This formula may serve as surrogate for body fat estimation when instrumental tools are not available. Dealing with changes of body fat instead of BMI Z-score may help children and parents to focus on diet for health.
Successful pregnancy with restorative reproductive medicine after 16 years of infertility, three recurrent miscarriages, and eight unsuccessful embryo transfers with in vitro fertilization/intracytoplasmic sperm injection: a case report
Authors: Boyle Phil C. , Stanford Joseph B. , Zecevic Ivana
Published: June 2022

Background

Restorative reproductive medicine represents a comprehensive approach to subfertility (infertility and miscarriage) with investigations, diagnoses, and treatments combined with fertility charting to restore optimal reproductive function. Restorative reproductive medicine assumes that multiple factors need to be identified and treated (cycle optimization) for up to 12 cycles to achieve a successful pregnancy. Conception can occur during normal intercourse without intrauterine insemination or in vitro fertilization.

Case presentation

A 35-year-old Croatian female presented for fertility treatment in May 2019 with a previous diagnosis of polycystic ovaries, infertility of 16 years duration, and 8 unsuccessful embryo transfers with in vitro fertilization and intracytoplasmic sperm injection. She was gravida 3 para 0, with 2 miscarriages after spontaneous conception at 5–6 weeks gestation in 2002 and 2004, followed by a miscarriage after in vitro fertilization at 12 weeks gestation in 2011. We initially found poor follicle function and suboptimal progesterone levels. Restorative reproductive medicine treatment resulted in conception after two cycles of treatment. This pregnancy ended in miscarriage at 7 weeks 4 days. Additional investigations found a balanced Robertsonian translocation (13, 14) and a uterine septum. We achieved repeat fertilization with restorative reproductive medicine after three cycles of treatment following resection of the uterine septum and ovulation induction with letrozole and human chorionic gonadotrophin. She had a full-term healthy pregnancy and live birth in 2021.

Conclusion

We propose that a full evaluation of underlying factors, and up to 12 cycles of cycle optimization, should be offered to subfertile patients before considering in vitro fertilization treatment.
Assessing the prevalence of young children living in households prepared for COVID-19 in 56 low- and middle-income countries
Authors: Lu Chunling , Luan Yiqun , Naicker Sara N. , Subramanian S. V. , Behrman Jere R. , Heymann Jody , Stein Alan , Richter Linda M.
Published: June 2022

Background

The COVID-19 pandemic and governments’ attempts to contain it are negatively affecting young children’s health and development in ways we are only beginning to understand and measure. Responses to the pandemic are driven largely by confining children and families to their homes. This study aims to assess the levels of and associated socioeconomic disparities in household preparedness for protecting young children under the age of five from being exposed to communicable diseases, such as COVID-19, in low- and middle-income countries (LMICs).

Methods

Using data from nationally representative household surveys in 56 LMICs since 2016, we estimated the percentages of young children under the age of five living in households prepared for communicable diseases (e.g., COVID-19) and associated residential and wealth disparities at the country- and aggregate-level. Preparedness was defined on the basis of space for quarantine, adequacy of toilet facilities and hand hygiene, mass media exposure at least once a week, and phone ownership. Disparities within countries were measured as the absolute gap in two domains—household wealth and residential area - and compared across regions and country income groups.

Results

The final data set included 766,313 children under age five. On average, 19.4% of young children in the 56 countries lived in households prepared for COVID-19, ranging from 0.6% in Ethiopia in 2016 to 70.9% in Tunisia in 2018. In close to 90% of countries (50), fewer than 50% of young children lived in prepared households. Young children in rural areas or in the poorest households were less likely to live in prepared households than their counterparts.

Conclusions

A large portion of young children under the age of five in LMICs were living in households that did not meet all preparedness guidelines for preventing COVID-19 and caring for patients at home. This study highlights the need to ensure all families in LMICs have the means to prevent the spread of the pandemic or other communicable illnesses to young children during pandemics.
Delirium detection in hospitalized adults: the performance of the 4 'A's Test and the modified Confusion Assessment Method for the Emergency Department. A comparison study
Authors: Muser Olga , Seiler Kevin , Bachnick Stefanie , Gehri Beatrice , Zúñiga Franziska , Hasemann Wolfgang
Published: June 2022

Background

Early detection of delirium through systematic screening is essential to mitigate and prevent possible consequences. The 4 'A's Test (4AT) is a new tool that can be used for delirium detection easily and without special training. The modified Confusion Assessment Method for Emergency Department (mCAM-ED) is an operationalized version of the Confusion Assessment Method, a worldwide used tool for delirium screening in clinical practice and research. This is the first comparison of both delirium screening tools. This study aimed to investigate performance accuracy of the 4AT compared to the mCAM-ED in detecting delirium in hospitalized patients.

