bluuebunny/crossref_metadata_2025 huggingface dataset:
Risk factors for blood component therapy in parturients—Case–control study
Authors: Gabbai Daniel , Many Ariel , Lerner‐Geva Liat , Attali Emmanuel
Published: April 2023

Objective

Postpartum hemorrhage is a major cause of maternal morbidity and mortality, so early identification of patients at risk is crucial. In this study, we aim to assess the risk factors for major transfusion in parturients.

Methods

A case–control study was conducted between 2011 and 2019. The cases included women who were treated with postpartum major transfusion compared with two control groups, one of which was treated with 1–2 packed red blood cells and one of which was not treated with packed red blood cells. Cases were matched with controls based on two variables: multiple pregnancies and previous history of three or more cesarean sections. A multivariable conditional logistic regression model was used to determine the role of the independent risk factors.

Results

Of the 187 424 deliveries included in the present study, 246 (0.3%) women were treated with major transfusions. After applying a multivariate analysis, maternal age (odds ratio [OR] 1.07, 95% confidence interval [CI] 0.996–1.16), antenatal anemia with hemoglobin less than 10 g/dL (OR 12.58, 95% CI 2.86–55.25), retained placenta (OR 5.5, 95% CI 2.15–13.78), and cesarean delivery (OR 10.12, 95% CI 0.93–1.95) remained independent risk factors for major transfusions.

Discussion

Retained placenta and antenatal anemia (hemoglobin < 10 g/dL) are independent risk factors for major transfusion. Of these, anemia was found to be the most significant.
Mitochondrial Ca2+ overload due to altered proteostasis amplifies apoptosis in C2C12 myoblasts under hypoxia: Protective role of nanocurcumin formulation
Authors: Kushwaha Asha D , Kalra Namita , Varshney Rajeev , Saraswat Deepika
Published: April 2023

Severe hypoxia triggers apoptosis leads to myofibers loss and is attributable to impaired intracellular calcium (iCa2+) homeostasis, resulting in reduced muscle activity. Hypoxia increases intracellular Ca2+ by activating the release of Ca2+ from iCa2+ stores, however, the effect of increased [iCa2+] on the mitochondria of muscle cells at high‐altitude hypoxia is largely unexplored. This study examined mitochondrial Ca2+ overload due to altered expression of mitochondrial calcium uptake 1 (MICU1), that is, a gatekeeper of the mitochondrial Ca2+ uniporter, impaired mitochondrial membrane potential (ΔΨm). p53 stabilization and its translocation to the mitochondria were observed following disrupted mitochondrial membrane integrity in myoblasts under hypoxia. Furthermore, the downstream effects of p53 led to the upregulation of proapoptotic proteins (Bax, Caspase‐3, and cytochrome C) in myoblasts under hypoxia. Nanocurcumin‐pyrroloquinoline quinone formulation (NCF; Indian patent no. 302877), developed to address hypoxia‐induced consequences, was found to be beneficial in maintaining mitochondrial Ca2+ homeostasis and limiting p53 translocation into mitochondria under hypoxia in muscle myoblasts. NCF treatment also modulates heat shock proteins and apoptosis‐regulating protein expression in myoblasts. Conclusively, we proposed that mitochondrial Ca2+ overload due to altered MICU1 expression intensifies apoptosis and mitochondrial dysfunctionality. The study also reported that NCF could improve mitochondrial [Ca2+] homeostasis and antiapoptotic ability in C2C12 myoblasts under hypoxia.
Preparation of Ferrocene‐Terminated Dendrimers for the Thermal Decomposition of Ammonium Perchlorate
Authors: Liu Jinyi , Yu Haojie , Wang Li , Chen Tao , Vatsadze Sergey Z. , Chen Dingning , Shen Di , Wang Yu
Published: April 2023

As a common oxidizer, ammonium perchlorate (AP) is an important component in composite solid propellants (CSPs). Ferrocene (Fc)‐based compounds are often selected as burning rate catalysts (BRCs) to catalyze AP decomposition owing to their excellent catalytic behavior. However, one of the drawbacks of Fc‐based BRCs is migration in CSPs. In this study, five Fc‐terminated dendrimers are designed and synthesized to improve the anti‐migration properties, and their chemical structures are confirmed systemically by the related spectra characterization techniques. Moreover, the redox performance, catalytic effect on AP decomposition, combustion performance, and mechanical properties in CSPs are also studied. The shapes of the prepared propellant samples are observed via scanning electron microscopy. The obtained Fc‐based BRCs have good redox performance, a positive effect on promoting AP decomposition, excellent combustion catalytic performance, and good mechanical properties. Meanwhile, they have a higher anti‐migration ability than catocene (Cat) and Fc. This study demonstrates that Fc‐terminated dendrimers have great potential to be applied as anti‐migration BRCs in CSPs.
On study the existence and uniqueness of the solution of the Caputo–Fabrizio coupled system of nonlocal fractional q‐integro differential equations
Authors: Ali Khalid K. , Raslan K. R. , Ibrahim Amira Abd‐Elall , Mohamed Mohamed S.
Published: April 2023

In this paper, we will use the definitions of the Caputo–Fabrizio fractional derivative and the Riemann–Liouville fractional q‐integral to look into the existence, uniqueness, and continuous dependence of solutions for a coupled system of fractional q‐integro‐differential equations. We provide an overview of the finite‐trapezoidal method. Finally, we present some numerical examples to demonstrate the method's effectiveness.
Bilateral Congenital Ossicular Anomalies: Are the Anomalies Symmetric for Both Ears?
Authors: Yeon Eun‐Kyeong , Son Hyo One , Sung Hanwool John , Choi Jin Woong
Published: April 2023

Objective

To evaluate whether bilateral congenital ossicular anomalies (COAs) differ regarding ossicular anomalies and hearing loss severities between the ears of the individual.

