bluuebunny/crossref_metadata_2025 huggingface dataset:
Rejuvenation of giant electrostrain in doped barium titanate single crystals
Authors: Patterson E. A. , Finkel P. , Cain M. G. , Thompson P. , Lucas C. , Staruch M.
Published: April 2023

Engineering materials through the introduction of point defects has resulted in significant advances in semiconductor processing and, more recently, the observation of novel phenomena such as large reconfigurable strains in ferroelectrics as a result of defect dipole complexes. Up to 0.8% strain has been demonstrated in BaTiO3 crystals dilutely doped with iron. However, the defect dipole pinning sites and the corresponding achievable strains are found to degrade as the crystal is electrically cycled as part of the measurement process. The strain degradation rate is dependent on the applied field values but shows an exponential change in materials properties regardless of the electric field. This behavior, plus a change in impedance with number of times cycled, suggests these changes are due to electric field induced oxygen migration—similar to the cause of the resistance degradation effect. Despite this, effective piezoelectric coefficients of over 4700 pm/V were recorded with 1.5 kV/cm fields, one of the largest values for a lead-free piezoelectric material thus far. In addition, the defect dipole-aligned state and the high strains can be repeatably recovered by a subsequent heat treatment step after cycling. Potential paths to exploiting the defect dipole induced effects and large piezoelectric coefficient in these dilutely doped systems are proposed.
Consistent, high-accuracy mapping of daily and sub-daily wildfire growth with satellite observations
Authors: McClure Crystal D. , Pavlovic Nathan R. , Huang ShihMing , Chaveste Melissa , Wang Ningxin
Published: April 2023

Background Fire research and management applications, such as fire behaviour analysis and emissions modelling, require consistent, highly resolved spatiotemporal information on wildfire growth progression. Aims We developed a new fire mapping method that uses quality-assured sub-daily active fire/thermal anomaly satellite retrievals (2003–2020 MODIS and 2012–2020 VIIRS data) to develop a high-resolution wildfire growth dataset, including growth areas, perimeters, and cross-referenced fire information from agency reports. Methods Satellite fire detections were buffered using a historical pixel-to-fire size relationship, then grouped spatiotemporally into individual fire events. Sub-daily and daily growth areas and perimeters were calculated for each fire event. After assembly, fire event characteristics including location, size, and date, were merged with agency records to create a cross-referenced dataset. Key results Our satellite-based total fire size shows excellent agreement with agency records for MODIS (R2 = 0.95) and VIIRS (R2 = 0.97) in California. VIIRS-based estimates show improvement over MODIS for fires with areas less than 4047 ha (10 000 acres). To our knowledge, this is the finest resolution quality-assured fire growth dataset available. Conclusions and Implications The novel spatiotemporal resolution and methodological consistency of our dataset can enable advances in fire behaviour and fire weather research and model development efforts, smoke modelling, and near real-time fire monitoring.
Aging and wear characteristics of A356 alloy with Er and Zr addition
Authors: Reihanian M. , Ranjbar Khalil , Hajizadeh Z.
Published: April 2023

The present work investigates the effect of aging on the microstructure, mechanical properties, and wear behaviour of the cast A356 alloy with Er and Zr addition. The aged A356-0.25Zr and A356-0.25Er alloys revealed some but not all of the eutectic and columnar structures. The microstructure of A356, A356-0.5Er, and A356-0.5Er-0.25Zr alloys exhibited large α-Al grains with discrete eutectic silicon. Various intermetallic types and morphologies were observed after the peak aging. The highest hardness (∼120 HV) and the highest tensile strength (∼215 MPa) were achieved in the A356-0.25Zr alloy under peak-aged conditions. The A356 alloy revealed the lowest weight loss and friction coefficient, though it had the least hardness. Delamination was the dominant wear mechanism in all alloys.
Physiological and cognitive responses to hyperoxic exercise in full water submersion
Authors: Möller Fabian , Jacobi Elena , Hoffmann Uwe , Vogt Tobias
Published: April 2023

The positive effects of combined hyperoxia and physical exercise on physiological parameters and cognitive functioning are established for normobaric laboratory contexts. Still, increased practicability exists in hyperbaric settings like underwater activities and SCUBA diving, where environmental and sport‐specific factors might moderate effects. Improved cognition, reduced ventilation (V̇E), and lower blood lactate concentrations [Lac‐] are highly relevant, especially during high‐stress and rescue scenarios. Fifteen participants performed 3 × 8 min of continuous underwater fin‐swimming at 25 % (low), 45 % (moderate), and 75 % (vigorous) heart rate reserve (HRR) in each test. Three separate test days differed solely by the inspiratory oxygen partial pressure (PIO2: 29 kPa, 56 kPa, and 140 kPa). V̇E was measured continuously, whereas breathing gas analysis, blood sampling, and Eriksen Flanker tasks for inhibitory control (100 stimuli) were performed post‐exercise. Two‐way ANOVAs with repeated measures on the factors PIO2 and exercise intensity analyzed physiological outcome variables and reactions times (RT) and accuracy (ACC) of inhibitory control. V̇E was significantly reduced for 140 kPa during moderate and vigorous and for 56 kPa during vigorous compared to 29 kPa. 56 kPa and 140 kPa showed no differences. [Lac‐], post‐exercise V̇CO2, and velocity were unaffected by PIO2. Faster RTs but lower ACC of inhibitory control were observed following exercise at 75 % HRR compared to rest, 25 %, and 45 % HRR, while PIO2 produced no effects. Underwater performance in hyperoxia presents reduced V̇E, possible by dampened chemoreceptor sensitivity, and effects on cognition that differ from laboratory results and emphasise the moderating role of sport‐specific factors.
A hybrid approach consisting of multi-objective and multivariate analyses for WAAM specimens
Authors: Bhadrakali A Sirisha , Rama Sastry D V A , Prabhu T Ram
Published: April 2023

