bluuebunny/crossref_metadata_2025 huggingface dataset:
The long-term outcome of New Zealand Maori and Pacific Island children diagnosed with childhood onset lupus nephritis
Authors: Concannon Anthony , Wong William , Han Dug Yeo
Published: September 2022

Objective

To determine the long-term outcome of Maori and Pacific Island children diagnosed with childhood onset lupus nephritis.

Method

A chart review was conducted of children diagnosed with biopsy proven lupus nephritis seen by the Starship Hospital and Kidz First paediatric rheumatology and/or Starship renal services between January 1992 and January 2018. Baseline and follow-up kidney histology, adherence and response to therapy including partial or full renal remission, refractory disease, end-stage kidney disease (ESKD) and mortality were determined.

Results

In a New Zealand cohort of 42 with childhood onset lupus nephritis, Maori and Pacific Island children were significantly more likely to develop class 4 lupus nephritis (RR (95% CI), 11.3 (3.84–49.9), p < 0.0001), demonstrate medication nonadherence (RR (95% CI) 12.4 (3.48–85.7), p < 0.0001) and experience end stage kidney disease (RR (95% CI) 15.7 (2.97–389.3), p = 0.0003) and mortality (RR (95% CI) 11.1 (1.91–280.1), p = 0.005) compared to non-Maori and Pacific Island children. In addition, Maori children with childhood onset lupus nephritis developed chronic histological changes significantly more rapidly than Pacific or Asian children ( p = 0.038).

Conclusion

Lupus nephritis is more common among Maori and Pacific Island children in New Zealand associated with a significant incidence of end stage kidney disease and mortality, with some Maori children developing rapid histologic disease progression.
Residual disease activity and treatment intensification in systemic lupus erythematosus: A cross-sectional study to quantify the need for new therapies
Authors: Gioti Ourania , Chavatza Katerina , Nikoloudaki Myrto , Katechis Spyridon , Bertsias George , Boumpas Dimitrios T , Fanouriakis Antonis
Published: September 2022

Objective

The proportion of SLE patients with residual disease activity in routine settings is variable. We assessed disease activity state in patients during their most recent visit, and whether patients with residual activity were offered therapy intensification.

Methods

Cross-sectional study of consecutive lupus patients in three tertiary centers. Patients were categorized as: i) remission off-therapy, ii) remission on-therapy, iii) low disease activity, and iv) non-optimally controlled disease. Multivariable regression identified factors associated with treatment intensification and ROC analysis calculated the accuracy of SLEDAI-2K to predict this intensification.

Results

Three hundred and thirty-two patients were included [93.1% female, mean (SD) age 48.5 (14.7) years, median (IQR) disease duration 6.5 (12.4) years]. Mean (SD) total and clinical SLEDAI at last visit were 3.7 (3.0) and 3.0 (2.9), respectively. Although 23.2% of patients were in remission, 40.1% were categorized as non-optimally controlled disease (79.2% due to SLEDAI-2K > 4), but less than 50% of them were offered therapy intensification. Proteinuria (OR 6.78, 95% CI 2.06–22.25), arthritis (OR 5.48, 95% CI 3.20–9.40), and rash (OR 3.23, 95% CI 1.81–5.75) were associated with intensification of therapy, but the accuracy of either total or clinical SLEDAI to predict it was moderate (ROC area under the curve 0.761 and 0.779, respectively).

Conclusions

About 40% of patients have evidence of residual disease activity and could qualify for novel treatments. Most treatment changes were triggered by active renal, joint, and skin disease, whereas the predictive value of SLEDAI-2K as a metric of disease activity was modest.
The influence of reduced graphene oxide on the polyamide 6 nanocomposite characteristics
Authors: Sabet Maziyar , Soleimani Hassan
Published: September 2022

Polyamide 6 (PA6) nanocomposites with high electrical and thermal conductive were formulated via melt processing of PA6 and different inclusion of reduced graphene oxide (RGO). These nanocomposites showed small percolation thresholds, and the optimum formation of conductive links occurred with 0.5 wt% and ̴3.0 wt% of RGO respectively. RGO is effective in terms of thermal stability, causing a char of 6.8% with only 2.0 wt% RGO content. The presence of 3.0 wt% RGO enhanced thermal conductivity by 62% and reduces the peak-heat release rate to 588 and 545 kW/m2 with RGO inclusions of 1.0 and 2.0 wt%, respectively. Crystallization examination confirmed that RGO enabled the crystallization of PA6 structure mostly through speeding up the formation of crystal nuclei, reaching a maximum and smallest crystal grain extent with RGO inclusion up to 2.0 wt% that improved the generation of the most unflawed crystalline matrix. With the dynamic rheological testing, frequency-independence of G′ and abruptly decreased phase angle at the small-frequency area via RGO content of 2.0 wt% signify an alteration from liquid-state to solid-state rheological performance and validate the development of percolation link structure with RGO in the function of a crosslinking factor. Enhancement of fire-retardant characteristics of PA6 was attained due to the inclusion of RGO owing to the improvement in the PA6 structure. Morphological research showed that RGO was spread uniformly in the PA6 structure. These tests show substantial capacity for the bulk manufacture of electrically conductive polymer/RGO nanocomposites.
Standardized Criteria Increases Palliative Care Consultation Utilization in Patients With End-Stage Liver Disease: A Pilot Study
Authors: Johnson Amy W. , Byriel Benjamin , Rubeck Jon , Ghabril Marwan , Orman Eric S.
Published: September 2022

