bluuebunny/crossref_metadata_2025 huggingface dataset:
Generation-based position taking: Unpacking Finland’s decision to join NATO
Authors: Fittante Daniel
Published: July 2023

Scholars have identified the important roles personal characteristics — such as religion, gender, and race — play in influencing policymakers' position-taking behavior. One important yet overlooked personal characteristic is generation. This personal characteristic is not only influencing individual policymakers’ position-taking behavior; it is also changing some important political realities across Europe. An illustrative example of these changes is Finland's decision to join NATO. Based on documentary analyses of parliamentary speeches and personal interviews with Finnish officials, this article demonstrates that Russia’s 2022 invasion of Ukraine revealed already established, generation-based cleavages among MPs whose parties had long opposed the prospect of joining NATO. The speeches also reveal a dynamic and evolving orientation to the Baltic states among an emerging political cohort of Finnish MPs, who have been socialized in a fully EU-integrated Finland.
Unionist unity? Strategic voting at Scottish parliamentary elections
Authors: Kelly Eoghan
Published: July 2023

This paper examines strategic voting at Scottish Parliamentary elections since 1999. The emergence of the pro-independence Scottish National Party as the dominant party in Scotland has forced unionist voters to carefully consider their options. Analysing differences between the simultaneous pluralist constituency ballot and proportional list ballot of Scotland’s Additional Member System provides a unique insight into how voter behaviour has changed in response to Scotland’s changing political reality. This paper finds that many unionist voters have put aside left-right rivalries to support fellow unionist candidates on the constituency ballot. This examination finds that Labour and Conservative voters are willing to work together, in some circumstances, to defeat a significant number of pro-independence candidates. I find that intra-unionist strategic voting helped prevent the separatist majorities in parliament in both 2016 and 2021.
Community Grievances, personal responsibility, and DIY protection: Frustrations and solution-seeking among marginalized Twitch streamers
Authors: Tomlinson Christine
Published: July 2023

Online spaces offer fan communities and content creators many outlets for expressing their interests, but they also tend to place users in positions where they encounter hostility, toxicity, and gatekeeping. In the case of online streaming on Twitch, users frequently encounter hostility based on identity and seek assistance from fellow users via social media. In this project, I highlight the ways that social media is used to try to organize against discriminatory cultures toward marginalized streamers. Ultimately, I find that much of the onus is placed directly on streamers themselves to circumvent, address, and keep themselves safe despite harassment. In this paper, I will argue that this feeds into the structures and cultures that allow racist and sexist hostilities in online and gaming spaces by placing responsibility – and blame – on individual users from marginalized backgrounds. Although the community is frequently supportive of users who seek advice for addressing hostility and there are attempts at raising awareness through collective online action, the lack of apparent resolution leaves many feeling that these experiences are inevitable, immutable, and within the realm of individual responsibility.
Self-representation as platform work: Stories about working as social media content creators
Authors: Hoose Fabian , Rosenbohm Sophie
Published: July 2023

Blogs and social media sharing platforms like YouTube and Instagram have become increasingly popular in recent years, and they also have become an outlet for income generation. In this paper, we focus on what stories content creators share about their professional activities on social media and what self-image and narratives they draw about their work as content creators. Based on a content analysis of blog and video posts as well as semi-structured interviews conducted with content creators in Germany, we identified a specific ‘professional creator narrative’ that serves the purpose of reconciling contradictory demands from their audience, sponsors and platforms. Our findings indicate that constructing those narratives helps to justify their activities and thus is an essential part of working as a content creator.
4chumblr’s divorce: Revisiting the online culture wars through the 2014 Tumblr-4chan raids
Authors: Hagen Sal
Published: July 2023

This text concerns conflict between users of 4chan and Tumblr, two groups said to have formed a vanguard to the ‘online culture wars’ of the last decade. Specifically, I focus on a 2014 clash known as the ‘Tumblr-4chan raids’. Predating the more infamous Gamergate controversy, I see this event as a useful alternative microcosm to study polarisation among online subcultures in the mid-2010s. Drawing from subculture studies, I first theorise cross-site clashes as puncturing a sense of ‘subcultural territoriality’ whereby an online platform is appropriated as a secluded refuge. Through a quali-quantitative archival study, I find that the raids were initiated and exacerbated by trolling 4channers rather than a clash between equal sides. I ultimately argue that the feud partially arose out of 4channers’ reactionary ‘media ideologies’ on the Internet, wherein sensitivity, empathy, and care were seen as incongruous with ideas on the online as brutal and unforgiving. Next to better-known political clashes between feminists and anti-feminists, the paper thus highlights the polarising role of media ideologies at the onset of the ‘online culture wars’ in the mid-2010s.
Fractional investigation of time-dependent mass pendulum
Authors: Baleanu Dumitru , Jajarmi Amin , Defterli Ozlem , Wannan Rania , Sajjadi Samaneh S , Asad Jihad H
Published: July 2023

