bluuebunny/crossref_metadata_2025 huggingface dataset:
An anthropomorphic pelvis phantom for MR‐guided prostate interventions
Authors: Bauer Dominik F. , Adlung Anne , Brumer Irène , Golla Alena‐Kathrin , Russ Tom , Oelschlegel Eva , Tollens Fabian , Clausen Sven , Aumüller Philipp , Schad Lothar R. , Nörenberg Dominik , Zöllner Frank G.
Published: October 2021

Purpose

To design and manufacture a pelvis phantom for magnetic resonance (MR)‐guided prostate interventions, such as MRGB (MR‐guided biopsy) or brachytherapy seed placement.

Methods

The phantom was designed to mimic the human pelvis incorporating bones, bladder, prostate with four lesions, urethra, arteries, veins, and six lymph nodes embedded in ballistic gelatin. A hollow rectum enables transrectal access to the prostate. To demonstrate the feasibility of the phantom for minimal invasive MRI‐guided interventions, a targeted inbore MRGB was performed. The needle probe was rectally inserted and guided using an MRI‐compatible remote controlled manipulator (RCM).

Results

The presented pelvis phantom has realistic imaging properties for MR imaging (MRI), computed tomography (CT) and ultrasound (US). In the targeted inbore MRGB, a prostate lesion was successfully hit with an accuracy of 3.5 mm. The experiment demonstrates that the limited size of the rectum represents a realistic impairment for needle placements.

Conclusion

The phantom provides a valuable platform for evaluating the performance of MRGB systems. Interventionalists can use the phantom to learn how to deal with challenging situations, without risking harm to patients.
Dual demise following laser surgery for twin‐twin transfusion syndrome: Analysis of 52 cases at a single fetal surgery center
Authors: Youssefzadeh Ariane C. , Glassen Gabrielle L. , Chon Andrew H. , Korst Lisa M. , Esakoff Tania F. , Afshar Yalda , Gheorghe Ciprian P. , Llanes Arlyn , Chmait Ramen H.
Published: October 2021

Objective

To evaluate all individual cases of dual twin demise following laser surgery for twin‐twin transfusion syndrome (TTTS).

Method

This is an analysis of all monochorionic diamniotic twin gestations with TTTS complicated by dual demise following laser surgery from 2006 to 2019. Cases were reviewed by (1) a fetal surgeon researcher and (2) a panel of independent experienced maternal‐fetal medicine specialists to code an etiology of demise for the donor and recipient, and to assess for possible preventability.

Results

Of 753 twins that underwent laser surgery for TTTS, 52 (6.9%) had postoperative dual demise. In this subgroup, gestational age at surgery was 19.5 (16.1–24.9) weeks, and 36 (69.2%) patients were Quintero stage III and IV. The most common etiology was the spectrum of disorders leading to preterm delivery, which included cervical insufficiency, preterm premature rupture of membranes, and preterm labor (44.2% and 48.1%, donor and recipient, respectively). Some degree of preventability was estimated for 23.1% of dual demises.

Conclusions

The most common cause of dual demise post laser surgery for TTTS was preterm birth, reinforcing the need for studies regarding the etiology and prevention of post‐fetoscopy prematurity. Nearly one‐quarter of dual demise cases were deemed potentially preventable.
International use of N = 1 research design with secondary students with disabilities
Authors: Hu Xiaoyi , Wilczynski Susan M. , Ma Yongqiang , Jin Ning
Published: October 2021

Schools must accurately implement effective interventions targeting deficits and/or learning challenges for secondary school‐aged students with disabilities to fulfill their responsibility of preparing students for life after high school. School psychologists supporting this mission may be frustrated by the limited research conducted with secondary students. This study is designed to describe the evidence base for interventions used with secondary school students by relying on N = 1 research design studies. N = 1 research design can establish a functional relationship between the independent and dependent variable(s) and allows for the complexity of real world intervention implementation as experienced by practicing school psychologists, making N = 1 an ideal research base on which to make practical decisions in secondary schools. Although interventions increased secondary school‐aged students' performance across studies, not enough well‐designed studies were conducted across research groups for any specific intervention (i.e., meeting the minimum criteria established by What Works Clearinghouse) at the secondary school level. As a result, school psychologists will need to rely heavily on their professional judgment when combining the best available evidence with client and contextual variables to make individualized decisions for secondary school students. An application of this evidence‐based practice decision‐making model for a secondary student is provided.
Protein Data Bank Japan: Celebrating our 20th anniversary during a global pandemic as the Asian hub of three dimensional macromolecular structural data
Authors: Bekker Gert‐Jan , Yokochi Masashi , Suzuki Hirofumi , Ikegawa Yasuyo , Iwata Takeshi , Kudou Takahiro , Yura Kei , Fujiwara Toshimichi , Kawabata Takeshi , Kurisu Genji
Published: October 2021

