bluuebunny/crossref_metadata_2025 huggingface dataset:
Outcomes of thoracic aortic interventions in Marfan syndrome in the state of Texas over 11 years
Authors: Mikulski Matthew F , Well Andrew , Mery Carlos M , Johnson Gregory , Gottlieb Erin A , Fraser Charles D , Beckerman Ziv
Published: August 2023

OBJECTIVES

Marfan syndrome is a heritable connective tissue disorder with significant aortopathy and conveys substantial cardiovascular morbidity. This study characterizes the mortality and morbidities of thoracic aortic interventions (TAI) in the Marfan syndrome population in the state of Texas from 2009 to 2019.

METHODS

A retrospective review of the Texas Inpatient Discharge Dataset from 1 January 2009 to 31 December 2019. Discharges from acute care hospitals with a Marfan syndrome diagnosis by the International Classification of Diseases 9/10 codes and a procedure code for TAI were analysed utilizing descriptive, univariate and multivariable regression statistics.

RESULTS

There were 4641 Marfan syndrome discharges identified, of whom 644 (13.9%) underwent TAI. Thoracic or thoraco-abdominal aortic dissection or rupture was noted in 223 (34.6%). Thirty-three (5.1%) had a concomitant coronary artery intervention. There were 30 (4.7%) in-hospital mortalities, 126 (19.6%) diagnoses of acute renal failure (ARF), 52 (8.1%) had mechanical ventilation >96 h and the median length of stay was 10 [interquartile range (IQR) 7–16] days. After adjustment, concomitant coronary artery intervention was associated with in-hospital mortality [odds ratio (OR) 3.69 [IQR 1.15–11.90], P = 0.029] and ARF (OR 2.66 [IQR 1.19–5.94], P = 0.017). Aortic dissections/ruptures were associated with ARF (OR 1.73 [IQR 1.14–2.63], P = 0.010), ventilation >96 h (OR 2.19 [IQR 1.21–3.97], P = 0.010), and 15% longer length of stay (95% confidence interval 2.4–29.1%, P = 0.038).

CONCLUSIONS

TAI are frequent among the hospitalized Marfan Syndrome population. Concomitant coronary intervention is associated with increased risk of death and aortic dissections/ruptures are associated with increased morbidity. The high prevalence of aortic dissections/ruptures points to a potential target for improving imaging surveillance, adherence to treatment guidelines and preventative management of Marfan syndrome aortopathy.
In vivo performance of a tri-leaflet mechanical heart valve prosthesis in an ovine model
Authors: Langenaeken Tom , De Meester Pieter , Verbrugghe Peter , Rega Filip , Lamberigts Marie , Van Hecke Manon , Van Hoof Lucas , Meuris Bart
Published: August 2023

OBJECTIVES

We present the long-term results of a trileaflet (Triflo) versus bileaflet (On-X) mechanical valve in both aortic and pulmonary positions in a sheep model.

METHODS

The Triflo valve was implanted in 21 female sheep in aortic (n = 8) and pulmonary position (n = 13). The On-X valve was implanted in 7 female sheep in aortic (n = 1) and pulmonary (n = 6) positions. No antithrombotic medication of any kind was given postoperatively. In the aortic group, survival cohorts were 3 and 5 months. In the pulmonary group, survival cohorts were 10 and 20 weeks. Valve performance was assessed using haematology, echocardiography and acoustic measurements combined with post-mortem pathology analysis of the downstream organs.

RESULTS

The mean gradients were lower for the Triflo valve in both pulmonary [4.30 mmHg (3.70–5.73) vs 6.80 mmHg (4.63–7.96), P = 0.012] and aortic [5.1 mmHg (4.2–7.7) vs 10.7 mmHg (8.7–12.9), P = 0.007] positions. Peak gradients were lower for the Triflo valve in both pulmonary [8.05 mmHg (6.75–10.23) vs 13.15 mmHg (9.20–14.76), P = 0.005] and aortic [8.7 mmHg (7.5–12.5) vs 16.5 mmHg (14.2–19.6), P = 0.009] positions. In both positions, leaflets and housing surface were free from any deposits macro- and microscopically and comparable to nonimplanted control valves. Peripheral organs showed no signs of thrombo-embolic damage. Biochemical and haematological were comparable to preoperative. The closing click sound pressure level of the Triflo was significantly lower in both aortic [108.4 sound pressure level (102.0–115.7) vs 111.7 sound pressure level (105.5–117.0), P < 0.001] and pulmonary [103.6 sound pressure level (99.1–108.9) vs 118.5 sound pressure level (116.7–120.2), P < 0.001] position.