In this paper, we aim to study the dynamical behaviour of the motion for a simple pendulum with a mass decreasing exponentially in time. To examine this interesting system, we firstly obtain the classical Lagrangian and the Euler-Lagrange equation of the motion accordingly. Later, the generalized Lagrangian is constructed via non-integer order derivative operators. The corresponding non-integer Euler-Lagrange equation is derived, and the calculated approximate results are simulated with respect to different non-integer orders. Simulation results show that the motion of the pendulum with time-dependent mass exhibits interesting dynamical behaviours, such as oscillatory and non-oscillatory motions, and the nature of the motion depends on the order of non-integer derivative; they also demonstrate that utilizing the fractional Lagrangian approach yields a model that is both valid and flexible, displaying various properties of the physical system under investigation. This approach provides a significant advantage in understanding complex phenomena, which cannot be achieved through classical Lagrangian methods. Indeed, the system characteristics, such as overshoot, settling time, and peak time, vary in the fractional case by changing the value of α. Also, the classical formulation is recovered by the corresponding fractional model when α tends to 1, while their output specifications are completely different. These successful achievements demonstrate diverse properties of physical systems, enhancing the adaptability and effectiveness of the proposed scheme for modelling complex dynamics.
Review and evaluation of metals and alloy’s compatibility with hydrogen-fueled internal combustion engines
Authors: Azeem Naqash , Beatrice Carlo , Vassallo Alberto , Pesce Francesco , Rossi Riccardo , Khalid Azka
Published: July 2023

Hydrogen internal combustion engines (H2-ICEs) are being examined primarily owing to their low criteria pollutants and zero carbon dioxide emissions. However, there are many components and systems of a H2-ICE (including, i.e., gaskets, fuel injection system, piston, cylinder head, exhaust manifolds,…) that are exposed to direct or indirect high-pressure and temperature hydrogen that can lead to deterioration and degradation of the materials, in particular rubbers, metals and their alloys. In the present article, the implications on the characteristics of metals and their alloys exposed to a hydrogen atmosphere are examined with reference to the typical materials and respective operating conditions found in H2-ICEs. The effects of direct or indirect exposure of high pressure and low/high-temperature hydrogen on the properties including mechanical properties of metals and their alloys have been explored. Finally, based on the previous review, a critical assessment of their suitability for a safe and reliable operation on H2-ICEs is provided.
BPA interferes with granulosa cell development and oocyte meiosis in mouse preantral follicles
Authors: Li Yaqiu , Liu Sitong , Gao Fan , Peng Zhendong , Zhang Jinyu , Li Song , Lu Dongjin , Pan Xiaoyan
Published: July 2023

Bisphenol A (BPA) is an established environmental endocrine disruptor and can interfere with the development of female germ cells. However, the underlying mechanisms are still unclear. We investigated the effects of BPA on granulosa cell development and meiosis of oocytes using in vitro culture system of mouse preantral follicles. Preantral follicles from D14 mouse ovary were treated with 10 μg/mL BPA in vitro for 11 days. The adherent area of follicles was measured. On D11, cumulus cell expansion was observed. The meiosis recovery rate was calculated. Western blot detected P53, proliferating cell nuclear antigen (PCNA), estrogen receptor α (ERα), and cyclin B1. ELISA measured estrogen and progesterone levels. Immunofluorescence detected Cx37 on oocyte membrane. Gap junction communication was assessed. We found that BPA significantly promoted the expressions of PCNA and ERα in granulosa cells and the secretion of estrogen and progesterone by granulosa cells on D10 and significantly increased the attachment area of the follicles on D8 and D10. However, it reduced the expansion of cumulus cells, Cx37 expression, and the gap junction communication between cumulus cells and oocytes on D11. BPA promoted the recovery of oocytes from meiosis, interrupted the expression of cyclin B1 protein in arrested germinal vesicle breakdown (GVBD) oocytes, and reduced the in vitro maturation rate of oocytes. These GVBD oocytes were live without apoptosis or death. Conclusively, BPA disturbs the development of granulosa cells and the meiosis progression of oocytes by decreasing gap junction communication between oocytes and the granulosa cells as well as regulating cyclin B1 expression in GVBD oocytes.
Review on ultrasound-guided photoacoustic imaging for complementary analyses of biological systems in vivo
Authors: Lee Haeni , Choi Wonseok , Kim Chulhong , Park Byullee , Kim Jeesu
Published: July 2023

Photoacoustic imaging has been developed as a new biomedical molecular imaging modality. Due to its similarity to conventional ultrasound imaging in terms of signal detection and image generation, dual-modal photoacoustic and ultrasound imaging has been applied to visualize physiological and morphological information in biological systems in vivo. By complementing each other, dual-modal photoacoustic and ultrasound imaging showed synergistic advances in photoacoustic imaging with the guidance of ultrasound images. In this review, we introduce our recent progresses in dual-modal photoacoustic and ultrasound imaging systems at various scales of study, from preclinical small animals to clinical humans. A summary of the works reveals various strategies for combining the structural information of ultrasound images with the molecular information of photoacoustic images.
Analysis of dengue fever disease in West Africa
Authors: Gyasi Prince , Bright Yakass Michael , Quaye Osbourne
Published: July 2023