Protein Data Bank Japan (PDBj), a founding member of the worldwide Protein Data Bank (wwPDB) has accepted, processed and distributed experimentally determined biological macromolecular structures for 20 years. During that time, we have continuously made major improvements to our query search interface of PDBj Mine 2, the BMRBj web interface, and EM Navigator for PDB/BMRB/EMDB entries. PDBj also serves PDB‐related secondary database data, original web‐based modeling services such as Homology modeling of complex structure (HOMCOS), visualization services and utility tools, which we have continuously enhanced and expanded throughout the years. In addition, we have recently developed several unique archives, BSM‐Arc for computational structure models, and XRDa for raw X‐ray diffraction images, both of which promote open science in the structural biology community. During the COVID‐19 pandemic, PDBj has also started to provide feature pages for COVID‐19 related entries across all available archives at PDBj from raw experimental data and PDB structural data to computationally predicted models, while also providing COVID‐19 outreach content for high school students and teachers.
Structural and biochemical studies of an iterative ribosomal peptide macrocyclase
Authors: Li Gengnan , Patel Krishna , Zhang Yi , Pugmire Jackson K. , Ding Yousong , Bruner Steven D.
Published: October 2021

Microviridins, tricyclic peptide natural products originally isolated from cyanobacteria, function as inhibitors of diverse serine‐type proteases. Here we report the structure and biochemical characterization of AMdnB, a unique iterative macrocyclase involved in a microviridin biosynthetic pathway from Anabaena sp. PCC 7120. The ATP‐dependent cyclase, along with the homologous AMdnC, introduce up to nine macrocyclizations on three distinct core regions of a precursor peptide, AMdnA. The results presented here provide structural and mechanistic insight into the iterative chemistry of AMdnB. In vitro AMdnB‐catalyzed cyclization reactions demonstrate the synthesis of the two predicted tricyclic products from a multi‐core precursor peptide substrate, consistent with a distributive mode of catalysis. The X‐ray structure of AMdnB shows a structural motif common to ATP‐grasp cyclases involved in RiPPs biosynthesis. Additionally, comparison with the noniterative MdnB allows insight into the structural basis for the iterative chemistry. Overall, the presented results provide insight into the general mechanism of iterative enzymes in ribosomally synthesized and post‐translationally modified peptide biosynthetic pathways.
Mist Chemical Vapor Deposition Growth of α‐In2O3 Films Using Indium Oxide Powder as Source Precursor
Authors: Taguchi Akito , Takahashi Subaru , Sekiguchi Atsushi , Kaneko Kentaro , Fujita Shizuo , Onuma Takeyoshi , Honda Tohru , Yamaguchi Tomohiro
Published: October 2021

The epitaxial growth of α‐In2O3 films by mist chemical vapor deposition (mist CVD) using In2O3 powder as a source precursor is conducted. To prepare the source precursor solution, the In2O3 powder is first dissolved in HCl aqueous solution. The concentrations of HCl in the source precursor solution are then adjusted to be between 0.82 and 2.3 mol L−1 by adding deionized water. An enhancement in α‐In2O3 phase formation and increases in its grain size and thickness are observed with increasing HCl concentration. A pure α‐In2O3 film grown using a source precursor solution with 1.2 mol L−1 of HCl shows a residual electron concentration of 8.4 × 1017 cm−3 and electron Hall mobility of 216 cm2 V−1s−1.
Structure, Stability, Properties, and Application of Atomically Thin Coinage Metal Flatland in Graphene Pore: A Density Functional Theory Calculation
Authors: Sangolkar Akanksha Ashok , Pawar Ravinder
Published: October 2021

2D metals are emerging materials in the 2D nanomaterials family and a rapid development is seen in the past few years. The properties of material that play a crucial role to determine their application in various fields need to be explored. Herein, a patch consisting of seven to nine coinage metal (Cu, Ag, and Au) atoms is created in the pore of graphene. Electronic properties, work function, and the interaction energy using periodic energy decomposition analysis (pEDA) of the materials are calculated using density functional theory (DFT). Carbon monoxide (CO) adsorption studies on these surfaces are also performed. All the metal atoms are found to align themselves in hexagonal arrangement in the graphene pore. All the materials with an exception of eight‐Au‐patched graphene are found to be metallic. The eight‐Au‐patched graphene is a low bandgap semiconductor exhibiting a direct bandgap of 0.23 eV. CO molecule adsorbs strongly on Cu‐patched surfaces in comparison to Ag‐ and Au‐patched surfaces. The interaction energy of CO is observed to be higher on seven‐Cu‐patched graphene as compared with Ag‐ and Au‐patched graphene.
Autoimmune pulmonary alveolar proteinosis with a history of vaping and vitamin E‐positive bronchoalveolar lavage
Authors: Chua Tzy Harn , Takano Angela , Yao Yi Ju , Chow Sau Yee , Devanand Anantham , Tay Chee Kiang
Published: October 2021

Pulmonary alveolar proteinosis (PAP) can be due to primary autoimmune and secondary causes, including e‐cigarette, or vaping, product use‐associated lung injury. We present a 33‐year‐old male presenting with PAP and a history of vaping. Serum anti‐granulocyte‐macrophage colony‐stimulating factor antibodies were present. Vitamin E (VE), but not VE acetate, was detected in bronchoalveolar lavage. This is the first report of potential association between vaping and autoimmune PAP.
Anti‐MDA5 antibody‐positive clinically amyopathic dermatomyositis with diffuse alveolar damage diagnosed by transbronchial lung cryobiopsy: A case report
Authors: Ishihara Hiroyuki , Kataoka Kensuke , Takei Reoto , Yamano Yasuhiko , Yokoyama Toshiki , Matsuda Toshiaki , Kimura Tomoki , Fukuoka Junya , Johkoh Takeshi , Kondoh Yasuhiro
Published: October 2021