CONCLUSIONS

Preliminary in vivo results of the Triflo valve are promising in both aortic and pulmonary positions in an ovine model. Excellent haemodynamics, stable long-term function, low valve noise and no thrombo-embolic events in the absence of antithrombotic medication lay the foundation to a future clinical first-in-man trial.
A new Malmquist productivity index with an application to commercial banks
Authors: Zhu Chuanjin , Zhu Nan , Emrouznejad Ali , Ye Tao
Published: August 2023

Accepted by: Aris Syntetos

Management-led productivity improvements are crucial for achieving sustainable development, and the Malmquist productivity index is known to be useful in relevant contexts. This study aims to extend such index by using non-parametric mathematical modelling of production processes. Specifically, and in the spirit of the existing index, we introduce the directional distance function to develop a new one applicable to the joint production of desirable and undesirable outputs. Furthermore, we decompose the new index into two constituent components to provide more intuitive explanations when revealing the root sources of productivity changes over time. Under the cost minimization assumption, the new index is applicable when producers implement resource allocation management, and the input–output quantities and the micro-level input prices are known. The index emphasizes that the allocative efficiency should be regarded as an important aspect of productivity assessment like the technical efficiency. As a practical benchmarking tool, it can offer valuable information and provide appropriate strategies for managerial decision-making. The index’s application and usefulness is demonstrated in the commercial bank sector in China.
Finite Idempotent Set-Theoretic Solutions of the Yang–Baxter Equation
Authors: Colazzo Ilaria , Jespers Eric , Kubat Łukasz , Van Antwerpen Arne , Verwimp Charlotte
Published: August 2023

It is proven that finite idempotent left non-degenerate set-theoretic solutions $(X,r)$ of the Yang–Baxter equation on a set $X$ are determined by a left simple semigroup structure on $X$ (in particular, a finite union of isomorphic copies of a group) and some maps $q$ and $\varphi _{x}$ on $X$, for $x\in X$. This structure turns out to be a group precisely when the associated Yang–Baxter monoid $M(X,r)$ is cancellative and all the maps $\varphi _{x}$ are equal to an automorphism of this group. Equivalently, the Yang–Baxter algebra $K[M(X,r)]$ is right Noetherian, or in characteristic zero it has to be semiprime. The Yang–Baxter algebra is always a left Noetherian representable algebra of Gelfand–Kirillov dimension one. To prove these results, it is shown that the Yang–Baxter semigroup $S(X,r)$ has a decomposition in finitely many cancellative semigroups $S_{u}$ indexed by the diagonal, each $S_{u}$ has a group of quotients $G_{u}$ that is finite-by-(infinite cyclic) and the union of these groups carries the structure of a left simple semigroup. The case that $X$ equals the diagonal is fully described by a single permutation on $X$.
The Effects of Bacillus subtilis QST713 and β-mannanase on growth performance, intestinal barrier function, and the gut microbiota in weaned piglets
Authors: Liu Junchen , Ma Xiangyuan , Zhuo Yong , Xu Shengyu , Hua Lun , Li Jian , Feng Bin , Fang Zhengfeng , Jiang Xuemei , Che Lianqiang , Zhu Zeyuan , Lin Yan , Wu De
Published: August 2023

