bluuebunny/crossref_metadata_2025 huggingface dataset:
Influence of zirconia on the sintering behaviour and mechanical properties of reaction-sintered mullite-based composite ceramics
Authors: Liu Zhenying , Xie Nan , Huang Shouwu , Zhang Hanxin , Wu Chongmei , Cui Kai , Liu Yin , Zhu Hongzheng , Zhu Jinbo , Xue Changguo
Published: October 2022

High-performance mullite-based composite ceramics were prepared successfully using natural kaolin and alumina as raw materials and ZrO2 as an additive. The influence of sintering temperature and ZrO2 content on the sintering behaviour and mechanical properties of zirconia-toughened mullite ceramics was studied systematically. With increasing sintering temperature from 1450°C to 1560°C, the primary phases of as-sintered composite ceramics were mullite and corundum with a small amount of ZrO2, and the bulk density of the composite ceramics increased from 2.29 to 2.72 g cm–3. Furthermore, the ZrO2 phase transition promoted transgranular fracture, and ZrO2 grains were pinned at the grain boundaries, thereby enhancing the mechanical strength of the composite ceramics. Moreover, the AZS12 sample, with 12 wt.% ZrO2 and sintered at 1560°C, had the greatest flexural strength and fracture toughness of 91.6 MPa and 2.47 MPa m–1/2, respectively. Adding ZrO2 to the composite ceramics increased their flexural strength by ~37.6%.
Genetic subgroups inform on pathobiology in adult and pediatric Burkitt lymphoma
Authors: Thomas Nicole , Dreval Kostiantyn , Gerhard Daniela S. , Hilton Laura K. , Abramson Jeremy S. , Ambinder Richard F. , Barta Stefan , Bartlett Nancy L. , Bethony Jeffrey , Bhatia Kishor , Bowen Jay , Bryan Anthony C. , Cesarman Ethel , Casper Corey , Chadburn Amy , Cruz Manuela , Dittmer Dirk P. , Dyer Maureen A. , Farinha Pedro , Gastier-Foster Julie M. , Gerrie Alina S. , Grande Bruno M. , Greiner Timothy , Griner Nicholas B. , Gross Thomas G. , Harris Nancy L. , Irvin John D. , Jaffe Elaine S. , Henry David , Huppi Rebecca , Leal Fabio E. , Lee Michael S. , Martin Jean Paul , Martin Marie-Reine , Mbulaiteye Sam M. , Mitsuyasu Ronald , Morris Vivian , Mullighan Charles G. , Mungall Andrew J. , Mungall Karen , Mutyaba Innocent , Nokta Mostafa , Namirembe Constance , Noy Ariela , Ogwang Martin D. , Omoding Abraham , Orem Jackson , Ott German , Petrello Hilary , Pittaluga Stefania , Phelan James D. , Ramos Juan Carlos , Ratner Lee , Reynolds Steven J. , Rubinstein Paul G. , Sissolak Gerhard , Slack Graham , Soudi Shaghayegh , Swerdlow Steven H. , Traverse-Glehen Alexandra , Wilson Wyndham H. , Wong Jasper , Yarchoan Robert , ZenKlusen Jean C. , Marra Marco A. , Staudt Louis M. , Scott David W. , Morin Ryan D.
Published: October 2022

Burkitt lymphoma (BL) accounts for most pediatric non-Hodgkin lymphomas, being less common but significantly more lethal when diagnosed in adults. Much of the knowledge of the genetics of BL thus far has originated from the study of pediatric BL (pBL), leaving its relationship to adult BL (aBL) and other adult lymphomas not fully explored. We sought to more thoroughly identify the somatic changes that underlie lymphomagenesis in aBL and any molecular features that associate with clinical disparities within and between pBL and aBL. Through comprehensive whole-genome sequencing of 230 BL and 295 diffuse large B-cell lymphoma (DLBCL) tumors, we identified additional significantly mutated genes, including more genetic features that associate with tumor Epstein-Barr virus status, and unraveled new distinct subgroupings within BL and DLBCL with 3 predominantly comprising BLs: DGG-BL (DDX3X, GNA13, and GNAI2), IC-BL (ID3 and CCND3), and Q53-BL (quiet TP53). Each BL subgroup is characterized by combinations of common driver and noncoding mutations caused by aberrant somatic hypermutation. The largest subgroups of BL cases, IC-BL and DGG-BL, are further characterized by distinct biological and gene expression differences. IC-BL and DGG-BL and their prototypical genetic features (ID3 and TP53) had significant associations with patient outcomes that were different among aBL and pBL cohorts. These findings highlight shared pathogenesis between aBL and pBL, and establish genetic subtypes within BL that serve to delineate tumors with distinct molecular features, providing a new framework for epidemiologic, diagnostic, and therapeutic strategies.
Deep-learning algorithm to detect fibrosing interstitial lung disease on chest radiographs
Authors: Nishikiori Hirotaka , Kuronuma Koji , Hirota Kenichi , Yama Naoya , Suzuki Tomohiro , Onodera Maki , Onodera Koichi , Ikeda Kimiyuki , Mori Yuki , Asai Yuichiro , Takagi Yuzo , Honda Seiwa , Ohnishi Hirofumi , Hatakenaka Masamitsu , Takahashi Hiroki , Chiba Hirofumi
Published: October 2022

Background

Antifibrotic therapies are available to treat chronic fibrosing interstitial lung diseases (CF-ILDs), including idiopathic pulmonary fibrosis. Early use of these treatments is recommended to slow deterioration of respiratory function and to prevent acute exacerbation. However, identifying patients in the early stages of CF-ILD using chest radiographs is challenging. In this study, we developed and tested a deep-learning algorithm to detect CF-ILD using chest radiograph images.

