bluuebunny/crossref_metadata_2025 huggingface dataset:
Gravity and Maximum Entropy Models
Authors: Rivers Ray , Evans Tim , Paliou Eleftheria
Published: November 2023

Gravity models are a class of quantitative models that can be used for describing the spatial characteristics of social interactions, providing a realization of Tobler’s “law” of geography that “near things are more related than distant things.” In archaeology, they are particularly suited for describing historic and prehistoric “exchange” and “settlement formation.” Although, quantitatively, they were originally little more than mimicry of Newtonian gravitation, they arise naturally in some forms of economic modeling and as the “most likely” outcomes (MaxEnt) from limited knowledge. We discuss several of their key applications to archaeological data.
Hydrographic Networks
Authors: Apolinaire Eduardo , Bastourre Laura
Published: November 2023

Hydrographic networks have been the stage for major historical processes worldwide because of their economic importance and role as travel and communication pathways. This chapter focuses on this second aspect and explores the contribution of network approaches to addressing fluvial waterways in archaeology. First, it enquires into basic methodological issues concerning the modeling of hydrographic networks and how to connect them with archaeological data. It subsequently provides a critical overview of the literature that has linked formal analysis of hydrographic networks to archaeological problems and explores the potential of this approach to deal with topics that have not yet been thoroughly analyzed from this viewpoint. In doing this, two main areas of interest are identified. On the one hand, the study of hydrographic networks has been useful as a means to explore the flow of goods, information, and people along riverine routes, and hence to address topics such as exchange systems, settlement patterns, social inequalities, and landscape social construction. On the other hand, this approach may provide new insights into classical archaeological problems such as migration and diffusion through fluvial networks.
Networks, Agent-Based Modeling, and Archaeology
Authors: Cegielski Wendy H.
Published: November 2023

Integrated agent-based modeling and social network analysis (ABM-SNA) has the power to transform the way we study the past. ABM-SNA moves beyond static, network pattern-analysis and inference by providing a computational laboratory for the hypothesis testing of social relationship formation processes. Archaeology assumes that the patterns of the material record are explainable as the result of underlying causes. Yet, we rarely have the advantage of first-person observation with our study subjects, instead relying on end-state patterns of material depositions to infer process. This chapter reviews the concept of ABM-SNA as well as the advantages an integrated approach confers, namely the ability to study individual agency and relationship dynamics in real time. Several archaeological use-cases are presented before the chapter concludes with suggested ways to utilize ABM-SNA in the simulation of social processes that shape the archaeological record, e.g. social influence, social contagion, and the maintenance of social stability.
Random Graph Models
Authors: Amati Viviana
Published: November 2023

Random graph models are probability distributions that model the structure of a network. These models are commonly applied to test hypotheses concerning the characteristics that might have led to an observed network, and generate networks according to different processes of tie formation. In this chapter, I discuss the application of random graph models to the study of past networks. After a brief introduction to random graph models, I describe how these models can contribute to enhancing archaeological network analyses by complementing the standard descriptive analysis often performed in archaeological studies. I also discuss the limits of these methods and the challenges that archaeologists must meet to apply random graph models in different archaeological contexts.
Challenges for Network Research in Archaeology
Authors: Peeples Matthew A. , Roberts John M. , Yin Yi
Published: November 2023

The field of archaeology has experienced a recent surge of interest in social network analysis. In this rush to incorporate new techniques developed in other disciplines, a number of significant methodological challenges have emerged in the analysis and interpretation of networks based on archaeological data. In this chapter, we explore a few of the of the key challenges involved in applications of archaeological network research including: (1) assessments of sampling variability and uncertainty in network metrics, (2) the special properties of networks constructed based on assessments of social distance, (3) filtering methods for extracting key features of networks, and (4) the complexities of dynamic networks and explorations of change through time. We argue that each of these areas presents challenges that archaeologists will need to address to push network research further and also to give opportunities to contribute to the broader world of network science.
Knowledge Networks
Authors: Mickel Allison , Sinclair Anthony , Brughmans Tom
Published: November 2023

Network approaches can be used to study how disciplinary knowledge is created, and how knowledge production draws on aspects of academic writings such as citations and co-authorship. In this chapter we introduce common concepts and techniques for the study of knowledge networks, how they can be applied more creatively than they currently are, and why their study matters. We first introduce bibliometrics and the formal network techniques frequently used for the formal study of knowledge flows in academic communities. In the second section, we illustrate the importance of appropriate data selection strategies in light of custom bibliometric research questions, and critically assess the way in which bibliometrics is used to speak to often-invisible power structures in knowledge production. Finally, we offer our wish list for the future of knowledge network study in archaeology. What do these techniques have to offer archaeologists, and what can the alignment of network science and archaeology tell us about the creation of knowledge across academia?
Networks and Catastrophes
Authors: Gjesfjeld Erik
Published: November 2023

Every catastrophic event has two distinct, yet closely connected, parts: the physical hazard and the social environment in which the physical hazard occurs. This chapter focuses on exploring how the social environment, through the lens of social networks, both influences and is influenced by catastrophic events. Broadly speaking, social networks play a number of vital roles in the preparation for, response to, and recovery from disasters. This includes the building of social capital, the distribution of information and resources, and the minimization of risk to future hazards. The changing structure of social networks can also be informative of the resilience and vulnerability of societies to catastrophes. This approach uses archaeological data to measure long-term changes in networks and to evaluate how these changes impact the capacity for communities to return to previous ways of life. Overall, this chapter demonstrates that archaeological network approaches provide a valuable diachronic perspective on catastrophic events by considering not only their short-term impacts, but also the long-term consequences of catastrophes on social relationships and community resilience.
Networks and Cultural Transmission in Hunter-Gatherer Societies
Authors: Buchanan Briggs , Hamilton Marcus J.
Published: November 2023

