bluuebunny/crossref_metadata_2025 huggingface dataset:
Consolidation of the clinical and genetic definition of aSOX4-related neurodevelopmental syndrome
Authors: Angelozzi Marco , Karvande Anirudha , Molin Arnaud N , Ritter Alyssa L , Leonard Jacqueline M M , Savatt Juliann M , Douglass Kristen , Myers Scott M , Grippa Mina , Tolchin Dara , Zackai Elaine , Donoghue Sarah , Hurst Anna C E , Descartes Maria , Smith Kirstin , Velasco Danita , Schmanski Andrew , Crunk Amy , Tokita Mari J , de Lange Iris M , van Gassen Koen , Robinson Hannah , Guegan Katie , Suri Mohnish , Patel Chirag , Bournez Marie , Faivre Laurence , Tran-Mau-Them Frédéric , Baker Janice , Fabie Noelle , Weaver K , Shillington Amelle , Hopkin Robert J , Barge-Schaapveld Daniela Q C.M , Ruivenkamp Claudia AL , Bökenkamp Regina , Vergano Samantha , Seco Moro Maria Noelia , Díaz de Bustamante Aranzazu , Misra Vinod K , Kennelly Kelly , Rogers Caleb , Friedman Jennifer , Wigby Kristen M , Lenberg Jerica , Graziano Claudio , Ahrens-Nicklas Rebecca C , Lefebvre Veronique
Published: March 2022

Background

A neurodevelopmental syndrome was recently reported in four patients withSOX4heterozygous missense variants in the high-mobility-group (HMG) DNA-binding domain. The present study aimed to consolidate clinical and genetic knowledge of this syndrome.

Methods

We newly identified 17 patients withSOX4variants, predicted variant pathogenicity using in silico tests and in vitro functional assays and analysed the patients’ phenotypes.

Results

All variants were novel, distinct and heterozygous. Seven HMG-domain missense and five stop-gain variants were classified as pathogenic or likely pathogenic variant (L/PV) as they precluded SOX4 transcriptional activity in vitro. Five HMG-domain and non-HMG-domain missense variants were classified as of uncertain significance (VUS) due to negative results from functional tests. When known, inheritance was de novo or from a mosaic unaffected or non-mosaic affected parent for patients with L/PV, and from a non-mosaic asymptomatic or affected parent for patients with VUS. All patients had neurodevelopmental, neurological and dysmorphic features, and at least one cardiovascular, ophthalmological, musculoskeletal or other somatic anomaly. Patients with L/PV were overall more affected than patients with VUS. They resembled patients with other neurodevelopmental diseases, including theSOX11-related and Coffin-Siris (CSS) syndromes, but lacked the most specific features of CSS.

Conclusion

These findings consolidate evidence of a fairly non-specific neurodevelopmental syndrome due toSOX4haploinsufficiency in neurogenesis and multiple other developmental processes.
Effect of rolling on microstructure and mechanical properties of HPS Al/Mg/Al composite plates
Authors: Yu Yang , Yan Pengfei , Chai Tingxi , Yan Biao
Published: March 2022

Al/Mg/Al composite plates were fabricated by hot pressed sintering (HPS) and hot rolling. The main purpose of this study is to understand the effect of rolling on the microstructure, interface and mechanical properties of HPS Al/Mg/Al composite plates. Rolling can increase the compactness of the microstructure by improving the distribution of internal voids and promote the diffusion of interfacial elements, forming a transition layer consisting of phases [Formula: see text]-Al3Mg2 and [Formula: see text]-Al[Formula: see text]Mg[Formula: see text], which improves the strength, plasticity, interfacial bonding strength and interfacial deformation compatibility of the HPS Al/Mg/Al composite plates. The bending strength, tensile strength and elongation of HPS Al/Mg/Al composite plates after rolling are 520 MPa, 300 MPa and 17%, respectively. The fracture mode changes from brittle intergranular fracture to ductile dimple.
The Jones polynomials of three-bridge knots via Chebyshev knots and billiard table diagrams
Authors: Cohen Moshe
Published: March 2022

This work presents formulas for the Kauffman bracket and Jones polynomials of three-bridge knots using the structure of Chebyshev knots and their billiard table diagrams. In particular, these give far fewer terms than in the Skein relation expansion. The subject is introduced by considering the easier case of two-bridge knots, where some geometric interpretation is provided, as well, via combinatorial tiling problems.
Homflypt skein theory, string topology and 2-categories
Authors: Kaiser Uwe
Published: March 2022

We show that relations in Homflypt type skein theory of an oriented [Formula: see text]-manifold [Formula: see text] are induced from a [Formula: see text]-groupoid defined from the fundamental [Formula: see text]-groupoid of a space of singular links in [Formula: see text]. The module relations are defined by homomorphisms related to string topology. They appear from a representation of the groupoid into free modules on a set of model objects. The construction on the fundamental [Formula: see text]-groupoid is defined by the singularity stratification and relates Vassiliev and skein theory. Several explicit properties are discussed, and some implications for skein modules are derived.
Quantitative characterization of traces of Sobolev maps
Authors: Mazowiecka Katarzyna , Van Schaftingen Jean
Published: March 2022

