bluuebunny/crossref_metadata_2025 huggingface dataset:
Transitioning to practice: a qualitative investigation of Australian graduate naturopath’s experiences of being in practice
Authors: Leach Matthew J. , Barnes Larisa A. J. , McLintock Andy , Diezel Helene M. , Ryan Kimberley , Steel Amie E.
Published: December 2021

Background

The transition from student to practitioner can be challenging, resulting in stress, burnout and attrition. While there has been ample research examining graduate medical and allied health practitioner experiences of transitioning to practice, there is a paucity of research exploring such experiences in newly qualified naturopathic medicine practitioners. In light of this knowledge gap, the objective of this study was to ascertain the experiences of practicing as a naturopath in Australia within the first 5 years post-graduation.

Methods

Using a qualitative descriptive approach, recent graduates of an Australian Bachelor of Naturopathy (or equivalent) program were invited to participate in a semi-structured telephone interview to address the study objective. Data were analysed utilising a framework approach.

Results

A total of 19 new graduates (94.7% female; 57.9% aged 40–59 years) undertook an interview. Five inter-related themes emerged from the data: practitioner, practice, proprietorship, professions, and perceptions. Connected with these themes were contrasting feelings, multiplicity of duties, small business challenges, professional collaboration, and professional identity, respectively.

Conclusions

Participants were generally content with their decision to become a naturopath. However, most were confronted by a range of challenges as they transitioned from graduate to practitioner, for which many felt ill-prepared. In light of the complexity of the issue, and the potential impact on the sustainability of the profession, it is evident that a multi-pronged, multi-stakeholder approach would be needed to better support graduate naturopath transition to practice.
Pre-medical students’ perceptions of educational environment and their subjective happiness: a comparative study before and after the COVID-19 pandemic
Authors: Lin Yanyan , Kang Ye Ji , Lee Hyo jeong , Kim Do-Hwan
Published: December 2021

Background

The COVID-19 pandemic necessarily changed pre-medical students’ educational environment into an online format—and students’ subjective happiness (SH) is highly impacted by their educational environment. This study investigates changes in pre-medical students’ perceptions of their educational environment and their SH before and after the pandemic, as well as explores the predictors related to their SH.

Methods

The Korean version of the Dundee Ready Educational Environment Measure (DREEM) questionnaire and single-item measures of SH and professional identity (PI) were used. The t-test was employed to analyze the differences of the SH, PI, and DREEM subscales scores before and after the onset of COVID-19. Cohen’s d was used as effect size and correlations between SH and different subscales of DREEM were analyzed using Pearson’s correlation. The multiple regression analysis was performed to reveal associations between predictors and SH.

Results

A total of 399 pre-medical students completed the survey both before and after the COVID-19 pandemic. The DREEM scores and all subscales scores significantly increased but each presents a different effect size. Students’ Perceptions of Learning (SPL: Cohen’s d = 0.97), Students’ Perceptions of Teaching (SPT: Cohen’s d = 1.13), and Students’ Perceptions of Atmosphere (SPA: Cohen’s d = 0.89) have large effect sizes. Students’ Academic Self-Perceptions (SASP: Cohen’s d = 0.66) have a medium effect size and Students’ Social Self-Perceptions (SSSP: Cohen’s d = 0.40) have a small effect size. In contrast, no significant change was noted in the SH and PI. Both PI and SSSP impacted SH before COVID-19, but after the pandemic, SH was impacted by SPL, SPA, and SSSP.

Conclusions

Students’ overall perception of their educational environment was more positive after the onset of COVID-19, but their social self-perceptions improved the least. Additionally, SSSP is the only predictor of SH both before and after the pandemic. The findings of this study suggest that educational institutions must pay attention to students’ social relationships when trying to improve their educational environment. Furthermore, so as to increase students’ SH, development of both educational environment and PI is essential.
splatPop: simulating population scale single-cell RNA sequencing data
Authors: Azodi Christina B. , Zappia Luke , Oshlack Alicia , McCarthy Davis J.
Published: December 2021

Population-scale single-cell RNA sequencing (scRNA-seq) is now viable, enabling finer resolution functional genomics studies and leading to a rush to adapt bulk methods and develop new single-cell-specific methods to perform these studies. Simulations are useful for developing, testing, and benchmarking methods but current scRNA-seq simulation frameworks do not simulate population-scale data with genetic effects. Here, we present splatPop, a model for flexible, reproducible, and well-documented simulation of population-scale scRNA-seq data with known expression quantitative trait loci. splatPop can also simulate complex batch, cell group, and conditional effects between individuals from different cohorts as well as genetically-driven co-expression.
The DNMT1 inhibitor GSK-3484862 mediates global demethylation in murine embryonic stem cells
Authors: Azevedo Portilho Nathalia , Saini Deepak , Hossain Ishtiaque , Sirois Jacinthe , Moraes Christopher , Pastor William A.
Published: December 2021

Background

DNA methylation plays an important role in regulating gene expression in mammals. The covalent DNMT1 inhibitors 5-azacytidine and decitabine are widely used in research to reduce DNA methylation levels, but they impart severe cytotoxicity which limits their demethylation capability and confounds interpretation of experiments. Recently, a non-covalent inhibitor of DNMT1 called GSK-3484862 was developed by GlaxoSmithKline. We sought to determine whether GSK-3484862 can induce demethylation more effectively than 5-azanucleosides. Murine embryonic stem cells (mESCs) are an ideal cell type in which to conduct such experiments, as they have a high degree of DNA methylation but tolerate dramatic methylation loss.

