bluuebunny/crossref_metadata_2025 huggingface dataset:
Effect of needle orientation during arteriovenous access puncture on needed compression time after hemodialysis: A randomized controlled trial
Authors: Loizeau Valérie , Tanouti Hanan , Marcheguet Audrie , Loubière Guillaume , Aegerter Philippe , Drioueche Hocine , Pembebjoglou Sandra
Published: July 2023

Background

There are two techniques for puncturing an arteriovenous fistula: one where the needle is inserted bevel up and then rotated to a bevel down position, and another where the needle is inserted bevel down. The aim of this study was to compare these two methods of needle insertion on minimum compression time required for hemostasis after needle removal.

Methods

This was a prospective, randomized, cross‐over, blinded, single‐center, routine care study. Each patient's average post‐dialysis puncture site compression time was determined during a 2‐week baseline period while using bevel‐up access puncture. Subsequently, minimum post‐dialysis puncture‐site compression time was determined during each of two sequential follow‐up periods, during which fistula puncture was done with needles inserted bevel up or down, respectively. The order of treatments (bevel up or bevel down insertion) was randomized. During each follow‐up period, the minimum compression time necessary to avoid bleeding on needle removal was determined by progressively shortening the compression time. Puncture‐associated pain was also assessed as prepump and venous pressures and ability to achieve desired blood flow rate during the dialysis session.

Results

Forty‐two patients were recruited. The baseline compression time after needle removal averaged 9.99 ± 2.7 min During the intervention periods, the minimum compression time was on average 10.8 min (9.23–12.4) when the access needles had been inserted bevel down versus 11.1 min (9.61–12.5) when the access needles had been inserted bevel up (p = 0.72). There was no difference in puncture‐associated pain between the two insertion techniques, and no difference in prepump or venous pressures or ability to achieve the desired blood flow rate during the dialysis session.

Conclusion

Bevel‐up and bevel‐down needle orientation during arteriovenous fistula puncture are equivalent techniques in terms of achieving hemostasis on needle removal, and puncture‐associated pain.
High‐temperature strength behavior of tantalum diboride to 2000°C
Authors: Vasylkiv Oleg , Demirskyi Dmytro
Published: July 2023

This study investigated the high‐temperature strength of spark plasma sintered tantalum diboride (TaB2) for the first time. TaB2 exhibited a unique elastic fracture behavior below 1900°C, unlike other transition metal diborides. The consolidation process involved spark plasma sintering at 2000–2200°C yielding dense TaB2 samples. The flexural strength was measured at elevated temperatures up to 2000°C, showing a quite high flexural strength of 400 ± 20 MPa at 1900°C. These findings provide valuable insights into the high‐temperature behavior of TaB2, highlighting its potential for advanced applications.
Enhancing cutting performance of Ti(C,N)‐based cermet tools on nodular cast iron by incorporating high‐entropy carbide
Authors: Zhou Yi , Liu Run‐Ping , Lao Zhen‐Yong , Luo Si‐Chun , You Yang , Sun Shi‐Kuan , Guo Wei‐Ming , Lin Hua‐Tay
Published: July 2023

In this study, we investigated the cutting performance and wear mechanisms of Ti(C,N)‐based cutting tools containing varying weight percentages (0%, 5%, 10%, and 15%) of high‐entropy carbide (HEC) (V0.2Nb0.2 Mo0.2Ta0.2W0.2)C phase, when used for turning nodular cast iron. According to the turning test results, the cermet cutting tools containing 0 wt%, 5 wt%, 10 wt%, and 15 wt% HEC phases demonstrated effective cutting lives of 402, 720, 632, and 465 s, respectively. The tool with 5 wt% HEC phase showed the best cutting performance. When cutting nodular cast iron with cermet cutting tools, the main wear mechanisms observed were diffusion, oxidation, adhesion, and abrasion on the flank surface, along with diffusion, oxidation, and abrasion on the rake surface. The results of this study indicated that (V0.2Nb0.2Mo0.2Ta0.2W0.2)C could be adopted as an effective reinforced phase in the cermet cutting tools.
Differences in Covid‐Related Regulatory Forbearance Within and Outside the Banking Union – The Case of East‐Central European EU Member States
Authors: Mérő Katalin
Published: July 2023

This article analyses the practice of Covid‐related bank regulatory forbearance measures of eight East‐Central European Union member states from the perspective of differentiated integration. In line with the integration‐deepening nature of the Single Supervisory Mechanism, our expectation was that countries within the Banking Union (BU) would impose harmonized forbearance measures, while non‐BU members would use more discretional measures. Indeed, the practice of forbearance measures is significantly more harmonized within the BU than outside; however, there were also notable differences in the practice of BU members. For non‐BU member states, our expectation was that countries with the intention of favouring their domestic financial system would ease regulatory requirements more, while those that wanted to place the burden of the pandemic on foreign banks would ease these requirements less. However, the analysis only partially confirmed this expectation.
Farnesoid X receptor is an important target for the treatment of disorders of bile acid and fatty acid metabolism in mice with nonalcoholic fatty liver disease combined with cholestasis
Authors: Liu Xinzhu , Wang Jiaxuan , Li Maogang , Qiu Jiannan , Li Xingying , Qi Li , Liu Jia , Liu Ping , Xie Guoxiang , Wang Xiaoning
Published: July 2023

Background and Aim

The prevalence of nonalcoholic fatty liver disease (NAFLD) has been rising globally. NAFLD patients combined with cholestasis have more obvious liver fibrosis, impaired bile acid (BA), and fatty acid (FA) metabolism and severer liver injury; however, its therapeutic options are limited, and the underlying metabolic mechanisms are understood. Here, we aimed to investigate the effects of farnesoid X receptor (FXR) on BA and FA metabolism in NAFLD combined with cholestasis and related signaling pathways.