Context: Patients with end-stage liver disease have high symptom burden and high healthcare utilization, which may be improved by palliative care consultation. Objectives: We sought to determine if implementing standardized palliative care consultation criteria in hospitalized patients with end-stage liver disease would increase palliative care utilization and improve patient outcomes. Methods: We conducted a retrospective cohort study of hospitalized patients with end-stage liver disease. Patients under the age of 18, received a previous liver transplant, or admitted for liver transplantation were not included. Patients with end-stage liver disease meeting two or more of the following criteria were included: (i)Child Pugh C cirrhosis, (ii)2 or more liver related hospitalizations within 6 months, (iii) current alcohol use with alcoholic cirrhosis, and (iv) unsuitable for transplantation work up. We compared consults before and after implementation of the criteria, and we compared outcomes in patients who did and did not see palliative care. Results: With implementation, consults increased (2/25 (8%) vs 11/33 (33%), p = .020). Palliative care was associated with higher completion of health care representative documentation (66.7% vs 35.7%, P = .20) and physician orders for scope of treatment forms (16.7% vs 0%, P = 0.13). Patients seen by palliative care had a higher rate of discharges with hospice (30.8% vs 0, P = .002). Conclusions: Implementation of standardized palliative care consultation criteria for patients with end-stage liver disease increased palliative care utilization. Patients seen by palliative care had increased discharges with hospice services and a trend towards higher completion rates of advanced directives.
Prescription Trends in Hospice Care: A Longitudinal Retrospective and Descriptive Medication Analysis
Authors: Wernli Ursina , Hischier Désirée , Meier Christoph R. , Jean-Petit-Matile Sibylle , Panchaud Alice , Kobleder Andrea , Meyer-Massetti Carla
Published: September 2022

Background

In hospice and palliative care, drug therapy is essential for symptom control. However, drug regimens are complex and prone to drug-related problems. Drug regimens must be simplified to improve quality of life and reduce risks associated with drug-related problems, particularly at end-of-life. To support clinical guidance towards a safe and effective drug therapy in hospice care, it is important to understand prescription trends.

Objectives

To explore prescription trends and describe changes to drug regimens in inpatient hospice care.

Design

We performed a retrospective longitudinal and descriptive analysis of prescriptions for regular and as-needed (PRN) medication at three timepoints in deceased patients of one Swiss hospice.

Setting/subjects

Prescription records of all patients ([Formula: see text] 18 years) with an inpatient stay of three days and longer (admission and time of death in 2020) were considered eligible for inclusion.

Results

Prescription records of 58 inpatients (average age 71.7 ± 12.8 [37-95] years) were analyzed. The medication analysis showed that polypharmacy prevalence decreased from 74.1% at admission to 13.8% on the day of death. For regular medication, overall numbers of prescriptions decreased over the patient stay while PRN medication decreased after the first consultation by the attending physician and increased slightly towards death.

Conclusions

Prescription records at admission revealed high initial rates of polypharmacy that were reduced steadily until time of death. These findings emphasize the importance of deprescribing at end-of-life and suggest pursuing further research on the contribution of clinical guidance towards optimizing drug therapy and deprescribing in inpatient hospice care.
Gamifying Online Training in Management Education to Support Emotional Engagement and Problem-solving Skills
Authors: Schöbel Sofia Marlena , Janson Andreas , Leimeister Jan Marco
Published: September 2022

Online training to improve problem-solving skills has become increasingly important in management learning. In online environments, learners take a more active role which can lead to stressful situations and decreased motivation. Gamification can be applied to support learner motivation and emotionally boost engagement by using game-like elements in a non-game context. However, using gamification does not necessarily result in supporting positive learning outcomes. Our analysis sheds light on these aspects and evaluates the effects of points and badges on engagement and problem-solving outcomes. We used an experimental approach with a fully randomized pre-test/post-test design of a gamified online management training program with 68 participants. The results demonstrate that points and badges do not directly improve problem-solving skills but are mediated by emotional engagement to positively influence problem-solving skills. Additionally, satisfaction with the gamification learning process positively relates to emotional engagement. Thus, when creating online training programs, it is essential to consider how to engage students and to think about the design of the learning environment. By identifying the limitations of gamification elements, the study’s results can provide educators with information about the design implications of online training programs for management learning.
The Influence of the BDNF Val66Met Variant on the Association Between Physical Activity/Grip Strength and Depressive Symptoms in Persons With Diabetes
Authors: Zeng Bin , Yue Yan , Liu Tingting , Ahn Hyochol , Li Changwei
Published: September 2022