Diffuse alveolar damage (DAD) is known to be a pathological hallmark of acute respiratory distress syndrome or acute interstitial pneumonia, and to have a poor prognosis. We report a case of anti‐melanoma differentiation‐associated gene 5 (MDA5) antibody‐positive clinically amyopathic dermatomyositis (CADM) with rapidly progressive interstitial lung disease (RP‐ILD), in which DAD was confirmed by transbronchial lung cryobiopsy at an early stage without respiratory failure. Although this patient initially did not show respiratory failure, his respiratory condition gradually worsened despite intensive immunosuppression therapy and he died 3 months later. Therefore, the early pathological findings of DAD did not match the clinical picture, which showed no respiratory failure. However, these findings were consistent with the subsequent course and poor outcome. Histological DAD, even in the absence of respiratory failure, may indicate a subsequent poor prognosis and explain the refractory course of RP‐ILD with anti‐MDA5 antibody‐positive CADM.
Encapsulating Fe2O3 Nanotubes into Carbon‐Coated Co9S8 Nanocages Derived from a MOFs‐Directed Strategy for Efficient Oxygen Evolution Reactions and Li‐Ions Storage
Authors: Huang Shoushuang , Jin Zhiqiang , Ding Yanwei , Ning Ping , Chen Qiaochuan , Fu Jie , Zhang Qian , Zhang Jie , Xin Peijun , Jiang Yong , Hu Zhangjun
Published: October 2021

The development of high‐efficiency, robust, and available electrode materials for oxygen evolution reaction (OER) and lithium‐ion batteries (LIBs) is critical for clean and sustainable energy system but remains challenging. Herein, a unique yolk–shell structure of Fe2O3 nanotube@hollow Co9S8 nanocage@C is rationally prepared. In a prearranged sequence, the fabrication of Fe2O3 nanotubes is followed by coating of zeolitic imidazolate framework (ZIF‐67) layer, chemical etching of ZIF‐67 by thioacetamide, and eventual annealing treatment. Benefiting from the hollow structures of Fe2O3 nanotubes and Co9S8 nanocages, the conductivity of carbon coating and the synergy effects between different components, the titled sample possesses abundant accessible active sites, favorable electron transfer rate, and exceptional reaction kinetics in the electrocatalysis. As a result, excellent electrocatalytic activity for alkaline OER is achieved, which delivers a low overpotential of 205 mV at the current density of 10 mA cm−2 along with the Tafel slope of 55 mV dec−1. Moreover, this material exhibits excellent high‐rate capability and excellent cycle life when employed as anode material of LIBs. This work provides a novel approach for the design and the construction of multifunctional electrode materials for energy conversion and storage.
Nanosilver‐Particles Integrated Ni3Sn2S2‐CoS Composite as an Advanced Electrode for High Energy Density Hybrid Cell
Authors: Sekhar S. Chandra , Ramulu Bhimanaboina , Arbaz Shaik Junied , Jin Sung Hun , Oh Hyung Suk , Yu Jae Su
Published: October 2021

An ion‐exchange process is a promising approach to design advanced electrode materials for high‐performance energy storage devices. Herein, a nanostructured Ni3Sn2S2‐CoS (NSS‐CS) composite is fabricated by successive hydrothermal and ion‐exchange processes. Since the incorporation of redox‐rich cobalt element enables the NSS‐CS composite to be more electrochemically active, its impact on the electrochemical performance is therefore extensively studied. Particularly, the NSS‐CS‐0.2 g electrode material delivered a high areal capacity of 830.4 µAh cm−2 at 5 mA cm−2. Additionally, a room‐temperature wet‐chemical approach is employed to anchor nanosilver (nAg)‐particles on the NSS‐CS‐0.2 g (nAg@NSS‐CS‐0.2 g) to further exalt its electrokinetics. Consequently, the nAg@NSS‐CS‐0.2 g electrode shows a higher areal capacity of 948.5 µAh cm−2 (193.5 mAh g−1) than that of the NSS‐CS‐0.2 g. Furthermore, its practicability is also examined by assembling a hybrid cell. The assembled hybrid cell delivers a high areal capacity of 969.2 µAh cm−2 (49.2 mAh g−1) at 7 mA cm−2 and maximum areal energies and power densities of 0.784 mWh cm−2 (40.8 Wh kg−1) and 45 mW cm−2 (2347.4 W kg−1), respectively. The efficiency of the hybrid cells is also tested by harvesting solar energy, followed by energizing electronic components. This work can pave the way for significant attraction in designing advanced electrodes for energy‐related fields.
Accelerated Isothermal Phase Transformation and Enhanced Mechanical Properties of Railway Wheel Steel: The Significant Role of Pre‐Existing Bainite
Authors: Gao Bo , Tan Zhunli , Tian Yu , Liu Yanru , Wang Rui , Gao Guhui , Wang Jiong , Zhang Min
Published: October 2021

