bluuebunny/crossref_metadata_2025 huggingface dataset:
Awareness of statin–food interactions using grapefruit as an example: a cross-sectional study in Eastern Province of Saudi Arabia
Authors: Baraka Mohamed A , Elnaem Mohamed Hassan , Elkalmi Ramadan , Sadeq Adel , Elnour Asim Ahmed , Joseph Chacko Royes , ALQarross Abdullah H , Moustafa Mahmoud M AbdRabo
Published: August 2021

Objectives

The purpose of this study is to assess patients’ knowledge regarding statin–grapefruit interactions, to identify any pertinent demographic characteristics that may influence knowledge of this drug–food interaction, and to identify preferred patient sources of health information.

Methods

A cross-sectional study was conducted to collect data from statins users about the awareness regarding drug interaction with foods. Self-administered questionnaires have been distributed to collect data from statins users regardless of the type and the reason they administer these medications. Respondents were statins users visiting the King Fahd Hospital’s outpatient clinic (KFHU) and community pharmacies in the Eastern province of Saudi Arabia.

Key findings

Our study revealed that 62% of statin users never heard about the statin–grapefruit interaction. Only 11% have correctly recognized the interaction effect. Only 11, 21 and 6% of users have reported that they often/always received information on drug–food interaction from pharmacists, physicians and nurses, respectively. Users aged above 60 years had lower awareness than those aged <40 (6.0% vs. 14.1%). Similarly, the proportion was lower among users who had primary or lower educational attainment, unemployed or had income lower than 5000 SAR compared with that among the contrary groups. However, only income showed a statistically significant association (P = 0.007).

Conclusions

The majority of statin users have never heard about their interaction with food. Geriatrics, low-income and less educated patients had a lower level of awareness compared with their counterparts. Many patients may end up discontinuing their medications because of that interaction and the consequent side effects. Pharmacists are requested to play their expected role in providing adequate patient counselling to help improve patients’ awareness regarding safety concerns of statins medication.
Sclerotherapy as an alternative treatment for complex, refractory seromas
Authors: Episalla Nicole C , Orra Susan , Black Cara K , Dekker Paige K , Kim Kevin G , Cardella John T , Evans Karen K
Published: August 2021

Traditional therapy for seromas often entails compression, aspiration, drainage, or surgical excision and re-closure; however, more complex, treatment-refractory seromas may require additional treatment. Sclerotherapy has been well documented in the treatment of simple pleural effusions, vascular malformations, lymphoceles and seromas. However, little evidence is available on the efficacy of sclerotherapy in complex, treatment-refractory seromas that develop post-operatively in patients with complex medical histories. We present a case series highlighting the use of sclerotherapy by interventional radiology as an alternative or adjunctive treatment method for chronic, high-volume post-operative seromas recalcitrant to multiple attempts of traditional treatment. At long-term follow-up, the seromas resolved after a maximum of four rounds of sclerotherapy with various combinations of known sclerosants. Highly complex cases of large, chronic seromas may be refractory to conservative modalities and re-closure. Sclerotherapy can be considered an alternative method or adjunctive treatment for chronic, recalcitrant post-operative seromas.
A case of traumatic rupture of the urinary bladder due to a fall from a chair-style ski lift
Authors: Tatekawa Yukihiro
Published: August 2021

We report our experience with an 8-year-old boy who incurred a traumatic rupture of the urinary bladder due to a fall from a chair-type ski lift. This boy felt like he needed to urinate before getting on the lift, but he did not do so. He was trembling from the sensation of needing to urinate and fell from the lift while it was at least 6 m in the air. He complained of abdominal pain, and on-site emergency physicians performed focused assessment with sonography for trauma, which showed fluid in the abdomen. He subsequently developed abdominal guarding. Enhanced abdominal computed tomography revealed a rupture of the urinary bladder. At laparotomy, two ruptures were seen along the dome of the bladder; the bladder wall was repaired in three layers. The patient was discharged with a cast on his foot for a fracture of the left heel bone on postoperative day 16.
Comparing theories of consciousness: why it matters and how to do it
Authors: Del Pin Simon Hviid , Skóra Zuzanna , Sandberg Kristian , Overgaard Morten , Wierzchoń Michał
Published: August 2021

The theoretical landscape of scientific studies of consciousness has flourished. Today, even multiple versions of the same theory are sometimes available. To advance the field, these theories should be directly compared to determine which are better at predicting and explaining empirical data. Systematic inquiries of this sort are seen in many subfields in cognitive psychology and neuroscience, e.g. in working memory. Nonetheless, when we surveyed publications on consciousness research, we found that most focused on a single theory. When ‘comparisons’ happened, they were often verbal and non-systematic. This fact in itself could be a contributing reason for the lack of convergence between theories in consciousness research. In this paper, we focus on how to compare theories of consciousness to ensure that the comparisons are meaningful, e.g. whether their predictions are parallel or contrasting. We evaluate how theories are typically compared in consciousness research and related subdisciplines in cognitive psychology and neuroscience, and we provide an example of our approach. We then examine the different reasons why direct comparisons between theories are rarely seen. One possible explanation is the unique nature of the consciousness phenomenon. We conclude that the field should embrace this uniqueness, and we set out the features that a theory of consciousness should account for.
Feasibility of magnetic resonance-guided high-intensity focused ultrasound treatment targeting distinct nodular lesions in neurofibromatosis type 1
Authors: Tydings Caitlin , Yarmolenko Pavel , Bornhorst Miriam , Dombi Eva , Myseros John , Keating Robert , Bost James , Sharma Karun , Kim AeRang
Published: August 2021

