bluuebunny/crossref_metadata_2025 huggingface dataset:
Nucleation–Growth Versus Spinodal Decomposition in Fe–Cr Alloys: An Experimental Verification by Atom Probe Tomography and Small Angle Neutron Scattering
Authors: Sarkar Sudip Kumar , Ray Debes , Sen Debasis , Biswas Aniruddha
Published: February 2023

Identifying the operative mode of phase separation [spinodal decomposition (SD) or nucleation–growth (NG)] remains an extremely important area of research. The present work examines this critically in the Fe–Cr system using atom probe tomography (APT) and small angle neutron scattering (SANS), and establishes the framework to distinguish the two different modes of α′ phase separation in thermally aged Fe–35 at% Cr and Fe–20 at% Cr alloys. Independent APT analysis determines the mode of phase separation on the basis of (i) the presence/absence of periodic chemical fluctuation through radial distribution function analysis and (ii) interphase interface characteristics (diffuse/sharp). SANS analysis, in contrast, yields virtually indistinguishable correlation peaks for both the modes, which necessitates further investigation of the several different aspects of SANS profiles in the light of APT results. For the first time, key features of SANS profiles have been identified that can unambiguously distinguish SD from NG in the Fe–Cr system: (i) nature of temporal evolution of FWHM of the correlation peak and (ii) appropriate value of γ for fitting with the dynamic scaling model (γ = 6 for SD, Fe–35 at% Cr alloy; γ = 4 for NG, Fe–20 at% Cr alloy).
Identifying the Best Approximating Model in Bayesian Phylogenetics: Bayes Factors, Cross-Validation or wAIC?
Authors: Lartillot Nicolas
Published: February 2023

There is still no consensus as to how to select models in Bayesian phylogenetics, and more generally in applied Bayesian statistics. Bayes factors are often presented as the method of choice, yet other approaches have been proposed, such as cross-validation or information criteria. Each of these paradigms raises specific computational challenges, but they also differ in their statistical meaning, being motivated by different objectives: either testing hypotheses or finding the best-approximating model. These alternative goals entail different compromises, and as a result, Bayes factors, cross-validation, and information criteria may be valid for addressing different questions. Here, the question of Bayesian model selection is revisited, with a focus on the problem of finding the best-approximating model. Several model selection approaches were re-implemented, numerically assessed and compared: Bayes factors, cross-validation (CV), in its different forms (k-fold or leave-one-out), and the widely applicable information criterion (wAIC), which is asymptotically equivalent to leave-one-out cross-validation (LOO-CV). Using a combination of analytical results and empirical and simulation analyses, it is shown that Bayes factors are unduly conservative. In contrast, CV represents a more adequate formalism for selecting the model returning the best approximation of the data-generating process and the most accurate estimates of the parameters of interest. Among alternative CV schemes, LOO-CV and its asymptotic equivalent represented by the wAIC, stand out as the best choices, conceptually and computationally, given that both can be simultaneously computed based on standard Markov chain Monte Carlo runs under the posterior distribution. [Bayes factor; cross-validation; marginal likelihood; model comparison; wAIC.]
An exercise in restraint: amending the presumption of advancement
Authors: Morsali Emitis
Published: February 2023

This article considers the law concerning the presumption of advancement as it applies in the United Kingdom and other common law countries. The article suggests that the proposed legislative reforms in the United Kingdom, by which the presumption would be abolished, provide no sure guide for the path the law will take in the future. This is evidenced by the fact that they have failed to come into force as of January 2023. Governments should instead exercise restraint, permitting the law to continue to be developed by the courts on a case-by-case basis, sensitive to the realities of modern social conditions and human relationships, on which the presumption has always been, and should continue to be, anchored.
Uterine Externalization Versus In Situ Repair of Hysterotomy During Cesarean Delivery: A Systematic Review, Equivalence Meta-analysis, and Trial Sequential Analysis
Authors: Bhat A. , Jaffer D. , Keasler P. , Kamath K. , Kelly J. , Singh P.M.
Published: February 2023

(Int J Obstet Anesth. 2022;50:103271)

Cesarean delivery (CD) technique should be optimized in order to optimize quality of recovery, oral intake, bowel function, and ambulation. Two different and contested forms of surgical techniques exist in order to repair the hysterotomy-externalization and in situ repair. Previous studies have demonstrated differing results in outcomes between the 2 techniques, leading to clinical equipoise and choice based on provider preference. This study examined different randomized controlled studies chosen for data accuracy and consistency that compared in situ and externalized uterine repair in an effort to analyze the greatest number of patients possible.
Supine Hypotensive Syndrome of Pregnancy: A Review of Current Knowledge
Authors: Massoth C. , Chappell D. , Kranke P. , Wenk M.
Published: February 2023

(Eur J Anaesthesiol. 2022;39:236–243)

Supine hypotensive syndrome was first described in 1953, which was used to describe acute hypotension associated with pallor, sweating, increased femoral venous pressure, and increased pulse rate during pregnancy when lying in a supine position for 3 to 7 minutes. It continues to be a peripartum challenge in the field of obstetrics today, and the use of the 15 degrees lateral tilt (first introduced in the 1970s) during labor and cesarean section remains a mandatory clinical practice worldwide. Modern physiological and anatomic knowledge prompts a reassessment of guidelines regarding supine hypotensive syndrome of pregnancy. This review looks at the definition and physiology of supine hypotensive syndrome; symptomatic vs. asymptomatic parturients; hemodynamic measurements and compression of the aorta when in the supine position; maternal position and fetal compromise; and implications for obstetric anesthesia.
Lawmakers v. The Scientific Realities of Human Reproduction
Authors: Rasmussen S.A. , Jamieson D.J.
Published: February 2023