Results

We determined the cytotoxicity and optimal concentration of GSK-3484862 by treating wild-type (WT) or Dnmt1/3a/3b triple knockout (TKO) mESC with different concentrations of the compound, which was obtained from two commercial sources. Concentrations of 10 µM or below were readily tolerated for 14 days of culture. Known DNA methylation targets such as germline genes and GLN-family transposons were upregulated within 2 days of the start of GSK-3484862 treatment. By contrast, 5-azacytidine and decitabine induced weaker upregulation of methylated genes and extensive cell death. Whole-genome bisulfite sequencing showed that treatment with GSK-3484862 induced dramatic DNA methylation loss, with global CpG methylation levels falling from near 70% in WT mESC to less than 18% after 6 days of treatment with GSK-3484862. The treated cells showed a methylation level and pattern similar to that observed in Dnmt1-deficient mESCs.

Conclusions

GSK-3484862 mediates striking demethylation in mESCs with minimal non-specific toxicity.
Recurrent autoimmune hypophysitis treated with rituximab: a case report
Authors: Kruse Maria , Olesen Thomas Bastholm , Markovic Ljubo , Glintborg Dorte , Andersen Marianne Skovsager
Published: December 2021

Background

Autoimmune hypophysitis is a rare condition that often results in enlargement of the pituitary gland and hypopituitarism due to inflammatory infiltration. Management of autoimmune hypophysitis can include long-term hormonal replacement and close control of the inflammatory pituitary mass. Mass-related symptoms in patients with autoimmune hypophysitis are treated with anti-inflammatory therapy, surgery, and/or radiotherapy.

Case presentation

We present a 25-year-old White man with visual field defects of the right eye, headache, and weight loss. Magnetic resonance imaging showed a sellar mass, and the patient underwent transcranial surgery. Histopathology revealed autoimmune hypophysitis with predominantly CD20 positive B-cell infiltration. Progression of visual field defects necessitated postoperatively anti-inflammatory treatment with prednisolone. Azathioprine was initiated under gradual tapering of prednisolone with stable conditions at first, but relapse followed after dose reduction. Therefore, rituximab treatment was initiated, which resulted in regression of the pituitary mass. Rituximab treatment was discontinued after 25 months. The patient has continuously been in remission for 4 years after rituximab treatment was stopped.

Conclusion

This case illustrates that rituximab might be an effective alternative treatment in B-cell predominant autoimmune hypophysitis.
Idiopathic pulmonary fibrosis diagnosed concomitantly with diffuse squamous cell lung cancer on surgical lung biopsy: a case report
Authors: Niel C. , Ricordel C. , Guy T. , Kerjouan M. , De Latour B. , Chiforeanu D. , Lederlin M. , Jouneau S.
Published: December 2021

Background

Idiopathic pulmonary fibrosis is a disease with a poor prognosis and has been associated with increased lung cancer incidence.

Case presentation

We report the case of a Caucasian 75-year-old woman, a former smoker, hospitalized for breathlessness with a chest computed tomography scan showing an interstitial lung disease. A surgical lung biopsy was performed, confirming a pattern of usual interstitial pneumonia but also numerous disseminated foci of well-differentiated focally invasive squamous cell carcinoma without hypermetabolic lung nodule, mass, or enlarged lymph node visualized on chest computed tomography or positron emission tomography scan. Nintedanib was started for its antifibrotic and antitumor properties, without any other antineoplastic treatment. Three years after initiation of nintedanib, clinical, functional, and computed tomography scan evaluations were stable, and there was no evidence for evolution of the squamous cell carcinoma.

Conclusions

Data are scarce regarding the benefit of nintedanib in patients with idiopathic pulmonary fibrosis-associated lung cancer, and it is unclear whether nintedanib could have a preventive role in lung carcinogenesis in idiopathic pulmonary fibrosis patients. This experience could help the scientific community in case of similar incidental findings.
A novel coconut-malt extract medium increases growth rate of morels in pure culture
Authors: Evangelista Fabiola Rodríguez , Chairez Isaac , Sierra Sigfrido , Leal Lara Hermilo , Martínez-González César Ramiro , Garín Aguilar María Eugenia , Valencia del Toro Gustavo
Published: December 2021

Morels are gourmet wild edible mushrooms that can grow on several substrates with significant growth rate variations. Such variations have hindered the development of a standardized culture media to promote morel’s sustainable production. The aim of this study is developing a novel culture media that takes advantage of coconut water as a complementary component of culture media. Coconut water has been extensively used as a growth-promoting component for plant tissue cultures; however, its application as component of fungi cultivation medium has not been fully developed. This study confirms that coconut water can be efficiently used as culture media component for morels using a kinetic characterization. Morchella sp. kinetic growth is evaluated in different cultures: agar, malt extract agar (MEA), lactose, coconut water (15%) and combinations of them. Kinetic growth parameters (lag phase, λ and maximum specific growth rate, µmax) are estimated using primary modeling methods. Among the selected models, the best fit is achieved using Baranyi’s model. A significant increase from 15.8% to 43.4% of the µmax values was observed when culture media (agar, lactose, MEA) is supplemented with coconut water. The largest values of µmax are obtained in MEA-coconut cultures (21.13 ± 0.43–22.57 ± 0.35). Micro-sclerotia and late sclerotia are observed in all cultures containing coconut water justifying the development of a feasible and cost-effective way of culturing morels. The results demonstrate that coconut water can be used for formulation of standard media for morel cultivation leading to a cheap alternative to produce dense mycelium and promote sclerotia formation.
Enhancement of membrane vesicle production by disrupting the degP gene in Meiothermus ruber H328
Authors: Asano Yuki , Onishi Manato , Nishi Kaito , Kawasaki Kazunori , Watanabe Kunihiko
Published: December 2021