Background

Patients with Neurofibromatosis Type 1 (NF1) and plexiform neurofibromas (PN) often have radiographically diagnosed distinct nodular lesions (DNL) which can cause pain and weakness. Magnetic resonance-guided high intensity focused ultrasound (MR-HIFU) can precisely and accurately deliver heat to thermally ablate target tissue. The aim of this study is to evaluate whole-body MRIs from patients with NF1 and DNL, applying volumetrics and a consistent treatment planning approach to determine the feasibility of MR-HIFU ablation of DNL.

Methods

A retrospective review of whole-body MRI scans from patients with NF1 and PN from CNH and NCI was performed. DNL are defined as lesions >3 cm, distinct from PN and lacking the “central dot” feature. Criteria for MR-HIFU thermal ablation include target location 1–8 cm from skin surface; >1 cm from visible plexus, spinal canal, bladder, bowel, physis; and ability to ablate ≥50% of lesion volume. Lesions in skull and vertebral body were excluded.

Results

In 26 patients, 120 DNL were identified. The majority of DNL were located in an extremity (52.5%). Other sites included head/neck (7%), chest (13%), and abdomen/pelvis (28%). The predefined HIFU ablation criteria was not met for 47.5% of lesions (n = 57). The main limitation was proximity to a vital structure or organ (79%). Complete and partial HIFU ablation was feasible for 25% and 27.5% of lesions, respectively.

Conclusion

Based on imaging review of lesion location, technical considerations and ability to target lesions, thermal ablation with MR-HIFU may be a feasible noninvasive alternative for symptom management in patients with NF1 and symptomatic DNL.
Social-specific impairment of negative emotion perception in alexithymia
Authors: Wang Zhihao , Goerlich Katharina S , Luo Yue-jia , Xu Pengfei , Aleman André
Published: August 2021

Alexithymia has been characterized as an impaired ability of emotion processing and regulation. The definition of alexithymia does not include a social component. However, there is some evidence that social cognition may be compromised in individuals with alexithymia. Hence, emotional impairments associated with alexithymia may extend to socially relevant information. Here, we recorded electrophysiological responses of individuals meeting the clinically relevant cutoff for alexithymia (ALEX; n = 24) and individuals without alexithymia (NonALEX; n = 23) while they viewed affective scenes that varied on the dimensions of sociality and emotional valence during a rapid serial visual presentation task. We found that ALEX exhibited lower accuracy and larger N2 than NonALEX in the perception of social negative scenes. Source reconstruction revealed that the group difference in N2 was localized at the dorsal anterior cingulate cortex. Irrespective of emotional valence, ALEX showed stronger alpha power than NonALEX in social but not non-social conditions. Our findings support the hypothesis of social processing being selectively affected by alexithymia, especially for stimuli with negative valence. Electrophysiological evidence suggests altered deployment of attentional resources in the perception of social-specific emotional information in alexithymia. This work sheds light on the neuropsychopathology of alexithymia and alexithymia-related disorders.
Teff grass for continuous stocking in the Southern High Plains by growing beef steers receiving protein supplements
Authors: Sugg Joel D , Sarturi Jhones O , West Charles P , Ballou Michael A , Henry Darren D
Published: August 2021

This experiment evaluated forage quality, total nutrient yield, water footprint, and growth performance of beef steers receiving protein supplements while grazing Teff grass [‘Tiffany’Eragrostis tef (Zucc.) Trotter] over two consecutive growing seasons. Each year, four 2.66-ha irrigated paddocks (experimental units) were stocked with crossbred beef steers (n = 5 per paddock, initial BW = 289 ± 30 for yr 1; and n = 6, initial BW = 286 ± 23 for yr 2) in a randomized complete block design and stocked continuously for 63 d. Daily supplements [0.45 kg/d of cottonseed meal (Control) enough to avoid a negative ruminal N balance; and 0.50% mean paddock BW animal-daily (approximately 1.65 kg) of sorghum-dried distillers grains plus solubles, (DDGS)] were randomly assigned to two paddocks each. Supplement did not influence forage neutral detergent fiber (NDF), acid detergent fiber, crude protein, or in vitro true digestibility (P ≥ 0.54), except for a tendency (P = 0.08) for a numerical increase in NDF content of paddocks with steers that received DDGS supplementation. Paddock nutrient-yields were similar (P ≥ 0.43) between supplement treatments. Supplementation with DDGS produced greater (P = 0.01) cattle shrunk average daily gain (ADG). Predicted teff dry matter intake (DMI), net energy for maintenance (NEm), and growth (NEg) (P ≤ 0.03) were greater with cattle offered Control treatment. Predicted total DMI was similar (P = 0.14) although predicted dietary NEm, NEg, gain:feed, and total BW gain were greater (P ≤ 0.02) with DDGS. Predicted forage intake was greater (P ≤ 0.05) for cattle offered Control treatment. Teff nutrients remaining on d 56 were similar (P = 0.33) between treatments. Water footprint for total production of forage nutrient components did not differ (P ≥ 0.12) by treatments. Nutrient yield and water use efficiency of continuously stocked teff grass was not affected by supplemental regimen. Using DDGS as a supplement may increase BW gain through increased nutrient utilization without hindering teff nutrient production on a continuous stocking system.
Molecular and Biological Characterization of Two New Species Causing Peach Shoot Blight in China
Authors: Yang Lina , Wang Lingyun , Cao Jun , Zhu Yuxin , Zhang Liang , Jin Weixin , Zhu Feng , Ji Zhaolin
Published: August 2021