We give a quantitative characterization of traces on the boundary of Sobolev maps in [Formula: see text], where [Formula: see text] and [Formula: see text] are compact Riemannian manifolds, [Formula: see text]: the Borel-measurable maps [Formula: see text] that are the trace of a map [Formula: see text] are characterized as the maps for which there exists an extension energy density [Formula: see text] that controls the Sobolev energy of extensions from [Formula: see text]-dimensional subsets of [Formula: see text] to [Formula: see text]-dimensional subsets of [Formula: see text].
Effect of Cutout on the Stability and Failure of Laminated Composite Cylindrical Panels Subjected to In-Plane Pulse Loads
Authors: Keshav Vasanth , Patel Shuvendu Narayan , Kumar Rajesh , Watts Gaurav
Published: March 2022

In this investigation, the nonlinear dynamic buckling analysis and the failure analysis of laminated composite cylindrical (LCC) panel with different shapes of cutouts under the action of rectangular in-plane pulse loads are performed in the finite element framework. Cross-ply laminates which are balanced symmetric are considered in the investigation. The first ply failure load (FPFL) of the panel is evaluated and checked whether it occurs before the nonlinear dynamic buckling phenomenon considering Tsai–Wu failure criterion. Convergence and validation studies are undertaken, and the results are compared with those from the existing literature. The effects of loading duration, cutout area and cutout geometry on the panel are investigated in detail and results are reported. The results indicate that for the panel with cutout, its dynamic buckling load (DBL), in certain cases, compared to the static buckling load (SBL), can be lower even if the loading duration is half of its first natural period. Additionally, the vibration and the static buckling analyses of the panels are carried out as and when required.
Optimal index and averaging principle for Itô–Doob stochastic fractional differential equations
Authors: Wang Wenya , Guo Zhongkai
Published: March 2022

In this paper, a class of Itô–Doob stochastic fractional differential equations (Itô–Doob SFDEs) models are discussed. Using the time scale transformation method, we consider the averaging principle of the transformed equations and establish the relevant results. At the same time, we find that the optimal index for the original Itô–Doob SFDEs can be determined, the selection of such index is similar to the classical stochastic differential equations model.
Brauer–Manin obstruction to the local–global principle for the embedding problem
Authors: Pál Ambrus , Schlank Tomer M.
Published: March 2022

We study an analogue of the Brauer–Manin obstruction to the local–global principle for embedding problems over global fields. We will prove the analogues of several fundamental structural results. In particular we show that the (algebraic) Brauer–Manin obstruction is the only one to strong approximation when the embedding problem has abelian kernel.
Analysis and control of a delayed population model with an Allee effect
Authors: Zhao Lichun , liu Jingna , Zhang Meng , liu Bing
Published: March 2022

Based on the population model with an Allee effect, the corresponding delayed model is built up. According to the qualitative theory of differential equations, the model is analyzed completely to describe various intriguing dynamic properties as singular point of high order, Hopf bifurcation, etc. Next, combined impulse control theory with the ecological principles, the control models with impulse effects are proposed and the corresponding controllers are designed not only to avoid the extinction of the populations but also to prevent outbreak of the populations. The study would not only reveal the complexity dynamic behavior of ecosystems, but also provide the theory reference for the management of populations.
Corona product of signed graphs and its application to modeling signed networks
Authors: Adhikari Bibhas , Singh Amrik , Yadav Sandeep Kumar
Published: March 2022

The notion of corona of two graphs was introduced by Frucht and Harary in 1970. In this paper, we generalize their definition of corona product of two graphs and introduce corona product of two signed graphs by utilizing the framework of marked graphs, which was introduced by Beineke and Harary in 1978. We study structural and spectral properties of corona product of signed graphs. Further, we define signed corona graphs by considering corona product of a fixed small signed graph with itself iteratively, and we call the small graph as the seed graph for the corresponding corona product graphs. Signed corona graphs can be employed as a signed network generative model for large growing signed networks. We study structural properties of corona graphs that include statistics of signed links, all types of signed triangles and degree distribution. Besides we analyze algebraic conflict of signed corona graphs generated by specially structured seed graphs. Finally, we show that a suitable choice of a seed graph can produce corona graphs which preserve properties of real signed networks.
A coupled thermal–electrical–mechanical analysis for lithium-ion battery
Authors: Wang Leyu , Ling Chenxi , Kan Cing-Dao , Yang Chi
Published: March 2022

A lithium-ion battery simulation model is developed for a fully coupled thermal–electrical–mechanical analysis. The model is calibrated with the hemispherical punch test for its mechanical response and an external short-circuit test for its electrical property. Realistic physical property and representative geometry are used to model each battery component. Randles circuit is used to represent the electric property of the battery. A piecewise linear plasticity model is applied to model the deformation and failure of each cell material. The simulation result of the external short-circuit test suggests that most heat is generated at the layer of cathode material near the current-collecting tabs. The punch test of a discharging battery is simulated; the result suggests the mechanical deformation can cause extra Ohm heating at the deformed location. The mechanically generated heat caused by impact also plays a role in the rise of the cell temperature.
Towards retina-quality VR video streaming
Authors: Hsiao Luke , Krajancich Brooke , Levis Philip , Wetzstein Gordon , Winstein Keith
Published: March 2022