(N Engl J Med. 2022;387:367–368)

The Dobbs v. Jackson Women’s Health Organization case was determined by the US Supreme Court in favor of having government dictate the health care of Americans regarding human reproduction, overturning the Roe v. Wade decision. The result of the trial was an effort to protect the health of persons seeking abortion, however, data from the National Center for Health Statistics and the Centers for Disease Control and Prevention indicate abortion is not a significant issue concerning maternal mortality rates (0.41 abortion deaths vs 23.8 overall deaths per 100000). Restricting abortion access does not dramatically decrease abortions performed, but it does dramatically impact the safety of those abortions. State laws against abortion can have severe adverse physical, financial, emotional, social, and legal ramifications as well as an impact on maternal mortality. New laws regarding human reproduction bring confusion around IVF rights and risk creating an even greater health and wealth disparity. The New England Journal of Medicine strongly condemns the decision made by the US Supreme Court in the Dobbs v. Jackson Women’s Health Organization case.
Could, Should Families Watch Their Loved One’s Surgeries and, If So, When?
Authors: Quiñónez Z.A. , Pyke-Grimm K.A. , Char D.
Published: February 2023

(Anesth Analg. 2022;135:704–707)

The quality of transparency in health care in an ongoing discussion in the United States. An increasing number of families desire to observe surgical procedures and decision-making processes within the operating room (OR). There are some care locations where families are already allowed such as the ED, ICU, and labor and delivery, and patients may move rapidly to or from one of these sites. This article discusses the presence of families (FP) in the procedural and perioperative environment and the factors and situations to consider including family presence during cesarean delivery, all trying to answer the question of whether FP should be part of family-centered care that would provide increased transparency provided there were not risk of worse clinical outcomes.
Maternal Vaccination and Risk of Hospitalization for Covid-19 Among Infants
Authors: Halasa N.B. , Olson S.M. , Staat M.A. , Newhams M.M. , Price A.M. ,   et al,   Overcoming COVID-19 Investigators
Published: February 2023

(N Engl J Med. 2022;387:109–119)

Coronavirus disease 2019 (COVID-19) increases the risk of maternal and neonatal adverse outcomes. COVID-19 vaccines during pregnancy have been shown to be effective at mitigating the risks of severe COVID-19 side effects in the mother, yet infants <6 months of age are not eligible for the vaccination though still prone to adverse effects of the infection. COVID-19 vaccination of the mother during pregnancy may propagate vaccination benefits to the neonate through transplacental transfer of severe acute respiratory syndrome coronavirus 2 (SARs-CoV-2) antibodies and provide protection to infants. The aim of this study is to analyze maternal vaccination and the risk of hospitalization of infants younger than 6 months of age from COVID-19.
Placenta Accreta Spectrum Disorders: Knowledge Gaps in Anesthesia Care
Authors: Warrick C.M. , Markley J.C. , Farber M.K. , Balki M. , Katz D. , Hess P.E. , Padilla C. , Waters J.H. , Weiniger C.F. , Butwick A.J.
Published: February 2023

(Anesth Analg. 2022;135:191–197)

Placenta accreta spectrum (PAS) disorder is a high-risk, life-threatening illness for pregnant women and its incidence has increased over time. Peripartum complications include massive blood loss, intensive care unit admission, and hysterectomy. Guidelines recommend a multidisciplinary team for PAS disorder management, within which anesthesiologists play an important role as they manage peridelivery care, oversee transfusion-related decisions, and oversee postpartum analgesia. Despite anesthesiologists’ key involvement in PAS disorder management during the peripartum period, the relationship between anesthesiologist involvement and maternal and neonatal outcomes in patients with PAS lacks data. This Special Article analyzes knowledge gaps in anesthesia care for patients with PAS disorder and what research is required to bridge these gaps.
Placenta Accreta Spectrum: We Can Do Better
Authors: Silveira C. , Kirby A. , Melov S.J. , Nayyar R.
Published: February 2023

(Aust N Z J Obstet Gynaecol. 2022;62:376–382)

Placenta accreta spectrum (PAS) describes the range of placental disorders. Based on classifications by the International Federation for Gynecology and Obstetrics, Grade 1 PAS indicates an abnormal adherent placenta (accreta), Grade 2 PAS indicates an abnormal invasive placenta into the uterine muscle (increta), and Grade 3 PAS indicates an abnormal placenta that grows into the uterine wall and surrounding organs (percreta). Risk factors for PAS include increased maternal age, multiparity, previous cesarean delivery (CD) or uterine surgery, in vitro fertilization, and placenta previa. The incidence of PAS has been increasing from 0.4 per 1000 births in earlier studies to as high as 3.7 per 1000 births—a trend largely attributed to the worldwide increase in CD. Because PAS is associated with a number of severe pregnancy complications, such as maternal hemorrhage, hysterectomy, and mortality, its accurate diagnosis is important for the appropriate transfer of care and multidisciplinary team (MDT) management. The aim of this study was to determine the rate of antenatal detection of PAS and the impact of MDT management on pregnancy outcomes.
The Impact on Obstetric and Perinatal Outcomes in Term Infants Following the Introduction of a Color-coded, Hierarchical Cardiotocography Classification System: A Retrospective Noninferiority Study
Authors: Willis M. , Dunn L. , Okano S. , Janssens S. , Kumar S.
Published: February 2023