Study Design

Retrospective case review.

Setting

Tertiary referral academic center.

Methods

Between March 2012 and December 2022, 7 consecutive patients (14 ears) with surgically confirmed bilateral COAs were included in the study. Preoperative pure‐tone thresholds, COA classification according to the Teunissen and Cremers system, surgical procedures, and postoperative audiometric results were compared between the 2 ears of each patient.

Results

The median age of the patients was 11.5 (range: 6‐25) years. Both ears of each patient were categorized based on the same classification. Three patients possessed class III COAs and the other 4 had class I COAs. The interaural differences in preoperative bone and air conduction thresholds were within 15 dB for all patients. Differences in postoperative air‐bone gaps between ears were not statistically significant. The surgical procedures required for ossicular reconstruction were almost identical for both ears.

Conclusion

The severity of ossicular abnormalities and hearing loss in patients with bilateral COAs were symmetrical between ears, thereby enabling prediction of the characteristics of the contralateral ear based on the findings observed in 1 ear. These symmetric clinical features can aid surgeons when operating on the contralateral ear.
The incidence of cytomegalovirus and BK polyomavirus infections in kidney transplant patients receiving mTOR inhibitors: A systematic review and meta‐analysis
Authors: Ye Chen , Li Jingjie , Liu Xiaoman , Yan Jiajia , Chen Jie , Wang Changxi , Huang Min , Chen Xiao , Tang Kejing , Chen Pan
Published: April 2023

Cytomegalovirus (CMV) and BK polyomavirus (BKPyV) infections after kidney transplant have become increasingly prevalent. Based on previous studies, the mammalian target of rapamycin (mTOR) inhibitors seem like attractive alternatives with antiviral activity. The objective of this systematic review and meta‐analysis was to investigate the incidence of CMV and BKPyV infections in kidney transplantation recipients receiving mTOR inhibitors. This meta‐analysis included three comparisons of immunosuppressant regimens commonly used after kidney transplantation: Comparison 1: mTOR inhibitors versus calcineurin inhibitors (CNI); Comparison 2: mTOR inhibitors versus antimetabolites (AM); and Comparison 3: mTOR inhibitors plus a reduced‐dose of CNI versus AM plus a standard‐dose of CNI. The group containing mTOR inhibitors was the study group and the remaining one was the control group. The incidence of CMV or BKPyV infection defined by positive culture, serology, or polymerase chain reaction testing was the primary outcome. A total of 61 studies involving 13,609 patients were included. As compared with the control group, a significantly decreased risk of CMV and BKPyV infections favoring the mTOR inhibitors‐based group was shown in comparisons 1, 2, and 3 (p < 0.05). Compared with the control group in all three comparisons, mTOR inhibitors made no difference in regard to death and graft loss (p > 0.05). Compared with CNI, the incidence of biopsy‐proven acute rejection (BPAR) and anemia was higher with mTOR inhibitors (p < 0.05). In comparisons 2 and 3, the risk of new‐onset diabetes mellitus (NODM) was higher with mTOR inhibitors (p < 0.05). Early introduction of mTOR inhibitors reduced more CMV infections in comparisons 1 and 2 (p < 0.05). The mTOR inhibitor‐based regimen is an attractive alternative with lower risk of CMV and BKPyV infections in kidney transplant recipients. The combination regimen is more appropriate and acceptable than the mTOR‐inhibitor monotherapy‐based regimen. Early introduction of mTOR inhibitors is recommended, although it is worth noting that attention should be paid to wound healing when mTOR inhibitors are introduced early.
Short‐term efficacy and safety of early medical abortion in Japan: A multicenter prospective study
Authors: Osuga Yutaka , Shirasu Kazuhiro , Tsushima Ruriko , Ishitani Ken
Published: April 2023

Purpose

To evaluate the short‐term efficacy and safety of a combined mifepristone‐misoprostol regimen in individuals seeking medical abortion at up to 63 days of gestational age.

Methods

This open‐label, multicenter, prospective study evaluated the short‐term efficacy and safety of medical abortion, with the primary outcome being the abortion success rate 24 h after misoprostol administration. The participants received 200 mg of mifepristone orally and 800 μg of misoprostol buccally in the hospital/clinic 36–48 h later. Bleeding and lower abdominal pain, which are the main symptoms associated with medical abortion, were recorded.

Results

The abortion success rate was 93.3% (95% confidence interval [CI]: 87.3–97.1%) within 24 h of misoprostol administration, 63.3% (95% CI: 54.05–71.94%) within 4 h, and 90.0% (95% CI: 83.18–94.73%) within 8 h. The median time from misoprostol administration to a successful abortion was 3.93 h. Bleeding was most commonly observed 0–4 h prior to the confirmation of gestational sac (GS) expulsion. The most intense lower abdominal pain occurred 0–1 h before the confirmation of GS expulsion.