Virtual reality systems today cannot yet stream immersive, retina-quality virtual reality video over a network. One of the greatest challenges to this goal is the sheer data rates required to transmit retina-quality video frames at high resolutions and frame rates. Recent work has leveraged the decay of visual acuity in human perception in novel gaze-contingent video compression techniques. In this paper, we show that reducing the motion-to-photon latency of a system itself is a key method for improving the compression ratio of gaze-contingent compression. Our key finding is that a client and streaming server system with sub-15ms latency can achieve 5x better compression than traditional techniques while also using simpler software algorithms than previous work.
Climate Change Risks to Global Forest Health: Emergence of Unexpected Events of Elevated Tree Mortality Worldwide
Authors: Hartmann Henrik , Bastos Ana , Das Adrian J. , Esquivel-Muelbert Adriane , Hammond William M. , Martínez-Vilalta Jordi , McDowell Nate G. , Powers Jennifer S. , Pugh Thomas A.M. , Ruthrof Katinka X. , Allen Craig D.
Published: March 2022

Recent observations of elevated tree mortality following climate extremes, like heat and drought, raise concerns about climate change risks to global forest health. We currently lack both sufficient data and understanding to identify whether these observations represent a global trend toward increasing tree mortality. Here, we document events of sudden and unexpected elevated tree mortality following heat and drought events in ecosystems that previously were considered tolerant or not at risk of exposure. These events underscore the fact that climate change may affect forests with unexpected force in the future. We use the events as examples to highlight current difficulties and challenges for realistically predicting such tree mortality events and the uncertainties about future forest condition. Advances in remote sensing technology and greater availably of high-resolution data, from both field assessments and satellites, are needed to improve both understanding and prediction of forest responses to future climate change.
Radar Emitter Classification Based on a Multiperspective Collaborative Clustering Method and Radar Characteristic Spectrum
Authors: Wang Jundi , Wang Xing , Zhou Yipeng , Chen You
Published: March 2022

Modern cognitive electronic reconnaissance methods for radar systems must contend with the complex electromagnetic environments arising from the deployment of multiple signal sources and radar countermeasures, which greatly limit access to the degree of prior information required to enable effective target recognition. The present work addresses this issue by proposing a multiperspective collaborative clustering method for sorting radiation sources based on the multiperspective information of radar signals. In contrast to conventional collaborative training approaches, which are suitable only for semisupervised learning, the proposed multiperspective collaborative clustering method performs unsupervised clustering, cluster label transfer, and dimensionality reduction by linear discriminant analysis iteratively based on the differences between the clustering results obtained from two signal perspectives radiation signal sorting can be conducted in a noncooperative context. The results of comparative experiments demonstrate that the proposed multiperspective sorting method can make full use of the difference information between basic signal characteristics and intrapulse features and thereby improve the accuracy of clustering-based radiation source sorting. Accordingly, the sorting ability of the proposed method is superior to those of other state-of-the-art clustering methods and that of the single-perspective clustering-based sorting method.
Exploration of the Construction Model of School-Business Collaboration System in Vocational Colleges Based on Information Resource Sharing
Authors: Wu Fang , Ji Ying
Published: March 2022

The exchange of literature and information resources between higher vocational colleges and cooperative enterprises is a win-win situation in which both parties benefit. Collaboration between schools and businesses is a significant departure from the traditional vocational education model, as well as an innovation in the talent training model, an important direction of higher vocational education reform, and the focal point for the formation of vocational education characteristics. Collaboration between schools and businesses is now not only an effective way for businesses to train a large number of applied technical talents, but also an effective way for vocational colleges to change their disciplinary structure. At the same time, collaboration between schools and businesses is critical to the advancement of vocational education. The focus of this article is on the publication of literature on the long-term mechanism of school-business collaboration, the field of research on the long-term mechanism of school-business collaboration, state laws and regulations on school-business collaboration, and academic opinions. The content, mode, problems to be solved, and importance of sharing document information resources in school-business collaboration are the main topics of this article. Vocational technical colleges and businesses should benefit from each other and maximize their respective advantages in school-business collaboration. One of the greatest advantages of higher vocational colleges is the abundance of literature and information resources. This article will raise a key question through a review of the literature: how can you establish an effective long-term mechanism for school-business collaboration? This theory has been enhanced by previous research in order to put the issue of school-business collaboration into practice and provide theoretical and practical guidance that will benefit the country, society, schools, and, most importantly, student employment.
Function of Psychological Analysis of Painting Based on Image Information in Cultivating College Students’ Entrepreneurship
Authors: Li Xu , He Zhenhua
Published: March 2022

Painting psychoanalysis is to allow artists to use nonverbal tools to present their subconscious self and personality characteristics in a safe and acceptable way of painting. College students need to have a correct understanding of them and know whether their personality characteristics are suitable for starting a business. In order to enable college students to better carry out entrepreneurial activities, painting psychological analysis can be integrated into the course of innovation and entrepreneurship education to guide students to analyze their own personality characteristics and better analyze and deal with psychological obstacles that may be encountered in entrepreneurship. This article starts with the lack of education and guidance for students’ entrepreneurial psychological quality in existing innovation and entrepreneurship education courses, aims at studying the education and guidance of students’ entrepreneurial psychological quality in innovative projects and existing entrepreneurship, and tries to help cultivate college students’ entrepreneurial interest through the method of drawing psychoanalysis. Due to the psychological barriers to entrepreneurship in business activities, many students begin to feel fear or frustration about entrepreneurship. Psychological analysis of painting helps to cultivate students’ commercial psychological quality. This article proposes a method of drawing psychoanalysis to speculate on students’ entrepreneurial desires, and to a certain extent encourage them to take the steps of entrepreneurship bravely in order to contribute to the country’s economic development. The experimental results of this article show that more than 70% of college students have a strong interest and desire for entrepreneurship, but less than 30% can put it into practice in the end. Therefore, this article hopes to help students through the psychological analysis of painting psychology and cultivate the psychological quality of entrepreneurship.
An Empirical Study on the Relationship between Community Sports Activities and Community Residents’ Mental Health
Authors: Wang Daojun , Xing Xinli
Published: March 2022

