bluuebunny/crossref_metadata_2025 huggingface dataset:
A Census of Archival X-Ray Spectra for Modeling Tidal Disruption Events
Authors: Goldtooth Aaron , Zabludoff Ann I , Wen Sixiang , Jonker Peter G. , Stone Nicholas C. , Cao Zheng
Published: March 2023

Tidal disruption events (TDEs) are highly energetic phenomena that occur when a star is tidally disrupted by the central massive black hole in a galaxy. Fitting the observed X-ray spectra of TDEs with a first-principles, general-relativistic slim-disk model for the emission from the inner accretion disk can constrain the black hole mass M
• and dimensionless spin a
•. Multiepoch spectra can break degeneracies in parameter estimation, particularly when they include a period of super-Eddington mass accretion. Even one observed super-Eddington epoch can be useful. Constraints on {M
•, a
•} improve as a power law with the number of spectral counts; the power-law index is higher for a higher mass accretion rate. These results are supported by the successful modeling of real spectra in the nearby (0.0206 ≤ z ≤ 0.145) TDEs ASASSN-14li, 3XMM J150052.0+015452, and 3XMM J215022.4–055108, which were observed over multiple epochs with >1 ks exposure times. Guided by these results, we create an updated and expanded TDE catalog from the Open TDE compilation. We then explore the XMM-Newton and Chandra archives to identify 37 TDE candidates with promising spectra for constraining {M
•, a
•} with slim-disk model fits. At least seven TDEs are likely associated with intermediate-mass black holes. Three of the 24 TDEs with multiepoch UV/optical photometry from Swift have late-time observations that allow their light curves to be compared directly to model predictions from the X-ray spectral fits. Existing X-ray spectra for other TDEs can be augmented with future optical/UV data. Ultimately, our new TDE catalog will reveal the {M
•, a
•} distributions traced by TDEs, thereby discriminating among black hole growth scenarios and providing insights on general relativity and dark matter particle candidates. The new TDE catalog is here: https://github.com/aarongoldtooth/Census-of-TDE-and-Archival-X-Ray-UV-Data/blob/main/Full%20New%20TDE%20Catalog%20(Published).tsv, and the codes used to construct it are here: https://github.com/aarongoldtooth/Census-of-TDE-and-Archival-X-Ray-UV-Data.
Survival in a nanoforest of absorbing pillars
Authors: Grebenkov Denis S , Skvortsov Alexei T
Published: March 2023

We investigate the survival probability of a particle diffusing between two parallel reflecting planes toward a periodic array of absorbing pillars. We approximate the periodic cell of this system by a cylindrical tube containing a single pillar. Using a mode matching method, we obtain an exact solution of the modified Helmholtz equation in this domain that determines the Laplace transform of the survival probability and the associated distribution of first-passage times (FPTs). This solution reveals the respective roles of several geometric parameters: the height and radius of the pillar, the inter-pillar distance, and the distance between confining planes. This model allows us to explore different asymptotic regimes in the probability density of the FPT. In the practically relevant case of a large distance between confining planes, we argue that the mean FPT is much larger than the typical time and thus uninformative. We also illustrate the failure of the capacitance approximation for the principal eigenvalue of the Laplace operator. Some practical implications and future perspectives are discussed.
Enlightening the temperature coefficient of triple mesoscopic CH3NH3PbI3−x
Cl
x
/NiO and double mesoscopic CsFAMAPbI3−x
Br
x
/CuSCN carbon perovskite solar cells
Authors: Bhandari Shubhranshu , Mallick Tapas Kumar , Sundaram Senthilarasu
Published: March 2023

Temperature is one of the most crucial outdoor variables that influence the photovoltaic performance and stability of carbon perovskite solar cells (CPSCs), although not many reports are there on temperature-dependent CPSCs performance based on various mesoscopic structures. This study demonstrates the temperature coefficient (T
C) of carbon-based triple and double mesoscopic devices having MAPICL [MAPbI3−x
Cl
x
] and CSFAMA [Cs0.05(FA0.83MA0.17)0.95Pb(I0.83Br0.17)3] to understand the performance compatibility of different CPSC configurations despite the thermal treatment (MA = methylammonium, FA = formamidinium). While treating a single device in the range of 5 °C–65 °C, MAPICL-based CPSC maintained a power conversion efficiency (PCE) of ∼9%–11.7%. In contrast, CSFAMA-based double mesoscopic devices showed a PCE variation of ∼14%–16% in the same temperature window. The interesting fact of this analysis is that the average T
C values for MAPICL and CSFAMA are in the order of 10−4, implying better retention of performance for both mesoscopic devices despite thermal stress. A photoluminescence analysis has been done to understand the temperature-dependent charge transfer properties between the perovskite and transport layer. To the best of our knowledge, this analysis, for the first time, provides insight into the temperature coefficient of different CPSC mesoscopic structures to promote suitable future development.
Matrix-scaled resilient consensus of discrete-time and continuous-time networks
Authors: Shang Yilun
Published: March 2023