Methods

In this prospective single-centre cross-sectional pilot study, patients from six wards were selected consecutively. All patients underwent a delirium screening with the gold standard, the mCAM-ED. To rate the algorithm of the 4AT, corresponding items of the mCAM-ED were derived and used.

Results

A total of 116 patients with a median age of 73 years could be included. Dementia was present in 11 (9.5%) patients, and 42.2% were women. Delirium was present in 8/116 (6.9%) and 16/116 (13.8%) patients according to the mCAM-ED and the 4AT, respectively. In comparison, the 4AT showed 100% (95% CI 0.63, 1.00) sensitivity, 93% (95% CI 0.86, 0.97) specificity, 13.50 (95% CI 6.93, 26.30) positive likelihood ratio and 0.00 (95% CI 0.00, NaN) negative likelihood ratio.

Conclusions

In this first comparison, the 4AT showed a high rate of false-positive scores, which may result in an increased need for further in-depth assessments.
Imaging of COVID-19 vasculopathy from head to toe: Egyptian collective experience after 2 years of the pandemic
Authors: Fathy Ahmed , Rizk Adel , Elnekeidy Abdelaziz , Gharraf Heba Said , Abdelgawad Mohamed Saied , Samir Ahmed
Published: June 2022

Background

COVID-19 vasculopathy is a critical condition that impacts the disease prognosis including vasculitis and thromboembolic complications. This study aimed to provide the Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic and to collectively include the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial vascular complications.

Results

This is a multi-center retrospective analysis of 3500 PCR-proved COVID-19 infection between March 2020 and December 2021. A cohort of 282 consecutive patients with COVID-19 vasculopathy was considered for inclusion. They included 204 males and 78 females (72:28%). The mean age was 68 years, and age ranged from 48 to 90 years. Five radiologists evaluated the different imaging examinations in consensus including computed tomography (CT), CT-angiography (CTA), CT-perfusion (CTP), magnetic resonance imaging (MRI), MR-arteriography (MRA), and MR-venography (MRV). 244/282 (86.5%) patients suffered from non-hemorrhagic cerebral ischemic infarctions. 13/282 (4.6%) patients suffered from hemorrhagic cerebral infarctions. 5/282 (1.8%) patients suffered from cerebral vasculitis. Pulmonary vascular angiopathy was detected in 10/282 (3.5%) patients, including pulmonary embolism in 10/10 patients, pulmonary infarctions in 8/10 patients, pulmonary vascular enlargement in 5/10 patients, and vascular "tree-in-bud" sign in 2/10 patients. Intestinal ischemia and small bowel obstruction were detected in 3/282 patients (1%) while GIT bleeding was encountered in 4/282 patients (1.4%). Lower limb arterial ischemia was found in 3/282 patients (1%). Additionally; 39/282 (13.8%) patients developed peripheral deep venous thrombosis (DVT) due to prolonged ICU recumbence while 28/282 (10%) patients developed jugular vein thrombosis sequel to prolonged catheterization. A p value (0.002) and (r) = 0.8 statistically proved strong significant relation between COVID-19 vasculopathy and D-dimer levels.

Conclusions

Multi-system vasculopathy was a serious complication of COVID-19 which impacted the patients' morbidity and mortality. An Egyptian experience about the COVID-19 vasculopathy during the past two years of the pandemic was provided. It encountered the different modalities and imaging techniques for the diagnosis of cerebrovascular, pulmonary, gastrointestinal, and peripheral arterial COVID-19 vascular complications.
Articulating fertilizer subsidy effects on women’s diet quality by food supply source in Mali
Authors: Assima Amidou , Zanello Giacomo , Smale Melinda
Published: June 2022

Background

Mali’s fertilizer subsidy program aims to reduce food insecurity among the nation’s predominantly rural people by jump-starting productivity gains of major crops. This paper contributes to sparse evidence regarding its effects.