In this chapter we examine current research on networks and cultural transmission in modern, historic, and prehistoric hunter-gatherer societies. Understanding networks in hunter-gatherer societies is important because hunting and gathering has been the socioeconomic framework for the vast majority of human evolutionary history. A better understanding of the structure and function of social networks in hunting and gathering societies has the potential to shed light on the evolution of human social organization. Our discussion of the structure and function of networks in hunter-gatherer societies uses studies of contemporary hunter-gatherers, ethnohistorical data, and ethnoarchaeological observations to frame inferences about prehistoric societies observable only in the archaeological record. We summarize recent work with contemporary hunter-gatherers that shows how large-scale networks link both unrelated and related individuals, optimizing flows of energy, material, and information. Next, we describe ethnohistorical and ethnoarchaeological studies of hunter-gatherers that link observations of the structure of modern hunter-gatherer societies to the archaeological record. Lastly, we examine case studies of Paleoindian hunter-gatherers from late Pleistocene North America. These studies focus on macro-scale cultural transmission in the deep past to show how network theory plays a fundamental role in understanding how low-density, sparsely populated groups adapted to the novel environmental conditions of the New World. We suggest that future research in hunter-gatherer studies should focus on the diversity of network structures across societies, especially in sedentary hunter-gatherer societies, and with the introduction of agricultural economies.
Inference from Archaeological Similarity Networks
Authors: Östborn Per , Gerding Henrik
Published: November 2023

It is now common to use similarity networks to analyze archaeological data. In such networks the nodes may correspond to archaeological contexts, and similar contexts are then connected by edges. Similarity is treated as a proxy for social or causal relationships. Often, similarity is defined by the presence of the same kind of find in two contexts. However, to detect relationships more effectively, we have to allow any kind of similarity relation as a criterion for connection, in which several different kinds of attributes that characterize the contexts may be combined. The flexibility of such general similarity networks allows for exploratory analyses in which the criterion for connection is varied. It is argued that structural properties of similarity networks that are robust to such variation, and only such properties, may be interpreted as properties of the underlying social or causal network. However, to allow such inferences, these structural properties should be statistically significant. To test for such significance, random permutation tests suited to archaeological similarity networks are introduced. The methods are exemplified by a case study of the diffusion of fired bricks in Hellenistic Europe. Analysis of general similarity networks is compared to other kinds of quantitative data analysis, such as correspondence analysis. It is argued that their relative merits depend on the data at hand, and on the questions posed to the material.
Introduction
Authors: Peeples Matthew A. , Munson Jessica , Mills Barbara J. , Brughmans Tom
Published: November 2023

Networks have become increasingly popular in archaeology in recent years and have been used to address a wide variety of archaeological questions. In this introductory chapter, we provide a brief history of network approaches in archaeological research as well as in the broader social sciences. We then present a discussion of some of the features of archaeological data and archaeological networks that are distinct from many other areas where network methods and models have been applied. We argue that the special features of archaeological networks present some challenges but also considerable opportunity for archaeologists to contribute to the broader sphere of network theory and methods. Finally, we conclude with a description of the structure of the Handbook and our reasoning in creating this structure.
Geochemical Networks
Authors: Golitko Mark
Published: November 2023

Provenance studies of archaeological materials and formal structural modeling of prehistoric exchange developed hand-in-hand during the 1960s and 70s. While network methods were first applied to archaeometric data during the 1970s, it was only when networks gained in archaeological popularity during the 2000s that the increasing amount of geochemical data available to archaeology was again analyzed using methods and concepts drawn from network science. Most such studies directly infer the structure of prehistoric exchange from the presence of shared material compositional types at archaeological sites. Validation of models produced from theoretical expectations has been rarer, yet represents a promising avenue of further linking geochemical data to higher-level theory. Alternatively, improvements in archaeometric methods may help in understanding how to interpret edges in archaeological networks produced by other means.
The Countries of the Former Yugoslavia
Authors: Milanović Marko , Papić Tatjana
Published: November 2023

This chapter takes up one of the themes of the handbook—diversity within Europe—to describe and discuss the international legal tradition in (some of) the countries of the former Yugoslavia. There are many possible approaches to studying any legal tradition. Bearing in mind the theme of the diversity within Europe and purposes of this handbook, the one the authors have decided to take here is first to give a brief socio-legal overview of the development of the international legal profession in the former Yugoslavia. Then the authors engage in a comparative study of the textbooks used at prominent universities in the post-Yugoslav States, in a kind of sociology of international law in the former Yugoslavia. The chapter’s main goal is to expose the underlying values and ideologies promoted by the authors of these textbooks, which are indicative of the understanding and the effect of international law in this part of the world.
A Community of Mavericks
Authors: Tenenbaum Elie
Published: November 2023

