bluuebunny/crossref_metadata_2025 huggingface dataset:
European Single Market: Evolution and Modern Challenges
Authors: Loktionova Yulia , Smirnov Artem , Giyasova Zeynab , Kondratenko Larisa , Aksenov Ilia
Published: June 2022

This paper draws on the methods of analysis and synthesis to study the regulatory framework governing the modern operating mechanism of the EU single market. Statistical analysis made it possible to reflect the market dynamics with reference to the pre‐ and post‐COVID crisis periods. Consolidation was applied to merge data on the trade of goods and services – the key elements of the EU Member States' trade indicators. Finally, the method of comparative analysis was employed to compare the single market environment of the EU with markets of other countries. The functioning of the single market depends on shared responsibility between the EU's centralized management and the many policies of its Member States. There are barriers within the single market system that limit the free movement of goods, services, people and capital and lead to an imbalance. These are sanitary and phytosanitary standards, tariff measures, and technical and quantitative barriers.
Safety of the inferolateral orbital access for filling the temporal region with the fanning technique
Authors: Faria Gladstone Eustaquio de Lima , Bastos Alyne Queiroga , Vilela Clarissa L. , Zattar Luciana , Boggio Ricardo Frota
Published: June 2022

Introduction

The anatomical complexity of the temporal region makes it so treatments with fill‐ins are challenging due to high vascular risk. Techniques which provide safer procedures must be encouraged.

Goal

Suggest access to the temple through the inferolateral orbital region as a means for safer temporal fill‐ins.

Methods

The fanning technique was plotted out not only via the conventional access (pretragal) but via the proposed one as well. The superficial temporal artery (STA) was mapped with ultrasound. The angles for each of the five retroinjection vectors were calculated in relation to STA and their mean was extracted. The longitudinality of the vector in regard to the vessel was considered the least safe factor.

Results

The mean injection angle towards the artery was a 35‐degree angle for the conventional access technique and a 73‐degree angle for the inferior‐lateral orbital access technique (p < 0.05). The more a degree is tangential to the vessel, the higher the chances for inadvertent puncture due to small technical issues. The safety of the procedure through the inferolateral orbital access is corroborated with blind ultrasound imaging done in real‐time by radiologists.

Conclusion

The suggested access is shown to be comparably safer from a vascular perspective than the conventional pretragal access.
In Vitro Analysis of Shear Stress: CAD Milled vs Printed Denture Base Resins with Bonded Denture Tooth
Authors: Kane Brittany , Shah Kumar C.
Published: June 2022

Purpose

As the fabrication of computer‐aided design (CAD) milled and 3D printed denture base resins with bonded denture teeth increase in popularity, there is a need for research comparing the shear bond stress of milled and printed denture base resins with bonded denture teeth to that of a conventional heat processed denture base.

Materials and methods

Denture base resin specimens (n = 9) were fabricated according to manufacturers’ instructions using a novel test design. Two milled (Ivobase CAD PMMA, Ivoclar Vivadent and Polident PMMA, Polident Dental) and two 3D printed (Denture Base LP Resin, Formlabs and Lucitone Digital Print, Dentsply Sirona) materials were used. Conventional heat processed polymethylmethacrylate was used as the control (Lucitone 199, Dentsply Sirona). Denture teeth (VITA Vitapan XL T44, #8, VITA Zahnfabrik) were bonded to their respective bases using denture tooth bonding agent (Ivobase CAD bonding system, Ivoclar). Specimens were aged in water for 600 hours at 37°C and loaded until failure in a Universal testing machine. Shear bond stress was calculated. All specimens were evaluated for mode of failure and select specimens under scanning electron microscope and vertical scanning interferometry. Data were analyzed with one‐way ANOVA followed by Tukey test (IBM SPSS) and fracture analysis performed.

Results

Shear stress was highest for the heat processed control (mean = 180 N ±26.76) and Polident test groups (mean = 180 N ± 34.90). Milled specimens were not significantly different from the control (p = 0.076 for IvoBase CAD and 1.00 for Polident), while the printed groups were significantly different from the control (p = 0.012 for Formlabs Denture Base Resin and p = 0.00 for Carbon Lucitone Digital Print). Milled denture base resins performed similarly to heat processed denture base resin and better than 3D printed denture bases.

Conclusion

For complete denture wearers, all resin materials used in this study may be clinically acceptable, as the sheer stress for all groups was higher than the reported maximum biting force of complete denture patients. However, for implant retained prostheses, the incorporation of additional retentive features should be considered when bonding denture teeth to printed bases. More research is needed to evaluate methods to increase the bond strength of denture teeth to printed denture base resins.
Cross‐sectional analysis of the association of periodontitis with carotid intima media thickness and atherosclerotic plaque in the Hamburg City health study
Authors: Lamprecht Ragna , Rimmele David Leander , Schnabel Renate B. , Heydecke Guido , Seedorf Udo , Walther Carolin , Mayer Carola , Struppek Julia , Borof Katrin , Behrendt Christian‐Alexander , Cheng Bastian , Gerloff Christian , Debus Sebastian , Smeets Ralf , Beikler Thomas , Blankenberg Stefan , Zeller Tanja , Karakas Mahir , Thomalla Götz , Aarabi Ghazal
Published: June 2022

Background

Previous epidemiological studies regarding the association between chronic periodontitis (CP) and carotid intima‐media thickness (cIMT) and subclinical atherosclerosis have been inconclusive.