The phenomenon of membrane vesicle (MV) production is known to be common to all bacterial cells. Although MVs are expected to be employed in a variety of applications, improving MV productivity is essential for applications. Since the deletion of the degP gene, a periplasmic dual-function protease and chaperone, in Escherichia coli has successfully improved MV production capacity, we tried to enhance MV productivity in the thermophilic M. ruber H328 by deleting the degP gene. One gene (mrH_0331) was selected for degP gene from the H328 genome and we constructed the mutant strain ∆degP by deleting the degP gene of the H328 strain that was replaced with the htk gene showing thermophilic kanamaycin resistance by homologous recombination. The mutant strain ∆degP exhibited smooth growth but a lower level of turbidity at 60 °C although there was no difference in growth at 55 °C between the wild strain and the mutant strain. Finally, we have confirmed that incubation at 60 °C increases MV in the mutant strain ∆degP strain about fivefold by using two fluorescent dyes, DiI and FM4-64, which is followed by TEM analysis. The deletion of the degP gene presumably causes an increase in denatured proteins at 60 °C, leading to enhanced MV production. Meanwhile, the S-layer protein included in the outer membrane of the H328 strain increased in the MV fraction prepared from the mutant cells incubated at 60 °C. This indicates that this method is effective for MV production and that degP deletion enhances it in strain H328.
Derivation of pb(II)-sensing Escherichia coli cell-based biosensors from arsenic responsive genetic systems
Authors: Lee Yejin , Jeon Yangwon , Jang Guepil , Yoon Youngdae
Published: December 2021

Heavy metal-responsive operons were used for the generation of Escherichia coli cell-based biosensors. The selectivity and specificity of the biosensors were determined based on the interaction between heavy metals and regulatory proteins; thereby, the modulating target selectivity of biosensors could be achieved by changing target sensing properties of regulatory proteins. The results of this study demonstrated that Pb(II)-sensing biosensors could be generated from an arsenic-responsive genetic system, which was originally used for arsenic-sensing biosensors. The amino acids around to As(III)-binding sites of ArsR were mutated and cysteine residues were relocated to modulate the metal selectivity. In addition, genes encoding metal ion-translocating P-type ATPases, such as copA and zntA, were deleted to enhance the specificity by increasing the intercellular levels of divalent metal ions. Based on the results, channel protein deleted E. coli cells harboring a pair of recombinant genes, engineered ArsR and arsAp::egfp, showed enhanced responses upon Pb exposure and could be used to quantify the amount of Pb(II) in artificially contaminated water and plants grown in media containing Pb(II). Although we focused on generating Pb(II)-specific biosensors in this study, the proposed strategy has a great potential for the generation of diverse heavy metal-sensing biosensors and risk assessment of heavy metals in environmental samples as well as in plants.
Improvement of putrescine production through the arginine decarboxylase pathway in Escherichia coli K-12
Authors: Thongbhubate Kullathida , Irie Kanako , Sakai Yumi , Itoh Akane , Suzuki Hideyuki
Published: December 2021

In the bio-based polymer industry, putrescine is in the spotlight for use as a material. We constructed strains of Escherichia coli to assess its putrescine production capabilities through the arginine decarboxylase pathway in batch fermentation. N-Acetylglutamate (ArgA) synthase is subjected to feedback inhibition by arginine. Therefore, the 19th amino acid residue, Tyr, of argA was substituted with Cys to desensitize the feedback inhibition of arginine, resulting in improved putrescine production. The inefficient initiation codon GTG of argA was substituted with the effective ATG codon, but its replacement did not affect putrescine production. The essential genes for the putrescine production pathway, speA and speB, were cloned into the same plasmid with argAATG Y19C to form an operon. These genes were introduced under different promoters; lacIp, lacIqp, lacIq1p, and T5p. Among these, the T5 promoter demonstrated the best putrescine production. In addition, disruption of the puuA gene encoding enzyme of the first step of putrescine degradation pathway increased the putrescine production. Of note, putrescine production was not affected by the disruption of patA, which encodes putrescine aminotransferase, the initial enzyme of another putrescine utilization pathway. We also report that the strain KT160, which has a genomic mutation of YifEQ100TAG, had the greatest putrescine production. At 48 h of batch fermentation, strain KT160 grown in terrific broth with 0.01 mM IPTG produced 19.8 mM of putrescine.
Sharing reflections and expressing appreciation upon completing a decade as co-editor of the IJHPR
Authors: Rosen Bruce
Published: December 2021