Conclusion

The combined regimen of mifepristone and buccal misoprostol for medical abortion showed short‐term efficacy and a favorable safety profile.
Monitoring of SARS‐CoV‐2 RNA in wastewater: A surveillance tool to foresee infection's evolution in the Mexican Caribbean
Authors: Hernández‐Terrones Laura Margarita , Carrillo‐Reyes Julián , Ayala‐Godoy Jairo A. , Guerrero‐Ruiz Eugenio , Vargas Leslie Meredith García , Prado‐Guevara Bruno Abraham , Rodríguez‐Abraham Melissa Fernanda , Buitrón Germán
Published: April 2023

The study aims to determine SARS‐CoV‐2 RNA in sewage of Cancun wastewater treatment plants, the main touristic destination of Mexico, and to estimate the infected persons during the sampling period. SARS‐CoV‐2 RNA traces were detected in the inlet of the five plants during almost all the sampling months. However, there is no presence of SARS‐CoV‐2 RNA traces in the effluent of the five WWTPs during the study period. ANOVA analysis showed differences in the concentrations of RNA traces of SARS‐CoV‐2 between the sample dates, but no differences were found from one WWTP to another. Estimated infected individuals by Markov chain Monte Carlo simulation are higher (between 77% and 91%) than the cases reported by the health authority. Wastewater monitoring and the estimation of infected individuals are a helpful tool, because estimation provides early warning signs on how broadly SARS‐CoV‐2 is circulating in the city, and led to the authorities to take measures wisely.

Practitioner Points

There is no presence of SARS‐CoV‐2 RNA traces in the effluent of the facilities, suggesting the effectiveness of treatment.

Surveillance of viral RNA concentrations at treatment plants revealed presence in the influent of five plants

Estimated infected individuals by MCMC simulation are higher than cases reported by health authority

Environmental surveillance approach in wastewater influent is helpful to identify the clusters and to take informed decisions
Injectable platelet-rich fibrin with demineralized freeze-dried bone allograft compared to demineralized freeze-dried bone allograft in intrabony defects of patients with stage-III periodontitis: a randomized controlled clinical trial
Authors: Alshoiby Mashaal Mohammed , Fawzy El-Sayed Karim Mohamed , Elbattawy Weam , Hosny Manal Mohamed
Published: April 2023

Aim

The current randomized controlled clinical trial assessed the effect of injectable platelet-rich fibrin (I-PRF) combined with demineralized freeze-dried bone allograft (DFDBA) compared to DFDBA alone in the management of intrabony defects of stage-III periodontitis patients.

Methodology

Following sample size calculation, twenty stage-III periodontitis patients with ≥ 5 mm clinical attachment level (CAL)-loss and ≥ 3 mm intrabony defects were randomized into test (I-PRF + DFDBA; n = 10) and control (DFDBA; n = 10) groups. CAL (primary outcome), periodontal probing depth (PPD), gingival recession depth (GRD), full-mouth plaque scores (FMPS), full-mouth bleeding scores (FMBS), radiographic linear defect depth (RLDD), and bone fill (secondary outcomes) were examined at baseline, 3, 6, and 9 months post-surgically.

Results

I-PRF + DFDBA and DFDBA independently demonstrated significant intragroup CAL-gain, PPD-, and RLDD-reduction at 3, 6, and 9 months (p < 0.05), with no significant intergroup differences observed (p > 0.05). CAL-gain (mean ± SD) of 2.40 ± 0.70 mm and 2.50 ± 0.85 mm and PPD-reduction of 3.50 ± 1.18 mm and 2.80 ± 0.42 mm were demonstrated for I-PRF + DFDBA and DFDBA at 9 months respectively. Both groups showed significant intragroup RLDD improvement, with a RLDD of 3.58 ± 0.66 mm and 3.89 ± 1.57 mm for I-PRF + DFDBA and DFDBA at 9 months respectively. Stepwise linear regression analysis revealed that baseline RLDD and bone fill at 9 months were significant predictors of CAL (p < 0.05).

Conclusion

Within the present study’s limitations, DFDBA with or without I-PRF resulted in significant improvement in clinical and radiographic periodontal parameters in the surgical treatment of periodontal intrabony defects of stage-III periodontitis patients. Addition of I-PRF to DFDBA does not appear to significantly enhance the DFDBA’s reparative/regenerative outcomes.

Clinical relevance

Within the current study’s limitations, routinely adding I-PRF to DFDBA cannot be recommended to significantly improve DFDBA’s treatment outcomes in intrabony defects.
Synthesis of porous C/Fe3O4 microspheres by spray pyrolysis with NaNO3 additive for lithium-ion battery applications
Authors: Adi Akylbek , Taniguchi Izumi
Published: April 2023

In this work, we successfully synthesized porous C/Fe3O4 microspheres by spray pyrolysis at 700ºC with a sodium nitrate (NaNO3) additive in the precursor solution. Furthermore, we studied their electrochemical properties as anode material for Li-ion batteries. The systematic studies by various characterization techniques show that NaNO3 catalyzes the carbonization of sucrose and enhances the crystallization of Fe3O4. Moreover, an aqueous etching can easily remove sodium compounds to produce porous C/Fe3O4 microspheres with large surface areas and pore volumes. The porous C/Fe3O4 microspheres exhibit a reversible capacity of ~780 mAh g–1 in the initial cycles and ~520 mAh g–1 after 30 cycles at a current density of 50 mA g–1. Moreover, a reversible capacity of ~400 mAh g–1 is attainable after 200 cycles, even at a high current density of 500 mA g–1. The wide range of pores produced from the removal of sodium compounds might enable easy electrolyte penetration and facilitate fast Li-ion diffusion, while the N-doping can promote the electronic conductivity of the carbon. These features of porous C/Fe3O4 microspheres led to the improved electrochemical properties of this sample.