A full understanding of mental health can improve people’s ability to identify mental diseases and cope with psychological problems, so as to improve the ability of the whole community to resist mental diseases. Community health education is particularly important in community mental health service. The traditional health education mode is carried out through lectures or paper brochures, and the effect is not significant, so we need to constantly improve the health education mode. Through the development of community mental health education and service, we can improve people’s mental health quality and promote family happiness and social stability. Based on this, this study mainly analyzes the relationship between community sports activities and mental health of community residents. Physical exercise can reduce stress reaction, regulate emotion, enhance mental health, prevent, and treat mental diseases. Therefore, physical exercise has been used not only as a method to enhance physical fitness but also as an important means to regulate psychology.
Comparison of Long-Term Outcomes and Refractive Stability following SMILE versus SMILE Combined with Accelerated Cross-Linking (SMILE XTRA)
Authors: Brar Sheetal , Sriganesh Skanda , Sute Smith Snehal , Ganesh Sri
Published: March 2022

Purpose. To compare the long-term safety, efficacy, predictability, and refractive stability following SMILE versus SMILE combined with accelerated cross-linking (SMILE XTRA), and to specifically study the regression patterns following the two procedures. Methods. This retrospective study included 54 eyes of SMILE and 54 eyes of SMILE XTRA treated for normal and borderline cases of myopia/myopic astigmatism, respectively, based on certain predefined topographic features and risk factors. Patients in both the groups were matched for age and refractive error. The mean postoperative follow-up for the SMILE group was 22.18 ± 10.41 months and the SMILE XTRA group was 21.81 ± 10.19 months. Results. At the end of follow-up, the mean sphere, cylinder, and SE reduced to −0.03, −0.09, and −0.08 D in the SMILE group and −0.06, −0.15, and −0.13 D in the SMILE XTRA group. 96% and 93% eyes remained within ±0.50 D in SMILE and SMILE XTRA groups, respectively, and 94% eyes maintained an UDVA of 20/20 or better in the SMILE as well as SMILE XTRA groups. Safety and efficacy indices for the SMILE group were 1.03 and 1.00. For the SMILE XTRA group, the safety and efficacy indices were 1.00 and 0.99. No eye in either group had postoperative ectasia or enhancement performed for significant residual refractive error. Conclusion. Both the SMILE and SMILE XTRA groups exhibited comparable visual outcomes, safety, and efficacy. Contrary to the belief, combination of prophylactic CXL with SMILE did not result in a hyperopic shift in the long term. No eye in either group encountered postoperative ectasia; however, further follow-up is suggested to establish the long-term effects on refractive and corneal stability following SMILE XTRA, as all the eyes treated in this group were borderline.
Biaxial Estimation of Biomechanical Constitutive Parameters of Passive Porcine Sclera Soft Tissue
Authors: Ndlovu Zwelihle , Desai Dawood , Pandelani Thanyani , Ngwangwa Harry , Nemavhola Fulufhelo
Published: March 2022

This study assesses the modelling capabilities of four constitutive hyperelastic material models to fit the experimental data of the porcine sclera soft tissue. It further estimates the material parameters and discusses their applicability to a finite element model by examining the statistical dispersion measured through the standard deviation. Fifteen sclera tissues were harvested from porcine’ slaughtered at an abattoir and were subjected to equi-biaxial testing. The results show that all the four material models yielded very good correlations at correlations above 96%. The polynomial (anisotropic) model gave the best correlation of 98%. However, the estimated material parameters varied widely from one test to another such that there would be need to normalise the test data to avoid long optimisation processes after applying the average material parameters to finite element models. However, for application of the estimated material parameters to finite element models, there would be need to consider normalising the test data to reduce the search region for the optimisation algorithms. Although the polynomial (anisotropic) model yielded the best correlation, it was found that the Choi-Vito had the least variation in the estimated material parameters, thereby making it an easier option for application of its material parameters to a finite element model and requiring minimum effort in the optimisation procedure. For the porcine sclera tissue, it was found that the anisotropy was more influenced by the fiber-related properties than the background material matrix-related properties.
The Interaction of Waves in the Zero-Pressure Euler Equations with a Coulomb-Like Friction Term
Authors: Wang Aiju , Yu Wangxun , Zhang Yanyan
Published: March 2022

