bluuebunny/crossref_metadata_2025 huggingface dataset:
Applying a support vector machine for hollow ball screw condition-based classification using feature extraction
Authors: Huang Yi-Cheng , Hsieh Yi-Keng
Published: October 2020

Ball screws play a critical role in high-quality precision manufacturing. The use of machine learning and artificial intelligence for the diagnosis of machines’ health status is increasingly pertinent. The processing of big data originating from machine sensors is crucial. However, installing multiple sensors on the object requiring diagnosis may be costly. A sensorless strategy using built-in signals to determine the conditions of a hollow ball screw was deployed. Moreover, we evaluated the most discriminative parameters among fusion sensor signals by using Fisher’ criteria. A support vector machine (SVM) as diagnostic tool was used. In the absence of prominent characteristic features in data, the conventional SVM cannot classify the data well. To address this concern, we constructed a feature engineering for distinguishing features from the raw data to facilitate the SVM classification process well. In addition, we validated the physical phenomenon in realistic ball screw conditions through feature extraction. Experimental results demonstrated the average diagnostic accuracy levels for the ball screw preload, pretension, cooling system, and table payload were 98.91%, 94.08%, 91.69%, and 93.5%, respectively, after feature engineering was applied successfully.
Experimental investigation into the bending energy absorption of hybrid aluminum/high strength and mild steel thin-walled sections joined by clinching
Authors: Khalkhali Abolfazl , Miandoabchi Elyar
Published: October 2020

The employment of hybrid material thin-walled sections in the vehicle body structure is an emerging approach adopted towards manufacturing of lightweight energy-absorbing components in the automotive industry. Utilizing multi-materials such as aluminum-steel in the automotive industry poses some manufacturing challenges in terms of joining technologies of dissimilar materials. Clinching is a cold forming process that includes severe local plastic deformation of the sheets leading to permanent mechanical interlock. This study undertakes the experimental investigation of bending energy absorption of the clinched top-hat thin-walled beams by means of a series of quasi-static three-point bending tests. Different types of clinched beams including homogeneous as well as hybrid material beams, with aluminum alloy Al5052/SPCC mild steel and Al5052/SPFC 390 high strength steel combinations, are studied. The bending behavior of such beams under two different loading conditions is investigated and compared in terms of crashworthiness indices such as specific energy absorption ( SEA), initial peak force ( Fip) and crash force efficiency (CFE). It is found that although the hybrid clinched beams show higher SEA as well as lower Fip than their steel counterparts, their CFE values are lower than the steel beams. Furthermore, the sheets arrangement change with respect to the punch and the die is shown to influence the energy absorbing capability of the hybrid clinched beams. Moreover, it is revealed that while the clinched beams show reduced Fip under the load applied to their hat-shaped part, they exhibit lower CFE values compared to when the load is applied to their plate part. Finally, considering SEA, Fip, and CFE as three criteria, TOPSIS as a multi-criteria decision-making method is employed to select the best compromise design solution.
Why International Students Choose to Study at Russia’s Leading Universities
Authors: Nefedova Alena
Published: October 2020

Many governments invest significant funds to promote their national higher education systems in the global education market, and Russia is no exception. In 2013, the government launched the Russian academic excellence 5-100 Project “to maximize the competitive position of a group of leading Russian universities in the global research and education market” and to attract international staff and students from all over the world. Although Russia is currently in the seventh place for international students globally, it has one of the fastest growth rates compared with its previous position in the global market. Existing literature on the motivation of international students who choose to study in Russia is minimal. To fill this gap, this study uses the results of interviews with international students to discover what brought them to Russia. The conclusions drawn highlight the need for the Russian government to improve its migration policy for international students as well as to publicize the quality of Russian higher education.
The Tale of the Unrepaired Cleft—Retrospective Evaluation of Cases Encountered by an Indigenous Mission in a Northern Nigerian Community
Authors: Oketade Ifeoluwa , Bello Seidu A. , Adeoye John
Published: October 2020

Objective:

This study aims to document the experience of an indigenous surgical mission on the occurrence of unrepaired cleft in 2 visits to Minna, North-Central Nigeria.

Design:

This retrospective study involved participants with orofacial cleft anomaly at 2 surgical outreaches held in Minna in 2011 and 2017. Baseline data were initially obtained from case files of patients at both programs. Data collected were analyzed employing appropriate statistical tests for continuous and categorical variables.

Setting:

Two outreach programs in Minna, North-Central Nigeria by Cleft and Facial Deformity Foundation in 2011 and 2017.

Results:

A total of 117 participants with cleft anomaly were encountered at both surgical outreach programs. The sample prevalence of unrepaired cleft was 61.5% with an overall mean age (standard deviation) of 10 (13.2) years. Most participants presented with unilateral complete cleft lip (70.8%) which was more common on the left side and had no family history of orofacial cleft (54.2%). Information on the surgical program was mostly obtained via friends and relatives in 32.6% and lack of wherewithal to offset the expense of cleft surgery and supportive treatment represented the most common reason for the delay of surgical repair (50%).