Exploring possible ways to accelerate bainite transformation kinetics and enhance mechanical properties, especially for large‐scale parts, attracted much attention both in industrial manufacturing and fundamental research. Herein, prior continuous cooling transformed bainite is introduced to promote isothermal transformation and improve strength toughness matching of bainite railway wheel steel. Phase transformation study by dilatometer indicates that the time–temperature–transformation curves of tested steel swing back at lower isothermal temperature. This acceleration effect is due to the formation of leaf‐shaped bainite at initial isothermal transformation stage. By tailoring the cooling rate, leaf‐shaped bainite can also be obtained during continuous cooling. It is confirmed that the formation of leaf‐shaped bainite during continuous cooling stage accelerates the subsequently isothermal bainite transformation. In situ microstructure evolution observation demonstrates that prior bainite/ austenite interface provides favorable nucleation site for initial isothermal bainite transformation. Moreover, pre‐existing bainite formed during continuous cooling stage can effectively divide the original austenite grain size. Concurrent enhancement of tensile strength and impact toughness in bainite wheel steel can be achieved by controlling the cooling rate.
Impact of Flow Boiling on Blast Furnace Tuyere Life: A Designer's Perspective
Authors: Chatterjee Rajeswar , Nag Samik , Kundu Subhashis , Ghosh Ujjal , Singh Uttam , Chandra Sanjay
Published: October 2021

Water‐cooled copper tuyeres of blast furnace are subjected to intense thermal conditions. Several modifications are attempted to prevent tuyere failure as the impact of failure is severe. What has, however, gone unnoticed is the peak “Cold face” temperature in tuyere and its implication. Numerical model incorporating water flow and conjugate heat transfer with a feature to identify onset of boiling by analytical correlations is developed. It is ascertained that, in tuyeres, the temperature of the Cold face exceeds the saturation temperature at the prevailing pressure by an amount high enough to cause nucleate boiling. The implication of the onset of boiling is discussed and a design modification is suggested by changing the aspect ratio of cooling passage. The impact of velocity distribution to achieve lower peak “Cold face” temperature is discussed. Modified design shows almost zero boiling prone zone for the range of operating parameters studied. Fourteen modified tuyeres are placed alongside original designed tuyeres in an blast furnace. The newly designed tuyeres outperform their counterparts. This approach to identifying and suppressing boiling of water in the cooling channel—a hitherto neglected phenomenon—gives an additional input towards designing a more robust tuyere.
The topologically twisted index of $$ \mathcal{N} $$ = 4 SU(N) Super-Yang-Mills theory and a black hole Farey tail
Authors: Hong Junho
Published: October 2021

Abstract

We investigate the large-N asymptotics of the topologically twisted index of $$ \mathcal{N} $$
N
= 4 SU(N) Super-Yang-Mills (SYM) theory on T2 × S2 and provide its holographic interpretation based on the black hole Farey tail [1]. In the field theory side, we use the Bethe-Ansatz (BA) formula, which gives the twisted index of $$ \mathcal{N} $$
N
= 4 SYM theory as a discrete sum over Bethe vacua, to compute the large-N asymptotics of the twisted index. In a dual $$ \mathcal{N} $$
N
= 2 gauged STU model, we construct a family of 5d extremal solutions uplifted from the 3d black hole Farey tail, and compute the regularized on-shell actions. The gravitational partition function given in terms of these regularized on-shell actions is then compared with a canonical partition function derived from the twisted index by the inverse Laplace transform, in the large-N limit. This extends the previous microstate counting of an AdS5 black string by the twisted index and thereby improves holographic understanding of the twisted index.
Adjuvant use of melatonin for pain management in dysmenorrhea — a randomized double-blinded, placebo-controlled trial
Authors: Söderman Lisa , Edlund Måns , Böttiger Ylva , Marions Lena
Published: October 2021

Purpose

Dysmenorrhea is a common, recurring, painful condition with a global prevalence of 71%. The treatment regime for dysmenorrhea includes hormonal therapies and NSAID, both of which are associated with side effects.

A dose of 10 mg melatonin daily has previously been shown to reduce the level of pelvic pain in women with endometriosis. We chose to investigate how this regime, administered during the week of menstruation, would affect women with dysmenorrhea but without any signs of endometriosis, as adjuvant analgesic treatment.

Methods

Forty participants with severe dysmenorrhea were randomized to either melatonin or placebo, 20 in each group. Our primary outcome was pain measured with numeric rating scale (NRS); a difference of at least 1.3 units between the groups was considered clinically significant. Secondary outcomes were use of analgesics, as well as absenteeism and amount of bleeding. Mixed model was used for statistical analysis.

Results

Eighteen participants completed the study in the placebo group and 19 in the melatonin group. Mean NRS in the placebo group was 2.45 and 3.18 in the melatonin group, which proved to be statistically, although not clinically significant.

Conclusion

This randomized, double-blinded, placebo-controlled trial could not show that 10 mg of melatonin given orally at bedtime during the menstrual week had better analgesic effect on dysmenorrhea as compared with placebo. However, no adverse effects were observed.