Dengue fever disease (DFD) which is caused by four antigenically distinct dengue viruses (DENV) presents a global health threat, with tropical and subtropical regions at a greater risk. The paucity of epidemiological data on dengue in West African subregion endangers efforts geared toward disease control and prevention. A systematic search of DFD prevalence, incidence, and DENV-infected Aedes in West Africa was conducted in PubMed, Scopus, African Index Medicus, and Google Scholar in line with the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. A total of 58 human prevalence studies involving 35,748 people from 8 countries were identified. Two incidence and six DENV-infected studies were also reviewed. Nigeria and Burkina Faso contributed the majority of the prevalence studies which spanned between 1968 and 2018, with a considerable variation in coverage among the countries reviewed in this study. An average prevalence of 20.97% was observed across both general prevalence and acute DENV infection study categories, ranging between 0.02% and 93%. The majority of these studies were conducted in acute febrile patients with a prevalence range of 0.02–93% while 19% ( n = 11) of all studies were general population-based studies and reported a prevalence range of 17.2–75.8%. DENV-infected Aedes aegypti were reported in four out of the five countries with published reports; with DENV-2 found circulating in Cape Verde, Senegal, and Burkina Faso while DENV-3 and DENV-4 were also reported in Senegal and Cape Verde, respectively. High prevalence of DFD in human populations and the occurrence of DENV-infected A. aegypti have been reported in West Africa, even though weaknesses in study design were identified. Epidemiological data from most countries and population in the subregion were scarce or non-existent. This study highlights the epidemic risk of DFD in West Africa, and the need for research and surveillance to be prioritized to fill the data gap required to enact effective control measures.
Neutrophil extracellular traps contributing to atherosclerosis: From pathophysiology to clinical implications
Authors: Gu Chun , Pang Bo , Sun Shipeng , An Cheng , Wu Min , Wang Na , Yuan Yuliang , Liu Guijian
Published: July 2023

Neutrophil extracellular traps (NETs) are network-like structures of chromatin filaments decorated by histones, granules, and cytoplasmic-derived proteins expelled by activated neutrophils under multiple pathogenic conditions. NETs not only capture pathogens in innate immunity but also respond to sterile inflammatory stimuli in atherosclerosis, such as lipoproteins and inflammatory cytokines. Atherosclerosis is a lipid-driven chronic inflammatory disease characterized by the accumulation and transformation of inflammatory cells, and smooth muscle cells in the intimal space. NETs-derived extracellular components possess toxic and proinflammatory properties leading to cellular dysfunction and tissue damage, which may establish a link among lipid metabolism, inflammatory immunity, and atherosclerosis. In this review, we discuss recent advances regarding the role of NETs engaged in the pathogenesis of atherosclerosis, particularly focusing on the interaction with lipids and inflammasomes, crosstalk with smooth muscle cells and inflammatory cells, and the association with aging. We also evaluate the current knowledge on the potential of NETs as biomarkers and therapeutic targets for atherosclerosis and its related diseases in clinical practice.
Appraising the Quality of Reporting of Vascular Surgery Studies That Use the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) Database
Authors: Mirzaie Amin A. , Ueland Walker R. , Lambert Katherine A. , Delgado Amanda M. , Rosen Jordan W. , Valdes Carlos A. , Scali Salvatore T. , Huber Thomas S. , Upchurch Gilbert R. , Shah Samir K.
Published: July 2023

Objective

The American College of Surgeons National Surgical Quality Improvement Program (NSQIP) is an important data source for observational studies. While there are guides to ensure appropriate study reporting, there has been no evaluation of NSQIP studies in vascular surgery. We sought to evaluate the adherence of vascular-surgery related NSQIP studies to best reporting practices.

Methods

In January 2022, we queried PubMed for all vascular surgery NSQIP studies. We used the REporting of studies Conducted using Observational Routinely-collected Health Data (RECORD) statement and the JAMA Surgery (JAMA-Surgery) checklist to assess reporting methodology. We also extracted the Journal Impact Factor (IF) of each article.

Results

One hundred and fifty-nine studies published between 2002 and 2022 were identified and analyzed. The median score on the RECORD statement was 6 out of 8. The most commonly missed RECORD statement items were describing any validation of codes and providing data cleaning information. The median score on the JAMA-Surgery checklist was 2 out of 7. The most commonly missed JAMA-Surgery checklist items were identifying competing risks, using flow charts to help visualize study populations, having a solid research question and hypothesis, identifying confounders, and discussing the implications of missing data. We found no difference in the reporting methodology of studies published in high vs low IF journals.

Conclusion

Vascular surgery studies using NSQIP data demonstrate poor adherence to research reporting standards. Critical areas for improvement include identifying competing risks, including a solid research question and hypothesis, and describing any validation of codes. Journals should consider requiring authors use reporting guides to ensure their articles have stringent reporting methodology.
How Institution of the Sup-ER Protocol in a Clinic Changed Procedure Patterns in Upper Brachial Plexus (Erb’s Type) Birth Injuries
Authors: Wong Vanessa Choi Yin , Balumuka Darius , Tuen Young Ji , Bucevska Marija , Courtemanche Rebecca , Durlacher Kim , Bellows Doria , Hynes Sally , Verchere Cynthia
Published: July 2023

Background:

For children with upper brachial plexus birth injury (BPBI; C5, C6, ±C7 roots), most clinics first recommend nonsurgical treatment followed by primary and/or secondary surgical interventions in selected patients. Since 2008, we have used an infant shoulder repositioning protocol (supination-external rotation [Sup-ER]) designed to prevent shoulder internal rotation contracture and its potential effects on the shoulder joint. This study characterizes our clinic’s current choice, number, and timing of primary and secondary procedural interventions (including Botox) and compares Sup-ER protocol patients with those of our historical controls.