In this study, the interaction of waves in the zero-pressure Euler equations with a Coulomb-like friction term is considered, which is equivalent to the Riemann problem with three constant initial states for the zero-pressure Euler equations. By solving generalized Rankine–Hugoniot relations under suitable entropy conditions, four different structures of explicit solutions are obtained uniquely, in which the interactions among contact discontinuity, vacuum, and delta shock are presented.
Association of TNF-Alpha, MBL2, NOS2, and G6PD with Malaria Outcomes in People in Southern Ghana
Authors: Futagbi Godfred , Otu Paulina S , Abdul-Rahman Mubarak , Aidoo Ebenezer K , Lo Aminata C , Gyan Ben A , Afrane Yaw A , Amoah Linda E
Published: March 2022

Background. One major issue that has set back the gains of the numerous malaria control interventions that national malaria control programs have implemented is asymptomatic malaria. Certain host genetic factors are known to influence symptomatic malaria; however, not much is known about how host genetics influences the acquisition of asymptomatic malaria. Methods. Genomic DNA was extracted from whole blood collected from 60 symptomatic and 149 nonfebrile (asymptomatic, N = 109, and uninfected, N = 40) volunteers aged between 2 and 69 years from a high (Obom) and a low (Asutsuare) malaria transmission setting in Southern Ghana. Restriction fragment length polymorphism (RFLP) was used to determine polymorphisms at the MBL2 54, TNF-α 308, NOS2 954, and G6PD 202/376 gene loci. Results. Polymorphisms at the MBL2 54 and TNF-α 308 loci were significantly different amongst the three categories of volunteers in both Asutsuare (p = 0.006) and Obom

p
=
0.05

. In Asutsuare, a low malaria transmission area, the allele G has significantly higher odds (3.15) of supporting asymptomatic malaria as against symptomatic malaria. There were significantly higher odds of TNF-α genotype GA being associated with symptomatic malaria as against asymptomatic malaria in both sites, Obom

p
=
0.027

and Asutsuare

p
=
0.027

. The allele B of the G6PD gene was more prevalent in symptomatic rather than asymptomatic parasite-infected individuals in both Obom

p

=

0.001

and Asutsuare

p
=
0.003

. Conclusion. Individuals in Southern Ghana carrying the TNF-α 308 GA genotype are more likely to exhibit symptoms of malaria when infected with the malaria parasite as opposed to harboring an asymptomatic infection. Also, the B allele of the G6PD gene is likely to prevent a P. falciparum-infected person from exhibiting symptoms and thereby promote asymptomatic parasite carriage.
Investigating the Influence of Design Frequency on the Ultrasonic Signal of PFSV-EMATs
Authors: Jia Xiaojuan , Liu Min , Zhang Jingjun , Ouyang Qi
Published: March 2022

The point-focusing shear vertical wave electromagnetic acoustic transducer (PFSV-EMAT) with a concentric meander line (CML) coil has been developed to detect and size micro defection concealed within a certain depth of materials. It is proved to be sensitive to the design frequency, which is associated with the spacing of CML coil. In this work, the relationship between the design frequency and characteristic of PFSV-EMATs, such as the particle displacement and focal offset, is studied quantitatively. First, the configuration and working principle of PFSV-EMATs are introduced comprehensively. Then, a finite element model is established to simulate the incentive and propagation process of ultrasonic waves. In addition, the relationship between magnet-to-coil radius ratio and the signal amplitude generated by the PFSV-EMATs is explored to ensure the consistency of transducer parameters at different frequencies. Furthermore, under the optimal magnet-to-coil radius ratio, the influence of design frequency on the characteristic of PFSV-EMATs is studied. Finally, the experimental results show good agreement with the simulation results and indicate that the signal amplitude and point-focusing performance of PFSV-EMATs employing CML coils could be improved by carefully choosing the design frequency.
Nonurgent Visits to the Pediatric Emergency Department before and during the First Peak of the COVID-19 Pandemic
Authors: Guckert Laura , Reutter Heiko , Saleh Nadia , Ganschow Rainer , Müller Andreas , Ebach Fabian
Published: March 2022

Background. Nonurgent visits in pediatric Emergency Departments are a growing burden. In order to find predictors for those nonurgent visits, we performed a retrospective analysis of unscheduled visits at the Pediatric Emergency Department of the University Hospital of Bonn, Germany, in the year 2017. Additionally, we compared these findings to unscheduled visits during the first peak of the worldwide pandemic of the Coronavirus disease 2019, to see if there would be an effect on nonurgent pediatric Emergency Department attendances. Methods. For our retrospective cohort study, we analyzed more than 5.000 visits at the pediatric Emergency Department of the University Hospital of Bonn, Germany, before and during the first peak of the ongoing worldwide pandemic of the Coronavirus disease 2019, particularly with regard to their urgency. Data included gender, age, zip code, urgency, and preexisting conditions. Results. Our study shows that more than half of unscheduled pediatric Emergency Department visits (69%) at the University Hospital in Bonn are for nonurgent reasons, with short living distance being a factor to present children to a pediatric Emergency Department, even with minor complaints. During the first peak of the pandemic of the Coronavirus disease 2019, nonurgent visits decreased significantly, potentially due to hesitation to attend a pediatric Emergency Department with minor issues, fearing an infection with SARS-CoV-2 at the hospital. Conclusion. Many people use pediatric Emergency Departments for nonemergency complaints. In order to address the reasons for nonurgent visits to pediatric Emergency Departments and to prevent parents from doing so, further studies and targeted education concepts for parents are needed.
Relationship between Undernutrition and Periodontal Diseases among a Sample of Yemeni Population: A Cross-Sectional Study
Authors: Al-Kalisi Milad , Al-Hajri Manal , Al-Rai Sarah
Published: March 2022

