bluuebunny/crossref_metadata_2025 huggingface dataset:
Hormonal regulation of glucose and system A amino acid transport in first trimester placental villous fragments
Authors: Ericsson Anette , Hamark Bengt , Jansson Nina , Johansson Bengt R. , Powell Theresa L. , Jansson Thomas
Published: November 2004

Alterations in placental nutrient transfer have been implicated in fetal growth abnormalities. In pregnancies complicated by diabetes and accelerated fetal growth, upregulations of glucose transporter 1 (GLUT1) and amino acid transporter system A have been shown in the syncytiotrophoblast of term placenta. In contrast, intrauterine growth restriction is associated with a downregulation of placental system A transporters. However, underlying mechanisms of transporter regulation are poorly understood, particularly in early pregnancy. In this study, hormonal regulation of placental glucose and system A transporters was investigated. The uptake of 3-O-[methyl-14C]-d-glucose was studied in villous fragments isolated from first trimester (6–13 wk of gestation) and term human placenta. Villous fragments were incubated in buffer containing insulin, leptin, cortisol, growth hormone (GH), prolactin, IGF-I, or under hypo/hyperglycemic conditions for 1 h. Subsequently, 3-O-[methyl-14C]-d-glucose uptake was measured with and without phloretin for 70 s in first trimester tissue and 20 s in term tissue. Methylaminoisobutyric uptake was measured with and without Na+ for 20 min. Glucose uptake was unaltered by hormones or hypo/hyperglycemia. GH decreased system A activity by 31% in first trimester ( P < 0.05). The uptake of glucose was 50% higher in term compared with first trimester fragments and increased markedly between 6 and 13 wk of gestation ( P < 0.05). We conclude that placental glucose transporter activity is not regulated by short exposures to the hormones or glucose concentrations tested. In contrast to term placental villous fragments, system A activity was not regulated by insulin or leptin in first trimester but was downregulated by GH.
Size Does Matter: Generation of Intrinsic Network Rhythms in Thick Mouse Hippocampal Slices
Authors: Wu Chiping , Luk Wah Ping , Gillis Jesse , Skinner Frances , Zhang Liang
Published: November 2004

Rodent hippocampal slices of ≤0.5 mm thickness have been widely used as a convenient in vitro model since the 1970s. However, spontaneous population rhythmic activities do not consistently occur in this preparation due to limited network connectivity. To overcome this limitation, we develop a novel slice preparation of 1 mm thickness from adult mouse hippocampus by separating dentate gyrus from CA3/CA1 areas but preserving dentate–CA3-CA1 connectivity. While superfused in vitro at 32 or 37°C, the thick slice exhibits robust spontaneous network rhythms of 1–4 Hz that originate from the CA3 area. Via assessing tissue O2, K+, pH, synaptic, and single-cell activities of superfused thick slices, we verify that these spontaneous rhythms are not a consequence of hypoxia and nonspecific experimental artifacts. We suggest that the thick slice contains a unitary circuitry sufficient to generate intrinsic hippocampal network rhythms and this preparation is suitable for exploring the fundamental properties and plasticity of a functionally defined hippocampal “lamella” in vitro.
The Mitochondrial Death Pathway and Cardiac Myocyte Apoptosis
Authors: Crow Michael T. , Mani Kartik , Nam Young-Jae , Kitsis Richard N.
Published: November 2004

Apoptosis has been causally linked to the pathogenesis of myocardial infarction and heart failure in rodent models. This death process is mediated by two central pathways, an extrinsic pathway involving cell surface receptors and an intrinsic pathway using mitochondria and the endoplasmic reticulum. Each of these pathways has been implicated in myocardial pathology. In this review, we summarize recent advances in the understanding of the intrinsic pathway and how it relates to cardiac myocyte death and heart disease.
Anglo-Indian Identity, Knowledge, and Power: Western Ballroom Music in Lucknow
Authors: Shope Bradley
Published: November 2004

From the 1920s to the 1940s, Anglo-Indians relished Western popular music. For this marginalized group, this music was a way of promoting respectability. And though the music mimicked styles from America and Europe, its celebration was distinctly local
Postconsumption Sewage Treatment in Environmental Systems Analysis of Foods
Authors: Sonesson Ulf , Jönsson Håkan , Mattsson Berit
Published: November 2004

Food in general has a high nutrient content, which essentially passes through the human organism and ends up in the sewage system. This high nutrient content in sewage, however, is rarely included in environmental systems analyses of food products or production systems. At the same time, several studies on sewage systems have shown the significance of plant nutrients in sewage system outlets. This means that important environmental effects may be neglected in environmental systems studies of food.

We present a method for including emissions that occur after food consumption in environmental systems analyses of foods. The method uses easily accessible input data to calculate the postconsumption emissions caused by certain food products.

The method was tested by completing the results for eutrophication from seven life‐cycle assessments (LCAs) on food products with the corresponding emissions caused by outlets from a sewage plant. The results showed that postconsumption eutrophication was a significant part of the products' total life‐cycle impact, ranging from 5.5% (beef) to 86% (apples).