Conclusion:

We found a high proportion of patients with unrepaired cleft in our sample which may mirror happenings in other developing world centers. We advocate continued collaborations between indigenous missions and international funding agencies to further encourage continued repair of unrepaired cleft in developing centers.
An improved nonlinear cumulative damage model for strength degradation considering loading sequence
Authors: Jiang Changjie , Liu Xintian , Zhang Minghui , Wang Xu , Wang Yansong
Published: October 2020

In order to determine the effect of different loads on fatigue damage, a strength degradation model is proposed according to the law of residual strength degradation of metal materials. The model is verified with the strength degradation test data, and the results show that the model can describe the strength degradation process of general metal materials well. Combined with the strength degradation model, an improved equivalent damage model for different loading sequences is proposed. On this basis, a nonlinear fatigue cumulative damage model based on strength degradation is derived. The cumulative damage model is applied to the estimation of fatigue residual life under two-, three-, and four-stage loads to investigate the effects of different loading sequence on fatigue damage under various loading conditions. Combining with experimental data, it is verified that the cumulative damage model can accurately estimate the fatigue life under two-, three-, and four-stage loads.
Treating relapsed and refractory metastatic germ cell tumours with high-dose chemotherapy with carboplatin and etoposide and autologous haematopoietic stem cell transplantation
Authors: Erturk Ismail , Karadurmus Nuri , Kızıloz Halil , Acar Ramazan , Yildiz Birol , Aykan Musa Baris , Esen Ramazan , Buyukturan Galip , Urun Yuksel , Erdem Gokhan , Arpacı Fikret
Published: October 2020

Introduction and aim

To demonstrate the real-life data about patients who underwent AHSCT due to GCT.

Methods

Between November 2016 and April 2020, 64 patients who received CE as high-dose chemotherapy for AHSCT in the Gulhane Education and Research Hospital were included in the study. Sixty-one patients received one AHSCT with CE chemotherapy regimen. Survival data and clinical characteristics were evaluated retrospectively.

Results

The mean age of the patients were 31.9 ± 9 (min-max:18–55). With a median follow-up of 10.7 ± 8.7 months, the 1-year progression-free survival (PFS) rate was 57.8%, and the 1-year overall survival rate was 77.5%. Median overall survival (OS) and progression-free survival (PFS) times were 21.5 ± 1.8 (95% CI: 14.5–33.4) and 20 ± 2 months, respectively. The response rate was 72%. There were three treatment-related deaths.

Conclusion

This sizeable single-centre study shows that patients with relapsed metastatic GCT are curable by CE as high dose chemotherapy plus AHSCT with reliable toxicity even for a single cycle.
The Impact of Mobile Health on Cancer Screening: A Systematic Review
Authors: Salmani Hosna , Ahmadi Maryam , Shahrokhi Nafiseh
Published: October 2020

Introduction:

Mobile health is an emerging technology around the world that can be effective in cancer screening. This study aimed to examine the effectiveness of mobile health applications on cancer screening.

Methods:

We conducted a systematic literature review of studies related to the use of mobile health applications in cancer screening. We also conducted a comprehensive search of articles on cancer screening related to the use of mobile health applications in journals published between January 1, 2008, and January 31, 2019, using 5 databases: IEEE, Scopus, Web of Science, Science Direct and PubMed.

Results:

A total of 23 articles met the inclusion criteria and were included in the present review. All studies have identified positive effects of applications on cancer screening and clinical health outcomes. Furthermore, more than half of mobile applications had multiple functions such as providing information, planning and education. Moreover, most of the studies, which examined the satisfaction of patients and quality improvement, showed healthcare application users have significantly higher satisfaction of living and it leads to improving quality.

Conclusion:

This study found that the use of mobile health applications has a positive impact on health-related behaviours and outcomes. Application users were more satisfied with applying mobile health applications to manage their health condition in comparison with users who received conventional care.
Lifestyle and Long-Term Smoking Cessation
Authors: Sohlberg Tove , Bergmark Karin Helmersson
Published: October 2020

Background:

Since smoking is the leading cause of preventable death, discouraging smoking initiation, encouraging smoking cessation, and exploring factors that help individuals to stay smoke free are immensely important. One such relevant factor may be the impact of lifestyle for long-term smoking cessation.

Method:

A representative sample of successful quitters was recruited for a study about smoking cessation. These respondents are now part of a 7-year follow-up with the overall aim of revealing factors affecting long-term smoking cessation. Descriptive analyses were carried out at baseline and at follow-up, as well as a further two-step cluster analysis to explore profiles of long-term smoke-free individuals.

Results:

A majority did not make any particular lifestyle changes, but among those who did, most adopted a healthier lifestyle and/or increased their quota of physical training, where permanent changes in this direction seem to promote a more enduring smoke-free life.