Method

From the image archive of Sapporo Medical University Hospital, 653 chest radiographs from 263 patients with CF-ILDs and 506 from 506 patients without CF-ILD were identified; 921 were used for deep learning and 238 were used for algorithm testing. The algorithm was designed to output a numerical score ranging from 0 to 1, representing the probability of CF-ILD. Using the testing dataset, the algorithm's capability to identify CF-ILD was compared with that of doctors. A second dataset, in which CF-ILD was confirmed using computed tomography images, was used to further evaluate the algorithm's performance.

Results

The area under the receiver operating characteristic curve, which indicates the algorithm's detection capability, was 0.979. Using a score cut-off of 0.267, the sensitivity and specificity of detection were 0.896 and 1.000, respectively. These data showed that the algorithm's performance was noninferior to that of doctors, including pulmonologists and radiologists; performance was verified using the second dataset.

Conclusions

We developed a deep-learning algorithm to detect CF-ILDs using chest radiograph images. The algorithm's detection capability was noninferior to that of doctors.
Identification and expression analysis of BURP domain-containing genes in jujube and their involvement in low temperature and drought response
Authors: Wang Wenzhu , Zhang Zhong , Li Xingang
Published: October 2022

Background

Plant-specific BURP domain-containing genes are involved in plant development and stress responses. However, the role of BURP family in jujube (Ziziphus jujuba Mill.) has not been investigated.

Results

In this study, 17 BURP genes belonging to four subfamilies were identified in jujube based on homology analysis, gene structures, and conserved motif confirmation. Gene duplication analysis indicated both tandem duplication and segmental duplication had contributed to ZjBURP expansion. The ZjBURPs were extensively expressed in flowers, young fruits, and jujube leaves. Transcriptomic data and qRT-PCR analysis further revealed that ZjBURPs also significantly influence fruit development, and most genes could be induced by low temperature, salinity, and drought stresses. Notably, several BURP genes significantly altered expression in response to low temperature (ZjPG1) and drought stresses (ZjBNM7, ZjBNM8, and ZjBNM9).

Conclusions

These results provided insights into the possible roles of ZjBURPs in jujube development and stress response. These findings would help selecting candidate ZjBURP genes for cold- and drought-tolerant jujube breeding.
Division of the role and physiological impact of multiple lysophosphatidic acid acyltransferase paralogs
Authors: Ogawa Takuya , Kuboshima Misaki , Suwanawat Nittikarn , Kawamoto Jun , Kurihara Tatsuo
Published: October 2022

Background

Lysophosphatidic acid acyltransferase (LPAAT) is a phospholipid biosynthesis enzyme that introduces a particular set of fatty acids at the sn-2 position of phospholipids. Many bacteria have multiple LPAAT paralogs, and these enzymes are considered to have different fatty acid selectivities and to produce diverse phospholipids with distinct fatty acid compositions. This feature is advantageous for controlling the physicochemical properties of lipid membranes to maintain membrane integrity in response to the environment. However, it remains unclear how LPAAT paralogs are functionally differentiated and biologically significant.

Results

To better understand the division of roles of the LPAAT paralogs, we analyzed the functions of two LPAAT paralogs, PlsC4 and PlsC5, from the psychrotrophic bacterium Shewanella livingstonensis Ac10. As for their enzymatic function, lipid analysis of plsC4- and plsC5-inactivated mutants revealed that PlsC4 prefers iso-tridecanoic acid (C12-chain length, methyl-branched), whereas PlsC5 prefers palmitoleic acid (C16-chain length, monounsaturated). Regarding the physiological role, we found that plsC4, not plsC5, contributes to tolerance to cold stress. Using bioinformatics analysis, we demonstrated that orthologs of PlsC4/PlsC5 and their close relatives, constituting a new clade of LPAATs, are present in many γ-proteobacteria. We also found that LPAATs of this clade are phylogenetically distant from principal LPAATs, such as PlsC1 of S. livingstonensis Ac10, which are universally conserved among bacteria, suggesting the presence of functionally differentiated LPAATs in these bacteria.

Conclusions

PlsC4 and PlsC5, which are LPAAT paralogs of S. livingstonensis Ac10, play different roles in phospholipid production and bacterial physiology. An enzyme belonging to PlsC4/PlsC5 subfamilies and their close relatives are present, in addition to principal LPAATs, in many γ-proteobacteria, suggesting that the division of roles is more common than previously thought. Thus, both principal LPAATs and PlsC4/PlsC5-related enzymes should be considered to decipher the metabolism and physiology of bacterial cell membranes.
Clinical value of fetal facial profile markers during the first trimester
Authors: Zhou Xiaofeng , Ji Chunya , Sun Lingling , Yin Linliang , Deng Xuedong , Pan Qi , Zhang Jun , Yang Zhong , Zheng Chenhan , Ling Chen , Shi Liping , Wu Yanqing
Published: October 2022

Objectives

To study the correlations between facial profile markers and crown-lump length (CRL) in a Chinese population, and to evaluate the clinical value of these markers for abnormal fetuses during the first trimester (11 to 13+6 gestational weeks). 

Methods

The facial profile markers were as followings: inferior facial angle (IFA), maxilla-nasion-mandible (MNM) angle, facial maxillary angle (FMA), frontal space (FS) distance and profile line (PL) distance. These markers were measured in facial mid-sagittal section through ViewPoint 6 software. The diagnostic value of these markers for abnormal fetuses was assessed by receiver operating characteristic (ROC) curves.

