bluuebunny/crossref_metadata_2025 huggingface dataset:
On the evolution of pebble-accreting planets in evolving protoplanetary discs
Authors: Pierens Arnaud
Published: October 2022

We examine the migration of luminous low-mass cores in laminar protoplanetary discs where accretion occurs mainly because of disc winds and where the planet luminosity is generated by pebble accretion. Using 2D hydrodynamical simulations, we determine the eccentricities induced by thermal forces as a function of gas and pebble accretion rates, and also evaluate the importance of the torque exerted by the solid component relative to the gas torque. For a gas accretion rate $\dot{M}= 2\times 10^{-8}\, \mathrm{ M}_\odot$ yr−1 and pebble flux $\dot{M}_{\mathrm{ peb}}=170\, \mathrm{ M}_\oplus$ Myr−1, we find that embryo eccentricities attain values comparable to the disc aspect ratio. The planet radial excursion in the disc, however, causes the torque exerted by inflowing pebbles to cancel on average and migration to transition from outward to inward. This is found to arise because the magnitude of thermal torques decreases exponentially with increasing eccentricity, and we provide a fitting formula for the thermal torque attenuation as a function of eccentricity. As the disc evolves, the accretion luminosity becomes at some point too small to make the core eccentricity grow such that the solid component can exert a non-zero torque on the planet. This torque is positive and for gas accretion rates $\dot{M} \lesssim 5\times 10^{-9}$M⊙ yr−1 and pebble fluxes $\dot{M}_{\rm {peb}} \lesssim 120\, \mathrm{ M}_\oplus $ Myr−1, it is found to overcome the gas torque exerted on cores with mass $m_\mathrm{ p}\lesssim \, 1\,\mathrm{ {M}}_\oplus$, resulting in outward migration.
The miniJPAS survey quasar selection – I. Mock catalogues for classification
Authors: Queiroz Carolina , Abramo L Raul , Rodrigues Natália V N , Pérez-Ràfols Ignasi , Martínez-Solaeche Ginés , Hernán-Caballero Antonio , Hernández-Monteagudo Carlos , Lumbreras-Calle Alejandro , Pieri Matthew M , Morrison Sean S , Bonoli Silvia , Chaves-Montero Jonás , Chies-Santos Ana L , Díaz-García L A , Fernandez-Soto Alberto , González Delgado Rosa M , Alcaniz Jailson , Benítez Narciso , Javier Cenarro A , Civera Tamara , Dupke Renato A , Ederoclite Alessandro , López-Sanjuan Carlos , Marín-Franch Antonio , Mendes de Oliveira Claudia , Moles Mariano , Muniesa David , Sodré Laerte , Taylor Keith , Varela Jesús , Vázquez Ramió Héctor
Published: October 2022

In this series of papers, we employ several machine learning (ML) methods to classify the point-like sources from the miniJPAS catalogue, and identify quasar candidates. Since no representative sample of spectroscopically confirmed sources exists at present to train these ML algorithms, we rely on mock catalogues. In this first paper, we develop a pipeline to compute synthetic photometry of quasars, galaxies, and stars using spectra of objects targeted as quasars in the Sloan Digital Sky Survey. To match the same depths and signal-to-noise ratio distributions in all bands expected for miniJPAS point sources in the range 17.5 ≤ r < 24, we augment our sample of available spectra by shifting the original r-band magnitude distributions towards the faint end, ensure that the relative incidence rates of the different objects are distributed according to their respective luminosity functions, and perform a thorough modelling of the noise distribution in each filter, by sampling the flux variance either from Gaussian realizations with given widths, or from combinations of Gaussian functions. Finally, we also add in the mocks the patterns of non-detections which are present in all real observations. Although the mock catalogues presented in this work are a first step towards simulated data sets that match the properties of the miniJPAS observations, these mocks can be adapted to serve the purposes of other photometric surveys.
Conservation of transcriptional regulation by BRCA1 and BARD1 inCaenorhabditis elegans
Authors: Thapa Ishor , Vahrenkamp Russell , Witus Samuel R , Lightle Caitlin , Falkenberg Owen , Sellin Jeffries Marlo K , Klevit Rachel E , Stewart Mikaela D
Published: October 2022

The tumor-suppressor proteins BRCA1 and BARD1 function as an E3 ubiquitin ligase to facilitate transcriptional repression and DNA damage repair. This is mediated in-part through its ability to mono-ubiquitylate histone H2A in nucleosomes. Studies in Caenorhabditis elegans have been used to elucidate numerous functions of BRCA1 and BARD1; however, it has not been established that the C. elegans orthologs, BRC-1 and BRD-1, retain all the functions of their human counterparts. Here we explore the conservation of enzymatic activity toward nucleosomes which leads to repression of estrogen-metabolizing cytochrome P450 (cyp) genes in humans. Biochemical assays establish that BRC-1 and BRD-1 contribute to ubiquitylation of histone H2A in the nucleosome. Mutational analysis shows that while BRC-1 likely binds the nucleosome using a conserved interface, BRD-1 and BARD1 have evolved different modes of binding, resulting in a difference in the placement of ubiquitin on H2A. Gene expression analysis reveals that in spite of this difference, BRC-1 and BRD-1 also contribute to cyp gene repression in C. elegans. Establishing conservation of these functions in C. elegans allows for use of this powerful model organism to address remaining questions regarding regulation of gene expression by BRCA1 and BARD1.
DeepST: identifying spatial domains in spatial transcriptomics by deep learning
Authors: Xu Chang , Jin Xiyun , Wei Songren , Wang Pingping , Luo Meng , Xu Zhaochun , Yang Wenyi , Cai Yideng , Xiao Lixing , Lin Xiaoyu , Liu Hongxin , Cheng Rui , Pang Fenglan , Chen Rui , Su Xi , Hu Ying , Wang Guohua , Jiang Qinghua
Published: October 2022