(Aust N Z J Obstet Gynaecol. 2022;62:370–375)

The effectiveness of continuous cardiotocograph (CTG) monitoring relies on the accurate interpretation of the fetal heart rate (FHR) tracing, taken together with all available clinical information, and followed by appropriate clinical responses. CTG interpretation is dependent on the observations of the obstetrical team and subject to bias. Staff training and consistent, standardized FHR interpretation may help to improve the effectiveness of CTG monitoring. The Royal Australian and New Zealand College of Obstetricians and Gynaecologists’ (RANZCOG) Intrapartum Fetal Surveillance recommends a CTG classification system using prose that defines fetal compromise as low, unlikely, maybe, or likely. A new color-coded system, the Queensland Clinical Guidelines (QCG), complements this prose-system, by using green, blue, yellow, and red to define fetal compromise, and recommends appropriate actions in response to each CTG category. The aim of this study was to assess the effectiveness of the color-coded CTG classification system on pregnancy outcomes before and after implementation.
Disconnected Perspectives: Patient and Care Provider’s Experiences of Substance Use in Pregnancy
Authors: Mitchell-Foster S.M. , Emon C.E. , Brouwer M. , Duncan Elder L. , King J.
Published: February 2023

(Int J Gynaecol Obstet. 2021;155:170–178)

A negative stigma surrounds substance use in pregnancy and can lead to suboptimal care of parturient women from providers. Indigenous women in Northern British Columbia (BC) have preexisting risk such as generational abuse, racism, and systemic trauma that contribute to increase risk of substance use in pregnancy, putting an already underserved population at greater risk for adverse outcomes. The aim of this study was to discuss substance use in pregnancy from the patient and provider perspective to increase understanding and bridge the gap between patients and providers.
Assessment of Sensory Block During Labor Epidural Analgesia: A Prospective Cohort Study to Determine the Influence of the Direction of Testing
Authors: De Souza Soares E.C. , Balki M. , Downey K. , Ye X.Y. , Carvalho J.C.A.
Published: February 2023

(Can J Anesth/J Can Anesth. 2022;69:750–755)

Sensory block, or a decreased sensitivity to sensory stimuli, occurs with epidural anesthesia during labor. Assessing the degree of sensory block is important both for clinical practice and for patient safety, yet the assessment procedure is not standardized. A variety of stimuli have been used, as well as a variety of endpoints for determining the level of sensory block. This lack of standardization causes not only a difference in the way independent clinicians determine sensory block, it can also result in inconsistent description of these levels for the same patient, as well as issues with replication of studies and implementation of clinical practice.
Pharmacokinetics and Tolerability of Intraperitoneal Chloroprocaine After Fetal Extraction in Women Undergoing Cesarean Delivery
Authors: Togioka B.M. , Zarnegarnia Y. , Bleyle L.A. , Koop D. , Brookfield K. , Yanez N.D. , Treggiari M.M.
Published: February 2023

(Anesth Analg. 2022;135:777–786)

When neuraxial anesthesia is inadequate, there are few analgesic supplemental options that do not cause adverse outcomes for neonate or alter the maternal birth experience. Intraperitoneal chloroprocaine has been used perioperatively for decades to compensate for suboptimal neuraxial anesthesia due to its short in vitro half-life, however, there is a lack of data regarding absorption rate. This study aims to determine intraperitoneal chloroprocaine in vivo half-life and assess tolerability in the clinical setting.
The Enhancing Life Research Laboratory: Tools for Addressing Orientational Distress in the Medical Profession
Authors: Thomas Guenter , Bigger Sara , Kim Jenny , Kim Marie , Yoon John D. , Schweiker William
Published: February 2023

Purpose

To explore distress in the medical profession and how it was highlighted by the ongoing COVID-19 pandemic. The term “orientational distress” was developed to name the experience of a breakdown in the patterns of moral self-understanding and one’s capacity to navigate professional responsibilities.

Method

The Enhancing Life Research Laboratory at the University of Chicago convened a 5-session online workshop (total 10 hours, May–June 2021) to explore orientational distress and to promote collaboration between academics and physicians. Sixteen participants from Canada, Germany, Israel, and the United States engaged in discussions of the conceptual framework and toolkit to address orientational distress within institutional settings. The tools included 5 dimensions of life, 12 dynamics of life, and the role of counterworlds. Follow-up narrative interviews were transcribed and coded using a consensus-based iterative process.

Results

Participants reported that the concept of orientational distress helped explain their professional experiences better than burnout or moral distress. Moreover, participants strongly endorsed the project’s supporting thesis that collaborative work on orientational distress and the tools provided in the research laboratory had a specific intrinsic value and provided benefits not found in other support instruments.