In this study, a combination of multivariate and multi-objective analyses, namely principal component analysis with fuzzy logic, has been proposed to identify the input parameters for ER4043, aluminum alloy in wire arc additive manufacturing. Taguchi L9 orthogonal array was designed with three-factor, three-level input parameters. Mechanical properties such as tensile strength and hardness were used as the output parameters. As the Taguchi optimization is not sufficient for multi-response optimization, observed data for each response were normalized and then principal component analysis was applied. Further, multi-response performance index (MRPI) was identified using fuzzy logic approach so that this hybrid approach could be successfully applied and MRPI could give a combination of input parameters at an optimal level.
Using language models and ontology topology to perform semantic mapping of traits between biomedical datasets
Authors: Liu Yi , Elsworth Benjamin L , Gaunt Tom R
Published: April 2023

Motivation

Human traits are typically represented in both the biomedical literature and large population studies as descriptive text strings. Whilst a number of ontologies exist, none of these perfectly represent the entire human phenome and exposome. Mapping trait names across large datasets is therefore time-consuming and challenging. Recent developments in language modelling have created new methods for semantic representation of words and phrases, and these methods offer new opportunities to map human trait names in the form of words and short phrases, both to ontologies and to each other. Here, we present a comparison between a range of established and more recent language modelling approaches for the task of mapping trait names from UK Biobank to the Experimental Factor Ontology (EFO), and also explore how they compare to each other in direct trait-to-trait mapping.

Results

In our analyses of 1191 traits from UK Biobank with manual EFO mappings, the BioSentVec model performed best at predicting these, matching 40.3% of the manual mappings correctly. The BlueBERT-EFO model (finetuned on EFO) performed nearly as well (38.8% of traits matching the manual mapping). In contrast, Levenshtein edit distance only mapped 22% of traits correctly. Pairwise mapping of traits to each other demonstrated that many of the models can accurately group similar traits based on their semantic similarity.

Availability and implementation

Our code is available at https://github.com/MRCIEU/vectology.
What Makes Discretionary Counter-Cyclical Fiscal Policy so Difficult? An Analysis of 32 OECD Countries
Authors: de Haan Jakob , Gootjes Bram
Published: April 2023

We examine the stance of fiscal policy for 32 OECD countries from 1986 to 2023 by comparing for each country-year observation the signs of the output gap and the change in the cyclically adjusted budget balance. We find that fiscal policies are often pro-cyclical. We test possible explanations using comparative statistics for country-year observations with pro- and counter-cyclical policies. Our evidence suggests that fiscal rules and institutional quality are not related to the prevalence of pro-cyclicality. Likewise, several political-economy arguments suggested for explaining pro-cyclical fiscal policies do not receive strong support. However, poor access to finance makes fiscal policies more pro-cyclical. (JEL codes: E62, H50, and H62)
Sternal cleft reconstruction with acellular dermal matrix and full-thickness calvarial graft
Authors: Ching Carmen , Sett Suvro , Walling Simon , Bezuhly Michael
Published: April 2023

We describe reconstruction of a sternal cleft in a neonate using acellular dermal matrix, full-thickness calvarial bone graft and myocutaneous pectoralis flaps.
Improving the classification accuracy of fishes and invertebrates using residual convolutional neural networks
Authors: Zhou Z , Yang X , Ji H , Zhu Z
Published: April 2023

The visibility of fishes and invertebrates is highly impacted by the complexity of the environment. Images acquired in underwater environments suffer from blurriness and low contrast. This results in a low classification accuracy. To address this problem, this study uses a pre-trained Resnet50 neural network as the feature extractor, which avoids over-fitting and accuracy saturation while realizing improved feature extraction capabilities. It also proposes an enhancement of the error-minimized random vector functional link (EEMRVFL) neural network, which is used as the classifier in the convolutional neural network (CNN) model instead of the original softmax classifier. EEMRVFL reduces the maximum residual error in each incremental process. The selected hidden nodes are added to the network, which improves the compactness of its structure. The proposed residual CNNs model exhibits improved classification accuracy for underwater image classification compared to existing methods. This is demonstrated experimentally on available datasets such as URPC, LifeCLEF 2015, and Fish4Knowledge with accuracy rates reaching 99.68%, 97.34%, and 99.77%, respectively.
Lasting change in competition law and policy
Authors: Waller Spencer Weber
Published: April 2023