This paper studies the matrix-scaled resilient consensus problems over multi-agent networks as occurring in computer science and distributed control. Unlike existing works on consensus problems, where the states of agents converge to a common value or reach some prescribed proportions, we take a more general matrix-scaled approach to accommodate the interdependence of multi-dimensional states. We develop a unified analytical framework to deal with matrix-scaled resilient consensus of discrete-time and continuous-time dynamical agents, where the underlying communication network is modeled as a generic directed time-dependent random graph. We propose new distributed protocols to guarantee the matrix-scaled consensus of cooperative agents in the network in the presence of Byzantine agents, who have full knowledge of the system and pose a severe security threat to the collective consensus objective. The cooperative agents feature multiple input and multiple output, and the number and identities of Byzantine agents are not available to the cooperative ones. Our mathematical approach capitalizes on matrix analysis, control theory, graph theory, and martingale convergence. Some numerical examples are presented to demonstrate the effectiveness of our theoretical results.
Predation by the Introduced Brown Widow Spider (Araneae: Theridiidae) May Explain Local Extinctions of Native Black Widows in Urban Habitats
Authors: Coticchio Louis A , Vetter Richard , Cassill Deby L
Published: March 2023

Invertebrates that successfully colonize new habitats often share life history characteristics including high fertility, rapid development, and early maturation. Since its introduction into Florida, USA, the non-native Brown Widow, Latrodectus geometricus (Kock 1841, Araneae: Theridiidae), has rapidly expanded its range into urban areas as far north as Kansas and as far west as California. During its expansion, the Brown Widow has displaced Florida’s Southern Black Widow, L. mactans (Fabricius 1775, Araneae: Tjerodoodae) and California’s Western Black Widow, L. Hesperus (Chamber lin & Ivie 1935, Araneae: Theridiidae). Here, based on a field survey and controlled laboratory experiments, we report possible causes for the rapid disappearance of Florida’s Southern Black Widows. Our field survey revealed that Brown Widows have twice the fertility potential as Southern Black Widows. In experiments comparing development, we show that sub-adult Brown Widows grew faster and matured earlier relative to Southern Black Widows. In our experiments on cohabitation with neighbors, bold Brown Widows were six times more likely to kill and consume shy Southern Black Widows than bold cobweb spiders and three times more likely to cohabitate with bold cobweb spiders than with shy Southern Black Widows. Our model of maternal risk-management revealed that competition for scarce prey was not a significant cause of offspring mortality for Latrodectus species. Hence, Brown Widows are not predating Black Widows or other cobweb spiders because prey is scarce. To our knowledge, this study is the first to suggest that aggressive predation by Brown Widows is a significant factor contributing to the local extinction of the shy Southern Black Widow in urban structures.
Non-linear consensus dynamics on temporal hypergraphs with random noisy higher-order interactions
Authors: Shang Yilun
Published: March 2023

Complex networks encoding the topological architecture of real-world complex systems have recently been undergoing a fundamental transition beyond pairwise interactions described by dyadic connections among nodes. Higher-order structures such as hypergraphs and simplicial complexes have been utilized to model group interactions for varied networked systems from brain, society, to biological and physical systems. In this article, we investigate the consensus dynamics over temporal hypergraphs featuring non-linear modulating functions, time-dependent topology and random perturbations. Based upon analytical tools in matrix, hypergraph, stochastic process and real analysis, we establish the sufficient conditions for all nodes in the network to reach consensus in the sense of almost sure convergence and $\mathscr{L}^2$ convergence. The rate of consensus and the moments of the equilibrium have been determined. Our results offer a theoretical foundation for the recent series of numerical studies and physical observations in the multi-body non-linear dynamical systems.
Technical success in performing esophageal high-resolution manometry: a review of competency recommendations, predictors of failure, and alternative techniques
Authors: Cohen Daniel L , Shirin Haim
Published: March 2023

Esophageal high-resolution manometry (HRM) is the gold standard for diagnosing esophageal motility disorders. As this is performed without sedation, it may be poorly tolerated by patients. Additionally, advancing the catheter tip until the stomach may also be difficult, especially if there is a disease affecting the esophagus or esophagogastric junction which may lead to coiling of the catheter. Currently, there are no guidelines as to who can perform HRM. An expert opinion has recommended minimum numbers of cases for the operator to perform in order to obtain and maintain competency. Several studies have reported on the rates of flawed HRM studies with approximately 20% being imperfect, including about 3% with critical flaws. The presence of a large hiatal hernia and achalasia have been identified as predictors of technical failure. Studies with minor flaws are usually still interpretable and clinically useful. Reports have also described several techniques for sedation-assisted placement of the HRM catheter, and this appears to be a promising alternative in cases of failed HRM, especially as sedation does not appear to significantly affect HRM measurements. An algorithm on how to proceed after a technically imperfect HRM study is proposed. Further research in this field is warranted including confirmation of the recommended competency numbers, assessing for quality measures in performing HRM such as technical success rate, identifying additional predictors of technical failure, standardization of the terminology, and qualifying the benefit of sedation-assisted HRM.
A Systematic Review on Long-Term Efficacy Outcome Measures in Crohn’s Disease Patients
Authors: Janssen Laura M , Creemers Rob H , van Bodegraven Adriaan A , Pierik Marie J
Published: March 2023

Background

The traditional long-term treatment goal of Crohn’s disease [CD] is maintenance of corticosteroid-free clinical remission. Additional treatment targets, such as biochemical, endoscopic and patient-reported remission, are advocated. The relapsing–remitting nature of CD provides a challenge to the timing of target assessment. Cross-sectional assessment at predetermined moments disregards the health state in between measurements. In this systematic review, we provide an overview of outcomes used to assess long-term efficacy in clinical trials in CD.