Conclusions

Orientational distress compromises medical professionals and threatens the medical system. Next steps include the dissemination of materials from the Enhancing Life Research Laboratory to more medical professionals and medical schools. In contrast to burnout and moral injury, the concept of orientational distress may better enable clinicians to understand and more fruitfully navigate the challenges of their professional situations.
Metabolomics as a tool to predict the risk of decompensation or liver-related death in patients with compensated cirrhosis
Authors: Nicoară-Farcău Oana , Lozano Juan J. , Alonso Cristina , Sidorova Julia , Villanueva Càndid , Albillos Augustín , Genescà Joan , Llop Elba , Calleja Jose L. , Aracil Carles , Bañares Rafael , Morillas Rosa , Poca Maria , Peñas Beatriz , Augustin Salvador , Tantău Marcel , Thompson Marcos , Perez-Campuzano Valeria , Baiges Anna , Turon Fanny , Hernández-Gea Virginia , Abraldes Juan G. , Tapias Edilmar A. , Torres Ferran , Bosch Jaime , García-Pagán Juan C. ,   on behalf of the PreDesCI Study Investigators
Published: February 2023

Background and Aims:

Patients with compensated cirrhosis with clinically significant portal hypertension (CSPH: HVPG >10 mm Hg) have a high risk of decompensation. HVPG is, however, an invasive procedure not available in all centers. The present study aims to assess whether metabolomics can improve the capacity of clinical models in predicting clinical outcomes in these compensated patients.

Approach and Results:

This is a nested study from the PREDESCI cohort (an RCT of nonselective beta-blockers vs. placebo in 201 patients with compensated cirrhosis and CSPH), including 167 patients for whom a blood sample was collected. A targeted metabolomic serum analysis, using ultra-high-performance liquid chromatography-mass spectrometry, was performed. Metabolites underwent univariate time-to-event cox regression analysis. Top-ranked metabolites were selected using Log-Rank p-value to generate a stepwise cox model. Comparison between models was done using DeLong test. Eighty-two patients with CSPH were randomized to nonselective beta-blockers and 85 to placebo. Thirty-three patients developed the main endpoint (decompensation/liver-related death). The model, including HVPG, Child-Pugh, and treatment received (HVPG/Clinical model), had a C-index of 0.748 (CI95% 0.664–0.827). The addition of 2 metabolites, ceramide (d18:1/22:0) and methionine (HVPG/Clinical/Metabolite model), significantly improved the model’s performance [C-index of 0.808 (CI95% 0.735–0.882); p=0.032]. The combination of these 2 metabolites together with Child-Pugh and the type of treatment received (Clinical/Metabolite model) had a C-index of 0.785 (CI95% 0.710–0.860), not significantly different from the HVPG-based models including or not metabolites.

Conclusions:

In patients with compensated cirrhosis and CSPH, metabolomics improves the capacity of clinical models and achieves similar predictive capacity than models including HVPG.
IgY antibodies against cytolysin reduce ethanol-induced liver disease in mice
Authors: Cabré Noemí , Hartmann Phillipp , Llorente Cristina , Kouno Tetsuya , Wang Yanhan , Zeng Suling , Kim Hyun Young , Zhang Xinlian , Kisseleva Tatiana , Iyer Subramanian , Kudumala Sirisha , Schnabl Bernd
Published: February 2023

Background and Aims:

Patients with severe alcohol-associated hepatitis have high morbidity and mortality. Novel therapeutic approaches are urgently needed. The aims of our study were to confirm the predictive value of cytolysin-positive Enterococcus faecalis (E. faecalis) for mortality in patients with alcohol-associated hepatitis and to assess the protective effect of specific chicken immunoglobulin Y (IgY) antibodies against cytolysin in vitro and in a microbiota-humanized mouse model of ethanol-induced liver disease.

Approach and Results:

We investigated a multicenter cohort of 26 subjects with alcohol-associated hepatitis and confirmed our previous findings that the presence of fecal cytolysin-positive E. faecalis predicted 180-day mortality in those patients. After combining this smaller cohort with our previously published multicenter cohort, the presence of fecal cytolysin has a better diagnostic area under the curve, better other accuracy measures, and a higher odds ratio to predict death in patients with alcohol-associated hepatitis than other commonly used liver disease models. In a precision medicine approach, we generated IgY antibodies against cytolysin from hyperimmunized chickens. Neutralizing IgY antibodies against cytolysin reduced cytolysin-induced cell death in primary mouse hepatocytes. The oral administration of IgY antibodies against cytolysin decreased ethanol-induced liver disease in gnotobiotic mice colonized with stool from cytolysin-positive patients with alcohol-associated hepatitis.

Conclusions:

E. faecalis cytolysin is an important mortality predictor in alcohol-associated hepatitis patients, and its targeted neutralization through specific antibodies improves ethanol-induced liver disease in microbiota-humanized mice.
Protocol Development and Initial Experience With Intravenous Sotalol Loading for Atrial Arrhythmias
Authors: Feuerborn Melissa L. , Dechand John , Vadlamudi Rohith S. , Torre Michael , Freedman Roger A. , Groh Christopher , Navaravong Leenhapong , Ranjan Ravi , Varela Daniel , Bunch T. Jared , Steinberg Benjamin A.
Published: February 2023

Background:

Oral sotalol is a class III antiarrhythmic commonly used for the maintenance of sinus rhythm in patients with atrial fibrillation (AF). Recently, the Food and Drug Administration (FDA) approved the use of IV sotalol loading, based primarily on modeling data for the infusion. We aimed to describe a protocol and experience with IV sotalol loading for elective treatment of adult patients with AF and atrial flutter (AFL).

Methods:

We present our institutional protocol and retrospective review of initial patients treated with IV sotalol for AF/AFL at the University of Utah Hospital between September 2020 and April 2021.