The conclusion is that including postconsumption emissions is important for studies aiming at mapping a product's life cycle to find the most environmentally relevant parts, as well as for eco‐labeling purposes. If the purpose of the study is decision support, the postconsumption phase should be included where the decision affects this part of the system, otherwise not. When products are compared, postconsumption emissions should be included if their nutrient contents differ.
Barth and Asia: 'No Boring Theology'
Authors: Hoekema Alle
Published: November 2004

Karl Barth never visited Asia; yet through discussions with Asian students in Europe, correspondence with scholars in Asia, and visits by colleagues from that continent, he had a vast network of contacts as the Karl Barth Archives show. His earliest and most intensive contacts have been with Christians and others from Japan, such as the philosopher Katsumi Takizawa, with whom Barth maintained an intimate relationship through the years. In this article we describe and analyze these Asian contacts. Also, the author tries to evaluate upon which theological fields his work exerted influence in that continent and to indicate in which areas of thought he was influenced by Asians as well.
Missing School
Authors: Macdonald Robert , Marsh Jane
Published: November 2004

Qualitative research with socially excluded young people in a prime underclass locale is the basis for this examination of experiences of schooling in the shaping of youth transitions. Young people’s accounts of school disaffection were depressingly familiar. Explanations for persistent truancy—for missing school—related, in part, to powerful, (sub)cultural critiques of orthodox claims about the instrumental relevance of education. Paradoxically, in retrospect the majority missed school, in the sense that they wished they were still there, and many came to hold more instrumental views about education. This research suggests, however, that qualifications appeared to play a minor role in the shaping of overall transitions. The authors conclude that we cannot understand these contradictory, shifting orientations to the value of schooling without understanding the changing structures of opportunity that prevail for young people in different places and their fit with localized, class-cultural tastes and aspirations.
Assessing the Correctional Orientation of Corrections Officers in South Korea
Authors: Moon Byongook , Maxwell Sheila Royo
Published: November 2004

The correctional goal in South Korea has recently changed from the straightforward punishment of inmates to rehabilitation. Currently, emphases are being placed on education, counseling, and other treatment programs. These changes have consequently begun to also change the corrections officers’ roles from a purely custodial role to a human service role, in which officers are expected to manage rehabilitation and treatment programs. Despite these changes, few studies have examined the attitudes of corrections officers toward rehabilitation programming. This is an important dimension to examine in rehabilitation programming, as corrections officers play a major role in the delivery of institutional programs. This study examines the attitudes of South Korean corrections officers toward rehabilitation programs. Approximately 430 corrections officers were sampled. Results show that correctional attitudes are largely influenced by not only officers’ own motivations for joining corrections but also by institutional factors such as job stress. Policy implications are discussed.
Crime Scene Staging and Its Detection
Authors: Hazelwood Robert R. , Napier Michael R.
Published: November 2004

Crime scene staging is a recognized phenomenon within the criminal justice field. This article defines the occurrence for staging, identifies the motives for staging, and identifies the act that precipitated the staging. It reports the results of an exploratory survey of 20 well-versed and highly trained law enforcement officers’ experience with staging in fatal and nonfatal incidents, and it reports the most commonly observed forms of crime scene staging. Investigative strategies and indicators of staging are also presented.
Shaping Up Planet Earth
Authors: Korsmo Fae L.
Published: November 2004

The U.S. National Academy of Sciences played a major role in preparing for the International Geophysical Year (IGY). The IGY organizers realized the importance of selling U.S. participation in international science and thus began a public relations effort by the mid-1950s that included the production of classroom materials and a film series, called Planet Earth, designed for television. This is the story of their efforts to bring the earth, atmospheric, and oceanic sciences into the classrooms and living rooms of the lay public and attract more students into scientific careers. The lessons they learned still apply today as researchers attempt to sell their science using new media and technologies.
Using the Extended Parallel Process Model to Prevent Noise-Induced Hearing Loss Among Coal Miners in Appalachia
Authors: Murray-Johnson Lisa , Witte Kim , Patel Dhaval , Orrego Victoria , Zuckerman Cynthia , Maxfield Andrew M. , Thimons Edward D.
Published: November 2004

Occupational noise-induced hearing loss is the second most self-reported occupational illness or injury in the United States. Among coal miners, more than 90% of the population reports a hearing deficit by age 55. In this formative evaluation, focus groups were conducted with coal miners in Appalachia to ascertain whether miners perceive hearing loss as a major health risk and if so, what would motivate the consistent wearing of hearing protection devices (HPDs). The theoretical framework of the Extended Parallel Process Model was used to identify the miners’ knowledge, attitudes, beliefs, and current behaviors regarding hearing protection. Focus group participants had strong perceived severity and varying levels of perceived susceptibility to hearing loss. Various barriers significantly reduced the self-efficacy and the response efficacy of using hearing protection.
The structure of l∞ in some generalized Orlicz sequence spaces
Authors: Ewert J. , Lewandowska Z.
Published: November 2004

In this paper we consider the structure of l∞ in the modular sequence space T(A, {fn}) defined in [2]. We obtain the conditions when l∞ = T(A, {fn}). We prove that if l∞ ≠ T(A, {fn}), then the space l∞ is an Fσ, σ-strorigly porous set in T(A, {fn}).
Diffusion‐Influenced Fluorescence Quenching by Electron Transfer: The Effect of an External Electric Field
Authors: Bandyopadhyay Tusar , Ghosh Swapan K. , Tachiya Masanori
Published: November 2004