Methods

A systematic search of the PubMed and EMBASE databases was performed to identify clinical trials in luminal CD reporting on maintenance treatment [strategies] since 1995. Two independent reviewers selected eligible articles for full text retrieval, and assessed if long-term corticosteroid-free clinical, biochemical, endoscopic or patient-reported efficacy outcomes were used.

Results

The search resulted in 2452 hits and 82 articles were included. Clinical activity was used in 80 studies [98%] as the long-term efficacy outcome, and in 21 [26%] of these concomitant corticosteroid use was taken into account. C-reactive protein was used in 32 studies [41%], faecal calprotectin in 15 studies [18%], endoscopic activity in 34 studies [41%] and patient-reported outcome in 32 studies [39%]. In seven studies, clinical, biochemical, endoscopic activity and the patient’s perspective were measured. In most studies cross-sectional measures or multiple measurements over time were used.

Conclusion

In none of the published clinical trials in CD was sustained remission on all treatment targets reported. Cross-sectional outcomes at predetermined times were widely applied, leading to lack of information regarding sustained corticosteroid-free remission for this relapsing–remitting chronic disease.
Multimodality imaging of a cardiac angiosarcoma presenting with atrial flutter
Authors: Garcia Brás Pedro , Aguiar Rosa Sílvia , Branco Luísa Moura , Sousa Lídia
Published: March 2023

A 39-year-old female patient presents to the emergency department with palpitations and dyspnoea, with the admission electrocardiogram revealing atrial flutter. Step-by-step multimodality imaging techniques, including transthoracic echocardiography, computed tomography, cardiac magnetic resonance imaging, and intracardiac echocardiography-guided tissue biopsy, led to the final diagnosis of a right atrial angiosarcoma.
MADS-box protein AGL8 interacts with chromatin-remodelling component SWC4 to activate thermotolerance and environment-dependent immunity in pepper
Authors: Zhang Yapeng , Cai Weiwei , Wang Aiwen , Huang Xueying , Zheng Xiang , Liu Qian , Cheng Xingge , Wan Meiyun , Lv Jingang , Guan Deyi , Yang Sheng , He Shuilin
Published: March 2023

Pepper (Capsicum annuum) employs distinct defence responses against Ralstonia solanacearum infection (RSI); however, the mechanisms by which pepper activates these defence responses in a context-dependent manner is unclear. Here we study pepper plants defence response to RSI under room temperature-high humidity (RSRT, 28 °C / 90%) and high temperature-high humidity (RSHT, 37 °C / 90%) conditions, and non-infected plants under high temperature-high humidity (HTHH, 42 °C / 90%) stress. Herein, we found that the MADS-box transcription factor CaAGL8 was up-regulated by HTHH stress and RSRT or RSHT, and its silencing significantly reduced pepper thermotolerance and susceptibility to infection under both room and high temperature-high humidity (RSRT and RSHT). This was coupled with down-regulation of CaSTH2 and CaDEF1 upon RSRT, down-regulation of CaMgst3 and CaPRP1 upon RSHT, and down-regulation of CaHSP24 upon HTHH. In contrast, the ectopic overexpression of CaAGL8 significantly increased the resistance of Nicotiana benthamiana plants to RSRT, RSHT, and HTHH. In addition, CaAGL8 was found to interact with CaSWC4, which acted as a positive regulator of the pepper response to RSRT, RSHT, and HTHH. Silencing of either CaAGL8 or CaSWC4 blocked the hypersensitive response (HR) cell death and context-dependent up-regulation of defence-related genes triggered by the other. Importantly, enrichment of H4K5Ac, H3K9Ac, H3K4me3, and H3K9me2 on the tested defence-related genes was context- and gene-specifically regulated through synergistic interaction between CaSWC4 and CaAGL8. Our results indicate that pepper employs CaAGL8 to modulate chromatin remodelling by interacting with CaSWC4, thereby activating defence responses to RSRT, RSHT, and HTHH.
Timing of pulsars in the globular cluster omega centauri
Authors: Dai S , Johnston S , Kerr M , Berteaud J , Bhattacharyya B , Camilo F , Keane E
Published: March 2023

We present the timing of the first five millisecond pulsars discovered in the globular cluster Omega Centauri and the discovery of a pulsar with a spin period of 3.68 ms. With a timing baseline of ∼3.5 yr we are able to measure the derivative of the spin frequency ($\dot{\nu }$) for the first five pulsars. Upper limits on the pulsar line-of-sight acceleration are estimated and compared with predictions based on analytical models of the cluster. We find that PSRs J1326−4728B and D show large negative accelerations, which are in tension with the minimum acceleration predicted by analytical models. We searched for pulsed γ-ray signals using 14.3 yr of data from the Fermi Large Area Telescope. Although we found no evidence for γ-ray pulsations, PSRs J1326−4728A, B, C, and E are associated with X-ray sources. This suggests that the observed γ-ray emission from Omega Centauri is likely caused by the emission of the ensemble of MSPs. Finally, the linearly polarized emission from PSR J1326−4728A yields a rotation measure of −18 ± 8 rad m−2.
Correlated motions in DNA: beyond base-pair step models of DNA flexibility
Authors: López-Güell Kim , Battistini Federica , Orozco Modesto
Published: March 2023