Modern counter-insurgency has usually been studied from a single case-study perspective (for instance, Malaya, Algeria, or Cuba) or with a focus on particular national styles and experiences (among which the so-called ‘British way’ of counter-insurgency is perhaps best known). However, recent comparative history scholarship has highlighted important similarities among Western democracies’ handling of insurgent challenges from the early Cold War era of decolonization to the most recent so-called Global War on Terror. This paper attempts to offer some insights into how these similarities might be approached from a transnational perspective. Focusing on the three main Western powers involved in counter-insurgency (Great Britain, France, and the United States), it draws connecting lines between their respective experiences, stressing the importance of the sharing of lessons learned, liaison exchanges, organizational learning, and even doctrinal standardization processes, both at bilateral and multilateral levels. While one should not overestimate the practical influence of such knowledge circulation, one also has to take it into account to achieve a more global history of late-colonial conflict and state-building.
The Afrikaner Rebellion 1914–1915
Authors: Fedorowich Kent , van der Waag Ian
Published: November 2023

The Afrikaner rebellion of 1914–1915 is an under-studied but significant event in South Africa’s troubled history. At its core was the struggle for the leadership and direction of an increasingly polarized Afrikaner community, elements of which were becoming gradually more impoverished and politically marginalized as the young dominion developed into a highly urbanized and modern industrial society. For those bywoners or ‘poor whites’ who were being economically sidelined, the beginnings of discontent originated in the politics of rural Afrikaner poverty that had been gripping specific regions of the country since the turn of the twentieth century. This essay explores the ‘geography of dissent’ and the multifaceted reasons surrounding the outbreak of the rebellion. It also investigates how a new generation of progressive Afrikaner leaders, epitomized by Louis Botha and Jan Smuts, sought to conciliate those of their brethren who rose up in 1914 to preserve the old patriarchal order. In the end, although the government’s counter-insurgency operations were overwhelmingly successful, it was the political settlement that followed which would define a new national identity.
Comparative effectiveness of biological disease-modifying antirheumatic drugs and Janus kinase inhibitor monotherapy in rheumatoid arthritis
Authors: Onishi Akira , Yamada Hirotaka , Yamamoto Wataru , Watanabe Ryu , Hara Ryota , Katayama Masaki , Okita Yasutaka , Maeda Yuichi , Amuro Hideki , Son Yonsu , Yoshikawa Ayaka , Hata Kenichiro , Hashimoto Motomu , Saegusa Jun , Morinobu Akio
Published: November 2023

Objectives

The objective of this study was to examine the effectiveness and drug tolerability of biological DMARD (bDMARD) and Janus kinase inhibitor (JAKi) monotherapy in patients with RA in a multicentre cohort study.

Methods

Patients with RA for whom bDMARD/JAKi monotherapy without conventional synthetic DMARDs has been initiated were included. Monotherapy regimens were categorized as IL-6 receptor inhibitors (IL-6Ris), cytotoxic T-lymphocyte–associated protein 4 immunoglobulin (CTLA4Ig), JAKis, or TNF inhibitors (TNFis). Multiple propensity score–based inverse probability weighting (IPW) was used to reduce selection bias. Linear mixed-effect models with IPW were used to examine changes in the DAS in 28 joints using ESR (DAS28)-ESR at 24 weeks, and drug retention was compared between monotherapy groups using IPW Cox proportional hazards models.

Results

A total of 849 treatment courses were included, involving 635 patients (IL-6Ris, 218; CTLA4Ig, 183; JAKis, 92; TNFis, 356). The change in DAS28-ESR at week 24 as the primary outcome was –0.93 (95% CI: –1.20 to –0.66) lower in the IL-6Ri group than in the TNFi group, while those of the CTLA4Ig and JAKi groups were similar to that of the TNFi group [–0.20 (–0.48 to 0.08), –0.25 (–0.67 to 0.16), respectively]. IL-6Ri use was associated with significantly lower overall drug discontinuation than that for TNFi use [hazard ratio = 0.55 (0.39–0.78), P = 0.001]. Similar retention rates were identified for the CTLA4Ig and JAKi groups to that of the TNFi group.

Conclusion

In the analysis with IPW to reduce selection bias, IL-6Ri monotherapy was superior to TNFi monotherapy in terms of effectiveness and drug retention. No significant differences were identified between CTLA4Ig, JAKi and TNFi monotherapy.
Radiation exposure during CT procedures in Tanzania
Authors: Ngoye Wilson , Ndukeki Mussa , Muhogora Wilbroad , Jusabani Ahmed , Ngaile Justine , Ngoya Patrick , Sungura Richard , Ngatunga Cecilia , Hashmi Nazrina , Makungu Hilda , Onoka Erick , Amirali Mudassir , Kileo Abdallah , Makoba Atumaini , Muhulo Alex , Ngulimi Miguta , Balobegwa Vitus , Edmund Elisha , Masoud Ali , Matulanya Machibya
Published: November 2023

The aim of this study was to evaluate optimisation status during common computed tomography (CT) procedures by determining values of volume computed tomography dose index (CTDIvol) and dose-length product (DLP) per examination. Patient and exposure data were collected from the CT console during various CT procedures. The results show that variations in CTDIvol and DLP values were mainly because of differences in the techniques used. The 75th percentile values were set as the third quartile of the median CTDIvol or DLP values for all hospitals. These values of 40.9, 9.0, 9.4 and 16.2 mGy for CTDIvol were determined for head, high-resolution chest, abdomen–pelvis and lumbar spine, respectively. The corresponding DLP values for the same sequence of CT procedures were 900, 360, 487 and 721 mGy.cm, respectively. The updated results provide a basis for optimising the procedures of CT in this country.
Group membership modulates the hold-up problem: an event-related potentials and oscillations study
Authors: Hao Su , Xin Qing , Xiaomin Zhang , Jiali Pan , Xiaoqin Wang , Rong Yu , Cenlin Zhang
Published: November 2023