Clinical trials

NCT03782740 registered on 17 December 2018.
Phytotoxic Effects of Antibiotics on Terrestrial Crop Plants and Wild Plants: A Systematic Review
Authors: Carballo Matilde , Rodríguez Antonio , de la Torre Ana
Published: October 2021

This review examines the state of knowledge on the phytotoxic effects of antibiotics on terrestrial crop plants and wild (non-crop) plants with the goal of evaluating differences in their sensitivity. This is important because environmental risk assessments of antibiotics currently consider their potential effects only on crop species but not wild species. Overall, we analysed 275 datasets consisting of antibiotic-plant species-endpoint combinations for germination (mg/L) and 169 datasets for plant growth (elongation and biomass) (mg/kg). EC10 and EC50 of each parameter were compared using a quotient approach, in which the geometric mean and the 5th percentile of the crop data were divided by wild data. Quotients were > 1 for elongation growth, suggesting that wild species were more sensitive than crops, while they were < 1 for biomass growth, suggesting quite the contrary. However, < 1% of the data in each dataset came from wild species, preventing definitive conclusions. Merging crop and wild data to evaluate differences in sensitivity among classes of antibiotics and plant families, we found using a linear mixed effect model and post hoc test that plants were most sensitive to phenicol and least sensitive to macrolides and tetracyclines. Further work must be conducted to gain a better understanding of the phytotoxic effects of antibiotics on terrestrial wild plants and subsequently assess whether the current approach to environmental risk assessment of antibiotics is sufficient to protect plant biodiversity.
Urbanisation weakens selection on the timing of breeding and clutch size in blue tits but not in great tits
Authors: Branston Claire J. , Capilla-Lasheras Pablo , Pollock Christopher J. , Griffiths Kate , White Stewart , Dominoni Davide M.
Published: October 2021

Urbanisation is a globally occurring phenomenon and is predicted to continue increasing rapidly. Urban ecosystems present novel environments and challenges which species must acclimate or adapt to. These novel challenges alter existing or create new selection pressures on behaviours which provide an opportunity to investigate eco-evolutionary responses to contemporary environmental change. We used 7 years of breeding data from urban and forest populations of blue and great tits to understand whether selection for timing of breeding or clutch size differed between the two habitats and species. We found that urban great tits laid eggs earlier than their forest counterparts, but there was no evidence of a difference in selection for earlier breeding. Blue tits, however, did not differ in timing of egg laying between the two habitats, but selection for earlier laying was weaker in the urban environment. Both species laid smaller clutches in the urban site and had positive selection for larger clutch sizes which did not differ in strength for the great tits but did for blue tits, with weaker selection in the urban population. Our results suggest that food availability for nestlings may be constraining urban birds, and that the temporal cues females use to time breeding correctly, such as tree budburst and food availability, may be absent or reduced in urban areas due to lower caterpillar availability. These results have implications for our understanding of the adaptation of wild animals to city life.

Significance statement

Urbanisation is expanding rapidly and changing the environment many species live in. A key challenge is to understand how species adapt to the urban environment, why some species can adapt, why others cannot and what we can do to ensure that cities are ecologically sustainable and biodiversity rich. Here we show that the strength of natural selection for early breeding and larger clutch size is weaker in urban than non-urban blue tits, likely due to reduced and irregular availability of natural insect food in urban areas. This effect was not found in great tits. Thus, urbanisation can alter the selection pressures wild animals are exposed to, but this effect may differ between species, even when closely related. This has implications for our understanding of how species adapt to urban life.
Long‐Term Impact of a Low‐Cost Paediatric Intussusception Air Enema Reduction Simulation‐Based Education Programme in a Low‐Middle Income Country
Authors: Nataraja R. M. , Yin Mar Oo  , Ljuhar D. , Pacilli M. , Nyo Nyo Win  , Stevens S. , Aye Aye  , Nestel D.
Published: October 2021

Introduction

Intussusception is one of the commonest causes of bowel obstruction in infants. Most infants in Low‐ and Middle‐Income Countries (LMICs) undergo an invasive operative intervention. Supported by simulation‐based education (SBE), the Air Enema (AE) non‐operative technique was introduced in 2016 in Myanmar. This study assesses the long‐term outcomes.

Methods

Mixed methods study design over 4 years including clinical outcomes and surgeon's attitudes towards the AE technique and SBE. Prospectively collected clinical outcomes and semi‐structured interview with reflexive thematic analysis (RTA). Primary outcome measure was a long‐term shift to non‐operative intervention. Secondary outcomes: Length of Stay (LoS), recurrence rates, intestinal resection rates, compared to the operative group. The data was analysed according to intention to treat. Quantitative data analysis with Mann–Whitney U test, Fisher's exact test, Student's T‐Test or Wilcoxon Signed‐Rank Test utilised. A p‐value of <.05 was considered significant.

Results

A total of 311 infants with intussusception were included. A sustained shift to AE was revealed with high success rates (86.1–91.2%). AE had a reduced LoS (4 vs. 7 days p ≤ 0.0001), Duration of Symptoms (DoS) was lower with AE (1.9/7 vs. 2.5/7, p = 0.002). Low recurrence rates (0–5.8%) and intestinal resection rates stabilised at 30.5–31.8% vs.15.3% pre‐intervention. Four RTA themes were identified: Expanding conceptions of healthcare professional education and training; realising far reaching advantages; promoting critical analysis and reflective practice of clinicians; and adapting clinical practice to local context. RTA revealed an overall positive paradigm shift in attitudes and application of SBE.