We investigated the effects of different Bacillus subtilis QST713 doses and a B. subtilis QST713 and β-mannanase mix on growth performance, intestinal barrier function, and gut microbiota in weaned piglets. In total, 320 healthy piglets were randomly assigned to four groups: 1) control group (basal diet), 2) BS100 group (basal diet plus 100 mg/kg B. subtilis QST713), 3) BS200 group (basal diet plus 200 mg/kg B. subtilis QST713), and 4) a BS100XT group (basal diet plus 100 mg/kg B. subtilis QST713 and 150 mg/kg β-mannanase). The study duration was 42 d. We showed that feed intake in weaned piglets on days 1 to 21 was increased in group BS100 (P < 0.05), and that the feed conversion ratio in group BS100XT animals decreased throughout the study (P < 0.05). In terms of microbial counts, the BS100XT group showed reduced Escherichia coli and Clostridium perfringens numbers on day 21 (P < 0.05). Moreover, no significant α-diversity differences were observed across all groups during the study (P > 0.05). However, principal coordinates analysis indicated clear separations in bacterial community structures across groups (analysis of similarities: P < 0.05) on days 21 and 42. Additionally, E-cadherin, occludin, and zonula occludens-1 (ZO-1) expression in piglet feces increased (P < 0.05) by adding B. subtilis QST713 and β-mannanase to diets. Notably, this addition decreased short-chain fatty acid concentrations. In conclusion, B. subtilis QST713 addition or combined B. subtilis QST713 plus β-mannanase effectively improved growth performance, intestinal barrier function, and microbial balance in weaned piglets.
Nepal’s worst dengue outbreak is a wake-up call for action
Authors: Bijukchhe Sanjeev M , Hill Matilda , Adhikari Bipin , Shrestha Ashis , Shrestha Shrijana
Published: August 2023

Nepal had its worst dengue outbreak in 2022. Climate change, urbanization and increased transportation networks have favoured dengue mosquito vectors. As the monsoon season approaches, dengue outbreak seems inevitable. Strengthening the national dengue preventive strategy, healthcare planning and resource allocation is essential to avoid future outbreaks.
Rehydration of Freeze Substituted Brain Tissue for Pre-embedding Immunoelectron Microscopy
Authors: Pérez-Garza Janeth , Parrish-Mulliken Emily , Deane Zachary , Ostroff Linnaea E
Published: August 2023

Electron microscopy (EM) volume reconstruction is a powerful tool for investigating the fundamental structure of brain circuits, but the full potential of this technique is limited by the difficulty of integrating molecular information. High quality ultrastructural preservation is necessary for EM reconstruction, and intact, highly contrasted cell membranes are essential for following small neuronal processes through serial sections. Unfortunately, the antibody labeling methods used to identify most endogenous molecules result in compromised morphology, especially of membranes. Cryofixation can produce superior morphological preservation and has the additional advantage of allowing indefinite storage of valuable samples. We have developed a method based on cryofixation that allows sensitive immunolabeling of endogenous molecules, preserves excellent ultrastructure, and is compatible with high-contrast staining for serial EM reconstruction.
Fabrication of Specimens for Atom Probe Tomography Using a Combined Gallium and Neon Focused Ion Beam Milling Approach
Authors: Allen Frances I , Blanchard Paul T , Lake Russell , Pappas David , Xia Deying , Notte John A , Zhang Ruopeng , Minor Andrew M , Sanford Norman A
Published: August 2023

We demonstrate a new focused ion beam sample preparation method for atom probe tomography. The key aspect of the new method is that we use a neon ion beam for the final tip-shaping after conventional annulus milling using gallium ions. This dual-ion approach combines the benefits of the faster milling capability of the higher current gallium ion beam with the chemically inert and higher precision milling capability of the noble gas neon ion beam. Using a titanium–aluminum alloy and a layered aluminum/aluminum-oxide tunnel junction sample as test cases, we show that atom probe tips prepared using the combined gallium and neon ion approach are free from the gallium contamination that typically frustrates composition analysis of these materials due to implantation, diffusion, and embrittlement effects. We propose that by using a focused ion beam from a noble gas species, such as the neon ions demonstrated here, atom probe tomography can be more reliably performed on a larger range of materials than is currently possible using conventional techniques.
SCHIZORIZA domain–function analysis identifies requirements for its specific role in cell fate segregation
Authors: Pardal Renan , Scheres Ben , Heidstra Renze
Published: August 2023