Methods

Theory predicts that agricultural productivity can affect diet quality directly through two channels. The production channel influences the availability of food for household consumption or sale. The income pathway, resulting from sales, leads to household food expenditure. We test this hypothesis by applying propensity score matching methods to farm household survey data collected from 2400 households in Mali in 2018.

Results

We find that the overall effect of the fertilizer subsidy on women’s dietary diversity is positive in the Niger Delta and negative on the Koutiala Plateau. Further examination by food supply source reveals no subsidy effects on the dietary diversity provided by on-farm production in either zone. The subsidy negatively influences dietary diversity of foods sourced as gifts in the Niger Delta. Subsidy effects on dietary diversity accessed through food purchases are strong and positive in the Niger Delta, but negative on the Koutiala Plateau. The Koutiala Plateau is found in the region of Sikasso, where rising incomes from cotton production, which is the major export crop of the region and of the nation, have been shown not to alleviate poverty and malnutrition (a dilemma known as the “Sikasso Paradox”).

Conclusions

Our approach reveals that additional income from increased yields stimulated by subsidized fertilizer can enable off-farm purchases of more nutritious food and thereby improve nutritional outcomes for women.
Improvements in pig agriculture through gene editing
Authors: Whitworth Kristin M. , Green Jonathan A. , Redel Bethany K. , Geisert Rodney D. , Lee Kiho , Telugu Bhanu P. , Wells Kevin D. , Prather Randall S.
Published: June 2022

Genetic modification of animals via selective breeding is the basis for modern agriculture. The current breeding paradigm however has limitations, chief among them is the requirement for the beneficial trait to exist within the population. Desirable alleles in geographically isolated breeds, or breeds selected for a different conformation and commercial application, and more importantly animals from different genera or species cannot be introgressed into the population via selective breeding. Additionally, linkage disequilibrium results in low heritability and necessitates breeding over successive generations to fix a beneficial trait within a population. Given the need to sustainably improve animal production to feed an anticipated 9 billion global population by 2030 against a backdrop of infectious diseases and a looming threat from climate change, there is a pressing need for responsive, precise, and agile breeding strategies. The availability of genome editing tools that allow for the introduction of precise genetic modification at a single nucleotide resolution, while also facilitating large transgene integration in the target population, offers a solution. Concordant with the developments in genomic sequencing approaches, progress among germline editing efforts is expected to reach feverish pace. The current manuscript reviews past and current developments in germline engineering in pigs, and the many advantages they confer for advancing animal agriculture.
Prevalence and related factors of child posttraumatic stress disorder during COVID-19 pandemic: A systematic review and meta-analysis
Authors: Yang Fan , Wen Jiaxing , Huang Ning , Riem Madelon M. E. , Lodder Paul , Guo Jing
Published: June 2022

Background

The COVID-19 pandemic has drastically impacted many aspects of society and has indirectly produced various psychological consequences. This systematic review aimed to estimate the worldwide prevalence of posttraumatic stress disorder (PTSD) in children due to the COVID-19 pandemic, as well as to identify protective or risk factors contributing to child PTSD.

Methods

We conducted a systematic literature search in the PubMed, ProQuest, PsycINFO, Embase, Web of Science, WanFang, CNKI, and VIP databases. We searched for studies published between January 1, 2020 and May 26, 2021, that reported the prevalence of child PTSD due to the COVID-19 pandemic, as well as factors contributing to child PTSD. Eighteen studies were included in our systematic review, of which 10 studies were included in the meta-analysis.

Results

The estimated prevalence of child PTSD after the COVID-19 outbreak was 28.15% (95% CI: 19.46–36.84%, I2 = 99.7%). In subgroup analyses for specific regions the estimated prevalence of post-pandemic child PTSD was 19.61% (95% CI: 11.23–27.98%) in China, 50.8% (95% CI: 34.12–67.49%) in the USA, and 50.08% in Italy (95% CI: 47.32–52.84%).