Methods

A mouse model of NAFLD combined with cholestasis was established by joint intervention with high‐fat diet (HFD) and alpha‐naphthylisothiocyanate. The effects of FXR on BA and FA metabolism were evaluated by serum biochemical analysis. Liver damage was identified by histopathology. The expression of nuclear hormone receptor, membrane receptor, FA transmembrane transporter, and BA transporter protein in mice were measured by western blot.

Results

NAFLD mice combined with cholestasis developed more severe cholestasis and dysregulated BA and FA metabolism. Meanwhile, the expression of FXR protein was decreased in NAFLD mice combined with cholestasis compared to the controls. Fxr−/− mice showed liver injury. HFD aggravated the liver injury with decreased BSEP expression, increased expression of NTCP, LXRα, SREBP‐1c, FAS, ACC1, and CD36, and significantly increased BA and FA accumulation.

Conclusion

All the results suggested that FXR plays a key role in both FA and BA metabolism in NAFLD combined with cholestasis and thus may be a potential target for the treatment of disorders of BA and FA metabolism in NAFLD combined with cholestasis.
Clinical study on the efficacy and tolerability of a topical regenerative treatment in patients with telogen effluvium and mild androgenetic alopecia
Authors: Cedirian S. , Bruni F. , Quadrelli F. , Caro G. , Fortuna M. , Rossi A. , Piraccini B. M. , Starace M.
Published: July 2023

Hair loss may change the quality of life since modern society considers hair an essential element in beauty definition. The most common causes of hair loss are androgenetic alopecia (AGA) and telogen effluvium (TE). AGA requires a lifetime use of minoxidil or finasteride (and sometimes they lose efficacy over the years), whereas TE has no standardized therapy available. Our study focuses on a novel topical regenerative preparation that, by mimicking autologous PRP, can safely and efficiently improve hair loss in patients affected by TE and AGA.
GROUPS 4 RETIREMENT: A new intervention that supports well‐being in the lead‐up to retirement by targeting social identity management
Authors: La Rue Crystal J. , Haslam Catherine , Bentley Sarah V. , Lam Ben C. P. , Steffens Niklas K. , Branscombe Nyla R. , Haslam S. Alexander , Cruwys Tegan
Published: July 2023

Successful retirement adjustment requires careful planning in the lead up to this important life transition. While financial planning is routinely prioritized, evidence suggests that the social changes in retirement can be just as challenging to manage — if not more. GROUPS 4 RETIREMENT (G4R) is a new online intervention that addresses this gap by targeting the identity changes that people typically experience in retirement. This paper reports findings from two studies evaluating the acceptability and efficacy of this intervention. Study 1 (N = 89) used a pre‐post design to assess G4R and found that the intervention was positively evaluated by users and led to significant increases in their sense of thriving, perceived control, life satisfaction, anticipated retirement satisfaction, and planning intentions. Study 2 (N = 98) tested the intervention using an experimental design in which participants were randomly assigned to either G4R or a financial planning control condition. Results showed that G4R was as effective as financial planning in improving most outcomes and showed a clear advantage in increasing anticipated retirement satisfaction and intentions to engage in social and activities planning. Together, these studies provide initial evidence of the value of engaging in social identity‐focused social planning to support well‐being and preparedness in the lead up to retirement.
Dynamic risk assessment for hepatocellular carcinoma in patients with chronic hepatitis C
Authors: Lu Mei , Salgia Reena , Li Jia , Trudeau Sheri , Rupp Loralee B. , Wu Trueman , Daida Yihe G. , Schmidt Mark A. , Gordon Stuart C.
Published: July 2023

Chronic hepatitis C (HCV) is a primary cause of hepatocellular carcinoma (HCC). Although antiviral treatment reduces risk of HCC, few studies quantify the impact of treatment on long‐term risk in the era of direct‐acting antivirals (DAA). Using data from the Chronic Hepatitis Cohort Study, we evaluated the impact of treatment type (DAA, interferon‐based [IFN], or none) and outcome (sustained virological response [SVR] or treatment failure [TF]) on risk of HCC. We then developed and validated a predictive risk model. 17186 HCV patients were followed until HCC, death or last follow‐up. We used extended landmark modelling, with time‐varying covariates and propensity score justification and generalized estimating equations with a link function for discrete time‐to‐event data. Death was considered a competing risk. We observed 586 HCC cases across 104,000 interval‐years of follow‐up. SVR from DAA or IFN‐based treatment reduced risk of HCC (aHR 0.13, 95% CI 0.08–0.20; and aHR 0.45, 95% CI 0.31–0.65); DAA SVR reduced risk more than IFN SVR (aHR 0.29, 95% CI 0.17–0.48). Independent of treatment, cirrhosis was the strongest risk factor for HCC (aHR 3.94, 95% CI 3.17–4.89 vs. no cirrhosis). Other risk factors included male sex, White race and genotype 3. Our six‐variable predictive model had ‘excellent’ accuracy (AUROC 0.94) in independent validation. Our novel landmark interval‐based model identified HCC risk factors across antiviral treatment status and interactions with cirrhosis. This model demonstrated excellent predictive accuracy in a large, racially diverse cohort of patients and could be adapted for ‘real world’ HCC monitoring.
Inclusion effect of jack mackerel,Trachurus japonicus, meal in the diet of rockfish,Sebastes schlegeli, on growth, feed utilization, biochemical composition, and innate immune responses
Authors: Kim June , Cho Sung Hwoan
Published: July 2023