Results:

Eleven patients received IV sotalol for initial loading or dose escalation. All patients were male, aged 56–88 years (median 69). Mean QT interval (QTc) intervals increased from baseline (mean 384 ms) immediately after infusion of IV sotalol (mean change 42ms), but no patient required discontinuation of the medication. Six patients were discharged after 1 night; 4 patients were discharged after 2 nights; and 1 patient was discharged after 4 nights. Nine patients underwent electrical cardioversion prior to discharge (2 prior to load; 7 post-load on the day of discharge). There were no adverse events during the infusion or within 6 months of discharge. Persistence of therapy was 73% (8 of 11) at mean 9.9 weeks to follow up, with no discontinuations for adverse effects.

Conclusions:

We employed a streamlined protocol that was successfully implemented to facilitate the use of IV sotalol loading for atrial arrhythmias. Our initial experience suggests feasibility, safety, and tolerability while reducing hospitalization duration. Additional data are needed to augment this experience as IV sotalol use is broadened across different patient populations.
Autoimmune Lymphoproliferative Syndrome (ALPS) Disease and ALPS Phenotype: Are They Two Distinct Entities?
Authors: Palmisani Elena , Miano Maurizio , Grossi Alice , Lanciotti Marina , Lupia Michela , Terranova Paola , Ceccherini Isabella , Montanari Eugenia , Calvillo Michaela , Pierri Filomena , Micalizzi Concetta , Maggiore Rosario , Guardo Daniela , Zanardi Sabrina , Facchini Elena , Maggio Angela , Mastrodicasa Elena , Corti Paola , Russo Giovanna , Pillon Marta , Farruggia Piero , Cesaro Simone , Barone Angelica , Tosetti Francesca , Ramenghi Ugo , Crescenzio Nicoletta , Bleesing Jack , Dufour Carlo , Fioredda Francesca
Published: February 2023

Autoimmune lymphoproliferative syndrome (ALPS) is an inherited disorder of lymphocyte homeostasis classically due to mutation of FAS, FASL, and CASP10 genes (ALPS-FAS/CASP10). Despite recent progress, about one-third of ALPS patients does not carry classical mutations and still remains gene orphan (ALPS-U, undetermined genetic defects). The aims of the present study were to compare the clinical and immunological features of ALPS-FAS/CASP10 versus those of ALPS-U affected subjects and to deepen the genetic characteristics of this latter group. Demographical, anamnestic, biochemical data were retrieved from medical record of 46 ALPS subjects. An enlarged panel of genes (next-generation sequencing) was applied to the ALPS-U group. ALPS-U subjects showed a more complex phenotype if compared to ALPS-FAS/CASP10 group, characterized by multiorgan involvement (P = 0.001) and positivity of autoimmune markers (P = 0.02). Multilineage cytopenia was present in both groups without differences with the exception of lymphocytopenia and autoimmune neutropenia that were more frequent in ALPS-U than in the ALPS-FAS/CASP10 group (P = 0.01 and P = 0.04). First- and second-line treatments were able to control the symptoms in 100% of the ALPS-FAS/CASP10 patients, while 63% of ALPS-U needed >2 lines of treatment and remission in some cases was obtained only after target therapy. In the ALPS-U group, we found in 14 of 28 (50%) patients 19 variants; of these, 4 of 19 (21%) were known as pathogenic and 8 of 19 (42%) as likely pathogenic. A characteristic flow cytometry panel including CD3CD4-CD8-+TCRαβ+, CD3+CD25+/CD3HLADR+, TCR αβ+ B220+, and CD19+CD27+ identified the ALPS-FAS/CASP10 group. ALPS-U seems to represent a distinct entity from ALPS-FAS/CASP10; this is relevant for management and tailored treatments whenever available.
Physical Properties and Interaction With the Ocular Surface of Water-Gradient Contact Lenses
Authors: Ponzini Erika , Recchioni Alberto , Cheloni Riccardo , Zeri Fabrizio , Tavazzi Silvia
Published: February 2023

Since the introduction of silicone hydrogel contact lenses, many silicone-hydrogel materials have been produced, including water-gradient contact lenses with a silicone hydrogel core and a thin hydrogel outer layer (e.g., delefilcon A, verofilcon A, and lehfilcon A). Their properties have been investigated in various studies assessing both the chemical–physical characteristics and the comfort, but the overall picture is not always consistent. In this study, water-gradient technology is reviewed by looking at basic physical properties both in vitro and in vivo and at the interaction with the human ocular surface. Surface and bulk dehydration, surface wetting and dewetting, shear stress, interaction with tear components and with other environmental compounds, and comfort are discussed.
The prognostic impact of acute kidney injury recovery patterns in critically ill patients with cirrhosis
Authors: Worden Astin , Pike Francis , Allegretti Andrew S. , Kaur Harleen , Peng Jennifer L. , Kettler Carla D. , Orman Eric S. , Desai Archita P. , Nephew Lauren D. , Ghabril Marwan S. , Patidar Kavish R.
Published: February 2023

Background:

The prognostic impact of acute kidney injury (AKI) recovery patterns in critically ill patients with cirrhosis is unknown. We aimed to compare mortality stratified by AKI recovery patterns and identify predictors of mortality in patients with cirrhosis and AKI admitted to the intensive care unit.

Materials and Methods:

Patients with cirrhosis and AKI from 2016 to 2018 at 2 tertiary care intensive care units were analyzed (N=322). AKI recovery was defined by Acute Disease Quality Initiative consensus: return of serum creatinine <0.3 mg/dL of baseline within 7 days of AKI onset. Recovery patterns were categorized by Acute Disease Quality Initiative consensus: 0–2 days, 3–7 days, and no-recovery (persistence of AKI >7 d). Landmark competing risk univariable and multivariable models (liver transplant as competing risk) was used to compare 90-day mortality between AKI recovery groups and to determine independent predictors of mortality.