Objective

The aim of this study was to determine whether CP is associated with subclinical atherosclerosis in a large population‐based cohort study conducted in northern Germany (the Hamburg City Health study).

Methods

Baseline data from 5781 participants of the Hamburg City Health Study with complete oral health and carotid ultrasound data (50.7% female, mean age: 62.1 ± 8.4 years) were evaluated. A standardized duplex sonography of the carotid artery was performed with measurement of carotid intima‐media thickness (cIMT) and atherosclerotic plaques. Oral health was assessed by recording the decayed, missing, and filled teeth (DMFT) index, clinical attachment loss (CAL), bleeding on probing (BOP), and the dental plaque index (PI). Correlations were tested for statistical significance by means of descriptive statistics and multivariate regression analyses.

Results

Moderate and severe CP were associated with the prevalence of cIMT ≥ 1 mm (none or mild CP: 5.1%, moderate CP: 6.1%, severe CP: 10%) and mean cIMT (none or mild CP: 0.72 mm, moderate CP: 0.75 mm, severe CP: 0.78 mm) in bivariate analyses (p < .001). Additionally, severe and moderate CP were associated with higher prevalence of carotid atherosclerotic plaques (plaque = yes: none or mild CP: 23.9%, moderate CP: 29%, severe CP: 40.2%,). After adjustment for age, sex, smoking, diabetes, hypertension, educational level, hypercholesterolemia, and hsCRP, severe CP still correlated significantly with cIMT and the prevalence of cIMT ≥1 mm and/or presence of carotid atherosclerotic plaques.

Conclusion

In this study, severe CP was associated with increased cIMT and higher prevalence of carotid plaques independent of common risk factors.
One size does not fit all; practical, personal tailoring of the diet to NAFLD patients
Authors: Zelber‐Sagi Shira , Grinshpan Laura Sol , Ivancovsky‐Wajcman Dana , Goldenshluger Ariela , Gepner Yftach
Published: June 2022

Different dietary regimens for weight loss have developed over the years. Since the most evidenced treatment for non‐alcoholic fatty liver disease (NAFLD) is weight reduction, it is not surprising that more diets targeting obesity are also utilized for NAFLD treatment. However, beyond the desired weight loss effects, one should not ignore the dietary composition of each diet, which may not necessarily be healthy or safe over the long term for hepatic and extrahepatic outcomes, especially cardiometabolic outcomes. Some of these diets are rich in saturated fat and red meat, are very strict, and require close medical supervision. Some may also be very difficult to adhere to for long periods, thus reducing the patient's motivation. The evidence for a direct benefit to NAFLD by restrictive diets such as very‐low‐carb, ketogenic, very‐low‐calorie diets, and intermittent fasting is scarce, and the long‐term safety has not been tested. Nowadays, the approach is that the diet should be tailored to the patient's cultural and personal preferences. There is strong evidence for the independent protective association of NAFLD with a diet based on healthy eating patterns of minimally‐processed foods, low in sugar and saturated fat, high in polyphenols, and healthy types of fats. This leads to the conclusion that a Mediterranean diet should serve as a basis that can be restructured into other kinds of diets. This review will elaborate on the different diets and their role in NAFLD. It will provide a practical guide to tailor the diet to the patients without compromising its composition and safety.
Genetic insight into primary glomerulonephritis
Authors: Wu Mei‐Yi , Chen Ying‐Chun , Chiu I‐Jen , Wu Mai‐Szu
Published: June 2022

Primary glomerulonephritis is a major global health concern and a disorder with significant heritable components. Rapid advances in sequencing technologies have led to genome‐wide, high‐throughput investigations of the genetic basis of complex human traits. Genetic studies have successfully mapped several susceptibility loci and disease‐causing genes for different subtypes of primary glomerulonephritis. These studies have revealed that IgA nephropathy–associated genes have a highly complex, polygenic and pleiotropic genetic architecture and that genetic susceptibility to membranous nephropathy may be driven by a few large‐effect loci. Furthermore, both susceptibility genes and high‐penetrant gene mutations reportedly contribute to the development of the most heterogeneous phenotype of focal segmental glomerulosclerosis. The genetic heterogeneity between each glomerular disease type and within different populations has indicated disease‐specific and ethnicity‐specific underlying molecular mechanisms for the disorders. The findings from genome‐wide association studies (GWAS) have mainly included variants on or near the major histocompatibility (MHC) loci, highlighting the molecular basis for the shared pathogenesis of the immune‐mediated disease. Recent studies with increased sample sizes and higher resolutions of genome‐wide imputation have provided novel insights into the pathogenesis of glomerular disorders. Further integration of results from genomic studies with functional genomics datasets can indicate novel targets for drug discovery as well as potential tools for patient diagnosis and stratification. However, larger GWASs and sequencing studies in independent cohorts and more standardized inclusion of phenotypes across studies are required for each subtype of glomerular disease.
Agent‐based models of scientific interaction
Authors: Šešelja Dunja
Published: June 2022

The paper examines recent developments in agent‐based modeling of scientific inquiry with a special focus on network epistemology. It provides a survey of different types of ABMs studying network effects in scientific inquiry: ABMs based on bandit problems, ABMs based on epistemic landscapes and ABMs based on argumentative dynamics. It further presents models that study the impact of biased and deceptive researchers on the success of collective inquiry. The paper concludes with a discussion on the contribution of ABMs to the broader field of philosophy of science given their highly idealized nature.
Measuring human trace fear conditioning
Authors: Wehrli Jelena M. , Xia Yanfang , Gerster Samuel , Bach Dominik R.
Published: June 2022