Graphical Abstract
Metabolomics of early myocardial ischemia
Authors: Hasselbalch Rasmus Bo , Kristensen Jonas Henrik , Strandkjær Nina , Jørgensen Nicoline , Bundgaard Henning , Malmendal Anders , Iversen Kasper Karmark
Published: April 2023

Introduction

Diagnosing myocardial infarction is difficult during the initial phase. As, acute myocardial ischemia is associated with changes in metabolic pathways, metabolomics may provide ways of identifying early stages of ischemia. We investigated the changes in metabolites after induced ischemia in humans using nuclear magnetic resonance spectroscopy (NMR).

Methods

We included patients undergoing elective coronary angiography showing normal coronary arteries. These were randomized into 4 groups and underwent coronary artery occlusion for 0, 30, 60 or 90 s. Blood was collected over the next 3 h and analyzed using NMR. We used 2-way ANOVA of time from baseline- and treatment group to find metabolites that changed significantly following the intervention and principal component analysis (PCA) to investigate changes between the 90 s ischemia- and control groups at 15 and 60 min after intervention.

Results

We included 34 patients. The most pronounced changes were observed in the lipid metabolism where 38 of 112 lipoprotein parameters (34%) showed a significant difference between the patients exposed to ischemia and the control group. There was a decrease in total plasma triglycerides over the first hour followed by a normalization. The principal component analysis showed a effects of the treatment after just 15 min. These effects were dominated by changes in high-density lipoprotein. An increase in lactic acid levels was detected surprisingly late, 1–2 h after the ischemia.

Conclusion

We investigated the earliest changes in metabolites of patients undergoing brief myocardial ischemia and found that ischemia led to changes throughout the lipid metabolism as early as 15 min post-intervention.
Seasonal and Morphological Controls on Nitrate Retention in Arctic Deltas
Authors: Knights Deon , Piliouras Anastasia , Schwenk Jon , Hariharan Jayaram , Russoniello Christopher
Published: April 2023

Estimates of nitrate loading to the Arctic Ocean are limited by the lack of field observations within deltas partly due to logistical constraints. To overcome this limitation, we use a remote sensing framework to estimate retention of nitrate in Arctic deltas. We achieve this by coupling hydrological and biogeochemical process models at the network scale for five major Arctic deltas. Binary masks of delta channels were used to simulate flow direction and magnitude through networks. Models were parameterized using historical and seasonal observations. Simulated nitrate retention ranged from 2.9% to 15% of the incoming load. Retention rates were largest during winter but smallest during spring conditions when increased discharges export large nitrate masses to the coast. Under future climate scenarios, retention rates fall by ∼1%–10%. Arctic deltas have an important effect on the magnitude of nitrate entering Arctic seas and the inclusion of processing in deltas can improve flux estimates.
Preparatory Slip in Laboratory Faults: Effects of Roughness and Load Point Velocity
Authors: Guérin‐Marthe Simon , Kwiatek Grzegorz , Wang Lei , Bonnelye Audrey , Martínez‐Garzón Patricia , Dresen Georg
Published: April 2023

Aseismic slip may occur during a long preparatory phase preceding earthquakes, and what controls it remains poorly understood. In this study, we explored the role of load point velocity and surface roughness on slow slip during the preparatory stage prior to stick‐slip events. To that end, we conducted displacement‐rate controlled friction experiments by imposing varying load point velocities on sawcut granite samples with different surface roughness at a confining pressure of 35 MPa. We measured the average slip along the fault with the recorded far‐field displacements and strain changes, while acoustic emission sensors and local strain gages were used to capture local slip variations. We found that the average amount of aseismic slip during the preparatory stage increases with roughness, whereas precursory slip duration decreases with increased load point velocity. These results reveal a complex slip pattern on rough faults which leads to dynamic ruptures at high load point velocities.
Tailoring particle size of PbI2 towards efficient perovskite solar cells under ambient air conditions
Authors: Zeng Qiang , Ma Qingman , Li Linhong , Zheng Bolin , Pan Yining , Zhao Xiangyun , Xiao Hanrui , Yan Chang , Liu Fangyang
Published: April 2023

Micrometer-sized PbI2 (P-PbI2) is beneficial for preparing higher-quality perovskite film and solar cells under low humidity conditions. Comparatively, millimeter-sized PbI2 crystals (C-PbI2) allow the growth of denser perovskite films under heavy humidity conditions.
Soybean peroxidase immobilised on cellulose-alginate hydrogels for removal of recalcitrant organic pollutants in water
Authors: Rigoletto Monica , Calza Paola , Santuchi da Cunha Alexandre , Sederino Valentina , Fabbri Debora , Tummino Maria Laura , Laurenti Enzo
Published: April 2023

Biodegradable, waste-derived hydrogels containing immobilised peroxidase were successfully used for enzymatic removal of organic pollutants in water. Hydrogels are reusable and provide detoxification of the contaminants solution.
Highly transparent to red/green/blue photo-crosslinkable polymer for patterned electrochromic device
Authors: Lv Xiaojing , Zhu Xuchen , Zhang Ling , Ouyang Mi , Xia Minao , Liu Chunyan , Zhang Cheng
Published: April 2023

