bluuebunny/crossref_metadata_2025_split huggingface dataset:
Redox-dependent AMPK inactivation disrupts metabolic adaptation to glucose starvation in xCT-overexpressing cancer cells
Authors: Lee Younghwan , Itahana Yoko , Ong Choon Chen , Itahana Koji 
Published: July 2022

ABSTRACT
Accelerated aerobic glycolysis is a distinctive metabolic property of cancer cells that confers dependency on glucose for survival. However, the therapeutic strategies targeting this vulnerability are still inefficient and have unacceptable side effects in clinical trials. Therefore, developing biomarkers to predict therapeutic efficacy would be essential to improve the selective targeting of cancer cells. Here, we found that cell lines that are sensitive to glucose deprivation have high expression of cystine/glutamate antiporter xCT (also known as SLC7A11). We found that cystine uptake and glutamate export through xCT contributed to rapid NADPH depletion under glucose deprivation. This collapse of the redox system oxidized and inactivated AMP-activated protein kinase (AMPK), a major regulator of metabolic adaptation, resulting in a metabolic catastrophe and cell death. Although this phenomenon was prevented by pharmacological or genetic inhibition of xCT, overexpression of xCT sensitized resistant cancer cells to glucose deprivation. Taken together, these findings suggest a novel crosstalk between AMPK and xCT that links metabolism and signal transduction, and reveal a metabolic vulnerability to glucose deprivation in cancer cells expressing high levels of xCT.
Chief Resident Election of Emergency Department (CREED) – An innovative approach to fair and bias-free chief resident selection in a residency program
Authors: Waheed Shahan , Ali Noman 
Published: July 2022

Emergency medicine has transitioned from developing to a developed specialty in Pakistan. It is gaining recognition in the national and international arena. Residency in emergency medicine is a tough pathway in which a resident learns and is assessed at multiple levels. The attributes that are needed for an empathetic emergency medicine physician are multifaceted. Chief resident selection has been an important step in postgraduate residency. The selection process was traditionally based on seniority and academic achievements with no consideration for soft skills. In the current write-up, we are proposing an evidence-base sequential chief resident selection process called Chief Resident Election of Emergency Department (CREED). The program was developed keeping in consideration the traditional method of election and interviews with the incorporation of reflexive, leadership, communication, and collaboration skills.
doi: https://doi.org/10.12669/pjms.38.6.6099
How to cite this:Waheed S, Ali N. Chief Resident Election of Emergency Department (CREED) – An innovative approach to fair and bias-free chief resident selection in a residency program. Pak J Med Sci. 2022;38(6):---------. doi: https://doi.org/10.12669/pjms.38.6.6099
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
The relationship of age, sex and prothrombin time related to the severity and mortality of COVID-19 patients with diabetes mellitus: a systematic review and meta analysis
Authors: Mirza Audrey Fabianisa , Halim Ceria , Sari Mutiara Indah 
Published: July 2022

Background: SARS-CoV-2 first appeared in Wuhan, China, in December 2019. Looking at the prevalence data in the world and in Indonesia, the highest mortality rate due to COVID-19 involves age, gender and comorbidities such as diabetes mellitus. Severity of the condition also refers to coagulation abnormalities, such as abnormal prothrombin time values. Methods: This systematic review study and meta-analysis used online literature sourced from PubMed, Science Direct, EBSCO, Cochrane and Google Scholar. The literature used here is literature that has data on age, sex and prothrombin time of COVID-19 patients with diabetes mellitus whose quality is assessed by the NOS (Newcastle-Ottawa Scale) criteria and processing data using Review Manager 5.4. Results: Out of 8711 literatures that were traced from various search sources, there were 46 literatures that were included in this study. The results of the analysis on age showed the Standardized Mean Difference (SMD) value of 0.45 and P <0.0001 (95% CI: 0.23–0.68), the gender analysis showed an Odds Ratio (OR) value of 3.28 and P = 0.01 (95% CI: 1.26–8.52) and the prothrombin time analysis showed SMD values of 0.41 and P = 0.07 (95%CI = -0.03–0.85). Conclusion: A person who is infected with COVID-19 and has comorbid diabetes mellitus has a high risk of disease severity and mortality if he is older and male.
Factor puzzles from definition to applications
Authors: Abusaris Raghib , ALHAMI KIFAH 
Published: July 2022