Conclusions:

Individuals who want to quit smoking should be encouraged to increase their level of physical activity. Swedish health care institutions should be able to provide support for this both initially and over time to promote the long-term maintenance of a smoke-free lifestyle.
Clinical Supervision for Support Workers in Paediatric Palliative Care: A Literature Review
Authors: Beavis Jonathan , Davis Lucy , McKenzie Sian
Published: October 2020

Providing home care to children with complex physical health needs is an emotionally challenging role. Extant literature and documents such as the Cavendish Review (2013) have reported that a large proportion of care for this population is carried out by non-registered staff (support workers). Provision of clinical supervision for nurses working in palliative care is increasing, however, supervision needs of support workers are commonly neglected. This paper sought to synthesise what is known about clinical supervision practices for support workers in paediatric palliative care (PPC). A literature review was conducted in accordance with integrative review guidelines. 315 papers were identified initially, 15 studies were included in this review. Four commonalities were identified: importance of team cohesion, varying degrees of formality, self-awareness and practicalities. Support workers received varying forms of supervision and some facilitators faced organisational difficulties involving staff in supervision. Support workers who received staff support generally appreciated it in recognition that their work is complex and emotionally difficult. This paper highlighted that further research should investigate the efficacy of clinical supervision as a method of reducing stress and burnout for support workers. Any implementation of supervision should involve a considered approach to training and supervision to ensure fidelity.
Experimental study on stress-strain curves of seawater sea-sand concrete under uniaxial compression with different strain rates
Authors: Zhang Kaijian , Xiao Jianzhuang , Zhang Qingtian
Published: October 2020

In order to investigate the mechanical properties of seawater sea-sand concrete (SSC) under uniaxial compression, the SSC prisms with different mix proportions are designed and prepared, and the compressive strength and stress-strain curves under uniaxial compression are tested, in which five loading strain rates 10−5/s, 10−4/s, 10−3/s, 10−2/s, and 10−1/s are selected. The failure patterns of the SSC specimens under different strain rates are discussed, and the peak stress, peak strain (strain at the peak stress), elastic modulus, and ultimate strain are analyzed. The influence of the strain rate and the shell particle content on the stress-strain curves is intensively evaluated. It shows that the peak stress and elastic modulus increase with an increasing strain rate while the peak strain and ultimate strain have no obvious trend. Additionally, the shell particles seem to have contributions to the increase of the compressive strength of SSC base on the test results of cube and prism specimens, but further considerations about this phenomenon are necessary. Finally, the dynamic increase factor (DIF) of characteristic indices of SSC is put forward.
The social life of COVID-19: Early insights from social media monitoring data collected in Poland
Authors: Burzyńska Joanna , Bartosiewicz Anna , Rękas Magdalena
Published: October 2020

Research has revealed that social media data may be promising in many health threats and help to understand how people respond to them. As the outbreak of a novel coronavirus disease (COVID-19) is a global pandemic, a real-time social media monitoring is needed to know the scale of this phenomenon. We have reported the frequency, reach and impact of online mentions about the COVID-19 illness taken from social media platforms: Facebook, Instagram, Twitter, blogs, forums, and news portals to highlight and better understand the scope of coronavirus discussion in Poland. We used SentiOne social listening tool to gather the data and perform the monitoring between 24 February 2020 to 25 March 2020. We found a total of 1,415,750 mentions related to COVID-19 which gives the average 47,192 mentions per day. 95.36% (1,350,059) of mentions were people’s updates and expressions, 4.64% (65,691) mentions were articles from news portals and social media. Males have dominated the online conversation about COVID-19 (65.32% vs 34.68% females). At the same time, women were more likely to discuss the topic on social media platforms such as: Facebook, Twitter, and Instagram. We concluded with theoretical and practical implications.
Climate change governance: An analysis of the climate change legal regime in Kenya
Authors: Naeku Meissy Janet
Published: October 2020

Kenya’s climate change legal environment is considered progressive, with the country being one of the first in the African continent to enact robust climate law and policies that guide national and local action. The presence of a comprehensive legal regime is meant to provide an opportunity for the country to coordinate climate change issues in a more structured manner. Despite this, Kenya continues to grapple with challenges presented by climate change, which have increased the country’s vulnerability to biodiversity loss, ecosystem degradation and immense impacts on livelihoods and infrastructure in both rural and urban areas. Climate-related disasters and extreme events have plagued the most vulnerable communities, particularly with the most affected being Indigenous People and marginalised local communities. It is against this backdrop that the extent to which procedural mechanisms and the substantive legal frameworks produced needs to be reflected upon, to determine their interaction and feedback with the ongoing climate crisis and their sufficiency to adequately deliver climate justice across various levels of climate change law implementation. As a starting point, this article builds a comprehensive understanding on the existing climate laws in Kenya and explores how this translates to climate resilience building. The coherences, practicalities and implementation dynamics of the legal instruments are analysed to provide a clear picture of how the country responds to international, regional and national expectations and obligations. We argue that the adequacy of climate instruments in Kenya has not satisfactorily translated into climate resilience. Although most of the instruments are informed by sustainability principles for climate justice and resilience building, they still face diverse socio-economic and political dynamics that impede its effective implementation.
Experimental investigation of effect of biodiesel fatty acid methyl ester on performance of engine oil dispersant additive
Authors: Chen Boshui , Jie Fangfang , Li Xiaoqing , Song Chunyu , He Tianxi , Wang Jiu
Published: October 2020