Trace fear conditioning is an important research paradigm to model aversive learning in biological or clinical scenarios, where predictors (conditioned stimuli, CS) and aversive outcomes (unconditioned stimuli, US) are separated in time. The optimal measurement of human trace fear conditioning, and in particular of memory retention after consolidation, is currently unclear. We conducted two identical experiments (N1 = 28, N2 = 28) with a 15‐s trace interval and a recall test 1 week after acquisition, while recording several psychophysiological observables. In a calibration approach, we explored which learning and memory measures distinguished CS+ and CS− in the first experiment and confirmed the most sensitive measures in the second experiment. We found that in the recall test without reinforcement, only fear‐potentiated startle but not skin conductance, pupil size, heart period, or respiration amplitude, differentiated CS+ and CS−. During acquisition without startle probes, skin conductance responses and pupil size responses but not heart period or respiration amplitude differentiated CS+ and CS−. As a side finding, there was no evidence for extinction of fear‐potentiated startle over 30 trials without reinforcement. These results may be useful to inform future substantive research using human trace fear conditioning protocols.
Unravelling the enigma of systemic lupus erythematosus‐associated ILD
Authors: Keir Gregory J.
Published: June 2022

See related article
Low levels of the innate immune system proteins MASP‐2 and MAp44 in patients with common variable immunodeficiency
Authors: Mistegaard Clara Elbæk , Jensen Lisbeth , Christiansen Mette , Bjerre Mette , Jensen Jens Magnus Bernth , Thiel Steffen
Published: June 2022

Patients with common variable immunodeficiency (CVID) display low antibody levels and associated symptoms, including an increased risk of infections. The causes of CVID are uncertain and likely heterogeneous. The complement system protects against pathogens and plays essential roles in homeostasis and development. The influence of the complement system in CVID is not established. We investigated CVID patients and healthy individuals for plasma levels of the complement proteins: MASP‐1, MASP‐2, MASP‐3, MAp19 and MAp44. We also tested other patients with symptoms similar to the CVID patients. CVID patients had lower average MASP‐2 and MAp44 levels than healthy individuals (P < 0.01); the MASP‐2 level was 0.73‐fold lower, and the MAp44 level was 0.87‐fold lower. This was not observed in the other patient cohorts studied. Our findings in this exploratory study provide new insights into CVID and introduce a complement perspective for future investigations into the underlying mechanisms of the disease.
Relationships of the Big Five facets and dysfunctional attitudes with depression
Authors: Fausor Rocío , Morán Noelia , Gesteira Clara , Cobos Beatriz , Sanz‐García Ana , Liébana Sara , Altungy Pedro , García‐Vera María Paz , Sanz Jesús
Published: June 2022

There are two parallel lines of research on the relationship between personality and depression, one based on the Big Five personality model and one on Beck's cognitive theory of depression. However, no study has jointly examined the dimensions and facets of the Big Five and the dysfunctional attitudes of Beck's theory. This was the objective of the present study. The Revised NEO Personality Inventory (NEO PI‐R), the Dysfunctional Attitude Scale (DAS‐A), and the Beck Depression Inventory (BDI‐IA) were applied to 221 adults from the Spanish general population (53.7% females; mean age: 38.3 years). Various multiple linear regression analyses revealed that only the facet of depression was significantly related to depressive symptomatology. The different associations of the broad and specific personality traits and the need to control as many third variables as possible to prevent the finding of spurious relationships are discussed.
Discovery of the novel HLA‐DRB1*11:01:47 allele in a Taiwanese individual
Authors: Yang Kuo‐Liang , Li Chi‐Cheng , Lin Py‐Yu
Published: June 2022

One nucleotide substitution in codon 8 of HLA‐DRB1*11:01:01:01 results in a novel allele HLA‐DRB1*11:01:47.
Identification of the novel HLA allele, HLA‐DRB1*14:50:02, in an individual from southern India
Authors: Tambe Manisha , Pinto Andrea , D'Silva Selma Z. , Singh Meenakshi
Published: June 2022

HLA‐DRB1*14:50:02 differs from DRB1*14:04:03 by one nucleotide change in codon 77 in exon 2.
Does antidumping drive exporters out of the market? Some evidence from Brazil
Authors: Mazzucco Bruno , Bittencourt Mauricio
Published: June 2022

This study quantifies the effect of antidumping investigations on the likelihood of an exporter being excluded from the domestic market in Brazil, a large developing country and a heavy user of antidumping measures (AD). A survival analysis methodology is used to measure the probability of exit with quarterly country–product data on imports and antidumping actions between 1997 and 2017. The results show that, during the course of an investigation, products from targeted countries present, on average, a 33% higher probability of ending a spell of trade compared to non‐targeted countries. We also identify at which stage of the investigation this effect is larger, whether at the beginning of the investigation, during the preliminary determination phase, or after the final duties are imposed. The results indicate that the effects are concentrated in the final phase, after the final determination, with a 47% increase in the hazard rate.
CT features of confirmed and presumed gastric wall edema in dogs
Authors: Murakami Masahiro , Heng Hock Gan , Sola Mario
Published: June 2022