Background: Factor puzzles are a salient tool that has been consigned to oblivion. Methods: In this paper, we introduce factor puzzles and study the existence and uniqueness of solutions along with their connections to other areas of mathematics and real-world applications. Results: Using concepts from elementary number theory, we prove several theorems pertinent to the existence and uniqueness of a solvable factor puzzle, and the number of solutions. Furthermore, we established connections between factor puzzles and polynomial as well as matrix factorizations. In addition, we demonstrate the importance of factor puzzles in the real world was evidenced by an application in cryptography. Conclusion: Factor puzzles are a prominent tool with many remarkable connections and real-world applications.
Improving symptom assessment and management in the community through capacity building of primary palliative care: A study protocol of exploratory research
Authors: Nayak Malathi G , Pai Radhika R , Nayak Baby S , Upadya P Sudhakara , Salins Naveen 
Published: July 2022

Aim: To determine the effectiveness of capacity building program on palliative care (PC) in enhancing the capacity of the primary health care workers in need assessment and symptom management of cancer patients. Background: In India, less than one percent of people living with cancer have access to palliative care since most are from low- and middle-income groups. Accredited social health activist (ASHA) and primary health care workers are grassroots workers who are the first contact with family members and are seldom aware of PC in India. It is essential to train them to give practical and efficient care to needy people. Design: A quasi-experimental design with follow-up will be conducted using an evaluative approach. Methods: The study population consists of 1440 Primary Health Care Workers (staff nurses, ANMs, and ASHA workers) of three taluks of Udupi District, Karnataka State, India. Training on PC will be provided for ASHA workers for one day and ANM/Staff nurses for three days. After their training, they are expected to demonstrate the gain in knowledge & skill in providing PC for cancer patients by identifying and implementing PC services using a mobile app at the primary healthcare level. Discussion: Palliative home care can give comfort and reduce patients' financial burden, and this training may help to improve the quality of life of needy patients. Impact: If this palliative care training program succeeds, it can be integrated into the healthcare continuum, making it an essential component of primary healthcare delivery to achieve universal health coverage. Moreover, home-based PC supports patients who want to die at home even though it reduces hospital stay costs. Trial registration: CTRI/2020/04/024792.
Performance evaluation of the smartphone-based AI cough monitoring app - Hyfe Cough Tracker against solicited respiratory sounds
Authors: Galvosas Mindaugas , Gabaldón-Figueira Juan C. , Keen Eric M. , Orrillo Virginia , Blavia Isabel , Chaccour Juliane , Small Peter M. , Giménez Gerard , Grandjean Lapierre Simon , Chaccour Carlos 
Published: July 2022

Background : Emerging technologies to remotely monitor patients’ cough show promise for various clinical applications. Currently available cough detection systems all represent a trade-off between convenience and performance. The accuracy of such technologies is highly contingent on the clinical settings in which they are intended to be used. Moreover, establishing gold standards to measure this accuracy is challenging. Objectives : We present the first performance evaluation study of the Hyfe Cough Tracker app, a passive cough monitoring smartphone application. We evaluate performance for cough detection using continuous audio recordings and cough counting by trained individuals as the gold standard. We propose standard procedures to use multi-observer cough sound annotation from continuous audio recordings as the gold standard for evaluating automated cough detection devices. Methods : This study was embedded in a larger digital acoustic surveillance study (clinicaltrial.gov NCT04762693). Forty-nine participants were included and instructed to produce a diverse series of solicited sounds in 10-minute sessions. Simultaneously, continuous audio recording was performed using a MP3 recorder and two smartphones running Hyfe Cough Tracker app monitored and identified cough events. All continuous audio recordings were independently labeled by three medically-trained researchers. Results : Hyfe Cough Tracker app showed sensitivity of 91% and specificity of 98% with a very high correlation between the cough rate measured by Hyfe and that of human annotators (Pearson correlation of 0.968). A standardized approach to establish an acoustic gold standard for identifying cough sounds with multiple observers is presented. Conclusion: This is the first performance evaluation of a new smartphone-based cough monitoring system. Hyfe Cough Tracker can detect, record and count coughs from solicited cough-like explosive sounds in controlled acoustic environments with very high accuracy. Additional steps are required to validate the system in clinical and community settings.
EXPORT OF AGRICULTURAL PRODUCTS FROM THE STATES OF THE ASSOCIATION OF SOUTH-EASTERN ASIAN COUNTRIES (ASEAN)
Authors: Aksenov Ilia A. , Afonin Petr N. , Shanazarova Elena V. 
Published: July 2022