Dietary inclusion effects of various levels of jack mackerel meal (JMM) on growth, feed utilization, biochemical composition, and innate immune response of rockfish were determined. The control (Con) diet included 550 g/kg fish meal (FM). Ten, 30, 50, 100, 200, 400, 600, and 1000 g/kg of JMM were included in the Con diet, referred to as the JMM10, JMM30, JMM50, JMM100, JMM200, JMM400, JMM600, and JMM1000diets, respectively. Eight hundred and ten fish (initial mean weight of 2.3 g) were distributed into 27 flow‐through tanks. The experimental diets were assigned to triplicate groups of fish. Fish were hand‐fed for 8 weeks. Weight gain of fish fed the JMM400diet was statistically better than that of fish fed the Con, JMM10, JMM30, JMM50, JMM100, and JMM200diets. Feed consumption of fish fed the JMM400diet was statistically higher than that of fish fed the Con, JMM10, JMM30, and JMM50diets. Dietary inclusion of JMM did not influence feed utilization, biochemical composition, and innate immune responses of fish. In conclusion, inclusion of JMM up to 400 g/kg of FM in diet improved growth and feed consumption of rockfish, and dietary optimum inclusion levels of JMM were estimated to be 396.7 and 403.1 g/kg based on regression analysis of weight gain and feed consumption, respectively.
Downregulation of BDNF–TrkB signaling may contribute to the colonic motility disorders in mice with streptozocin‐induced diabetes
Authors: Quan Xiaojing , Chen Wei , Liang Chunni , Jia Yuan , Wang Yonghua , Luo Hesheng , Wang Jinhai
Published: July 2023

Background

Brain‐derived neurotrophic factor (BDNF) acts as a neuromodulator to regulate gut motility, but the role of BDNF in diabetes‐related dysmotility is uncertain. The aim of this study was to investigate the possible involvement of BDNF and its receptor TrkB in the colonic hypomotility of mice with streptozotocin (STZ)‐induced diabetes.

Methods

A single intraperitoneal injection of STZ was used to establish a type 1 diabetes model. An organ bath system was applied to observe the contractile activities of colonic muscle strips. Immunofluorescence and western blotting were performed to evaluate the expression of BDNF and TrkB in the colon. ELISA was used to detect BDNF and SP levels in the serum and colon. The patch‐clamp technique was applied to record the currents of L‐type calcium channels and large conductance Ca2+‐activated K+ channels on smooth muscle cells.

Key Results

Compared with healthy controls, diabetic mice showed attenuated colonic muscle contraction (p < 0.001), which was partly reversed by BDNF supplementation. TrkB protein expression was significantly reduced in diabetic mice (p < 0.05). In addition, both BDNF and substance P (SP) levels were decreased, and exogenous administration of BDNF increased SP levels in diabetic mice (p < 0.05). Both the TrkB antagonist and the TrkB antibody inhibited the spontaneous contraction of colonic muscle strips (p < 0.01). Moreover, the BDNF–TrkB signaling system enhanced SP‐induced muscle contraction.

Conclusions

Downregulation of BDNF/TrkB signaling and reduced SP release from the colon may contribute to the colonic hypomotility associated with type 1 diabetes. Brain‐derived neurotrophic factor supplementation may have therapeutic potential for diabetes‐related constipation.
Optimal cardinal contests
Authors: Takasi Goutham , Dawande Milind , Janakiraman Ganesh
Published: July 2023

We study the design of crowdsourcing contests in settings where the outputs of the contestants are quantifiable, for example, a data science challenge. This setting is in contrast to those where the output is only qualitative and cannot be objectively quantified, for example, when the goal of the contest is to design a logo. The literature on crowdsourcing contests focuses largely on ordinal contests, where contestants' outputs are ranked by the designer and awards are based on relative ranks. Such contests are ideally suited for the latter setting, where output is qualitative. For our setting (quantitative output), it is possible to design cardinal contests, where awards could be based on the actual outputs and not on their ranking alone—thus, the family of cardinal contests includes the family of ordinal contests. We study the problem of designing an optimal cardinal contest. We use mechanism design theory to derive an optimal cardinal mechanism and provide a convenient implementation—a decreasing reward‐meter mechanism—of the optimal contest. We establish the practicality of our mechanism by showing that it is “Obviously Strategy‐Proof,” a recently introduced formal notion of simplicity in the literature. We also compare the optimal cardinal contest with the most popular ordinal contest—namely, the Winner‐Takes‐All (WTA) contest, along several metrics. In particular, the optimal cardinal mechanism delivers a superior expected best output, whereas the WTA contest yields a greater expected contestant welfare. Furthermore, under a sufficiently large budget, the contest designer's expected net‐benefit is higher under the optimal cardinal mechanism than that under the WTA contest, regardless of the number of contestants in the two mechanisms. Our numerical analysis suggests that, for the contest designer, the average improvement provided by the optimal cardinal mechanism over the WTA contest is about 23%. For a given number of contestants, the benefit of the optimal cardinal mechanism is especially appreciable for projects where the ratio of the designer's utility to agents' cost‐of‐effort falls within a wide practical range. For projects where this ratio is very high, the expected profit of the best WTA contest is reasonably close to that of the optimal cardinal mechanism.
Cooperative security against interdependent risks
Authors: Gopalakrishnan Sanjith , Sankaranarayanan Sriram
Published: July 2023