Postcontrast computed tomographic (CT) characteristics of gastrointestinal (GI) wall edema in humans have been described as GI wall thickening with a thickened submucosal layer and thin enhanced inner and outer layers. Published studies describing CT features of gastric wall edema in dogs are currently lacking. The aim of this retrospective, case series was to describe CT features of gastric wall edema in a group of dogs. Medical records were searched for dogs with postcontrast abdominal CT scans and a diagnosis of gastric wall edema based on histopathology (group I) or CT characteristics consistent with those reported in humans (group II). Clinical diagnosis, mean serum albumin concentration, and histopathological diagnosis were recorded. The following CT characteristics were recorded: numbers of wall layers, attenuation and contrast enhancement, presence of blood vessels, locations, distribution, and thickness. Twelve dogs (3 in group I and 9 in group II) were included. The most common clinical finding was hypoalbuminemia. In group I, a well‐defined three‐layer appearance with a non‐enhancing fluid‐attenuating middle layer was observed in three dogs and thin blood vessels in the middle layer in two dogs. In group II, nine dogs had a three‐layer appearance with a non‐enhancing fluid‐attenuating middle layer. Locations of gastric wall thickening were diffuse in two, focal concentric in six, and focal asymmetric in four dogs. Findings supported including gastric wall edema as a differential diagnosis for dogs with hypoalbuminemia and CT characteristics of a three‐layer appearance in the gastric wall, with a non‐enhancing fluid‐attenuating middle layer and thin blood vessels.
Proximal sesamoid bone microdamage is localized to articular subchondral regions in Thoroughbred racehorses, with similar fracture toughness between fracture and controls
Authors: Luedke Lauren K. , Ilevbare Phoebe , Noordwijk Kira J. , Palomino Pablo M. , McDonough Sean P. , Palmer Scott E. , Basran Parminder S. , Donnelly Eve , Reesink Heidi L.
Published: June 2022

Objective

To determine whether proximal sesamoid bone (PSB) microdamage and fracture toughness differ between Thoroughbred racehorses sustaining PSB fracture and controls.

Study design

Cadaveric case–control.

Animals

Twenty‐four Thoroughbred racehorses (n = 12 PSB fracture,n = 12 control).

Methods

Proximal sesamoid bones were dissected, and gross pathological changes and morphological measurements were documented. High‐speed exercise history data were evaluated. Microdamage was assessed in fracture, fracture‐contralateral limb (FXCL) and control PSBs using whole bone lead uranyl acetate (LUA) staining with micro‐CT imaging or basic fuchsin histological analysis. Fracture toughness mechanical testing was carried out in 3‐point‐bending of microbeams created from PSB flexor cortices. Data were analyzed using ordinal logistic and linear regression models.

Results

Microdamage was detected most commonly in the articular subchondral region of PSBs via LUA micro‐CT and basic fuchsin histology. There were no differences in microdamage between FXCL and control PSBs. Fracture toughness values were similar for FXCL (1.31 MPa√m) and control (1.35 MPa√m) PSBs. Exercise histories were similar except that horses sustaining fracture spent a greater percentage of their careers in rest weeks.

Conclusion

Microdamage was detected in the articular region of PSBs but was not greater in horses sustaining catastrophic PSB fracture. Fracture toughness of PSB flexor cortices did not differ between FXCL and control PSBs.

Clinical significance

Although uncommon, microdamage is localized to the articular region of Thoroughbred racehorse PSBs. Catastrophic PSB failure is not associated with lower PSB flexor cortex fracture toughness.
Mechanical evaluation of a novel angle‐stable interlocking nail in a gap fracture model
Authors: Deprey Julie , Blondel Margaux , Saban Charles , Massenzio Michel , Gauthier Olivier , Moissonnier Pierre , Viguier Eric , Cachon Thibaut
Published: June 2022

Objective

To describe the mechanical characteristics of a novel angle‐stable interlocking nail (NAS‐ILN) and compare them to those of a locking compression plate (LCP) by using a gap‐fracture model.

Study design

Experimental study.

Sample population

Synthetic bone models.

Methods

Synthetic bone models simulating a 50 mm diaphyseal comminuted canine tibial fracture were treated with either a novel angle‐stable interlocking nail (NAS‐ILN) or a locking compression plate (LCP). Maximal axial deformation and load to failure in compression and 4‐point bending, as well as maximal angular deformation, slack, and torque to failure in torsion, were statistically compared (P < .05).

Results

In compression, the maximal axial deformation was lower for NAS‐ILN (0.11 mm ± 0.03) than for LCP (1.10 mm ± 0.22) (P < .0001). The ultimate load to failure was higher for NAS‐ILN (803.58 N ± 29.52) than for LCP (328.40 N ± 11.01) (P < .0001).

In torsion, the maximal angular deformation did not differ between NAS‐ILN (22.79° ± 1.48) and LCP (24.36° ± 1.45) (P = .09). The ultimate torque to failure was higher for NAS‐ILN (22.45 Nm ± 0.24) than for LCP (19.10 Nm ± 1.36) (P = .001). No slack was observed with NAS‐ILN.

In 4‐point bending, the maximal axial deformation was lower for NAS‐ILN (3.19 mm ± 0.49) than for LCP (4.17 mm ± 0.34) (P = .003). The ultimate bending moment was higher for NAS‐ILN (25.73 Nm, IQR [23.54‐26.86] Nm) than for LCP (16.29 Nm, IQR [15.66‐16.47] Nm) (P = .002).