Conclusions

A sustained change in clinical outcomes and appreciation of the value of SBE was demonstrated following the intervention.
Half-dose glucarpidase as efficient rescue for toxic methotrexate levels in patients with acute kidney injury
Authors: Heuschkel Sandra , Kretschmann Theresa , Teipel Raphael , von Bonin Simone , Richter Stephan , Quick Susanne , Alakel Nael , Röllig Christoph , Balaian Ekaterina , Kroschinsky Frank , Knoth Holger , Bornhäuser Martin , von Bonin Malte
Published: October 2021

Purpose

High-dose methotrexate (HDMTX)-associated acute kidney injury with delayed MTX clearance has been linked to an excess in MTX-induced toxicities. Glucarpidase is a recombinant enzyme that rapidly hydrolyzes MTX into non-toxic metabolites. The recommended dose of glucarpidase is 50 U/kg, which has never been formally established in a dose finding study in humans. Few case reports, mostly in children, suggest that lower doses of glucarpidase might be equally effective in lowering MTX levels.

Methods

Seven patients with toxic MTX plasma concentrations following HDMTX therapy were treated with half-dose glucarpidase (mean 25 U/kg, range 17–32 U/kg). MTX levels were measured immunologically as well as by liquid chromatography–mass spectrometry (LC–MS). Toxicities were assessed according to National Cancer Institute—Common Terminology Criteria for Adverse Events (CTCAE) v5.0.

Results

All patients experienced HDMTX-associated kidney injury (median increase in creatinine levels within 48 h after HDMTX initiation compared to baseline of 251%, range 80–455%) and showed toxic MTX plasma concentrations (range 3.1–182.4 µmol/L) before glucarpidase injection. The drug was administered 42–70 h after HDMTX initiation. Within one day after glucarpidase injection, MTX plasma concentrations decreased by ≥ 97.7% translating into levels of 0.02–2.03 µmol/L. MTX rebound was detected in plasma 42–73 h after glucarpidase initiation, but concentrations remained consistent at < 10 µmol/L.

Conclusion

Half-dose glucarpidase seems to be effective in lowering MTX levels to concentrations manageable with continued intensified folinic acid rescue.
A score appraising Paleolithic diet and the risk of cardiovascular disease in a Mediterranean prospective cohort
Authors: de la O Víctor , Zazpe Itziar , Goni Leticia , Santiago Susana , Martín-Calvo Nerea , Bes-Rastrollo Maira , Martínez J. Alfredo , Martínez-González Miguel Á. , Ruiz-Canela Miguel
Published: October 2021

Purpose

To assess the association between a score appraising adherence to the PaleoDiet and the risk of cardiovascular disease (CVD) in a Mediterranean cohort.

Methods

We included 18,210 participants from the Seguimiento Universidad de Navarra (SUN) cohort study. The PaleoDiet score comprised six food groups promoted within this diet (fruit, nuts, vegetables, eggs, meat and fish) and five food groups whose consumption is discouraged (cereals and grains, dairy products, legumes, culinary ingredients, and processed/ultra-processed foods). CVD was defined as acute myocardial infarction with or without ST elevation, non-fatal stroke and cardiovascular death. Cox proportional hazards models adjusted for potential confounders were fitted to assess the association between the PaleoDiet score and CVD risk, and the PaleoDiet and MedDiet indices to explore differences between both diets.

Results

During 12.2 years of follow-up, 165 incident CVD cases were confirmed. A significant inverse association was found between the PaleoDiet score and CVD (HR Q5 vs. Q1: 0.45, 95% CI 0.27–0.76, P for trend = 0.007). A weaker association that became non-significant was observed when the item for low consumption of ultra-processed foods was removed from the score. Joint analysis of PaleoDiet and MedDiet Trichopoulou scores suggested that the inverse association between PaleoDiet and CVD was mainly present when adherence to the MedDiet was also high (HR for high adherence vs low adherence to both diet scores: 0.22, 95% CI 0.08–0.64).

Conclusions

Our findings suggest that the PaleoDiet may have cardiovascular benefits in participants from a Mediterranean country. Avoidance of ultra-processed foods seems to play a key role in this inverse association.
Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results
Authors: Bamiou Doris-Eva , Kikidis Dimitris , Bibas Thanos , Koohi Nehzat , Macdonald Nora , Maurer Christoph , Wuyts Floris L. , Ihtijarevic Berina , Celis Laura , Mucci Viviana , Maes Leen , Van Rompaey Vincent , Van de Heyning Paul , Nazareth Irwin , Exarchos Themis P. , Fotiadis Dimitrios , Koutsouris Dimitrios , Luxon Linda M.
Published: October 2021

Background

Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data.

Aim

To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care.

Methods

Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (− DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the “gold standard” against which the + DSS, − DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated.

Results

One hundred ninety-four participants (age range 25–85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the − DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the − DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the − DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group.

Conclusion

There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care.