This paper investigates the neural mechanism that underlies the effect of group identity on hold-up problems. The behavioral results indicated that the investment rate among members of the in-group was significantly higher than that of the out-group. In comparison to the NoChat treatment, the Chat treatment resulted in significantly lower offers for both in-group and out-group members. The event-related potentials (ERP) results demonstrated the presence of a distinct N2 component in the frontal midline of the brain when investment decisions were made for both in-group and out-group members. During the offer decision-making stage, the P3 peak amplitude was significantly larger when interacting with in-group members compared to the out-group members. The event-related potentials oscillations (ERO) results indicated that when investment decisions were made for in-group members in the NoChat treatment, the beta band (18–28 Hz, 250–350 ms) power was more pronounced than when decisions were made for out-group members. In the NoChat treatment, offer decisions for in-group members yielded a more pronounced difference in beta band (15–20 Hz, 200–300 ms) power when compared to out-group members. Evidence from this study suggests that group identity can reduce the hold-up problem and corroborates the neural basis of group identity.
Efficacy of Serratus Anterior Plane Block vs Paravertebral and Intercostal Blocks for Pain Control after Surgery
Authors: Qian Ping , Zheng Xiaoyu , Wei Huaying , Ji Kemin
Published: November 2023

Objective:

Our study aims at comparing the analgesic efficacy of serratus anterior plane block (SAB) with the paravertebral block (PVB) and intercostal block (ICB) for patients undergoing surgical procedures.

Material and methods:

An extensive literature search was performed on the databases of ScienceDirect, Google Scholar, PubMed, and Embase from inception to 24th October 2021. Only randomized controlled trials (RCTs) comparing SAB with either PVB or ICB and reporting pain outcomes were included.

Results:

16 RCTs were included. 13 compared SAB with PVB and 3 with ICB. Comparing SAB with PVB, we noted no difference in 24-hour morphine consumption between the groups (MD: 1.37, 95% CI: -0.33, 3.08 I2=96%, P=0.11). However, the exclusion of one study indicated significantly increased analgesic consumption with the SAB. No difference was found in pain scores between SAB and PVB at 2, 4, 6, 8, 12, and 24 hours. Meta-analysis failed to demonstrate any statistically significant difference in time to first analgesic request (TFAR) between the two groups (MD: -0.79, 95% CI: -0.17, 1.75 I2=94%, P=0.11). We also noted no statistically significant difference in the incidence of nausea/vomiting with SAB or PVB (OR: 0.79, 95% CI: 0.41, 1.51 I2=0%, P=0.47).

Conclusions:

Evidence on the analgesic efficacy of the SAB vs. the PVB is conflicting. 24-hour total analgesic consumption (TAC) may be higher with the SAB as compared to PVB but with no difference in pain scores and TFAR. Data on the comparison of the SAB with the ICB is scarce to draw strong conclusions.
Efficacy and Safety of Erector Spinae Plane Block versus Thoracolumbar Interfascial Plane Block in Patients Undergoing Spine Surgery
Authors: Peng Qing , Meng Bo , Yang Sheng , Ban Zhenghu , Zhang Yu , Hu Man , Zhao Wenjie , Wu Haisheng , Tao Yuping , Zhang Liang
Published: November 2023

Objectives:

As two novel peripheral nerve blocks, the erector spinae plane block (ESPB) and thoracolumbar interfascial plane (TLIP) block can relieve postoperative pain in spinal surgery. This systematic review and meta-analysis aimed to determine the efficacy and safety of ESPB versus TLIP block in patients undergoing spine surgery.

Methods:

An extensive search of English online databases, including PubMed, Web of Sciences, Embase, Medline and Cochrane Central Register of Controlled Trials and Chinese online databases like Wanfang Data, CNKI and CQVIP until March 31, 2023, with no language restrictions was performed. This systematic review and meta-analysis are based on the PRISMA statement and has been registered on PROSPERO (International Prospective Register of Systematic Reviews) with registered ID: CRD42023420987.

Results:

Five studies involving 457 patients were eligible for this study. Compared with TLIP block, ESPB had lower postoperative opioid consumption at postoperative 48 hours (SMD=−1.31, 95% CI=−2.54 to −0.08, P=0.04, I2=80%) and postoperative pain score at postoperative 24 hours (SMD=−0.72, 95% CI=−1.43 to −0.02, P=0.04, I2=95%) in patients undergoing spine surgery. Complications associated with ESPB and TLIP block were not reported in the included studies.

Discussion:

ESPB and TLIP block are two novel and effective block methods. Patients receiving ESPB had lower postoperative opioid consumption and postoperative pain score compared with patients receiving TLIP block, there was no significant difference between the two groups in intraoperative opioid consumption, adverse events and rescue analgesia.
Rosacea: Clinical Aspects and Treatments
Authors: Geng Ryan , Bourkas Adrienn N. , Sibbald R. Gary
Published: November 2023

Rosacea is a chronic inflammatory disease characterized by a diverse set of nonspecific clinical signs including erythema, flushing, papules and pustules, skin thickening (especially enlarged nose) and thread-like vessels in the central facial region, and potential ocular involvement. This review focuses on the epidemiology, clinical presentation, and treatment of rosacea. Other related topics discussed include the psychosocial impact and differential diagnoses.