Recent advances in spatial transcriptomics (ST) have brought unprecedented opportunities to understand tissue organization and function in spatial context. However, it is still challenging to precisely dissect spatial domains with similar gene expression and histology in situ. Here, we present DeepST, an accurate and universal deep learning framework to identify spatial domains, which performs better than the existing state-of-the-art methods on benchmarking datasets of the human dorsolateral prefrontal cortex. Further testing on a breast cancer ST dataset, we showed that DeepST can dissect spatial domains in cancer tissue at a finer scale. Moreover, DeepST can achieve not only effective batch integration of ST data generated from multiple batches or different technologies, but also expandable capabilities for processing other spatial omics data. Together, our results demonstrate that DeepST has the exceptional capacity for identifying spatial domains, making it a desirable tool to gain novel insights from ST studies.
The Cancer Epitope Database and Analysis Resource (CEDAR)
Authors: Koşaloğlu-Yalçın Zeynep , Blazeska Nina , Vita Randi , Carter Hannah , Nielsen Morten , Schoenberger Stephen , Sette Alessandro , Peters Bjoern
Published: October 2022

We established The Cancer Epitope Database and Analysis Resource (CEDAR) to catalog all epitope data in the context of cancer. The specific molecular targets of adaptive T cell and B cell immune responses are referred to as epitopes. Epitopes derived from cancer antigens are of high relevance as they are recognized by anti-cancer immune cells. Detailed knowledge of the molecular characteristic of cancer epitopes and associated metadata is relevant to understanding and planning prophylactic and therapeutic applications and accurately characterizing naturally occurring immune responses and cancer immunopathology. CEDAR provides a freely accessible, comprehensive collection of cancer epitope and receptor data curated from the literature and serves as a companion site to the Immune Epitope Database (IEDB), which is focused on infectious, autoimmune, and allergic diseases. CEDAR is freely accessible at https://cedar.iedb.org/.
The limits of molecular signatures for pancreatic ductal adenocarcinoma subtyping
Authors: Lautizi Manuela , Baumbach Jan , Weichert Wilko , Steiger Katja , List Markus , Pfarr Nicole , Kacprowski Tim
Published: October 2022

Molecular signatures have been suggested as biomarkers to classify pancreatic ductal adenocarcinoma (PDAC) into two, three, four or five subtypes. Since the robustness of existing signatures is controversial, we performed a systematic evaluation of four established signatures for PDAC stratification across nine publicly available datasets. Clustering revealed inconsistency of subtypes across independent datasets and in some cases a different number of PDAC subgroups than in the original study, casting doubt on the actual number of existing subtypes. Next, we built sixteen classification models to investigate the ability of the signatures for tumor subtype prediction. The overall classification performance ranged from ∼35% to ∼90% accuracy, suggesting instability of the signatures. Notably, permuted subtypes and random gene sets achieved very similar performance. Cellular decomposition and functional pathway enrichment analysis revealed strong tissue-specificity of the predicted classes. Our study highlights severe limitations and inconsistencies that can be attributed to technical biases in sample preparation and tumor purity, suggesting that PDAC molecular signatures do not generalize across datasets. How stromal heterogeneity and immune compartment interplay in the diverging development of PDAC is still unclear. Therefore, a more mechanistic or a cross-platform multi-omic approach seems necessary to extract more robust and clinically exploitable insights.
Investigation of a Prolonged and Large Outbreak of Healthcare-Associated Mucormycosis Cases in an Acute Care Hospital—Arkansas, June 2019–May 2021
Authors: Jordan Alexander , James Allison E , Gold Jeremy A W , Wu Karen , Glowicz Janet , Wolfe Frankie , Vyas Keyur , Litvintseva Anastasia , Gade Lalitha , Liverett Hazel , Alverson Mary , Burgess Mary , Wilson Amy , Li Ruoran , Benowitz Isaac , Gulley Trent , Patil Naveen , Chakravorty Rohan , Chu Winston , Kothari Atul , Jackson Brendan R , Garner Kelley , Toda Mitsuru
Published: October 2022

Background

Outbreaks of healthcare-associated mucormycosis (HCM), a life-threatening fungal infection, have been attributed to multiple sources, including contaminated healthcare linens. In 2020, staff at Hospital A in Arkansas alerted public health officials of a potential HCM outbreak.

Methods

We collected data on patients at Hospital A who had invasive mucormycosis during January 2017–June 2021 and calculated annual incidence of HCM (defined as mucormycosis diagnosed within ≥7 days after hospital admission). We performed targeted environmental assessments, including linen sampling at the hospital, to identify potential sources of infection.

Results

During the outbreak period (June 2019–June 2021), 16 patients had HCM; clinical features were similar between HCM patients and non-HCM patients. Hospital-wide HCM incidence (per 100 000 patient-days) increased from 0 in 2018 to 3 in 2019 and 6 in 2020. For the 16 HCM patients, the most common underlying medical conditions were hematologic malignancy (56%) and recent traumatic injury (38%); 38% of HCM patients died in-hospital. Healthcare-associated mucormycosis cases were not epidemiologically linked by common procedures, products, units, or rooms. At Hospital A and its contracted offsite laundry provider, suboptimal handling of laundered linens and inadequate environmental controls to prevent mucormycete contamination were observed. We detected Rhizopus on 9 (9%) of 98 linens sampled at the hospital, including on linens that had just arrived from the laundry facility.