Peach shoot blight (PSB), which kills shoots, newly sprouted leaf buds, and peach fruits, has gradually increased over the last 10 years and resulted in 30 to 50% of total production loss of the peach industry in China. Phomopsis amygdali has been identified as the common causal agent of this disease. In this study, two new species, Phomopsis liquidambaris (strain JW18-2) and Diaporthe eres (strain JH18-2), were also pathogens causing PSB, as determined through molecular phylogenetic analysis based on the sequences of the internal transcribed spacer (ITS) region, translation elongation factor 1-α (EF1-α) and beta-tubulin (TUB), and colony and conidial morphological characteristics. Biological phenotypic analysis showed that the colony growth rate of strain JW18-2 was faster than that of strains JH18-2 and ZN32 (one of the P. amygdali strains that we previously found and identified). All three strains produced α-conidia; however, JW18-2 could not produce β-conidia on alfalfa decoction and Czapek media, and the β-conidia produced by strain JH18-2 were shorter in length and thicker in width than those produced by strain ZN32. Pathogenicity tests showed that JW18-2 presented the strongest pathogenicity for peach fruits and twigs and was followed by strains JH18-2 and ZN32. The results shed light on the etiology of PSB and provide a warning that P. liquidambaris or D. eres might develop into dominant species after a few years while also potentially benefitting the development of effective disease control management strategies.
Age-Related Changes in Voice Emotion Recognition by Postlingually Deafened Listeners With Cochlear Implants
Authors: Cannon Shauntelle A. , Chatterjee Monita
Published: August 2021

Objectives:

Identification of emotional prosody in speech declines with age in normally hearing (NH) adults. Cochlear implant (CI) users have deficits in the perception of prosody, but the effects of age on vocal emotion recognition by adult postlingually deaf CI users are not known. The objective of the present study was to examine age-related changes in CI users’ and NH listeners’ emotion recognition.

Design:

Participants included 18 CI users (29.6 to 74.5 years) and 43 NH adults (25.8 to 74.8 years). Participants listened to emotion-neutral sentences spoken by a male and female talker in five emotions (happy, sad, scared, angry, neutral). NH adults heard them in four conditions: unprocessed (full spectrum) speech, 16-channel, 8-channel, and 4-channel noise-band vocoded speech. The adult CI users only listened to unprocessed (full spectrum) speech. Sensitivity (d’) to emotions and Reaction Times were obtained using a single-interval, five-alternative, forced-choice paradigm.

Results:

For NH participants, results indicated age-related declines in Accuracy and d’, and age-related increases in Reaction Time in all conditions. Results indicated an overall deficit, as well as age-related declines in overall d’ for CI users, but Reaction Times were elevated compared with NH listeners and did not show age-related changes. Analysis of Accuracy scores (hit rates) were generally consistent with d’ data.

Conclusions:

Both CI users and NH listeners showed age-related deficits in emotion identification. The CI users’ overall deficit in emotion perception, and their slower response times, suggest impaired social communication which may in turn impact overall well-being, particularly so for older CI users, as lower vocal emotion recognition scores have been associated with poorer subjective quality of life in CI patients.
Comparison of Machine Learning Methods for Predicting Outcomes After In-Hospital Cardiac Arrest
Authors: Mayampurath Anoop , Hagopian Raffi , Venable Laura , Carey Kyle , Edelson Dana , Churpek Matthew ,   for the American Heart Association's Get With the Guidelines-Resuscitation Investigators
Published: August 2021

OBJECTIVES:

Prognostication of neurologic status among survivors of in-hospital cardiac arrests remains a challenging task for physicians. Although models such as the Cardiac Arrest Survival Post-Resuscitation In-hospital score are useful for predicting neurologic outcomes, they were developed using traditional statistical techniques. In this study, we derive and compare the performance of several machine learning models with each other and with the Cardiac Arrest Survival Post-Resuscitation In-hospital score for predicting the likelihood of favorable neurologic outcomes among survivors of resuscitation.

DESIGN:

Analysis of the Get With The Guidelines-Resuscitation registry.

SETTING:

Seven-hundred fifty-five hospitals participating in Get With The Guidelines-Resuscitation from January 1, 2001, to January 28, 2017.