Undernutrition is an inadequate supply of energy and nutrients. Periodontal diseases (PDs) are defined as a broad form of chronic inflammatory disease of the gingiva, bone, and ligaments supporting the teeth. This study aimed to reveal the relationship between undernutrition, using body mass index (BMI) and serum albumin level (Alb), and PDs in a sample of Yemeni population. A cross-sectional study was conducted at dental teaching clinics at the Faculty of Dentistry, Sana’a University. Of 1920 patients who attended clinics, only 229 matched the study criteria. Oral examination was performed to assess the periodontal clinical parameter measurements. BMI and Alb were measured. Participants of both genders were involved, with a slight increase in males (n = 134, 58.5%), and most of the study sample was in the age group of 18–35 years (n = 209, 91.3%). Regarding habits, only 18.2% (n = 43) of patients were smokers and about half of the participants (n = 136, 59.4%) were khat chewers. Most cases had mild undernutrition according to BMI (n = 139, 60.7%) and normal Alb level (n = 213, 93%). Regarding the periodontal diagnosis, most of the participants were diagnosed with gingivitis (n = 186, 81.2%). BMI and albumin level were nonsignificantly associated with PDs. PDs were statistically significant with the participant’s age, gender, level of education, and smoking (P>0.05). However, BMI, khat chewing, and albumin level were nonsignificant factors of periodontal diseases among Yemeni participants (P>0.05). In both genders, variables such as age of the patients, smoking, khat chewing, and PDs were nonsignificantly associated with BMI. This study showed that the majority of the participants had been diagnosed with gingivitis, but there was not an association between PDs and undernutrition. This paper is presented on research square URL // https://www.researchsquare.com/article/rs-429796/v1 with DOI 10.21203/rs.3.rs-429796/v1.
Analysis of the Smart Medical Service Model in Super-Aged Society-UR Agency as an Example
Authors: Zhang Lei , Hu Xueqing
Published: March 2022

Urban Renaissance (UR) Agency in Japan is one of the world’s largest public housing institutions. When faced with the serious aging problems in Japan, the Japanese implemented innovative reform, with the smart medical and pension service launched according to the characteristics of resident population and their variation trends. As it well mastered the actual needs of residents by establishing the intelligent medical system, the occupancy rate was increased. Meanwhile, the problem of inadequate local medical resources was solved, with the satisfaction of residents as well as the cultural exchange and integration within communities ameliorated, which hence realized the sustainable development of communities. In this study, the smart medical experience of Urban Renaissance Agency in Japan was explored in the hope of providing enlightenment for the development of smart communities in China. Relevant Chinese enterprises can draw lessons from the experience of community services in Japan, and via the cooperation among industries, governments, and universities, they can collaborate with universities, scientific research institutions, high-tech enterprises, district governments, and grassroots communities to give full play to the advantages of the platform and improve service quality.
Tailoring the Ablative Strategy for Atrial Fibrillation: A State-of-the-Art Review
Authors: Palamà Zefferino , Nesti Martina , Robles Antonio Gianluca , Scarà Antonio , Romano Silvio , Cavarretta Elena , Penco Maria , Delise Pietro , Rillo Mariano , Calò Leonardo , Sciarra Luigi
Published: March 2022

In spite of technological progress and the improving skills of operators, atrial fibrillation (AF) ablation results appear to date to be at a plateau. In any case, the superiority of ablation over pharmacological therapy in terms of effectiveness, reduction of hospitalizations, and improvement has been well demonstrated in recent randomized trials. Triggers, substrate, and modulating factors (elements of Coumel’s triangle) play different roles in paroxysmal and persistent AF, so induction and perpetuation mechanisms of arrhythmia may be different in each patient. Although effective ablative strategies are available for the treatment of paroxysmal AF triggers and persistent AF substrates, an adequate clinical evaluation of the patient is crucial in order to increase the chances of success. Recognizing triggers allows not only performing an effective ablation but also to avoid unnecessary lesions and at the same time reducing the risk of complications. AF beginning and triggers could be recorded by 12-lead ECG, continuous Holter monitoring, or implantable devices. In case of an unsuccessful noninvasive evaluation, nonpulmonary vein triggers should be investigated with an electrophysiological study. Persistent AF needs more effort to perform an accurate substrate characterization. Among the many methods proposed, recently the use of high-density mapping and multipolar catheters seems of particular benefit in order to clarify the arrhythmia mechanisms. Surgical and hybrid techniques allow to treat regions such as the posterior wall or Bachmann’s bundle, which is fundamental for an ablative strategy that goes beyond just pulmonary vein isolation. Too often, patients are referred to electrophysiology laboratories without adequate preprocedural screening and planning in order to submit them to a standard “ready-made” procedure. The accurate search for triggers in paroxysmal AF and the correct recognition of the link between a possible underlying heart disease and the substrate in persistent AF could allow us to tailor the interventional approach in order to overcome the current plateau, increasing ablative procedure success and minimizing complications.
Storage Stability of Chilled and Frozen Starch Gels as Affected by Blended Starch Formulation, Sucrose Syrup, and Coconut Milk
Authors: Arlai Aumaporn , Tananuwong Kanitha
Published: March 2022