Results:

Sixteen percent (N=50) and 27% (N=88) achieved AKI recovery within 0–2 and 3–7 days, respectively; 57% (N=184) had no-recovery. Acute on chronic liver failure was prevalent (83%) and patients with no-recovery were more likely to have grade 3 acute on chronic liver failure (N=95, 52%) compared to patients with AKI recovery [0–2: 16% (N=8); 3–7: 26% (N=23); p<0.001]. Patients with no-recovery had significantly higher probability of mortality [unadjusted-sub-HR (sHR): 3.55; 95% CI: 1.94–6.49; p<0.001] compared to patients with recovery within 0–2 days, while the probability was similar between 3–7 and 0–2 days (unadjusted-sub-HR: 1.71; 95% CI: 0.91–3.20; p=0.09). On multivariable analysis, AKI no-recovery (sub-HR: 2.07; 95% CI: 1.33–3.24; p=0.001), severe alcohol-associated hepatitis (sub-HR: 2.41; 95% CI: 1.20–4.83; p=0.01), and ascites (sub-HR: 1.60; 95% CI: 1.05–2.44; p=0.03) were independently associated with mortality.

Conclusion:

AKI no-recovery occurs in over half of critically ill patients with cirrhosis and AKI and is associated with worse survival. Interventions that facilitate AKI recovery may improve outcomes in this patient population.
Extracorporeal Membrane Oxygenation for Neonates With Congenital Diaphragmatic Hernia: Prevalence of Seizures and Outcomes
Authors: Danzer Enrico , Massey Shavonne L. , Flohr Sabrina J. , Mathew Leny , Hoffman Casey , Abramson Abigail , Selenski Paige , Canning Caroline E. , Eppley Elizabeth , Connelly James T. , Herkert Lisa , Rintoul Natalie E. , Adzick N. Scott , Abend Nicholas S. , Hedrick Holly L.
Published: February 2023

OBJECTIVES:

We aimed to determine the prevalence of electrographic seizures and associated odds of adverse outcomes of electrographic seizures in neonates with congenital diaphragmatic hernia (CDH) receiving extracorporeal membrane oxygenation (ECMO).

DESIGN:

Retrospective, descriptive case series.

SETTING:

Neonatal ICU (NICU) in a quaternary care institution.

PATIENTS:

All neonates with CDH receiving ECMO undergoing continuous electroencephalographic monitoring (CEEG) and follow-up between January 2012 and December 2019.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

All eligible neonates with CDH receiving ECMO underwent CEEG (n = 75). Electrographic seizures occurred in 14 of 75 (19%): they were exclusively electrographic-only in nine of 14, both electrographic-only and electroclinical in three of 14, and electroclinical only in two of 14. Two neonates developed status epilepticus. We identified an association between presence of seizures, rather than not, and longer duration of initial session of CEEG monitoring (55.7 hr [48.2–87.3 hr] vs 48.0 hr [43.0–48.3 hr]; p = 0.001). We also found an association between presence of seizures, rather than not, and greater odds of use of a second CEEG monitoring (12/14 vs 21/61; odds ratio [OR], 11.43 [95% CI, 2.34–55.90; p = 0.0026). Most neonates with seizures (10/14), experienced their onset of seizures more than 96 hours after the start of ECMO. Overall, the presence of electrographic seizures, compared with not, was associated with lower odds of survival to NICU discharge (4/14 vs 49/61; OR 0.10 [95% CI 0.03 to 0.37], p = 0.0006). Also, the presence of seizures—rather than not—was associated with greater odds of a composite of death and all abnormal outcomes on follow-up (13/14 vs 26/61; OR, 17.5; 95% CI, 2.15–142.39; p = 0.0074).

CONCLUSIONS:

Nearly one in five neonates with CDH receiving ECMO developed seizures during the ECMO course. Seizures were predominantly electrographic-only and when present were associated with great odds of adverse outcomes. The current study provides evidence to support standardized CEEG in this population.
Endometrioid Endometrial Carcinoma With NKX3.1 Expression in a Transgender Man: A Case Report
Authors: Yoshida Hiroshi , Uno Masaya , Ogimoto Keisuke , Kobayashi-Kato Mayumi , Tanase Yasuhito , Ishikawa Mitsuya , Kato Tomoyasu
Published: February 2023

Endometrial cancer in transgender men is rare, and its histopathologic features remain unknown. A 30-yr-old transgender man with an intrauterine tumor, an ovarian mass, and a 2-yr history of testosterone use was referred to us for treatment. The presence of the tumors was confirmed via imaging, and the intrauterine tumor was identified as an endometrial endometrioid carcinoma via endometrial biopsy. The patient underwent hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection. Pathologic examination revealed grade 3 endometrioid endometrial carcinoma, and the synchronous endometrial and ovarian tumors were collectively characterized as primary endometrial carcinoma. Metastatic carcinomas were discovered in both ovaries and the omentum, pelvic peritoneum, and a para-aortic lymph node. On immunohistochemistry, the tumor cells diffusely expressed p53, retained expression of PTEN, ARID1A, PMS2, and MSH6, and focally expressed estrogen receptors, androgen receptors, and NKX3.1. NKX3.1 was also expressed in glandular structures within the exocervical squamous epithelium. Prostate-specific antigen and prostatic acid phosphatase were focally positive. In conclusion, we describe a transgender man with NKX3.1-expressing endometrioid endometrial carcinoma who provides valuable suggestions regarding the effects of testosterone on endometrial cancer and appropriate gynecological care for transgender men.
Cervical Gastric-type Adenosquamous Carcinoma: Case Report of a Rare Neoplasm Associated With a BRCA1 Pathogenic Variant
Authors: Rajendran Simon , McGivern Ursula , Gonzalez David , McCluggage W. Glenn
Published: February 2023