Results

According to the first-trimester scanning (FTS) and follow-up, 31 fetuses were enrolled in the abnormal group, including 14 cases of trisomy 21, 7 cases of trisomy 18, 10 cases with cleft lip and palate (CLP), and 1000 normal fetuses were selected. Among the normal fetuses, the IFA, FS distance and PL distance had negative correlations with CRL. The MNM angle and FMA had positive correlations with CRL. The mean IFA values for fetuses with trisomy 21 and trisomy 18 were 74.11° (standard deviation (SD) 7.48) and 69.88° (SD 7.08), respectively, which were significantly smaller than the normal fetuses (p = 0.013; p = 0.003). The mean MNM angle of fetuses with trisomy 18 and CLP were 6.98° (SD 2.61) and 9.41° (SD 2.57), respectively, which were significantly greater than the normal fetuses (p = 0.005; p < 0.001). The mean FMA values of trisomy 18 fetuses were 63.95° (SD 4.77), which was significantly smaller than the normal fetuses (p < 0.001). The mean FS distance of CLP fetuses was -0.22 mm (SD 1.38), which was significantly smaller than the normal fetuses (p < 0.001). The mean PL distance of trisomy 21, trisomy 18 and CLP fetuses were 2.89 mm (SD 0.41), 2.91 mm (SD 0.56) and 2.71 mm (SD 0.37), respectively. The difference with the normal fetuses had no statistical significance (p = 0.56; p = 0.607; p = 0.54).

Conclusions

Fetal facial profile markers had excellent correlations with CRL during the first trimester. IFA had certain clinical significance in detecting trisomy 21. FMA, IFA and MNM angle were reliable indicators for screening trisomy 18. The abnormal MNM angle and FS distance could be used as sensitive indicators for CLP. However, PL distance was not the best markers for trisomy 21, trisomy 18 and CLP.
Promoter methylation changes in the placenta involved in the relationship between prenatal depression and small for gestational age
Authors: Yang Jianhui , Xu Aitong , Zhang YuMin , Deng Jiahui , Lin Xuemei , Xie Lili , Deng Xiaochun , Liu Honglin , Chen Peishan , Huang Yuejun
Published: October 2022

Background

Recent studies suggest that the incidence of small for gestational age (SGA) birth related to maternal depression, but the mechanism is unclear. The aim of this study was to explore the changes of promoter methylation in the placenta which may be involved in the relationship between prenatal depression and SGA.

Methods

Three hundred forty-five pregnant women were enrolled in this prospective cohort study. Perinatal emotion and sleep quality in the second and third trimesters were assessed using self-rating depression scale, self-rating anxiety scale, and Pittsburgh sleep quality index. According to the exposure (depressed emotion of mother) and outcome (SGA), the placentas were divided into four groups. Methylation of the promoter regions of the placental CRH, HSD11β2, SLA16A10, DIO3, and MTNR1B genes was determined using next generation sequencing based on bisulfite sequencing PCR.

Results

There were 97 (28.1%) and 95 (27.5%) pregnant women who had depression in the second trimester and third trimester, respectively. Thirty-five pregnant women had an SGA birth. The incidence of SGA births in this prospective cohort was 10.1%. The risk factors of SGA birth were low BMI of pregnancy women (RR = 0.71, 95%CI = 0.54 ~ 0.92), hypertensive disorder complicating pregnancy (HDCP, RR = 4.7, 95%CI = 1.18 ~ 18.72), and maternal depression in the second trimester (RR = 3.71, 95%CI = 1.31 ~ 12.16). We found that the CRH and HSD11β2 methylation levels were higher in the depression group than those in the non-depression group. Methylation levels of DIO3 were higher in SGA group than that in the non-SGA group. Higher methylation levels of CRH correlated with higher methylation levels of DIO3 in the placenta.

Conclusions

Maternal depression in the second trimester may lead to the changes of methylation levels in the promoter region of CRH and HSD11β2 gene, while the changes of methylation of DIO3 in subsequent could related to SGA. This study suggests that maternal depressed emotion during pregnancy may result in SGA due to the epigenetic changes of placenta.
Diagnostic value of the microcolon using ultrasonography in small bowel atresia
Authors: Ju Hao , Feng Shu , Huang Ying
Published: October 2022

Background

Microcolon helps diagnose small bowel atresia (SBA) using contrast enema. However, there are no ultrasonography (US) microcolon criteria for diagnosing SBA. Therefore, this study aimed to evaluate colon accuracy and other characteristics for diagnosing SBA by US, using surgical or clinical information as the reference standard.

Methods

US was performed on 46 neonates aged ≤ 7 days old. In the study group (n = 15), neonates with SBA were confirmed following surgery. In the study group without SBA (n = 15), neonates with other gastrointestinal problems besides SBA were confirmed by surgical or clinical follow-up. Sixteen neonates without gastrointestinal problems were classified as the control group. The colonic diameter was measured, and colonic gas was sought and observed. Statistical analysis was performed to compare US parameters between the study group and other two groups. The optimal cut-off value of the colonic diameter for SBA diagnosis was obtained using receiver operating characteristic analysis.

Results

Colonic diameters (0.5 cm) in the study group (interquartile ranges [IQR], 0.5–0.6 cm) was significantly smaller than that in the group without SBA (0.9 cm; IQR, 0.8–1.2 cm) (P <  0.001) and in the control group (1.2 cm; IQR, 0.8–1.35 cm) (P < 0.001). Optimum cut-off value for diagnosing SBA was 0.65 cm (sensitivity, 90.3%; specificity, 86.7%; accuracy, 89.1%) for the colonic diameter. Combining microcolon and gas-negativity showed the best performance in SBA diagnosis using US, with increased accuracy (91.3%).