Conclusions

We describe the largest, single-center, HCM outbreak reported to date. Our findings underscore the importance of hospital-based monitoring for HCM and increased attention to the safe handling of laundered linens.
A Multicenter Comparison of Prevalence and Predictors of Antimicrobial Resistance in Hospitalized Patients Before and During the Severe Acute Respiratory Syndrome Coronavirus 2 Pandemic
Authors: Bauer Karri A , Puzniak Laura A , Yu Kalvin C , Klinker Kenneth P , Watts Janet A , Moise Pamela A , Finelli Lyn , Ai ChinEn , Gupta Vikas
Published: October 2022

Background

Antibacterial therapy is frequently used in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) without evidence of bacterial infection, prompting concerns about increased antimicrobial resistance (AMR). We evaluated trends in AMR before and during the SARS-CoV-2 pandemic.

Methods

This multicenter, retrospective cohort analysis included hospitalized adults aged ≥18 years with >1-day inpatient admission and a record of discharge or death from 271 US facilities in the BD Insights Research Database. We evaluated rates of AMR events, defined as positive cultures for select gram-negative and gram-positive pathogens from any source, with nonsusceptibility reported by commercial panels before (1 July 2019–29 February 2020) and during (1 March 2020–30 October 2021) the SARS-CoV-2 pandemic.

Results

Of 5 518 666 admissions evaluated, AMR rates per 1000 admissions were 35.4 for the prepandemic period and 34.7 for the pandemic period (P ≤ .0001). In the pandemic period, AMR rates per 1000 admissions were 49.2 for SARS-CoV-2–positive admissions, 41.1 for SARS-CoV-2–negative admissions, and 25.7 for patients untested (P ≤ .0001). AMR rates per 1000 admissions among community-onset infections during the pandemic were lower versus prepandemic levels (26.1 vs 27.6; P < .0001), whereas AMR rates for hospital-onset infections were higher (8.6 vs 7.7; P < .0001), driven largely by SARS-CoV-2–positive admissions (21.8). AMR rates were associated with overall antimicrobial use, rates of positive cultures, and higher use of inadequate empiric therapy.

Conclusions

Although overall AMR rates did not substantially increase from prepandemic levels, patients tested for SARS-CoV-2 infection had a significantly higher rate of AMR and hospital-onset infections. Antimicrobial and diagnostic stewardship is key to identifying this high-risk AMR population.
Effect of Severe Acute Respiratory Syndrome Coronavirus 2 Vaccine Booster on Human Immunodeficiency Virus Reservoirs and Immune Markers
Authors: Rai M Ali , Shi Victoria , Kennedy Brooke D , Justement Jesse S , Gittens Kathleen , McCormack Genevieve , Blazkova Jana , Moir Susan , Chun Tae-Wook
Published: October 2022

We investigated effects of the severe acute respiratory syndrome coronavirus 2 (SARV-CoV-2) booster vaccination on human immunodeficiency virus (HIV) reservoir size, immune markers, and host immune responses in people with HIV receiving antiretroviral therapy. Our data suggest that the SARS-CoV-2 booster vaccine is not likely to replenish the persistent HIV reservoir nor provide an immunologic environment to facilitate active HIV expression/replication.
Auxin-Induced WUSCHEL-RELATED HOMEOBOX13 Mediates Asymmetric Activity of Callus Formation upon Cutting
Authors: Tanaka Hayato , Hashimoto Naoki , Kawai Satomi , Yumoto Emi , Shibata Kyomi , Tameshige Toshiaki , Yamamoto Yuma , Sugimoto Keiko , Asahina Masashi , Ikeuchi Momoko
Published: October 2022

Plants have the regenerative ability to reconnect cut organs, which is physiologically important to survive severe tissue damage. The ability to reconnect organs is utilized as grafting to combine two different individuals. Callus formation at the graft junction facilitates organ attachment and vascular reconnection. While it is well documented that local wounding signals provoke callus formation, how callus formation is differentially regulated at each cut end remains elusive. Here, we report that callus formation activity is asymmetrical between the top and bottom cut ends and is regulated by differential auxin accumulation. Gene expression analyses revealed that cellular auxin response is preferentially upregulated in the top part of the graft. Disruption of polar auxin transport inhibited callus formation from the top, while external application of auxin was sufficient to induce callus formation from the bottom, suggesting that asymmetric auxin accumulation is responsible for active callus formation from the top end. We further found that the expression of a key regulator of callus formation, WUSCHEL-RELATED HOMEOBOX 13 (WOX13), is induced by auxin. The ectopic callus formation from the bottom end, which is triggered by locally supplemented auxin, requires WOX13 function, demonstrating that WOX13 plays a pivotal role in auxin-dependent callus formation. The asymmetric WOX13 expression is observed both in grafted petioles and incised inflorescence stems, underscoring the generality of our findings. We propose that efficient organ reconnection is achieved by a combination of local wounding stimuli and disrupted long-distance signaling.
Anti-transcription intermediary factor 1-gamma IgG2 isotype is associated with cancer in adult dermatomyositis: an ENMC multinational study
Authors: Cordel Nadège , Dechelotte Benoît , Jouen Fabienne , Lamb Janine A , Chinoy Hector , New Paul , Vencovsky Jiri , Mann Herman , Galindo-Feria Angeles S , Dani Lara , Selva-O’Callaghan Albert , Werth Victoria P , Ravishankar Adarsh , Landon-Cardinal Océane , Tressières Benoit , Boyer Olivier
Published: October 2022

Objective

To assess the role of the anti-TIF1γ auto-antibody (aAb) IgG2 isotype as a biomarker of cancer in anti-TIF1γ aAb-positive adult DM.