Diffusion‐assisted fluorescence quenching by electron transfer (ET) from a photoexcited electron donor to an acceptor in liquid solution in the presence of an external electric field is studied theoretically. The relevant reaction‐diffusion equation is solved by a numerical procedure based on an alternating direction‐implicit generalization of the finite difference method with implementation of the appropriate boundary conditions. Increasing the mobility of the reactants enhances the ET and therefore always reduces the fluorescence in any systems. Therefore, in the field‐reduced fluorescence system where the fluorescence is reduced by the field in the absence of diffusion, the fluorescence is further reduced by increasing the mobility, while in the originally field‐enhanced fluorescence system, the system is converted to the field‐reduced fluorescence system at high mobilities.
Superexchange Pathways in Charge Transfer through a DNA π‐Stack
Authors: Voityuk Alexander A. , Rösch Notker
Published: November 2004

We studied contributions of different electronic states of intervening bases to the superexchange interaction between donor and acceptor in single‐ and double‐strand DNA fragments with quantum chemistry calculations. Hole‐transfer pathways through thymine bases entailed substantial destructive interference whereas the influence of high‐lying electronic states of adenine turned out to be weak. Contributions of different superexchange pathways depended on the duplex conformation. For bridges of several base pairs, very many electronic states had to be taken into account to estimate properly the electronic coupling if the superexchange approach is broken down to the separate bridge units. From these results, we concluded that qualitative results on superexchange‐mediated couplings in DNA fragments can be obtained with only a few low‐lying virtual electronic states of the bridge (one or two states per nucleobase pair). However, reliable quantitative estimates of the coupling matrix element for hole transfer in DNA π‐stacks require summing the contributions of tens of bridge states.
Nonlinear Photoabsorption in Metallic Clusters
Authors: Gerchikov Leonid G. , Guet Claude , Ipatov Andrey N.
Published: November 2004

The optical response of simple metal clusters to strong laser fields should bear evidence of possible anharmonicities of dipole surface plasmon collective excitations. We present a theoretical method that allows one to calculate the excitation spectrum of sodium clusters beyond the linear response theory, including highly excited states with more than one plasmon. We make use of a coordinate transformation to separate center of mass (c.m.) and intrinsic motion of delocalized electrons. The coupling between c.m. motion and intrinsic excitations leads to some anharmonicity of the giant dipole oscillations. We calculate the photoabsorption spectrum of sodium clusters for increasing laser intensities and find sizeable anharmonic effects.
Remarks on Negative Heat Capacities of Clusters
Authors: Berry R. Stephen
Published: November 2004

The concept of negative heat capacities of clusters has been examined and argued. This discussion examines the arguments and concepts with the goal of clarifying the inherent ambiguities in the concept itself. We also show how one must use caution with this and related concepts that extend to nonequilibrium systems properties that are well defined just for equilibrium systems.
Smoking Status and Survival in Patients With Early-Stage Primary Cutaneous Melanoma
Authors: Jackson Katherine M. , Jones Peter C. , Fluke Laura M. , Fischer Trevan D. , Thompson John F. , Cochran Alistair J. , Stern Stacey L. , Faries Mark B. , Hoon Dave S. B. , Foshag Leland J.
Published: February 2024

Importance

While smoking is associated with a decreased incidence of cutaneous melanoma, the association of smoking with melanoma progression and death is not well defined.

Objective

To determine the association of smoking with survival in patients with early-stage primary cutaneous melanoma.

Design, Setting, and Participants

This cohort study performed a post hoc analysis of data derived from the randomized, multinational first and second Multicenter Selective Lymphadenectomy Trials (MSLT-I and MSLT-II). Participants were accrued for MSLT-I from January 20, 1994, to March 29, 2002; MSLT-II, from December 21, 2004, to March 31, 2014. Median follow-up was 110.0 (IQR, 53.4-120.0) months for MSLT-I and 67.6 (IQR, 25.8-110.2) months for MSLT-II. Patients aged 18 to 75 years with clinical stages I or II melanoma with a Breslow thickness of 1.00 mm or greater or Clark level IV to V and available standard prognostic and smoking data were included. Analyses were performed from October 4, 2022, to March 31, 2023.

Exposure

Current, former, and never smoking.

Main Outcomes and Measures

Melanoma-specific survival of patients with current, former, and never smoking status was assessed for the entire cohort and for nodal observation and among subgroups with sentinel lymph node biopsy (SLNB)–negative and SLNB-positive findings.

Results

Of 6279 included patients, 3635 (57.9%) were men, and mean (SD) age was 52.7 (13.4) years. The most common tumor location was an extremity (2743 [43.7%]), and mean (SD) Breslow thickness was 2.44 (2.06) mm. Smoking status included 1077 (17.2%) current, 1694 (27.0%) former, and 3508 (55.9%) never. Median follow-up was 78.4 (IQR, 30.5-119.6) months. Current smoking was associated with male sex, younger age, trunk site, thicker tumors, tumor ulceration, and SLNB positivity. Current smoking was associated with a greater risk of melanoma-associated death by multivariable analysis for the entire study (hazard ratio [HR], 1.48 [95% CI, 1.26-1.75]; P < .001). Former smoking was not. The increased risk of melanoma-specific mortality associated with current smoking was greatest for patients with SLNB-negative melanoma (HR, 1.85 [95% CI, 1.35-2.52]; P < .001), but also present for patients with SLNB-positive melanoma (HR, 1.29 [95% CI, 1.04-1.59]; P = .02) and nodal observation (HR, 1.68 [95% CI, 1.09-2.61]; P = .02). Smoking at least 20 cigarettes/d doubled the risk of death due to melanoma for patients with SLNB-negative disease (HR, 2.06 [95% CI, 1.36-3.13]; P < .001).