This is a time of passionate debate on the fundamental goals of competition law. Should there be a single overarching goal for all competition law and policy? Should that goal be framed in purely economic terms? Should antitrust focus on protecting the competitive process, preventing unfair market conduct, or the abuse of superior bargaining position? Should antitrust promote and protect democracy, address social and racial injustice, or address climate change and sustainability? How should multiple goals be administered, weighed, and traded off in enforcement priorities and litigation? There is a progressive turn in the USA at the moment. But regardless of the nature and direction of the desired change, there is the equally important issue of how to achieve lasting change that survives the inevitable change in enforcement personnel and political leaders over time. In this essay, I focus on how to achieve that lasting change regardless of the goals and direction of change that any particular jurisdiction seeks to adopt. Most of the specific examples come from current developments in the USA, but are illustrative of the process of lasting change in competition. Enforcement agencies are key players in this process, but are constrained by the constitutions, treaties, legislation, and court decisions of their jurisdictions. Any campaign for change therefore depends on the wise use of the full substantive and procedural powers assigned to them by the political branches of the government. Successfully achieving substantial change rarely happens by accident, and most often requires a combination of such factors as: (i) creatively using the full statutory powers assigned to the agencies, (ii) striving for a unified whole-of-government approach to competition policy and (iii) deeply engaging the general public.
Power purchase agreements affected by unexpected circumstances: lessons from real litigation
Authors: Vial Gonzalo
Published: April 2023

This article analyses different situations that impacted an electricity system and resulted in claims related to power purchase agreements affected by unexpected circumstances. The analysis allows reaching lessons with a global scope that are useful to prevent the mentioned disputes or to deal with them. It concludes that power purchase agreements must be drafted using clear language, avoiding ambiguous clauses, with a careful distribution of risks, adequate mechanisms for solving disputes and according to the regulations that govern a specific contract. In the context of a dispute, it is important to consider the perks of negotiation, the background of the tribunal, the social consequences of the conflict and the rules governing the pertinent agreement.
Development and Validation of a Prognostic Risk Model for Patients with Advanced Melanoma Treated with Immune Checkpoint Inhibitors
Authors: Stukalin Igor , Navani Vishal , Gupta Mehul , Ruan Yibing , Boyne Devon J , O’Sullivan Dylan E , Meyers Daniel E , Goutam Siddhartha , Sander Michael , Ewanchuk Benjamin W , Brenner Darren R , Suo Aleksi , Cheung Winson Y , Heng Daniel Y C , Monzon Jose G , Cheng Tina
Published: April 2023

Background

Risk stratification tools for patients with advanced melanoma (AM) treated with immune checkpoint inhibitors (ICI) are lacking. We identified a new prognostic model associated with overall survival (OS).

Patients and Methods

A total of 318 treatment naïve patients with AM receiving ICI were collected from a multi-centre retrospective cohort study. LASSO Cox regression identified independent prognostic factors associated with OS. Model validation was carried out on 500 iterations of bootstrapped samples. Harrel’s C-index was calculated and internally validated to outline the model’s discriminatory performance. External validation was carried out in 142 advanced melanoma patients receiving ICI in later lines.

Results

High white blood cell count (WBC), high lactate dehydrogenase (LDH), low albumin, Eastern Cooperative Oncology Group (ECOG) performance status ≥1, and the presence of liver metastases were included in the model. Patients were parsed into 3 risk groups: favorable (0-1 factors) OS of 52.9 months, intermediate (2-3 factors) OS 13.0 months, and poor (≥4 factors) OS 2.7 months. The C-index of the model from the discovery cohort was 0.69. External validation in later-lines (N = 142) of therapy demonstrated a c-index of 0.65.

Conclusions

Liver metastases, low albumin, high LDH, high WBC, and ECOG≥1 can be combined into a prognostic model for AM patients treated with ICI.
WTAP-Mediated m6A RNA Methylation Regulates the Differentiation of Bone Marrow Mesenchymal Stem Cells via the miR-29b-3p/HDAC4 Axis
Authors: Liu Jincheng , You Yunhao , Sun Zhenqian , Zhang Lu , Li Xiang , Dai Zihan , Ma Jinlong , Chen Yunzhen , Jiao Guangjun
Published: April 2023

N6-methyladenosine (m6A) methylation, a well-known modification with new epigenetic functions, has been reported to participate in the progression of osteoporosis (OP), providing novel insights into the pathogenesis of OP. However, as the key component of m6A methylation, Wilms tumor 1-associated protein (WTAP) has not been studied in OP. Here we explored the biological role and underlying mechanism of WTAP in OP and the differentiation of bone marrow mesenchymal stem cells (BMMSCs). We demonstrated that WTAP was expressed at low levels in bone specimens from patients with OP and OVX mice. Functionally, WTAP promoted osteogenic differentiation and inhibited adipogenic differentiation of BMMSCs in vitro and in vivo. In addition, microRNA-29b-3p (miR-29b-3p) was identified as a downstream target of WTAP. M6A modifications regulated by WTAP led to increased miR-29b-3p expression. WTAP interacted with the microprocessor protein DGCR8 and accelerated the maturation of pri-miR-29b-3p in an m6A-dependent manner. Target prediction and dual-luciferase reporter assays identified the direct binding sites of miR-29b-3p with histone deacetylase 4 (HDAC4). WTAP-mediated m6A modification promoted osteogenic differentiation and inhibited adipogenic differentiation of BMMSCs through the miR-29b-3p/HDAC4 axis. Furthermore, WTAP-mediated m6A methylation negatively regulates osteoclast differentiation. Collectively, our study first identified a critical role of WTAP-mediated m6A methylation in BMMSC differentiation and highlighted WTAP as a potential therapeutic target for OP treatment.
Engaging diverse midlife and older adults in a multilevel participatory physical activity intervention: evaluating impacts using Ripple Effects Mapping
Authors: Rodriguez Espinosa Patricia , King Abby C , Blanco-Velazquez Isela , Banchoff Ann W , Campero Maria Ines , Chen Wei-ting , Rosas Lisa G
Published: April 2023