Background. ASEAN currently forms a solid economic bloc with a combined GDP of US $ 3 trillion, a relatively high share of agriculture in GDP (11.3% in 2010-2020) and an expanding agri-food market based on changing conditions. global and regional trade patterns.
Purpose. It consists in analyzing and identifying the problems of agri-food exports of the states that are members of the Association of Southeast Asian Nations (ASEAN).
Materials and methods. The research is based on the Declaration on the Establishment of ASEAN (Signed in Bangkok on August 08, 1967), statistics from the Food and Agriculture Organization of the United Nations, ASEAN, and the World Trade Center. In this work, dialectical, systemic, logical research methods were used.
Results. As a result of the analysis carried out in the article on agri-food exports by product, it was revealed that animal, vegetable fats and oils are the most important agricultural products of the ASEAN countries, providing a quarter of regional and more than a third of world exports.
Conclusion. The agro-export policy of the ASEAN countries is largely fragmented. This is mainly due to the internal differences between the states that make up this bloc.
Oxidized zirconium versus cobalt-chrome femoral heads in total hip arthroplasty: a multicentre prospective randomized controlled trial with ten years’ follow-up
Authors: Kayani Babar , Baawa-Ameyaw Joanna , Fontalis Andreas , Tahmassebi Jenni , Wardle Nick , Middleton Robert , Stephen Arthur , Hutchinson James , Haddad Fares S. 
Published: July 2022

Aims This study reports the ten-year wear rates, incidence of osteolysis, clinical outcomes, and complications of a multicentre randomized controlled trial comparing oxidized zirconium (OxZr) versus cobalt-chrome (CoCr) femoral heads with ultra-high molecular weight polyethylene (UHMWPE) and highly cross-linked polyethylene (XLPE) liners in total hip arthroplasty (THA). Methods Patients undergoing primary THA were recruited from four institutions and prospectively allocated to the following treatment groups: Group A, CoCr femoral head with XLPE liner; Group B, OxZr femoral head with XLPE liner; and Group C, OxZr femoral head with UHMWPE liner. All study patients and assessors recording outcomes were blinded to the treatment groups. The outcomes of 262 study patients were analyzed at ten years’ follow-up. Results Patients in Group C were associated with increased mean liner wear rates compared to patients in Group A (0.133 mm/yr (SD 0.21) vs 0.031 mm/yr (SD 0.07), respectively; p < 0.001) and Group B (0.133 mm/yr (SD 0.21) vs 0.022 mm/yr (SD 0.05), respectively; p < 0.001) at ten years’ follow-up. Patients in Group C were also associated with increased risk of osteolysis and aseptic loosening requiring revision surgery, compared with patients in Group A (7/133 vs 0/133, respectively; p = 0.007) and Group B (7/133 vs 0/135, respectively; p = 0.007). There was a non-statistically significant trend towards increased mean liner wear rates in Group A compared with Group B (0.031 mm/yr (SD 0.07) vs 0.022 mm/yr (SD 0.05), respectively; p = 0.128). All three groups were statistically comparable preoperatively and at ten years’ follow-up when measuring normalized Western Ontario and McMaster Universities Osteoarthritis Index (p = 0.410), 36-Item Short Form Health Survey (p = 0.465 mental, p = 0.713 physical), and pain scale scores (p = 0.451). Conclusion The use of UHMWPE was associated with progressively increased annual liner wear rates after THA compared to XLPE. At ten years’ follow-up, the group receiving UHMWPE demonstrated an increased incidence of osteolysis and aseptic loosening requiring revision surgery compared to XLPE. Femoral heads composed of OxZr were associated with trend towards reduced wear rates compared to CoCr, but this did not reach statistical significance and did not translate to any differences in osteolysis, functional outcomes, or revision surgery between the two femoral head components. Cite this article: Bone Joint J 2022;104-B(7):833–843.
Effective single-stage revision using intra-articular antibiotic infusion after multiple failed surgery for periprosthetic joint infection
Authors: Ji Baochao , Li Guoqing , Zhang Xiaogang , Xu Boyong , Wang Yang , Chen Yongjie , Cao Li 
Published: July 2022