In the present work, blends of methyl oleate (MO), polyisobutylene-bis-succinimide (PIBSI) and a mineral lubricant base oil were oxidized and some of their physicochemical properties were evaluated to understand the effects of biodiesel fatty acid methyl esters on the performance of the engine oil dispersant additive PIBSI. The oxidation experimentations of blends were conducted under elevated temperatures. Thereafter, the viscosity and acidity of fresh and oxidized blends were determined. The dispersancy, thermal stability and chemical species of oxidized samples were tested and analyzed by the blotter spot method, a TGA, and a GC/MS, respectively. Results showed that the viscosity and acidity of blends containing MO increased significantly after oxidation. The dispersing ability of PIBSI was markedly impaired by only a small amount of MO in a blend. In addition, the thermal characteristics of blends were altered by MO. Many varieties of oxygenated chemicals in the oxidized blend containing MO were detected. The negative impact of MO on performances of PIBSI was attributed to the accelerated oxidation caused by MO, and to the chemical interactions between MO and PIBSI. The present results demonstrated that PIBSI was incompatible with MO.
Epicardial and Endocardial Validation of Conduction Block After Thoracoscopic Epicardial Ablation of Atrial Fibrillation
Authors: Vroomen Mindy , Maesen Bart , Luermans Justin L. , Maessen Jos G. , Crijns Harry J. , La Meir Mark , Pison Laurent
Published: October 2020

Objective

It is unknown whether epicardial and endocardial validation of bidirectional block after thoracoscopic surgical ablation for atrial fibrillation is comparable. Epicardial validation may lead to false-positive results due to epicardial tissue edema, and thus could leave gaps with subsequent arrhythmia recurrence. It is the aim of the present study to answer this question in patients who underwent hybrid atrial fibrillation ablation (combined thoracoscopic epicardial and endocardial catheter ablation).

Methods

After epicardial ablation of the pulmonary veins (PVs) and connecting inferior and roof lines (box lesion), exit and entrance block were epicardially and endocardially evaluated using an endocardial His Bundle catheter and electrophysiological workstation. If incomplete lesions were found, endocardial touch-up ablation was performed. Validation results were also compared to predictions about conduction block based on tissue conductance measurements of the epicardial ablation device.

Results

Twenty-five patients were included. Epicardial validation results were 100% equal to the endocardial results for the left superior, left inferior, and right inferior PVs and box lesion. For the right superior PV, 85% similarity was found. Based on tissue conductance measurements, 139 lesions were expected to be complete; however, in 5 (3.6%) a gap was present.

Conclusions

Epicardial bidirectional conduction block in the PVs and the box lesion corresponded well with endocardial bidirectional conduction block. Conduction block predictions by changes in tissue conductance failed in few cases compared to block confirmation. This emphasizes that tissue conduction measurements can provide a rough indication of lesion effectiveness but needs endpoint confirmation by either epicardial or endocardial block testing.
Emergency Department Utilization After Administration of Peripheral Nerve Blocks for Upper Extremity Surgery
Authors: Loewenstein Scott N. , Bamba Ravinder , Adkinson Joshua M.
Published: October 2020

Background

The purpose of this study was to determine the impact of upper extremity peripheral nerve blocks on emergency department (ED) utilization after hand and upper extremity surgery.

Methods

We reviewed all outpatient upper extremity surgeries performed in a single Midwestern state between January 2009 and June 2019 using the Indiana Network for Patient Care. These encounters were used to develop a database of patient demographics, comorbidities, concurrent procedures, and postoperative ED visit utilization data. We performed univariate, bivariate, and multivariate logistic regression analyses.

Results

Among 108 451 outpatient surgical patients, 9079 (8.4%) received blocks. Within 1 week of surgery, a greater proportion of patients who received peripheral nerve blocks (1.4%) presented to the ED than patients who did not (0.9%) ( P < .001). The greatest risk was in the first 2 postoperative days (relative risk, 1.78; P < .001). Pain was the principal reason for ED utilization in the block cohort (53.6%) compared with those who did not undergo a block (35.1%) ( P < .001). When controlling for comorbidities and demographics, only peripheral nerve blocks (adjusted odds ratio [OR], 1.71; P = 0.007) and preprocedural opioid use (adjusted OR, 1.43; P = .020) conferred an independently increased risk of ED utilization within the first 2 postoperative days.

Conclusions

Peripheral nerve blocks used for upper extremity surgery are associated with a higher risk of unplanned ED utilization, most likely related to rebound pain. Through proper patient education and pain management, we can minimize this unnecessary resource utilization.
Risk of community-acquired pneumonia requiring hospitalization in patients with spondyloarthritis
Authors: Chung Ho Yin , Tam Lai Shan , Chan Shirley Chiu Wai , Cheung Jason Pui Yin , Wong Pui Yan , Ciang Chu Oi , Ng Hoi Yan , Law Mei Yan , Lai Tin Lok , Wong Ching Han ,   Hong Kong Society of Rheumatology
Published: October 2020

Aims:

To compare the risk of community-acquired pneumonia (CAP) requiring hospitalization in spondyloarthritis (SpA) and non-specific back pain (NSBP), and to identify the risk factors for CAP in SpA.