Methods

International multicentre retrospective study with the following inclusion criteria: (i) diagnosis of DM according to ENMC criteria; (ii) presence of anti-TIF1γ IgG aAb determined using an in-house addressable laser bead immunoassay (ALBIA) from cryopreserved serums sampled at time of DM diagnosis and (iii) available baseline characteristics and follow-up data until the occurrence of cancer and/or a minimum follow-up of 1 year for patients without known cancer at diagnosis. Detection and quantification of anti-TIF1γ IgG2 aAb was done using the in-house ALBIA. In addition, a recent ELISA commercial kit was used for anti-TIF1γ IgG aAb quantification.

Results

A total of 132 patients (mean age 55±15 years) of whom 72 (54.5%) had an associated cancer were analysed. The association between the presence of cancer and the presence of anti-TIF1γ IgG2 aAb was statistically significant (P = 0.026), with an OR of 2.26 (95% CI: 1.10, 4.76). Patients with cancer displayed significantly higher anti-TIF1γ IgG2 aAb ALBIA values with a median value of 1.15 AU/ml (IQR: 0.14–9.76) compared with 0.50 AU/ml (IQR: 0.14–1.46) for patients without cancer (P = 0.042). In addition, patients with cancer displayed significantly higher anti-TIF1γ IgG aAb ELISA values with a median value of 127.5 AU/ml (IQR: 81.5–139.6) compared with 93.0 AU/ml (IQR: 54.0–132.9) for patients without cancer (P = 0.004).

Conclusion

These results suggest considering anti-TIF1γ IgG2 ALBIA and IgG ELISA values as biomarkers of cancer in anti-TIF1 γ aAb-positive adult DM.
Conifer water-use patterns across temporal and topographic gradients in the southern Sierra Nevada
Authors: Goodwin Marissa J , Kerhoulas Lucy P , Zald Harold S J , North Malcolm P , Hurteau Matthew D
Published: October 2022

Climate change is increasing the severity and duration of drought events experienced by forest ecosystems. Because water is essential for tree physiological processes, the ability of trees to survive prolonged droughts will largely depend on whether they have access to reliable water sources. While many woody plant species exhibit the ability to shift water sources between different depths of soil and rock water in response to changes in climate and water availability, it is unclear if Sierra Nevada conifers exhibit this plasticity. Here we analysed the δ18O and δ13C values of annual tree rings to determine the water-use patterns of large Sierra Nevada conifers during the 2012–16 California drought and 4 years before this drought event (2004–07). We analysed four species (Pinus jeffreyi Grev. & Balf. (Jeffrey pine), Pinus lambertiana Dougl. (sugar pine), Abies concolor (Gord. & Glend.) Lindl. Ex Hilderbr (white fir) and Calocedrus decurrens (Torr.) Florin (incense-cedar)) across a range of topographic positions to investigate differences in water-use patterns by species and position on the landscape. We found no significant differences in δ18O and δ13C values for the pre-drought and drought periods. This stability in δ18O values suggests that trees did not shift their water-use patterns in response to the 2012–16 drought. We did find species-specific differences in water-use patterns, with incense-cedar exhibiting more depleted δ18O values than all other species. We also found trends that suggest the water source used by a tree may depend on topographic and growing environment attributes such as topographic wetness and the surrounding basal area. Overall, our results suggest that the water source used by trees varies by the species and topographic position, but that Sierra Nevada conifers do not switch their water-use patterns in response to the drought. This lack of plasticity could make Sierra Nevada conifers particularly vulnerable to drought mortality as their historically reliable water sources begin to dry out with climate change.
Legal Bans, Female Genital Cutting, and Education: Evidence from Senegal
Authors: García-Hombrados Jorge , Salgado Edgar
Published: October 2022

A law that banned the practice of female genital cutting (FGC) in Senegal in 1999 reduced its prevalence and increased educational investments in girls. These results are not driven by mechanisms like health, broader changes in empowerment, or child marriage. Suggestive evidence indicates that results could be driven by some parents of future brides reacting to the increase in the cost of FGC caused by the law by abandoning this practice and investing in their daughter’s education to compensate for smaller bride prices among uncut women.
Kif26b contributes to the progression of interstitial fibrosis via migration and myofibroblast differentiation in renal fibroblast
Authors: Yamamura Yuta , Iwata Yasunori , Furuichi Kengo , Kato Takahiro , Yamamoto Naoki , Horikoshi Keisuke , Ogura Hisayuki , Sato Koichi , Oshima Megumi , Nakagawa Shiori , Miyagawa Taro , Kitajima Shinji , Toyama Tadashi , Hara Akinori , Sakai Norihiko , Shimizu Miho , Horike Shinichi , Daikoku Takiko , Nishinakamura Ryuichi , Wada Takashi
Published: October 2022