Conclusion

A colon < 0.65 cm in diameter should be called a microcolon; combining US with gas-negativity is an essential diagnostic basis for SBA.
Patterns of alcohol and alcohol-flavoured non-alcoholic beverage advertisements over Japanese free-to-air television networks
Authors: Kato Mio , Ishikawa Hirono , Kiuchi Takahiro , Akiyama Miki , Kawamura Yoko , Okuhara Tsuyoshi , Ono Naoko , Miyawaki Rina
Published: October 2022

Background

Alcohol use is a serious public health challenge worldwide. Japan has no government regulations or legal penalties against advertising alcoholic beverages on television (TV). Instead, advertisements depend on the Japanese alcohol industry’s self-regulation on airtime (no advertisements from 5 am to 6 pm) and the content of alcoholic beverages, which must not tempt minors. However, many adolescents (10 to 19 years old) watch TV from 6 pm to 11 pm. The aim of this study was to describe the pattern in the advertising of alcoholic beverages and alcohol-flavoured non-alcoholic beverages (AFNAB) in Japan during the popular TV viewing time for adolescents.

Methods

A secondary analysis of advertising airtime data from five free-to-air Japanese TV networks in the Greater Tokyo area that aired between 12 August and 3 November 2019, was performed.

Results

During the study period, 5215 advertisements for alcoholic beverages and AFNABs aired (1451.75 min). In total, 2303 advertisements (44.2%) were beer, low-malt beer, or beer-taste beverages, 277 (5.3%) were whisky, 2334 (44.8%) were local alcoholic beverages (shochu and seishu), and 301 (5.8%) were AFNAB. On average, more advertisements aired on weekends (67.6 advertisements) than on weekdays (59.3 advertisements) per day. Approximately 30% of advertisements for AFNABs were aired during the time restricted for alcohol advertising, although AFNABs are considered alcohol according to industry guidelines. During the popular television viewing time for young adolescents, about two to three times more advertisements were aired per hour than during the rest of the day, on both weekdays and weekends (p < 0.001).

Conclusion

The number of alcohol advertisements aired at times when adolescents often watch TV is 2 to 3.2 times higher than that at other times of the day. Furthermore, despite the industry’s self-imposed regulations, some alcoholic beverages are still advertised. Therefore, other methods to protect children and adolescents from exposure to advertisements for alcoholic beverages should be investigated and implemented.
The associations between body composition and vital capacity index of medical students in Shenyang of China: a cross-sectional survey
Authors: Zhang Han , Sun Lu , Yu Ye , Xin Hong , Wu Li , Yang Fengmei , Liu Jie , Zhang Zhuo
Published: October 2022

Objectives

This study aimed to examine the associations between body composition and vital capacity index (VCI) among medical students of Shenyang, China.

Study design

The design of this study is a cross-sectional study.

Methods

Participants were 2063 individuals (17–25 years) from a medical college in Shenyang, who participated in this survey from April to May 2017. Height, weight, fat mass (FM), fat free mass (FFM), protein mass (PM), total body water (TBW), mineral mass (MM), vital capacity were measured, then BMI and VCI were calculated. Stepwise multiple linear regression analysis was used to evaluate the effect of body composition on VCI of participants in different genders. In addition, subgroup analysis was carried out according to BMI levels.

Results

Male students showed significantly higher height, weight, BMI, FFM, PM, TBW, MM, VC, and VCI, but lower FM in comparison with female students. Stepwise multiple linear regression analysis showed that in both sexes FM was negatively correlated with VCI which represents pulmonary function (r < 0; P < 0.001). After dividing the whole participants by BMI, further correlation analysis showed FM was positively correlated with VCI only for male subgroups with BMI < 18.5 (r > 0; P = 0.050).

Conclusion

Overall, FM is highly negatively correlated with the VCI of Chinese medical students of both genders. However, there was a positive correlation between FM and VCI among low-weight male students.
Association between hyperglycemia on admission and preoperative deep venous thrombosis in patients with femoral neck fractures
Authors: Yao Wei , Tang Wanyun , Wang Wei , Lv Qiaomei , Ding Wenbo
Published: October 2022

Background

Elevated blood glucose is the most frequent electrolyte disturbance in acutely ill patients. This study aimed to determine whether admission hyperglycemia is associated with the incidence of preoperative deep venous thrombosis (DVT) in patients with femoral neck fractures.

Methods

This retrospective study was conducted on consecutive patients with femoral neck fractures admitted to our institution from March 2018 to March 2022. Blood glucose levels were measured within 24 h of admission and categorized into quartiles (Q1 = 5.30; Q2 = 5.70; Q3 = 6.60). Patients were divided into four groups (Group1-4) based on the quartiles. Preoperative DVT was diagnosed using venous compression ultrasonography. Multivariable logistic regression models and propensity score matching analysis evaluated the association between blood glucose and preoperative DVT in patients.

Results

Of 217 patients included in this study, 21(9.7%) had preoperative DVT in hospital, and admission hyperglycemia was observed in 83 (38.2%). Preoperative DVT was higher in patients with hyperglycemia (n = 15) than patients without hyperglycemia (n = 6) in the multivariable logistic regression models (OR 3.03, 95% CI 0.77–11.87). Propensity scores matching analyses manifested that compared with patients with group 2 (5.30 – 5.70 mmol/L) of glucose levels, the odds of preoperative DVT were slightly higher (OR 1.94, 95% CI 0.31–12.12) in patients with group 3 (5.70 – 6.60 mmol/L), substantially higher (OR 6.89, 95% CI 1.42–33.44, P trend < 0.01) in patients with the group 4 (> 6.60 mmol/L) of glucose levels.