Methods:

The records of all patients with upper BPBI who underwent procedures from 2001 to 2018 were retrospectively reviewed and grouped into a historical (2001-2007, n = 20) and recent (2008-2018, n = 23) cohort. Patient demographics, procedure types and timing, and functional outcomes were collected and analyzed.

Results:

Since the 2008 institution of the Sup-ER protocol, fewer brachial plexus exploration and grafting (BPEG) surgeries were performed and none in later infancy, where nerve transfers were preferred. There were more and earlier Botox injections. There were fewer tendon transfers, and the preoperative indications were from a higher level of function.

Conclusions:

We now see fewer indications for BPEG surgeries overall. After the 3-month-age group, more direct nerve transfers are indicated instead of the BPEG surgery if nerve surgery is required at all. Shoulder tendon transfer rates have decreased. Humeral osteotomies are not seen in our recent group. Glenoid osteotomies within tendon transfers are rare in both groups.
The Suitability and Acceptability of the Think-Aloud Method to Aboriginal and Torres Strait Islander Adults
Authors: Gall Alana , Howard Kirsten , Anderson Kate , Diaz Abbey , Garvey Gail
Published: July 2023

Background

There is a long history of research being conducted on Aboriginal and Torres Strait Islander peoples that has offered questionable benefit but occasioned great distress and distrust. Using research methods that are suitable and acceptable to Aboriginal and Torres Strait Islander peoples is a critically important step towards restoring trust and improving the accessibility and relevancy of research that better addresses the needs of Aboriginal and Torres Strait Islander peoples. The current research aims to qualitatively evaluate Aboriginal and Torres Strait Islander peoples’ perceptions of the suitability and acceptability of engaging in a think-aloud interview embedded in an individual yarn; a think-aloud yarn.

Methods

We employed the think-aloud method as part of the larger What Matters 2Adults study. Aboriginal and Torres Strait Islander participants were engaged in a think-aloud yarn, then immediately following, a follow-up yarn to explore the acceptability of the think-aloud method. The follow-up yarns were audio recorded, transcribed verbatim, and analysed utilising reflexive thematic analysis with an Indigenous epistemological lens.

Results

A total of 17 Aboriginal and Torres Strait Islander adults participated in our study. Participants reported that taking part in the think-aloud yarn was acceptable, not difficult and was less onerous than writing down their thoughts. Engaging participants in a social yarn before the think-aloud research yarn ensured they were comfortable verbalising and assured them that the process was confidential. Thinking out loud gave participants the opportunity to reflect and to think critically about their responses. Some found that by thinking out loud they were able to better understand the statements in their own mind and felt they were therefore able to provide a more authentic response. Because of these benefits, participants conveyed that the think-aloud yarn is a vitally important component in testing items and developing measures for Aboriginal and Torres Strait Islander people.

Conclusions

Overall, our study found that the think-aloud yarn is acceptable to Aboriginal and Torres Strait Islander peoples and therefore a suitable method for use in studies that involve them.
Research on dynamic characteristic of compressor RIP under thermal oxygen aging and variable preload conditions
Authors: Chen Junjie , Chen Changyao , Gan Yufeng , Liu Jia , Gao Xiangdong
Published: July 2023

The dynamic characteristics of rubber isolation pad (abbreviated as RIP) after service under the high temperature thermal oxygen aging and the variable preloads have preload dependence and thermal oxygen aging dependence, which is a crucial problem for matching the vibration isolation system of air conditioner compressor to reveal the dynamic characteristic mechanism of the RIP with different preloads and thermal oxygen aging conditions. The Peck model is first introduced to characterize the thermal oxygen aging factor, the fractional derivative Kelvin-Voigt thermal oxygen aging-perturbation model (FDKVTPM) and the Coulomb frictional thermal oxygen aging-perturbation model (CFTPM) are established to describe the frequency dependence and the amplitude dependence, respectively. The thermal oxygen aging-dynamic characteristic model of the RIP is built by considering the influence of variable preloads, the model parameters under different preloads are further identified, the validity of the model was examined by the experimental data. The concepts of the stiffness transition point (STP) and the stiffness transition frequency (STF) are innovatively proposed to better describe softening effect of the RIP under variable preload and variable amplitude working conditions. The results show that the static stiffness of RIP increases by 20.7%, the dynamic stiffness increases by 9.3%, and the loss factor decreases by 35% after thermal oxygen aging under different preload conditions, which can lay a theoretical foundation for in-depth study of the stiffness matching and optimization of air conditioner compressor with the RIP.
Reality television and the politics of mass surveillance in channel 4’s Hunted
Authors: Brayton Sean
Published: July 2023