Traditional mesoscopic models of DNA flexibility use a reductionist-local approach, which assumes that the flexibility of DNA can be expressed as local harmonic movements (at the base-pair step level) in the helical space, ignoring multimodality and correlations in DNA movements, which have in reality a large impact in modulating DNA movements. We present a new multimodal-harmonic correlated model, which takes both contributions into account, providing, with a small computational cost, results of an unprecedented local and global quality. The accuracy of this method and its computational efficiency make it an alternative to explore the dynamics of long segments of DNA, approaching the chromatin range.
MIRELLA: a mathematical model explains the effect of microRNA-mediated synthetic genes regulation on intracellular resource allocation
Authors: Cella Federica , Perrino Giansimone , Tedeschi Fabiana , Viero Gabriella , Bosia Carla , Stan Guy-Bart , Siciliano Velia
Published: March 2023

Competition for intracellular resources, also known as gene expression burden, induces coupling between independently co-expressed genes, a detrimental effect on predictability and reliability of gene circuits in mammalian cells. We recently showed that microRNA (miRNA)-mediated target downregulation correlates with the upregulation of a co-expressed gene, and by exploiting miRNAs-based incoherent-feed-forward loops (iFFLs) we stabilise a gene of interest against burden. Considering these findings, we speculate that miRNA-mediated gene downregulation causes cellular resource redistribution. Despite the extensive use of miRNA in synthetic circuits regulation, this indirect effect was never reported before. Here we developed a synthetic genetic system that embeds miRNA regulation, and a mathematical model, MIRELLA, to unravel the miRNA (MI) RolE on intracellular resource aLLocAtion. We report that the link between miRNA-gene downregulation and independent genes upregulation is a result of the concerted action of ribosome redistribution and ‘queueing-effect’ on the RNA degradation pathway. Taken together, our results provide for the first time insights into the hidden regulatory interaction of miRNA-based synthetic networks, potentially relevant also in endogenous gene regulation. Our observations allow to define rules for complexity- and context-aware design of genetic circuits, in which transgenes co-expression can be modulated by tuning resource availability via number and location of miRNA target sites.
The complex pathology of diabetic nephropathy in humans
Authors: Kriz Wilhelm , Löwen Jana , Gröne Hermann-Josef
Published: March 2023

This review summarizes the pathomorphological sequences of nephron loss in human diabetic nephropathy (DN). The relevant changes may be derived from two major derangements. First, a failure in the turnover of the glomerular basement membrane (GBM) based on an increased production of GBM components by podocytes and endothelial cells leading to the thickening of the GBM and accumulation of worn-out GBM in the mesangium. This failure may account for the direct pathway to glomerular compaction and sclerosis based on the continuous deposition of undegraded GBM material in the mesangium. Second, an increased leakiness together with an increased propensity of glomerular capillaries to proliferate leads to widespread plasma exudations. Detrimental are those that produce giant insudative spaces within Bowman's capsule, spreading around the entire glomerular circumference and along the glomerulo-tubular junction onto the tubule resulting in tubular obstruction and retroactively to glomerulosclerosis. Tubular atrophy and interstitial fibrosis develop secondarily by transfer of the glomerular damage onto the tubule. Interstitial fibrosis is locally initiated and apparently stimulated by degenerating tubular epithelia. This leads to a focal distribution of interstitial fibrosis and tubular atrophy accompanied by a varying interstitial mononuclear cell infiltration. Spreading of fibrotic areas between intact nephrons, much less to the glomerulus, has not been encountered.
Effects of a pre- and probiotic mixture and an autogenous vaccine on growth performance in newly weaned piglets experimentally challenged with an enterotoxigenic Escherichia coli strain
Authors: Zeilinger Katharina , Wessels Anna G , Vahjen Wilfried , Zentek Jürgen
Published: March 2023

Beneficial effects of pro- and prebiotics in weanling piglets are of great interest in livestock production. Similarly, the use of specific vaccines is of interest as alternative to antibiotics to reduce postweaning performance losses. The aim of this study was the assessment of the effect of a dual-strain probiotic (Bacillus subtilis and Bacillus licheniformis) and a prebiotic (fructo-oligosaccharides) as well as the additional vaccination with an autogenous inactivated Escherichia coli vaccine on the performance of newly weaned piglets after experimental infection with an enterotoxigenic E. coli. Forty piglets at the age of 28 d were randomly allotted to one of five groups: nonchallenged control (NC); challenged positive control (PC); challenged and vaccinated (CV); challenged and diet supplemented with pre- and probiotic mix (CM) and challenged, diet supplemented with pro- and prebiotic mix and vaccinated (CMV). Piglets of CV and CMV were vaccinated parenterally prior to the trial at the age of 17 d. Compared to NC, the experimental infection with E. coli resulted in a significant reduction of body weight gain in both vaccinated groups (P = 0.045), which was associated with an impaired gain to feed ratio (P = 0.012), but not feed intake. In contrast, piglets in the group supplemented with pro- and prebiotics (group CM) were able to maintain their weight and had an average daily gain, which was not significantly different from groups NC and PC. No differences regarding body weight gain, feed intake, gain to feed ratio and fecal score were observed between groups during the 3rd and 4th week of the trial. A significant impairment of fecal consistency and frequency of diarrhea was observed related to the oral challenge when comparing PC and NC treatments (P = 0.024). Neither vaccine, nor supplementation with pro- and prebiotics were able to significantly improve fecal consistency, nor did they have a positive effect on the prevalence of diarrhea. The results show no positive synergistic effect of the specific combination of vaccine and pre- and probiotics used in this trial on performance and diarrhea. The results show that the concept of a combination of a specific vaccination and a probiotic with a prebiotic needs further investigation. In the sense of avoiding the use of antibiotics, this seems to be an attractive approach.
Behavior and brain size of larval zebrafish exposed to environmentally relevant concentrations of beta-methylamino-l-alanine
Authors: Reside Amanda M , Gavarikar Sana , Laberge Frédéric , Bernier Nicholas J
Published: March 2023