Kinesin family member 26b (Kif26b) is essential for kidney development, and its deletion in mice leads to kidney agenesis. However, the roles of this gene in adult settings remain elusive. Thus, this study aims to investigate the role of Kif26b in the progression of renal fibrosis. A renal fibrosis model with adenine administration using Kif26b heterozygous mice and wild‐type mice was established. Renal fibrosis and the underlying mechanism were investigated. The underlying pathways and functions of Kif26b were evaluated in an in vitro model using primary renal fibroblasts. Kif26b heterozygous mice were protected from renal fibrosis with adenine administration. Renal expressions of connective tissue growth factor (CTGF) and myofibroblast accumulation were reduced in Kif26b heterozygous mice. The expression of nonmuscle myosin heavy chain II (NMHCII), which binds to the C‐terminus of Kif26b protein, was also suppressed in Kif26b heterozygous mice. The in vitro study revealed reduced expressions of CTGF, α‐smooth muscle actin, and myosin heavy chain 9 (Myh9) via transfection with siRNAs targeting Kif26b in renal fibroblasts (RFB). RFBs, which were transfected by the expression vector of Kif26b, demonstrated higher expressions of these genes than non‐transfected cells. Finally, Kif26b suppression and NMHCII blockage led to reduced abilities of migration and collagen gel contraction in renal fibroblasts. Taken together, Kif26b contributes to the progression of interstitial fibrosis via migration and myofibroblast differentiation through Myh9 in the renal fibrosis model. Blockage of this pathway at appropriate timing might be a therapeutic approach for renal fibrosis.
The “Kite-t-FAMMIF”: A Novel Technique for Reconstruction of Extensive Soft Palate Resection
Authors: Massarelli Olindo , Carnevale Claudio
Published: October 2022

Total soft palate reconstruction is a challenge for the head and neck surgeon. Velopharyngeal incompetence resulting from soft palate resection impairs both speech and swallowing and significantly affects the quality of life of the patients. Radial forearm free flap is the reconstructive technique most used worldwide, but it requires microsurgical skills, is associated with high donor site morbidity, and shrinks during the healing process, especially after adjuvant radiotherapy. We present a novel technique using a single “kite-shaped” tunnelized-facial artery myomucosal island flap (t-FAMMIF) and report very favorable functional outcomes. Three patients in whom a kite-shaped flap was used to reconstruct a total soft palate defect after squamous cell carcinoma resection were included. In two of them, the resection included both tonsils due to cancer spreading to the tonsillar fossae. The mucosal and muscular sides of a single t-FAMMIF flap were able to restore the oral and nasal lining of the palate, respectively, without the need to fold the flap. All patients were able to tolerate an oral soft diet 10 days after surgery. No complications were detected. A complete mucosalization on the nasal lining was observed by video-endoscopy 3 weeks after surgery. No case of shrinking of the flap was observed during the follow-up, and speech and swallowing functions were not impaired after complete wound healing. Kite-shaped t-FAMMIF represents an excellent and feasible reconstructive option for extensive postablative soft palate defects.
Trends in Fellowship Training across United States Plastic and Reconstructive Surgery Academic Faculty
Authors: Bovill John D. , Haffner Zoë K. , Huffman Samuel S. , Sayyed Adaah A. , Shan Holly D. , Abu El Hawa Areeg A. , Slamin Robert P. , Evans Karen K. , Song David H.
Published: October 2022

Background:

Plastic and reconstructive surgery (PRS) academic positions are more coveted each year. We aim to determine the requirement of fellowship training before PRS academic appointments.

Methods:

PRS faculty at U.S. academic institutions associated with the American Society of Plastic Surgeons were identified. Outcomes studied included integrated versus independent training, fellowships, gender, academic title, years on faculty, and publications before current hire.

Results:

Of the 1052 PRS faculty identified, 646 were included across 41 states and the District of Columbia. Seventy-four percent were identified as men (n = 477), and 26.2% (n = 169) identified as women. Academic faculty were significantly more likely to have completed fellowship before hire than not (p<0.0001). An integrated route of training was associated with higher odds of fellowship completion before appointment (OR = 2.19, 95% CI: 1.49–3.22). Odds of fellowship completion was significantly greater among faculty who graduated 5–10 years ago (OR = 2.55, 95% CI: 1.48–4.41) and within the last 5 years (OR = 1.93, 95% CI: 1.18–3.17). Professors were less likely to have completed fellowship training before appointment compared with assistant professors (OR = 0.51, 95% CI: 0.33–0.80). Regarding gender, number of prior publications, or completion of another degree, no significant difference was found between fellowship- and non-fellowship-trained faculty.

Conclusions:

Although more plastic surgeons enter the field through a shortened integrated residency, the increasing demand for further subspecialization may cause significant challenges for upcoming graduates pursuing an academic appointment. Undergoing additional training considerably impacts social and financial decision-making early in surgical careers for newly graduated residents.
Symptom experiences in hypertension: a mixed methods systematic review
Authors: Horne Carolyn E. , Stayt Louise C. , Schutz Susan , Smith Christopher M. , Haberstroh Amanda , Bolin Linda P. , Taylor Catherine L. , Moosavi Shakeeb H. , Bibbey Adam
Published: October 2022

Aim:

Understanding patients’ hypertension (HTN) symptoms can assist healthcare professionals’ awareness of individual, cultural, and behavioral responses and improve diagnostic accuracy to optimize treatment. The purpose of this review was to evaluate and synthesize current literature exploring HTN symptoms.

Methods:

Databases searched included MEDLINE (PubMed), CINAHL (EBSCO), Scopus, and Web of Science from January 2010 to January 2022. The search followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The McMaster critical review forms were used to determine the quality of both qualitative and quantitative articles. Synthesis of the data was guided by the Joanna Briggs Institute Convergent Integrated Approach to Mixed Study Systematic Reviews.