Conclusions and Relevance

The findings of this cohort study suggest that patients with clinical stage I and II melanoma who smoked had a significantly increased risk of death due to melanoma. Smoking status should be assessed at time of melanoma diagnosis and may be considered a risk factor for disease progression.
Bildgebung in der Kindertraumatologie/Kinderorthopädie
Authors: Slongo Theddy , Stranzinger Enno
Published: February 2024

Nach wie vor ist das konventionelle bzw. das digitale Röntgenbild die Grundlage der bildgebenden Diagnostik des Skelettsystems im Kindesalter. Es gilt als „Goldstandard“ in der Diagnostik, bei der Durchführung von Therapien sowie für Verlaufskontrollen. Ergänzend dazu sollen und können Verfahren wie Ultraschall, Computertomographie (CT), Magnetresonanztomographie (MRT), aber auch nuklearmedizinische Techniken eingesetzt werden. Es ist von Vorteil, dass in der Röntgendiagnostik von Kindern geschulte Radiologiefachpersonen eingesetzt werden. Im Falle von nicht spezifisch eingerichteten Kinderradiologien sollen zumindest die von Fachgesellschaften („as low as reasonable achievable“ [ALARA]) und Strahlenschutzkommissionen empfohlenen Richtlinien eingehalten werden. Es wird dargestellt, wie modernste Hilfsmittel wie Dosisüberwachungssysteme und Software-gesteuerte Bildbearbeitung und auch Nachbearbeitung sowie die verschiedenen Modalitäten optimal eingesetzt werden können, um mit möglichst geringem Aufwand und möglichst geringer Belastung für das Kind ein optimales Resultat, sprich Diagnostik, zu erreichen.
Patient satisfaction after elective implant removal of the lower extremity — a retrospective cohort study
Authors: Hambrecht Jan , Canal Claudio , Klingebiel Felix Karl-Ludwig , Köhli Paul , Neuhaus Valentin , Pape Hans-Christoph , Kalbas Yannik , Hierholzer Christian
Published: February 2024

Purpose

The topic of elective implant removal (IR) in healed fractures of the lower extremity remains controversial, particularly when unspecific symptoms of discomfort, which cannot be quantified, are the primary indication. This study aims to assess indications and outcomes of elective IR of the lower extremity, focusing on unspecific symptoms of discomfort and patient satisfaction postoperatively.

Materials and methods

The retrospective cohort study was conducted at a single level I academic trauma center. We included patients who underwent elective IR for healed fractures of the ankle, foot, patella, and proximal tibia from 2016 to 2021. All patients were followed-up for a minimum of 6 weeks after IR. Our outcomes of interest were patient satisfaction, complications, and alleviation of complaints.

Results

A total of 167 patients were included in the study. Unspecific symptoms of discomfort were the most common reason for IR in all investigated anatomical regions of the lower extremity (47.9%), followed by pain (43.1%) and limited range of motion (4.2%). 4.8% of patients experienced a combination of pain and range of motion limitation. Among all patients, 47.9% reported subjective improvement after IR. IRs based on unspecific symptoms of discomfort were significantly less likely to show alleviation of complaints after IR (27.5%, OR 0.19, p ≤ 0.01). Patients who reported limited range of motion (OR 1.7, p = 0.41) or pain (OR 6.0, p = 0) were significantly more likely to be satisfied after IR. Patients who reported sensitivity to cold weather also showed a decrease of complaints after IR (OR 3.6, p = 0.03). Major complications occurred in 2.1% of cases. The minor complication rate was 8.4% (predominantly impaired wound healing). Smoking patients showed a significantly higher risk of complications after IR (OR 5.2, p = 0.006). Persistent pain postoperatively was detected in 14.7%.

Conclusion

When elective IR for consolidated fractures of the lower extremity is primarily motivated by patients’ subjective symptoms of discomfort, the risk for postoperative dissatisfaction significantly increases. Objective symptoms on the other hand are associated with higher satisfaction after IR. While the procedure is generally safe, minor complications such as wound healing disorders can occur, especially in smokers. Patient education and well-documented informed consent are critical.
General practitioner consultations for mental health reasons prior to and following bereavement by suicide
Authors: Bélanger Sissel Marguerite , Hauge Lars Johan , Reneflot Anne , Øien-Ødegaard Carine , Christiansen Solveig Glestad , Magnus Per , Stene-Larsen Kim
Published: February 2024

Purpose

Prior research has shown that the majority of those bereaved by suicide express a need for mental health care services. However, there is a lack of knowledge about these individuals’ use of primary health care. The objective of our study was to estimate the association between suicide bereavement and general practitioner (GP) consultations for mental health reasons.

Methods

A population-wide, register-based cohort study identifying 25,580 individuals bereaved by suicide. Estimations of increases in consultation rate were modeled through individual fixed-effects linear analyses adjusted for age and time-period.