This paper is interested in representations of mass surveillance in Hunted, Channel 4’s reality tv series in which ‘ordinary British citizens’ roleplay as ‘fugitives’ that must evade surveillance and capture by ‘the state.’ Here contentious powers of state surveillance are mitigated by (a) the programme’s deployment of a myth of surveillance ‘symmetry’ and a ‘fugitive fantasy’ that obfuscate the racial politics of ‘being watched’ in a post-9/11 climate; (b) personal stories of contestants or ‘fugitives’ that enable a ‘therapeutic self’ that situates the mass surveillance experience as productive and transformative; and (c) the ‘gamification’ of surveillance itself.
SARS-CoV-2 breakthrough infections after COVID-19 vaccination in patients with inflammatory bowel disease: a systematic review and meta-analysis
Authors: van de Pol Natasja , Pan Qiuwei , Derikx Lauranne A. A. P. , Bakker Linda , van der Woude C. Janneke , de Vries Annemarie C.
Published: July 2023

Background:

Patients with inflammatory bowel disease (IBD) have an attenuated serologic response to COVID-19 vaccination. It is unclear whether an impaired immune response in vaccinated IBD patients impacts the susceptibility to SARS-CoV-2 infection and occurrence of severe COVID-19.

Objectives:

To evaluate SARS-CoV-2 breakthrough infection rates and the disease course of COVID-19 in vaccinated IBD patients.

Design:

A systematic literature search and meta-analysis was performed.

Data sources and methods:

The search was performed in Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and CINAHIL. The articles were independently screened and selected by two reviewers. A random-effects model was used to calculate the pooled relative risk for breakthrough infections in vaccinated IBD patients and controls.

Results:

A total of 16 studies were included, with study periods ranging from January 2020 to October 2021 and follow-up time from 3 weeks to 6 months. The breakthrough infection rates range from 0 to 37.4% in vaccinated IBD patients. The disease course of COVID-19 was generally mild, with low hospitalization and mortality rates (0–8.7% and 0–4.3%, respectively). Vaccinated IBD patients had a significantly lower relative risk of breakthrough infection rate compared to unvaccinated controls (risk ratio: 0.07, 95% CI: 0.03–0.18). No difference was observed between IBD patients and non-IBD controls, and between partially and fully vaccinated IBD patients. The impact of immunosuppressive therapy on breakthrough infection rates differs between studies. Most studies showed no impact from immunosuppressive treatment, anti-tumour necrosis factor alpha or corticosteroids and other biologics; one study reported higher rates for patients treated with infliximab versus vedolizumab.

Conclusion:

Vaccination is effective to prevent COVID-19 infections in patients with IBD. Breakthrough infections do occur, but the disease course is generally mild. Available data seem to suggest a declining trend of breakthrough infections during calendar time.

Registration:

The protocol was published in the PROSPERO database (CRD42021292853).
Alpha-methyl acetyl-coA racemase deficiency. Magnetic resonance imaging findings of three patients with encephalopathy, epilepsy, and stroke-like episodes
Authors: Palacio-Montoya Maria I , Herrera Diego A , Vargas Sergio A , Castillo Mauricio
Published: July 2023

Alpha-methyl acyl-CoA racemase deficiency (AMACRD) is a rare peroxisomal disorder that results in the accumulation of pristanic acid and 16 cases have been reported in the literature. Here, we present three additional patients, two confirmed by genomic study and one suspected. Three siblings who were born to healthy unrelated parents developed recurrent episodes of encephalopathy, seizures, and behavioral disturbances. In all 3, brain MRI showed lesions in the thalami, cerebral peduncles, and mesencephalic tegmentum, as well as brain volume loss. In addition, one patient had a chronic hemispheric infarct and an acute contralateral infarct, and another had a subacute infarct involving multiple vascular territories without abnormalities on MR angiography.
Standardized management of pediatric abdominal pain admissions improves patient outcomes – A quality improvement project
Authors: Lu Lok Hui , Arbab Hana , Cheng Choo Suet , Yin Ong Lin , Caroline Ong Choo Phaik
Published: July 2023

Background

Children commonly present at the emergency department with abdominal pain and it is challenging to identify urgent surgical conditions. An audit conducted at a tertiary children’s hospital showed that 70% of patients admitted to Department of Pediatric Surgery (PAS) for abdominal pain had non-surgical diagnoses and wide variation in management.

Objective

Our quality improvement (QI) project aimed to reduce length of stay (LOS) and unnecessary investigations performed for patients admitted to PAS with abdominal pain, without causing complications or delayed diagnosis of surgical conditions.

Methods

The QI project consists of a standardised management workflow with stringent discharge criteria. We reviewed outcome measures of LOS, number of investigations ordered, compliance to workflow and readmission within 1-week post discharge at the end of each Plan-Do- Study-Act (PDSA) cycle and iteratively improved the workflow following QI principles.

Results

61% of patients were admitted to PAS for non-surgical abdominal pain throughout three PDSA cycles conducted. The third cycle showed improved compliance to workflow (80.7%) with reduced median LOS by 1 day, reduced median number of blood, stool and urine investigations by 1 and reduced range of investigations ordered. Readmission and CE attendance rate 1 week after discharge was 1.6% ( n = 3), which was comparable to audit at 2.3% ( n = 4), p = 0.709.