Conclusion

The NAS‐ILN showed greater stiffness in compression and 4‐point bending, and a greater resistance to failure in compression, torsion, and 4‐point bending, than LCP.

Clinical impact

Based on these results, NAS‐ILNs could be considered as alternative implants for the stabilization of comminuted fractures.
Children’s Comprehension of Narrative and Expository Texts: The Contributions of Word Decoding and Knowledge Integration Skills Vary Within and Between Text Types
Authors: Hannon Brenda
Published: June 2022

This study examined the concurrent (mean age:  5.96 years) and longitudinal (mean age: 5.96 years) contributions that multiple component skills of reading made to 155 beginning readers’ comprehension scores for narrative and expository texts. The component skills included: word decoding, text memory, knowledge integration, and working memory. For narrative texts, word decoding was one of the best predictors of comprehension scores both concurrently and longitudinally; although longitudinally, the predictive strength of word decoding was equivalent to knowledge integration. In contrast, for expository texts, knowledge integration was a much better predictor of comprehension scores than any other component skill, including word decoding. When the contributions of the component skills were considered between text types, word decoding was a better predictor of comprehension scores for narrative texts than expository texts, whereas knowledge integration was a better predictor of comprehension scores for expository texts than narrative texts. Taken as a whole, these findings suggest that the contributions that component skills make to the comprehension scores of beginning readers vary as a function of text type, and that the common assumption that word decoding is the most important skill for beginning readers may be limited to just the comprehension scores of narrative texts.
An Evaluation of the Conversion of Gasoline and Natural Gas Spark Ignition Engines to Ammonia/Hydrogen Operation From the Perspective of Laminar Flame Speed
Authors: Yan Yuchao , Liu Zhentao , Liu Jinlong
Published: June 2022

Power generation systems will reduce carbon emissions primarily through the application of low or even zero carbon fuels under the global decarbonization trend. Ammonia is an ideal alternative fuel because it is cheap, readily available, and easy to store and transport. However, its mediocre combustion performance has raised concerns about its use in engines. The objective of this paper was to evaluate the amount of hydrogen that would need to be added to the ammonia from a laminar flame speed perspective if converting existing spark ignition engines to ammonia operation. The benchmark for determining the hydrogen blending ratio was to help ammonia achieve efficient combustion in the cylinder comparable to that of gasoline or natural gas. The results showed that hydrogen addition had the potential to greatly improve engine efficiency and emissions, although the combustion kinetics of ammonia-hydrogen mixtures were still dominated by ammonia with hydrogen addition levels below 60%. In addition, the hydrogen addition ratio was mainly determined by the kernel inception process, as this burning stage heavily influenced the repeatability of the combustion and the ease of combustion control. Also, at least 20% of hydrogen was required to be added to ammonia to adapt the engine to various operating conditions, while such a strategy still cannot help ammonia to obtain a rapid burning event compatible with gasoline or methane. Moreover, natural gas engines were more suitable for retrofitting to ammonia-hydrogen operation because they have a higher compression ratio and their combustion chambers are less demanding on the fuel laminar flame speed. Further, ammonia lean operation was recommended to be avoided in spark ignition configurations. Altogether, all of these findings support the need for additional efforts in ammonia engine optimizations and onboard ammonia dissociation system efficiency improvements.
Epidemiology beyond its limits
Authors: McCullough Lauren E. , Maliniak Maret L. , Amin Avnika B. , Baker Julia M. , Baliashvili Davit , Barberio Julie , Barrera Chloe M. , Brown Carolyn A. , Collin Lindsay J. , Freedman Alexa A. , Gibbs David C. , Haddad Maryam B. , Hall Eric W. , Hamid Sarah , Harrington Kristin R. V. , Holleman Aaron M. , Kaufman John A. , Khan Mohammed A. , Labgold Katie , Lee Veronica C. , Malik Amyn A. , Mann Laura M. , Marks Kristin J. , Nelson Kristin N. , Quader Zerleen S. , Ross-Driscoll Katherine , Sarkar Supriya , Shah Monica P. , Shao Iris Y. , Smith Jonathan P. , Stanhope Kaitlyn K. , Valenzuela-Lara Marisol , Van Dyke Miriam E. , Vyas Kartavya J. , Lash Timothy L.
Published: June 2022

In 1995, journalist Gary Taubes published an article inSciencetitled “Epidemiology faces its limits,” which questioned the utility of nonrandomized epidemiologic research and has since been cited more than 1000 times. He highlighted numerous examples of research topics he viewed as having questionable merit. Studies have since accumulated for these associations. We systematically evaluated current evidence of 53 example associations discussed in the article. Approximately one-quarter of those presented as doubtful are now widely viewed as causal based on current evaluations of the public health consensus. They include associations between alcohol consumption and breast cancer, residential radon exposure and lung cancer, and the use of tanning devices and melanoma. This history should inform current debates about the reproducibility of epidemiologic research results.
Meta-analysis of donor–recipient gender profile in paediatric living donor liver transplantation
Authors: Wong Zhen Yu , Low Zhi Rong , Chen Yong , Danaee Mahmoud , Nah Shireen Anne
Published: June 2022

Objective

Paediatric living donor liver transplantation (LDLT) has gained popularity due to limited deceased donor organ supply. Some studies report inequalities in donor and recipient gender profiles, but data are sparse. We evaluated LDLT donor–recipient gender profiles, comparing country income categories and gender disparity level.