Gastric-type adenocarcinoma is the commonest human papillomavirus (HPV)-independent adenocarcinoma of the cervix. We report a rare case of a primary cervical gastric-type adenocarcinoma with malignant squamous elements (gastric-type adenosquamous carcinoma) in a 64-yr-old female. This is only the third report of a cervical gastric-type adenosquamous carcinoma. The tumor was p16 negative and molecular studies for HPV were negative. Next-generation sequencing showed pathogenic variants in BRCA1 and KRAS, as well as variants of unknown significance in CDK12 and ATM and homozygous deletion of CDKN2A/CDKN2B. Pathologists should be aware that not all cervical adenosquamous carcinomas are HPV-associated and the term gastric-type adenosquamous carcinoma is recommended when malignant squamous elements are present within a gastric-type adenocarcinoma. In reporting this case, we discuss the differential and the possible therapeutic options raised by the presence of pathogenic variants in BRCA1.
Naive songbirds show seasonally appropriate spring orientation in the laboratory despite having never completed first migration
Authors: Wynn Joe , Leberecht Bo , Liedvogel Miriam , Burnus Lars , Chetverikova Raisa , Döge Sara , Karwinkel Thiemo , Kobylkov Dmitry , Xu Jingjing , Mouritsen Henrik
Published: February 2023

The role of inherited orientation programmes in determining the outbound migratory routes of birds is increasingly well understood, though less is known about the influence of inherited information on return migration. Previous studies suggest that spatial gradient cues learnt through experience could be of considerable importance when relocating the natal site, though such cues could, in principle, augment rather than replace inherited migratory information. Here, we show that juvenile Eurasian blackcaps (
Sylvia atricapilla
) that have never left northwest Europe (i.e. never had the opportunity to learn navigational information on a continental scale) show significant spring orientation in a direction near-identical to that expected based on ringing recoveries from free-flying individuals. We suggest that this is probably indicative of birds inheriting an orientation programme for spring as well as autumn migration and speculate that, as long as the birds are not displaced far from their normal migration route, the use of inherited spring migratory trajectories might make uni-coordinate ‘stop signs’ sufficiently accurate for the long-distance targeting of their breeding sites.
Context-aware controller inference for stabilizing dynamical systems from scarce data
Authors: Werner Steffen W. R. , Peherstorfer Benjamin
Published: February 2023

This work introduces a data-driven control approach for stabilizing high-dimensional dynamical systems from scarce data. The proposed context-aware controller inference approach is based on the observation that controllers need to act locally only on the unstable dynamics to stabilize systems. This means it is sufficient to learn the unstable dynamics alone, which are typically confined to much lower dimensional spaces than the high-dimensional state spaces of all system dynamics and thus few data samples are sufficient to identify them. Numerical experiments demonstrate that context-aware controller inference learns stabilizing controllers from orders of magnitude fewer data samples than traditional data-driven control techniques and variants of reinforcement learning. The experiments further show that the low data requirements of context-aware controller inference are especially beneficial in data-scarce engineering problems with complex physics, for which learning complete system dynamics is often intractable in terms of data and training costs.
The radial slump of a gravity current in a confined porous layer
Authors: Zheng Zhong
Published: February 2023

The flow of a gravity current widely occurs in many geophysical, environmental and industrial processes. We focus on the overlooked process of radial slump of a gravity current in confined porous layers, which is related to the post-injection flow dynamics of many subsurface displacement processes, initiated by fluid injection through vertical wells. Specifically, we describe the time evolution of the interface shape and location of the propagating front, governed by a second-order nonlinear partial differential equation (PDE). By solving a nonlinear eigenvalue problem, we identify a self-similar solution to describe the dynamics of confined flows at early times, when the interface attaches to both the top and bottom boundaries of the porous layer. As time progresses, the flow gradually becomes unconfined, as gravity-driven slump causes the interface to detach from one boundary; the interface evolution at late times is then described by a self-similar solution of a nonlinear diffusion equation. Time transition from the early-time confined towards late-time unconfined self-similar solutions is also verified by comparing the self-similar solutions and numerical solutions of the governing PDE for both the interface shape and the frontal location. Interestingly, two special vertical locations have also been identified where the best agreement appears between the PDE numerical solutions and the early-time self-similar solutions for the interface shape, which is a novel feature of the radial flow, and the degree of agreement is not impacted by the time evolution.
Sunflower sea star predation on urchins can facilitate kelp forest recovery
Authors: Galloway A. W. E. , Gravem S. A. , Kobelt J. N. , Heady W. N. , Okamoto D. K. , Sivitilli D. M. , Saccomanno V. R. , Hodin J. , Whippo R.
Published: February 2023