Trial registration number

NCT02704819 (clinicaltrials.gov).
Anti-VEGF therapies for age-related macular degeneration: a powerful tactical gear or a blunt weapon? The choice is ours
Authors: Lanzetta Paolo
Published: October 2021

Purpose

Blindness and vision loss are still frequent disabilities associated with a relevant impact on health care and quality of life, and a high economic burden. Supranational programs established by the World Health Organization (WHO), International Agency for the Prevention of Blindness (IAPB), and World Health Assembly (WHA) aim at reducing avoidable visual impairment. Age-related macular degeneration (AMD), diabetic retinopathy (DR), and other retinal diseases are well known causes of visual disability. Since more than a decade, intravitreal agents are available for the treatment of these diseases. The aim of this study is to review whether pharmacotherapy with anti-vascular endothelial growth factor (VEGF) drugs has led to a decrease in the prevalence of blindness with emphasis on AMD and different countries. A brief analysis of other factors correlated to changes in the rate of blindness is also presented.

Methods

PubMed and Scopus web platforms were used to identify relevant studies on epidemiology of blindness and vision impairment, the influence of intravitreal therapies, and the existence of different vision care models. Additional data and material was searched in web internet accessed by the web browser Firefox.

Results

Age-standardized prevalence of blindness secondary to AMD has started to decline as testified by a number of studies in different countries. This is due to the adoption of anti-VEGF therapy and its adequate management. The frequency of treatment and regimens applied are indirect signs of successful treatment. Local rules and regulations may represent an obstacle.

Conclusions

This review shows that by implementing existing health care systems and dispensing adequate therapies in the field of retinal diseases, the prevalence of blindness due to these conditions can decline.
BINGO: brain-inspired learning memory
Authors: Chakraborty Prabuddha , Bhunia Swarup
Published: October 2021

Storage and retrieval of data in a computer memory play a major role in system performance. Traditionally, computer memory organization is ‘static’—i.e. it does not change based on the application-specific characteristics in memory access behaviour during system operation. Specifically, in the case of a content-operated memory (COM), the association of a data block with a search pattern (or cues) and the granularity (details) of a stored data do not evolve. Such a static nature of computer memory, we observe, not only limits the amount of data we can store in a given physical storage, but it also misses the opportunity for performance improvement in various applications. On the contrary, human memory is characterized by seemingly infinite plasticity in storing and retrieving data—as well as dynamically creating/updating the associations between data and corresponding cues. In this paper, we introduce BINGO, a brain-inspired learning memory paradigm that organizes the memory as a flexible neural memory network. In BINGO, the network structure, strength of associations, and granularity of the data adjust continuously during system operation, providing unprecedented plasticity and performance benefits. We present the associated storage/retrieval/retention algorithms in BINGO, which integrate a formalized learning process. Using an operational model, we demonstrate that BINGO achieves an order of magnitude improvement in memory access times and effective storage capacity using the CIFAR-10 dataset and the wildlife surveillance dataset when compared to traditional content-operated memory.
Endogenous growth factors and their empirical verification in the Colombian business context by applying fuzzy measurement techniques
Authors: Gómez-Caicedo Melva Inés , Gaitán-Angulo Mercedes , Quintero Anderson , Danna-Buitrago Jenny Paola
Published: October 2021

This paper centers on the role and economic effect of the factors that affect the endogenous growth of organizations. To this end, it analyzes the case of Colombian companies, whose economy has been characterized in Latin America by maintaining a traditional economic policy and sectors that seek to maximize the opportunities offered by international markets. This study seeks to identify and analyze the factors that influence the endogenous economic growth of organizations and that allow them to be sustainable over time. For this purpose, adaptation algorithms based on fuzzy logics and supervised and unsupervised learning methods were used, generating an adaptation strategy that allows classifying and knowing the endogenous growth of companies in the Colombian context and identifying the most relevant aspects to take into account. Finally, it was found that most Colombian companies focus their business policies on strengthening human capital, followed by innovation, financial resources and, to a lesser extent, strategic alliances.
Social implementation of a remote surgery system in Japan: a field experiment using a newly developed surgical robot via a commercial network
Authors: Morohashi Hajime , Hakamada Kenichi , Kanno Takahiro , Kawashima Kenji , Akasaka Harue , Ebihara Yuma , Oki Eiji , Hirano Satoshi , Mori Masaki
Published: October 2021

Purpose

In recent years, the expectations for telesurgery have grown with the development of robot-assisted surgical technology and advances in communication technology. To verify the feasibility of the social implementation of telesurgery, we evaluated the communication integrity, availability, and communication delay of robotic surgery by remote control under different communication conditions of commercial lines.

Methods

A commercial line was used to connect hospitals 150 km apart. We had prepared guaranteed-type lines (1Gbps, 10Mbps, 5Mbps) and best effort-type lines. Two types of robotic teleoperations were performed, and we evaluated the round-trip time (RTT) of communication, packet loss, and glass-to-glass time.

Results

The communication delay was 4 ms for the guaranteed-type line and 10 ms for the best effort-type line. Packet loss occurred on the 5 Mbps guaranteed-type line. The mean glass-to-glass time was 92 ms for the guaranteed-type line and 95 ms for the best effort-type line. There was no significant difference in the number of errors in the task according to the type of line or the bandwidth speed.