Plant development continues postembryonically with a lifelong ability to form new tissues and organs. Asymmetric cell division, coupled with fate segregation, is essential to create cellular diversity during tissue and organ formation. Arabidopsis (Arabidopsis thaliana) plants harboring mutations in the SCHIZORIZA (SCZ) gene display fate segregation defects in their roots, resulting in the presence of an additional layer of endodermis, production of root hairs from subepidermal tissue, and misexpression of several tissue identity markers. Some of these defects are observed in tissues where SCZ is not expressed, indicating that part of the SCZ function is nonautonomous. As a class B HEAT-SHOCK TRANSCRIPTION FACTOR (HSFB), the SCZ protein contains several conserved domains and motifs. However, which domain(s) discriminates SCZ from its family members to obtain a role in development remains unknown. Here, we investigate how each domain contributes to SCZ function in Arabidopsis root patterning by generating altered versions of SCZ by domain swapping and mutation. We show that the SCZ DNA-binding domain is the main factor for its developmental function, and that SCZ likely acts as a nonmotile transcriptional repressor. Our results demonstrate how members of the HSF family can evolve toward functions beyond stress response.
Measuring Climate Transition Risk Spillovers
Authors: Yang Runfeng , Caporin Massimiliano , Jiménez-Martin Juan-Angel
Published: August 2023

In this article, we study the transition risk spillover among six major financial markets from 2013 to 2021. The USA is the main transition risk contributor, while Japan and China are the net risk receivers. Risk spillover may change over time and change according to different types of transition risk shocks. It takes around 6 weeks for transition risks to be fairly transmitted. On average, around 50% of local climate shocks to a given financial market originate from other markets. Transmission channels include the transmission of information and the economic connections between countries.
Prefrontal and Hippocampal Parvalbumin Interneurons in Animal Models for Schizophrenia: A Systematic Review and Meta-analysis
Authors: Santos-Silva Thamyris , dos Santos Fabris Débora , de Oliveira Cilene Lino , Guimarães Francisco S , Gomes Felipe V
Published: August 2023

Background

Consistent with postmortem findings in patients, most animal models for schizophrenia (SCZ) present abnormal levels of parvalbumin (PV), a marker of fast-spiking GABAergic interneurons, in the prefrontal cortex (PFC) and hippocampus (HIP). However, there are discrepancies in the literature. PV reductions lead to a functional loss of PV interneurons, which is proposed to underly SCZ symptoms. Given its complex etiology, different categories of animal models have been developed to study SCZ, which may distinctly impact PV levels in rodent brain areas.

Study Design

We performed a quantitative meta-analysis on PV-positive cell number/density and expression levels in the PFC and HIP of animal models for SCZ based on pharmacological, neurodevelopmental, and genetic manipulations.

Results

Our results confirmed that PV levels are significantly reduced in the PFC and HIP regardless of the animal model. By categorizing into subgroups, we found that all pharmacological models based on NMDA receptor antagonism decreased PV-positive cell number/density or PV expression levels in both brain areas examined. In neurodevelopmental models, abnormal PV levels were confirmed in both brain areas in maternal immune activation models and HIP of the methylazoxymethanol acetate model. In genetic models, negative effects were found in neuregulin 1 and ERBB4 mutant mice in both brain regions and the PFC of dysbindin mutant mice. Regarding sex differences, male rodents exhibited PV reductions in both brain regions only in pharmacological models, while few studies have been conducted in females.

Conclusion

Overall, our findings support deficits in prefrontal and hippocampal PV interneurons in animal models for SCZ.
Awareness of alcohol as a breast cancer risk factor and intentions to reduce alcohol consumption among U.S. young adult women
Authors: Alalwan Mahmood A , Long Lauren , Hirko Kelly A , LoConte Noelle K , Scherr Courtney L , Keller-Hamilton Brittney , Atkinson Leanne , Suraapaneni Sriya , Gatti-Mays Margaret E , Manne Sharon , Mays Darren
Published: August 2023