Results:

In total, 41 articles were included, nine qualitative studies and 32 quantitative. The quality of the articles varied. Symptoms included commonly reported symptoms and some less prevalent, including some reporting absence of symptoms. Factors that affected symptoms included culture, beliefs, psychosocial factors, and knowledge. We also found that there may be a bidirectional relationship between symptoms and behaviors that may lead to self-management.

Conclusion:

HTN is common and symptoms are frequently reported. HTN management is related to multiple factors. Symptoms continue in a number of individuals after initial diagnosis. Evaluating symptoms after initial diagnosis may help to optimally manage and meet blood pressure guidelines.
Persistent hyperparathyroidism in long-term kidney transplantation: time to consider a less aggressive approach
Authors: Disthabanchong Sinee
Published: October 2022

Purpose of review

Persistent hyperparathyroidism affects 50% of long-term kidney transplants with preserved allograft function. Timing, options and the optimal target for treatment remain unclear. Clinical practice guidelines recommend the same therapeutic approach as patients with chronic kidney disease.

Recent findings

Mild to moderate elevation of parathyroid hormone (PTH) levels in long-term kidney transplants may not be associated with bone loss and fracture. Recent findings on bone biopsy revealed the lack of association between hypercalcaemic hyperparathyroidism with pathology of high bone turnover. Elevated PTH levels may be required to maintain normal bone volume. Nevertheless, several large observational studies have revealed the association between hypercalcemia and the elevation of PTH levels with unfavourable allograft and patient outcomes. Both calcimimetics and parathyroidectomy are effective in lowering serum calcium and PTH. A recent meta-analysis suggested parathyroidectomy may be performed safely after kidney transplantation without deterioration of allograft function.

Treatment of persistent hyperparathyroidism is warranted in kidney transplants with hypercalcemia and markedly elevated PTH levels. A less aggressive approach should be applied to those with mild to moderate elevation. Whether treatments improve outcomes remain to be elucidated.
The changing trajectory of diabetic kidney disease
Authors: Mistry Nupur , Bakris George L.
Published: October 2022

Purpose of review

Progression of diabetic kidney disease has slowed over the past 40 years by as much as 70–75%, thanks to a diversity of drug classes that have less effect on glucose and more on reducing cardiorenal risk.

Recent findings

With the advent of sodium-glucose co-transporter 2 (SGLT2) inhibitors and the novel nonsteroidal mineralocorticoid antagonist, finerenone, we now have three ‘pillars of therapy’ considering the renin–angiotensin system (RAS) inhibitors as already established treatment to slow diabetic kidney disease. Both renal and cardiovascular outcomes trials have provided solid evidence of the benefit by these agents to slow kidney disease progression and reduce heart failure hospitalizations. Using these agents together reduces the risk of hyperkalemia by finerenone and further reduces albuminuria in animal models. Trials are underway to also see if the glucagon-like peptide 1 receptor agonist, semaglutide, will also protect against diabetic kidney disease progression as seen in post hoc analyses of positive cardiovascular outcome trials. If positive, this would be the fourth pillar to support cardiorenal protection without fear of hypoglycemia.

Nephrologists now have three different agents neither of which has a major effect on blood pressure but both add to further reduce progression of diabetic nephropathy and hospitalization from heart failure.
Negative pressure wound therapy with instillation and dwell time (NPWTi-d) with antiseptic solution leads to a greater reduction in the number of pathogen species detected compared to conventional NPWT despite the recontamination of the wound by eluates with high bacterial load.
Authors: Stichling Marcus , Wiessner Alexandra , Kikhney Judith , Gatzer Renate , Müller Martin , Scheuermann-Poley Catharina , Moter Annette , Willy Christian
Published: October 2022

The aim of the study was to investigate bacterial colonisation of the foam eluate after negative pressure wound therapy with instillation and dwell time (NPWTi-d) to obtain an indication of possible recontamination of the wound during NPWTi-d. To detect bacterial colonisation and the extent of planktonic and non-planktonic bioburden as comprehensively as possible, routine culture and molecular biology methods were used.

Methods:

Before (TP1) and after (median 3.0 days, TP2) of NPWT (n=15) and NPWTi-d with antiseptic installation (n=15), wound bed (WB) (n=22 acute, n=8 chronic wounds, median age 51 (24-91) years; 26 male), foam and eluate were examined by routine culture methods and fluorescence in situ hybridisation (FISH), polymerase chain reaction (PCR) and sequencing (FISHseq).

Results:

At TP2, 94.9% (37/39) of the pathogens identifiable in the eluate were also detected in WB. Foam and eluate were always bacterially contaminated. NPWTi-d resulted in a significant reduction in the number of pathogen species compared to NPWT (NPWTi-d: TP1 vs. TP2: p=0.026; NPWT: TP1 vs. TP2: ns). Routine culture of WB samples at TP2 identified only 28/52 (53.8%) of the pathogens, while examination of WB, foam and eluate and additional FISHseq use detected 50/52 (96.2%) of the bacterial species. FISHseq identified biofilm in n=1 and microcolonies in n=10 wounds (TP2).