The Israel Journal of Health Policy Research (IJHPR) was launched in January 2012. In December 2021 it will be completing 10 years of continuous publication. I have had the privilege of serving as the journal’s co-editor in chief during this period, and after ten years of service I am now preparing to step down from that role. IJHPR achievements of which I am particularly proud include remaining true to its mission, attracting manuscripts from virtually all the Israeli institutions engaged in health policy research as well as many leading institutions abroad, widening the circle of Israeli professionals who are submitting manuscripts to journals, and helping many established Israeli academics expand their repertoires to include articles with strong policy components. Several people and organizations have helped make editing the IJHPR such a wonderful experience for me. They include IJHPR co-editor Avi Israeli, IJHPR associate editor Steve Schoenbaum, the Israel National Institute for Health Policy Research (which sponsors the journal), BioMed Central (which publishes the journal), the Myers-JDC-Brookdale Institute (my employer), my family (and particularly my wife, Laura Rosen), and the thousands of authors who have chosen to publish with the IJHPR. May the journal’s second decade be even better than its first one!
A platform for the international exchange of ideas: the Israel Journal of Health Policy Research celebrates its first decade
Authors: McKee Martin
Published: December 2021

For ten years the Israel Journal of Health Policy Research has provided a platform for exchange of knowledge and insights on health policy. It is a unique attempt by scholars and practitioners in one small country to share their knowledge with the world and, in turn to learn from experience elsewhere. Never has this role been as important as during the COVID pandemic, a message that is very clear when we look at failings elsewhere.
Antioxidant activity of thymol essential oil and inhibition of polyphenol oxidase enzyme: a case study on the enzymatic browning of harvested longan fruit
Authors: Khan Muhammad Rafiullah , Huang Chongxing , Zhao Hui , Huang Haohe , Ren Liu , Faiq Muhammad , Hashmi Majid Suhail , Li Bo , Zheng Dantong , Xu Yangfan , Su Hongxia , An Jiejie
Published: December 2021

Background

Enzymatic browning and microbial decay are the primary concerns that limit the postharvest life of longan fruit. These factors can be effectively prevented by sulfur dioxide (SO2) fumigation; however, due to the safety and regulatory issues of SO2, other alternatives must be tested. In this study, antioxidant and antimicrobial activities of thymol were determined against the pericarp browning and decay of longan fruit. A simple, cost-effective method was designed for its controlled release. Thymol vapors were obtained from the slurry prepared from 5 g of thymol in 5 mL of distilled water in a 180-mL glass jar, hermetically sealed and allowed for 24 h to accumulate the vapors in the headspace. Fruits were packed in polyethylene packages and fumigated with thymol through a septum. Non-fumigated fruits served as control and all the packages were stored at 25 ± 2 °C for 8 days.

Results

Thymol significantly (P ≤ 0.05) retarded pericarp browning (BI), delayed the decay incidence (DI) and maintained high color values of longan pericarp. Thymol also retained high total phenolic (TPC) and total flavonoid (TFC) contents, inhibited polyphenol oxidase (PPO) and peroxidase (POD) activities than those in control. A high coefficient of correlation of PPO with BI (r = 0.86), L* (r =  − 0.94), weight loss (r = 0.93), TPC (r =  − 0.77), TFC (r =  − 0.80), DI (r = 0.92) and many other quality and color parameters indicated the antioxidant efficacy of thymol. Longer shelf life of 8 days with good quality attributes was obtained in thymol-treated fruits than 6 days in control.

Conclusion

Thymol could be effectively used as a natural antioxidant for a wide range of fruits.

Graphic abstract
Classification of imbalanced cloud image data using deep neural networks: performance improvement through a data science competition
Authors: Matsuoka Daisuke
Published: December 2021

Image data classification using machine learning is an effective method for detecting atmospheric phenomena. However, extreme weather events with a small number of cases cause a decrease in classification prediction accuracy owing to the imbalance in data between the target class and the other classes. To build a highly accurate classification model, I held a data analysis competition to determine the best classification performance for two classes of cloud image data, specifically tropical cyclones including precursors and other classes. For the top models in the competition, minority data oversampling, majority data undersampling, ensemble learning, deep layer neural networks, and cost-effective loss functions were used to improve the classification performance of the imbalanced data. In particular, the best model of 209 submissions succeeded in improving the classification capability by 65.4% over similar conventional methods in a measure of the low false alarm ratio.
The needs of terminally ill patients at home: directing one's life, health and things related to beloved others
Authors: Proot Ireen M , Abu-Saad Huda Huijer , ter Meulen Ruud HJ , Goldsteen Minke , Spreeuwenberg Cor , Widdershoven Guy AM
Published: December 2021

This article describes the results of a grounded theory study among terminally ill patients (with a life expectancy of less than three months) at home ( n = 13, aged 39-83). The most commonly recurring theme identified in the analysis is ‘directing’, in the sense of directing a play. From the perspectives of patients in our study, ‘directing’ concerns three domains: 1) directing one's own life; 2) directing one's own health and health care; and 3) directing things related to beloved others (in the meaning of taking care of beloved ones). The patient's directing is affected by impeding and facilitating circumstances: the patient's needs and problems in the physical, psychological and existential/spiritual domain, and the support by family members and providers. Supporting patients and families, stimulating the patients' directing, giving attention to all domains of needs and counselling patients' families in the terminal phase are issues that need attention and warrant further investigation.
Transdermal buprenorphine in cancer pain and palliative care
Authors: Sittl Reinhard
Published: December 2021