Effects of starch formulation, highly concentrated sucrose solution, and coconut milk on the stability of starch gels kept under chilled and frozen conditions were determined. Gels containing rice starch (RS), tapioca starch (TS) (RS:TS of 1 : 0.85), and hydroxypropyl distarch phosphate (HDP, 0-50% of total starch) were prepared from 15% starch suspension using water, 45°Brix sucrose syrup or coconut milk as liquid media. After aging at 4°C for 21 days, starch gels had higher hardness and chewiness, with lower cohesiveness and springiness (

p
≤
0.05

). Water-based gels containing HDP had less extent of texture hardening, lower degree of crystallinity, and more homogeneous microstructure during 4°C aging. However, for the starch gels in sucrose syrup or coconut milk, HDP induced greater gel hardening, higher degree of crystallinity, and denser gel microstructure during chilled storage. This could be due to the crystallization of sucrose or lipid/amylose-lipid complexes. Nevertheless, HDP enhanced freeze-thaw stability of the gels, regardless of the liquid media used (

p
≤
0.05

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Clinicopathological Features Associated with Microsatellite Instability/Mismatch Repair Deficiency in Uterine Carcinosarcoma: A Quantitative Systematic Review
Authors: Travaglino Antonio , Raffone Antonio , Santoro Angela , Raimondo Diego , Orsini Benedetta , Casadio Paolo , Zullo Fulvio , Seracchioli Renato , Zannoni Gian Franco , Insabato Luigi , Mollo Antonio
Published: March 2022

Introduction: Recent studies suggested that microsatellite instability/mismatch repair deficiency (MSI/MMR-d) might define a clinicopathologically distinct subset of uterine carcinosarcomas (UCSs). Objective: The aim of this study was to compare clinicopathological features between MSI/MMR-d and microsatellite-stable/mismatch repair-proficient (MSS/MMR-p) UCSs. Methods: A quantitative systematic review was performed by searching electronic databases from January 2000 to January 2021. All studies assessing MSI/MMR status in UCS were included. Odds ratio (OR) with a significant two-tailed p value <0.05 was used to assess the association of MSI/MMR-d with clinicopathological features. Results: Eleven studies with 783 patients were included. MSI/MMR-d was directly associated with endometrioid (pure: p < 0.001; pure + mixed: p < 0.001), undifferentiated/dedifferentiated (p < 0.001), and clear cell carcinoma component (p = 0.046), and inversely associated with age >60 (p = 0.034), serous carcinoma component (pure: p < 0.001; pure + mixed: p < 0.001), heterologous sarcoma component (p = 0.027), TP53-mutation/p53-abnormal expression (p < 0.001), and recurrence (p < 0.001). MSI/MMR-d showed no significant association with advanced FIGO stage (OR = 1.259; p = 0.517), low-grade carcinoma component (pure: p = 0.596; pure + mixed: p = 0.307), mixed carcinoma component (p = 1), and proportion of patients “dead of disease” (p = 0.352), “alive with disease” (p = 1) or with “no evidence of disease” (p = 0.458). Conclusion: MSI/MMR-d UCSs show younger age, more common endometrioid, undifferentiated or clear cell carcinoma component, and less common serous carcinoma component, heterologous sarcoma component, and TP53 mutation than MSS/MMR-p UCSs. Given the discrepancy between recurrence rate and oncologic outcomes at the last follow-up, further studies are necessary to define whether MSI/MMR-d UCSs have better prognosis.
Severe Vulvar and Perianal Crohn’s Disease: A Case Report and Review of the Literature
Authors: Le Cosquer Guillaume , Barranca Alexis , Lapotre Louise , Casassa Eline , Chaput Benoit , Ciron Jonathan , Buscail Louis , Paul Carle , Gilletta Cyrielle
Published: March 2022

Association of vulvar Crohn’s disease (CD) with pyoderma gangrenosum (PG) has been described, yet due to its low prevalence, data on therapeutic management of this association are still limited. We here present a 22-year-old woman with severe vulvar and perianal CD with a major inguinal and perineal ulceration. In the hypothesis of an associated PG, oral corticosteroids were prescribed at a dose of 40 mg with limited efficacy for a duration of 3 months. Afterward, a combination treatment of cyclosporine and infliximab followed by negative pressure wound therapy and split-thickness skin graft resulted in complete healing.
Today’s Mistakes and Tomorrow’s Wisdom… In Barrett’s Surveillance
Authors: Zellenrath Pauline A. , Roumans Carlijn A.M. , Spaander Manon C.W.
Published: March 2022