Conclusion:

The bacterial load of the foam is flushed back into the wound during NPWTi-d. FISHseq should be used in addition to the routine culture method when pathogen identification and detection of non-planktonic bacterial growth is particularly important for the patient's therapy.
Reconstruction of dentomaxillofacial deformity secondary to a long-term mandibular defect using concomitant orthognathic surgery and fibula free flap: a preliminary study
Authors: Cao Jian , Shen Shunyao , Liu Zhixu , Wu Jinyang , Shi Jun , Zhang Lei , Zhu Min , Wang Xudong
Published: October 2022

The reconstruction of mandibular defect may be delayed or compromised due to many reasons, especially in pediatric patients. With the growth of the remaining mandible and the maxilla in the malocclusion status, the secondary dentomaxillofacial deformity is plausible. To treat the concomitant mandibular defect and secondary dentomaxillofacial deformity, a hierarchical algorithm using orthodontics, orthognathic surgery, and fibula free flap was developed. This retrospective case series included six patients with long-term mandibular defects caused by tumor resection without repair or with compromised costochondral reconstruction. All patients were treated using the same staged protocol, but with minor changes: 1) pre-surgical orthodontics, 2) virtual surgical planning, 3) fabrication of the guides and splints, 4) sequenced operations and 5) postoperative care. The sequence of surgery included the Le Fort I osteotomy, mandibular sagittal split ramus osteotomy (MSSO) of the remaining ramus, final occlusion registration, repositioning of the distal segment of the mandible, segmented fibula reconstruction, and finally the fixation of MSSO. The operations and wound healing were uneventful in all patients, and no flap failure or severe complications were detected. Also, the patients exhibited no signs of temporomandibular joint ankylosis during the follow-up. The subspinale-nasion-supramental angle (ANB) reduced significantly after the surgery. A significant improvement was detected in the facial contour symmetry measurements postoperatively. This proposed workflow of concomitant orthognathic surgery and the fibula free flap is effective and reliable for the reconstruction of dentomaxillofacial deformity secondary to the long-term mandibular defect.
“Migraine Surgery and Determination of Success Over Time by Trigger Site: A Systematic Review of the Literature”
Authors: Huayllani Maria T. , Janis Jeffrey E.
Published: October 2022

Background:

Migraine surgery is a debilitating disorder that produces high costs and compromises the quality of life. This study aimed to evaluate surgery success and the longevity of the surgical benefit by trigger site.

Methods:

A systematic literature review was performed by querying PubMed, EMBASE, Scopus, and Web of Science databases. The keywords “surgery”, “migraine”, “outcomes”, “headache index” and synonyms in titles and abstracts were used to perform the search.

Results:

A total of 17 articles published between 2009 and 2019 met the inclusion criteria. Six studies were prospective and eleven were retrospective. Most of the studies (77.8%, 77.8%, and 80%) reported success of migraine surgery at 12 months follow-up for trigger sites I, II, and III, respectively. For trigger site IV, the greatest MHI reduction (93.4%) was observed at 12 months follow-up, and the earliest MHI reductions (80.3% and 74.6%) were observed at 6 months follow-up. All studies that evaluated trigger sites V and VI identified surgery success at 12 months follow-up. Migraine surgery was found to remain beneficial at 22 months for trigger sites I, II, III, and IV.

Conclusions:

The symptomatic improvement may initially be evident at 6 months for trigger site IV and at 12 months for trigger sites I, II, III, V, and VI. Surgical benefit in trigger sites I, II, III, IV can persist after 22 months. Further studies are required to evaluate results at longer follow-up.
Machine learning-based Automatic Evaluation of Tissue Handling Skills in Laparoscopic Colorectal Surgery: A Retrospective Experimental Study
Authors: Sasaki Shoma , Kitaguchi Daichi , Takenaka Shin , Nakajima Kei , Sasaki Kimimasa , Ogane Tateo , Takeshita Nobuyoshi , Gotohda Naoto , Ito Masaaki
Published: October 2022

Objective:

To develop a machine learning model that automatically quantifies the spread of blood in the surgical field using intraoperative videos of laparoscopic colorectal surgery and evaluate whether the index measured with the developed model can be used to assess tissue handling skill.

Background:

Although skill evaluation is crucial in laparoscopic surgery, existing evaluation systems suffer from evaluator subjectivity and are labor-intensive. Therefore, automatic evaluation using machine learning is potentially useful.

Materials and Methods:

In this retrospective experimental study, we used training data with annotated labels of blood or non-blood pixels on intraoperative images to develop a machine learning model to classify pixel RGB values into blood and non-blood. The blood pixel count per frame (the total number of blood pixels throughout a surgery divided by the number of frames) was compared among groups of surgeons with different tissue handling skills.

Results:

The overall accuracy of the machine learning model for the blood classification task was 85.7%. The high tissue handling skill group had the lowest blood pixel count per frame, and the novice surgeon group had the highest count (mean [SD]: high tissue handling skill group 20972.23 [19287.05] vs. low tissue handling skill group 34473.42 [28144.29] vs. novice surgeon group 50630.04 [42427.76], P<0.01). The difference between any 2 groups was significant.

Conclusions:

We developed a machine learning model to measure blood pixels in laparoscopic colorectal surgery images using RGB information. The blood pixel count per frame measured with this model significantly correlated with surgeons’ tissue handling skills.
A systematic review and meta-analysis comparing postoperative outcomes of laparoscopic versus open omental patch repair of perforated peptic ulcer
Authors: Chan Kai Siang , Ng Shi Tong Carissa , Tan Chin Hong Ben , Gerard Gheslynn , Oo Aung Myint
Published: October 2022

BACKGROUND

The mainstay of surgical management of perforated peptic ulcer is omental patch repair. Advances in minimally invasive techniques have shown feasibility of laparoscopic omental patch repair (LOPR). Laparoscopic omental patch repair is limited by learning curve (LC), but there is a lack of reporting of LC in LOPR. This study aims to compare outcomes following LOPR versus open omental patch repair (OOPR) with reporting of LC.