Harmful algal blooms (HABs) release toxic compounds in water and are increasing in frequency worldwide. The neurotoxin β-methylamino-l-alanine (BMAA) is released by HABs and has garnered much attention over the past 20 years due to its association with human neurodegenerative disorders, but its effects on wildlife are still largely unknown. This study characterized the effects of chronic exposure to environmentally relevant concentrations of BMAA on the behavior and brain size of developing zebrafish (Danio rerio). Zebrafish were continuously exposed to 0, 1, 10, or 100 µg/l waterborne BMAA between 0- and 5-days postfertilization (dpf) before the onset of exogenous feeding. At 5 dpf, locomotion and responses to vibrational and visual stimuli were assessed. Following behavioral testing, larvae body and brain size were measured. Survival between 0 and 5 dpf did not differ between treatments. Moreover, BMAA exposure did not affect thigmotaxis, startle response magnitude, habituation to repeated presentation of vibrational startling stimuli, or relative brain size. A moderate increase in overall activity was observed in larvae exposed to 10 μg/l BMAA under light, but this effect was not seen in dark conditions, indicating that visual processing may have been affected by chronic BMAA exposure. Thus, passive continuous exposure to environmentally relevant concentrations of BMAA prior to first feeding in zebrafish did not affect survival or selected measures used to represent brain development, anxiety, and motor reflexes, but a limited light-dependent effect on locomotion suggests targeted neurotoxicity within the visual system.
Adolescent exposure to low-dose Δ9-tetrahydrocannabinol depletes the ovarian reserve in female mice
Authors: Lim Jinhwan , Lee Hye-Lim , Nguyen Julie , Shin Joyce , Getze Samantha , Quach Caitlin , Squire Erica , Jung Kwang-Mook , Mahler Stephen V , Mackie Ken , Piomelli Daniele , Luderer Ulrike
Published: March 2023

Cannabis use by adolescents is widespread, but its effects on the ovaries remain largely unknown. Δ9-tetrahydrocannabinol (THC) exerts its pharmacological effects by activating, and in some conditions hijacking, cannabinoid receptors (CBRs). We hypothesized that adolescent exposure to THC affects ovarian function in adulthood. Peripubertal female C57BL/6N mice were given THC (5 mg/kg) or its vehicle, once daily by intraperitoneal injection. Some mice received THC from postnatal day (PND) 30–33 and their ovaries were harvested PND34; other mice received THC from PND30–43, and their ovaries were harvested PND70. Adolescent treatment with THC depleted ovarian primordial follicle numbers by 50% at PND70, 4 weeks after the last dose. The treatment produced primordial follicle activation, which persisted until PND70. THC administration also caused DNA damage in primary follicles and increased PUMA protein expression in oocytes of primordial and primary follicles. Both CB1R and CB2R were expressed in oocytes and theca cells of ovarian follicles. Enzymes involved in the formation (N-acylphosphatidylethanolamine phospholipase D) or deactivation (fatty acid amide hydrolase) of the endocannabinoid anandamide were expressed in granulosa cells of ovarian follicles and interstitial cells. Levels of mRNA for CBR1 were significantly increased in ovaries after adolescent THC exposure, and upregulation persisted for at least 4 weeks. Our results support that adolescent exposure to THC may cause aberrant activation of the ovarian endocannabinoid system in female mice, resulting in substantial loss of ovarian reserve in adulthood. Relevance of these findings to women who frequently used cannabis during adolescence warrants investigation.
Percutaneous release for trigger thumb in children under local anesthesia
Authors: Çimen Oğuzhan , Irgit Kaan Süleyman , Nami Şahin
Published: March 2023

Trigger thumb surgery can be performed through open surgery or percutaneous release. Open surgery often requires hospitalization, an operating room, a surgical incision, and postoperative wound care; however, percutaneous release does not require hospitalization or surgery, and is relatively easier and faster. We aimed to assess the results of percutaneous A-1 pulley release using local anesthesia without hospitalization for the treatment of pediatric trigger thumb. In this retrospective study, we included patients operated on between March 2013 and August 2020 with the diagnosis of trigger thumb. The percutaneous release under local anesthesia was applied to all the children by one orthopedic surgeon. All percutaneous release procedures were performed in outpatient clinic conditions. There were 183 children (218 thumbs) who were enrolled in the clinic. Eighty-seven patients were male (47.5%) and 96 were female (52.5%). The average follow-up duration was 5 years (1–8.5 years). Among the 218 trigger thumb cases, 211 were satisfactory (successful result rate 96.8%). Relapse was seen in only 3 thumbs in the early postoperative period. No patient experienced neurovascular deficit or infection. The percutaneous surgical release in pediatric trigger thumb treatment is a simple, minimally invasive procedure that can be done in an outpatient setting under local anesthesia. In addition, the procedure duration is short and has minimal complication rates and maximum patient satisfaction. Level of Evidence III.
The role of menopausal hormone therapy in the prevention and treatment of low bone density in perimenopausal and postmenopausal women
Authors: Shah Nandi , Ariel Danit
Published: March 2023

Purpose of review

The purpose of this review is to summarize the evidence on the benefits of menopausal hormone therapy (MHT) for the maintenance of skeletal health, prevention of osteoporosis and related fractures in peri and postmenopausal women.