The rs6265 in the brain-derived neurotrophic factor (BDNF) is associated with depression in people with diabetes. Both physical activity (PA) and grip strength are negatively associated with depression. We conducted cross-sectional analyses of the wave 10 survey data for a nationally representative sample of 1,051 diabetes participants of the Health and Retirement Study. Both greater PA (β = −.15) and stronger grip strength (β = −.02) were independently associated with depression. Although the interaction between BDNF rs6265 and PA on depressive symptoms was not significant, the negative PA-depression association was stronger among female non-Met carriers (β = −.19) and male Met carriers (β = −.14). Meanwhile, grip strength was associated with depression only in Met carriers (β = −.04), and similar association was observed in both males and females. In conclusion, female non-Met carriers and male Met carriers may benefit from PA.
Primary small gauge pars plana vitrectomy and silicone oil endotamponade for endophthalmitis after cataract surgery: Clinical and OCT findings
Authors: Fiore Tito , Lupidi Marco , Cerquaglia Alessio , Giansanti Fabrizio , Reibaldi Michele , Iaccheri Barbara , Tucci Davide , Messina Marco , Cagini Carlo
Published: September 2022

Background

Retrospective analysis of morphological and functional outcomes after pars-plana vitrectomy and Silicone-Oil (SO) endotamponade in acute postoperative endophthalmitis (APOE).

Methods

Minimum follow-up was 6 months. Every included patient received best-corrected visual acuity (BCVA) assessment, pre-operatively and at last follow-up. Spectralis OCT was used to investigate disorganization of inner (DRIL) and outer (DROL) retinal layers at 1, 3, 6 months and at last follow-up. OCT-A was performed to assess foveal avascular zone (FAZ) and vascular perfusion density (VPD) at 6 months and at last follow-up.

Results

Seventeen eyes were recruited. Postoperative findings: BCVA ≥ 20/40 (in 14 eyes); epiretinal membranes (13); hyperreflective epiretinal material soon after surgery in (6) SO-filled eyes; inner retinal layers atrophy (5); macular edema (2); DROL (4) with persistent EZ disruption at final visit (2); no significant difference between study and fellow eyes in central macular thickness, FAZ and VPD; VPD decreased in all cases with prominent disorganization of retinal architecture.

Conclusion

OCT changes after APOE can be persistent or completely/partially self-resolving and seems related to the outward progression path of the infection/inflammation from the vitreous cavity to the inner and outer retina, rather than to the surgery.
Muscle fenestration in vertical rectus muscle surgeries
Authors: Awadein Ahmed , Arfeen Shaimaa
Published: September 2022

Purpose

To evaluate the outcome of fenestration of the vertical rectus muscles in correcting vertical deviations.

Material and Methods

A retrospective chart review was conducted on patients who underwent fenestration surgery on the superior rectus (SR) or inferior rectus (IR) muscles. Ductions, versions, angle of deviations before and after surgery, and surgical details were analyzed. Success was defined as vertical alignment within 4 PD of orthophoria.

Results

Nineteen patients were identified. The mean age of the patients was 19.3 ± 13.1 (range; 4 to 48) years. The mean follow-up was 6.5 ± 2.7 (range, 3 to 12) months. Eleven patients presented with dissociated vertical deviation (DVD), 2 patients with sensory hypertropia, and 6 patients with sensory hypotropia. Fourteen patients had concomitant horizontal muscle surgery. The mean change of the angle of deviation was 13 ± 3 (range, 8 to 20) PD after SR fenestration. and 12 ± 2 (range; 10 to 15) PD after IR fenestration. There was a significant improvement in the post operative angle of deviation in both groups (P value <0.001). Success was achieved in 10 (77%) of patients who underwent SR fenestration and in all patients underwent ir fenestration. Only one patient in the IR group developed a 1-mm lower lid retraction.

Conclusion

Fenestration of the vertical rectus muscles is an effective and safe method for correcting vertical deviations. We recommend increasing the amount of fenstration in DVD to further improve the outcome.
Engaging Community Partners to Understand and Respond to Substance Use and Addiction Crisis Facing Families in Prince Albert, Saskatchewan
Authors: Maina Geoffrey , Ogenchuk Marcella , Sherstobitoff Jordan , Bratvold Robert , Robinson Barbara
Published: September 2022

Substance use is a persisting health care crisis that has led to residents’ addiction to diverse substances in Prince Albert, Saskatchewan. This public health issue affects not only those with a substance use disorder but also those within their circle of family and friends. This paper aims to outline the community engagement processes that we undertook to identify community priorities for addressing the substance use and addiction issues facing them. We began the community engagement using a patient-oriented research process, which led to the development of a grant application. Following the awarding of this grant application by the Saskatchewan Health Research Foundation and Saskatchewan Centre for Patient-Oriented Research, we conducted interviews with family members affected by addiction in the city. The study provided us with significant insight into the impacts of substance use disorders on family members. The importance of collaboration among people with lived experience, health care providers, and community partners helped us to identify our research questions. Community members also actively participated in the data collection, analysis, and presentation of the findings where priorities for the interventions were identified. The conversations we had because of the community’s engagement and participation in the research process enhanced our understanding of the realities of caring for people with substance use disorders and the importance of family involvement throughout the process. We also learned lessons regarding community engagement and participation in research on a stigmatizing and complex topic.
The transition from conventional biodiesel combustion to RCCI with CNG/ethanol induction in CI engine: A comparative combustion analysis and relative effects on performance-emissions
Authors: Biswas Srijit , Sengupta Anindita , Kakati Dipankar , Banerjee Rahul
Published: September 2022