Methods:

A total of 2984 patients with SpA from 11 rheumatology centers and 2526 patients with NSBP from orthopedic units were reviewed from the centralized electronic database in Hong Kong. Incidence of CAP requiring hospitalization and demographic data including age, gender, smoking and drinking status, use of sulfasalazine, individual biological-disease modifying anti-rheumatic drugs (DMARDs) used, micro-organisms, other immunosuppressants or immunosuppressive states, use of steroid for more than ½ year, and co-morbidities were identified. Risks of CAP in SpA were compared with those in NSBP using propensity score regression method. Multivariate Cox regression model was used to identify the risk factors in SpA.

Results:

CAP requiring hospitalization was found in 183 patients with SpA and 138 patients with NSBP. Increased risk for CAP was found in the following groups with SpA: all subgroups (hazard ratio (HR) 2.14, p < 0.001), without use of DMARDs (HR 2.64, p < 0.001), without psoriasis and not taking DMARDs (HR 2.38, p < 0.001). Infliximab (HR2.55, p = 0.04), smoking (HR 1.68, p = 0.003), comorbid psoriasis (HR 1.67, p = 0.003), and use of steroid for more than ½ year (HR 1.94, p = 0.003) were found to associate with CAP after adjustments for traditional risk factors.

Conclusion:

Risk of CAP is increased in patients with SpA. Our data favor universal influenza and pneumococcal vaccination programs in the population. Rheumatologists should also advise smoking cessation and avoid long term steroid therapy.
Blockchain-based human resource management practices for mitigating skills and competencies gap in workforce
Authors: Fachrunnisa Olivia , Hussain Farookh Khadeeer
Published: October 2020

Skills gap between company needs and competencies occupied by the workforce can be the source of inefficiencies. The purpose of this research is to develop a blockchain-based human resource (HR) framework to match the needs from the company and workforce competencies This framework will help Corporate Training Centre to standardized the competencies which then used by HR Department to develop the training material. In order to get valid information regarding skills that are needed from the company, we develop a prototype based on Blockchain. Hence, blockchain-based HRM is built to improve the quality of workforce competency in an organization. The current organizations are struggling to fulfil the needs of the workforce in accordance with industry quality standards. Therefore, this will help all parties to create a consensus between the needs of the industry with the labour market. Corporate Training Centre through the competent institution will be the mediator or intermediary to unite the information from companies, training institutions, and Professional Certification Institutions. As a result, in the long term, the needs of the workforce with the qualification required by the company in such industries will always fit the current situation. Blockchain helps to process the information and data needed by each party so that the connection between parties will be assisted efficiently and effectively.
In situ suturing of a post-meatal segment of the anterior inferior cerebellar artery dissected by an aneurysm: A technical note
Authors: Hou Kun , Xu Kan , Guo Yunbao , Yu Jinlu
Published: October 2020

Aneurysms originating along the peripheral portion of the anterior inferior cerebellar artery (AICA) are rare entities. As a result of the small diameter of the AICA, it is very challenging to preserve the parent artery during endovascular treatment for a peripheral AICA aneurysm. In this report, we present a rare case of aneurysm in the a2 segment of the right AICA. During surgery, the aneurysm was found to be a dissecting aneurysm. As the tissue of the aneurysm neck had a similar thickness to that of the adjacent normal vessel, interrupted suturing of the vessel was performed after partial removal and trimming of the aneurysm wall. The patient experienced an uneventful postoperative recovery. No other neurological deficit was noted. Magnetic resonance imaging three days after surgery revealed no acute ischaemia in the brainstem and cerebellum. Catheter angiography nine months later showed no recurrence of the aneurysm or stenosis of the AICA. The a2 segment of the AICA runs tortuously along the subarachnoid space of the cerebellopontine angle, which permits higher vascular mobility. In selected cases, in situ suturing or re-anastomosis could be considered for a2 segment aneurysms.
Remedies for breaches of prisoners’ rights in the European Prison Rules
Authors: Kamber Kresimir
Published: October 2020

This article looks into the architecture of remedies for breaches of the right of prisoners not to be subjected to inadequate conditions of detention under the revised 2020 European Prison Rules (EPR). It seeks to expound the consistency and rationality of the relevant provisions of the 2020 EPR from the perspective of relevant principles and specific prescriptions of European prison law. For the purpose of the present article, the term ‘European prison law’ encompasses rules and standards set out in the case law of the European Court of Human Rights, practice of the European Committee for the Prevention of Torture and Inhuman or Degrading Treatment or Punishment and the provisions of the EPR. The article finds that, in this context, there is sufficient coherence in the relevant principles of European prison law – faithfully codified in the 2020 EPR – providing clear guidance to European States on how to put in place a system of remedies for breaches of prisoners’ rights and how to ensure its effective operation in practice.
An Overview of Vesicobullous Conditions Affecting the Oral Mucosa
Authors: Hayes Emma , Challacombe Stephen J
Published: October 2020

Vesicobullous diseases are characterised by the presence of vesicles or bullae at varying locations in the mucosa. The most common occurring in the oral cavity are mucous membrane pemphigoid (MMP) and pemphigus vulgaris (PV). Both are autoimmune diseases with a peak age onset of over 60 years and females are more commonly affected than men. This paper reviews the structure of the oral mucosa, with specific reference to the basement membrane zone, as well as bullous conditions affecting the mucosa, including PV and pemphigoid, their aetiology, clinical presentation, and management.