Background: Barrett’s esophagus (BE) is the only known precursor lesion of esophageal adenocarcinoma, a malignancy with increasing incidence and poor survival rates. To reduce mortality, regular endoscopic surveillance of BE patients is recommended to detect neoplasia in an (endoscopically) curable stage. In this review, we aim to provide an overview of current BE surveillance strategies, its pitfalls, and potential future directions to optimize BE surveillance. Summary: Several societal guidelines provide surveillance strategies. However, when practicing those endoscopies multiple drawbacks are encountered. Important challenges are time-consuming biopsy protocols with low adherence rates, biopsy sampling error, interobserver variability in endoscopic detection of lesions, and interobserver variability in diagnosis of dysplasia. Furthermore, the overall efficacy and cost-effectiveness of surveillance are questioned. Using novel techniques, such as artificial intelligence and personalized surveillance intervals, can help to overcome these obstacles. Key Messages: Currently, there is room for improvement in BE surveillance. Better risk-stratification is expected to reduce both patient and healthcare burdens. Personalized and dynamic surveillance intervals accompanied by novel techniques in detection and histopathological assessment of dysplasia may be tools for a change in the right direction.
Temporal Trends in Racial and Ethnic Disparities in Endovascular Therapy in Acute Ischemic Stroke
Authors: Sheriff Faheem , Xu Haolin , Maud Alberto , Gupta Vikas , Vellipuram Anantha , Fonarow Gregg C. , Matsouaka Roland A. , Xian Ying , Reeves Mathew , Smith Eric E. , Saver Jeffrey , Rodriguez Gustavo , Cruz‐Flores Salvador , Schwamm Lee H.
Published: March 2022

Introduction

Endovascular therapy (EVT) use increased following clinical trials publication in 2015, but limited data suggest there may be persistent race and ethnicity differences.

Methods and Results

We included all patients with acute ischemic stroke arriving within 6 hours of last known well and with National Institute of Health Stroke Scale (NIHSS) score ≥6 between April 2012 and June 2019 in the Get With The Guidelines‐Stroke database and evaluated the association between race and ethnicity and EVT use and outcomes, comparing the era before versus after 2015. Of 302 965 potentially eligible patients; 42 422 (14%) underwent EVT. Although EVT use increased over time in all racial and ethnic groups, Black patients had reduced odds of EVT use compared with non‐Hispanic White (NHW) patients (adjusted odds ratio [aOR] before 2015, 0.68 [0.58‒0.78]; aOR after 2015, 0.83 [0.76‒0.90]). In‐hospital mortality/discharge to hospice was less frequent in Black, Hispanic, and Asian patients compared with NHW. Conversely discharge home was more frequent in Hispanic (29.7%; aOR, 1.28 [1.16‒1.42]), Asian (28.2%; aOR, 1.23 [1.05‒1.44]), and Black (29.1%; aOR, 1.08 [1.00‒1.18]) patients compared with NHW (24%). However, at 3 months, functional independence (modified Rankin Scale, 0–2) occurred less frequently in Black (37.5%; aOR, 0.84 [0.75‒0.95]) and Asian (33%; aOR, 0.79 [0.65‒0.98]) patients compared with NHW patients (38.1%).

Conclusions

In a large cohort of patients treated with EVT, Black versus NHW patient disparities in EVT use have narrowed over time but still exist. Discharge related outcomes were slightly more favorable in racial and ethnic underrepresented groups; 3‐month functional outcomes were worse but improved across all groups with time.
Association Between Aortic Aneurysm and Aortic Dissection With Fluoroquinolones Use in Patients With Urinary Tract Infections: A Population‐Based Cohort Study
Authors: Chen Yin‐Yang , Yang Shun‐Fa , Yeh Han‐Wei , Yeh Ying‐Tung , Huang Jing‐Yang , Tsao Shao‐Lun , Yeh Chao‐Bin
Published: March 2022

Background

Fluoroquinolones are first‐line antibiotics recommended for the treatment of complicated urinary tract infections (UTIs), with frequent reports of adverse effects of aortic aneurysm (AA) and aortic dissection (AD). We examined whether fluoroquinolones can increase the risk of AA and AD in patients with UTIs in the Taiwanese population.

Methods and Results

We used the National Health Insurance Research Database to identify patients diagnosed with UTIs under single antibiotic treatment of fluoroquinolones and first‐, second‐, or third‐generation cephalosporins. An AA and AD diagnosis within a year constituted the study event. Multivariable analysis with a multiple Cox regression model was applied for comparing the hazard risk of AA and AD between fluoroquinolones and first‐ or second‐generation cephalosporins. Propensity score matching was performed to reduce the potential for bias caused by measured confounding variables. Among 1 249 944 selected patients with UTIs, 28 568 patients were assigned to each antibiotic group after propensity score matching. The incidence of AA and AD was not significantly different between the fluoroquinolones and first‐ or second‐generation cephalosporins (adjusted HR [aHR], 0.86 [95% CI, 0.59–1.27]). However, the mortality increased in the fluoroquinolones group (aHR, 1.10 [95% CI, 1.04–1.16]).

Conclusions

Compared with first‐ or second‐generation cephalosporins, fluoroquinolones were not associated with increased risk of AA and AD in patients with UTI. However, a significant risk of mortality was still found in patients treated with fluoroquinolones. The priority is to control infections with adequate antibiotics rather than exclude fluoroquinolones considering the risk of AA and AD for patients with UTI.
The Concatenative Structure of Tonal Overwriting
Authors: Trommer Jochen
Published: March 2022

Replacive overwriting by morphological tone has been used as major evidence for cyclic construction approaches to phonology (Hyman 2013, Inkelas 2018, Rolle 2018). In this article, I show that this argument is unwarranted: tonal overwriting can be derived by simple concatenation of tonal morphemes, general phonological constraints, and minimal access to morphological information—in Autosegmental Colored Containment Theory. In detailed analyses, I demonstrate that neither morpheme-specific phonology nor cyclicity is necessary to capture tonal overwriting, whereas cyclic analyses actually make wrong predictions on possible overwriting patterns.