Concerning the national biofuel policies in India, increasing plant-based fuels and lowering the use of fossil diesel in CI engines reduces the burden on foreign exchange and carbon footprints in the environment, which helps achieve “net-zero carbons emissions.” In this present study, Mahua biodiesel (BD) was used here as an ignition energy source, and CNG/ethanol (Et) was used here as the primary energy source replacing the biodiesel with a significant energy share during the combustion process. The effects of various injection and reactivity phasing strategies on a diesel engine’s combustion characteristics has been evaluated here. However, effect of this combustion characteristics on the corresponding performance and emission has also been evaluated here. This study revealed the ignition delay (ID) and combustion duration (CD) trade-off for almost every combustion phase achieved here during the testing. This analysis also incorporates the widespread effect of combustion characteristics on the performance and emission behavior of the diesel engine for both types of fuel combinations, that is, CNG + BD and Et + BD operation. For example, the lowest ID for CNG enriched combustion was 26.62% greater than ethanol enriched combustion, signifying that the ethanol delayed the start of ignition at polit-main angle of 35°-05° CA. Hence, NHC, PM, and CO2 emissions registered a lower footprint for CNG-BD operation, while ethanol-BD mode reported lower CO emission. However, ethanol-enriched combustion registered a 31.25% higher maximum CD than CNG-coupled operation, signifying a more extended period of energy release. CNG-BD operation also observed lower NHC, CO, and CO2 footprint corresponding to maximum combustion duration, and ethanol-BD mode reported lower PM emission.
Surgical Resection of an Intravascular Lipoma of the Superior Vena Cava
Authors: Cohen-Mussali Salomon , Leon Monica , Rey-Rodriguez Alejandro , Canalizo Eduardo , Yebra-Lopez Adrian , Gómez-González Mauricio Damian , Ramírez-Cerda Claudio , Valdes-Flores Jaime
Published: September 2022

Intravascular lipomas (IVL) located in the superior vena cava (SVS) are rare benign primary venous tumors with less than 15 cases reported in the literature. We report a case of a 64-year-old woman with IVL of the SVC extending to the right brachiocephalic vein. She was treated successfully using a hybrid procedure which involved endovascular control of the right subclavian vein and surgical approach via median sternotomy followed by mass resection and use of pericardial patch for vein defect closure.
A Volar Locking Plate With Fossa Specific Fixation Provides Comparable Stability Between Articular and Nonarticular Cadaveric Models of Distal Radius Fracture
Authors: Heifner John J. , McIver Natalia D. , Salas Christina , Mercer Deana M.
Published: September 2022

Background:

Distal radius fractures often present with a 3-part articular fragmentation pattern, with separation of the dorsal and volar lunate fossa. The column concept of distal radius fixation addresses the importance of stabilizing both the scaphoid fossa lateral column and the lunate fossa intermediate column. Recent evidence strengthens the value of immediate postoperative mobilization. Satisfactory outcomes following these protocols are predicated on volar locking plates (VLPs) providing adequate stability to the fracture repair. We hypothesize that a VLP which individually supports both lateral and intermediate distal radius columns may provide comparable stability between articular and non-articular cadaveric fracture models under parameters meant to simulate postoperative loading.

Methods:

Eleven cadaveric matched pair specimens were randomized to receive a simulated AO Type A2 non-articular distal radius fracture on one side with an AO Type C3 articular fracture on the contralateral side. Stiffness during cyclic loading was compared between fracture groups. A matched-paired Student t-test was used to determine statistical significance ( P = .05).

Results:

There were no significant differences ( P = .35) in stiffness between the articular models (mean 370.0 N/mm, +/-93.5) and the non-articular models (360.4 N/mm, +/-60.0) of distal radius fracture.

Conclusion:

A VLP that individually supports the scaphoid and lunate fossa with fixed angle subchondral support may provide comparable fixation strength with resistance to displacement between articular and non-articular fracture patterns. The current results suggest that fossa-specific VLP fixation in articular fractures can maintain construct stability during postoperative loading.
The Scientific Study of Consciousness Cannot and Should Not Be Morally Neutral
Authors: Mazor Matan , Brown Simon , Ciaunica Anna , Demertzi Athena , Fahrenfort Johannes , Faivre Nathan , Francken Jolien C. , Lamy Dominique , Lenggenhager Bigna , Moutoussis Michael , Nizzi Marie-Christine , Salomon Roy , Soto David , Stein Timo , Lubianiker Nitzan
Published: September 2022