Conclusion

The workflow reduced LOS, number of unnecessary investigations and variability in investigations ordered, without causing misdiagnosis. It improved patient experience with sizeable cost savings for the patient and the hospital. QI projects can improve patient outcomes by introducing standard protocols that aid clinical management.
Treatment approaches for urachal cancer: Use of immunotherapy and targeted therapies
Authors: Benjamin David J , Kalebasty Arash Rezazadeh
Published: July 2023

Urachal cancer is a rare genitourinary malignancy that arises from the embryologic remnant of the urachus. The malignancy is considered to be aggressive, with no clear consensus on appropriate management for advanced disease. Although traditionally considered to be related to bladder cancer given its embryologic origin, several next generation sequencing studies have revealed the genomic profile of this genitourinary malignancy most closely resembles colorectal cancer. Moreover, these studies have identified potentially actionable mutations including EGFR, KRAS and MET. In addition, recent data suggests that immunotherapy may benefit some patients with advanced urachal cancer. Nonetheless, continued research is warranted to better understand how to treat this rare genitourinary cancer.
Designing a flow-controlled STA-MCA anastomosis based on the Hagen–Poiseuille law for preventing postoperative hyperperfusion in adult moyamoya disease
Authors: Hu Miao , Yu Jin , Zhang Jianjian , Chen Jincao
Published: July 2023

Background:

Technical improvements for preventing postoperative symptomatic cerebral hyperperfusion (CHP) during superficial temporal artery-middle cerebral artery (STA-MCA) anastomosis for moyamoya disease (MMD) were seldom reported.

Objectives:

The aim of this study was to investigate the significance of application of a novel flow-controlled concept which voluntarily reduces the hemodynamic difference between the donor and recipient arteries based on the Hagen–Poiseuille law when performing direct anastomoses of recipient parasylvian cortical arteries (PSCAs) with anterograde hemodynamic sources from the MCA (M-PSCAs) in adult MMD.

Design:

This was a retrospective observational study.

Methods:

Direct anastomoses of recipient M-PSCAs were performed on 89 symptomatic hemispheres in 82 adult MMD patients in our hospital from January 2020 to June 2021. They were divided into the flow-controlled group (patients who received direct anastomosis under designed flow-controlled principles) and non-flow-controlled group (patients who received conventional direct anastomosis to obtain maximum flow). The patients’ basic characteristics and incidence of postoperative CHP were compared between the two groups. Risk factors for occurrence of postoperative CHP were analyzed.

Results:

Overall, 36 hemispheres were included in the non-flow-controlled group and 53 in flow-controlled group. The incidences of postoperative focal (22.6%) and symptomatic CHP (5.7%) in the flow-controlled group were significantly lower than those (focal, 52.8%; symptomatic, 25.0%) in the non-flow-controlled group ( p = 0.003 and 0.009, respectively). Multivariate analysis revealed that the flow-controlled concept was significantly associated with the development of focal ( p = 0.005) and symptomatic ( p = 0.012) CHP.

Conclusion:

The flow-controlled STA-MCA anastomosis can significantly decrease the incidence of postoperative CHP during direct anastomoses of recipient M-PSCAs in adult MMD.
Young stroke patient with patent foramen ovale and intracranial stenosis—a case report
Authors: Šunde Domagoj , Ljevak Josip , Ozretić David , Perić Ivan , Blažević Nikola , Poljakovic Zdravka
Published: July 2023

The prevalence of patent foramen ovale is approximately 20% in the global population. In patients under the age of 55 years, it has been proven as a cause of acute ischemic embolic stroke of otherwise undetermined source. We present a case of a 25-year-old patient who experienced an acute stroke of dominant hemisphere due to internal carotid artery occlusion.The patient underwent mechanical thrombectomy, followed by acute intracranial stenting due to persistent subocclusion of internal carotid artery. Further diagnostic investigations revealed a significant patent foramen ovale. During subsequent follow-up periods, the patient encountered multiple transient ischemic attacks despite receiving antithrombotic therapy. The indicated angiography examination revealed in-stent stenosis and thrombosis, which were resolved after optimal medical treatment. Following patent foramen ovale closure, the patient remained free from further neurological events during the subsequent two-year follow-up periods. This case emphasizes the necessity of comprehensive diagnostic evaluations in young individuals with stroke and underscores the importance of prudent slection of medical therapies.
Phase II randomised, placebo-controlled, clinical trial of interleukin-1 receptor antagonist in intracerebral haemorrhage: BLOcking the Cytokine IL-1 in ICH (BLOC-ICH)
Authors: Parry-Jones Adrian R , Stocking Katie , MacLeod Mary Joan , Clarke Brian , Werring David J , Muir Keith W , Vail Andy
Published: July 2023

Purpose:

Recombinant human interleukin-1 receptor antagonist (anakinra) is an anti-inflammatory with efficacy in animal models of stroke. We tested the effect of anakinra on perihaematomal oedema in acute intracerebral haemorrhage (ICH) and explored effects on inflammatory markers.

Methods:

We conducted a multicentre, randomised, double-blind, placebo-controlled trial in patients with acute, spontaneous, supratentorial ICH between May 2019 and February 2021. Patients were randomised to 100 mg subcutaneous anakinra within 8 h of onset, followed by five, 12-hourly, 100 mg subcutaneous injections, or matched placebo. Primary outcome was oedema extension distance (OED) on a 72 h CT scan. Secondary outcomes included plasma C-reactive protein (CRP) and interleukin-6 (IL-6).