Recent findings

We will review the impact of estrogen on skeletal health as well as the physiology of bone loss during the perimenopause and postmenopause. We will then elucidate the data that include estrogen alone and combination of MHT to demonstrate that in the absence of contraindication, MHT should be considered as an option for the maintenance of skeletal health both when concomitant menopausal symptoms are present and when not.

It has been well established that estrogens maintain bone mineral density (BMD) and reduce fracture risk at all sites. However, the most extensively studied form of estrogen with established fracture prevention is oral doses of synthetic estrogens. Due to the reduced risk profile, lower doses of bioidentical oral or transdermal estrogens are often preferred in clinical practice. We will highlight the current data on improvement in BMD and fracture risk reduction, including differences in formulation, dose, and route of delivery, to support a provider in the clinical decision-making process.
SEVERE VISUAL LOSS DURING ANTI-VEGF INTRAVITREAL INJECTIONS IN NEOVASCULAR AGE-RELATED MACULAR DEGENERATION: TIMING, PROGNOSIS, AND OPTICAL COHERENCE TOMOGRAPHY FINDINGS
Authors: GRASSI MARIA OLIVA , MONTELEONE GIUSEPPINA , POZHARITSKIY NIKOLAI , MOLFETTA TERESA , BOSCIA GIACOMO , ALESSIO GIOVANNI , BOSCIA FRANCESCO
Published: March 2023

Purpose:

Intravitreal injection (IVI) of anti–vascular endothelial growth factor (VEGF) is the standard of care for neovascular age-related macular degeneration (nAMD). However, a small subgroup of patients still experience severe visual impairment, which may be related to the number of IVI administered.

Methods:

This retrospective observational study analyzed data from patients with sudden severe visual decline (≥15 Early Treatment Diabetic Retinopathy Study [ETDRS] letters loss between two consecutive IVIs) during anti-VEGF treatment for nAMD. Best-corrected visual acuity examination, optical coherence tomography (OCT), and OCT angiography (OCTA) were performed before every IVI and central macular thickness (CMT) and drug injected were collected.

Results:

1,019 eyes received anti-VEGF IVI for nAMD from December 2017 to March 2021. Severe VA loss occurred in 15.1% after a median of 6 (range 1–38) IVI. Ranibizumab was injected in 52.8% and aflibercept in 31.9% of cases. Functional recovery after 3 months was significant, without further improvement at 6 months. Visual prognosis relative to the percentage of CMT change showed better visual outcome in eyes with no substantial change in CMT compared with an increase of >20% or a decrease of >5%.

Conclusion:

In this first real-life study exploring severe VA loss during anti-VEGF treatment in patients with nAMD, it was found that it was not unusual for a ≥15 ETDRS letters loss to occur between two consecutive IVIs, often within 9 months of diagnosis and 2 months after the last IVI. Close follow-up and a proactive regimen should be preferred, at least in the first year.
FLUID–FLUID EXCHANGE AND EXTERNAL NEEDLE DRAINAGE WITH MINIMAL GAS VITRECTOMY ASSOCIATED WITH RETINAL DISPLACEMENT
Authors: Bansal Aditya , Escaf Luis C. , Lee Wei Wei , Muni Rajeev H.
Published: March 2023

Purpose:

To determine whether fluid–fluid exchange (endodrainage) or external needle drainage can result in retinal displacement following minimal gas vitrectomy (MGV) with no fluid–air exchange for rhegmatogenous retinal detachment repair.

Methods:

Two patients with macula-off rhegmatogenous retinal detachment underwent MGV with and without segmental buckle. First case had MGV with segmental buckle (MGV-SB), along with endodrainage, whereas the second case had MGV only with external fluid drainage. At the completion of surgery, the patient was immediately log rolled to face down for 6 hours followed by positioning to the break.

Results:

Both patients achieved retinal reattachment, and postoperative widefield fundus autofluorescence imaging demonstrated a low-integrity retinal attachment with retinal displacement.

Conclusion:

Iatrogenic fluid drainage techniques, such as fluid–fluid exchange or external needle drainage during MGV (without fluid–air exchange), may result in retinal displacement. Allowing the retinal pigment epithelial pump to reabsorb the fluid naturally may reduce the risk of retinal displacement.
SEVERE MULTIFOCAL PLACOID CHORIORETINITIS ASSOCIATED WITH IMMUNE CHECKPOINT INHIBITOR THERAPY
Authors: Yu Jeffrey J. , Everett Lesley , Sassalos Therese M. , Johnson Mark W.
Published: March 2023

Purpose:

To report a case of severe bilateral multifocal placoid chorioretinitis in a patient receiving ipilimumab and nivolumab therapy for metastatic melanoma.

Methods:

Retrospective, observational case report.