A target question for the scientific study of consciousness is how dimensions of consciousness, such as the ability to feel pain and pleasure or reflect on one’s own experience, vary in different states and animal species. Considering the tight link between consciousness and moral status, answers to these questions have implications for law and ethics. Here we point out that given this link, the scientific community studying consciousness may face implicit pressure to carry out certain research programs or interpret results in ways that justify current norms rather than challenge them. We show that because consciousness largely determines moral status, the use of nonhuman animals in the scientific study of consciousness introduces a direct conflict between scientific relevance and ethics—the more scientifically valuable an animal model is for studying consciousness, the more difficult it becomes to ethically justify compromises to its well-being for consciousness research. Finally, in light of these considerations, we call for a discussion of the immediate ethical corollaries of the body of knowledge that has accumulated and for a more explicit consideration of the role of ideology and ethics in the scientific study of consciousness.
Indonesia under threat: The danger of corruption to political legitimacy
Authors: Tambunan Derwin
Published: September 2022

The association between corruption and poverty, inequality, economic development and resource distribution has been investigated widely in the Indonesian context. However, the impact of corruption on political legitimacy is still understudied, particularly for post-Soeharto Indonesia. Hence, we are left with many puzzles and a baffling picture of political legitimacy. This research corrects this picture and aims to ascertain two interrelated questions: (a) how and in what way does corruption erode political legitimacy? and (b) what evidence suggests that corruption deteriorates legitimacy? A qualitative and a quantitative research method are deployed to address these questions. The quantitative analysis demonstrates that corruption is statistically significant in predicting political legitimacy, suggesting that corruption erodes citizens’ trust in the rule of law, democracy, political actors and institutions. The qualitative model reinforces the quantitative results that corruption undermines the rule of law, hijacks democracy and erodes people’s trust in political actors and institutions.
State-sponsored institute-based provision of advanced artificial limbs for rehabilitation of amputees
Authors: Lakkireddy Maheshwar , Taduri Gangadhar , Kandakatla Manohar , Cherukuri Nagesh , Iyengar Raju , Patnala Chandrashekar , Karra Madhu Latha
Published: September 2022

Introduction: Amputation is a painful functional experience and optimal rehabilitation of an amputee is a team effort. Functional restitution depends on many factors including the type of prosthesis available. We report our experience of providing advanced artificial limbs at free of cost to the underprivileged through a state-sponsored pilot initiative. Material and methods: This is a retrospective cohort study of amputees who have been rehabilitated with advanced artificial limbs through the Department of Orthopaedics at Nizam's Institute of Medical Sciences, Punjagutta, Hyderabad, India from the years 2017 to 2021. Prostheses were procured through rate contract and monitory support was provided by the state. Evaluation, fitment and functional restitution were supervised by the orthopaedic surgeons to the utmost satisfaction of the amputees. Results: A total of 136 subjects received 142 advanced artificial limbs. Out of 136 subjects, 130 received unilateral and 6 subjects received bilateral prosthesis. Ninety-two percent (n  =  125) were men and 8% (n  =  11) were women. Eighty-eight (n  =  125) were lower limb prosthesis and 12% (n  =  17) were upper limb prosthesis. All the amputees fitted with advanced artificial limbs were highly satisfied at the end of the procedure and were confident of independent living. Conclusion: Appropriate rehabilitative measures are required for amputees to lead an independent life. Paucity of institutional support and monitory challenges preclude them from advanced prosthesis. State-sponsored, institute-based supply of advanced artificial limbs at free of cost to the beneficiaries is a replicable and feasible option for optimal rehabilitation of amputees with appropriate prosthesis.
No Difference in Knee Kinematics Between Anterior Cruciate Ligament–First and Posterior Cruciate Ligament–First Fixation During Single-Stage Multiligament Knee Reconstruction: A Biomechanical Study
Authors: Fayed Aly M. , Kanto Ryo , Price Taylor M. , DiNenna Michael , Linde Monica A. , Smolinski Patrick , van Eck Carola
Published: September 2022

Background:

For combined reconstruction of both the anterior cruciate ligament (ACL) and the posterior cruciate ligament (PCL), there is no consensus regarding which graft should be tensioned and fixed first.

Purpose:

The purpose of this study was to determine which sequence of graft tensioning and fixation better restores normal knee kinematics. The hypothesis was that ACL-first fixation would more closely restore normal knee kinematics, graft force, and the tibiofemoral orientation in the neutral (resting) position compared with PCL-first fixation.

Study Design:

Controlled laboratory study.

Methods:

A total of 15 unpaired human cadaveric knees were examined using a robotic testing system under the following 4 conditions: (1) 89.0-N anterior tibial load at different knee angles; (2) 89.0-N posterior tibial load at different knee angles; (3) combined rotational 7.0-N·m valgus and 5.0-N·m internal rotation load (simulated pivot shift) at 0°, 15°, and 30° of flexion; and (4) 5.0-N·m external rotation load at 0°, 15°, and 30° of flexion. The 4 evaluated knee states were (1) intact ACL and PCL (intact), (2) ACL and PCL deficient (deficient), (3) combined anatomic ACL-PCL reconstruction fixing the ACL first (ACL-first), and (4) combined anatomic ACL-PCL reconstruction fixing the PCL first (PCL-first). A 9.0 mm–diameter quadriceps tendon autograft was used for the ACL graft, tensioned with 40.0 N at 30° of flexion. A 9.5 mm–diameter hamstring tendon autograft (gracilis and semitendinosus, quadrupled loop, and augmented with an additional allograft strand if needed), tensioned with 40.0 N at 90° of flexion, was used for the PCL graft.