Highly transparent to red/green/blue photocrosslinkable polymers were designed and synthesized for patterned electrochromic devices.
Collaborative stochastic expansion planning of cyber‐physical system considering extreme scenarios
Authors: Zhang Yiwei , Li Chengze , Wan Haiyang , Shi Qingxin , Liu Wenxia , Xu Yanhui
Published: April 2023

In this paper, a collaborative stochastic expansion planning model of cyber‐physical system (CPS) with resilience constraints is proposed. The model can reduce the coupling risk and enhance the resilience under extreme scenarios, from the perspective of the structural/functional coupling between the physical and cyber systems. The model is to collaboratively optimize expansion transmission line siting, expansion communication fibre siting, and service routing distribution to minimize total investment cost. Constraints are divided into conventional constraints and resilience constraints. In the resilience constraints, the impact of cyber failures on the dispatch strategy is analyzed, and the load shedding in stochastic scenarios is limited to guarantee the resilience of the planning scheme. Particularly, to reach a stable solution for the stochastic planning, a mixed scenario set is proposed based on the probabilistic typhoon model and the complex network theory. Finally, the model is solved by the progressive hedging (PH) algorithm. The case studies of the IEEE RTS‐79 test system demonstrate that, compared with the traditional independent planning model, the model proposed in this paper performs better in limiting load loss and enhancing resilience under extreme scenarios.
Discovery of a massive giant planet with extreme density around the sub-giant star TOI-4603
Authors: Khandelwal Akanksha , Sharma Rishikesh , Chakraborty Abhijit , Chaturvedi Priyanka , Ulmer-Moll Solène , Ciardi David R. , Boyle Andrew W. , Baliwal Sanjay , Bieryla Allyson , Latham David W. , Prasad Neelam J. S. S. V. , Nayak Ashirbad , Lendl Monika , Mordasini Christoph
Published: April 2023

We present the discovery of a transiting massive giant planet around TOI-4603, a sub-giant F-type star from NASA’s Transiting Exoplanet Survey Satellite (TESS). The newly discovered planet has a radius of 1.042−0.035+0.038 RJand an orbital period of 7.24599−0.00021+0.00022days. Using radial velocity measurements with the PARAS and TRES spectrographs, we determined the planet’s mass to be 12.89−0.57+0.58 MJ, resulting in a bulk density of 14.1−1.6+1.7g cm−3. This makes it one of the few known massive giant planets with an extreme density. It lies in the transition mass region of massive giant planets and low-mass brown dwarfs, an important addition to the population of fewer than five known objects in this mass range. The eccentricity of 0.325 ± 0.020 and an orbital separation of 0.0888 ± 0.0010 AU from its host star suggest that the planet is likely undergoing high-eccentricity tidal migration. We find a fraction of heavy elements of 0.13−0.06+0.05and metal enrichment of the planet (ZP/Zstar) of 4.2−2.0+1.6. Detection of such systems will enable us to gain valuable insights into the governing mechanisms of massive planets and improve our understanding of their dominant formation and migration mechanisms.
Withdrawing Assisted Nutrition in Neonates: A Survey on Attitudes and Insights in Argentina
Authors: Mariani Gonzalo L. , Konikoff Laura L.
Published: April 2023

Objective This study aimed to assess beliefs and attitudes of Argentinean neonatologists and neonatal nurses regarding end-of-life care of newborn infants, including withdrawal of clinically assisted nutrition and hydration (CANH).

Study Design A five-domain survey was sent to 465 neonatal health care workers, which included demographic data, general ethical concepts, participation in end-of-life decisions, beliefs about end-of-life care practices, and presentation of four clinical scenarios. Standard statistical tests were used, and a multivariable analysis was done to evaluate variables independently associated with rejecting the withdrawal of CANH.

Results A total of 227 questionnaires were anonymously completed, 60% by physicians and 40% by nurses. More respondents agreed to withdraw mechanical ventilation in comparison to CANH in patients under certain circumstances (88 vs. 62%, p < 0.01). The most accepted variables when deciding to withdraw care were the quality of life perceived by parents (86%) and their religious beliefs (73%). A total of 93% agreed that parents should be included in the decision, but only 74% acknowledged they are included in real practice. Considering the scenario of a newborn with severe and irreversible neurological compromise, 46% of respondents were opposed to suspending enteral nutrition. No independent variables were found to be associated with opposing the withdrawal of CANH. Of those agreeing to withdraw enteral feeds under certain circumstances, for the severely neurologically affected neonate 58% would either refuse to limit enteral feeds or consult with an ethics committee before doing so. When given the scenario of their own severe and irreversible neurological compromise, 68% agreed to have enteral feeds withdrawn to themselves, and they were more likely to agree with withdrawing feeds for the severely compromised neonate (odds ratio: 7.2; 95% confidence interval: 2.7–24.1).

Conclusion While most health care providers agreed to withdraw life-sustaining support under certain conditions, many were reluctant to suspend CANH. Many responses differed when being asked as general statements versus actual clinical scenarios.

Key Points
Predictors of Metformin Side Effects in Patients with Newly Diagnosed Type 2 Diabetes Mellitus
Authors: Alibrahim Nassar Taha Yaseen , Chasib Mohammed Ghazi , Hamadi Saad Shaheen , Mansour Abbas Ali
Published: April 2023

Introduction Metformin has become the first-line agent for the treatment of type 2 diabetes mellitus (T2DM) in several international guidelines. Up to 25% of patients suffer from gastrointestinal side-effects, with approximately 5% unable to tolerate metformin at all.

Objective We aimed to study the effect of variables that may influence the development of metformin side effects and/or intolerance.