Results:

A 31-year-old woman on ipilimumab and nivolumab for metastatic melanoma developed severe multifocal placoid chorioretinitis in both eyes. The patient was started on topical and systemic corticosteroid therapy, and immune checkpoint inhibitor therapy was paused. After resolution of ocular inflammation, the patient was restarted on immune checkpoint inhibitor therapy without return of ocular symptoms.

Conclusion:

Extensive multifocal placoid chorioretinitis may occur in patients undergoing immune checkpoint inhibitor therapy. Some patients with immune checkpoint inhibitor–related uveitis may successfully resume immune checkpoint inhibitor therapy under close collaboration with the treating oncologist.
Regional analgesia techniques for lumbar spine surgery: a frequentist network meta-analysis
Authors: Hong Boohwi , Baek Sujin , Kang Hyemin , Oh Chahyun , Jo Yumin , Lee Soomin , Park Seyeon
Published: March 2023

Background:

Various regional analgesia techniques are used to reduce postoperative pain in patients undergoing lumbar spine surgery. Traditionally, wound infiltration (WI) with local anesthetics has been widely used by surgeons. Recently, other regional analgesia techniques, such as the erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block, are being used for multimodal analgesia. The authors aimed to determine the relative efficacy of these using a network meta-analysis.

Materials and methods:

The authors searched PubMed, EMBASE, the Cochrane Controlled Library, and Google Scholar databases to identify all randomized controlled trials that compared the analgesic efficacy of the following interventions: ESPB, TLIP block, WI technique, and controls. The primary endpoint was postoperative opioid consumption during the first 24 hours after surgery, while the pain score, estimated postoperatively at three different time periods, was the secondary objective.

Results:

The authors included 34 randomized controlled trials with data from 2365 patients. TLIP showed the greatest reduction in opioid consumption compared to controls [mean difference (MD) =−15.0 mg; 95% CI: −18.8 to −11.2]. In pain scores, TLIP had the greatest effect during all time periods compared to controls (MD=−1.9 in early, −1.4 in middle, −0.9 in late). The injection level of ESPB was different in each study. When only surgical site injection of ESPB was included in the network meta-analysis, there was no difference compared with TLIP (MD=1.0 mg; 95% CI: −3.6 to 5.6).

Conclusions:

TLIP showed the greatest analgesic efficacy after lumbar spine surgery, in terms of postoperative opioid consumption and pain scores, while ESPB and WI are also alternative analgesic options for these surgeries. However, further studies are needed to determine the optimal method of providing regional analgesia after lumbar spine surgery.
Reacting to Epidemics: The Innovative Imperial Public Health System during the Late Northern Song Dynasty
Authors: Goldschmidt Asaf
Published: March 2023

Song China was a period in which China experienced a great increase in its population. Concurrently, the Song dynasty also experienced a rise in the frequency of epidemics and two major wars with the Western Xia and Liao dynasties during the 1000s and 1040s. The consequences of these changes were exacerbated by the increased geographical mobility of certain social groups such as traders and examinees attending civil service examinations. Thus, casualties of wars, epidemics, or disease, especially of people whose families were far away and could not care for them were left without care and “their corpses often lay bare along the roads.” This new social environment created a need for general relief. The Northern Song government (960–1127 CE), especially during the reign of Emperor Huizong, established an innovative public health system to address this issue. The public health system included poorhouses, public hospitals, and pauper’s cemeteries. The first were more of charity organizations, whereas the latter two promoted public health by providing medical services for the poor and burial for those that nobody cared for. In terms of rationale behind these institutions, on the one hand, they constituted an attempt to get the poor and homeless off the streets while providing them relief or burial. On the other hand, it seems that Huizong’s deep concern with medicine propelled him to design and implement a comprehensive public health system oriented to prevent contagion and outbreak of epidemics. This article depicts the background, the organization, and the functions of the system. The article also discusses the conditions and reasons that gave rise to such a unique undertaking by the Northern Song government.
Literature review: are NSAIDs harmful and is acetaminophen well tolerated?
Authors: Abbasi Momen , Teakell Jade
Published: March 2023

Purpose of review

On the basis of previous literature, NSAID use is typically avoided in patients at risk for kidney disease, while acetaminophen has generally been considered well tolerated. However, the extent of NSAID effect on the kidneys is not clear, especially in chronic kidney disease (CKD), and the concerns about the safety of acetaminophen have been rising. In this review, we will discuss the latest evidence of the effects of NSAIDs and acetaminophen in the context of nephrology and hypertension.

Recent findings

The risk of acute kidney injury (AKI) by NSAIDs is higher with longer courses and in the presence of several factors such as older age, diabetes mellitus, lower eGFR, diuretic use and cardiovascular disease. The timing of NSAID use in relation to the onset of AKI may affect its progression. Regular NSAID use could be associated with an increased incidence of CKD, but the relation between NSAID use and CKD progression is less clear. Regular acetaminophen use was associated with increased SBP, while its use could have a renoprotective effect in certain situations.

In patients at risk of kidney disease, NSAIDs may be used cautiously after discussing possible adverse effects. Regular acetaminophen use should be reassessed in patients with uncontrolled hypertension.
Management of the brachial plexus in head and neck cancer
Authors: Fockens M. Matthijs , Kraak Jeroen T. , Leemans C. René , Eerenstein Simone E.J.
Published: March 2023

Purpose of review

The brachial plexus is an important anatomical structure that is regularly encountered by head and neck surgeons and radiation oncologists. Surgical or radiation-induced brachial plexus injury have great impact on arm function and quality of life. Anatomical variations and management of the brachial plexus in head and neck cancer treatment are discussed.