Results:

There were no statistically significant differences between ACL-first and PCL-first fixation regarding knee kinematics. ACL-first fixation restored anterior tibial translation to the intact state at all tested knee angles, while PCL-first fixation showed higher anterior tibial translation than the intact state at 90° of flexion (9.05 ± 3.05 and 5.87 ± 2.40 mm, respectively; P = .018). Neither sequence restored posterior tibial translation to the intact state at 30°, 60°, and 90° of flexion. At 15° of flexion, PCL-first fixation restored posterior tibial translation to the intact state, whereas ACL-first fixation did not.

Conclusion:

There were no differences in knee laxity between ACL-first and PCL-first fixation with the ACL graft fixed at 30° and the PCL graft fixed at 90°.

Clinical Relevance:

This study showed that there was no evidence to support the use of one tensioning sequence over the other in single-stage multiligament knee reconstruction.
Superior Bone Microarchitecture in Anatomic Versus Nonanatomic Fibular Drill Tunnels for Reconstruction of the Posterolateral Corner of the Knee
Authors: Stürznickel Julian , Schmidt Felix N. , Schweizer Conradin , Mushumba Herbert , Krause Matthias , Püschel Klaus , Rolvien Tim
Published: September 2022

Background:

Several fibula-based reconstruction techniques have been introduced to address ligamentous injuries of the posterolateral corner of the knee. These techniques involve a drill tunnel with auto- or allograft placement through the proximal fibula.

Purpose:

To determine the skeletal microarchitecture of the proximal fibula and its association with age and to compare the microarchitecture within the regions of different drill tunnel techniques for reconstruction of the posterolateral corner.

Study Design:

Descriptive laboratory study.

Methods:

A total of 30 human fibulae were analyzed in this cadaveric imaging study. High-resolution peripheral quantitative computed tomography measurements were performed in a 4.5 cm–long volume of interest at the proximal fibula. Three-dimensional microarchitectural data sets of cortical and trabecular compartments were evaluated using customized scripts. The quadrants representing the entry and exit drill tunnel positions corresponding to anatomic techniques (LaPrade/Arciero) and the Larson technique were analyzed. Linear regression models and group comparisons were applied.

Results:

Trabecular microarchitecture parameters declined significantly with age in women but not men. Analysis of subregions with respect to height revealed stable cortical and decreasing trabecular values from proximal to distal in both sexes. Along with a structural variability in axial slices, superior values were found for the densitometric and microarchitectural parameters corresponding to the fibular drill tunnels in the anatomic versus Larson technique (mean ± SD; bone volume to tissue volume at the entry position, 0.273 ± 0.079 vs 0.175 ± 0.063; P < .0001; cortical thickness at the entry position, 0.501 ± 0.138 vs 0.353 ± 0.081 mm; P < .0001).

Conclusion:

Age represented a relevant risk factor for impaired skeletal microarchitecture in the proximal fibula in women but not men. The region of drill tunnels according to anatomic techniques showed superior bone microarchitecture versus that according to the Larson technique.
Liminal Lives in Uncertain Times: Health Management During the COVID-19 Pandemic Among Transgender and Non-Binary Older Adults
Authors: Lampe Nik M.
Published: September 2022

Older adulthood is a crucial time in the health management journeys of transgender and non-binary (TNB) people. Understanding how the COVID-19 pandemic has impacted TNB older patients (65 years and over) offers critical guidance for successful health services reform and continued delivery systems change. Using qualitative data from 47 semi-structured individual interviews, I investigate how TNB older Americans—as a medically and socially vulnerable population in the United States—manage their health during the COVID-19 pandemic. Results indicated a need for enhancing health services and resources for TNB older adults while creating a culture of age-friendly and gender-affirming healthcare. Four primary themes emerged: (1) exacerbated mental health challenges, (2) disrupted social relationships and support, (3) adopting cost-effective health management strategies, and (4) incorporating family care partners in health management. Such themes were shaped by respondents’ privileged and marginalized social locations, such as access to financial security, social support, and adequate medical care. Although these research findings should not be generalized to the TNB older adult population, they suggest that broader patterns of inequity affect how TNB older Americans manage their health during the COVID-19 pandemic.
In the Eye of the Beholder: Visualising Students’ Implicit Entrepreneurship Theories
Authors: Ellborg Katarina
Published: September 2022