Firms in interorganizational networks are exposed to interdependent risks that are transferable across partner firms, such as contamination in food supply chains or data breaches in technology networks. They can be decomposed into intrinsic risks a firm faces from its own operations and extrinsic risks transferred from its partners. Firms have access to two security strategies: either they can independently eliminate both intrinsic and extrinsic risks by securing their links with partners or, alternatively, firms can cooperate with partners to eliminate sources of intrinsic risk in the network. We develop a graph‐theoretic model of interdependent security and demonstrate that the network‐optimal security strategy can be computed in polynomial time. Then, we use cooperative game‐theoretic tools to examine, under different informational assumptions, whether firms can sustain the network‐optimal security strategy via suitable cost‐sharing mechanisms. We design a novel cost‐sharing mechanism: a restricted variant of the well‐known Shapley value, the agreeable allocation, that is easy to compute, bilaterally implementable, ensures stability, and is fair. However, the agreeable allocation need not always exist. Interestingly, we find that in networks with homogeneous cost parameters, the presence of locally dense clusters of connected firms precludes the existence of the agreeable allocation, while the absence of sufficiently dense clusters (formally, k‐cores) guarantees its existence. Finally, using the SDC Platinum database, we consider all interfirm alliances formed in the food manufacturing sector from 2006 to 2020. Then, with simulated cost parameters, we examine the practical feasibility of identifying bilaterally implementable security cost‐sharing arrangements in these alliances.
Stochastic flocking dynamics of the inertial spin model with state‐dependent noises
Authors: Ko Dongnam , Ha Seung‐Yeal , Lee Euntaek , Shim Woojoo
Published: July 2023

We study stochastic flocking dynamics of the inertial spin (IS) model with state‐dependent noises. The IS model was considered to describe the collective behaviors of starling flocks moving with constant speed. Unlike mechanical flocking models extensively studied in the literature, this model incorporates an internal dynamic observable, namely spin (internal angular momentum) in addition to mechanical observables (position and velocity), and it describes how spin interacts with mechanical observables. In previous works, emergent dynamics of the deterministic counterparts for the IS model and its mean‐field limit have been investigated under some specific setting in which network topology is multiplicatively separable. In this work, we present sufficient frameworks for stochastic flocking dynamics of the IS model, which state‐dependent noises vanish at the equilibria of the deterministic IS model. The proposed frameworks are in terms of coupling strength, friction, and inertial coefficients, and our asymptotic convergence results for sample paths are given in both an almost sure and an expectation sense. We have also conducted several numerical experiments to verify our analytical results and to explore what can be studied further in future work
Validation of a Low-Cost Portable Device for Inducing Noninvasive Anterior Cruciate Ligament Injury in Mice
Authors: Jbeily Elias H. , Lin Yu-Yang , Elmankabadi Seif B. , Osipov Benjamin , June Ron K. , Christiansen Blaine A.
Published: July 2023

Noninvasive compression-induced anterior cruciate ligament rupture (ACL-R) is an easy and reproducible model for studying post-traumatic osteoarthritis (PTOA) in mice. However, equipment typically used for ACL-R is expensive, immobile, and not available to all researchers. In this study, we compared PTOA progression in mice injured with a low-cost custom ACL-rupture device (CARD) to mice injured with a standard system (ElectroForce 3200). We quantified anterior–posterior (AP) joint laxity immediately following injury, epiphyseal trabecular bone microstructure, and osteophyte volume at 2 and 6 weeks post injury using micro-computed tomography, and osteoarthritis progression and synovitis at 2 and 6 weeks post injury using whole-joint histology. We observed no significant differences in outcomes in mice injured with the CARD system compared to mice injured with the Electroforce (ELF) system. However, AP joint laxity data and week 2 micro-CT and histology outcomes suggested that injuries may have been slightly more severe and PTOA progressed slightly faster in mice injured with the CARD system compared to the ELF system. Altogether, these data confirm that ACL-R can be successfully and reproducibly performed with the CARD system and that osteoarthritis (OA) progression is mostly comparable to that of mice injured with the ELF system, though potentially slightly faster. The CARD system is low cost and portable, and we are making the plans and instructions freely available to all interested investigators in the hopes that they will find this system useful for their studies of OA in mice.
Conformal Theoretical Modeling of Arbitrary Shape Flexible Electronic Sensors Mounted Onto General Curved Surface Substrates
Authors: Wang Shihang , Jin Jie , Mei Deqing , Wang Yancheng
Published: July 2023

Stretchable and flexible electronic sensors have been attracted to novel applications due to their conformal integration onto complex curved surfaces, whereas the mounting strains generated by the geometric mismatch of substrate surface and electronic sensors may cause non-conformal contact at the interface, thus would induce non-negligible effects on the performance of sensors. To investigate the influence rules of the shape of electronic sensors and their geometric parameters on conformal contacts, this paper presents a novel conformal model to study the arbitrary shaped films as flexible sensors mounted onto general curved-surface substrates. The energy minimization principle and the integral summation method play vital roles during the modeling, and three types of films with various shapes including rectangular, oval, and hexagonal mounted onto a bicurvature substrate are investigated. The influences of three dimensionless shape parameters of oval and hexagonal film/substrate contacts are analyzed for the dimensionless strain energy of conformal mounting. The strain and critical dimensionless strain energy of three films/bicurvature substrate contacts are calculated and compared under the same conformal area. The results demonstrated that the contour shape of electronic sensor has a considerable effect on conformal mounting and strain. Thus, the developed conformal model would have great significance in guiding the design of flexible electronic devices and sensors when applied to general curved surfaces.
Investigation of Fluid Flow and Heat Transfer Characteristics in Wavy Mini-Channel Heat Sink With Interconnectors
Authors: Morshed A. K. M. Monjur , Shuvo Abdul Aziz , Bappy Md. Omarsany , Tikadar Amitav , Paul Titan C.
Published: July 2023