Method A prospective study was conducted from April 1, 2021 to March 30, 2022. One-hundred and forty-eight patients newly diagnosed with T2DM were enrolled in the study, and divided into two groups—those who were escalate to the maximum dose of metformin over 2 weeks (n = 43) and the other group over 4 weeks (n = 105). We studied the variables that may affect the development of side effects including age, gender, body mass index (BMI), lipid profile, glycemic level, and the use of other antidiabetic medications besides the duration of dose escalation.

Results Total number of patients who developed side effects was 59 (39.9%). Twenty-four (55.8%) and 35 (33.3%) patients were put in the rapid and slow escalation groups, respectively. Twenty-six (17.6%) patients developed diarrhea that was the most common side effect. Two (2.7%) men and ten women (13.5%) had stopped metformin due to severe side effects developed after initiation (p = 0.016). The mean BMI for the patients who discontinued metformin was 34.7 ± 4.1 kg/m2 in the rapid escalation arm and 31.6 ± 3.3 kg/m2 in the slow escalation arm (p = 0.003). The mean of fasting blood glucose for the patients who discontinued metformin in the rapid and slow escalation arms was 200.6 ± 25.6 and 173.4 ± 36.5 mg/dL, respectively (p = 0.022).

Conclusion The severity of metformin side effects is higher in women than in men, making more women to discontinue the drug. Besides, a higher fasting blood sugar and BMI are associated with a higher rate of discontinuation. A rapid dose escalation is associated with a higher frequency of side effects. Diarrhea is the commonest side effect encountered.
Unveiling the mystery of solar-coronal heating
Authors: Sigalotti Leonardo Di G. , Cruz Fidel
Published: April 2023

Miniature flares recently discovered by probes that have approached the Sun’s surface are helping physicists understand how the Sun’s corona reaches temperatures of millions of kelvin.
Hailey–Hailey disease (benign familial pemphigus) responsive to treatment with ocrelizumab for multiple sclerosis
Authors: Adamson Sarah R , Higgins Claire L , Veysey Emma 
Published: April 2023

Benign familial pemphigus, also known as Hailey–Hailey disease (HHD), is a rare autosomal-dominant genetic skin disorder characterized by symmetrical, well-demarcated, erythematous, painful erosive and crusted plaques in the intertrigous regions. Treatment options are limited and aimed at control and limiting complications. Ocrelizumab, an anti-CD20 antibody, was given to treat our patient’s multiple sclerosis, and incidentally found to have cleared her HHD, thus offering a potential effective treatment option.
Understanding the real-world patient journey and unmet needs of people with hidradenitis suppurativa through social media research
Authors: Kirby Joslyn S , Martorell Antonio , Sayed Christopher J , Alarcon Ivette , Kasparek Torben , Frade Susan , McGrath Barry M , Villumsen Bente , Zouboulis Christos C
Published: April 2023

People with hidradenitis suppurativa (HS) have a high burden of unmet needs and a better understanding of their lived experience is needed. Social media research is a novel approach that can improve such understanding by collecting and analysing publicly available information related to patient experiences. This study found that people with HS are unhappy with the management of their disease and highlights the need for greater awareness and research, as well as treatment effectiveness and options.
Epidemiology of porocarcinoma in England 2013–2018: a population-based registry study
Authors: Joshy Jilse , van Bodegraven Birgitta , Mistry Khaylen , Craig Paul , Rajan Neil , Vernon Sally , Levell Nick J , Venables Zoe C
Published: April 2023

Background

Porocarcinoma (PC) is a cutaneous malignancy that differentiates towards (possibly arises from) the sweat ducts and glands. Lack of histological diagnostic markers makes clinical and pathological diagnosis complex. The limited data available suggest the incidence is increasing; however, this remains to be established in national epidemiological studies.

Objectives

To report the incidence, treatment and survival of patients with PC in England from 1 January 2013 to 31 December 2018 using national cancer registry data.

Methods

PC diagnoses in England during 2013–2018 were identified from the National Disease Registration Service using morphology and behaviour codes. These were registered from routinely collected pathology reports and cancer outcomes and services datasets. The 2013 European age standardized incidence rates (EASRs), Kaplan–Meier all-cause survival and log-rank test were calculated.

Results

In total, 738 tumours (396 in males and 342 in females) were diagnosed. The median age at diagnosis was 82 years old (interquartile range 74–88). The most frequently affected site were lower limbs (35.4%), followed by the face (16%). The majority of the cohort received surgical excision (73.0%). The Kaplan–Meier all-cause survival was 45.4% at 5 years, which was lower than in previous studies. The EASR for the whole population was 0.25 [95% confidence interval (CI) 0.23–0.27] per 100 000 person-years (PY)]. PC incidence rates in the East of England (EASR of 0.54, 95% CI 0.47–0.63 per 100 000 PY) were three times higher than the South West (EASR of 0.14, 95% CI 0.10–0.19 per 100 000 PY) where the regional rates were the lowest.

Conclusions

This study shows that there is large variation in the EASRs of PC across England. This may reflect differences in how PC is diagnosed and registered in different regions in England. These data support national assessment of the management of PC, which will inform future studies and guideline development.
Clinical and immunological characteristics of patients with combined anti-glomerular basement membrane disease and IgA nephropathy
Authors: Shen Cong-rong , Jia Xiao-yu , Cui Zhao , Yu Xiao-juan , Zhao Ming-hui
Published: April 2023

Background

The combination of anti–glomerular basement membrane (GBM) disease and immunoglobulin A nephropathy (IgAN) has been well documented in sporadic cases, but lacks overall assessment in large collections. Herein, we investigated the clinical and immunological characteristics and outcome of this entity.