Transdermal buprenorphine has been assessed as a therapy for chronic cancer and non-cancer pain in both clinical and postmarketing surveillance studies. Data from 239 patients who had participated in a follow-up study of up to six years have shown efficacy and safety, and good tolerability over prolonged treatment periods with a marked stability of doses. From the cancer pain population (134 patients), 20% stayed on transdermal buprenorphine until the end of their lives. Postmarketing surveillance study data from 13 179 patients, including 3690 cancer patients assessed during a 10-week observation period, showed that 81% of patients achieved good/very good pain relief with transdermal buprenorphine. Furthermore, 49.6% of patients did not require any analgesic comedication or rescue therapy, a point that is particularly important in the elderly population. Results from the Spanish Pain Society on transdermal buprenorphine in chronic non-cancer, neuropathic and cancer-related pain, and on switching from morphine, also confirmed its beneficial efficacy and safety, and showed that buprenorphine does not antagonize pain relief, or cause withdrawal when combined with full μ-agonists. The effectiveness of buprenorphine is further supported by evidence of its pronounced anti-hyperalgesic effect in a human pain model, which may be a factor in explaining the efficacy of buprenorphine in neuropathic pain. When switching of opioids is indicated to improve pain relief or reduce adverse events, equipotency dosage ratios are important. The equipotency ratio for morphine to buprenorphine, previously established as 75:1, is now being questioned as new data from a retrospective cohort study were published indicating a ratio of 100:1. Moreover, transdermal buprenorphine has superior safety in respect to respiratory depression, immunological and renal effects compared with standard World Health Organization step III opioids, which makes it highly suitable for treating moderate-to-severe pain also in cancer patients, a per se vulnerable patient population requiring a sensible selection of potent analgesics.
Applications of Artificial Intelligence in Pediatric Oncology: A Systematic Review
Authors: Ramesh Siddhi , Chokkara Sukarn , Shen Timothy , Major Ajay , Volchenboum Samuel L. , Mayampurath Anoop , Applebaum Mark A.
Published: December 2021

PURPOSE

There is a need for an improved understanding of clinical and biologic risk factors in pediatric cancer to improve patient outcomes. Machine learning (ML) represents the application of computational inference from advanced statistical methods that can be applied to increasing amount of data available for study in pediatric oncology. The goal of this systematic review was to systematically characterize the state of ML in pediatric oncology and highlight advances and opportunities in the field.

METHODS

We conducted a systematic review of the Embase, Scopus, and MEDLINE databases for applications of ML in pediatric oncology. Query results from all three databases were aggregated and duplicate studies were removed.

RESULTS

A total of 42 unique articles that examined the applications of ML in pediatric oncology met inclusion criteria for review. We identified 20 studies of CNS tumors, 13 of solid tumors, and nine of leukemia. ML tasks included classification, prediction of treatment response, and dose optimization with a variety of methods being used including neural network, k-nearest neighbor, random forest, naive Bayes, and support vector machines. Strengths of the identified studies included matching or outperforming physician comparators via automated analysis and predicting therapeutic response. Common limitations included significant heterogeneity in reporting standards, clinical applicability, small sample sizes, and missing external validation cohorts.

CONCLUSION

We identified areas where ML can enhance clinical care in ways that may not otherwise be achievable. Although ML promises enormous potential in improving diagnostics, decision making, and monitoring for children with cancer, the field remains in early stages and future work will be aided by standards and guidelines to ensure rigorous methodologic design and maximizing clinical utility.
Practical Tools and Guidelines for Young Oncologists From Resource-Limited Settings to Publish Excellence and Advance Their Career
Authors: El Bairi Khalid , Al Jarroudi Ouissam , Afqir Said
Published: December 2021

Cancer research is evolving worldwide. However, publishing high-quality academic literature in oncology remains challenging for authors in the developing world. Young oncologists in low- and middle-income countries experience several barriers including lack of funding and research facilities, as well as inadequate training. Publication best practices, science integrity, and ethics are required to improve oncology research quality and therefore, improve patients' care in these countries. To achieve this goal, we propose some basic principles and tools that may help young oncologists especially in developing countries overcome these issues and boost their academic careers.
Inflammatory Biomarker Levels After Propofol or Sevoflurane Anesthesia: A Meta-analysis
Authors: O’Bryan Liam J. , Atkins Kelly J. , Lipszyc Adam , Scott David A. , Silbert Brendan S. , Evered Lis A.
Published: December 2021

BACKGROUND:

The perioperative inflammatory response may be implicated in adverse outcomes including neurocognitive dysfunction and cancer recurrence after oncological surgery. The immunomodulatory role of anesthetic agents has been demonstrated in vitro; however, its clinical relevance is unclear. The purpose of this meta-analysis was to compare propofol and sevoflurane with respect to biomarkers of perioperative inflammation. The secondary aim was to correlate markers of inflammation with clinical measures of perioperative cognition.

METHODS:

Databases were searched for randomized controlled trials examining perioperative inflammation after general anesthesia using propofol compared to sevoflurane. Inflammatory biomarkers investigated were interleukin (IL)-6, IL-10, tissue necrosis factor alpha (TNF-α), and C-reactive protein (CRP). The secondary outcome was incidence of perioperative neurocognitive disorders. Meta-analysis with metaregression was performed to determine the difference between propofol and sevoflurane.

RESULTS:

Twenty-three studies were included with 1611 participants. Studies varied by surgery type, duration, and participant age. There was an increase in the mean inflammatory biomarker levels following surgery, with meta-analysis revealing no difference in effect between propofol and sevoflurane. Heterogeneity between studies was high, with surgery type, duration, and patient age contributing to the variance across studies. Only 5 studies examined postoperative cognitive outcomes; thus, a meta-analysis could not be performed. Nonetheless, of these 5 studies, 4 reported a reduced incidence of cognitive decline associated with propofol use.