Design

We performed a systematic review, searching PubMed, Embase and Cochrane databases for publications dated January 2006–September 2021. We included full-text English articles reporting gender in ≥40 universally sampled donor–recipient pairs. Search terms were permutations of ‘liver transplant’, ‘living donor’ and ‘paediatric’. Countries were grouped as high/middle/low-income economies based on World Bank criteria and into groups based on deviation from gender parity in Gender Development Index (GDI) values (group 1 indicating closest to gender parity, group 5 indicating furthest). Proportions analysis with corresponding 95% CI were used for analysis of dichotomous variables, with significance when 95% CI did not cross 0.5. Data are reported as female proportion (%) and 95% CI.

Results

Of 12 525 studies identified, 14 retrospective studies (12 countries; 6152 recipients and 6138 donors) fulfilled study inclusion criteria. Male recipient preponderance was seen in lower middle-income countries (all were also GDI group 5) (39.3 (95% CI 34.7 to 44.0)) and female recipient preponderance in GDI groups 1 and 3. Female donor preponderance was seen overall (57.4% (95% CI 55.1 to 59.6)), in middle income countries and in three of four GDI groups represented.

Conclusion

There are significant imbalances in recipient-donor gender profiles in paediatric LDLT that are not well explained. The reasons for overall female donor preponderance across income tiers must be scrutinised.
Insight into hypoglycemia frequency in congenital hyperinsulinism: evaluation of a large UK CGM dataset
Authors: Worth Chris , Tropeano Yesica , Gokul Pon Ramya , Cosgrove Karen E , Salomon-Estebanez Maria , Senniappan Senthil , Dastamani Antonia , Banerjee Indraneel
Published: June 2022

Introduction

Hypoglycemia is often recurrent and severe in patients with congenital hyperinsulinism (CHI). However, there is little information regarding frequency or patterns of episodes to inform clinical management and future trial design.

Research design and methods

We aimed to describe frequency and patterns of hypoglycemia by varying thresholds through a large continuous glucose monitoring (CGM) dataset. Through the UK CHI centers of excellence, data were analyzed from patients with CHI over a 5-year period. Hypoglycemia thresholds of 3.0 (H3.0), 3.5 (H3.5) and 3.9 (H3.9) mmol/L were used to test threshold change on hypoglycemia frequencies.

Results

From 63 patients, 3.4 million data points, representing 32 years of monitoring, were analyzed. By UK consensus threshold H3.5, patients experienced a mean 1.3 hypoglycemic episodes per day. Per cent time hypoglycemic increased from 1.2% to 3.3% to 6.9% when threshold changed from H3.0 to H3.5 and H3.9. Merged data showed periodicity of hypoglycemia risk in 24-hour periods in all patients.

Conclusions

We have evaluated a large dataset to provide a comprehensive picture of the frequency and patterns of hypoglycemia for patients with CHI in the UK. These data establish a baseline risk of hypoglycemia by CGM and provide a framework for clinical management and clinical trial design.
Implementing an emergency risk communication campaign in response to the COVID-19 pandemic in Nigeria: lessons learned
Authors: Ihekweazu Vivianne , Ejibe Ukwori , Kaduru Chijioke , Disu Yahya , Oyebanji Oyeronke , Oguanuo Emeka , Anueyiagu Chimezie , Obanor Oreoluwa Oluwabukunola , Akande-Alegbe Atinuke , Egwuenu Abiodun , Ojumu Tijesu , Abara Abara Erim , Ochu Chinwe Lucia
Published: June 2022

At the onset of the COVID-19 pandemic, the WHO recommended the prioritisation of risk communication and community engagement as part of response activities in countries. This was related to the increasing spread of misinformation and its associated risks, as well as the need to promote non-pharmaceutical interventions (NPIs) in the absence of an approved vaccine for disease prevention. The Nigeria Centre for Disease Control, the national public health institute with the mandate to prevent and detect infectious disease outbreaks, constituted a multidisciplinary Emergency Operations Centre (EOC), which included NCDC staff and partners to respond to the COVID-19 outbreak. Risk communication, which also comprised crisis communication, was a pillar in the EOC. As the number of cases in Nigeria increased, the increasing spread of misinformation and poor compliance to NPIs inspired the development of the #TakeResponsibility campaign, to encourage individual and collective behavioural change and to foster a shared ownership of the COVID-19 outbreak response. Mass media, social media platforms and community engagement measures were used as part of the campaign. This contributed to the spread of messages using diverse platforms and voices, collaboration with community leaders to contextualise communication materials and empowerment of communication officers at local levels through training, for increased impact. Despite the challenges faced in implementing the campaign, lessons such as the use of data and a participatory approach in developing communications campaigns for disease outbreaks were documented. This paper describes how a unique communication campaign was developed to support the response to the COVID-19 pandemic.
Body dysmorphic disorder, muscle dysmorphia, weight and shape dissatisfaction and the use of appearance-enhancing drugs in the military: a systematic review
Authors: Applewhite Briana , Olivola M , Tweed C , Wesemann U , Himmerich H
Published: June 2022

Background

Body dysmorphic disorder (BDD) and muscle dysmorphia (MD) are common but often underdiagnosed disorders. These disorders have rarely been explored in the context of military personnel by mental health researchers despite the emphasis on physical fitness in military populations. We conducted a comprehensive systematic literature review on scientific studies of BDD and MD and the accompanying symptoms within the military.