Results

Overall, 35% of those bereaved by suicide had a GP consultation for mental health reasons during the first 1–2 months, and 53% after two years. In the month immediately after bereavement by suicide, there was a large increase in the consultation rate with a GP for mental health reasons. In the months that followed, the consultation rate gradually decreased. One year after bereavement, the consultation rate stabilized at a somewhat higher level than before the death. The increase in consultation rate was evident across all kinship groups, and the increase was greatest for partners and smallest for siblings. Women had more contact with the GP before the suicide and a greater increase in contact than men.

Conclusion

Our findings suggest that many of those bereaved by suicide seek assistance from primary health care, and that some are in need of prolonged follow-up from the GP. Health governments should be aware of this and seek to strengthen the GPs knowledge of the needs and challenges associated with this patient group. Measures should also be taken to remove barriers to contact the health care system, especially for men and bereaved siblings.
Mechanical and microstructural characterization of Ti6Al4V lattice structures with and without solid shell manufactured via electron beam powder bed fusion
Authors: Cantaboni Francesco , Battini Davide , Hauber Keren Z. , Ginestra Paola S. , Tocci Marialaura , Avanzini Andrea , Ceretti Elisabetta , Pola Annalisa
Published: February 2024

The topological optimization of components by means of lattice structures allows to reduce their weight avoiding a loss in the mechanical performance. Often the lattice parts are integrated in a more complex geometry, and they present an interface with a solid part.

In the present paper, the mechanical and microstructural characterization of Ti6Al4V lattice structures with body-centered cubic unit cell was carried out. Samples with and without an external solid shell were designed and produced with electron beam powder bed fusion in order to investigate the behavior of these complex structures, especially at the interface between the solid and lattice parts. The microstructure and defects were analyzed, and compression tests were performed on the samples with and without solid shell to understand the influence of the solid part and its interaction with the lattice structure. After the fracture and detachment of the shell, the same behavior for both set of samples was observed.

Finally, a finite element model was defined to better understand the mechanical behavior of the investigated structures. The nominal sample stiffness was significantly higher than the experimental one. This discrepancy can be attributed to local defects, both in terms of porosities and deviations from ideal geometry.
Comparing AGS Beers 2019, STOPP version 2, and EU(7)-PIM list in Portuguese older adults in primary health care
Authors: Rodrigues Daniela A. , Herdeiro Maria Teresa , Mateos-Campos Ramona , Figueiras Adolfo , Roque Fátima
Published: February 2024

Purpose

This study aims to identify PIM prevalence in older adults according to the 2019 Beers criteria, Screening Tool of Older Person’s Prescriptions version 2 (STOPP v2) criteria, and the Portuguese EU(7)-PIM list and also to analyze the concordance between these criteria.

Methods

A retrospective study was conducted among 1200 Portuguese older adults (≥ 65 years old), users of primary health care. Demographic, clinical, and pharmacological data were collected concerning the period between April 2021 and August 2022. A comparative analysis was performed between the three PIM identification criteria, and the concordance was determined according to the Lin concordance correlation coefficient.

Results

The mean age was 76.3 (SD 7.7) years old and 57.6% of the older adults were females. Our findings indicate varying prevalence rates among these criteria with 63.8% (95% CI 61.0–66.6%), 66.8% (95% CI 64.1–69.5%), and 50.1% (95% CI 47.2–53.0%) of the older adults take at least one PIM according to the EU(7)-PIM list, Beers 2019, and STOPP v2 criteria, respectively. The highest prevalence observed was for proton pump inhibitors according to EU(7)-PIM list (30.1%, 95% CI 27.6–32.9) and Beers criteria (30.1%, 95% CI 27.6–32.9) and alprazolam according to STOPP v2 criteria (10.1%, 95% CI 8.4–11.9%). A poor concordance between criteria was observed (< 0.834). The highest concordance coefficient was found between the EU(7)-PIM list and the Beers criteria (0.833), and the lowest between the EU(7)-PIM list and STOPP criteria (0.735).

Conclusion

This study reveals varying prevalence rates of PIM in older adults, as assessed by different criteria, and highlights the need for targeted interventions and improved prescribing practices. In the future, studies should focus on the occurrence of negative outcomes in older adults associated with PIM consumption.
Surgical revascularization as a procedure to prevent neurological complications in children with moyamoya syndrome associated with neurofibromatosis I: a single institution case series
Authors: Morello Alberto , Scala Marcello , Schiavetti Irene , Diana Maria Cristina , Severino Mariasavina , Tortora Domenico , Piatelli Gianluca , Pavanello Marco
Published: February 2024

Background

The optimal timing and surgical approach for surgical revascularization in patients with moyamoya syndrome (MMS) associated with neurofibromatosis type I (NF1) remain so far elusive. We aimed to compare the long-term clinical, radiological, and cognitive effects of different revascularization procedures in a pediatric cohort of NF1-associated MMS.

Methods

We reviewed the clinical, radiological, and surgical data of 26 patients with NF1-associated MMS diagnosed at our institution between 2012 and 2022, at the clinical onset and last follow-up.

Results

Indirect bypasses were performed in 12/26 patients (57.1%), while combined direct and indirect procedures in 9/26 subjects (42.9%); 5 patients did not undergo surgery. Through logistic regression analysis, pathological Wechsler Intelligence Scale for Children (WISC) at onset was found to be associated with symptom improvement at 1-year follow up (p = 0.006). No significant differences were found in long-term neurocognitive outcome and stroke rate in patients receiving combined or indirect bypass (p > 0.05).