In this paper, a novel sinusoidal wavy mini-channel heat sink (MCHS) with interconnectors (IC w-MCHS) has been introduced, and the effectiveness of the proposed heat sink over conventional mini-channel heat sink (s-MCHS) has been numerically investigated. Different parameters, i.e., wavelengths, wave amplitudes, and phase shifts of the proposed sinusoidal wavy MCHS, were varied to study its effect on thermal and hydraulic performance. This study used three different wavelengths, three different amplitudes, and two different phase shifts, and Reynolds number (Re) varied from 300 to 800. The Nusselt number (Nu) of IC w-MCHS increased as the wave amplitude ratio (α) and Re increased, whereas it increased with the decrement of the wavelength ratio (β). Nu of the IC w-MCHS was also found to depend on phase shift (θp); for θp = π, the chaotic advection and increment of flow reversal were observed in the IC w-MCHS compared to θp = 0, resulting in higher Nu and higher pressure drop penalty. Nu of the IC w-MCHS was found to be 115% higher compared to s-MCHS at Re 550, θp = π, and α = 0.3, whereas it was found 77% higher for θp = 0. The maximum temperature of the IC w-MCHS heat sink was also found to decrease compared to that of the s-MCHS due to enhanced coolant mixing. A maximum 26% decrease in the heat sink temperature was observed for the IC w-MCHS at Re 800 compared to the s-MCHS.
Theoretical study of electronic sum frequency generation spectroscopy to assess the buried interfaces
Authors: Kumar Yogesh , Dhami Suman , Pandey Ravindra
Published: July 2023

This article provides a comprehensive theoretical background of electronic sum frequency generation (ESFG), a second-order nonlinear spectroscopy technique. ESFG is utilized to investigate both exposed and buried interfaces, which are challenging to study using conventional spectroscopic methods. By overlapping two incident beams at the interface, ESFG generates a beam at the sum of their frequencies, allowing for the extraction of valuable interfacial molecular information such as molecular orientation and density of states present at interfaces. The unique surface selectivity of ESFG arises from the absence of inversion symmetry at the interfaces. However, detecting weak signals from interfaces requires the ultrafast lasers to generate a sufficiently strong signal. By understanding the theoretical foundations of ESFG presented in this article, readers can gain a solid grasp of the basics of ESFG spectroscopy.
Structural insights into human TFIIIC promoter recognition
Authors: Seifert-Davila Wolfram , Girbig Mathias , Hauptmann Luis , Hoffmann Thomas , Eustermann Sebastian , Müller Christoph W.
Published: July 2023

Transcription factor (TF) IIIC recruits RNA polymerase (Pol) III to most of its target genes. Recognition of intragenic A- and B-box motifs in transfer RNA (tRNA) genes by TFIIIC modules τA and τB is the first critical step for tRNA synthesis but is mechanistically poorly understood. Here, we report cryo–electron microscopy structures of the six-subunit human TFIIIC complex unbound and bound to a tRNA gene. The τB module recognizes the B-box via DNA shape and sequence readout through the assembly of multiple winged-helix domains. TFIIIC220 forms an integral part of both τA and τB connecting the two subcomplexes via a ~550–amino acid residue flexible linker. Our data provide a structural mechanism by which high-affinity B-box recognition anchors TFIIIC to promoter DNA and permits scanning for low-affinity A-boxes and TFIIIB for Pol III activation.
Fueling the fire of B cell activation
Authors: Sikorski Patricia M. , Kusner Linda L.
Published: July 2023

Antigen activated naïve B cells undergoing germinal center responses have distinct metabolic requirements.
Prevalence of symptomatic tracheal morbidities after fetoscopic endoluminal tracheal occlusion: a systematic review and meta-analysis
Authors: Tho Adam Lye Wye , Rath Chandra Prakash , Tan Jason Khay Ghim , Rao Shripada C
Published: July 2023

Background

Fetoscopic endoluminal tracheal occlusion (FETO) has been shown to improve survival of infants with congenital diaphragmatic hernia (CDH). However, there are concerns that FETO may lead to tracheomegaly, tracheomalacia and related complications.

Methods

A systematic review was conducted to estimate the prevalence of symptomatic tracheal complications in infants who underwent FETO for CDH. Presence of one or more of the following was considered as tracheal complication: tracheomalacia, stenosis, laceration or tracheomegaly with symptoms such as stridor, effort-induced barking cough, recurrent chest infections or the need for tracheostomy, tracheal suturing, or stenting. Isolated tracheomegaly on imaging or routine bronchoscopy without clinical symptoms was not considered as tracheal morbidity. Statistical analysis was performed using the metaprop command on Stata V.16.0.