Alcohol consumption is prevalent in young adult women and linked with breast cancer risk. Research to inform interventions targeting alcohol consumption as a breast cancer prevention strategy is limited. We examined young women’s awareness of alcohol use as a breast cancer risk factor, identified correlates of awareness, and determined how awareness and conceptual predictors relate to intentions to reduce drinking. Women aged 18–25 years who drank alcohol in the past month (N = 493) completed a cross-sectional survey. Measures captured sociodemographics, breast cancer risk factors, awareness of alcohol use as a breast cancer risk factor, intentions to reduce drinking, and conceptual predictors. Analyses examined correlates of awareness and associations between awareness, conceptual predictors, and intentions to reduce drinking. Awareness was low (28%) and intentions to reduce drinking were moderate (M = 2.60, SD = 0.73, range 1–4). In multivariable analyses, awareness was associated with greater worry about cancer, beliefs that there’s not much one can do to reduce cancer risk and everything causes cancer, higher perceived breast cancer risk, and stronger beliefs that reducing drinking reduces breast cancer risk. Awareness was not associated with intentions to reduce drinking. Younger age, older age of alcohol initiation, negative attitudes towards alcohol, fewer friends consuming alcohol, and stronger self-efficacy were associated with intentions to reduce drinking. Few young women recognize alcohol consumption as a breast cancer risk factor. Researchers and policymakers can apply our findings to design new or refine existing interventions to optimize their impact on awareness and alcohol consumption in young women.
Tropical forest lianas have greater non-structural carbohydrate concentrations in the stem xylem than trees
Authors: Signori-Müller Caroline , Galbraith David , Tavares Julia V , Reis Simone M , Diniz Francisco C , Gilpin Martin , Marimon Beatriz S , van der Heijden Geertje M F , Borges Camila , Cintra Bruno B L , Mião Sarah , Morandi Paulo S , Nina Alex , Salas Yupayccana Carlos A , Marca Zevallos Manuel J , Cosio Eric G , Junior Ben H Marimon , Mendoza Abel M , Phillips Oliver , Salinas Norma , Vasquez Rodolfo , Mencuccini Maurizio , Oliveira Rafael S
Published: August 2023

Lianas (woody vines) are important components of tropical forests and are known to compete with host trees for resources, decrease tree growth and increase tree mortality. Given the observed increases in liana abundance in some forests and their impacts on forest function, an integrated understanding of carbon dynamics of lianas and liana-infested trees is critical for improved prediction of tropical forest responses to climate change. Non-structural carbohydrates (NSC) are the main substrate for plant metabolism (e.g. growth, respiration), and have been implicated in enabling tree survival under environmental stress, but little is known of how they vary among life-forms or of how liana infestation impacts host tree NSC. We quantified stem xylem total NSC concentrations and its fractions (starch and soluble sugars) in trees without liana infestation, trees with ˃50% of the canopy covered by lianas, and the lianas infesting those trees. We hypothesized that (i) liana infestation depletes NSC storage in host trees by reducing carbon assimilation due to competition for resources; (ii) trees and lianas, which greatly differ in functional traits related to water transport and carbon uptake, would also have large differences in NSC storage. As water availability has a significant role in NSC dynamics of Amazonian tree species, we tested these hypotheses within a moist site in western Amazonia and a drier site in southern Amazonia. We did not find any difference in NSC, starch or soluble sugar concentrations between infested and non-infested trees, in either site. This result suggests that negative liana impact on trees may be mediated through mechanisms other than depletion of host tree NSC concentrations. We found lianas have higher stem NSC and starch than trees in both sites. The consistent differences in starch concentrations, a long-term NSC reserve, between life forms across sites reflect differences in lianas and trees carbon gain and use. Soluble sugar concentrations were higher in lianas than in trees in the moist site but indistinguishable between life forms in the dry site. The lack of difference in soluble sugars between trees and lianas in the dry site emphasizes the importance of this NSC fraction for the metabolism of plants occurring in water limited environments.

Abstracts in Portuguese and Spanish are available in the supplementary material.
Trauma systems in Canada: striving for quality across an expansive landmass
Authors: Caminsky Natasha G. , Wong Evan G.
Published: August 2023

Although Canada has a universal health care program that provides free in-hospital services to all citizens, its vast landmass and nonstandardized prehospital and posthospital systems make delivering quality trauma care challenging, particularly to resource-limited rural regions. This article summarizes the strengths of the prehospital system, facility-based care, trauma network, trauma registry, rehabilitation, and governance/financing/quality assurance components of Canada’s trauma system. Future directions, including the use of telemedicine, standardization of practices, and resource optimization, are also explored. Canada’s trauma system is well developed, yet geography impedes equitable access. More standardization and resource optimization are needed.
Nasopharyngeal Swabs in Pediatric Patients With Thrombocytopenia and Anticoagulant Use
Authors: Greenmyer Jacob R. , Kohorst Mira A. , Thompson Whitney S. , Kaczor Mark , Alajbegovic Katarina , Kranz Lincoln A. , Cain Meghan , Ristagno Elizabeth H.
Published: August 2023

Background:

Nasopharyngeal (NP) swabbing is a technique that is commonly used to test pediatric patients for viral infections with increased use during the coronavirus disease 2019 pandemic. Complications from NP swabbing are rare and seem to occur more frequently in patients at risk of bleeding. Little is known about institutional or individual practices and experiences with NP swab testing in pediatric patients with risk factors for bleeding.