Findings:

25 patients (target = 80) were recruited, 14 randomised to anakinra, 11 to placebo. Mean age was 67 and 52% were male. The anakinra group had higher median baseline ICH volume (12.6 ml, interquartile range[IQR]:4.8–17.9) versus placebo (5.5 ml, IQR:2.1–10.9). Adjusting for baseline, 72 h OED was not significantly different between groups (mean difference OED anakinra vs placebo -0.05 cm, 95% confidence interval [CI]: −0.17–0.06, p = 0.336). There was no significant difference in area-under-the-curve to Day 4 for IL-6 and CRP, but a post-hoc analysis demonstrated IL-6 was 56% (95% CI: 2%–80%) lower at Day 2 with anakinra. There were 10 and 2 serious adverse events in anakinra and placebo groups, respectively, none attributed to anakinra.

Conclusion:

We describe feasibility for delivering anakinra in acute ICH and provide preliminary safety data. We lacked power to test for effects on oedema thus further trials will be required.
Pleiotrophin Signals Through ALK Receptor to Enhance the Growth of Neurons in the Presence of Inhibitory Chondroitin Sulfate Proteoglycans
Authors: Gupta Somnath J , Churchward Matthew A , Todd Kathryn G , Winship Ian R
Published: July 2023

Chondroitin sulfate proteoglycans (CSPGs), one of the major extracellular matrix components of the glial scar that surrounds central nervous system (CNS) injuries, are known to inhibit the regeneration of neurons. This study investigated whether pleiotrophin (PTN), a growth factor upregulated during early CNS development, can overcome the inhibition mediated by CSPGs and promote the neurite outgrowth of neurons in vitro. The data showed that a CSPG matrix inhibited the outgrowth of neurites in primary cortical neuron cultures compared to a control matrix. PTN elicited a dose-dependent increase in the neurite outgrowth even in the presence of the growth inhibitory CSPG matrix, with optimal growth at 15 ng mL−1 of PTN (114.8% of neuronal outgrowth relative to laminin control). The growth-promoting effect of PTN was blocked by inhibition of the receptor anaplastic lymphoma kinase (ALK) by alectinib in a dose-dependent manner. Neurite outgrowth in the presence of this CSPG matrix was induced by activation of the protein kinase B (AKT) pathway, a key downstream mediator of ALK activation. This study identified PTN as a dose-dependent regulator of neurite outgrowth in primary cortical neurons cultured in the presence of a CSPG matrix and identified ALK activation as a key driver of PTN-induced growth.
Tribology analysis of MMT nanoclay alkali-treated coconut sheath reinforced hybrid composite
Authors: Ganapathy Srinivasan R , Pragadish N , Esakkiraj ES , Selvam M , Rajaravi C
Published: July 2023

This research paper focuses on the tribology analysis of MMT - Montmorillonite nanoclay alkali-treated coconut sheath reinforced hybrid composite. The study aims to analyze the mechanical properties of coconut sheath reinforced polymer composites as compared to traditional synthetic fibers. The specific impact of MMT clay on the material’s mechanical properties is also considered. The experimental method involves the use of compression molding for fabrication, and various treatments are applied to the coconut sheath to improve its mechanical properties. The microstructure, tensile, flexural, and impact characterization of the specimens are analyzed. The results indicate that alkali-treated coconut sheath outperforms untreated coconut sheath in terms of surface quality. Additionally, the addition of MMT clay improves the bonding and surface area coverage, resulting in better mechanical properties. However, the brittleness of the treated coconut sheath specimen increased, reducing its energy absorption in impact tests. Overall, the study highlights the potential of coconut sheath as a natural fiber reinforcement for polymer composites and the impact of MMT clay on its mechanical properties.
Notch signaling pathway: a new target for neuropathic pain therapy
Authors: Zhang Yan , Wang Tingting , Wu Sanlan , Tang Li , Wang Jia , Yang Jinghan , Yao Shanglong , Zhang Yan
Published: July 2023

The Notch gene, a highly evolutionarily conserved gene, was discovered approximately 110 years ago and has been found to play a crucial role in the development of multicellular organisms. Notch receptors and their ligands are single-pass transmembrane proteins that typically require cellular interactions and proteolytic processing to facilitate signal transduction. Recently, mounting evidence has shown that aberrant activation of the Notch is correlated with neuropathic pain. The activation of the Notch signaling pathway can cause the activation of neuroglia and the release of pro-inflammatory factors, a key mechanism in the development of neuropathic pain. Moreover, the Notch signaling pathway may contribute to the persistence of neuropathic pain by enhancing synaptic transmission and calcium inward flow. This paper reviews the structure and activation of the Notch signaling pathway, as well as its potential mechanisms of action, to provide novel insights for future treatments of neuropathic pain.
Independent flavonoid and anthocyanin biosynthesis in the flesh of a red-fleshed table grape revealed by metabolome and transcriptome co-analysis
Authors: Lu Renxiang , Song Miaoyu , Wang Zhe , Zhai Yanlei , Hu Chaoyang , Perl Avihai , Ma Huiqin
Published: July 2023

Background

Red flesh is a desired fruit trait, but the regulation of red flesh formation in grape is not well understood. ‘Mio Red’ is a seedless table grape variety with light-red flesh and blue-purple skin. The skin color develops at veraison whereas the flesh color develops at a later stage of berry development. The flesh and skin flavonoid metabolomes and transcriptomes were analyzed.