Results

A total of 10 studies (449 infants) were included (6 retrospective cohort, 2 prospective cohort and 2 randomised controlled trials). There were 228 infants who survived to discharge. Prevalence rates of tracheal complications in infants born alive were 6% (95% CI 2% to 12%) and 12% (95% CI 4% to 22%) in those who survived to discharge. The spectrum of severity ranged from relatively mild symptoms such as effort-induced barking cough to the need for tracheostomy/tracheal stenting.

Conclusion

A significant proportion of FETO survivors have symptomatic tracheal morbidities of varying severity. Units that are planning to adopt FETO for managing CDH should consider ongoing surveillance of survivors to enable early identification of upper airway issues. Inventing FETO devices that minimise tracheal injury is needed.
Incidental diagnosis of asymptomatic lipaemia retinalis in a patient with uncontrolled type 2 diabetes mellitus: ‘white lines’
Authors: Majeed Ghulam Mustafa , Valor Suárez Clara , Mann Samantha
Published: July 2023

A man in his 60s presented for his medical retina clinic appointment, reporting increasing shortness of breath, aches and pains, and increasing insulin requirements during a difficult early lockdown. Wide-field colour fundus imaging (Optos Optomap) and an optical coherence tomography scan (Heidelberg Spectralis) revealed whitened and enlarged hyper-reflective vessels. Retinal colour photography also confirmed a creamy white discolouration of the vessels, which prompted the team to order a lipid profile. The profile showed a raised cholesterol level of 17.5 mmol/L (normal: <4mmol/L) and a marked elevated triglyceride level of 38.41 mmol/L (normal: <1.7 mmol/L).

The clinical picture, alongside the biochemical results, suggested a diagnosis of secondary lipaemia retinalis due to poorly controlled diabetes. With aggressive treatment, the patient’s biochemistry and vessels returned to baseline.

This rare condition should be taken as an indicator of a potential underlying life-threatening medical condition and the role an ophthalmologist has in initiating potential lifesaving intervention.
Is it time to include oxygen needs as an endpoint in clinical trials in patients with fibrosing interstitial lung disease? If so, how?
Authors: Aronson Kerri , Jacobs Susan S , Repola Dawn , Swigris Jeffrey J
Published: July 2023

Many patients with fibrosing interstitial lung disease (fILD) will need to use supplemental oxygen (O2) to maintain normoxia at some point in their illness. If it is not needed at the time of diagnosis, then if fILD progresses—or if a comorbid condition like pulmonary hypertension develops—O2will become necessary, often, initially, during exertion and all-too-often, eventually, at rest as well. But presumably, if all else remains stable, if fILD progression is halted or slowed, O2needs follow in parallel. Despite perceived or unnoticed benefits of O2, and prescribers’ good intentions to improve patients’ sense of well-being, patients with fILD generally view O2with frustration and fear, as it threatens their already-impaired quality of life. Because of how meaningful and impactful O2is to the lives of patients with fILD, ‘O2need’ is a critically important—and perhaps the most—patient-centred metric that should be considered for incorporation as an endpoint in therapeutic trials. It is unclear how this should be done, but in this paper, we offer some possible approaches that merit consideration.
Clot composition and recanalization outcomes in mechanical thrombectomy
Authors: Nogueira Raul G , Pinheiro Agostinho , Brinjikji Waleed , Abbasi Mehdi , Al-Bayati Alhamza R , Mohammaden Mahmoud H , Souza Viana Lorena , Ferreira Felipe , Abdelhamid Hend , Bhatt Nirav R , Kvamme Peter , Layton Kennith F , Delgado Almandoz Josser E , Hanel Ricardo A , Mendes Pereira Vitor , Almekhlafi Mohammed A , Yoo Albert J , Jahromi Babak S , Gounis Matthew J , Patel Biraj , Arturo Larco Jorge L , Fitzgerald Sean , Mereuta Oana Madalina , Doyle Karen , Savastano Luis E , Cloft Harry J , Thacker Ike C , Kayan Yasha , Copelan Alexander , Aghaebrahim Amin , Sauvageau Eric , Demchuk Andrew M , Bhuva Parita , Soomro Jazba , Nazari Pouya , Cantrell Donald Robert , Puri Ajit S , Entwistle John , Polley Eric C , Frankel Michael R , Kallmes David F , Haussen Diogo C
Published: July 2023

Background

Mechanical thrombectomy (MT) has become standard for large vessel occlusions, but rates of complete recanalization are suboptimal. Previous reports correlated radiographic signs with clot composition and a better response to specific techniques. Therefore, understanding clot composition may allow improved outcomes.

Methods

Clinical, imaging, and clot data from patients enrolled in the STRIP Registry from September 2016 to September 2020 were analyzed. Samples were fixed in 10% phosphate-buffered formalin and stained with hematoxylin-eosin and Martius Scarlett Blue. Percent composition, richness, and gross appearance were evaluated. Outcome measures included the rate of first-pass effect (FPE, modified Thrombolysis in Cerebral Infarction 2c/3) and the number of passes.

Results

A total of 1430 patients of mean±SD age 68.4±13.5 years (median (IQR) baseline National Institutes of Health Stroke Scale score 17.2 (10.5–23), IV-tPA use 36%, stent-retrievers (SR) 27%, contact aspiration (CA) 27%, combined SR+CA 43%) were included. The median (IQR) number of passes was 1 (1–2). FPE was achieved in 39.3% of the cases. There was no association between percent histological composition or clot richness and FPE in the overall population. However, the combined technique resulted in lower FPE rates for red blood cell (RBC)-rich (P<0.0001), platelet-rich (P=0.003), and mixed (P<0.0001) clots. Fibrin-rich and platelet-rich clots required a higher number of passes than RBC-rich and mixed clots (median 2 and 1.5 vs 1, respectively; P=0.02). CA showed a trend towards a higher number of passes with fibrin-rich clots (2 vs 1; P=0.12). By gross appearance, mixed/heterogeneous clots had lower FPE rates than red and white clots.