Multilevel interventions are increasingly recommended to increase physical activity (PA) but can present evaluation challenges. Participatory qualitative evaluation methods can complement standard quantitative methods by identifying participant-centered outcomes and potential mechanisms of individual and community-level change. We assessed the feasibility and utility of Ripple Effects Mapping (REM), a novel qualitative method, within the context of a multi-level cluster randomized trial, Steps for Change. Housing sites with ethnically diverse, low-income aging adults were randomized to a PA behavioral intervention alone or in combination with a citizen science-based intervention (Our Voice) for promoting PA-supportive neighborhoods. Four REM sessions were conducted after 12 months of intervention and involved six housing sites (n = 35 participants) stratified by intervention arm. Interviews (n = 5) were also conducted with housing site staff. Sessions leaders engaged participants in visually mapping intended and unintended outcomes of intervention participation and participant-driven solutions to reported challenges. Maps were analyzed using Excel and Xmind 8 Pro and data were classified according to the socio-ecological model. Eight themes were identified for outcomes, challenges, and solutions. Most themes (6/8) were similar across intervention arms, including increasing PA and PA tracking, improving health outcomes, and increasing social connectedness. Groups (n = 2) engaged in Our Voice additionally identified increased community knowledge and activities directly impacting local environmental change (e.g., pedestrian infrastructure changes). Housing staff interviews revealed additional information to enhance future intervention recruitment, sustainability, and implementation. Such qualitative methodologies can aid in evaluating multi-level, multi-component interventions and inform future intervention optimization, implementation, and dissemination.
Community-based N95 distribution during the COVID-19 Omicron BA.1 surge: feasibility, 1-month utilization, and price implications
Authors: Moran James B , Dunn Addison , Kim Seowoo , Zapolin Dana , Rivera Dulcé , Hoerger Michael
Published: April 2023

Masks and other non-pharmaceutical interventions can complement vaccines and treatments as a part of multilayered mitigation to reduce the burden of COVID-19 in high-risk settings like surges. Although N95s provide greater protection than cloth and procedure masks against airborne infectious illnesses, few people used N95s historically, potentially due to lack of familiarity and cost. The study was designed to examine the feasibility of distributing N95s during a COVID-19 surge. A follow-up survey summarized mask behavior. The investigators aimed to distribute 2,500 N95s to 500 adults in 5-packs with informational handouts at community locations during the COVID-19 Omicron BA.1 surge in New Orleans, Louisiana. A 1-month follow-up survey assessed utilization, safety perceptions, social diffusion of awareness of N95s, and purchase intentions. The investigators successfully distributed all 2,500 N95s during the peak of the BA.1 surge (December 13, 2021 to January 17, 2022). At 1-month follow-up, 96.7% of participants had tried an N95. They utilized an average of 3.42 (68.4%) of the five N95s, felt safer wearing N95s (Ps < 0.0001), discussed N95s with others (80.4%), and would wear N95s again if free (87.9%). Future utilization intentions were price sensitive. Communities will readily use public health tools like N95s when at risk and offered for free with useful information. Cost was identified as a key barrier to sustained utilization. Findings have immediate public policy implications for reducing national, regional, and organizational surges. The research provides an illustrative example of the importance of behavioral science in responding to public health crises.
Interpersonal Transphobia Within Nursing
Authors: Crawford Jess , Schultz Annette , Chernomas Wanda M.
Published: April 2023

Transphobic perceptions negatively impact health care access and outcomes among transgender and gender-diverse people and challenge nurses’ capacity to maintain ethical practice standards. The concept of transphobia has not been well defined in the literature or nursing. Using a critical realist lens, this concept exploration sought to define interpersonal transphobia through a review of purposefully selected literature. Attributes included discrimination and prejudice, while antecedents were cisnormativity, erasure, and stigma. Nurses can help reduce transphobia by seeking education and practicing gender-affirming care, including transgender people in research, and advocating for equitable policies and procedures.
Ferroptosis in Acute Leukemia
Authors: Lyu Tianxin , Li Xudong , Song Yongping
Published: April 2023

Ferroptosis is an iron-dependent cell death pathway that is different from apoptosis, pyroptosis, and necrosis. The main characteristics of ferroptosis are the Fenton reaction mediated by intracellular free divalent iron ions, lipid peroxidation of cell membrane lipids, and inhibition of the anti-lipid peroxidation activity of intracellular glutathione peroxidase 4 (GPX4). Recent studies have shown that ferroptosis can be involved in the pathological processes of many disorders, such as ischemia–reperfusion injury, nervous system diseases, and blood diseases. However, the specific mechanisms by which ferroptosis participates in the occurrence and development of acute leukemia still need to be more fully and deeply studied. This article reviews the characteristics of ferroptosis and the regulatory mechanisms promoting or inhibiting ferroptosis. More importantly, it further discusses the role of ferroptosis in acute leukemia and predicts a change in treatment strategy brought about by increased knowledge of the role of ferroptosis in acute leukemia.
Difference in symptom manifestation between postmenopausal and premenopausal women in acute uncomplicated cystitis: A multi-institutional pilot study
Authors: Wanifuchi Atsushi , Kyoda Yuki , Ogasawara Takuto , Kobayashi Ko , Ito Naoki , Shindo Tetsuya , Takahashi Atsushi , Kunishima Yasuharu , Masumori Naoya
Published: April 2023

Objectives

We aimed to prospectively compare lower urinary tract symptoms in premenopausal and postmenopausal women with acute uncomplicated cystitis before and after antibiotic therapy.