GENERAL PURPOSE

To review the clinical presentation and treatment of rosacea.

TARGET AUDIENCE

This continuing education activity is intended for physicians, physician assistants, nurse practitioners, and nurses with an interest in skin and wound care.

LEARNING OBJECTIVES/OUTCOMES

After participating in this educational activity, the participant will:

1. Distinguish the clinical manifestations of rosacea subtypes.

2. Identify pharmacologic and nonpharmacologic treatment options for patients who have rosacea.
In Their Own Voices; Living with Hidradenitis Suppurativa: A Qualitative Study
Authors: Durgu Nihan , Ozan Erol , Gencoglan Gulsum
Published: November 2023

OBJECTIVE:

To provide a deeper assessment of the lived experience of patients with hidradenitis suppurativa, a chronic inflammatory disorder characterized by recurrent abscess, sinuses, and scars.

METHODS

This study used a phenomenologic approach. Researchers recruited 10 participants via purposive sampling. Data were collected via semistructured, in-depth, face-to-face interviews, and interpretative phenomenologic analysis was performed.

RESULTS

Data analysis uncovered two primary themes among participants’ interview responses: “unending symptoms” and “life becoming hard.”

CONCLUSIONS

The symptoms of hidradenitis suppurativa negatively affect individuals’ family, professional, and daily lives, and patients may benefit from psychiatric intervention.
A New Method for Constructing Macrophage-Associated Predictors of Treatment Efficacy Based on Single-Cell Sequencing Analysis
Authors: Lin Jianxiu , Ran Yang , Wu Tengfei , Wang Zishan , Zhao Jinjin , Tian Yun
Published: November 2023

Tumor-associated macrophages (TAMs) are highly infiltrated in the tumor microenvironment (TME) of colorectal cancer (CRC) and play a vital role in CRC’s development as well as prognosis. The required data were obtained from the Gene Expression Omnibus database and The Cancer Genome Atlas. Univariate Cox regression and least absolute shrinkage operator analyses were executed for model construction. TME assessment and immune prediction were performed using the ESTIMATE software package and the single sample genome enrichment analysis algorithm. The results show patients with low a TAMs risk score (TRS) had a better prognosis in both The Cancer Genome Atlas and Gene Expression Omnibus cohorts. Patients with low TRS were more sensitive to 3 chemotherapeutic agents: oxaliplatin, paclitaxel, and cisplatin (P<0.05). TME assessment showed that the low TRS group had less infiltration of M2 macrophages and regulatory T cells, but CD4+ T cells, NK cells, and dendritic cells occupy a greater proportion of TME. Low TRS group patients have a low StromalScore and ImmuneScore but have high TumorPurity. The immune checkpoint TIM-3 gene HAVCR2 expression was significantly higher in the high TRS group. Finally, we created a nomogram including TRS for forecasting survival, and TRS was significantly associated with the clinical stage of the patients. In conclusion, the TRS serves as a reliable prognostic indicator of CRC; it predicts patient outcomes to immunotherapy and chemotherapy and provides genomic evidence for the subsequent development of modulated TAMs for treating CRC.
SBRT vs. Y90
Authors: deBettencourt Mark F. , Liu Yirong , Cotler Scott J. , Molvar Chris A. , Abdelrahman Tamer , Thomas Tarita O.
Published: November 2023

Objectives:

Stereotactic Body Radiotherapy (SBRT) and Yttrium-90 (Y90) are among the ablative therapies used as treatment options for localized hepatocellular carcinoma (HCC). To date, direct comparisons of the 2 modalities’ outcomes and costs are lacking. This study aimed to analyze demographic, treatment, and cost information for patients with HCC treated with SBRT and Y90.

Methods:

Patients with HCC treated with SBRT or Y90 radioembolization between January 2018 and January 2020 at one institution were retrospectively reviewed. Demographic and treatment data were compared utilizing χ2 tests. Kaplan-Meier curves and log-rank tests were applied to compare overall survival and progression-free survival in different treatment groups. Cox proportional hazard models were applied to analyze the unadjusted and adjusted survival differences. Ten SBRT and 10 Y90 patients were randomly selected for Medicare cost analysis.

Results:

Sixty-three patients received Y90, and 21 received SBRT. On univariable and multivariable analysis, there was no significant difference in overall survival or progression-free survival between the Y90 and SBRT cohorts. SBRT patients had higher American Joint Committee on Cancer staging (P=0.039), greater tumor size (4.07 vs. 2.96 cm, P=0.013), and greater rates of prior liver-directed therapy (71.4% SBRT vs. 12.7% Y90, P<0.001). The average cost for SBRT was $15,148, and Y90 was $41,360.

Conclusions:

SBRT and Y90 are effective therapies in the treatment of HCC, specifically having similar overall survival and progression-free survival. Y90 was found to have a significantly higher cost than SBRT. This study demonstrates the need for prospective studies to assess these modalities in treating HCC.
Glandular Schwannoma With Apocrine Decapitation Secretion: A True Divergent Differentiation or Entrapped Normal Tissue?
Authors: Mansour Boulos , Rossi Silvia Maria , Kazakov Dmitry V. , Donati Michele
Published: November 2023

We report an unusual case of schwannoma with glandular elements that demonstrated apocrine decapitation secretion. The glandular structures were embedded within the tumor, varied in shape and size, and were lined by a double-to-multilayered epithelium, with the inner layer composed of monomorphous cuboidal to columnar cells, focally with apocrine decapitation secretion, and the outer layer representing myoepithelial cells. A normal eccrine unit was observed near the lesion. Immunohistochemical studies showed that all luminal cells of the glandular structures stained positive for CK7, whereas myoepithelial cells expressed S100 and p63, and epithelial membrane antigen highlighted the luminal border. CK20 and neuroendocrine markers were negative in the glandular elements.