Recent findings

The brachial plexus consists of spinal roots from C5–C8 and T1. The most prevalent anatomical variations in brachial plexus anatomy include the prefixed brachial plexus (additional contribution from C4) in 11%, the roots of C5 and C6 piercing the belly of the anterior scalene muscle in 6.8%, and presence of the scalenus minimus muscle in 4.1–46%. Due to its location, the brachial plexus is at risk of inadvertent division or neuropraxia during surgical procedures such as neck dissection or robot-assisted transaxillary thyroid surgery (RATS). In case of inadvertent division, nerve reconstruction surgery is warranted and may lead to improved function. The risk of radiation-induced brachial plexus injury is dose-dependent and occurs in approximately 12–22%. Currently, no successful treatment options exist for radiation-induced injury.

Knowledge of anatomical variations is important for head and neck surgeons to minimize the risk of brachial plexus injury. Limiting radiation therapy dose to the brachial plexus is desirable to decrease the risk of brachial plexus injury.
Are we ready for deintensification in human papillomavirus-positive oropharyngeal carcinomas?
Authors: Huang Shao Hui , Hahn Ezra , Salunkhe Rohan , Barcelona Marc Vincent N. , O'Sullivan Brian
Published: March 2023

Purpose of review

Excellent outcomes following contemporary treatment of human papillomavirus (HPV)-positive oropharyngeal carcinoma (HPV+ OPC) have prompted the exploration of deintensification approaches to minimize treatment-related toxicities. This review describes the landscape of deintensification to date (up to November 2022).

Recent findings

Although several deintensification trials have been published, none are practice changing. Three phase III randomized-controlled trials studying cetuximab and radiation therapy vs. standard chemoradiotherapy all showed inferior outcomes. Although some phase II trials reported favourable outcomes, they are often single-arm trials without an adequate control arm, thereby limiting the ability to modify practice.

Substantial effort has been expended to explore deintensification options for selected HPV+ OPC patients aiming to avoid unnecessary toxicity. Strategies have included replacing cisplatin with cetuximab, reduced chemotherapy or radiotherapy intensity, reduction of radiotherapy volumes and risk stratification after trans-oral surgery or following induction chemotherapy. Challenges remain in the current deintensification landscape, including identifying the most suitable candidates along with a choice of most appropriate deintensification strategies. Promising selection criteria included either static baseline features or kinetic characteristics of clinical-biological parameters. Practice-changing trials remain elusive, and the search continues to attempt optimization of the therapeutic ratio for these patients.
Disease Experience of Patients With Differentiated Thyroid Cancer at Different Phases Based on Timing It Right Framework
Authors: Pei Jiaqin , Meng Jingyu , Xue Yajuan , Zhang Li
Published: March 2023

Background

As the incidence of differentiated thyroid cancer (DTC) continues to rise globally, it is important to gain insight into the disease experience of cancer patients at different phases of the disease. However, surveys addressing the longitudinal disease experience and specific needs of this population are lacking.

Objective

The aim of this study was to explore the disease experience of people with DTC at key time points in their cancer trajectory so support can be rendered for “patient-centered” supportive care services.

Methods

On the basis of the Timing It Right framework, a semistructured in-depth interview was conducted with 14 patients with DTC at 5 key phases from initial diagnosis to 6 months postoperatively, and data were analyzed using the Colaizzi 7-step analysis.

Results

The themes of disease experience at different phases were as follows: (1) diagnostic phase: differences in acceptance; (2) perioperative phase: physical and mental distress; (3) discharge preparation phase: anxiety and helplessness, and gap of disease knowledge; (4) discharge adjustment phase: fear of recurrence and proactive health; and (5) discharge adaptation phase: multiple needs.

Conclusion

The experience, care needs, and nature of the needs of patients with DTC change dynamically with the different phases of the disease. Capturing the most appropriate time throughout the continuum of care to implement supportive care that patients need most will help to improve the continuity and precision of cancer care.

Implications for Practice

Healthcare providers should provide a continuum of dynamic care by scientifically and systematically assessing the actual supportive care needs of patients with DTC according to their different phases of disease.
Foreign Body in the Bronchus Intermedius: Inadvertent Deployment of a Bravo Wireless pH Probe in the Airway
Authors: Andreoli Steven M. , Schrum Stefanie , McGoogan Katherine
Published: March 2023

The Bravo pH probe is a wireless capsule allowing remote quantification of gastroesophageal reflux. A 14-year-old male presented for Bravo probe placement. Following esophagogastroduodenoscopy, attachment of the Bravo probe was attempted. Immediately, the patient began coughing without oxygen desaturation. Repeat endoscopy did not reveal the probe within the esophagus or stomach. He was then intubated, and fluoroscopy demonstrated a foreign body within the bronchus intermedius. Rigid bronchoscopy was performed to retrieve the probe using optical forceps. This is the first case of pediatric inadvertent airway deployment requiring retrieval. We recommend endoscopic visualization of the delivery catheter entering the cricopharyngeus before Bravo probe deployment, then followed by repeat endoscopy to confirm position of the probe after attachment.