Materials and methods

This study included adult women with acute uncomplicated cystitis who visited 4 institutions between 2019 and 2020. After registration, we administered oral antibiotics and prospectively documented the changes in lower urinary tract symptoms from the first visit to a follow-up visit at 1 week using the Core Lower Urinary Tract Symptoms Score (CLSS) questionnaire.

Results

After treatment, pyuria disappeared in 60 of the 66 patients (14 premenopausal and 46 postmenopausal). The CLSS total score (range) changed from 13 (3–29) to 4 (0–18) with a significant improvement in all CLSS items. At baseline, nocturia, urgency, and urgency incontinence were more prominent in postmenopausal women than in premenopausal women. In contrast, baseline urethral pain and quality of life index were more severe in premenopausal women than in postmenopausal women. After treatment, the CLSS total score was still higher in postmenopausal women, as reflected by the relatively higher scores for nocturia and urgency, irrespective of the comparable scores for urethral pain and the quality of life index in the 2 groups.

Conclusions

Our results suggest that if storage symptoms persist, they should be carefully interpreted according to menopausal status.
Treatment of localized well-differentiated rectal neuroendocrine tumors: A focused review
Authors: Emoto Shigenobu , Nozawa Hiroaki , Sasaki Kazuhito , Murono Koji , Matsuzaki Hiroyuki , Yokoyama Yuichiro , Abe Shinya , Nagai Yuzo , Yoshioka Yuichiro , Shinagawa Takahide , Sonoda Hirofumi , Ishihara Soichiro
Published: April 2023

The frequency of rectal neuroendocrine tumors increases with the increase in the number of colonoscopies performed for colorectal cancer screening. The treatment of localized rectal well-differentiated neuroendocrine tumors involves local excision, including endoscopic treatment or rectal resection with lymphadenectomy. Although it is important to determine the risk of lymph node metastasis, there are points of disagreement among the guidelines regarding surgical indications. In this review, we discuss the current status of the treatment of well-differentiated rectal neuroendocrine tumors. The PubMed database was searched for relevant studies. In Japan, the criteria for curative endoscopic resection are very strict: less than 10 mm, G1, no invasion of the muscularis propria, no suspicion of lymph node metastasis, and no lymphovascular invasion. Meanwhile, in Western guidelines, local excision (endoscopic treatment is preferable) is recommended as the initial treatment for tumors measuring ≥10 mm and <20 mm in diameter, and radical surgery is recommended for tumors ≥20 mm in diameter. There are still many points where evidence is lacking, and future research is warranted.
Exploring the possible therapeutic role of influenza vaccine in chronic kidney disease patients
Authors: Shrestha Abhigan B. , Mohammed Yasmine A. , Umar Tungki P. , Shrestha Sajina , Mehta Aashna , Jaiswal Vikash
Published: April 2023

Chronic kidney disease (CKD) is an irreversible change in kidney function and structure with a prevalence of about 9.1% worldwide. Toxins and heavy metal exposure, as well as hypertension and diabetes mellitus, are common causes of CKD. Despite extensive therapeutic options such as renal replacement therapy and renal transplants, most changes in kidney function remain irreversible, causing lifelong morbidity and affecting the quality of life of patients. Increased susceptibility to infections as well as serious complications from influenza, is a major cause of concern in nephrological care. Therefore, it is imperative to consider the protective role of influenza vaccination against seasonal influenza, which can worsen preexisting kidney dysfunction. This commentary explores a possible relationship between the influenza vaccine and patient outcomes in CKD in terms of complications, hospitalization, and possibly prognostic improvements in patient outcomes from CKD.
Retinal artery macroaneurysm complicated with subhyaloid hemorrhage: two case reports
Authors: Mahjoub Ahmed , Zaafrane Nesrine , Ben Youssef Chiraz , Sellem Ilhem , Guiga Ahmed , Jabri Ahmed , Ben Saidi Oussama , Feki Omar , Krifa Fethi , Mahjoub Hechemi
Published: April 2023

The authors report two cases of retinal artery macroaneurysm (RAM) complicated with subhyaloid hemorrhage. There are multiple cases about RAM that have been published; however, none of them present all the different treatments with its benefits and its limitations. Our study highlights all aspects of treatment. RAM is an uncommon pathology that affects generally elderly women with systemic vascular pathologies. It is often unilateral, and the patients stay mostly asymptomatic. Most cases of RAM regress without any treatment. A case of a 54-year-old male, with a medical history of hypertension who presented with an acute and unilateral decreased visual acuity (VA). Initial VA was limited to counting fingers at 1 m in the right eye (RE). The anterior segment was normal in both eyes. A fundus examination in the RE showed a large subhyaloid hemorrhage associated to retinal hemorrhage. Fluorescein angiography in the RE did not reveal any sign of macroaneurysm due to blockage of fluorescein by the hemorrhage. In the left eye, there was a hyperfluorescent paramacular lesion. Optical coherence tomography showed the hyperreflectivity of the subhyaloid hemorrhage and the underlying retinal layers could not be seen. Neodymium-doped yttrium aluminum garnet laser hyaloidotomy was performed for this patient to release the trapped hemorrhage into the vitreous, 3 weeks after initial loss of vision with a good visual outcome after the treatment. An 80-year-old woman, with medical history of rheumatoid arthritis who presented with an acute loss of vision in the RE. VA in the RE was 20/200. She had a nuclear cataract in both eyes. A fundus examination showed a subyaloid hemorrhage. Fluorescein angiography in the RE revealed a hyperfluorescent structure emanating from the superotemporal arcade of the artery compatible with a macroaneurysm. The patient was treated with three intravitreal antivascular endothelial growth factor injections with poor visual outcomes. Vision loss occurs with RAM complications. They mainly involve hemorrhages and macular exudations and are usually associated with poor visual recovery. There is no established treatment for RAM and its complications. There are many options, but the optimal therapy is still unknown.
Adherence to guidelines in the follow-up of non-muscle-invasive bladder cancer among urology trainers and trainees in Jordan: a cross-sectional study
Authors: Al-Azab Rami , Al-Zubi Mohammad , Al Demour Saddam , Khaled Al-Jamal Suad , Nabeel Mahdawi Lobana , Saleh Al-Omari Salsabeel , Rasmi Banibakr Rania , Ali Alhallaq Luma , Abdelqader Yaseen Asa’d Yaseen , Omar Rjoub Wasan
Published: April 2023