Methods

We used the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines and used PubMed, Web of Science and PsycINFO as databases with “body dysmorphic disorder,” “muscle dysmorphia,” “body image,” “performance and image enhancing drugs,” “anabolic steroid,” military personnel,” “soldiers,” “navy,” “air force,” “army” and “armed forces” as search terms.

Results

A total of 20 eligible articles reporting data of 42 952 study participants were used. According to the identified literature, prevalence rates of BDD in the military are ~10% in men and ~20% in women, whereas ~15% of men and ~5% of women may suffer from MD. Further identified related problems in military populations were excessive bodybuilding, the use of anabolic drugs, the intake of stimulants, weight and shape concerns, and weight-control behaviours.

Conclusions

BDD, MD, as well as the use of anabolic and stimulating drugs, are highly prevalent in military personnel. Despite the importance of these problems in the military, there are no military-specific treatment studies available. A pre-existing focus on physical appearance and fitness might contribute to the decision to pursue a professional military career. The military environment might be a maintaining factor of BDD or MD, but not the ultimate cause of the disorder in an affected individual.
Nomenclature and diagnosis of seronegative coeliac disease and chronic non-coeliac enteropathies in adults: the Paris consensus
Authors: Schiepatti Annalisa , Sanders David S , Baiardi Paola , Caio Giacomo , Ciacci Carolina , Kaukinen Katri , Lebwohl Benjamin , Leffler Daniel , Malamut Georgia , Murray Joseph A , Rostami Kamran , Rubio-Tapia Alberto , Volta Umberto , Biagi Federico
Published: June 2022

Objective

Differential diagnosis of villous atrophy (VA) without coeliac antibodies in adults includes seronegative coeliac disease (CD) and chronic enteropathies unrelated to gluten, ie. non-coeliac enteropathies (NCEs). There is currently no international consensus on the nomenclature and diagnostic criteria for these enteropathies. In this work, a Delphi process was conducted to address this diagnostic and clinical uncertainty.

Design

An international task force of 13 gastroenterologists from six countries was recruited at the 16th International Coeliac Disease Symposium, Paris, 2019. Between September 2019 and July 2021, a Delphi process was conducted through mail surveys to reach a consensus on which conditions to consider in the differential diagnosis of VA with negative coeliac serology and the clinical diagnostic approaches required for these conditions. A 70% agreement threshold was adopted.

Results

Chronic enteropathies characterised by VA and negative coeliac serology can be attributed to two main clinical scenarios: forms of CD presenting with negative serology, which also include seronegative CD and CD associated with IgA deficiency, and NCEs, with the latter recognising different underlying aetiologies. A consensus was reached on the diagnostic criteria for NCEs assisting clinicians in differentiating NCEs from seronegative CD. Although in adults seronegative CD is the most common aetiology in patients with VA and negative serology, discriminating between seronegative CD and NCEs is key to avoid unnecessary lifelong gluten-free diet, treat disease-specific morbidity and contrast poor long-term outcomes.

Conclusion

This paper describes the Paris consensus on the definitions and diagnostic criteria for seronegative CD and chronic NCEs in adults.
Neuro-Inspired Reinforcement Learning to Improve Trajectory Prediction in Reward-Guided Behavior
Authors: Chen Bo-Wei , Yang Shih-Hung , Kuo Chao-Hung , Chen Jia-Wei , Lo Yu-Chun , Kuo Yun-Ting , Lin Yi-Chen , Chang Hao-Cheng , Lin Sheng-Huang , Yu Xiao , Qu Boyi , Ro Shuan-Chu Vina , Lai Hsin-Yi , Chen You-Yin
Published: June 2022

Hippocampal pyramidal cells and interneurons play a key role in spatial navigation. In goal-directed behavior associated with rewards, the spatial firing pattern of pyramidal cells is modulated by the animal’s moving direction toward a reward, with a dependence on auditory, olfactory, and somatosensory stimuli for head orientation. Additionally, interneurons in the CA1 region of the hippocampus monosynaptically connected to CA1 pyramidal cells are modulated by a complex set of interacting brain regions related to reward and recall. The computational method of reinforcement learning (RL) has been widely used to investigate spatial navigation, which in turn has been increasingly used to study rodent learning associated with the reward. The rewards in RL are used for discovering a desired behavior through the integration of two streams of neural activity: trial-and-error interactions with the external environment to achieve a goal, and the intrinsic motivation primarily driven by brain reward system to accelerate learning. Recognizing the potential benefit of the neural representation of this reward design for novel RL architectures, we propose a RL algorithm based on [Formula: see text]-learning with a perspective on biomimetics (neuro-inspired RL) to decode rodent movement trajectories. The reward function, inspired by the neuronal information processing uncovered in the hippocampus, combines the preferred direction of pyramidal cell firing as the extrinsic reward signal with the coupling between pyramidal cell–interneuron pairs as the intrinsic reward signal. Our experimental results demonstrate that the neuro-inspired RL, with a combined use of extrinsic and intrinsic rewards, outperforms other spatial decoding algorithms, including RL methods that use a single reward function. The new RL algorithm could help accelerate learning convergence rates and improve the prediction accuracy for moving trajectories.
Arthroscopic Dorsal Ligamentocapsulodesis in the Treatment of Isolated Lunotriquetral Interosseous Ligamentous Injury: A Retrospective Case Series of 22 Patients
Authors: ÖZÇELİK İsmail Bülent , AYIK Ömer , DEMİREL Mehmet , YILDIRIM Tuğrul , UĞURLAR Meriç
Published: June 2022

Background: The literature is scarce regarding isolated tears of lunotriquetral interosseous ligament (LTIL). The purpose of this study was to present mid-term clinical and functional results of arthroscopic dorsal ligamentocapsulodesis in the treatment of isolated LTIL tears.