CONCLUSIONS:

Surgery induces an inflammatory response; however, the inflammatory response did not differ as a function of anesthetic technique. This absence of an effect suggests that patient and surgical variables may have a far more significant impact on the postoperative inflammatory responses than anesthetic technique. The majority of studies assessing perioperative cognition in older patients reported a benefit associated with the use of propofol; however, larger trials using homogenous outcomes are needed to demonstrate such an effect.
Impact of Intraoperative Data on Risk Prediction for Mortality After Intra-Abdominal Surgery
Authors: Yan Xinyu , Goldsmith Jeff , Mohan Sumit , Turnbull Zachary A. , Freundlich Robert E. , Billings Frederic T. , Kiran Ravi P. , Li Guohua , Kim Minjae
Published: December 2021

BACKGROUND:

Risk prediction models for postoperative mortality after intra-abdominal surgery have typically been developed using preoperative variables. It is unclear if intraoperative data add significant value to these risk prediction models.

METHODS:

With IRB approval, an institutional retrospective cohort of intra-abdominal surgery patients in the 2005 to 2015 American College of Surgeons National Surgical Quality Improvement Program was identified. Intraoperative data were obtained from the electronic health record. The primary outcome was 30-day mortality. We evaluated the performance of machine learning algorithms to predict 30-day mortality using: 1) baseline variables and 2) baseline + intraoperative variables. Algorithms evaluated were: 1) logistic regression with elastic net selection, 2) random forest (RF), 3) gradient boosting machine (GBM), 4) support vector machine (SVM), and 5) convolutional neural networks (CNNs). Model performance was evaluated using the area under the receiver operator characteristic curve (AUROC). The sample was randomly divided into a training/testing split with 80%/20% probabilities. Repeated 10-fold cross-validation identified the optimal model hyperparameters in the training dataset for each model, which were then applied to the entire training dataset to train the model. Trained models were applied to the test cohort to evaluate model performance. Statistical significance was evaluated using P < .05.

RESULTS:

The training and testing cohorts contained 4322 and 1079 patients, respectively, with 62 (1.4%) and 15 (1.4%) experiencing 30-day mortality, respectively. When using only baseline variables to predict mortality, all algorithms except SVM (area under the receiver operator characteristic curve [AUROC], 0.83 [95% confidence interval {CI}, 0.69–0.97]) had AUROC >0.9: GBM (AUROC, 0.96 [0.94–1.0]), RF (AUROC, 0.96 [0.92–1.0]), CNN (AUROC, 0.96 [0.92–0.99]), and logistic regression (AUROC, 0.95 [0.91–0.99]). AUROC significantly increased with intraoperative variables with CNN (AUROC, 0.97 [0.96–0.99]; P = .047 versus baseline), but there was no improvement with GBM (AUROC, 0.97 [0.95–0.99]; P = .3 versus baseline), RF (AUROC, 0.96 [0.93–1.0]; P = .5 versus baseline), and logistic regression (AUROC, 0.94 [0.90–0.99]; P = .6 versus baseline).

CONCLUSIONS:

Postoperative mortality is predicted with excellent discrimination in intra-abdominal surgery patients using only preoperative variables in various machine learning algorithms. The addition of intraoperative data to preoperative data also resulted in models with excellent discrimination, but model performance did not improve.
Long-Term Results of Deep Brain Stimulation for Treatment-Resistant Depression: Outcome Analysis and Correlation With Lead Position and Electrical Parameters
Authors: Aibar-Durán Juan Ángel , Rodríguez Rodríguez Rodrigo , de Diego Adeliño Francisco Javier , Portella María J. , Álvarez-Holzapfel María Jesús , Martín Blanco Ana , Puigdemont Campos Dolors , Molet Teixidó Joan
Published: December 2021

BACKGROUND:

Long-term efficacy and mechanisms of action of deep brain stimulation (DBS) for treatment-resistant depression (TRD) are under investigation.

OBJECTIVE:

To compare long-term outcomes with active electrode's coordinates and its electrical parameters in patients with TRD treated with DBS in the subgenual cingulate gyrus (SCG-DBS).

METHODS:

Seventeen patients with TRD underwent SCG-DBS. Demographic and baseline characteristics were recorded. The 17-item Hamilton Depression Rating Scale was used to measure the response to the therapy. The anterior commissure-posterior commissure coordinates of the active contacts and the total electrical energy delivered were calculated and correlated with clinical outcomes. Patient-specific tractographic analysis was performed to identify the modulated pathways in responders.

RESULTS:

Twelve women (70.6%) and 5 men (29.4%) with a median age of 48 yr (34-70 years) were included. Along the 5-year follow-up, 3 main clinical trajectories were observed according to symptom's improvement: great responders (≥80%), medium responders (≥50%-79%), and poor responders (<50%). Active contacts' coordinates and total electrical energy delivered showed no correlation with clinical outcomes. Brodmann area 10 medial was the most frequently stimulated area and the forceps minor, the most frequently modulated tract.