Conclusions

Currently, whether combined or indirect bypass should be considered the treatment of choice in pediatric patients with NF1-associated MMS remains unclear, as well as the optimal time approach. In our series, no significant differences were found in long-term neurocognitive outcome and stroke rate between patients treated with either of these two approaches. Clinical evidence supports the crucial role of early diagnosis and surgical revascularization in subjects with MMS-associated NF1, even in case of mildly symptomatic vasculopathy. This allows to achieve a good long-term outcome with improved intellectual function and prevention of stroke and seizure in these patients.
Forensic investigation on a combined death by food aspiration and acute escitalopram intoxication occurred to a psychiatric subject in a nursing home
Authors: Zuccarello P. , Carnazza G. , Salerno M. , Esposito M. , Cosentino S. , Giorlandino A. , Sessa F. , Pomara C. , Barbera N.
Published: February 2024

Food aspiration is one of the major health risks for elderly people in nursing homes which could lead to death. Moreover, misconducts in pharmacotherapy may represent a potential risk of adverse drug reactions. It is reported here the toxicological evaluation of a combined death by food aspiration and acute escitalopram intoxication of a psychiatric subject, occurred in a nursing home. An 89-year-old man, suffering from dysphagia and Alzheimer’s, was resident in a nursing home. He was fed with a liquid diet administered directly in mouth using a syringe. The man was also being treated with escitalopram 10 mg tablet. One evening, after receiving the meal in the usual way, the man complained of sudden illness. Carried to the emergency room, the man died about 3 h later with a diagnosis of cardiogenic shock subsequentially to ab ingestis. The histological findings revealed the presence of exogenous material, probably food, up to the finest bronchial branches. The toxicological examination revealed the presence of escitalopram and its main metabolite, desmethylcitalopram: in the blood 1972 ng/ml and 285 ng/ml, in the brain 4657 ng/g and 1025 ng/g, in the gastric content 2317 ng/g and 423 ng/g, in the lung 21,771 ng/g and 468 ng/g, respectively. The bad practice of the nurses to dissolve the escitalopram tablet in the liquefied food and to administer the therapy with a syringe directly into the mouth emerged thanks this investigation. Following food aspiration, escitalopram was absorbed by inhalation route, reaching high concentrations in blood and tissues. The death occurred due to a combined mechanism between food aspiration and the escitalopram toxic action.
Effects of cardiovascular risk factors and pre-existing diseases on the short-term outcome of Takotsubo syndrome
Authors: Mousavi Roya Anahita , Schober Andreas , Kronberger Christina , Han Emilie , Litschauer Brigitte , Pichler Gernot , Badr Eslam Roza
Published: February 2024

Background

The effects of cardiovascular risk factors (CVRF) on the development of most acute cardiac conditions are well established; however, little is known about the frequency and effects of CVRF in Takotsubo syndrome (TTS) patients.

Objective

The aim of our study was to compare the frequency of CVRF and pre-existing diseases (PD) of TTS patients to ST-elevation myocardial infarction (STEMI) patients and analyze their effects on short-term outcome.

Methods

We analyzed the frequency of CVRF (hypertension, hyperlipidemia, type II diabetes mellitus, smoking, chronic kidney disease, family history) as well as somatic and psychiatric PD at admission in TTS patients and compared them with STEMI patients. Their effect on short-term outcome was calculated using a combined endpoint of cardiogenic shock, cardiopulmonary resuscitation, mechanical ventilation, and/or in-hospital death.

Results

In total, 150 TTS and 155 STEMI patients were included in our study. We observed a higher frequency of psychiatric (30% vs. 7%, p < 0.001), neurological (5% vs. 0%, p = 0.01), and pulmonary (18% vs. 5%, p < 0.001) PD in TTS patients as compared to STEMI patients. There were less smokers (47% vs. 61%, p = 0.03) and patients with hyperlipidemia (24% vs. 51%, p < 0.001) in the TTS cohort than in the STEMI cohort. None of the CVRF or PD behaved as an independent predictor for adverse short-term outcome in TTS patients.

Conclusion

Psychiatric, neurological, and pulmonary pre-existing diseases are more common in TTS than in STEMI patients. Interestingly, PD and CVRF do not seem to have any impact on the short-term outcome of TTS patients.
The fusion rates at different times of cortical iliac crest autograft or allograft compared with cages after anterior cervical discectomy and fusion: a meta-analysis
Authors: Li Yongai , Su Tong , Meng Tong , Song Dianwen , Yin Huabin
Published: February 2024

Objective

The cortical iliac crest autograft (CICA)/structural allograft (SA) has still been recognized as the gold standard for the ACDF technique for its high degree of histocompatibility and osteoinduction ability though the flourishing and evolving cage development. However, there was no further indication for using CICA/SA in ACDF based on basic information of inpatients. Our operative experience implied that applying CICA/SA has an advantage on faster fusion but not the long-term fusion rate. Therefore, our study aimed to compare the fusion rates between CICA and cage, between SA and cage, and between CICA/CA and cage.