METHODS

PubMed, Embase, The Cochrane Library, and Scopus were systematically searched from inception till January 2022 for randomized controlled trials (RCTs) and non-RCTs comparing LOPR and OOPR in perforated peptic ulcer. Exclusion criteria were primary repair without use of omental patch repair. Primary outcomes were 30-day mortality, postoperative leak, and LC analysis.

RESULTS

There were a total of 29 studies including 5,311 patients (LOPR, n = 1,687; OOPR, n = 3,624), with 4 RCTs with 238 patients (LOPR, n = 118; OOPR, n = 120). Majority of ulcers were located in the duodenum (57.0%) followed by stomach (30.7%). Mean ulcer size ranged from 5 to 16.2 mm in LOPR and 4.7 to 15.8 mm in OOPR. Laparoscopic omental patch repair was associated with lower 30-day mortality (odds ratio [OR], 0.57; 95% confidence interval [CI], 0.35–0.92; p = 0.02), overall morbidity (OR, 0.31; 95% CI, 0.18–0.53; p < 0.0001), surgical site infection (OR, 0.27; 95% CI, 0.18–0.42; p < 0.00001), and length of stay (mean difference, −2.84 days; 95% CI, −3.63 to −2.06; p < 0.00001). Postoperative leakage (OR, 1.06; 95% CI, 0.43–2.61; p = 0.90) was comparable between LOPR and OOPR. Only three studies analyzed the proportion of consultants to trainees; LOPR was performed mainly by consultants (range, 82.4–91.4%), while OOPR was mainly performed by trainees (range, 52.8–96.8%). One study showed that consultants who performed open conversion had shorter operating time compared with chief residents (85 vs. 186.6 minutes, p < 0.003).

CONCLUSION

Laparoscopic omental patch repair has lower mortality, overall morbidity, length of stay, intraoperative blood loss, and postoperative pain compared with OOPR. More prospective studies should be conducted to evaluate LC in LOPR.

LEVEL OF EVIDENCE

Systematic Review and Meta-Analysis; Level IV.
Reconceptualizing high-quality emergency general surgery care: Non–mortality-based quality metrics enable meaningful and consistent assessment
Authors: Zogg Cheryl K. , Staudenmayer Kristan L. , Kodadek Lisa M. , Davis Kimberly A.
Published: October 2022

BACKGROUND

Ongoing efforts to promote quality-improvement in emergency general surgery (EGS) have made substantial strides but lack clear definitions of what constitutes “high-quality” EGS care. To address this concern, we developed a novel set of five non–mortality-based quality metrics broadly applicable to the care of all EGS patients and sought to discern whether (1) they can be used to identify groups of best-performing EGS hospitals, (2) results are similar for simple versus complex EGS severity in both adult (18–64 years) and older adult (≥65 years) populations, and (3) best performance is associated with differences in hospital-level factors.

METHODS

Patients hospitalized with 1-of-16 American Association for the Surgery of Trauma–defined EGS conditions were identified in the 2019 Nationwide Readmissions Database. They were stratified by age/severity into four cohorts: simple adults, complex adults, simple older adults, complex older adults. Within each cohort, risk-adjusted hierarchical models were used to calculate condition-specific risk-standardized quality metrics. K-means cluster analysis identified hospitals with similar performance, and multinomial regression identified predictors of resultant “best/average/worst” EGS care.

RESULTS

A total of 1,130,496 admissions from 984 hospitals were included (40.6% simple adults, 13.5% complex adults, 39.5% simple older adults, and 6.4% complex older adults). Within each cohort, K-means cluster analysis identified three groups (“best/average/worst”). Cluster assignment was highly conserved with 95.3% of hospitals assigned to the same cluster in each cohort. It was associated with consistently best/average/worst performance across differences in outcomes (5×) and EGS conditions (16×). When examined for associations with hospital-level factors, best-performing hospitals were those with the largest EGS volume, greatest extent of patient frailty, and most complicated underlying patient case-mix.

CONCLUSION

Use of non–mortality-based quality metrics appears to offer a needed promising means of evaluating high-quality EGS care. The results underscore the importance of accounting for outcomes applicable to all EGS patients when designing quality-improvement initiatives and suggest that, given the consistency of best-performing hospitals, natural EGS centers-of-excellence could exist.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level III.
The development of the amnion in mice and other amniotes
Authors: Chuva de Sousa Lopes Susana M. , Roelen Bernard A. J. , Lawson Kirstie A. , Zwijsen An
Published: October 2022

The amnion is an extraembryonic tissue that evolutionarily allowed embryos of all amniotes to develop in a transient and local aquatic environment. Despite the importance of this tissue, very little is known about its formation and its molecular characteristics. In this review, we have compared the basic organization of the extraembryonic membranes in amniotes and describe the two types of amniogenesis, folding and cavitation. We then zoom in on the atypical development of the amnion in mice that occurs via the formation of a single posterior amniochorionic fold. Moreover, we consolidate lineage tracing data to better understand the spatial and temporal origin of the progenitors of amniotic ectoderm, and visualize the behaviour of their descendants in the extraembryonic–embryonic junctional region. This analysis provides new insight on amnion development and expansion. Finally, using an online-available dataset of single-cell transcriptomics during the gastrulation period in mice, we provide bioinformatic analysis of the molecular signature of amniotic ectoderm and amniotic mesoderm. The amnion is a tissue with unique biomechanical properties that deserves to be better understood.

This article is part of the theme issue ‘Extraembryonic tissues: exploring concepts, definitions and functions across the animal kingdom’.