Methods

Seventy-five consecutive patients with biopsy-proven anti-GBM disease from March 2012 to March 2020 were screened. Among them, patients with concurrent IgAN were identified and enrolled. The control group included biopsied classical anti-GBM patients during the same period, excluding patients with IgAN, other glomerular diseases or tumors, or patients with unavailable blood samples and missing data. Serum IgG and IgA autoantibodies against GBM were detected by enzyme-linked immunosorbent assay, as were circulating IgG subclasses against GBM.

Results

Fifteen patients with combined anti-GBM disease and IgAN were identified, accounting for 20% (15/75) of all patients. Among them, nine were male and six were female, with an average (± standard deviation) age of 46.7 ± 17.3 years. Thirty patients with classical anti-GBM disease were enrolled as controls, with 10 males and 20 females at an average age of 45.4 ± 15.3 years. Patients with combined anti-GBM disease and IgAN had restricted kidney involvement without pulmonary hemorrhage. Compared with classical patients, anti-GBM patients with IgAN presented with significantly lower levels of serum creatinine on diagnosis (6.2 ± 2.9 vs 9.5 ± 5.4 mg/dL, P = .03) and less occurrence of oliguria/anuria (20%, 3/15 vs 57%, 17/30, P = .02), but more urine protein excretion [2.37 (1.48, 5.63) vs 1.11 (0.63, 3.90) g/24 h, P = .01]. They showed better kidney outcome during follow-up (ESKD: 47%, 7/15 vs 80%, 24/30, P = .03). The autoantigen and epitope spectrum were comparable between the two groups, but the prevalence of circulating anti-α3(IV)NC1 IgG1 (67% vs 97%, P = .01) and IgG3 (67% vs 97%, P = .01) were lower in patients with IgAN.

Conclusions

Concurrent IgAN was not rare in anti-GBM disease. Patients showed milder kidney lesions and better recovery after immunosuppressive therapies. This might be partly explained by lower prevalence of anti-GBM IgG1 and IgG3 in these patients.
Whole genome assemblies of Zophobas morio and Tenebrio molitor
Authors: Kaur Sabhjeet , Stinson Sydnie A , diCenzo George C
Published: April 2023

Zophobas morio (=Zophobas atratus) and Tenebrio molitor are darkling beetles with industrial importance due to their use as feeder insects and their apparent ability to biodegrade plastics. High quality genome assemblies were recently reported for both species. Here, we report additional independent Z. morio and T. molitor genome assemblies generated from Nanopore and Illumina data. Following scaffolding against the published genomes, haploid assemblies of 462 Mb (scaffold N90 of 16.8 Mb) and 258 Mb (scaffold N90 of 5.9 Mb) were produced for Z. morio and T. molitor, respectively. Gene prediction led to the prediction of 28,544 and 19,830 genes for Z. morio and T. molitor, respectively. Benchmarking Universal Single Copy Orthologs (BUSCO) analyses suggested that both assemblies have a high level of completeness; 91.5 and 89.0% of the BUSCO endopterygota marker genes were complete in the Z. morio assembly and proteome, respectively, while 99.1 and 92.8% were complete in the T. molitor assembly and proteome, respectively. Phylogenomic analyses of four genera from the family Tenebrionidae yielded phylogenies consistent with those previously constructed based on mitochondrial genomes. Synteny analyses revealed large stretches of macrosynteny across the family Tenebrionidae, as well as numerous within-chromosome rearrangements. Finally, orthogroup analysis identified ∼28,000 gene families across the family Tenebrionidae, of which 8,185 were identified in all five of the analyzed species, and 10,837 were conserved between Z. morio and T. molitor. We expect that the availability of multiple whole genome sequences for Z. morio and T. molitor will facilitate population genetics studies to identify genetic variation associated with industrially relevant phenotypes.
From ‘no problem’ to ‘a lot of difficulties’: barriers to health service utilization among migrants in Rakai, Uganda
Authors: Young Ruth , Kennedy Caitlin E , Dam Anita , Nakyanjo Neema , Ddaaki William , Kiyingi Anne Catherine , Mukwana Emmanuel , Edwards Abagail , Nalugoda Fred , Chang Larry W , Wawer Maria J , Oaks Maya , Paina Ligia
Published: April 2023

Migration is increasingly common in Africa, especially for employment. Migrants may face additional barriers to accessing health care, including human immunodeficiency virus (HIV) prevention and treatment, compared with long-term residents. Exploring migrants’ experiences with health services can provide insights to inform the design of health programmes. In this study, we used qualitative methods to understand migrants’ barriers to health service utilization in south-central Uganda. This secondary data analysis used data from in-depth semi-structured interviews with 35 migrants and 25 key informants between 2017 and 2021. Interviews were analysed thematically through team debriefings and memos. We constructed three representative migrant journeys to illustrate barriers to accessing health services, reflecting experiences of migrant personas with differing HIV status and wealth. Migrants reported experiencing a range of barriers, which largely depended on the resources they could access, their existing health needs and their ability to form connections and relationships at their destination. Migrants were less familiar with local health services, and sometimes needed more time and resources to access care. Migrants living with HIV faced additional barriers to accessing health services due to anticipated discrimination from community members or health workers and difficulties in continuing antiretroviral therapy when switching health facilities. Despite these barriers, social networks and local connections facilitated access. However, for some migrants, such as those who were poorer or living with HIV, these barriers were more pronounced. Our work highlights how local connections with community members and health workers help migrants access health services. In practice, reducing barriers to health services is likely to benefit both migrants and long-term residents.
Extracting social determinants of health events with transformer-based multitask, multilabel named entity recognition
Authors: Richie Russell , Ruiz Victor M , Han Sifei , Shi Lingyun , Tsui Fuchiang (Rich)
Published: April 2023