Methods: Twenty-two patients (8 females, 14 males; mean age: 31 years; age range: 18–42) with isolated LTIL tears verified by wrist arthroscopy were retrospectively reviewed and included in the study. The mean follow-up was 55 months (range: 24–84). The modified Mayo wrist score, visual analog scale (VAS), flexion and extension deficits of passive wrist range of motion (ROM), pain-free ROM with forced wrist extension and grip strength were measured in all patients preoperatively and at final follow-up.

Results: The mean modified Mayo wrist score significantly improved from 50 ± 10.29 preoperatively (range: 30–65) to 86 ± 11.61 (range: 60–100) at the final follow-up (p < 0.001). The mean VAS score significantly improved from 7.1 ± 0.83 (range: 6–8) preoperatively to 2.2 ± 1.35 (range: 0–6; p < 0.001) at the final follow-up. At the final follow-up examination, the forced wrist extension was painless in all but three patients who developed pain at 70º, 75º and 80º of extension, respectively. The mean strength of hand grip significantly increased from 38.6 ± 9.68 (range: 24–54) kg to 49.5 ± 12.36 (range: 33–66) kg at the final assessment (p < 0.001). No major complications were observed during or after the procedure.

Conclusions: With the encouraging mid-term outcomes and a lower complication rate, arthroscopic LTIL dorsal ligamentocapsulodesis seems to be a safe and effective surgical technique in improving functional outcomes and reducing pain in patients with isolated LTIL tears.

Level of Evidence: Level IV (Therapeutic)
Patterns of Involvement of Digits in Patients with Multiple Trigger Digits: A Retrospective Study
Authors: SUZUKI Ayumi , MATSUYAMA Yukihiro , OJIMA Toshiyuki , WATANABE Takuya , INOUE Yoshiya
Published: June 2022

Background: The involvement of digits in patients with multiple trigger digits often displays specific patterns. We aimed to determine the patterns of involvement of digits in multiple trigger digits and their association with patient-related factors and compare them to those of patients with a single trigger digit.

Methods: All patients with trigger digits treated over a 2-year period were retrospectively examined in June 2020. Data regarding the age at occurrence of initial trigger digit, sex, occupation, presence of diabetes mellitus, carpal tunnel syndrome and de Quervain disease, and hand dominance was determined. The data obtained from patients with multiple trigger digits was compared with those with a single trigger digit. Additionally, we investigated the patterns of involvement of the first two affected digits in patients with multiple trigger digits and their association with patient-related factors and compared them to those in patients with a single trigger digit.

Results: Three hundred and eighty-seven and 577 patients with multiple and single trigger digits, respectively, were studied. Their median age was 60 (range: 17–92) years. The incidence of concomitant diabetes mellitus was 150% higher in patients with multiple trigger digits than in those with a single trigger digit. Symmetric occurrence and adjacent occurrence patterns were observed in 42.4 % and 28.4% of the 387 patients, respectively. Initial onset in the fifth and sixth decades of life, female sex and a time lag between occurrences were significantly associated with symmetric occurrence. Male sex and simultaneous occurrence in two digits were significantly associated with adjacent occurrence. Diabetes mellitus was not associated with each occurrence pattern.

Conclusions: We have confirmed the presence of two involvement patterns in patients with multiple trigger digits: symmetric and adjacent. Our data will help in the prevention, early detection and management of multiple trigger digits.

Level of Evidence: Level III (Therapeutic)
A Biomechanical Comparison of Gliding Resistance between Modified Lim Tsai and Asymmetric Tendon Repair Techniques in Zone II Flexor Tendon Repairs
Authors: HUAN Khian Wan Sarah Joy , LIM Rebecca Qian Ru , WONG Yoke Rung
Published: June 2022

Background: Early active motion protocols have shown better functional outcomes in zone II flexor tendon lacerations. Different techniques of tendon repair have different effects on gliding resistance, which can impact tendon excursion and adhesion formation. For successful initiation of early active mobilisation, the repair technique should have high breaking strength and low gliding resistance. Previous studies have shown the Modified Lim-Tsai technique demonstrates these characteristics. The Asymmetric repair has also shown superior ultimate tensile strength. This study aims to compare the gliding resistance between the two techniques.

Methods: FDP tendons from ten fresh frozen cadaveric fingers were randomly divided into two groups, transected completely distal to the sheath of the A2 pulley and repaired using either the Modified Lim-Tsai or Asymmetric technique. The core repair was performed with Supramid 4-0 looped sutures and circumferential epitendinous sutures were done with nylon monofilament Prolene 6-0 sutures. The gliding resistance and ultimate tensile strength were then tested.

Results: The gliding resistance of the Asymmetric and Modified Lim-Tsai repair techniques were 0.2 and 0.95 N respectively. This difference was significant (p = 0.008). The Modified Lim-Tsai technique had a higher ultimate tensile strength and load to 2 mm gap formation, though this was not significant.

Conclusions: Gliding resistance of the Asymmetric repair is significantly less than that of Modified Lim-Tsai. Ultimate tensile strength and load to 2 mm gap formation are comparable.