CONCLUSION:

SCG-DBS for TRD is clearly effective in some patients. Active contacts' coordinates were highly variable within the region and, like electrical parameters, did not seem to correlate with clinical outcomes. In the current series, Brodmann area 10 medial and the forceps minor were the most frequently targeted area and modulated pathway, respectively.
Meeting report – the ever-fascinating world of septins
Authors: Baillet Anita , McMurray Michael A. , Oakes Patrick W.
Published: December 2021

Septins are GTP-binding proteins that assemble into hetero-oligomers. They can interact with each other end-to-end to form filaments, making them the fourth element of the cytoskeleton. To update the current knowledge on the ever-increasing implications of these fascinating proteins in cellular functions, a hundred expert scientists from across the globe gathered from 12 to 15 October 2021 in Berlin for the first hybrid-format (on site and virtual) EMBO workshop Molecular and Cell Biology of Septins.
Pneumonia-related pneumatoceles in infants: CT assessment and image-guided treatment
Authors: Mercanzin Elisa , Bonaffini Pietro Andrea , Barletta Antonino , Stanco Francesco , Valle Clarissa , Marra Paolo , Sironi Sandro
Published: December 2021

Lung pneumatoceles represent a potential life-threatening complication of pneumonia in infants, especially when they do not spontaneously reabsorb. In this category of patients, scientific literature lacks and no consensus guidelines for management have been proposed. Imaging plays a key role in the diagnosis, characterization, and follow-up of pneumatoceles. Image-guided percutaneous drainage can be considered a safe and effective treatment in children, although it is not widely recognized in newborns and infants. The aim of this case series review is to describe the main CT features of complicated or persistent pneumatoceles in infants and to highlight the potential role of image-guided percutaneous drainage as an effective approach for their treatment. Successful management of four infants affected by pneumonia-related pneumatoceles with percutaneous drainage is presented.
Μελέτη συσχέτισης προεγχειρητικών και διεγχειρητικών δεικτών συννοσηρότητας σε ουρολογικές επεμβάσεις
Authors: Σαρρή Ειρήνη
Published: December 2021

Συσχέτιση των προεγχειρητικών δεικτών συνοδού νοσηρότητας με δείκτες περι- και μετεγχειρητικού κινδύνου σε ασθενείς που υποβάλλονται σε ουρολογικές επεμβάσεις. Εισαγωγή και σκοπός: Η συχνότητα της μετεγχειρητικής νοσηρότητας και θνητότητας χρησιμοποιείται σαν ποιοτικός δείκτης των υπηρεσιών υγείας. Τα μεγέθη προβλέπονται με δείκτες όπως ο POSSUM, ενώ ο μετεγχειρητικός κίνδυνος μπορεί να υπολογισθεί με βάση το χειρουργικό Apgar score. Η προεγχειρητική συνοδός νοσηρότητα μπορεί όμως να επηρρεάζει τους περιεγχειρητικούς δείκτες και συνακόλουθα, την νοσηρότητα και θνησιμότητα. Σκοπός της μελέτης ήταν η εκτίμηση της συσχέτισης της προεγχειρητικής συνοδού νοσηρότητας και άλλων προεγχειρητικών δεικτών με δείκτες περι- και μετεγχειρητικού κινδύνου. Υλικό και Μέθοδοι: Στη μελέτη συμπεριελήφθησαν 100 ασθενείς που υπεβλήθησαν σε μείζονες, ανοικτές, ουρολογικές επεμβάσεις (39 νεφρεκτομές, 43 ριζικές προστατεκτομές, 18 ριζικές κυστεκτομές). Η προεγχειρητική συνοδός νοσηρότητα υπολογίσθηκε με τους δείκτες: Charlson Comorbidity Index (CCI), age-adjusted CCI (AA-CCI), Cumulative Illness Rating Scale (CIRS), Index of Co-Existent Diseases (ICED). Ο προεγχειρητικός κίνδυνος εκτιμήθηκε με τον δείκτη ASA (American Society of Anesthesiologists) και η προεγχειρητική λειτουργική κατάσταση με τα μεταβολικά ισοδύναμα (MET). Οι περιεγχειρητικοί δείκτες ήταν ο POSSUM και το χειρουργικό Apgar score. Αποτελέσματα: Οι τιμές (min-max, μέση±ΣΑ) των διαφόρων δεικτών ήταν: CCI: 0-8, 1,5±1,8, AA-CCI: 0-11, 3,7±2,4, CIRS: 0-8, 3,0±2,1, ICED: 0-16, 4,7±3,9, ASA: 0-4, 2,2±0,7, MET: 2-6, 3,8±0,9, POSSUM: 20-44, 27,6±5,1 και χειρουργικό Apgar: 0-10, 6,2±1,4. Ολοι οι προεγχειρητικοί δείκτες έδειξαν στατιστικά σημαντική συσχέτιση με τον POSSUM (αντίστοιχα r2: 0,146, 0,148, 0,191, 0,260, 0,135 και 0,061), ενώ δεν σημειώθηκε στατιστικά σημαντική συσχέτιση κάποιου από αυτούς με το χειρουργικό Apgar score. Συμπεράσματα: Η μετεγχειρητική κατάσταση (χειρουργικό Apgar score) είναι ανεξάρτητη της προεγχειρητικής συνοδού νοσηρότητας, άρα απαιτείται καλύτερος προσδιορισμός των διεγχειρητικών παραγόντων που καθορίζουν τον μετεγχειρητικό κίνδυνο νοσηρότητας/θνησιμότητας. Αντίθετα, οι προεγχειρητικοί δείκτες συνοδού νοσηρότητας και χειρουργικού κινδύνου συσχετίζονται με περιεγχειρητικούς δείκτες πρόβλεψης κινδύνου νοσηρότητας/θνητότητας. Η αναφορά των δεικτών αυτών θα πρέπει να γίνεται ανάλογα με την προεγχειρητική νοσηρότητα προκειμένου να μπορεί να γίνει με δίκαιο τρόπο η σύγκριση της απόδοσης χειρουργών και νοσοκομείων σε συγκεκριμένες επεμβάσεις.
Experimental study and modeling the tensile strength of 3D‐printed aluminium polylactic acid (PLA) parts using artificial neural networks
Authors: Palanisamy Chockalingam , Aaron Tay Hong Kiat Hong Kiat
Published: December 2021

Background: High quality 3D printed products are in high demand, resulting in an increase in the production of 3D printed parts with precise tolerances, improved surface roughness, and overall durability. The processing parameters of 3D printers have a significant impact on the quality of 3D printed parts. Three-dimensionally printed parts must be durable, especially in terms of tensile strength, and its impact on the printer's process parameters must be investigated.