PATIENTS:

Adult in-hospital cardiac arrest survivors.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Of 117,674 patients in our cohort, 28,409 (24%) had a favorable neurologic outcome, as defined as survival with a Cerebral Performance Category score of less than or equal to 2 at discharge. Using patient characteristics, pre-existing conditions, prearrest interventions, and periarrest variables, we constructed logistic regression, support vector machines, random forests, gradient boosted machines, and neural network machine learning models to predict favorable neurologic outcome. Events prior to October 20, 2009, were used for model derivation, and all subsequent events were used for validation. The gradient boosted machine predicted favorable neurologic status at discharge significantly better than the Cardiac Arrest Survival Post-Resuscitation In-hospital score (C-statistic: 0.81 vs 0.73; p < 0.001) and outperformed all other machine learning models in terms of discrimination, calibration, and accuracy measures. Variables that were consistently most important for prediction across all models were duration of arrest, initial cardiac arrest rhythm, admission Cerebral Performance Category score, and age.

CONCLUSIONS:

The gradient boosted machine algorithm was the most accurate for predicting favorable neurologic outcomes in in-hospital cardiac arrest survivors. Our results highlight the utility of machine learning for predicting neurologic outcomes in resuscitated patients.
The Edmonton Symptom Assessment Scale in Heart Failure
Authors: Asano Reiko , Anderson Kelley M. , Koirala Binu , Abshire Martha , Himmelfarb Cheryl Dennison , Davidson Patricia M.
Published: August 2021

Background

Heart failure is a troublesome condition with high healthcare utilization and cost. Most individuals with heart failure experience multiple symptoms including breathlessness, pain, depression, and anxiety.

Purpose

The aim of this study was to review the literature describing the use of the Edmonton Symptom Assessment Scale to assess the burden of symptoms and the impact of symptoms on heart failure outcomes including quality of life and functional outcomes.

Methods

The search engines PubMed, Scopus, CINAHL, and Web of Science were searched from January 2001 to March 2020. A review of literature was undertaken using key terms “heart failure,” “CHF,” “cardiac failure,” “heart decompensation,” “myocardial failure,” “Edmonton Symptom Assessment Scale”. Hand searching of articles was also undertaken.

Results

The search resulted in 33 relevant articles, which were imported into Rayyan, a Web-based systematic review software program. We present synthesis of results of studies (1) using the Edmonton Symptom Assessment Scale as an assessment of symptom burden and (2) evaluating the impact of symptom burden on quality of life and functional status.

Conclusion

This review highlighted the Edmonton Symptom Assessment Scale as a predictive instrument to identify symptom burden, symptom clusters, and symptom changes for patients living with heart failure. The clinical use of the Edmonton Symptom Assessment Scale may identify treatment priorities, promote self-management, inform the treatment plan, and advance effective therapeutic adjustments. The symptom burden in heart failure is high, and improving the symptom experience is an important focus of future healthcare interventions. The Edmonton Symptom Assessment Scale has utility in heart failure management due to psychometric properties and ease of administration.

Clinical Implications

The Edmonton Symptom Assessment Scale may be useful in measuring patient-reported symptom burden in patients with heart failure in the clinical setting because it correlates well with other heart failure measures on quality of life and functional outcomes and provides useful information on symptom burden.
A large subclavian artery aneurysm inducing subclavian steal syndrome
Authors: Zheng Dingdan , Wu Jibao , Li Qiuli , Li Haipeng , Yao Xiaoxi , Zhou Huayang , Chen Jing , Liu Shufang
Published: August 2021

Introduction:

Subclavian steal syndrome (SSS) is primarily due to occlusion or stenosis of the innominate or proximal subclavian artery (SA). Subclavian artery aneurysm (SAA) is a rare type of peripheral vascular aneurysm. SAA inducing SSS is rare and only three case reports have been described in the literature. In our case, we document a large SAA located at the origin of vertebral artery that induced SSS.

Patient concerns:

A 65-year -old woman complained about repeated vertigo over the past 6 months. Her past history was significant for hypertension over 15 years and the blood pressure was not well controlled.

Diagnosis:

The computed tomography angiography showed a true SAA of size 4.2cmx3.8 cm. The transcranial Doppler showed reverse flow during systole and forward flow in diastole. Combined with the clinical manifestation and auxiliary examination, we diagnosed the patient with SSS induced by SAA.

Interventions:

The patient was treated with conventional blood pressure control and underwent aneurysmectomy and bypass surgery via right supraclavicular incision.

Outcomes:

After the surgery, the patient recovered successfully without any complications and the symptom of vertigo disappeared. During the 6-month follow-up period, her clinical condition remained stable.

Conclusion:

SAA causing SSS is very rare and is an often-overlooked cause of vertigo. Hence, when patients suffer from vertebrobasilar insufficiency such as vertigo or walking instability, examinations using ultrasonography, transcranial Doppler and even computed tomography angiography are necessary to exclude the complications caused by SAA and SSS.
Assessing left ventricular systolic function by emergency physician using point of care echocardiography compared to expert: systematic review and meta-analysis
Authors: Albaroudi Bilal , Haddad Mahmoud , Albaroudi Omar , Abdel-Rahman Manar E. , Jarman Robert , Harris Tim
Published: August 2021