Our findings suggest that the origin of the glandular elements in our case was represented by entrapped glands. Two theories may explain the epithelial hyperplasia observed in the present case as follows: the obstructive effect theory and the inductive ability of a mesenchymal proliferation to produce epidermal or adnexal changes. We suggest that, in a subset of cases, the origin of the glandular elements might represent entrapped glands, wherein their histomorphology/cytomorphology recapitulates the elements comprising the normal adjacent tissue. Further research is necessary to elucidate the histogenesis of glandular schwannoma.
Round Bodies Detected by Treponema pallidum Immunohistochemical Stain in Two Cases of Cutaneous Syphilitic Gummata
Authors: Birmingham Suzanne W. , Saeed Lina , Thurlow Charles M. , Vilfort Kendra , Pillay Allan , Rojek Nathan W. , Doan Linda T. , Lee Bonnie A.
Published: November 2023

Tertiary syphilis may present a diagnostic challenge due to negative nontreponemal serologies in up to 30% of cases and frequent lack of identifiable spirochetes on histopathology or other direct detection tests. We report 2 cases of round bodies staining with Treponema pallidum immunohistochemistry by light microscopy in biopsies from cutaneous syphilitic gummata. In 1 case, the finding was validated 3 times by 2 independent laboratories; in the other case, T. pallidum was detected by polymerase chain reaction in the biopsy sample. Spirochete round bodies have previously been reported in the setting of electron microscopy and fluorography, but to the best of our knowledge, have not been reported by light microscopy in a routine skin biopsy. Although the clinical implications are unclear, this may represent a helpful new paradigm for the diagnosis of tertiary syphilis.
Evaluation of the ‘Sip Til Send’ regimen before elective caesarean delivery using bedside gastric ultrasound
Authors: Harnett Colleen , Connors Jesse , Kelly Shane , Tan Terry , Howle Ryan
Published: November 2023

BACKGROUND

Pre-operative fasting is routinely advocated to avoid pulmonary aspiration. The European Society of Anaesthesiology and Intensive Care (ESAIC) recommends a fasting period of 2 h for liquids before surgery. Liberal drinking policies such as the ‘Sip Til Send’ are a suggested alternative to maintain hydration before surgery.

OBJECTIVES

To compare residual gastric volumes in fully fasted nonlabouring parturients before elective caesarean delivery with the ‘Sip Til Send’ with water liberal drinking protocol. Our hypothesis was the ‘Sip Til Send’ would be noninferior to standard fasting at minimising the residual gastric volume immediately before surgery.

DESIGN

A paired cohort prospective observational pragmatic study using gastric ultrasound, analysed by an operator blinded to the fasting status of each scan.

SETTING

A tertiary maternity hospital in Dublin, Ireland. The study was conducted between January and June 2023.

PARTICIPANTS

Pregnant women about to undergo elective caesarean delivery who had followed ESAIC fasting guidelines before admission.

INTERVENTIONS

Each participant underwent two pairs (semi-recumbent and the semi-recumbent right lateral positions) of standardised ultrasound examinations of the gastric antrum: the order of these scans was randomised. The first pair of scans occurred on admission before the ‘Sip Til Send’ protocol commenced, the other pair just before spinal anaesthesia for caesarean delivery, after a variable time following the ‘Sip Til Send’ protocol.

MAIN OUTCOME MEASURE

The primary outcome was the difference in antral cross-sectional area (CSA) between the fully fasted women on admission and the same women after following the ‘Sip Til Send’ protocol until just before spinal anaesthesia.

RESULTS

Fifty-eight women were randomised for the study: 55 and 54 scans in the semi-recumbent position on admission, and 55 and 54 scans in the right lateral position just before spinal anaesthesia. The mean differences (95% CI) in CSA in the semi-recumbent and RL positions were 0.07 (-0.39 to 0.53) cm2 and 0.04 (-0.60 to 0.68) cm2, respectively. Since the of 95% CIs did not cross the predefined noninferiority margin of 0.88 cm2, ‘Sip Til Send’ was noninferior to fully fasting in in terms of the antral CSA.

CONCLUSION

The ‘Sip Til Send’ protocol of liberal hydration with water was noninferior to standard fasting prior to elective caesarean delivery.

TRIAL REGISTRY NUMBER

NCT05783427 ClinicalTrials.gov
Nuclear Acly protects the liver from ischemia-reperfusion injury
Authors: Gao Wenbin , Zhang Liping , Li Ziru , Wu Tong , Lang Chunhui , Mulholland Michael W. , Zhang Weizhen
Published: November 2023

Background and Aims:

Hepatic ischemia-reperfusion (IR) injury is the most common complication that occurs in liver surgery and hemorrhagic shock. ATP citrate lyase (Acly) plays a pivotal role in chromatin modification via generating acetyl-CoA for histone acetylation to influence biological processes. We aim to examine the roles of Acly, which is highly expressed in hepatocytes, in liver IR injury.