The recent collapse of predatory sunflower sea stars (
Pycnopodia helianthoides
) owing to sea star wasting disease (SSWD) is hypothesized to have contributed to proliferation of sea urchin barrens and losses of kelp forests on the North American west coast. We used experiments and a model to test whether restored
Pycnopodia
populations may help recover kelp forests through their consumption of nutritionally poor purple sea urchins (
Strongylocentrotus purpuratus
) typical of barrens.
Pycnopodia
consumed 0.68
S. purpuratus
d
−1
, and our model and sensitivity analysis shows that the magnitude of recent
Pycnopodia
declines is consistent with urchin proliferation after modest sea urchin recruitment, and even small
Pycnopodia
recoveries could generally lead to lower densities of sea urchins that are consistent with kelp-urchin coexistence.
Pycnopodia
seem unable to chemically distinguish starved from fed urchins and indeed have higher predation rates on starved urchins owing to shorter handling times. These results highlight the importance of
Pycnopodia
in regulating purple sea urchin populations and maintaining healthy kelp forests through top-down control. The recovery of this important predator to densities commonly found prior to SSWD, whether through natural means or human-assisted reintroductions, may therefore be a key step in kelp forest restoration at ecologically significant scales.
An Explorative Assessment of ChatGPT as an Aid in Medical Education: Use it with Caution
Authors: Han Zhiyong , Battaglia Fortunato , Udaiyar Abinav , Fooks Allen , Terlecky Stanley R.
Published: February 2023

Objective

To explore the use of ChatGPT by educators and students in a medical school setting.

Method

This study used the public version of ChatGPT launched by OpenAI on November 30, 2022 (https://openai.com/blog/chatgpt/). We employed prompts to ask ChatGPT to 1) generate a content outline for a session on the topics of cholesterol, lipoproteins, and hyperlipidemia for medical students; 2) produce a list of learning objectives for the session; and 3) write assessment questions with and without clinical vignettes related to the identified learning objectives. We assessed the responses by ChatGPT for accuracy and reliability to determine the potential of the chatbot as an aid to educators and as a “know-it-all” medical information provider for students.

Results

ChatGPT can function as an aid to educators, but it is not yet suitable as a reliable information resource for educators and medical students.

Conclusion

ChatGPT can be a useful tool to assist medical educators draft course and session content outlines and create assessment questions. At the same time, caution must be taken as ChatGPT is prone to providing incorrect information; expert oversight and caution are necessary to ensure the information generated is accurate and beneficial to students. Therefore, it is premature for medical students to use the current version of ChatGPT as a “know-it-all” information provider. In the future, medical educators should work with programming experts to explore and grow the full potential of AI in medical education.
EarlyDetect: Development of tool for early detection of stomach adenocarcinoma based on blood-lipid profile as clinicopathological feature
Authors: Prakash Om , Khan Feroz
Published: February 2023

Background

Clinicopathological features are used for detection of diseases. Early detection of cancer can be significance for understanding the behavior of disease.

Results

We developed a tool to observe stomach adenocarcinoma in reference of blood-lipid profile. Background of the tool is based on the study made on RNAseq expression analysis of stomach adenocarcinoma. Raw data for study was collected as gene-expression profile from population of cancer-vs-normal. A series of studies performed including: differential gene expression analysis, plasma proteome mapping, extraction of gene-signature enriched with LSTM system model, AI-guided simulation of systems model of gene network, and AI-guided mapping with blood lipid profile to develop R-Shiny web-application.

Conclusion

‘EarlyDetect’ is freely available athttps://csir-icmr.shinyapps.io/EarlyDetect/. The tool can be utilized for (i) virtual observation of impact of different combinations of lipid profile in cancer progression; (ii) early detection of cancer state for new comer patients.
Clinical feature, treatment pattern and survival of Esophageal cancer at Tikur Anbessa Specialized Hospital, Ethiopia: a prospective cohort study
Authors: Feyisa Jilcha Diribi , Adisse Adamu , Kantelhardt Eva Johanna , Zingeta Girum Tesema , Negash Eyoel , Wondimagegnewu Abigiya , Hirpha Selamawit , Gizaw Muluken , Aseffa Mathewos
Published: February 2023

Purpose

Ethiopia is located within the esophageal belt of Africa. Esophageal cancer is the seventh leading cause of death in Ethiopia. There is a paucity of literature regarding the clinical features, treatment patterns, and survival of patients with esophageal cancer. We report the clinical profile, treatment pattern, and survival of patients with esophageal cancer at Tikur Anbessa Specialized Hospital, Ethiopia.

Methods

An unmatched prospective cohort study was conducted from February 27, 2018 to February 28, 2020. We used the Kaplan–Meier method to assess the overall survival time and survival time according to stage and treatment type. Multivariate Cox regression analysis with the backward LR selection method was used to fit the final model.

Result

In total, 230 patients with esophageal cancer were recruited for this study. The median survival time was six months (95%CI) (5, 7). A total of 170 (73.9%) patients died during the 1,244 person-month follow-up period, resulting in an overall event rate of 162 per 1,000 person– months. The overall survival rate was very low with 6 months, 1-, and 2-year survival rates of 54.6% (95%CI:47.5%-61.2%), 19.5% (13.8% -25.9%), and 2.0% (0.45%–5.9%), respectively. Chemotherapy, local recurrence, and brain metastases were variables that explained the model.

Conclusion

survival of patients with esophageal cancer at Tikur Anbessa Specialized Hospital was very short. We recommend multimodal treatment to improve treatment outcomes.