Assessing left ventricular systolic function (LVSF) by echocardiography assists in the diagnosis and management of a diverse range of patients presenting to the emergency department (ED). We evaluated the agreement between ED-based clinician sonographers and apriori-defined expert sonographers. We conducted a systematic review and meta-analysis based on Preferred Reporting Items for Systematic reviews and Meta-Analysis guidelines. We searched Medline, EMBASE, Cochrane, ClinicalTrials.gov, TRIP and Google Scholar for eligible studies from inception to February 2021. Risk of bias was evaluated using Quality Assessment Tool for Diagnostic Accuracy Studies-2 tool. The level of agreement between clinician and expert sonographers was measured using kappa, sensitivity, specificity, positive and negative likelihood ratio statistics using random-effects models. Twelve studies were included (1131 patients, 1229 scans and 159 clinician sonographers). Significant heterogeneity was identified in patient selection, methods of assessment of LVSF, reference standards and statistical methods for assessing agreement. The overall quality of studies was low, with most being small, single centre convenience samples. A meta-analysis including seven studies (786 scans) where visual estimation method was used by clinician sonographers demonstrated simple Kappa of 0.68 [95% confidence interval (CI), 0.57–0.79], and sensitivity, specificity, positive and negative likelihood ratio of 89% (95% CI, 80–94%), 85% (95% CI, 80–89%), 5.98 (95% CI, 4.13–8.68) and 0.13 (95% CI, 0.06–0.24), respectively, between clinician sonographer and expert sonographer for normal/abnormal LVSF. The weighted kappa for five studies (429 scans) was 0.70 (95% CI, 0.61–0.80) for normal/reduced/severely reduced LVSF. There is substantial agreement between ED-based clinician sonographers and expert sonographers for assessing LVSF using visual estimation and ranking it as normal/reduced, or normal/reduced/severely reduced, in patients presenting to ED.
Quantitative analysis in parathyroid adenoma scintigraphy
Authors: Havel Martin , Dedek Vladimir , Kolacek Michal , Formanek Martin
Published: August 2021

Objective

Surgery is the only curative treatment for primary hyperparathyroidism. Parathyroid scintigraphy is one method used to preoperatively localize the lesion. We examined time-related changes in radiopharmaceutical uptake in parathyroid adenomas (PTAs) and thyroid gland by quantitative single-photon-emission computed tomography (SPECT) imaging to assess differences between rapid and delayed washout patterns.

Patients and methods

The study group consisted of 35 histologically verified PTAs after radio-guided surgery extirpation in 33 patients with primary hyperparathyroidism. Patients underwent a three-phase SPECT/CT study of the neck and upper thorax post 99mTc-methoxyisobutylisonitrile (MIBI) injection. Images were reconstructed using a proprietary ordered-subset-conjugate-gradient-maximization algorithm (Siemens xSPECT Quant). PTAs were divided into those with a rapid (group A) and those with a slow (group B) washout pattern. SUVmax values of PTAs and thyroid gland tissue at 10, 90 and 180 min post 99mTc-MIBI injection were recorded and statistically assessed. Retention indexes related to the early examination were calculated for PTA and thyroid gland (RI-PTA and RI-TG).

Results

There were 11 PTAs in group A and 24 in group B. Significant between-group differences in PTA SUVmax and PTA/thyroid gland ratios were observed only at 180 min postinjection (P = 0.0297, P = 0.0222, respectively). RI-PTAs differed significantly at 90 and 180 min postinjection (P = 0.0298, P = 0.0431). No differences in PTA volumes, thyroid gland SUVmax values or RI-TG were observed between the groups.

Conclusion

PTAs with rapid and slow washout patterns have different characteristics on quantitative analysis in later phases. No significant differences in directly measurable quantitative values (SUVmax, PTA/thyroid gland ratio) at the early stages of multi-phase examination were observed.
A systematic review of the use of titanium versus stainless steel implants for fracture fixation
Authors: Barber Collin C. , Burnham Matthew , Ojameruaye Ogaga , McKee Michael D.
Published: August 2021

Background:

Controversy exists regarding the use of titanium and stainless steel implants in fracture surgery. To our knowledge, no recent, comprehensive review on this topic has been reported.

Purpose:

To perform a systematic review of the evidence in the current literature comparing differences between titanium and stainless steel implants for fracture fixation.

Methods:

A systematic review of original research articles was performed through the PubMed database using PRISMA guidelines. Inclusion criteria were English-language studies comparing titanium and stainless steel implants in orthopaedic surgery, and outcome data were extracted.

Results:

The search returned 938 studies, with 37 studies meeting our criteria. There were 12 clinical research articles performed using human subjects, 11 animal studies, and 14 biomechanical studies. Clinical studies of the distal femur showed the stainless steel cohorts had significantly decreased callus formation and an increased odds radio (OR 6.3, 2.7-15.1; P < .001) of nonunion when compared with the titanium plate cohorts. In the distal radius, 3 clinical trials showed no implant failures in either group, and no difference in incidence of plate removal, or functional outcome. Three clinical studies showed a slightly increased odds ratio of locking screw breakage with stainless steel intramedullary nails compared with titanium intramedullary nails (OR 1.52, CI 1.1-2.13).

Conclusion:

Stainless steel implants have equal or superior biomechanical properties when compared with titanium implants. However, there is clinical evidence that titanium plates have a lower rate of failure and fewer complications than similar stainless steel implants in some situations. Although our review supports the use of titanium implants in these clinical scenarios, we emphasize that further prospective, comparative clinical studies are required before the conclusions can be made.
Impact on Patient Safety Culture by the Intervention of Multidisciplinary Medical Teams
Authors: Weng Shao-Jen , Wu Chieh-Liang , Gotcher Donald F. , Liu Shih-Chia , Yang Kuei-Fen , Kim Seung-Hwan
Published: August 2021

Objective

To provide comprehensive patient-centered care, we need multidisciplinary teams to face challenges of advanced and complex care. The Taichung Veterans General Hospital has had a ward-based multidisciplinary team system in each ward for 10 years. This study aimed to investigate whether better team performance results in a more positive response in patient safety culture (PSC).