Results

A total of 161 flavonoids were identified, including 16 anthocyanins. A total of 66 flavonoids were found at significantly different levels in the flesh and skin (fold change ≥ 2 or ≤ 0.5, variable importance in projection (VIP) ≥ 1). The main anthocyanins in the flesh were pelargonidin and peonidin, and in the skin were peonidin, delphinidin, and petunidin. Transcriptome comparison revealed 57 differentially expressed structural genes of the flavonoid-metabolism pathway (log2fold change ≥ 1, FDR < 0.05, FPKM ≥ 1). Two differentially expressed anthocyanin synthase (ANS) genes were annotated, ANS2 (Vitvi02g00435) with high expression in flesh and ANS1 (Vitvi11g00565) in skin, respectively. One dihydro flavonol 4-reductase (DFR, Vitvi18g00988) gene was differentially expressed although high in both skin and flesh. Screened and correlation analysis of 12 ERF, 9 MYB and 3 bHLH genes. The Y1H and dual luciferase assays showed that MYBA1 highly activates the ANS2 promoter in flesh and that ERFCBF6 was an inhibitory, EFR23 and bHLH93 may activate the DFR gene. These genes may be involved in the regulation of berry flesh color.

Conclusions

Our study revealed that anthocyanin biosynthesis in grape flesh is independent of that in the skin. Differentially expressed ANS, MYB and ERF transcription factors provide new clues for the future breeding of table grapes that will provide the health benefits as red wine.
Development and assessment of the performance of a shared ventilatory system that uses clinically available components to individualize tidal volumes
Authors: Hannon David M. , Jones Tim , Conolly Jack , Judge Conor , Iqbal Talha , Shahzad Atif , Madden Michael , Kirrane Frank , Conneely Peter , Harte Brian H. , O’Halloran Martin , Laffey John G.
Published: July 2023

Objectives

To develop and assess a system for shared ventilation using clinically available components to individualize tidal volumes.

Design

Evaluation and in vitro validation study

Setting

Ventilator shortage during the SARS-CoV-2 pandemic.

Participants

The team consisted of physicians, bioengineers, computer programmers, and medical technology professionals.

Methods

Using clinically available components, a system of ventilation consisting of two ventilatory limbs was assembled and connected to a ventilator. Monitors for each limb were developed using open-source software. Firstly, the effect of altering ventilator settings on tidal volumes delivered to each limb was determined. Secondly, the impact of altering the compliance and resistance of one limb on the tidal volumes delivered to both limbs was analysed. Experiments were repeated three times to determine system variability.

Results

The system permitted accurate and reproducible titration of tidal volumes to each limb over a range of ventilator settings and simulated lung conditions. Alteration of ventilator inspiratory pressures, of respiratory rates, and I:E ratio resulted in very similar tidal volumes delivered to each limb. Alteration of compliance and resistance in one limb resulted in reproducible alterations in tidal volume to that test lung, with little change to tidal volumes in the other lung. All tidal volumes delivered were reproducible.

Conclusions

We demonstrate the reliability of a shared ventilation system assembled using commonly available clinical components that allows titration of individual tidal volumes. This system may be useful as a strategy of last resort for Covid-19, or other mass casualty situations, where the need for ventilators exceeds supply.
Association of cardiovascular health at old age with all-cause mortality: a prospective cohort study in China
Authors: Chen Shimin , Li Haowei , Wang Shengshu , Yang Shanshan , Liu Shaohua , Song Yang , Li Xuehang , Li Rongrong , Wang Jianhua , Liu Miao , He Yao
Published: July 2023

Background

Cardiovascular disease has become the leading cause of death worldwide, but there is a lack of data on whether cardiovascular health (CVH) is associated with elderly mortality in China. We investigated the relationship between the ideal CVH score of Chinese elderly and the all-cause mortality.

Methods

The Beijing Elderly Comprehensive Health Cohort Study included a total of 4,499 participants aged 60 years and above. The CVH metric was calculated at baseline and had a score ranging from 0 to 12. The relationship of CVH metrics with all-cause mortality was investigated using Cox proportional hazard regression analysis. The robustness of results was tested using subgroup and sensitivity analysis.

Results

The median CVH score among participants was 8.00 (2.00), with only 8.0% scoring 11–12 points. 667 deaths were observed during an average follow-up time of 8.2 years. Participants with a CVH score of 11–12 had a decreased risk of all-cause mortality when compared to those with a CVH score of 0–4(HR = 0.584, 95% CI: 0.373–0.913). Participants had a 7.5% lower risk of all-cause death with each unit higher CVH score (HR = 0.925, 95%CI: 0.885–0.967) with a linearly decreasing trend (P nonlinear = 0.575). The relationships were greater in younger elderly people and stroke patients (P interaction = 0.011 and 0.037. respectively). The consistency of significant trends in sensitivity analysis shows the robustness of association (P trend < 0.001).

Conclusions

Among the Chinese elderly, there was a linear relationship between improving CVH scores and a lower risk of all-cause mortality. Because of the enormous benefits brought by one point, strategies are essential for improving cardiovascular health attainment.

Trial registration

This study was registered at China Clinical Trial Registration Center (ChiCTR2100049866).