Conclusions

In patients hospitalized for femoral neck fracture, markedly elevated blood glucose is associated with increased preoperative DVT in patients. The development of this biomarker could help in guiding patient counseling, risk assessment, and future management decisions.
An expansion to the Nägerl’s theory of proportionality in reduced alveolar bone height models: a 3D finite element analysis
Authors: Geramy Allahyar , Geramy Amir Reza , Fazli Behzad
Published: October 2022

Introduction

Orthodontic tooth movement is a basic theme in an orthodontic treatment. According to Nägerl, A nearer force application to the center of resistance will bring a farther center of rotation to the center of resistance. The main goal of this study was to evaluate this theory of proportionality by Finite element method (FEM) and find out its applicability in a bone loss situation.

Materials and methods

Three 3D FEM of an upper central incisor were designed in Solidworks 2016, the first one with a healthy bone height (model 1), with 3 mm of bone loss (model 2) and with 4.5 mm of bone loss (model 3). An 0.5 N force was applied in different predefined locations on the labial surface of the crown in model 2. This was 0.2 N for the model 3. The exact location of the center of resistance (Cres), center of rotation (Crot) for each force application point was calculated using a C++ code specially design for this study in all models.

Results

An apical shift of the Cres positions were shown in gradual steps of bone loss from 7.9708 mm incisal from the apex to 6.6292 mm in model 2 and 5.6105 mm in model 3. Modification of the location of the Crot in different force magnitudes and points of force applications were shown whit a constant a*b.

Conclusion

In healthy teeth and teeth with alveolar bone loss, Cres located in the apical third of the root. The product of the distance between the point of force application and Cres (“a”) and the Cres and Crot (“b”) is constant, thus; Nägerl theory is applicable in both healthy and reduced bone height. In this way, applying a single force nearer to the cervical point will result in a more apical location of the Crot, reducing the angle change in the long axis of the tooth.
Gender differences in the intention to withhold life-sustaining treatments involving severe dementia for self and on behalf of parent or spouse
Authors: Chen Duan-Rung , Jerng Jih-Shuin , Tsai Daniel Fu-Chang , Young Yuchi
Published: October 2022

Background

Few studies have explored gender differences in the attitudes toward advanced care planning and the intention to withhold life-sustaining treatments (LSTs) involving severe dementia in Asian countries. We examined gender differences in the attitude toward the Patient Autonomy Act (PAA) in Taiwan and how the gender differences in these attitudes affect the intention to withhold LSTs for severe dementia. We also investigated self–other differences in the intention to withhold LSTs between genders.

Methods

Between March and October 2019, a structured questionnaire was distributed to hospitalized patients’ family members through face-to-face contact in an academic medical center. Exploratory factor analysis and independent and paired-sample t-tests were used to describe gender differences. Mediation analyses controlled for age, marital status, and education level were conducted to examine whether the attitude toward the PAA mediates the gender effect on the intention to withhold LSTs for severe dementia.

Results

Eighty respondents filled out the questionnaire. Exploratory factor analysis of the attitude toward the PAA revealed three key domains: regarding the PAA as (1) promoting a sense of abandonment, (2) supporting patient autonomy, and (3) contributing to the collective good. Relative to the men, the women had lower average scores for promoting a sense of abandonment (7.48 vs. 8.94, p = 0.030), higher scores for supporting patient autonomy (8.74 vs. 7.94, p = 0.006), and higher scores for contributing to the collective good (8.64 vs. 7.47, p = 0.001). Compared with the women, the men were less likely to withhold LSTs for severe dementia (15.84 vs. 18.88, p = 0.01). Mediation analysis revealed that the attitude toward the PAA fully mediated the gender differences in the intention to withhold LSTs for severe dementia. Both men and women were more likely to withhold LSTs for themselves than for their parents. Compared with the women, the men were more likely to withhold resuscitation for themselves than for their parents (p = 0.05). Women were more likely to agree to enteral tube feeding and a tracheotomy for their husbands than for themselves; men made consistent decisions for themselves and their wives in those LST scenarios.

Conclusion

Gender influences the attitude toward advanced care planning and consequently affects the intention to withhold LSTs, indicating that there may be a difference in how men and women perceive EOL decision-making for severe dementia in Taiwan. Further studies are warranted.
Talking with pediatric patients with overweight or obesity and their parents: self-rated self-efficacy and perceived barriers of Dutch healthcare professionals from seven disciplines
Authors: van der Voorn B. , Camfferman R. , Seidell J. C. , Halberstadt J.
Published: October 2022

Background

Many healthcare professionals (HCPs) feel uncomfortable and incompetent talking about weight with children with overweight and obesity and their parents. To optimally target interventions that can improve obesity care for children, we assessed the self-efficacy (SE) and perceived barriers (PBs) of Dutch HCPs with regard to talking about weight and lifestyle when treating children with overweight or obesity. We also analyzed interdisciplinary differences.

Methods

A newly developed, practice- and literature-based questionnaire was completed by 578 HCPs from seven disciplines. ANOVA and chi-square tests were used to analyze interdisciplinary differences on SE, PBs, and the effort to discuss weight and lifestyle despite barriers. Regression analyses were used to check whether age, sex or work experience influenced interdisciplinary differences.