Methods

Based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), a comprehensive literature search of electronic databases including PubMed, Embase, Cochrane Library and Web of Science was conducted to identify these clinical trials that investigated the postoperative 3, 6, 12 and 24 months fusion rates of CICA/structural SA versus cage. Assessment of risk of bias, data extraction and statistical analysis were then carried out by two independent authors with the resolve-by-consensus method. The primary outcome was fusion rate at 3, 6, 12 and 24 months postoperatively. The secondary outcomes were also meta-analyzed such as hardware complications, operative duration and hospitalization time. Our meta-analysis was registered with PROSPERO (Identifier: CRD42022345247).

Result

A total of 3451 segments (2398 patients) derived from 34 studies were included after the screening of 3366 articles. The segmental fusion rates of CICA were higher than cages at 3 (P = 0.184, I2 = 40.9%) and 6 (P = 0.147, I2 = 38.8%) months postoperatively, but not 12 (P = 0.988, I2 = 0.0%) and 24 (P = 0.055, I2 = 65.6%) months postoperatively. And there was no significant difference in segmental fusion rates between SA and cage at none of 3 (P = 0.047, I2 = 62.2%), 6 (P = 0.179, I2 = 41.9%) and 12 (P = 0.049, I2 = 58.0%) months after operations. As for secondary outcomes, the CICA was inferior to cages in terms of hardware complications, operative time, blood loss, hospitalization time, interbody height, disk height and Odom rating. The hardware complication of using SA was significantly higher than the cage, but not the hospitalization time, disk height, NDI and Odom rating.

Conclusion

Applying CICA has an advantage on faster fusion than using a cage but not the long-term fusion rate in ACDF. Future high-quality RCTs regarding the hardware complications between CICA and cage in younger patients are warranted for the deduced indication.
Does the angle of trocar insertion affect the fascial defect caused? A porcine model
Authors: Paasch C. , Meyer J. , Hunger R. , Krollmann N. , Heisler S. , Mantke R.
Published: February 2024

Introduction

With an incidence of 0–5.2%, trocar site hernias frequently occur following laparoscopy. It is unclear to what extent the angle of trocar insertion affects the size of the fascial defect caused. Hence, we performed a porcine model.

Methods

In October 2022, a total of five female pigs were euthanized. In alternating order, three bladeless and two bladed conical 12-mm trocars were inserted at an angle of 45° on each side for 60 min twice each pig. For this purpose, an epoxy resin handmade cuboid with a central channel that runs at an angle of 45° was used. Subsequently, photo imaging and defect size measurement took place. The results were compared with those of our previously conducted and published porcine model, in which the trocars were inserted at an angle of 90°. Effects of trocar type (bladed vs. bladeless) and angle on defect size were analyzed using a mixed model regression analysis.

Results

The bladeless trocars caused statistically significant smaller defects at the fascia than the bladed (23.4 (SD = 16.9) mm2 vs. 41.3 (SD = 14.8) mm2, p < 0.001). The bladeless VersaOne trocar caused the smallest defect of 16.0 (SD = 6.1) mm2. The bladed VersaOne trocar caused the largest defect of 47.7 (SD = 10.5) mm2. The defect size of the trocars used at a 45° angle averaged 30.5 (SD = 18.3) mm2. The defect size of trocars used at a 90° angle was significantly larger, averaging 58.3 (SD = 20.2) mm2 (p = 0.007).

Conclusion

When conical 12-mm trocars are inserted at a 45° angle, especially bladeless ones, they appear to cause small fascial defects compared with insertion at a 90° angle. This might lead also to a lower rate of trocar hernias. Bladeless trocars might cause smaller fascial defects than bladed trocars.
Host finding and probing behavior by Philaenus spumarius on olive varieties with a different degree of susceptibility to Xylella fastidiosa
Authors: Cornara Daniele , Zaffaroni-Caorsi Valentina , Hamouche Zeinab , Avosani Sabina , Cavallo Giuseppe , Verrastro Vincenzo , Lago Clara , Trani Antonio , De Stradis Angelo , Almeida Rodrigo P. P. , Fereres Alberto
Published: February 2024

Abundance on and access time to the host plant are the pivotal factors in Xylella fastidiosa transmission to olive by the meadow spittlebug Philaenus spumarius. Therefore, olive varieties suitable for the vectors, i.e., plants providing all the necessary cues to the insect for their location, settling and acceptance, and devoid of antixenotic defenses, could be more susceptible to infection than varieties non- or less suitable for the vector. Here we evaluated whether a bacterium-susceptible olive variety, Ogliarola Salentina, could be a more suitable host for P. spumarius than the two resistant varieties Leccino and FS-17. We carried out: (i) an evaluation of between-hosts and within-host preference; (ii) an insect survival analysis; (iii) an Electrical Penetration Graph (EPG)-assisted analysis of the probing behavior; (iv) light microscopy of the tissues the spittlebugs had access to; (v) an analysis of the xylem sap primary metabolites. In choice tests, the insect exhibited a significant preference for Ogliarola Salentina. In addition, spittlebugs displayed longer xylem sap ingestion bouts on the bacterium-susceptible variety compared to resistant genotypes, possibly because of differences in the xylem sap chemical profile rather than xylem anatomy. Spittlebugs preference for Ogliarola over both Leccino and FS-17 could be a relevant and so far overlooked component of the low disease prevalence in these two olive varieties reported in Southern Italian olive orchards. Overall, our data point toward the importance of incorporating studies on vector-plant interaction and host traits of resistance to the vector in research on genotypes resistant to X. fastidiosa.
Three-way decisions in generalized intuitionistic fuzzy environments: survey and challenges
Authors: Ding Juanjuan , Zhang Chao , Li Deyu , Zhan Jianming , Li Wentao , Yao Yiyu
Published: February 2024