Design/Setting

From 2014 to 2017, there were 21 ward-based multidisciplinary teams. We organized an evaluation panel to assess the performance of the teams. Those teams were divided into 3 groups: high, medium, and low according to their annual performance scores. The Taichung Veterans General Hospital used annual Safety Attitude Questionnaire–based surveys concerning patient safety issues. We used the generalized estimating equation to analyze the dataset over 4 years. All analyses were carried out using SAS Version 9.4 (SAS Institute, Cary, NC).

Results

Taking the trend effects from 2014 to 2017 into account, we found that teamwork climate, safety climate, and perception of management were significantly better in the high and medium groups of the ward-based multidisciplinary teams. There was no significant difference in the dimensions of job satisfaction, stress recognition, and working conditions, which suggests that all staff had the same degree of stress or work loading.

Conclusions

Our ward-based multidisciplinary team system had a positive effect on PSC, which demonstrates the following: when team performance is better, patient safety climate is also better. We should keep the ward-based multidisciplinary team system, improve its performance, and maximize positive attitudes about PSC among our staff.
Diagnostic Accuracy of Magnetic Resonance Imaging for International Federation of Gynecology and Obstetrics 2018 IB to IIB Cervical Cancer Staging: Comparison Among Magnetic Resonance Sequences and Pathologies
Authors: Matsumoto Yuka Kuriyama , Kido Aki , Moribata Yusaku , Chigusa Yoshitsugu , Himoto Yuki , Kurata Yasuhisa , Otani Satoshi , Yajima Ryo , Nishio Naoko , Kuwahara Ryo , Minamiguchi Sachiko , Mandai Masaki , Nakamoto Yuji
Published: August 2021

Objective

This study aimed to investigate the most accurate magnetic resonance (MR) sequence for tumor detection, maximal tumor diameter, and parametrial invasion compared with histopathologic diagnoses.

Methods

Fifty-one patients with International Federation of Gynecology and Obstetrics 2018 IB1 to IIB cervical cancer underwent preoperative MR imaging and surgical resection. Two radiologists independently evaluated the tumor detection, parametrial invasion, and tumor size in each of T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Results obtained for squamous cell carcinoma (SCC) and adenocarcinoma were also compared.

Results

Neither the tumor detection rate nor parametrial invasion was found to be significantly different among sequences. Tumor size assessment using MR imaging with pathology showed good correlation: r = 0.63–0.72. The adenocarcinoma size tended to be more underestimated than SCC in comparison with the pathologic specimen.

Conclusions

Cervical cancer staging by MR images showed no significant difference among T2-weighted image, diffusion-weighted image, and contrast-enhanced T1-weighted image. Adenocarcinoma was prone to be measured as smaller than the pathologic specimen compared with SCC.
Enlarged Parathyroid Glands on Trauma Computed Tomography: Frequency and Assessment for Possible Primary Hyperparathyroidism
Authors: Bunch Paul M. , Dietzen Michael J. , Randle Reese W.
Published: August 2021

Objectives

The aims of the study were to determine the frequency of enlarged parathyroid glands among patients undergoing trauma computed tomography (CT) who fall within the typical primary hyperparathyroidism (PHPT) age range and to assess for evidence of PHPT.

Methods

For this retrospective study of 336 emergency department patients, concurrent cervical spine CT and neck CT angiography (CTA) examinations were reviewed for visible parathyroid glands. When visible, estimated weight was calculated, and a PHPT likelihood category was assigned after medical record review.

Results

At least 1 parathyroid gland was visible in 17 patients (5%) and enlarged (estimated weight > 60 mg) in 11 (3%). Patients classified as “highly likely” or “likely” of having PHPT exhibited larger glands (median, 355 mg) than those classified as “unlikely” or “highly unlikely” (median, 47 mg; P = 0.01).

Conclusions

Parathyroid glands were enlarged in 3% of our cohort. Although PHPT likelihood seems to increase with gland size, definitive determination requires both serum calcium and serum parathyroid hormone.
Early 18F-FDG PET Flare-up Phenomenon After CAR T-Cell Therapy in Lymphoma
Authors: Boursier Caroline , Perrin Mathieu , Bordonne Manon , Campidelli Arnaud , Verger Antoine
Published: August 2021

18F-FDG PET/CT imaging series were acquired on a 64-year-old woman with refractory diffuse large B lymphoma to monitor chimeric antigen receptor (CAR) T-cell therapy. Because of a clinical deterioration, 18F-FDG PET/CT performed 8 days after CAR T-cell therapy suggested an early flare-up phenomenon with new lymph node involvement, lymph node progression while a decrease in metabolic tumor volume. The 18F-FDG PET/CT 1 month after CAR T-cell therapy confirmed this hypothesis. Pseudoprogression in solid tumors treated by immunotherapy has generally been reported later after treatment.
Increased 68Ga-FAPI Uptake in the Pulmonary Cryptococcus and the Postradiotherapy Inflammation
Authors: Zhao Liang , Pang Yizhen , Sun Long , Lin Qin , Chen Haojun
Published: August 2021