Learning outcomes

• Understand the common presentation of vesicobullous diseases.

• Appreciate the role of investigations in diagnosis and its interpretation.

• Appreciate the roles of both primary and secondary care in patient management.
Dry Mouth and Sjögren's Syndrome: An Overview
Authors: Khan Abgeena , Shirlaw Penelope J
Published: October 2020

Dry mouth is a common condition presenting to a GP or general dental practitioner. The most common cause of a dry mouth is related to medication use, however patients with Sjögren's syndrome, a multisystem autoimmune condition, may present to their dentist rather than their GP complaining of dry mouth and dry eyes. This article explores the causes of dry mouth and how a patient can be investigated to find the cause of their dry mouth. An overview of Sjögren's syndrome, the relevant diagnostic criteria, presenting signs and symptoms, investigations and management principles are outlined.
A Dental Hygienist's and Therapist's Guide to the Management of Tooth Erosion
Authors: Ariyanayagam Yana
Published: October 2020

Dental care professionals can support patients to prevent and manage tooth erosion. The role of the dentist is to restore the structure and function of teeth damaged by acid erosion, while the role of the dental hygienist therapist is to work alongside the dentist to help manage and reduce the risk of tooth erosion. This article will highlight how the dental hygienist or therapist can identify tooth erosion. It will describe the features of tooth erosion and outline the causes. This article will discuss preventative care options for patients who are at risk of tooth erosion, including specific oral hygiene instructions, fluoride advice and use of other dental products.
Dental Pain: Dentine Sensitivity, Hypersensitivity and Cracked Tooth Syndrome
Authors: Longridge Nicholas Neil , Youngson Callum Cormack
Published: October 2020

Dentine hypersensitivity is a frequently encountered patient complaint that can present with a number of associated factors including erosion and abrasion. The hydrodynamic mechanism responsible for dentine hypersensitivity is intimately related to the anatomical and physiological composition of teeth. Alterations to the integrity of the enamel and dentine through processes of trauma, decay and toothwear can increase dentine permeability. This gives rise to symptoms of sensitivity as dentinal fluid movement in response to thermal, chemical and mechanical cues stimulate the pulpal Aδ fibres. Restorative procedures can also rapidly change the architecture of the protective enamel and dentine layers leading to pulpal inflammation and increased thermal sensitivity of the tooth.

Patient-reported symptoms of dentine hypersensitivity can be attributed to a number of possible causes and a definitive diagnosis can therefore be difficult. A full history including social and medical factors such as occupation, diet and/or medication is likely to provide significant information to aid a diagnosis. Consideration of occlusal factors should not be overlooked as these may contribute to symptoms arising from a cracked tooth.

Management strategies are linked to the diagnosis – from topically applied desensitising pastes and resin bonding agents to direct restorations and possibly more advanced restorative procedures such as root canal treatment. Management should, however, be staged to enable more conservative strategies to prevail prior to considering irreversible dental interventions.
Treatment patterns of women with endometriosis in Canada
Authors: Singh Sukhbir , Soliman Ahmed M , Rahal Yasmine , Robert Catherine , Defoy Isabelle , Nisbet Paul , Leyland Nicholas
Published: October 2020

Introduction:

We aimed to characterize the treatment patterns of women with a self-reported diagnosis of endometriosis in Canada.

Methods:

Between December 2018 and January 2019 an online cross-sectional survey was administered to women aged 18 to 49 who were members of the Survey Sampling International and two partner panels in Canada. The survey included a prevalence screener and an endometriosis-focused section. Self-reported treatment patterns among women reporting endometriosis diagnosis were analyzed descriptively.

Results:

Of 30,000 survey respondents, 2004 reported an endometriosis diagnosis (prevalence after weighting of 7%). Treatment status reported by these women was: 34.2% currently treated, 35.9% with prior but no current treatment, and 27.1% never treated. Among women with prior or current treatment, over-the-counter (OTC) medications, contraceptive pills/patches, and surgical procedures were used by 42.0%, 37.1%, and 26.4%, respectively, prior to diagnosis and by 39.9%, 33.0%, and 43.5%, respectively, following diagnosis. First treatments for endometriosis most commonly reported were OTC medications (28.9%) and surgical procedures (21.6%). Second treatments were reported by 46.5% of women, with surgical procedures (26.1%) being the most frequently reported. The most commonly reported endometriosis-associated surgeries were surgical ablation/excision (37.4%).