Teaching methods and students’ preconceptions are considered a crucial basis for entrepreneurship education, not least when entrepreneurship is taught outside business schools with differentiated learning outcomes. This qualitative study seeks to explore students’ experiences of a visual-based teaching exercise––“Images of entrepreneurship”––and examines how the exercise contributes to making their preconceptions of entrepreneurship explicit. The study presents the exercise and its theoretical underpinnings and then, via interviews with 28 students from various educational backgrounds, gives a unique insight into their experiences of the exercise. The purpose is to contribute to the development of theory on pedagogical practices in classroom settings in entrepreneurship education in higher education. In order to systematically discuss the students’ relationship to the exercise and to their preconceptions of entrepreneurship, implicit theories are proposed and developed as a theoretical framework. Based on the students’ views, this study shows that entrepreneurship educators can use visual material to initiate reflective conversations about students’ implicit entrepreneurship theories, and involve students in evaluations of teaching methods in order to promote their perspective.
A novel hybrid framework for metabolic pathways prediction based on the graph attention network
Authors: Yang Zhihui , Liu Juan , Shah Hayat Ali , Feng Jing
Published: September 2022

Background

Making clear what kinds of metabolic pathways a drug compound involves in can help researchers understand how the drug is absorbed, distributed, metabolized, and excreted. The characteristics of a compound such as structure, composition and so on directly determine the metabolic pathways it participates in.

Methods

We developed a novel hybrid framework based on the graph attention network (GAT) to predict the metabolic pathway classes that a compound involves in, named HFGAT, by making use of its global and local characteristics. The framework mainly consists of a two-branch feature extracting layer and a fully connected (FC) layer. In the two-branch feature extracting layer, one branch is responsible to extract global features of the compound; and the other branch introduces a GAT consisting of two graph attention layers to extract local structural features of the compound. Both the global and the local features of the compound are then integrated into the FC layer which outputs the predicted result of metabolic pathway categories that the compound belongs to.

Results

We compared the multi-class classification performance of HFGAT with six other representative methods, including five classic machine learning methods and one graph convolutional network (GCN) based deep learning method, on the benchmark dataset containing 6999 compounds belonging to 11 pathway categories. The results showed that the deep learning-based methods (HFGAT, GCN-based method) outperformed the traditional machine learning methods in the prediction of metabolic pathways and our proposed HFGAT method performed better than the GCN-based method. Moreover, HFGAT achieved higher $$F_1$$

F
1

scores on 8 of 11 classes than the GCN-based method.

Conclusions

Our proposed HFGAT makes use of both the global and local information of the compounds to predict their metabolic pathway categories and has achieved a significant performance. Compared with the GCN model, the introduction of the GAT can help our model pay more attention to substructures of the compound that are useful for the prediction task. The study provided a potential method for drug discovery with all types of metabolic reactions that may be involved in the decomposition and synthesis of pharmaceutical compounds in the organism.
Neural representations of cryo-EM maps and a graph-based interpretation
Authors: Ranno Nathan , Si Dong
Published: September 2022

Background

Advances in imagery at atomic and near-atomic resolution, such as cryogenic electron microscopy (cryo-EM), have led to an influx of high resolution images of proteins and other macromolecular structures to data banks worldwide. Producing a protein structure from the discrete voxel grid data of cryo-EM maps involves interpolation into the continuous spatial domain. We present a novel data format called the neural cryo-EM map, which is formed from a set of neural networks that accurately parameterize cryo-EM maps and provide native, spatially continuous data for density and gradient. As a case study of this data format, we create graph-based interpretations of high resolution experimental cryo-EM maps.

Results

Normalized cryo-EM map values interpolated using the non-linear neural cryo-EM format are more accurate, consistently scoring less than 0.01 mean absolute error, than a conventional tri-linear interpolation, which scores up to 0.12 mean absolute error. Our graph-based interpretations of 115 experimental cryo-EM maps from 1.15 to 4.0 Å resolution provide high coverage of the underlying amino acid residue locations, while accuracy of nodes is correlated with resolution. The nodes of graphs created from atomic resolution maps (higher than 1.6 Å) provide greater than 99% residue coverage as well as 85% full atomic coverage with a mean of 0.19 Å root mean squared deviation. Other graphs have a mean 84% residue coverage with less specificity of the nodes due to experimental noise and differences of density context at lower resolutions.

Conclusions

The fully continuous and differentiable nature of the neural cryo-EM map enables the adaptation of the voxel data to alternative data formats, such as a graph that characterizes the atomic locations of the underlying protein or macromolecular structure. Graphs created from atomic resolution maps are superior in finding atom locations and may serve as input to predictive residue classification and structure segmentation methods. This work may be generalized to transform any 3D grid-based data format into non-linear, continuous, and differentiable format for downstream geometric deep learning applications.
Enhanced autophagy interacting proteins negatively correlated with the activation of apoptosis-related caspase family proteins after focal ischemic stroke of young rats
Authors: Wang Jie , Xia Zihao , Sheng Peng , Shen Mengmeng , Ding Lidong , Liu Dezhi , Yan Bing Chun
Published: September 2022

Background

Neuronal injury induced in young rats by cerebral ischemia reperfusion (CIR) is known to differ substantially from that in adult rats. In the present study, we investigated the specific differences in neuronal injury induced by focal CIR between young and adult rats.