Aims Periprosthetic joint infections (PJIs) with prior multiple failed surgery for reinfection represent a huge challenge for surgeons because of poor vascular supply and biofilm formation. This study aims to determine the results of single-stage revision using intra-articular antibiotic infusion in treating this condition. Methods A retrospective analysis included 78 PJI patients (29 hips; 49 knees) who had undergone multiple prior surgical interventions. Our cohort was treated with single-stage revision using a supplementary intra-articular antibiotic infusion. Of these 78 patients, 59 had undergone more than two prior failed debridement and implant retentions, 12 patients had a failed arthroplasty resection, three hips had previously undergone failed two-stage revision, and four had a failed one-stage revision before their single-stage revision. Previous failure was defined as infection recurrence requiring surgical intervention. Besides intravenous pathogen-sensitive agents, an intra-articular infusion of vancomycin, imipenem, or voriconazole was performed postoperatively. The antibiotic solution was soaked into the joint for 24 hours for a mean of 16 days (12 to 21), then extracted before next injection. Recurrence of infection and clinical outcomes were evaluated. Results A total of 68 patients (87.1%) were free of infection at a mean follow-up time of 85 months (24 to 133). The seven-year infection-free survival was 87.6% (95% confidence interval (CI) 79.4 to 95.8). No significant difference in infection-free survival was observed between hip and knee PJIs (91.5% (95% CI 79.9 to 100) vs 84.7% (95% CI 73.1 to 96.3); p = 0.648). The mean postoperative Harris Hip Score was 76.1 points (63.2 to 92.4) and Hospital for Special Surgery score was 78. 2 (63.2 to 92.4) at the most recent assessment. Polymicrobial and fungal infections accounted for 14.1% (11/78) and 9.0% (7/78) of all cases, respectively. Conclusion Single-stage revision with intra-articular antibiotic infusion can provide high antibiotic concentration in synovial fluid, thereby overcoming reduced vascular supply and biofilm formation. This supplementary route of administration may be a viable option in treating PJI after multiple failed prior surgeries for reinfection. Cite this article: Bone Joint J 2022;104-B(7):867–874.
Treatment patterns and clinical and economic burden of hip dislocation following primary total hip arthroplasty in England
Authors: Galvain Thibaut , Mantel Jack , Kakade Onkar , Board Tim N. 
Published: July 2022

Aims The aim of this study was to estimate the clinical and economic burden of dislocation following primary total hip arthroplasty (THA) in England. Methods This retrospective evaluation used data from the UK Clinical Practice Research Datalink database. Patients were eligible if they underwent a primary THA (index date) and had medical records available 90 days pre-index and 180 days post-index. Bilateral THAs were excluded. Healthcare costs and resource use were evaluated over two years. Changes (pre- vs post-THA) in generic quality of life (QoL) and joint-specific disability were evaluated. Propensity score matching controlled for baseline differences between patients with and without THA dislocation. Results Among 13,044 patients (mean age 69.2 years (SD 11.4), 60.9% female), 191 (1.5%) had THA dislocation. Two-year median direct medical costs were £15,333 (interquartile range (IQR) 14,437 to 16,156) higher for patients with THA dislocation. Patients underwent revision surgery after a mean of 1.5 dislocations (1 to 5). Two-year costs increased to £54,088 (IQR 34,126 to 59,117) for patients with multiple closed reductions and a revision procedure. On average, patients with dislocation had greater healthcare resource use and less improvement in EuroQol five-dimension index (mean 0.24 (SD 0.35) vs 0.44 (SD 0.35); p < 0.001) and visual analogue scale (0.95 vs 8.85; p = 0.038) scores, and Oxford Hip Scores (12.93 vs 21.19; p < 0.001). Conclusion The cost, resource use, and QoL burden of THA dislocation in England are substantial. Further research is required to understand optimal timing of revision after dislocation, with regard to cost-effectiveness and impact on QoL. Cite this article: Bone Joint J 2022;104-B(7):811–819.
20-year hip survivorship and patient-reported outcome measures after transpositional osteotomy of the acetabulum for dysplastic hips
Authors: Nakashima Yasuharu , Ishibashi Shojiro , Kitamura Kenji , Yamate Satoshi , Motomura Goro , Hamai Satoshi , Ikemura Satoshi , Fujii Masanori 
Published: July 2022