Conclusion:

A relevant proportion of women with endometriosis in Canada have multiple therapies with medical management as a first line followed by surgical options. These results emphasize the need to identify more effective and specific endometriosis treatment options and novel strategies.
Understanding the risks of total hip arthroplasty in patients with von Willebrand’s disease
Authors: Yun Andrew G. , Qutami Marilena , Fischer Sean A. , Dylan Pasko Kory B.
Published: October 2020

Purpose:

Patients with von Willebrand’s disease (VWD) have either a qualitative or quantitative deficiency in a key clotting protein called von Willebrand’s factor. Type Ⅰ disease is the most common variant, but its clinical implications in total hip arthroplasty (THA) are unclear. Our purpose is to describe the perioperative impact of VWD in THA.

Methods:

We retrospectively reviewed a total of 17 primary THAs in 14 patients with type Ⅰ VWD performed between 2008 and 2019. Almost all cases (88%) received tranexamic acid, and most (59%) received DDAVP. All patients had a direct anterior approach (DAA) THA.

Results:

None of these cases required a blood transfusion. Mean estimated blood loss was 229 mL, and the mean hemoglobin dropped from 13.9 g/dL to 10.2 g/dL. There were no major bleeding complications. After a mean follow-up of 4 years, the mean hip disability and osteoarthritis outcome score, junior (HOOS, JR) was 79, and there were no reoperations or revisions for any cause.

Conclusion:

Patients with type Ⅰ VWD do not experience severe bleeding with routine chemoprophylaxis combined with DAA THA.
Successful Resolution of Early-Onset Prosthetic Valve Endocarditis Associated With Extended Spectrum β-Lactamases Producing Escherichia coli With Medical Management
Authors: Dhamrah Umaima , Johnson Keely , Amin Aisha , Policar Maurice
Published: October 2020

A 74-year-old male with a recent bioprosthetic mitral valve placement presented with dyspnea, chills, and palpitations. Blood cultures on admission grew extended spectrum β-lactamase Escherichia coli. Transthoracic echocardiogram and transesophageal echocardiography were negative for valvular vegetations, but given the recent history of mitral valve replacement and difficulty visualizing valvular vegetations in prosthetic valve, we initiated treatment of our patient with antibiotics for 6 weeks. Repeat blood cultures showed clearance of the organism and on follow-up, and the patient had no signs of recurrence of infection.
Distal Chevron Osteotomy Increases Anatomic Intermetatarsal Angle in Hallux Valgus
Authors: Chan Jeremy Y. , Noori Naudereh , Chen Stephanie , Pfeffer Glenn B. , Charlton Timothy P. , Thordarson David B.
Published: October 2020

Background:

Distal chevron metatarsal osteotomy (DCO) is a common technique to address hallux valgus (HV), which involves coronal translation of the capital fragment resulting in a nonanatomic first metatarsal. The purpose of this study was to evaluate the radiographic effect of the DCO on the anatomic vs the mechanical axis of the first metatarsal. Our hypothesis was that patients undergoing DCO would have improvement in the mechanical metatarsal axis but worsening of the anatomic axis.

Methods:

This was a retrospective case series of consecutive patients who underwent DCO for HV. The primary outcomes were the change in anatomic first–second intermetatarsal angle (a1-2IMA) vs mechanical first–second intermetatarsal angle (m1-2IMA). Secondary outcomes included the change in hallux valgus angle (HVA) and medial sesamoid position.

Results:

40 feet were analyzed with a mean follow-up of 21.2 weeks. The a1-2IMA increased significantly (mean, 4.1 degrees) whereas the m1-2IMA decreased significantly (mean, 4.6 degrees) following DCO. There was a significant improvement in HVA (mean, 12.5 degrees). Medial sesamoid position was improved in 21 feet (52.5%). Patients with no improvement in sesamoid position were found to have a larger increase in a1-2IMA (mean, 4.7 vs 3.5 degrees, P = .03) and less improvement in m1-2IMA (mean, 3.8 vs 5.2 degrees, P = .02) compared to patients with improvement in sesamoid position.

Conclusion:

Distal chevron osteotomy for HV was associated with worsening of the anatomic axis of the first metatarsal despite improvements in the mechanical metatarsal axis, HVA, and medial sesamoid position. Greater worsening of the anatomic axis was associated with less improvement of sesamoid position. Our findings may suggest the presence of intermetatarsal instability, which could limit the power of DCO in HV correction for more severe deformities and provide a mechanism for HV recurrence.

Level of Evidence:

Level IV, retrospective case series.
Hydration of Na-saturated synthetic stevensite, a peculiar trioctahedral smectite
Authors: Vinci Doriana , Lanson Bruno , Lanson Martine , Magnin Valérie , Findling Nathaniel
Published: October 2020