Objective

Social determinants of health (SDOH) are nonclinical, socioeconomic conditions that influence patient health and quality of life. Identifying SDOH may help clinicians target interventions. However, SDOH are more frequently available in narrative notes compared to structured electronic health records. The 2022 n2c2 Track 2 competition released clinical notes annotated for SDOH to promote development of NLP systems for extracting SDOH. We developed a system addressing 3 limitations in state-of-the-art SDOH extraction: the inability to identify multiple SDOH events of the same type per sentence, overlapping SDOH attributes within text spans, and SDOH spanning multiple sentences.

Materials and Methods

We developed and evaluated a 2-stage architecture. In stage 1, we trained a BioClinical-BERT-based named entity recognition system to extract SDOH event triggers, that is, text spans indicating substance use, employment, or living status. In stage 2, we trained a multitask, multilabel NER to extract arguments (eg, alcohol “type”) for events extracted in stage 1. Evaluation was performed across 3 subtasks differing by provenance of training and validation data using precision, recall, and F1 scores.

Results

When trained and validated on data from the same site, we achieved 0.87 precision, 0.89 recall, and 0.88 F1. Across all subtasks, we ranked between second and fourth place in the competition and always within 0.02 F1 from first.

Conclusions

Our 2-stage, deep-learning-based NLP system effectively extracted SDOH events from clinical notes. This was achieved with a novel classification framework that leveraged simpler architectures compared to state-of-the-art systems. Improved SDOH extraction may help clinicians improve health outcomes.
Recent trends of characteristics and treatments in adults with newly diagnosed brain metastases
Authors: Koide Yutaro , Nagai Naoya , Miyauchi Risei , Kitagawa Tomoki , Aoyama Takahiro , Shimizu Hidetoshi , Hashimoto Shingo , Tachibana Hiroyuki , Kodaira Takeshi
Published: April 2023

Objective

We aimed to evaluate recent trends in characteristics and treatments among patients with brain metastases in clinical practice.

Methods

All newly diagnosed patients with brain metastases during 2016–2021 at a single cancer center were enrolled. We collected the detailed features of each patient and estimated the number of candidates considered to meet the following criteria used in common clinical trials: Karnofsky performance status ≥ 70 and mutated non-small cell lung cancer, breast cancer or melanoma. The brain metastases treatments were classified as follows: (i) stereotactic radiosurgery, (ii) stereotactic radiosurgery and systemic therapy, (iii) whole-brain radiotherapy, (iv) whole-brain radiotherapy and systemic therapy, (v) surgery, (vi) immune checkpoint inhibitor or targeted therapy, (vii) cytotoxic agents and (ix) palliative care. Overall survival and intracranial progression-free survival were estimated from brain metastases diagnosis to death or intracranial progression.

Results

A total of 800 brain metastases patients were analyzed; 597 (74.6%) underwent radiotherapy, and 422 (52.7%) underwent systemic therapy. In addition, 250 (31.3%) patients were considered candidates for common clinical trials. Compared to 2016, the later years tended to shift from whole-brain radiotherapy to stereotactic radiosurgery (whole-brain radiotherapy: 35.7–29.1% and stereotactic radiosurgery: 33.4–42.8%) and from cytotoxic agents to immune checkpoint inhibitor/targeted therapy (cytotoxic agents: 10.1–5.0 and immune checkpoint inhibitor/targeted therapy: 7.8–10.9%). There was also an increase in the proportion of systemic therapy combined with radiation therapy (from 26.4 to 36.5%). The median overall survival and progression-free survival were 12.7 and 5.3 months, respectively.

Conclusions

This study revealed the diversity of brain metastases patient characteristics, recent changes in treatment selection and the percentage of candidates in clinical trials.
A stress disturbance barrier on a circular torque tube blocking the end effects
Authors: Wang Chung-Hao
Published: April 2023

Knowing that the end effects arising from the end torsional loads will disturb the stress distribution in a torque tube, this paper develops a means of blocking the stress disturbances from the end where a torsional load is applied, such that the stress distributions of the Saint-Venant torsion can be maintained. The stress disturbance barrier (SDB) as an end effect shielding barrier is considered installed on an end of a circular toque tube whose material property can be with the cylindrical orthotropy. In general, the SDB is comprised of two layers: the front layer and the blocking layer. The front layer, which is optional and directly contacted with the external load, is for enhancing the durability, while the blocking layer situated between the front layer and the torque tube body is mainly for blocking the stress disturbances. The analysis is based on the state-space formalism, whose uncoupling feature on cylindrically orthotropic materials is beneficial for the further extension of the research. It is found that the parameters crucial to determine an effective SDB with a given thickness are the cylindrical orthotropy parameter and the longitudinal shear modulus. The approach of how to determine the proper material constants for having an effective SDB is clearly provided. As shown by the numerical results presented in the examples, an effective SDB of this research can fully block the stress disturbances from the external torsional loads that can be mathematically expanded by power series.