Aims Although periacetabular osteotomies are widely used for the treatment of symptomatic dysplastic hips, long-term surgical outcomes and patient-reported outcome measures (PROMs) are still unclear. Accordingly, we assessed hip survival and PROMs at 20 years after transpositional osteotomy of the acetabulum (TOA). Methods A total of 172 hips in 159 patients who underwent TOA were followed up at a mean of 21.02 years (16.6 to 24.6) postoperatively. Kaplan-Meier analysis was used to assess survivorship with an endpoint of total hip arthroplasty (THA). PROMs included the visual analogue scale (VAS) Satisfaction, VAS Pain, Oxford Hip Score (OHS), and Forgotten Joint Score-12 (FJS-12). Thresholds for favourable outcomes for OHS (≥ 42) and FJS-12 (≥ 51) were obtained using the receiver operating characteristic curve with VAS Satisfaction ≥ 50 and VAS Pain < 20 as anchors. Results THA was performed on 37 hips (21.5%) by the latest follow-up. Kaplan-Meier analysis indicated that the hip survival rate at 20 years was 79.7% (95% confidence interval (CI) 73.7 to 86.3). Multivariate analysis showed that preoperative Tönnis grade significantly influenced hip survival. Tönnis grades 0, 1, and 2 were associated with 20-year survival rates of 93.3% (95% CI 84.8 to 100), 86.7% (95% CI 79.8 to 94.3), and 54.8% (95% CI 41.5 to 72.3), respectively. More than 60% of the patients exhibited favourable PROMs. An advanced Tönnis grade at the latest follow-up and a higher BMI were both significantly associated with unfavourable OHS, but not with other PROMs. Conclusion This study demonstrated the durability of TOA for hips with Tönnis grades 0 to 1 at 20 years. While the presence of advanced osteoarthritis and higher BMI was associated with lower hip functions (OHS), it was not necessarily associated with worse patient satisfaction and joint awareness. Cite this article: Bone Joint J 2022;104-B(7):767–774.
Modifiable and non-modifiable risk factors in hip fracture mortality in Norway, 2014 to 2018
Authors: Kjærvik Cato , Gjertsen Jan-Erik , Stensland Eva , Saltyte-Benth Jurate , Soereide Odd 
Published: July 2022

Aims This study aimed to identify risk factors (patient, healthcare system, and socioeconomic) for mortality after hip fractures and estimate their relative importance. Further, we aimed to elucidate mortality and survival patterns following fractures and the duration of excess mortality. Methods Data on 37,394 hip fractures in the Norwegian Hip Fracture Register from January 2014 to December 2018 were linked to data from the Norwegian Patient Registry, Statistics Norway, and characteristics of acute care hospitals. Cox regression analysis was performed to estimate risk factors associated with mortality. The Wald statistic was used to estimate and illustrate relative importance of risk factors, which were categorized in modifiable (healthcare-related) and non-modifiable (patient-related and socioeconomic). We calculated standardized mortality ratios (SMRs) comparing deaths among hip fracture patients to expected deaths in a standardized reference population. Results Mean age was 80.2 years (SD 11.4) and 67.5% (n = 25,251) were female. Patient factors (male sex, increasing comorbidity (American Society of Anesthesiologists grade and Charlson Comorbidity Index)), socioeconomic factors (low income, low education level, living in a healthcare facility), and healthcare factors (hip fracture volume, availability of orthogeriatric services) were associated with increased mortality. Non-modifiable risk factors were more strongly associated with mortality than modifiable risk factors. The SMR analysis suggested that cumulative excess mortality among hip fracture patients was 16% in the first year and 41% at six years. SMR was 2.48 for the six-year observation period, most pronounced in the first year, and fell from 10.92 in the first month to 3.53 after 12 months and 2.48 after six years. Substantial differences in median survival time were found, particularly for patient-related factors. Conclusion Socioeconomic, patient-, and healthcare-related factors all contributed to excess mortality, and non-modifiable factors had stronger association than modifiable ones. Hip fractures contributed to substantial excess mortality. Apparently small survival differences translate into substantial disparity in median survival time in this elderly population. Cite this article: Bone Joint J 2022;104-B(7):884–893.