Approach and Results:

The functions of Acly in hepatic IR injury were examined in the mouse model with a hepatocyte-specific knockout of Acly. The Acly target genes were analyzed by CUT&RUN assay and RNA sequencing. The relationship between the susceptibility of the steatotic liver to IR and Acly was determined by the gain of function studies in mice. Hepatic deficiency of Acly exacerbated liver IR injury. IR induced Acly nuclear translocation in hepatocytes, which spatially fueled nuclear acetyl-CoA. This alteration was associated with enhanced acetylation of H3K9 and subsequent activation of the Foxa2 signaling pathway. Nuclear localization of Acly enabled Foxa2-mediated protective effects after hypoxia-reperfusion in cultured hepatocytes, while cytosolic Acly demonstrated no effect. The presence of steatosis disrupted Acly nuclear translocation. In the steatotic liver, restoration of Acly nuclear localization through overexpression of Rspondin-1 or Rspondin-3 ameliorated the IR-induced injury.

Conclusions:

Our results indicate that Acly regulates histone modification by means of nuclear AcCoA production in hepatic IR. Disruption of Acly nuclear translocation increases the vulnerability of the steatotic liver to IR. Nuclear Acly thus may serve as a potential therapeutic target for future interventions in hepatic IR injury, particularly in the context of steatosis.
Nervous System Involvement in Hospitalized Patients With COVID-19
Authors: Harirchian Mohammad Hossein , Ghabaee Mojdeh , Sarraf Payam , Ranji-Burachaloo Sakineh , Agah Elmira , Mousavi Seyed Vahid , Abkhoo Aminreza , Amani Kiana , Javadian Nina , Farahmand Ghasem , Magrouni Hannah , Alizadeh Boroujeni Fatemeh , Nazari Fatemeh , Ghafouri Shima , Hosseinzadeh Maryam , Enayati Sonya , Kabiri Samaneh , Pasebani Yeganeh , Rafati Ali , Azizmohammad Looha Mehdi , Tafakhori Abbas , Jameie Melika
Published: November 2023

Background

COVID-19 patients with neurological manifestations have poorer outcomes. We investigated the association between clinicodemographic and laboratory findings with poorer outcomes among COVID-19 inpatients with neurological manifestations.

Methods

This was a retrospective study of consecutive medical records (March–April 2020). Neurological manifestations (altered level of consciousness, acute cerebrovascular disease, ataxia, seizure, headaches, dizziness/vertigo, muscle weakness, and peripheral neuropathies) were categorized into serious and nonserious.

Results

Of 119 COVID-19 inpatients, 38 with neurological manifestations were included (age, 63.7 ± 13.4 years; male, 65.8%), of whom 27 (71.1%) had serious manifestations. Muscle weakness (57.9%), impaired consciousness (47.4%), and acute cerebrovascular disease (23.7%) were the most frequent manifestations. The in-hospital mortality rate was 28.9%. Patients with serious manifestations were significantly older (66.9 vs 55.7, P = 0.018), with significantly higher white blood cell count (6.8 vs 5.1 × 103/μL, P = 0.023), direct bilirubin (0.3 vs 0.2 mg/dL, P = 0.030), prothrombin time (PT) (15.4 vs 14.4 seconds, P = 0.006), international normalized ratio (1.2 vs 1.1, P = 0.005), and model for end-stage liver disease (MELD) scores (10 vs 7, P = 0.011), compared with those with nonserious manifestations. In addition, the nonsurvivors had higher potassium (4.5 vs 4.0 mEq/L, P = 0.021), total bilirubin (1.1 vs 0.6 mg/dL, P = 0.008), and MELD scores (12 vs 8, P = 0.025) compared with the survivors. After adjustment, we found significant impacts of age (adjusted odds ratio [aOR], 1.11; P = 0.032), PT (aOR, 5.04; P = 0.019), and MELD score (aOR, 1.27, P = 0.047) on poorer outcomes.

Conclusions

Older age, higher white blood cell count, bilirubin, PT, international normalized ratio, potassium, and MELD scores were associated with poorer outcomes in COVID-19 inpatients with neurological manifestations.
Predictive Factors of Apathy in Stroke Survivors During the Recovery Period
Authors: Wang Pao-Chen , Pai Hsiang-Chu
Published: November 2023

BACKGROUND: Apathy may be an important predictor of depression and significantly negatively affect the quality of life and functional recovery of stroke survivors. However, the evidence reflects the inconsistent findings of studies on the impact of individual-related variables on apathy in patients with stroke. OBJECTIVES: This study examines the relationships among stroke survivors' individual characteristics, background variables, disease-related variables, and apathy; furthermore, we identify predictors of apathy. METHODS: In this cross-sectional correlational study, the participants were recruited from a medical university hospital. Three measurement tools were used: individual and background variables, the modified Rankin Scale, and the Apathy Evaluation Scale. Hierarchical multiple regression analysis was used to identify the predictors of apathy. RESULTS: Participants included 100 stroke survivors with a mean age of 59.9 (12.1) years. The prevalence of apathy among stroke survivors was 27%. Stroke survivors' economic sources (β = 0.430, P = .001), perceived family support (β = −0.163, P = .048), and modified Rankin Scale (β = 0.283, P = .001) accounted for 43.7% of the variance in survivor apathy. CONCLUSION: The results of this study clarified which individual characteristics, background variables, and disease-related variables are key predictors of apathy in patients with stroke.
PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant pancreatic cancer patients
Authors: Gong Mengyuan , Zhang Bo , Wang Xueni , Zhu Zeen , Li Wei , Han Liang , Wu Zheng , Ma Qingyong , Wang Zheng , Qian Weikun
Published: November 2023

Background:

Partly due to the limited effect of chemotherapy or other therapeutic strategies, which may be due to the insufficient knowledge of the tumor promotion markers and targets, pancreatic cancer (PC) holds the position of one of the most malignant tumors. This study aims to find a diagnosis/therapeutic molecule that can predict the prognosis of PC with different gene background.