Enhancing decision-making under risks is crucial in various fields, and three-way decision (3WD) methods have been extensively utilized and proven to be effective in numerous scenarios. However, traditional methods may not be sufficient when addressing intricate decision-making scenarios characterized by uncertain and ambiguous information. In response to this challenge, the generalized intuitionistic fuzzy set (IFS) theory extends the conventional fuzzy set theory by introducing two pivotal concepts, i.e., membership degrees and non-membership degrees. These concepts offer a more comprehensive means of portraying the relationship between elements and fuzzy concepts, thereby boosting the ability to model complex problems. The generalized IFS theory brings about heightened flexibility and precision in problem-solving, allowing for a more thorough and accurate description of intricate phenomena. Consequently, the generalized IFS theory emerges as a more refined tool for articulating fuzzy phenomena. The paper offers a thorough review of the research advancements made in 3WD methods within the context of generalized intuitionistic fuzzy (IF) environments. First, the paper summarizes fundamental aspects of 3WD methods and the IFS theory. Second, the paper discusses the latest development trends, including the application of these methods in new fields and the development of new hybrid methods. Furthermore, the paper analyzes the strengths and weaknesses of research methods employed in recent years. While these methods have yielded impressive outcomes in decision-making, there are still some limitations and challenges that need to be addressed. Finally, the paper proposes key challenges and future research directions. Overall, the paper offers a comprehensive and insightful review of the latest research progress on 3WD methods in generalized IF environments, which can provide guidance for scholars and engineers in the intelligent decision-making field with situations characterized by various uncertainties.
Clustering-based attack detection for adversarial reinforcement learning
Authors: Majadas Rubén , García Javier , Fernández Fernando
Published: February 2024

Detecting malicious attacks presents a major challenge in the field of reinforcement learning (RL), as such attacks can force the victim to perform abnormal actions, with potentially severe consequences. To mitigate these risks, current research focuses on the enhancement of RL algorithms with efficient detection mechanisms, especially for real-world applications. Adversarial attacks have the potential to alter the environmental dynamics of a Markov Decision Process (MDP) perceived by an RL agent. Leveraging these changes in dynamics, we propose a novel approach to detect attacks. Our contribution can be summarized in two main aspects. Firstly, we propose a novel formalization of the attack detection problem that entails analyzing modifications made by attacks to the transition and reward dynamics within the environment. This problem can be framed as a context change detection problem, where the goal is to identify the transition from a “free-of-attack” situation to an “under-attack” scenario. To solve this problem, we propose a groundbreaking “model-free” clustering-based countermeasure. This approach consists of two essential steps: first, partitioning the transition space into clusters, and then using this partitioning to identify changes in environmental dynamics caused by adversarial attacks. To assess the efficiency of our detection method, we performed experiments on four established RL domains (grid-world, mountain car, carpole, and acrobot) and subjected them to four advanced attack types. Uniform, Strategically-timed, Q-value, and Multi-objective. Our study proves that our technique has a high potential for perturbation detection, even in scenarios where attackers employ more sophisticated strategies.
A note on the convergence of deterministic gradient sampling in nonsmooth optimization
Authors: Gebken Bennet
Published: February 2024

Approximation of subdifferentials is one of the main tasks when computing descent directions for nonsmooth optimization problems. In this article, we propose a bisection method for weakly lower semismooth functions which is able to compute new subgradients that improve a given approximation in case a direction with insufficient descent was computed. Combined with a recently proposed deterministic gradient sampling approach, this yields a deterministic and provably convergent way to approximate subdifferentials for computing descent directions.
Vine Copula Approach to Understand the Financial Dependence of the Istanbul Stock Exchange Index
Authors: Evkaya Ozan , Gür İsmail , Yıldırım Külekci Bükre , Poyraz Gülden
Published: February 2024

Recently, the complex dependence patterns among various stocks gained more importance. Measuring the dependency structure is critical for investors to manage their portfolio risks. Since the global financial crisis, researchers have been more interested in studying the dynamics of dependency within stock markets by using novel methodologies. This study aims to investigate a Regular-Vine copula approach to estimate the interdependence structure of the Istanbul Stock Exchange index (ISE100). For this purpose, we consider 32 stocks related to 6 sectors belonging to ISE100. To reflect the time-varying impacts of the 2008–2009 global financial crisis, the dependence analysis is conducted over pre-, during-, and post-global financial crisis periods. Portfolio analysis is considered via a rolling window approach to capture the changes in the dependence. We compare the Regular-Vine-based generalized autoregressive conditional heteroskedasticity (GARCH) against the conventional GARCH model with different innovations. Value at risk and expected shortfall risk measures are used to validate the models. Additionally, for the constructed portfolios, return performance is summarized using both Sharpe and Sortino ratios. To test the ability of the considered Regular-Vine approach on ISE100, another evaluation has been done during the COVID-19 pandemic crisis with various parameter settings. The main findings across different risky periods illustrate the suitability of using the Regular-vine GARCH approach to model the complex dependence among stocks in emerging market conditions.