Conclusions

Despite the lack of correlation between clot histology and FPE, our study adds to the growing evidence supporting the notion that clot composition influences recanalization treatment strategy outcomes.
Written on milk: exploring messages written on donated human-milk bags
Authors: Oreg Ayelet
Published: July 2023

Every so often, among the bags of breast milk sent for donation to milk banks, clear bags of milk are found that are hand decorated and accompanied by short texts written by donating mothers. In the bank labs, the milk is poured into pasteurisation containers, and the bags are thrown away. The milk comes to the neonatal ward packed in bar-coded bottles. Both donor and the recipient are anonymous to one another. To whom are the donating mothers writing their messages? What can be learnt from their writings and drawings about their lived experiences of transitioning into motherhood? In the current study I integrate theoretical content about the transition to motherhood and theories about epistolary literature, likening the milk bags to postcards and letters. In contrast to a private letter written with ink on folded paper in a closed envelope, writing on ‘milk postcards’ is exposed and privacy is absent. ‘Milk postcards’ have a double transparency: the self is reflected in the messages and the contents of the bag—breast milk, a bodily fluid from the body of the donor. From a visual analysis of 81 photos of human-milk bags with text and drawings photographed by milk banks laboratory technicians, it appears that the milk postcards serve as a ‘third voice’ that echoes the difficulties and the joys in the transition to motherhood, and that donors experience an imagined solidarity with unknown mothers. The milk itself serves sometimes as an image and sometimes as the background for the writing, while its colour, texture and the form in which it is frozen constitute part of the text and serve as self-testimony for the mother of her capability and of her being a nurturing mother, for both her own baby and other unknown babies.
Brain imaging inspired by outer space
Authors: Garg Divyani , Agarwal Ayush , Srivastava Achal K , Garg Ajay
Published: July 2023

Medicine has many vividly named signs. We have compiled a list of radiological cerebral signs inspired by phenomena in outer space. These range from the well-known ‘starry sky’ appearance of neurocysticercosis or tuberculomas, to various lesser known signs including the ‘starfield’ pattern of fat embolism; ‘sunburst’ sign of meningiomas; ‘eclipse’ sign of neurosarcoidosis; ‘comet tail’ sign of cerebral metastases; ‘Milky Way’ sign of progressive multifocal leukoencephalopathy; ‘satellite’ and ‘black hole’ sign of intracranial haemorrhage; ‘crescent’ sign of arterial dissection and ‘crescent moon’ sign of Hirayama disease.
Tracking persistent postoperative opioid use: a proof-of-concept study demonstrating a use case for natural language processing
Authors: Seng Eri C , Mehdipour Soraya , Simpson Sierra , Gabriel Rodney A
Published: July 2023

Background

Large language models have been gaining tremendous popularity since the introduction of ChatGPT in late 2022. Perioperative pain providers should leverage natural language processing (NLP) technology and explore pertinent use cases to improve patient care. One example is tracking persistent postoperative opioid use after surgery. Since much of the relevant data may be ‘hidden’ within unstructured clinical text, NLP models may prove to be advantageous. The primary objective of this proof-of-concept study was to demonstrate the ability of an NLP engine to review clinical notes and accurately identify patients who had persistent postoperative opioid use after major spine surgery.

Methods

Clinical documents from all patients that underwent major spine surgery during July 2015–August 2021 were extracted from the electronic health record. The primary outcome was persistent postoperative opioid use, defined as continued use of opioids greater than or equal to 3 months after surgery. This outcome was ascertained via manual clinician review from outpatient spine surgery follow-up notes. An NLP engine was applied to these notes to ascertain the presence of persistent opioid use—this was then compared with results from clinician manual review.

Results

The final study sample consisted of 965 patients, in which 705 (73.1%) were determined to have persistent opioid use following surgery. The NLP engine correctly determined the patients’ opioid use status in 92.9% of cases, in which it correctly identified persistent opioid use in 95.6% of cases and no persistent opioid use in 86.1% of cases.

Discussion

Access to unstructured data within the perioperative history can contextualize patients’ opioid use and provide further insight into the opioid crisis, while at the same time improve care directly at the patient level. While these goals are in reach, future work is needed to evaluate how to best implement NLP within different healthcare systems for use in clinical decision support.
Detection and Classification of Objects in Video Content Analysis Using Ensemble Convolutional Neural Network Model
Authors: Yadav Sita M. , Chaware Sandeep M.
Published: July 2023