Objective:

To assess the clinical practice in the follow-up of non-muscle-invasive bladder cancer (NMIBC) among urology specialists (trainers) and residents (trainees) in Jordan.

Methods:

An electronic questionnaire containing, in addition to demographic data, four questions regarding the follow-up of NMIBC was sent by e-mail to 115 urologists (53 residents and 62 specialists) selected randomly by stratified random sampling from different clinical institutions, 105 of them were returned complete.

Results:

In all, 105 out of 115 (91%) questionnaires were returned complete. All of the candidates are male. For low-risk NMIBC follow-up, 46 of the specialists (79%) and 35 of the trainees (74%) decided to do a follow-up cystoscopy at 3 months after diagnosis, followed by a check cystoscopy 9 months later than yearly, while for high-risk patients, all of the specialists and 45 of the trainees (96%) decide to do a check cystoscopy every 3 months in the first 2 years after diagnosis. For upper tract follow-up in high-risk NMIBC, all of the urologists in the survey (specialists and trainees) routinely perform upper tract imaging in the form of a computed tomography scan with contrast in the first year after diagnosis. On the other hand, in the follow-up of the upper urinary tract in low-risk NMIBC, 16 of the trainees (34%) and 19 of the specialists (33%) still perform a yearly scan.

Conclusion:

Because of the high recurrence rate for NMIBC, this raises the importance of adherence to guidelines in the follow-up for these patients and, at the same time to avoid overdoing unnecessary cystoscopies or upper tract scans.
Tumour necrosis factor-alpha levels as predictor factor on clinical response of anthracycline-based neoadjuvant chemotherapy in locally advance breast cancer patients: experimental research
Authors: Adrian Kevin , Ghaib Husnul , Ali Iskandar
Published: April 2023

Background:

The prevalence of locally advanced breast cancer is increasing yearly, so biomarkers are needed to assist in its management, one of which is tumour necrosis factor-alpha (TNF-α).

Objective:

Analysing TNF-α levels as a predictor factor on clinical response anthracycline-based neoadjuvant chemotherapy.

Methods:

This study design used observational analysis. The length of study was carried out in the period from May 2021 to June 2022. The study procedure included measuring participants' TNF-α levels the day before chemotherapy was carried out and clinical response. Participants received anthracycline-based neoadjuvant chemotherapy (cyclophosphamide of 500 mg/m2, doxorubicin of 50 mg/m2 and fluorouracil/5FU of 500 mg/m2) for 3 cycles. The study analysis used the Chi-square, logistic regression and Spearman’s test with P<0.05.

Results:

The average TNF-α levels was 137.2±311.8 pg/ml, ranging from 5.74 to 1.733 pg/ml. The results of the calculation of the cutoff value of TNF-α in the study were 18 635 pg/ml (area under curve =0.850; 95% CI =0.729–0.971). Based on cutoff 1, most participants with high TNF-α levels also had a negative response of 83.3% and those with low TNF-α levels also had a positive response of 75% (P<0.001). Meanwhile, at cutoff 2, similar conditions were also found, namely high TNF-α levels, negative response (84.2%) and low TNF-α levels, positive response (78.9%; P<0.001). The statical analysis showed a significant association of TNF-α levels on the clinical response of chemotherapy, which showed r=−0.606 and P<0.001.

Conclusion:

TNF-α levels predict clinical response for anthracycline-based neoadjuvant chemotherapy in locally advanced breast cancer patients.
Immune reconstitution inflammatory syndrome following disseminated TB with cerebral venous thrombosis in HIV-negative women during their postpartum period: a case report
Authors: Yadav Prashant , Bari Md Anwarul , Yadav Sushmita , Khan Amzad H.
Published: April 2023

Introduction:

Immune reconstitution inflammatory syndrome (IRIS) is characterized by exuberant and dysregulated inflammatory responses to invading microorganisms. IRIS associated with tuberculosis (TB-IRIS) is widely known in HIV-positive patients after starting highly active antiretroviral therapy (HAART) therapy. However, IRIS has also been observed in solid organ transplant recipients, neutropenic patients, tumor necrosis factor antagonist recipients, and women during the postpartum period despite their HIV status.