Results

On average, the reported score on SE was 7.2 (SD 1.2; scale 1–10) and the mean number of PBs was 4.0 (SD 2.3). The majority of HCPs (94.6%) reported perceiving one or more barriers (range 0–12 out of 17). HCPs who in most cases perceived too many barriers to discuss weight and lifestyle of the child (9.6%,n = 55) reported a lower SE (mean 6.3) than professionals who were likely to discuss these topics (mean SE 7.3,p < 0.01), despite having a similar number of PBs (mean 4.5 vs 4.0,p > 0.05). In total, 14.2% (n = 82) of HCPs either felt incapable (SE ≤ 5) or reported that in most cases they did not address weight and lifestyle due to PBs.

Conclusions

Although on average Dutch HCPs rated their self-efficacy as fairly good, for a subgroup major improvements are necessary to lower perceived barriers and improve self-efficacy, in order to improve the quality of care for Dutch children with obesity.
Establishment and validation of a novel prognostic model for non-virus-related hepatocellular carcinoma
Authors: Jiang Yu , Chen Shulin , Wu Yaxian , Qu Yuanye , Jia Lina , Xu Qingxia , Dai Shuqin , Xue Ning
Published: October 2022

Objective

The incidence of non-virus-related hepatocellular carcinoma (NV-HCC) in hepatocellular carcinoma (HCC) is steadily increasing. The aim of this study was to establish a prognostic model to evaluate the overall survival (OS) of NV-HCC patients.

Methods

Overall, 261 patients with NV-HCC were enrolled in this study. A prognostic model was developed by using LASSO-Cox regression analysis. The prognostic power was appraised by the concordance index (C-index), and the time-dependent receiver operating characteristic curve (TD-ROC). Kaplan–Meier (K–M) survival analysis was used to evaluate the predictive ability in the respective subgroups stratified by the prognostic model risk score. A nomogram for survival prediction was established by integrating the prognostic model, TNM stage, and treatment.

Results

According to the LASSO-Cox regression results, the number of nodules, lymphocyte-to-monocyte ratio (LMR), prognostic nutritional index (PNI), alkaline phosphatase (ALP), aspartate aminotransferase (AST)/alanine aminotransferase (ALT) ratio (SLR) and C-reactive protein (CRP) were included for prognostic model construction. The C-index of the prognostic model was 0.759 (95% CI 0.723–0.797) in the development cohort and 0.796 (95% CI 0.737–0.855) in the validation cohort, and its predictive ability was better than TNM stage and treatment. The TD-ROC showed similar results. K–M survival analysis showed that NV-HCC patients with low risk scores had a better prognosis (P < 0.05). A nomogram based on the prognostic model, TNM stage, and treatment was constructed with sufficient discriminatory power with C-indexes of 0.78 and 0.85 in the development and validation cohort, respectively.

Conclusion

For NV-HCC, this prognostic model could predict an OS benefit for patients, which may assist clinicians in designing individualized therapeutic strategies.
Costunolide is a dual inhibitor of MEK1 and AKT1/2 that overcomes osimertinib resistance in lung cancer
Authors: Tian Xueli , Wang Rui , Gu Tingxuan , Ma Fayang , Laster Kyle Vaughn , Li Xiang , Liu Kangdong , Lee Mee-Hyun , Dong Zigang
Published: October 2022

EGFR-TKI targeted therapy is one of the most effective treatments for lung cancer patients harboring EGFR activating mutations. However, inhibition response is easily attenuated by drug resistance, which is mainly due to bypass activation or downstream activation. Herein, we established osimertinib-resistant cells by stepwise dose-escalation in vitro and an osimertinib-resistant patient-derived xenograft model through persistent treatment in vivo. Phosphorylated proteomics identified that MEK1 and AKT1/2 were abnormally activated in resistant cells compared with parental cells. Likewise, EGFR inhibition by osimertinib induced activation of MEK1 and AKT1/2, which weakened osimertinib sensitivity in NSCLC cells. Consequently, this study aimed to identify a novel inhibitor which could suppress resistant cell growth by dual targeting of MEK1 and AKT1/2. Based on computational screening, we identified that costunolide could interact with MEK1 and AKT1/2. Further exploration using in vitro kinase assays validated that costunolide inhibited the kinase activity of MEK1 and AKT1/2, which restrained downstream ERK-RSK2 and GSK3β signal transduction and significantly induced cell apoptosis. Remarkably, the combination of osimertinib and costunolide showed synergistic or additive inhibitory effects on tumor growth in osimertinib-resistant cell lines and PDX model. Hence, this study highlights a potential therapeutic strategy for osimertinib-resistant patients through targeting of MEK1 and AKT1/2 by costunolide.
Cough suppression and HRQoL in adult people with cystic fibrosis: an unexplored correlation
Authors: Niehammer Ute , Steindor Mathis , Straßburg Svenja , Sutharsan Sivagurunathan , Taube Christian , Welsner Matthias , Hirtz Raphael , Stehling Florian
Published: October 2022

Background

Cough suppression assessed by embarrassment about coughing has been shown in adolescents with cystic fibrosis (CF) and negatively affects health-related quality of life (HRQoL) and clinical indicators of disease severity in adolescent females. However, whether cough suppression exists in adults has been studied as little as its effects on clinical and psychological outcomes beyond adolescence.

Methods

Seventy-one subjects completed the self-reported 'Cystic Fibrosis Questionnaire-Revised (CFQ-R + 14)' and a self-report questionnaire about cough suppression, health-related perspectives, and therapy adherence. The status of CF disease was quantified in terms of the percentage of predicted forced expiratory volume in one second (ppFEV1), body mass index (BMI), Pseudomonas aeruginosa, pancreatic status, and CF-related diabetes (CFRD). Additional demographic data for sex, age, graduation, employment, and marital status were assessed.