Conclusions

Factors contributing to child PTSD were categorized into four aspects: personal factors, family factors, social factors and infectious diseases related factors. Based on this, we presented a new framework summarizing the occurrence and influence of the COVID-19 related child PTSD, which may contribute to a better understanding, prevention and development of interventions for child PTSD in forthcoming pandemics.
Pinning forces of sliding drops at defects
Authors: Saal Alexander , Straub Benedikt B. , Butt Hans-Jürgen , Berger Rüdiger
Published: June 2022

Wetting of surfaces depends critically on defects which alter the shape of the drop. However, no experimental verification of forces owing to the three phase contact line deformation at single defects is available. We imaged the contact line of sliding drops on hydrophobic surfaces by video microscopy. From the deformation of the contact line, we calculate the force acting on a sliding drop using an equation going back to Joanny and de Gennes (J. Chem. Phys., 81 (1984) 554). The calculated forces quantitatively agree with directly measured forces acting between model defects and water drops. In addition, both forces quantitatively match with the force calculated by contact angle differences between the defect and the surface. The quantitative agreement even holds for defects reaching a size of

of the drop diameter. Our validation for drop’s pinning forces at single defects is an important step towards a general understanding of contact line motion on heterogeneous surfaces.
Artificial Neural Network Approach to Competency-Based Training Using a Virtual Reality Neurosurgical Simulation
Authors: Reich Aiden , Mirchi Nykan , Yilmaz Recai , Ledwos Nicole , Bissonnette Vincent , Tran Dan Huy , Winkler-Schwartz Alexander , Karlik Bekir , Del Maestro Rolando F.
Published: June 2022

BACKGROUND:

The methodology of assessment and training of surgical skills is evolving to deal with the emergence of competency-based training. Artificial neural networks (ANNs), a branch of artificial intelligence, can use newly generated metrics not only for assessment performance but also to quantitate individual metric importance and provide new insights into surgical expertise.

OBJECTIVE:

To outline the educational utility of using an ANN in the assessment and quantitation of surgical expertise. A virtual reality vertebral osteophyte removal during a simulated surgical spine procedure is used as a model to outline this methodology.

METHODS:

Twenty-one participants performed a simulated anterior cervical diskectomy and fusion on the Sim-Ortho virtual reality simulator. Participants were divided into 3 groups, including 9 postresidents, 5 senior residents, and 7 junior residents. Data were retrieved from the osteophyte removal component of the scenario, which involved using a simulated burr. The data were manipulated to initially generate 83 performance metrics spanning 3 categories (safety, efficiency, and motion) of which only the most relevant metrics were used to train and test the ANN.

RESULTS:

The ANN model was trained on 6 safety metrics to a testing accuracy of 83.3%. The contributions of these performance metrics to expertise were revealed through connection weight products and outlined 2 identifiable learning patterns of technical skills.

CONCLUSION:

This study outlines the potential utility of ANNs which allows a deeper understanding of the composites of surgical expertise and may contribute to the paradigm shift toward competency-based surgical training.
Sacroiliac Joint Fusion Using Robotic Navigation: Technical Note and Case Series
Authors: Wang Timothy Y. , Bergin Stephen M. , Murphy Kelly R. , Abd-El-Barr Muhammad M. , Grossi Peter , Shaffrey Christopher I. , Crutcher Clifford , Than Khoi D.
Published: June 2022

BACKGROUND:

Patients undergoing sacroiliac (SI) fusion can oftentimes experience significant improvements in pain and quality of life.

OBJECTIVE:

To describe a novel application of robotic navigation to assist with minimally invasive SI joint fusion.

METHODS:

Patients undergoing stand-alone SI joint fusion with ExcelsiusGPS robotic navigation from July 2020 through June 2021 were retrospectively enrolled. Baseline demographic and perioperative variables including radiation exposure, postoperative pain scores, and narcotic requirements in the postanesthesia care unit (PACU) were recorded. Length of stay and any postoperative complications were also noted.

RESULTS:

A total of 10 patients (64.4 ± 8.2 years, body mass index 28.7 ± 4.8 kg/m2) met inclusion criteria. Seven patients (70.0%) were female, and there was a 6:4 split between left-sided and right-sided SI joint fusion. The total operative time was 54 ± 9 minutes, and the estimated blood loss was 21.0 ± 16.7 mL. The intraoperative radiation exposure was 13.7 ± 6.2 mGy, and there were no complications. The average pain score in PACU was 5.2 ± 1.0, and the average opioid administration in PACU was 27.6 ± 10.3 morphine equivalents. Length of stay was 0.4 ± 0.7 days, with 7 of 10 patients discharged on the same day as surgery. There were no readmissions. The average length of follow-up was 4.3 ± 2.5 months. At the last follow-up, patients reported an average of 73.1% ± 30.1% improvement in their preoperative pain.