Video content analysis (VCA) is the process of analyzing the contents in the video for various applications. Video classification and content analysis are two of the most difficult challenges that computer vision researchers must solve. Object detection plays an important role in the VCA and is used for identification, detection and classification of objects in the images. The Chaser Prairie Wolf optimization-based deep Convolutional Neural Network classifier (CPW opt-deep CNN classifier) is used in this research to identify and classify the objects in the videos. The deep CNN classifier correctly detected the objects in the video, and the CPW optimization boosted the deep CNN classifier’s performance, where the decision-making behavior of the chasers is enhanced by the sharing nature of the prairie wolves. The classifier’s parameters were successfully tuned by the enabled optimization, which also aids in producing better results. The Ensemble model developed for the object detection adds value to the research and is initiated by the standard hybridization of the YOLOv4 and Resnet 101 model, which evaluated the research’s accuracy, sensitivity, and specificity, improving its efficacy. The proposed CPW opt-deep CNN classifier attained the values of 89.74%, 89.50%, and 89.19% while classifying objects in dataset 1, 91.66%, 86.01%, and 91.52% while classifying objects in dataset 2, compared to the preceding method that is efficient.
Seed Selection for Testing Deep Neural Networks
Authors: Zhi Yuhan , Xie Xiaofei , Shen Chao , Sun Jun , Zhang Xiaoyu , Guan Xiaohong
Published: July 2023

Deep learning (DL) has been applied in many applications. Meanwhile, the quality of DL systems is becoming a big concern. To evaluate the quality of DL systems, a number of DL testing techniques have been proposed. To generate test cases, a set of initial seed inputs are required. Existing testing techniques usually construct seed corpus by randomly selecting inputs from training or test dataset. Till now, there is no study on how initial seed inputs affect the performance of DL testing and how to construct an optimal one. To fill this gap, we conduct the first systematic study to evaluate the impact of seed selection strategies on DL testing. Specifically, considering three popular goals of DL testing (i.e., coverage, failure detection, and robustness), we develop five seed selection strategies, including three based on single-objective optimization (SOO) and two based on multi-objective optimization (MOO). We evaluate these strategies on seven testing tools. Our results demonstrate that the selection of initial seed inputs greatly affects the testing performance. SOO-based selection can construct the best seed corpus that can boost DL testing with respect to the specific testing goal. MOO-based selection strategies can construct seed corpus that achieve balanced improvement on multiple objectives.
Co-lexicographically Ordering Automata and Regular Languages - Part I
Authors: Cotumaccio Nicola , D’Agostino Giovanna , Policriti Alberto , Prezza Nicola
Published: July 2023

The states of a finite-state automaton 𝒩 can be identified with collections of words in the prefix closure of the regular language accepted by 𝒩. But words can be ordered, and among the many possible orders a very natural one is the co-lexicographic order. Such naturalness stems from the fact that it suggests a transfer of the order from words to the automaton’s states. This suggestion is, in fact, concrete and in a number of articles automata admitting a
total
co-lexicographic (
co-lex
for brevity) ordering of states have been proposed and studied. Such class of ordered automata —
Wheeler automata
— turned out to require just a constant number of bits per transition to be represented and enable regular expression matching queries in constant time per matched character.

Unfortunately, not all automata can be totally ordered as previously outlined. In the present work, we lay out a new theory showing that all automata can always be
partially
ordered, and an intrinsic measure of their complexity can be defined and effectively determined, namely, the minimum width
p
of one of their admissible
co-lex partial orders
–dubbed here the automaton’s
co-lex width
. We first show that this new measure captures
at once
the complexity of several seemingly-unrelated hard problems on automata. Any NFA of co-lex width
p
: (i) has an equivalent powerset DFA whose size is exponential in
p
rather than (as a classic analysis shows) in the NFA’s size; (ii) can be encoded using just Θ(log
p
) bits per transition; (iii) admits a linear-space data structure solving regular expression matching queries in time proportional to
p
2
per matched character. Some consequences of this new parameterization of automata are that PSPACE-hard problems such as NFA equivalence are FPT in
p
, and quadratic lower bounds for the regular expression matching problem do not hold for sufficiently small
p
.

Having established that the co-lex width of an automaton is a fundamental complexity measure, we proceed by (i) determining its computational complexity and (ii) extending this notion from automata to regular languages by studying their smallest-width accepting NFAs and DFAs. In this work we focus on the deterministic case and prove that a canonical minimum-width DFA accepting a language ℒ–dubbed the Hasse automaton ℋ of ℒ–can be exhibited. ℋ provides, in a precise sense, the best possible way to (partially) order the states of any DFA accepting ℒ, as long as we want to maintain an operational link with the (co-lexicographic) order of ℒ’s prefixes. Finally, we explore the relationship between two conflicting objectives: minimizing the width and minimizing the number of states of a DFA. In this context, we provide an analogue of the Myhill-Nerode Theorem for co-lexicographically ordered regular languages.
Efficient Density-peaks Clustering Algorithms on Static and Dynamic Data in Euclidean Space
Authors: Amagata Daichi , Hara Takahiro
Published: July 2023

Clustering multi-dimensional points is a fundamental task in many fields, and density-based clustering supports many applications because it can discover clusters of arbitrary shapes. This article addresses the problem of Density-Peaks Clustering (DPC) in Euclidean space. DPC already has many applications, but its straightforward implementation incurs
O
(
n
2
) time, where
n
is the number of points, thereby does not scale to large datasets. To enable DPC on large datasets, we first propose empirically efficient exact DPC algorithm, Ex-DPC. Although this algorithm is much faster than the straightforward implementation, it still suffers from
O
(
n
2
) time theoretically. We hence propose a new exact algorithm, Ex-DPC++, that runs in
o
(
n
2
) time. We accelerate their efficiencies by leveraging multi-threading. Moreover, real-world datasets may have arbitrary updates (point insertions and deletions). It is hence important to support efficient cluster updates. To this end, we propose D-DPC for fully dynamic DPC. We conduct extensive experiments using real datasets, and our experimental results demonstrate that our algorithms are efficient and scalable.