Results

CS exists in adult CF and is associated with impaired HRQoL but not the overall CF disease status regarding BMI, ppFEV1, or health-related perspectives. Despite a higher prevalence of cough suppression in women, no effect of sex regarding either outcome measure was observed.

Conclusion

The results of this study suggest that mental health indicators have an impact on cough suppression.
Combined impact of elevated arterial stiffness and left ventricular filling pressure on outcomes after off-pump coronary artery bypass grafting
Authors: Choi Jae-Sung , Oh Se Jin , Oh Sohee
Published: October 2022

Background

Brachial-ankle pulse wave velocity (baPWV) and early diastolic transmitral flow velocity to mitral annular tissue velocity (E/e′)—which are markers of arterial stiffness and left ventricular (LV) filling pressure, respectively—have been associated with morbidity and mortality. We investigated their combined impact on postoperative complications and long-term survival of patients undergoing off-pump coronary artery bypass grafting (OPCAB).

Methods

A cohort of 164 patients were divided into four groups: baPWV ≤ 19 m/s and E/e′ ≤ 15 (reference), baPWV > 19 m/s and E/e′ ≤ 15 (high-PWV-only), baPWV ≤ 19 m/s and E/e′ > 15 (high-E/e′-only), and baPWV > 19 m/s and E/e′ > 15 (high-PWV-and-E/e′). After inverse probability treatment weighting adjustment, each group was compared with the reference group to analyze the odds ratios of postoperative complications and the Kaplan–Meier survival curves, and to identify the group representing an independent prognostic predictor.

Results

The median age and follow-up duration were 69 years and 57.2 months, respectively. Both postoperative acute kidney injury (POAKI) and atrial fibrillation (POAF) were higher in the high-PWV-and-E/e′ group (adjusted odds ratio (OR) = 89.5; 95% confidence interval (CI), 8.5–942.3; p < 0.001 and OR = 12.5; CI, 2.5–63.8; p = 0.002, respectively). Compared to the reference group, only the high-PWV-and-E/e′ group showed significantly lower survival rate (91.0%; CI, 82.8–100% vs. 44.8%; CI, 21.2–94.6%) and a higher hazard for all-cause mortality after adjustment for covariates (hazard ratio = 6.1; p = 0.002).

Conclusion

Concurrent elevation in PWV and E/e′ may independently affect not only the rates of POAKI and POAF but also long-term survival after OPCAB.
Thymic adenocarcinoma presenting as an incidental mediastinal mass
Authors: O’Shea Anne E. , Nissen Alexander P. , Bowen Donnell K. , Barnett Taylor L. , Gustafson Joshua D.
Published: October 2022

Background

Primary thymic adenocarcinoma represents an exceptionally rare malignancy, for which the cornerstone of therapy is margin-negative resection, with radiation and systemic therapy reserved for invasive and advanced disease. Thymic adenocarcinoma has not been previously reported in the setting of a concomitant malignancy, as reported herein.

Case presentation

We present a case of a 55-year-old previously healthy male diagnosed with acute myeloid leukemia, also found to have a mediastinal mass. Evaluation of the mediastinal mass with tumor markers, biopsies, and next-generation sequencing proved non-diagnostic, while he was simultaneously treated with induction chemotherapy to prevent leukemia-related blast crisis. After completing and recovering from induction chemotherapy, he underwent successful thymectomy during a chemotherapy holiday, with a margin-negative resection of thymic adenocarcinoma. He has subsequently recovered and undergone successful allogeneic hematopoietic stem cell transplant.

Conclusions

We present a case of synchronous adult acute myeloid leukemia and primary thymic adenocarcinoma requiring a tailored approach for management of simultaneous malignancies.
Post-esophagectomy chylothorax refractory to mass ligation of thoracic duct above diaphragm: a case report
Authors: Wang Shengxi , Jiang Wenpeng
Published: October 2022

Background

Post-esophagectomy chylothorax is a relatively rare but potentially lethal complication. The treatment strategy of post-esophagectomy chylothorax remains a subject of debate which mainly focuses on the indication and timing of surgical intervention. For cases in which the leakage site is not localized, a mass ligation of the thoracic duct above diaphragm is advocated as the surgical procedure is believed to ensure sealing all the accessory ducts that could be the source of the chylothorax. But in this paper, we report a case of post-esophagectomy chylothorax which was refractory to mass ligation of thoracic duct above diaphragm.

Case presentation

A 59-year old man suffered from high output chylothorax (> 1000 ml/24 h for more than 30 days) after esophagectomy through left thoracotomy. Considering the failure of lymphangiography, we performed mass ligation of thoracic duct above diaphragm. However, we failed to close the chylous leakage. Finally, we found that a rare variated tributary of thoracic duct was the resource of the chylous output. Both the variation of lymphatic system and the coincidence of injured site lead to the invalidness of reoperation. After definitely ligating the variated tributary, chylothorax was cured.