CONCLUSION:

Robot-navigated SI joint fusion is a feasible and reproducible method for addressing refractory SI joint disease. Further investigation on clinical outcomes and long-term fusion rates is needed, as are studies comparing robot-navigated SI joint fusion with more traditional techniques.
Fully Endoscopic Microvascular Decompression for Hemifacial Spasm Using Improved Retrosigmoid Infrafloccular Approach: Clinical Analysis of 81 Cases
Authors: Guo Xing , Zhang Chao , Li Yuexuan , Li Xingang , Ma Xiangyu , Li Weiguo
Published: June 2022

BACKGROUND:

Microvascular decompression (MVD) is widely accepted as the preferred treatment for hemifacial spasm (HFS). Endoscopy has been implemented to provide a comprehensive view of neurovascular conflicts and minimize the damage caused by brain retraction while exploring the facial nerve root exit zone of the brain stem.

OBJECTIVE:

To preliminarily evaluate the surgical safety and efficacy of fully endoscopic MVD for HFS using an improved retrosigmoid infrafloccular approach.

METHODS:

The clinical data of 81 patients with HFS who underwent fully endoscopic MVD using an improved endoscopic retrosigmoid infrafloccular approach from June 2019 to December 2020 were retrospectively analyzed. The reliability and advantages of this surgical technique in the treatment of HFS were evaluated according to the intraoperative situation, outcomes of postoperative symptoms, and main complications.

RESULTS:

During the follow-up period, 77 cases (95.1%) were completely cured, with immediate facial twitch disappearance in 56 cases and a delayed cure in 21 cases; in 4 cases (4.9%), there was no obvious improvement. There were no cases of recurrence. There were 4 cases (4.9%) of transient facial paralysis after MVD, all of which were completely cured in 3 months. Three cases (3.7%) had hearing loss postoperatively, of whom 2 showed good improvement. At the end of the follow-up period, 1 case (1.2%) still had tinnitus. There were no cases of postoperative intracranial hemorrhage, cerebellar swelling, or death.

CONCLUSION:

Fully endoscopic MVD using an improved retrosigmoid infrafloccular approach not only has the advantages of panoramic surgical visualization but also takes into account the requirements of minimally invasive surgery.
Mobility-Maintaining Facet Arthroplasty of the Lumbar Spine With the Second-Generation TOPS System: A Case Series
Authors: Lack Werner , Kutschera Hans Paul , Krugluger Josef
Published: June 2022

BACKGROUND:

Lumbar spinal stenosis results from spinal canal narrowing and can lead to pain and dysfunction. Until recently, surgical treatment for lumbar spinal stenosis requiring an extensive decompression, with or without spondylolisthesis, had to balance pain relief with the long-term risks of spinal instability after decompression and adjacent segment disease (ASD) after spinal fusion. Spinal motion-preserving devices aim to reduce the incidence of ASD after posterolateral fusion and consequent need for revision surgery.

OBJECTIVE:

To present a single-center experience with a facet replacement implant (TOPS System [TOtal Posterior Spine System], Premia Spine) designed to stabilize the spine and prevent further degeneration while maintaining a normal range of motion (ROM).

METHODS:

Seventeen patients received the implant after a laminotomy. Clinical assessments included surgery duration, complication rates, and visual analog score for back pain. Radiographs were used to measure ROM changes from flexion to extension and assess for any repositioning of a degenerative spondylolisthesis and segment lordosis.

RESULTS:

The average operative time was 102 minutes. The average visual analog score reduction was 7.5 at 3 months, 6.8 at 12 months, and 6.7 at the longest follow-up (average: 51 months, range: 26-77), demonstrating an average improvement of 81%. The preoperative and postoperative average ROMs were 8.2° and 7.4°, respectively.