Methods:

We conducted a survey study of pediatric hematology/oncology (PHO) attending physicians to assess practices and experiences with NP swab testing in pediatric patients with thrombocytopenia and/or on anticoagulation.

Results:

There were 130 total respondents (5.6%, n = 130/2327) from 6 countries. Relatively few respondents (n = 17/130, 13.1%) reported that their institution had a policy specifying a lower-level platelet cutoff for patients undergoing NP swabbing. The median platelet cutoff below which NP swabs are not performed according to existing policies is 30,000×10(9)/L (interquartile range: 20,000 to 40,000). The median cutoff based on the opinion of the respondents was 10,000 (interquartile range: 10,000 to 20,000). There were 24 episodes of epistaxis among PHO patients that were NP swabbed; many adverse events (56.5%, n = 13/23) were described as persistent, severe, and/or required intervention. Three reported cases of epistaxis with anticoagulation or antiplatelet therapy occurred in patients with concomitant thrombocytopenia. Only 1 respondent (n = 1/130, 0.7%) reported an institutional policy for limiting NP swabs in patients on anticoagulant therapy. NP (66.9%) and nares (33.1%) were the most common sources of coronavirus disease 2019 testing that were reported.

Conclusion:

A small percentage of institutions in this survey have a policy restricting NP swabs in PHO patients. The discrepancy between lower platelet cutoffs proposed by experts and institutional policy suggests that existing policies may be too conservative. Expert guidelines are needed on this topic. Other bleeding risk factors (eg, aspirin use and von Willebrand disease) should be considered in policies and guidelines.
A Study of Medical Surgical Nurses Leaders' Evidence-Based Practice Attributes
Authors: Gallagher-Ford Lynn , Hinkley Teresa-Lynn (Terri) , Thomas Bindu , Hertel Robin , Messinger Jeff D. , Cengiz Adem , Yoder Linda H.
Published: August 2023

OBJECTIVE

The purpose of this study was to determine medical-surgical nurse leaders' evidence-based practice (EBP) attributes, perceived barriers to EBP, and whether there were differences in leaders' EBP competencies and EBP implementation by demographic and organizational factors.

BACKGROUND

Leaders are crucial to the development of cultures that support EBP implementation, but little is known about medical-surgical nurse leaders' capacity to perform this aspect of their role.

METHODS

A cross-sectional design using survey methodology was used. The survey contained demographic/work setting questions and 3 instruments to measure EBP beliefs, implementation, and competencies.

RESULTS

Senior leaders self-reported higher EBP attributes compared with nurses in other roles; nurses with an MSN or higher reported greater frequency of EBP implementation. A regression revealed that EBP competencies, EBP beliefs, having a DNP degree, and working in an Academy of Medical-Surgical Nurses Premier Recognition In the Specialty of Med-surg unit or a Pathway to Excellence® organization had significant, positive effects on EBP implementation scores (R
2 = 0.37).

CONCLUSIONS

Findings demonstrate there is a range of EBP beliefs and competencies, and barriers to EBP among medical-surgical nurse leaders. Because medical-surgical nursing is the largest acute care practice specialty in the United States and many other countries, leaders fully integrating EBP into their practice would be a substantial contribution to advancing EBP in healthcare.
Recurrent Tumefactive Central Nervous System Lesions Due to BRIP1-Related Fanconi Anemia
Authors: Nathoo Nabeela , Gavrilova Ralitza H. , Trejo-Lopez Jorge A. , McGarrah Patrick W. , Go Ronald S. , Alqallaf Abdulradha , Tobin W. Oliver
Published: August 2023

Introduction:

Fanconi anemia (FA) is an inherited condition associated with genetic mutations that affect DNA repair proteins. More than 20 genes involved in the FA/BRCA pathway have been implicated in FA, including BRIP1. Tumefactive brain lesions are rare in FA.