A 51-year-old man, previously treated for nasopharyngeal carcinoma, presented a newly detected pulmonary nodule. This patient underwent 18F-FDG and 68Ga-FAPI PET/CT to detect tumor recurrence under the prospective study NCT04416165. Both 18F-FDG and 68Ga-FAPI PET/CT showed intense uptake in a pulmonary nodule in the right lower lobe. In addition, 68Ga-FAPI PET/CT demonstrated increased uptake in the nasopharynx that previously treated with radiotherapy. The pulmonary nodule was found to be cryptococcus by the CT-guided biopsy, and the increased 68Ga-FAPI uptake in the nasopharynx was interpreted as false-positive finding due to a stable Epstein-Barr virus level and no progression on follow-up imaging.
Cognitive impairment in type 2 diabetes patients with and without diabetic peripheral neuropathy: a mismatch negativity study
Authors: Zhao Lili , Mao Limei , Liu Qian , Chen Xiang , Tang Xiangdong , An Dongmei
Published: August 2021

Objectives

To assess the cognitive impairment in patients with type 2 diabetes mellitus (T2DM) using mismatch negativity (MMN) and to explore the relationship between cognitive impairment and diabetic peripheral neuropathy (DPN).

Methods

Sixty-six T2DM patients and 40 healthy controls were included. For each participant, mini-mental state examination (MMSE) was applied to assess the general cognitive function and MMN was elicited. T2DM patients were divided into two subgroups: subgroup DPN−, patients without DPN; subgroup DPN+, patients with DPN. The MMSE scores, MMN amplitudes and latencies were compared between the T2DM group and the control group using univariate analysis of variance procedures, and also among the controls, subgroup DPN− and subgroup DPN+. Pearson’s correlation coefficients (r) were used to analyze potential confounding clinical factors associated with MMN.

Results

T2DM patients had significantly lower MMSE scores compared with controls (23.25 ± 2.86 vs. 27.15 ± 1.83; P < 0.01), whereas those of the two subgroups were not significantly different. Both subgroup DPN+ and DPN− had longer latencies and lower amplitudes of MMN than the controls. The latencies of MMN were significantly longer in subgroup DPN+ compared with subgroup DPN−. The latency of MMN was positively correlated with the duration of the disease.

Conclusion

Cognitive decline exists in patients with T2DM irrespective of the presence of DPN. Patients with DPN may have more severe cognitive dysfunction than those without DPN. MMN may be a promising tool for evaluating cognitive function.
Fragmentation in trader preferences among multiple markets: market coexistence versus single market dominance
Authors: Nicole Robin , Alorić Aleksandra , Sollich Peter
Published: August 2021

Technological advancement has led to an increase in the number and type of trading venues and a diversification of goods traded. These changes have re-emphasized the importance of understanding the effects of market competition: does proliferation of trading venues and increased competition lead to dominance of a single market or coexistence of multiple markets? In this paper, we address these questions in a stylized model of zero-intelligence traders who make repeated decisions at which of three available markets to trade. We analyse the model numerically and analytically and find that the traders’ decision parameters—memory length and how strongly decisions are based on past success—make the key difference between consolidated and fragmented steady states of the population of traders. All three markets coexist with equal shares of traders only when either learning is too weak and traders choose randomly, or when markets are identical. In the latter case, the population of traders fragments across the markets. With different markets, we note that market dominance is the more typical scenario. Overall we show that, contrary to previous research emphasizing the role of traders’ heterogeneity, market coexistence can emerge simply as a consequence of co-adaptation of an initially homogeneous population of traders.
Neural closure models for dynamical systems
Authors: Gupta Abhinav , Lermusiaux Pierre F. J.
Published: August 2021

Complex dynamical systems are used for predictions in many domains. Because of computational costs, models are truncated, coarsened or aggregated. As the neglected and unresolved terms become important, the utility of model predictions diminishes. We develop a novel, versatile and rigorous methodology to learn non-Markovian closure parametrizations for known-physics/low-fidelity models using data from high-fidelity simulations. The newneural closure modelsaugment low-fidelity models with neural delay differential equations (nDDEs), motivated by the Mori–Zwanzig formulation and the inherent delays in complex dynamical systems. We demonstrate that neural closures efficiently account for truncated modes in reduced-order-models, capture the effects of subgrid-scale processes in coarse models and augment the simplification of complex biological and physical–biogeochemical models. We find that using non-Markovian over Markovian closures improves long-term prediction accuracy and requires smaller networks. We derive adjoint equations and network architectures needed to efficiently implement the new discrete and distributed nDDEs, for any time-integration schemes and allowing non-uniformly spaced temporal training data. The performance of discrete over distributed delays in closure models is explained using information theory, and we find an optimal amount of past information for a specified architecture. Finally, we analyse computational complexity and explain the limited additional cost due to neural closure models.
On the degeneracy of spin ice graphs, and its estimate via the Bethe permanent
Authors: Caravelli Francesco , Saccone Michael , Nisoli Cristiano
Published: August 2021