Smectite interlayer water plays a key role in the mobility of elements and molecules and affects a variety of geological processes. In trioctahedral smectites, in contrast to saponite and hectorite, the layer charge of which originates from isomorphic substitutions, the stevensite layer charge originates from the presence of octahedral vacancies. Despite its common occurrence in lacustrine environments, stevensite hydration has received little attention compared to saponite and hectorite. Early reports mention a specific hydration behaviour, however, with the systematic presence of a low-angle reflection attributed to the regular interstratification of various hydration states. The present study aims to revisit this specific hydration behaviour in more depth. Within this scope, the hydration behaviour of the three smectite varieties above are compared using synthetic trioctahedral smectites of similar layer charge and various compositions of their octahedral sheets. The chemical composition of the octahedral sheet does not appear to influence significantly smectite hydration for saponite and hectorite. Compared to its saponite and hectorite equivalents, H2O content in stevensite is lower by ~2.0 mmol H2O per g of dry clay. Consistent with this lower H2O content, Zn-stevensite lacks a stable monohydrated state, with dehydrated layers prevailing from 60% to 0% relative humidity. The presence of the regular interstratification of 0W and 1W layers is responsible for the low-angle reflection commonly observed for stevensite under air-dried conditions. Finally, the stevensite identification method based on X-ray diffraction of heated and ethylene glycol-solvated samples is challenged by the possible influence of the octahedral sheet chemical composition (Zn or Mg in the present study) on hectorite swelling behaviour in synthetic Zn-smectites. The origin of this effect remains undetermined and further work is needed to propose a more general identification method.
Salt-induced expression of intracellular vesicle trafficking genes, CaRab-GTP, and their association with Na+ accumulation in leaves of chickpea (Cicer arietinum L.)
Authors: Sweetman Crystal , Khassanova Gulmira , Miller Troy K. , Booth Nicholas J. , Kurishbayev Akhylbek , Jatayev Satyvaldy , Gupta Narendra K. , Langridge Peter , Jenkins Colin L.D. , Soole Kathleen L. , Day David A. , Shavrukov Yuri
Published: October 2020

Background

Chickpea is an important legume and is moderately tolerant to salinity stress during the growing season. However, the level and mechanisms for salinity tolerance can vary among accessions and cultivars. A large family of CaRab-GTP genes, previously identified in chickpea, is homologous to intracellular vesicle trafficking superfamily genes that play essential roles in response to salinity stress in plants.

Results

To determine which of the gene family members are involved in the chickpea salt response, plants from six selected chickpea accessions (Genesis 836, Hattrick, ICC12726, Rupali, Slasher and Yubileiny) were exposed to salinity stress and expression profiles resolved for the major CaRab-GTP gene clades after 5, 9 and 15 days of salt exposure. Gene clade expression profiles (using degenerate primers targeting all members of each clade) were tested for their relationship to salinity tolerance measures, namely plant biomass and Na+ accumulation. Transcripts representing 11 out of the 13 CaRab clades could be detected by RT-PCR, but only six (CaRabA2, −B, −C, −D, −E and −H) could be quantified using qRT-PCR due to low expression levels or poor amplification efficiency of the degenerate primers for clades containing several gene members. Expression profiles of three gene clades, CaRabB, −D and −E, were very similar across all six chickpea accessions, showing a strongly coordinated network. Salt-induced enhancement of CaRabA2 expression at 15 days showed a very strong positive correlation (R2 = 0.905) with Na+ accumulation in leaves. However, salinity tolerance estimated as relative plant biomass production compared to controls, did not correlate with Na+ accumulation in leaves, nor with expression profiles of any of the investigated CaRab-GTP genes.

Conclusion

A coordinated network of CaRab-GTP genes, which are likely involved in intracellular trafficking, are important for the salinity stress response of chickpea plants.
Hyperhomocysteinemia and dyslipidemia in point mutation G307S of cystathionine β-synthase-deficient rabbit generated using CRISPR/Cas9
Authors: Zhang Ting , Lu Rui , Chen Yibing , Yuan Yuguo , Song Shaozheng , Yan Kunning , Zha Yiwen , Zhuang Wenwen , Cheng Yong , Liang Jingyan
Published: October 2020

Background

Congenital hyper-homocysteinemia (HHcy) is caused by a defective cystathionine β-synthase (CBS) gene, and is frequently associated with dyslipdemia. The aim of this study was to further elucidate the effect of mutatedCBSgene on circulating lipids using a rabbit model harboring a homozygous G307S point mutation inCBS.

Methods

CRISPR/Cas9 system was used to edit theCBSgene in rabbit embryos. The founder rabbits were sequenced, and their plasma homocysteine (Hcy) and lipid profile were analyzed.

Results

SixCBS-knockout (CBS-KO) founder lines with biallelic modifications were obtained. Mutation inCBScaused significant growth retardation and high mortality rates within 6 weeks after birth. In addition, the 6-week oldCBS-KO rabbits showed higher plasma levels of Hcy, triglycerides (TG), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) compared to the age-matched wild-type (WT) controls. Histological analysis of the mutants showed accumulation of micro-vesicular cytoplasmic lipid droplets in the hepatocytes. However, gastric infusion of vitamin B and betaine complex significantly decreased the plasma levels of TG, TC and LDL-C in theCBS-KO rabbits, and alleviated hepatic steatosis compared to the untreated animals.

Conclusion

ACBSG307Srabbit model was generated that exhibited severe dyslipidemia when fed on a normal diet, indicating that G307S mutation in theCBSgene is a causative factor for dyslipidemia.