Case Presentation:

We report an exceptional case of a 19-year-old HIV-negative lady who presented as IRIS following disseminated TB with cerebral venous thrombosis during her postpartum period. After 1 month of starting anti-TB therapy, we found a paradoxical worsening of her symptoms and further deterioration of radiological features showing extensive tubercular spondylodiscitis involving almost all the vertebral with extensive prevertebral and paravertebral soft tissue collections. Significant improvement was observed after 3 months of continuation of steroids along with an adequate dose of anti-TB therapy.

Discussion:

The possible mechanism that could explain this dysregulated and exuberant immune response in HIV-negative postpartum women would be rapidly changing immunologic repertoire, as the recovery of the immune system causes an abrupt shift of host immunity from an anti-inflammatory and immunosuppressive status toward a pathogenic proinflammatory state. Its diagnosis mostly depends on having a high degree of suspicion and ruling out alternative etiology.

Conclusion:

Therefore, clinicians should be aware of the paradoxical worsening of TB-related symptoms and/or radiological features at the primary site of infection or new location following an initial improvement in adequate anti-TB therapy despite HIV status.
Partial hydatidiform mole and coexistent live fetus with placenta previa: a case report
Authors: Santoso Dhanny P.J. , Anton Anton , Nugrahani Annisa D. , Pribadi Adhi , Kurniadi Andi
Published: April 2023

Introduction and importance:

Partial molar pregnancy with a coexistent live fetus is very rare. This type of mole mostly ends in the early termination of pregnancy due to an abnormally developed fetus.

Case presentation:

Here, we report a case of a 24-year-old Indonesian woman with an ultrasonographic appearance of partial hydatidiform mole with initial placenta covering the internal uterine ostium in the late first trimester which then became marginal placenta previa in the third trimester. The woman decided to continue the pregnancy after considering the risks and benefits. The normal anatomy of the premature infant was vaginally delivered alive with a large and hydropic placenta.

Clinical discussion:

Proper diagnosis, management, and monitoring remain challenging as this case is still rarely reported. Although embryos from partial mole forms generally do not survive since the first trimester, our case reported the singleton pregnancy with the coexistent normal fetus and the partial mole characteristic of the placenta. Diploid karyotype, few and focal extent of hydatidiform tissue of placenta, low rate of molar degeneration, and the absence of fetal anemia hypothesized as the factors that influenced survival of the fetus. There were two maternal complications such as hyperthyroidism and frequent vaginal bleeding without subsequent anemia in this patient.

Conclusions:

A rare case of partial hydatidiform mole coexistent with a live fetus with placenta previa was reported in this study. There were also maternal complications. Thus, prompt and regular monitoring of maternal and fetal condition holds an important role.
An unexpected overlap syndrome of mitral valve prolapse with COVID-19 related myocarditis: case report from two patients
Authors: Alsagaff Mochamad Y. , Shonafi Khubay A. , Handari Saskia D. , Sembiring Yan E. , Lusida Terrence T. E. , Nugraha Ricardo A.
Published: April 2023

The authors reported two patients with a history of asymptomatic mild mitral valve prolapse, a male in his late 40s (Case 1, vaccinated) and a female in her late 20s (Case 2, unvaccinated), who developed worsening (severe) mitral prolapse and New York Heart Association symptoms class III–IV after exposure to coronavirus disease 2019 with evidence of myocarditis on MRI. Both patients received similar 6-month of heart failure therapy; however, the outcomes did not affect the severity of their symptoms or mitral regurgitation. Subsequently, both patients underwent mitral valve surgery.
The microbiota-gut-brain axis and three common neurological disorders: a mini-review
Authors: Mhanna Amjad , Alshehabi Zuheir
Published: April 2023

Neurological disorders are an important cause of disability and death globally. Recently, a large body of research shows that the gut microbiome affects the brain and its conditions, through the gut-brain axis. The purpose of this mini-review is to provide a brief overview of the relationship between the microbiota-gut-brain axis in three neurological disorders: epilepsy, Parkinson’s disease, and migraine. The authors chose these three disorders because of their burdensome and great effect on health care. We live on a microbial planet. Before humans, microorganisms existed for a hundred million years. Today, there are trillions of these microbes living in our bodies, it is called human microbiota. These organisms have a crucial role in our homeostasis and survival. Most of the human microbiota live in the gut. The number of gut microbiota is much more than the number of body cells. Gut microbiota has been regarded as a crucial regulator of the gut-brain axis. The discovery of the microbiota-gut-brain axis is described as a major advancement in neuroscience because it influences the pathophysiology of several neurological and psychiatric disorders. From this, more studies of the microbiota-gut-brain axis are needed in the future, to provide a better understanding of brain disorders and so that better treatment and prognosis.
A Sore Subject? An Examination of National Case–Based Chancroid Surveillance
Authors: Ogale Yasmin P. , Ridpath Alison D. , Torrone Elizabeth , Quilter Laura A. S. , Grey Jeremy A.
Published: April 2023

Background

Chancroid has been a nationally notifiable condition in the United States since 1944, with cases reported to Centers Disease Control and Prevention through the National Notifiable Diseases Surveillance System. Although frequently reported during the 1940s, <20 cases have been reported annually since 2011. We assessed the performance and utility of national case-based chancroid surveillance.