Conclusions

The social implementation of telesurgery using the currently available commercial communication network is feasible.
Soft tissue dimensional changes after alveolar ridge preservation using different sealing materials: a systematic review and network meta-analysis
Authors: Canullo Luigi , Pesce Paolo , Antonacci Donato , Ravidà Andrea , Galli Matthew , Khijmatgar Shahnawaz , Tommasato Grazia , Sculean Anton , Del Fabbro Massimo
Published: October 2021

Background

Alveolar ridge preservation (ARP) is a proactive treatment option aiming at attenuating post-extraction hard and soft tissue dimensional changes. A high number of different types of biomaterials have been utilized during ARP to seal the socket, but their effectiveness in terms of soft tissue outcomes has rarely been investigated and compared in the literature.

Objective

To evaluate the efficacy of different types of membranes and graft materials in terms of soft tissue outcomes (keratinized tissue width changes, vertical buccal height, and horizontal changes) after ARP, and to assign relative rankings based on their performance.

Materials and methods

The manuscript represents the proceedings of a consensus conference of the Italian Society of Osseointegration (IAO).

PUBMED (Medline), SCOPUS, Embase, and Cochrane Oral Health’s Information Specialist were utilized to conduct the search up to 06 April 2021. English language restrictions were placed and no limitations were set on publication date. Randomized controlled trials that report ARP procedures using different sealing materials, assessing soft tissue as a primary or secondary outcome, with at least 6-week follow‐up were included.

Network meta-analysis (NMA) was performed using mean, standard deviation, sample size, bias, and follow-up duration for all included studies. Network geometry, contribution plots, inconsistency plots, predictive and confidence interval plots, SUCRA (surface under the cumulative ranking curve) rankings, and multidimensional (MDS) ranking plots were constructed.

Results

A total of 11 studies were included for NMA. Overall, the level of bias for included studies was moderate. Crosslinked collagen membranes (SUCRA rank 81.8%) performed best in vertical buccal height (VBH), autogenous soft tissue grafts (SUCRA rank 89.1%) in horizontal width change (HWch), and control (SUCRA rank 85.8%) in keratinized mucosa thickness (KMT).

Conclusions

NMA confirmed that the use of crosslinked collagen membranes and autogenous soft tissue grafts represented the best choices for sealing sockets during ARP in terms of minimizing post-extraction soft tissue dimensional shrinkage.

Clinical relevance

Grafting materials demonstrated statistically significantly better performances in terms of soft tissue thickness and vertical buccal height changes, when covered with crosslinked collagen membranes. Instead, soft tissue grafts performed better in horizontal width changes. Non-crosslinked membranes and other materials or combinations presented slightly inferior outcomes.
Influence of microstructure and crystalline phases on impedance spectra of sodium conducting glass ceramics produced from glass powder
Authors: Kusnezoff Mihails , Wagner Dörte , Schilm Jochen , Heubner Christian , Matthey Björn , Lee Chang Woo
Published: October 2021

Crystallization of highly ionic conductive N5 (Na5YSi4O12) phase from melted Na3+3x-1Y1-xPySi3-yO9 parent glass provides an attractive pathway for cost-effective manufacturing of Na-ion conducting thin electrolyte substrates. The temperature-dependent crystallization of parent glass results in several crystalline phases in the microstructure (N3 (Na3YSi2O7), N5 and N8 (Na8.1Y Si6O18) phases) as well as in rest glass phase with temperature dependent viscosity. The electrical properties of dense parent glass and of compositions densified and crystallized at 700 °C, 800 °C, 900 °C, 1000 °C, and 1100 °C are investigated by impedance spectroscopy and linked to their microstructure and crystalline phase content determined by Rietveld refinement. The parent glass has high isolation resistance and predominantly electrons as charge carriers. For sintering at ≥ 900 °C, sufficient N5 phase content is formed to exceed the percolation limit and form ion-conducting pathways. At the same time, the highest content of crystalline phase and the lowest grain boundary resistance are observed. Further increase of the sintering temperature leads to a decrease of the grain resistance and an increase of grain boundary resistance. The grain boundary resistance increases remarkably for samples sintered at 1100 °C due to softening of the residual glass phase and wetting of the grain boundaries. The conductivity of fully crystallized N5 phase (grain conductivity) is calculated from thorough impedance spectra analysis using its volume content estimated from Rietveld analysis, density measurements and assuming reasonable tortuosity to 2.8 10−3 S cm−1 at room temperature. The excellent conductivity and easy processing demonstrate the great potential for the use of this phase in the preparation of solid-state sodium electrolytes.
Service Providers Perspectives on Personal Recovery from Severe Mental Illness in Cape Town, South Africa: A Qualitative Study
Authors: Gamieldien Fadia , Galvaan Roshan , Myers Bronwyn , Sorsdahl Katherine
Published: October 2021

Severe mental illnesses (SMI) contribute significantly to the global burden of disease. In low-and-middle-income countries (LMICs), the treatment gap impacts the clinical and personal recovery of people living with an SMI. The drive to reduce this treatment gap in LMICs makes it pertinent to understand service providers’ views on recovery from SMI. Semi-structured interviews and focus groups with service providers from health services and non-profit organisations in the Western Cape Province, South Africa, were conducted in this qualitative study. Seventeen participants were purposively selected, and data were thematically analysed. Three major themes emerged: delineating recovery, available services supporting recovery from SMI, and facilitators and barriers to recovery at the service level. Health services favoured clinical over personal recovery. Participants thought that many service users’ personal recovery from SMI was hindered by intersecting social, economic, cultural, and political inequalities that extended beyond the influence of the health sector.