Results

2, 3, 5-triphenyl tetrazolium chloride (TTC) staining revealed a gradual increase in the infarct volume of both young and adult rats in accordance with I/R times and was significantly lower in young rats than in adult rats under the same conditions. The number of cells in the cortex showing immunoreactivity for neuronal nuclei (NeuN) gradually decreased in both young and adult rats in accordance with I/R times; these numbers were significantly higher in young rats than in adult rats under the same conditions. Similarly, as the duration of I/R increased, the degree of glial activation in the cortex penumbra region became more severe in both young and adult groups; however, glial activation was significantly lower in the cortex penumbra region of young rats when compared with that in adult rats. In addition, the expression of Beclin-1 was significantly higher in the infarct penumbra of young rats than adult rats and was more frequently co-expressed with neurons. The levels of autophagy-related proteins increased significantly in the penumbra region after I/R in both young and adult groups, this increase was more pronounced in young rats than in adult rats. Following CIR, analysis revealed significantly lower levels of pro-apoptosis-related factors and significantly higher levels of anti-apoptosis-related proteins in the young rats than in adult rats.

Conclusions

Collectively, the present results suggest that the the reduced levels of neuronal death after CIR in young rats were closely related to enhanced levels of autophagy and reduced levels of pro-apoptosis in neurons.
Descriptive study of foodborne disease using disease monitoring data in Zhejiang Province, China, 2016–2020
Authors: Qi Xiaojuan , Alifu Xialidan , Chen Jiang , Luo Wenliang , Wang Jikai , Yu Yunxian , Zhang Ronghua
Published: September 2022

Background

This study aimed to identify the epidemiology, seasonality, aetiology and clinical characteristics of sporadic foodborne diseases in Zhejiang province during 2016–2020.

Methods

Descriptive statistical methods were used to analyze the data from surveillance network established by the Zhejiang Provincial Center for Disease Control and Prevention. There were 31 designated hospitals in all 11 cities which were selected using probability proportionate to size sampling method.

Results

During the study period, the surveillance system received 75,124 cases with 4826 (6.42%) hospitalizations from 31 hospitals. The most common cause was Norovirus, 6120 cases (42.56%), followed by Salmonella, 3351 cases (23.30%). A significant seasonal trend was observed for the V. parahaemolyticus, with the highest rates over the summer period, peaking in August, 1171 cases (38.75%), a similar trend was also observed with Salmonella and Diarrheagenic E. coli. Norovirus infections showed the highest rate in November (904, 14.77%) and March (660,10.78%), the lowest in August, 215 cases (3.51%). Patients between 19 ~ 40 years were more likely to infected by Norovirus, V. parahaemolyticus and Diarrheagenic E. coli, patients below 1 year were the highest among patients with Salmonella infection, 881 cases (26.3%). The Norovirus, V. parahaemolyticus and Diarrheagenic E. coli infection with the highest positive detection rates among the workers were observed. The largest number cases of food categories were from aquatic product infection. The private home was the most common exposure setting.

Conclusion

Our study highlighted the necessity for conducting an active, comprehensive surveillance for pathogens in all age groups, to monitor the changing dynamics in the epidemiology and aetiology of foodborne diseases to guide policies that would reduce related illnesses.
Clinical benefits of inhaled ciclesonide for hospitalized patients with COVID-19 infection: a retrospective study
Authors: Kuo Kuan-Chih , Chen Chao-Hsien , Wang Chieh-Jen , Wu Jou-Chun , Chung Hsin-Pei , Chen Yen-Ting , Tang Yen-Hsiang , Chang Wen-Kuei , Lin Chang-Yi , Wu Chien-Liang
Published: September 2022

Background

The successful management of patients infected with coronavirus disease 2019 (COVID-19) with inhaled ciclesonide has been reported, however few studies have investigated its application among hospitalized patients.

Methods

This retrospective cohort study enrolled all adult patients admitted to our hospital with confirmed COVID-19 infection from May to June 2021. Critical patients who received mechanical ventilation within 24 h after admission and those who started ciclesonide more than 14 days after symptom onset were excluded. The in-hospital mortality rate was compared between those who did and did not receive inhaled ciclesonide.

Results

A total of 269 patients were enrolled, of whom 184 received inhaled ciclesonide and 85 did not. The use of ciclesonide was associated with lower in-hospital mortality (7.6% vs. 23.5%, p = 0.0003) and a trend of shorter hospital stay (12.0 (10.0–18.0) days vs. 13.0 (10.0–25.3) days, p = 0.0577). In subgroup analysis, the use of inhaled ciclesonide significantly reduced mortality in the patients with severe COVID-19 infection (6.8% vs. 50.0%, p < 0.0001) and in those with a high risk of mortality (16.4% vs. 43.2%, p = 0.0037). The use of inhaled ciclesonide also reduced the likelihood of receiving mechanical ventilation in the patients with severe COVID-19 infection. After multivariate analysis, inhaled ciclesonide remained positively correlated with a lower risk of in-hospital mortality (odds ratio: 0.2724, 95% confidence interval: 0.087–0.8763, p = 0.0291).

Conclusions

The use of inhaled ciclesonide in hospitalized patients with COVID-19 infection can reduce in-hospital mortality. Further randomized studies in patients with moderate to severe COVID-19 infection are urgently needed.