Methods: Tensile test specimens were printed in the Makerbot 3D printer with aluminium polylactic acid (PLA) material. The three controllable input parameters taken into consideration were layer thickness, infill density and number of shells. The three levels for each of the respective parameters were 0.1mm, 0.2mm and 0.3mm for layer thickness; 2,3 and 4 for number of shells; 20% 40% and 60% for Infill density. Tensile testing was carried out on the specimens and data was tabulated. Using these data, an artificial neural network model was created using Matlab R2021b software’s neural network toolbox (alternatively Scilab can be used).

Results: A high layer thickness (0.3mm) and a 40% infill density were found to be the most effective among all other parameters. The specimen with the lowest layer thickness of 0.1mm, four shells, and a 20% infill density had the highest tensile strength. With the tensile test data, a Matlab ANN model was developed. Validation was done by comparing the values obtained from the model with the experimental data by using random layer thickness, infill density, and number of shells.

Conclusions:  In conclusion, higher layer thickness has lower tensile strengths. However, as the number of shells and infill density increases, the tensile strength increases. In summary an ANN model was successfully developed and validated to predict 3D printed aluminium parts.
Availability and use of technology for e-learning: to what extent do these impact Bangladeshi university students? A cross-sectional study
Authors: Hasan Md. Kamrul , Tonmon Tajrin Tahrin , Kabir Humayun , Masud Sumaya Binte , Hasan Md. Abeed , Das Bikash , Akter Monira , Hawlader Mohammad Delwer Hossain , Mitra Dipak Kumar
Published: December 2021

Background: E-learning is making education globally and conveniently attainable with the deliverance of advanced technology. However, this mode of academia is still not commonly practiced locally. Thus, the study aimed to investigate technological availability, usability, and association to university students' perceived stress due to e-learning curriculum.

Methods: A cross-sectional study commenced among Bangladeshi university students enrolled in the e-learning curriculum. A total of 1162 university students were included. The main explanatory variables were related to the availability of technology and the use of technology. The outcome variable was perceived e-learning stress. In statistical analysis, p-value < 0.05 was considered statistically significant with a 95% confidence interval.

Results: In this study, lack of technological availability and usability were associated with higher level of perceived e-learning stress. Being female, living in rural areas, and outside of Dhaka division were found the associated factors in the lack of technological availability and usability.

Conclusions: A significant association between the availability and usability of technology with perceived e-learning stress was observed. Thus, measures should be taken to initialize e-learning adaptivity by increasing technological growth across the nation, considering educational preparedness for future catastrophes.
Deadlines and Memory Limitations
Authors: Altmann Steffen , Traxler Christian , Weinschenk Philipp
Published: December 2021

This paper presents the results of two natural field experiments at a dental clinic. Guided by a simple theoretical model, we exogenously vary deadlines and associated rewards for arranging checkup appointments. Our data show strong and systematic effects of deadlines on patients’ behavior. Imposing deadlines induces patients to act earlier and at a persistently higher frequency than without a deadline. We further document that individuals systematically respond to deadlines even if these are not tied to explicit rewards. Several of our findings suggest that individuals’ responses to deadlines are shaped by limitations in memory and attention. Our results illustrate that deadlines can be a powerful management tool to encourage timely task completion and to increase the cost effectiveness of performance-contingent rewards.

This paper was accepted by Axel Ockenfels, behavioral economics and decision analysis.
Choroidal Metastasis as the Initial Presentation of Rectal Adenocarcinoma
Authors: Amisha FNU , Patel Tanvi Harishbhai , Biyani Shubham , Saluja Prachi , Gautam Nitesh , Kakadia Sunilkumar
Published: December 2021

Choroidal metastasis from rectal cancer is a rare occurrence with limited literature on appropriate evidence-based treatment options. We describe the case of 44-year-old man who presented with left-sided painful vision loss who was found to have left choroidal and multiple lung metastasis from an unknown primary which was later found to be rectal adenocarcinoma.
Towards the Creative-Oriented University
Authors: Tajpour Mehdi , Hosseini Elahe
Published: December 2021

Entrepreneurial universities are the center of progressive organizations that have reconsidered themselves in order to adapt to complex environmental conditions. Thus, the purpose of this study is to investigate the towards the creative-oriented university. In this research, which has used descriptive methods, in order to understand the concepts of towards the creative-oriented university, the background of the subject has been studied in the form of library and documentary studies. Thus,conclusion show that the effect of entrepreneurial universities on a regional scale extends far beyond commercial outputs while a simple cost-benefit analysis can provide indirect and tangible results in terms of human capital attraction, entrepreneurial capital formation, informal networks, new ideas, and so on.