CONCLUSION:

This series shows that the TOPS System has the potential to relieve back pain and maintain close-to-normal ROM over longer time periods without inducing ASD. The TOPS System is the first to allow the patient to settle into physiological lordosis adjustment thus presenting new treatment possibilities with mobility-maintaining dorsal instrumentation.
Nondominant Hand Skills Spatial and Psychomotor Analysis During a Complex Virtual Reality Neurosurgical Task—A Case Series Study
Authors: Yilmaz Recai , Ledwos Nicole , Sawaya Robin , Winkler-Schwartz Alexander , Mirchi Nykan , Bissonnette Vincent , Fazlollahi Ali M. , Bakhaidar Mohamad , Alsayegh Ahmad , Sabbagh Abdulrahman J. , Bajunaid Khalid , Del Maestro Rolando
Published: June 2022

BACKGROUND:

Virtual reality surgical simulators provide detailed psychomotor performance data, allowing qualitative and quantitative assessment of hand function. The nondominant hand plays an essential role in neurosurgery in exposing the operative area, assisting the dominant hand to optimize task execution, and hemostasis. Outlining expert-level nondominant hand skills may be critical to understand surgical expertise and aid learner training.

OBJECTIVE:

To (1) provide validity for the simulated bimanual subpial tumor resection task and (2) to use this simulation in qualitative and quantitative evaluation of nondominant hand skills for bipolar forceps utilization.

METHODS:

In this case series study, 45 right-handed participants performed a simulated subpial tumor resection using simulated bipolar forceps in the nondominant hand for assisting the surgery and hemostasis. A 10-item questionnaire was used to assess task validity. The nondominant hand skills across 4 expertise levels (neurosurgeons, senior trainees, junior trainees, and medical students) were analyzed by 2 visual models and performance metrics.

RESULTS:

Neurosurgeon median (range) overall satisfaction with the simulated scenario was 4.0/5.0 (2.0-5.0). The visual models demonstrated a decrease in high force application areas on pial surface with increased expertise level. Bipolar-pia mater interactions were more focused around the tumoral region for neurosurgeons and senior trainees. These groups spent more time using the bipolar while interacting with pia. All groups spent significantly higher time in the left upper pial quadrant than other quadrants.

CONCLUSION:

This work introduces new approaches for the evaluation of nondominant hand skills which may help surgical trainees by providing both qualitative and quantitative feedback.
Prostate organogenesis
Authors: Pletcher Andrew , Shibata Maho
Published: June 2022

Prostate organogenesis begins during embryonic development and continues through puberty when the prostate becomes an important exocrine gland of the male reproductive system. The specification and growth of the prostate is regulated by androgens and is largely a result of cell-cell communication between the epithelium and mesenchyme. The fields of developmental and cancer biology have long been interested in prostate organogenesis because of its relevance for understanding prostate diseases, and research has expanded in recent years with the advent of novel technologies, including genetic-lineage tracing, single-cell RNA sequencing and organoid culture methods, that have provided important insights into androgen regulation, epithelial cell origins and cellular heterogeneity. We discuss these findings, putting them into context with what is currently known about prostate organogenesis.
The gut parasite Nosema ceranae impairs olfactory learning in bumblebees
Authors: Gómez-Moracho Tamara , Durand Tristan , Lihoreau Mathieu
Published: June 2022

Pollinators are exposed to numerous parasites and pathogens when foraging on flowers. These biological stressors may affect critical cognitive abilities required for foraging. Here, we tested whether exposure to Nosema ceranae, one of the most widespread parasites of honey bees also found in wild pollinators, impacts cognition in bumblebees. We investigated different forms of olfactory learning and memory using conditioning of the proboscis extension reflex. Seven days after being exposed to parasite spores, bumblebees showed lower performance in absolute, differential and reversal learning than controls. The consistent observations across different types of olfactory learning indicate a general negative effect of N. ceranae exposure that did not specifically target particular brain areas or neural processes. We discuss the potential mechanisms by which N. ceranae impairs bumblebee cognition and the broader consequences for populations of pollinators.
“Frenemies” of innovation: understanding the role of coopetition in service innovation in emerging markets
Authors: Hassan Sohaib S. , Egbetokun Abiodun , Bzhalava Levan
Published: June 2022