Methods

We reviewed the literature to contextualize chancroid surveillance through National Notifiable Diseases Surveillance System. We then assessed 4 system attributes, including data quality, sensitivity, usefulness, and representativeness: we reviewed chancroid cases reported during 2011–2020, conducted interviews with (a) sexually transmitted disease programs reporting ≥1 case in 2019 or 2020 (n = 9) and (b) Centers Disease Control and Prevention subject matter experts (n = 10), and reviewed published communicable disease reporting laws.

Results

Chancroid diagnostic testing is limited, which affects the surveillance case definition. National case-based surveillance has poor data quality; of the 2019 and preliminary 2020 cases (n = 14), only 3 were verified by jurisdictions as chancroid cases. Sexually transmitted disease programs report the system has low sensitivity given limited clinician knowledge and resources; experts report the system is not useful in guiding national control efforts. Review of reporting laws revealed it is not representative, as chancroid is not a reportable condition nationwide.

Conclusions

Critical review of system attributes suggest that national case-based chancroid surveillance data have limited ability to help describe and monitor national trends, and chancroid's inclusion on the national notifiable list might need to be reconsidered. Alternative strategies might be needed to monitor national chancroid burden.
“The Cost in the Individual”
Authors: Lee Kenneth , Doan Quynh , Thompson Graham C. , Sandhu Ash , Bone Jeffrey N. , Ting Daniel K.
Published: April 2023

Objectives

Emergency medicine (EM) confers a high risk of burnout that may be exacerbated by the COVID-19 pandemic. We aimed to determine the longitudinal prevalence of burnout in pediatric EM (PEM) physicians/fellows working in tertiary PEM departments across Canada and its fluctuation during the pandemic.

Methods

A national mixed-methods survey using a validated 2-question proxy for burnout was distributed monthly through 9 months. The primary outcome was the trajectory in probability of burnout, which was examined as both emotional exhaustion (EE) and depersonalization (DP), EE alone, and DP alone. Secondary outcomes investigated burnout and its association with demographic variables. Quantitative data were analyzed using logistic regression for primary outcomes and subanalyses for secondary outcomes. Conventional content analysis was used to analyze qualitative data and generate themes.

Results

From February to October 2021, 92 of 98 respondents completed at least 1 survey, 78% completed at least 3 consecutive surveys, and 48% completed at least 6 consecutive surveys. Predicted probability of EE was bimodal with peaks in May (25%) and October (22%) 2021. Rates of DP alone or having both EE and DP were approximately 1% and stable over the study period. Mid-career physicians were at lower risk of EE (odds ratio, 0.02; 95% confidence interval, 0–0.22) compared with early-career physicians. Underlying drivers of burnout were multifaceted.

Conclusions

Our study suggests that increased COVID-19 case burden was correlated with EE levels during the third and fourth waves of the pandemic. Emotional exhaustion was worsened by systemic factors, and interventions must target common themes of unsustainable workloads and overwhelming lack of control.
Analysis of age-related changes in lower facial fat compartments and of the course of blood vessels using computed tomography
Authors: Guo Yixuan , Wen Lihong , Wang Xianlong , Zou Huan , Liang Weiqiang , Wang Jinhuang , Zhu Xiongxiang
Published: April 2023

Background:

According to the volume restoration theory, lower facial fat compartments tend to selectively atrophy or hypertrophy with age. The aim of this study was to demonstrate age-related changes in lower facial fat compartments using computed tomography (CT), with strict control of the body mass index (BMI) and underlying diseases.

Patients and methods:

This study included 60 adult women in three age-based categories. The thicknesses of the jowl, labiomandibular, and chin fat compartments were measured using CT images. The distribution and arrangement of facial blood vessels were further analyzed to provide evidence of the safety of rejuvenation strategies based on facial volumetric theory.

Results:

The inferior part of the superficial jowl fat compartment and deep jowl fat compartment thickened with age. The deep layer of the labiomandibular fat compartment thinned with age, and the superficial layer thickened with age. The deep and superficial layers of the chin compartments thickened with age. The facial vein passes through the lower mandibular border at the anterior edge of the masseter muscle and moves upward, perpendicular to the lower mandibular border. The high-risk area of the facial artery had an angle of approximately 45° to the lower mandibular border.

Conclusions:

This study suggests that with age, selective thickening or thinning occurs in different lower facial fat compartments. The mandible and masseter muscle were used as reference markers to analyze the courses of the facial artery and facial vein, which can help clinicians to reduce vascular injury.
Botulinum Toxins for the Treatment of Raynaud Phenomenon
Authors: Zhou Yannan , Yu Yue , Bi Siwei , Cen Ying
Published: April 2023

Objective

Botulinum toxin (Btx) therapy has emerged as a potential treatment for patients with Raynaud phenomenon (RP) in recent years. This study aimed to investigate the efficacy and safety of Btx treatment for RP.

Methods

Databases of PubMed, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials were searched from their inception up to August 2022. Studies that reported Btx use for the treatment of RP were included. A meta-analysis was conducted for the Shortened version of the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) score and visual analog scale pain score using a random-effects model.

Results

Thirteen full-text studies were included. The pooled standard mean changes for the visual analog scale pain score and QuickDASH score were −3.82 (95% confidence interval, −6.62 to −1.02) and 0.83 (95% confidence interval, −1.47 to −0.19), respectively. The 2 most common complications were injection site pain and intrinsic hand weakness.

Conclusions

The effect of Btx treatment on RP is promising based on current evidence. Nevertheless, more studies and randomized clinical trials with larger sample sizes are needed to confirm the current results.