Methods:

The Cancer Genome Atlas (TCGA) pancreatic duct adenocarcinoma (PAAD)–based single nucleotide polymorphisms and gene expression data were used to find the differentially expressed genes (DEGs) between KRAS/TP53 mutant samples and no gene mutation samples. Gene Set Enrichment Analysis (GSEA)-based Kyoto Encyclopedia of Genes and Genomes (KEGG) analysis and R-based gene oncology (GO) or immune cell invasion assay were used to explore the above DEGs involved pathways. The single-center PC cohort accompanied with next-generation sequence testing was used to verify the TCGA PAAD–based bioinformatic results.

Results:

First, we found PC patients who harbored KRAS and/or TP53 gene mutation have poor overall survival. Besides, the enrichment analysis showed that mutant KRAS/TP53 was correlated with PC tumor-promotion–related pathways and immune microenvironment. Next, we detected that prostate stem cell antigen (PSCA) was one of the most differential genes in KRAS/TP53 mutant PC tissues. Indeed, the bioinformatic analysis and our clinical data showed that PSCA was a biomarker of poor prognosis in PC.

Conclusion:

PSCA is a critical biomarker for predicting the prognosis of KRAS/TP53 mutant PC patients.
Treatment strategies to prevent or mitigate the outcome of postpancreatectomy hemorrhage: a review of randomized trials
Authors: Montorsi Roberto M. , Zonderhuis Babs M. , Daams Freek , Busch Olivier R. , Kazemier Geert , Marchegiani Giovanni , Malleo Giuseppe , Salvia Roberto , Besselink Marc G.
Published: November 2023

Background:

Postpancreatectomy hemorrhage (PPH) is a leading cause for surgical mortality after pancreatic surgery. Several strategies for the prevention and management of PPH have been studied in randomized controlled trials (RCTs) but a systematic review is lacking. The authors systematically reviewed RCTs regarding the impact of treatment strategies on the incidence and outcome of PPH.

Material and methods:

Eligible RCTs reporting on impact of treatment on the rate of PPH were identified through a systematic literature search using the Evidence Map of Pancreatic Surgery (2012–2022). Methodological quality was assessed using the Cochrane Risk of Bias 2 (RoB-2) tool for RCTs. Various definitions of PPH were accepted and outcome reported separately for the International Study Group for Pancreatic Surgery (ISGPS) definition.

Results:

Overall, 99 RCTs fulfilled the eligibility criteria with a pooled 6.1% rate of PPH (range 1–32%). The pooled rate of PPH defined as ISGPS grade B/C was 8.1% (range 0–24.9%). Five RCTs reported five strategies that significantly reduced the rate of PPH. Three concerned surgical technique: pancreatic anastomosis with small jejunal incision, falciform ligament wrap around the gastroduodenal artery stump, and pancreaticojejunostomy (vs pancreaticogastrostomy). Two concerned perioperative management: perioperative pasireotide administration, and algorithm-based postoperative patient management. No single RCT specifically focused on the treatment of patients with PPH.

Conclusion:

This systematic review of RCTs identified five strategies which reduce the rate of PPH; three concerning intraoperative surgical technique and two concerning perioperative patient management. Future studies should focus on the treatment of patients with PPH as RCTs are currently lacking.
Preliminary report on a novel technique for endoscopic transaxillary thyroidectomy: A case control study
Authors: Liu Yang , Wang Jiazhong , Chen Shuo , Lv Hao , Yu Shuo , Ran Xiaoli , Gao Nan , Sun Yun , Cao Gang
Published: November 2023

Background:

Endoscopic transaxillary approaches to thyroidectomy have been well described and gasless transaxillary endoscopic thyroidectomy (GTET) is the most popular method. However, this require a single long axillary incision which is longer than most remote access thyroidectomy procedures. We improved the GTET and provided a novel way to access the thyroid. The purpose of this study was to test the feasibility of our novel transaxillary thyroidectomy procedure and to attempt to reduce the size of the scar and reduce the flap creation area.

Methods:

116 patients who underwent our novel transaxillary thyroidectomy procedure were compared with the patients who underwent open and GTET procedures. The patients’ demographics, outcomes, and complications were analyzed.

Results:

Although the operation time (121.48±23.91mins) was longer in the novel endoscopic group compare to the open group, it was shorter than GTET group. Intraoperative blood loss was similar between the groups. However, the novel procedure group had more drainage volume within 48 postoperative hours compare to other two groups. Despite the VAS pain score didn’t reveal a difference between the open and novel endoscopic procedure, it was lower in the novel procedure than GTET. The hospital stay days didn’t show a difference between the two groups. The number of resected central lymph nodes was similar between the groups. Differences didn’t reveal between the groups regarding to the complications rate.

Conclusion:

Our results showed that our novel transaxillary thyroidectomy procedure is feasible and safe. This procedure can be an alternative endoscopic transaxillary method for thyroidectomy.