The concept of spin ice can be extended to a general graph. We study the degeneracy of spin ice graph on arbitrary interaction structures via graph theory. We map spin ice graphs to the Ising model on a graph and clarify whether the inverse mapping is possible via a modified Krausz construction. From the gauge freedom of frustrated Ising systems, we derive exact, general results about frustration and degeneracy. We demonstrate for the first time that every spin ice graph, with the exception of the one-dimensional Ising model, is degenerate. We then study how degeneracy scales in size, using the mapping between Eulerian trails and spin ice manifolds, and a permanental identity for the number of Eulerian orientations. We show that the Bethe permanent technique provides both an estimate and a lower bound to the frustration of spin ices on arbitrary graphs of even degree. While such a technique can also be used to obtain an upper bound, we find that in all finite degree examples we studied, another upper bound based on Schrijver inequality is tighter.
On the identification of power-law creep parameters from conical indentation
Authors: Zhang Yupeng , Needleman Alan
Published: August 2021

Load and hold conical indentation responses calculated for materials having creep stress exponents of 1.15, 3.59 and 6.60 are regarded as input ‘experimental’ responses. A Bayesian-type statistical approach (Zhang
et al.
2019
J. Appl. Mech.
86
, 011002 (
doi:10.1115/1.4041352
)) is used to infer power-law creep parameters, the creep exponent and the associated pre-exponential factor, from noise-free as well as noise-contaminated indentation data. A database for the Bayesian-type analysis is created using finite-element calculations for a coarse set of parameter values with interpolation used to create the refined database used for parameter identification. Uniaxial creep and stress relaxation responses using the identified creep parameters provide a very good approximation to those of the ‘experimental’ materials with stress exponents of 1.15 and 3.59. The sensitivity to noise increases with increasing stress exponent. The uniaxial creep response is more sensitive to the accuracy of the predictions than the uniaxial stress relaxation response. Good agreement with the indentation response does not guarantee good agreement with the uniaxial response. If the noise level is sufficiently small, the model of Bower
et al.
(1993
Proc. R. Soc. Lond. A
441
, 97–124 ()) provides a good fit to the ‘experimental’ data for all values of creep stress exponent considered, while the model of Ginder
et al.
(2018
J. Mech. Phys. Solids
112
, 552–562 ()) provides a good fit for a creep stress exponent of 1.15.
Mathematical study of a system of multi-dimensional non-local evolution equations describing surfactant-laden two-fluid shear flows
Authors: Papageorgiou Demetrios T. , Tanveer Saleh
Published: August 2021

This article studies a coupled system of model multi-dimensional partial differential equations (PDEs) that arise in the nonlinear dynamics of two-fluid Couette flow when insoluble surfactants are present on the interface. The equations have been derived previously, but a rigorous study of local and global existence of their solutions, or indeed solutions of analogous systems, has not been considered previously. The evolution PDEs are two-dimensional in space and contain novel pseudo-differential terms that emerge from asymptotic analysis and matching in the multi-scale problem at hand. The one-dimensional surfactant-free case was studied previously, where travelling wave solutions were constructed numerically and their stability investigated; in addition, the travelling wave solutions were justified mathematically. The present study is concerned with some rigorous results of the multi-dimensional surfactant system, including local well posedness and smoothing results when there is full coupling between surfactant dynamics and interfacial motion, and global existence results when such coupling is absent. As far as we know such results are new for non-local thin film equations in either one or two dimensions.
A new type of constitutive equation for nonlinear elastic bodies. Fitting with experimental data for rubber-like materials
Authors: Bustamante Roger , Rajagopal Kumbakonam R.
Published: August 2021

In this article, we develop a new implicit constitutive relation, which is based on a thermodynamic foundation that relates the Hencky strain to the Cauchy stress, by assuming a structure for the Gibbs potential based on the Cauchy stress. We study the tension/compression of a cylinder, biaxial stretching of a thin plate and simple shear within the context of our constitutive relation. We then compare the predictions of the constitutive relation that we develop and that of Ogden’s constitutive relation with the experiments of Treloar concerning tension/compression of a cylinder, and we show that the predictions of our constitutive relation provide a better description than Ogden’s model, with fewer material moduli.
Riemann–Hilbert problem on a hyperelliptic surface and uniformly stressed inclusions embedded into a half-plane subjected to antiplane strain
Authors: Antipov Y. A.
Published: August 2021

An inverse problem of the elasticity of

n

elastic inclusions embedded into an elastic half-plane is analysed. The boundary of the half-plane is free of traction. The half-plane and the inclusions are subjected to antiplane shear, and the conditions of ideal contact hold in the interfaces between the inclusions and the half-plane. The shapes of the inclusions are not prescribed and have to be determined by enforcing uniform stresses inside the inclusions. The method of conformal mappings from a slit domain onto the

(
n
+
1
)

-connected physical domain is worked out. It is shown that to recover the map and the shapes of the inclusions, one needs to solve a vector Riemann–Hilbert problem on a genus-

n

hyperelliptic surface. In a particular case of loading, the vector problem reduces to two scalar Riemann–Hilbert problems on

n
+
1

slits on a hyperelliptic surface. In the elliptic case, in addition to three parameters of the model, the conformal map possesses a free geometric parameter. The results of numerical tests in the elliptic case show the impact of these parameters on the inclusion shape.