Conclusion

This case supplies a direct evidence that mass ligation of thoracic duct is of no avail in some refractory chylothorax, which indicates the importance of chylous leakage localization.
Structural Behavior Analysis of UHPC Hybrid Tower for 3-MW Super Tall Wind Turbine Under Rated Wind Load
Authors: Wu Xiangguo , Zhang Xuesen , Bhattarai Hom Bahadur , Hwang Hyeon-Jong , Yang Jing , Kang Soonpil
Published: October 2022

Based on the conceptual design of an advanced wind turbine tower system, use of ultra-high-performance cementitious composites material with compressive strength of 200 MPa (UHPC-200) is proposed to ensure high durability and ductility of the UHPC hybrid wind turbine tower. Key design parameters are proposed for the structural design of a 3-MW wind turbine. The material properties, mixing compositions, simplified constitutive relationship, and model parameters are outlined. Using nonlinear finite element analysis, the effects of wall thickness, wall thickness ratio, and prestressing tendon on the structural performance including the longitudinal stress field, lateral displacement, stress concentration at the transition zone between the middle and bottom segments are evaluated. Based on the stress-field analysis, the design limitation of the segmental wall thickness and its ratio is recommended. The numerical results show that the tower with the wall thickness ratio of 2:3 (i.e., thickness 200–300 mm) with prestressing tendons is an optimal design for the UHPC hybrid tower. The results of this study can be used as a reference for the engineering design of a new type of UHPC hybrid wind turbine tower.
Effects of lactic acid bacteria-fermented formula milk supplementation on ileal microbiota, transcriptomic profile, and mucosal immunity in weaned piglets
Authors: Lin Ailian , Yan Xiaoxi , Wang Hongyu , Su Yong , Zhu Weiyun
Published: October 2022

Background

Lactic acid bacteria (LAB) participating in milk fermentation naturally release and enrich the fermented dairy product with a broad range of bioactive metabolites, which has numerous roles in the intestinal health-promoting of the consumer. However, information is lacking regarding the application prospect of LAB fermented milk in the animal industry. This study investigated the effects of lactic acid bacteria-fermented formula milk (LFM) on the growth performance, intestinal immunity, microbiota composition, and transcriptomic responses in weaned piglets. A total of 24 male weaned piglets were randomly divided into the control (CON) and LFM groups. Each group consisted of 6 replicates (cages) with 2 piglets per cage. Each piglet in the LFM group were supplemented with 80 mL LFM three times a day, while the CON group was treated with the same amount of drinking water.

Results

LFM significantly increased the average daily gain of piglets over the entire 14 d (P < 0.01) and the average daily feed intake from 7 to 14 d (P < 0.05). Compared to the CON group, ileal goblet cell count, villus-crypt ratio, sIgA, and lactate concentrations in the LFM group were significantly increased (P < 0.05). Transcriptomic analysis of ileal mucosa identified 487 differentially expressed genes (DEGs) between two groups. Especially, DEGs involved in the intestinal immune network for IgA production pathways, such as polymeric immunoglobulin receptor (PIGR), were significantly up-regulated (P < 0.01) by LFM supplementation. Moreover, trefoil factor 2 (TFF2) in the LFM group, one of the DEGs involved in the secretory function of goblet cells, was also significantly up-regulated (P < 0.01). Sequencing of the 16S rRNA gene of microbiota demonstrated that LFM led to selective enrichment of lactate-producing and short-chain fatty acid (SCFA)-producing bacteria in the ileum, such as an increase in the relative abundance of Enterococcus (P = 0.09) and Acetitomaculum (P < 0.05).

Conclusions

LFM can improve intestinal health and immune tolerance, thus enhancing the growth performance of weaned piglets. The changes in microbiota and metabolites induced by LFM might mediate the regulation of the secretory function of goblet cells.
The mediating role of psychological capital in relations between spiritual well-being and mental health among nursing students
Authors: Parviniannasab Ali Mohammad , Bijani Mostafa , Dehghani Ali
Published: October 2022

Background

Nursing students face mental and emotional issues due to the nature of their profession. The role of protective factors such as psychological capital and spiritual well-being is vital in improving mental health. This study investigated the mediating role of psychological capital as a mediator in the relationships between spiritual well-being and mental health in Iran.

Methods

The present study was descriptive, cross-sectional research conducted on 426 undergraduate nursing students within a four-year educational program in Iran from July to December 2021. The participants were selected via convenience sampling. This research used psychological capital scale, spiritual well-being, and general health questionnaire. The collected data were then analyzed using descriptive tests, Pearson correlation, and a structural equation model.

Results

Spiritual well-being positively affects mental health and psychological capital. Psychological capital also is positively related to mental health. Psychological capital partially mediated the effect of spiritual well-being on mental health.

Conclusion

According to the results, High level of spiritual well-being can improve nursing students' mental health and the relationship is partially mediated Psychological capital. Therefore, psychological capital is an important factor in improving nursing students’ mental health.
Deep learning enhancing banking services: a hybrid transaction classification and cash flow prediction approach
Authors: Kotios Dimitrios , Makridis Georgios , Fatouros Georgios , Kyriazis Dimosthenis
Published: October 2022

Small Medium Enterprises (SMEs) are vital to the global economy and all societies. However, they face a complex and challenging environment, as in most sectors they are lagging behind in their digital transformation. Banks, retaining a variety of data of their SME customers to perform their main activities, could offer a solution by leveraging all available data to provide a Business Financial Management (BFM) toolkit to their customers, providing value added services on top of their core business. In this direction, this paper revolves around the development of a smart, highly personalized hybrid transaction categorization model, interconnected with a cash flow prediction model based on Recurrent Neural Networks (RNNs). As the classification of transactions is of great significance, this research is extended towards explainable AI, where LIME and SHAP frameworks are utilized to interpret and illustrate the ML classification results. Our approach shows promising results on a real-world banking use case and acts as the foundation for the development of further BFM banking microservices, such as transaction fraud detection and budget monitoring.