Coopetition is considered an important strategy for innovation. However, the literature provides limited evidence on how coopetition relates to innovation in service sector, particularly in emerging markets. Moreover, little is known about the effects of the formal and informal aspects of coopetition on innovation and how absorptive capacity of firm may influence this relationship. Against this background, using the official national innovation surveys of Nigeria (2008 and 2011), this study contributes to the ongoing debate by empirically examining the innovation endeavors of 421 Nigerian SMEs. The study employs logistic regression methods to model and explore the relationships between coopetition and innovation in the sample. The results show that that formal coopetition hinders innovation while informal coopetition supports it and absorptive capacity moderates these relationships. The study provides important insights about the concept of coopetition in emerging markets, especially vis-à-vis their institutional idiosyncrasies. Finally, the study highlights its implications and suggests some avenues for future research.
Pandemic preparedness and responsiveness of research review committees: lessons from review of COVID-19 protocols at KEMRI Wellcome Trust Research Programme in Kenya
Authors: Hinga Alex , Jeena Lisha , Awuor Esther , Kahindi Jane , Munene Marianne , Kinyanjui Samson , Molyneux Sassy , Marsh Vicki , Kamuya Dorcas
Published: June 2022

Background: The scale of the COVID-19 pandemic and novelty of SARS-CoV-2 presented unprecedented challenges in the review of COVID-19 protocols. We investigated how research at the KEMRI Wellcome Trust Research Programme (KWTRP) was reviewed, including by institutional and national level committees.

Methods: A document review and in-depth interviews with researchers, regulators and research reviewers were conducted. Documents reviewed included research logs of all protocols submitted between April-1-2020 and March-31-2021, feedback letters from review committees for 10 new COVID-19 protocols (n=42), and minutes from 35 COVID-19 research review meetings. Fifteen in-depth interviews were conducted with respondents purposively selected because of their experience of developing or reviewing COVID-19 protocols at the institution level (n=9 researchers, engagement officers and regulators) or their experience in reviewing proposals at a national-level (n=6 committee members). Data were managed and analyzed using MS Excel and NVivo12.

Results: Between April-1-2020 and March-31-2021, 30 COVID-19-related submissions by KWTRP researchers were approved. Changes to the review system included strengthening the online system for protocol submission and review, recruiting more reviewers, and trialing a joint review process where one protocol was submitted to multiple review committees simultaneously . The turnaround time from submission to national approval/rejection over this period was faster than pre-pandemic, but slower than the national committee’s target. COVID-19-specific ethics questions centred on: virtual informed consent and data collection; COVID-19 prevention, screening and testing procedures; and the challenges of study design and community engagement during the pandemic.

Conclusions: The unprecedented challenges of the pandemic and added bureaucratic requirements created a more complex review process and delayed final approval of research protocols. The feasibility of conducting joint review of research during public health emergencies in Kenya needs further investigation. Consideration of the unique COVID-19 ethics issues raised in this paper might aid expedience in current and future reviews.
USE OF CAMEL RATING FRAMEWORK: A COMPARATIVE PERFORMANCE ANALYSIS OF SELECTED COMMERCIAL BANKS IN INDIA
Authors: Kulshrestha Preeti , Srivastava Anubha
Published: June 2022

The performance of the banking sector is significant for any economy. The growth of a nation relies significantly upon efficient and optimum utilization of resources and also on operational efficiency of various sectors of an economy, of which the banking sector is a critical part. Banking system strengthens the stimulation of capital formation and provides liquidity. Indian banking sector comprises private, public, rural and foreign banks. In India, public sector banks are encountering challenges from private sector banks and are under constant pressure to perform better. Hence, this study endeavors mainly to analyze and compare the financial performance of the private and public banking sector by using CAMEL rating approach and for this purpose total of fourteen banks, representing the private and public, have been selected. The selected sample are the market leaders and have the highest market capitalization in the capital market. Overall, the paper aims to measure and compare the financial performance of private and public sector banks by employing CAMEL approach on their audited financial reports of eight years period i.e. (2011–2018). The ratios considered for this analysis includes Capital Adequacy (CA), Asset Quality (AQ), Management Soundness (MS), Earnings and Liquidity (LR). This study devised ranking method based on averages of various ratios and one way annova test is applied to find out statistical significance difference amongst groups. Results shown that private sector banks are better performers compare to Public sector bank. The overall results signify that the performance of private sector banks has improved because of the implementation ofmodern technology banking reforms and recovery mechanism.