Case Report:

We describe a patient with FA and recurrent tumefactive brain lesions preceded by calcifications on head computed tomography. A biopsy revealed white-matter gliosis with severe vasculopathy. Whole-genome sequencing demonstrated a BRIP1 homozygous variant with a final diagnosis of recurrent tumefactive brain lesions due to BRIP1-associated CNS vasculopathy. Immunosuppressive treatment was ineffective in the present case.

Conclusions:

Mechanistically, the specific role of BRIP1 mutation in CNS inflammation and vasculopathy is unclear. However, immunodeficiency disorders can lead to autoimmunity and/or immune dysregulation due to the possible loss or gain of function of components of the immune system.
Effects of Prostaglandin E1 on Mastectomy Flap Necrosis in Immediate Implant-Based Breast Reconstruction
Authors: Hwang Ji Won , Lim Woo Sung , Kim Hyun Goo , Park Jin-Woo , Bae Juyoung , Park Seyeon , Jeon Byung-Joon , Woo Kyong-Je
Published: August 2023

Background:

Necrosis of a cutaneous flap including the nipple-areola complex is a common complication in immediate implant-based breast reconstruction following nipple-sparing mastectomy (NSM)/skin-sparing mastectomy (SSM). This study aimed to evaluate the efficacy of prostaglandin E1 (PGE1) in reducing such complications.

Methods:

A retrospective analysis of prospectively collected data was conducted at two centers, and the cohort consisted of patients undergoing NSM/SSM followed by immediate reconstruction with a prosthesis. Patients who were randomly allocated to the treatment group were administered daily intravenous PGE1 (10 μg/2 mL) beginning intraoperatively through postoperative day 6. Skin flap complications including nipple/skin necrosis, delayed wound healing, and postoperative wound revision were recorded. Complication rates were compared between the PGE1 and control groups.

Results:

A total of 276 breasts in 259 patients were included for analysis (139 breasts in the treatment group and 137 breasts in the control group). There was no difference in patient demographics between the control and treatment groups. Reconstructed breasts receiving PGE1 had significantly lower rates of overall skin complications (21.6% versus 34.3%; P = 0.022) and wound revision (2.9% versus 9.5%; P = 0.025). Among NSM cases, the PGE1 group showed a significantly lower rate of nipple necrosis (15.5% versus 29.4%; P = 0.027). In the multivariate analysis, the use of PGE1 significantly reduced the risk of overall skin flap complications (OR, 0.491; P = 0.018) and wound revision (OR, 0.213; P = 0.018) in NSM/SSM cases, and nipple necrosis (OR, 0.357; P = 0.008) in NSM cases.

Conclusion:

PGE1 can be effective in reducing risk of mastectomy flap complications in immediate implant-based breast reconstructions.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Fracture Patterns, Associated Injuries, Management, and Treatment Outcomes of 530 Pediatric Mandibular Fractures
Authors: Irgebay Zhazira , Glenney Anne E. , Cheng Lucille , Li Runjia , Mocharnuk Joseph W. , Smetona John , Balasubramani G. K. , Losee Joseph E. , Goldstein Jesse A.
Published: August 2023

Background:

Mandibular fractures account for up to 48.8% of pediatric facial fractures; however, there are a wide range of available treatment modalities, and few studies describe trends in adverse outcomes of these injuries. This study describes fracture cause, pattern, management, and treatment outcomes in pediatric mandibular fracture patients.

Methods:

A retrospective review was performed of patients younger than 18 years who were evaluated for mandibular fractures at a pediatric level I trauma center between 2006 and 2021. Variables studied included demographics, cause, medical history, associated facial fractures, other associated injuries, treatments, and outcomes.

Results:

A total of 530 pediatric patients with 829 mandibular fractures were included in the analysis. Most isolated mandibular fractures were treated with physical therapy and rest (n = 253 [47.7%]). Patients with combination fractures, specifically those involving the parasymphysis and angle, were 2.63 times more likely to undergo surgical management compared with patients with a single facial fracture (P < 0.0001). Older age (P < 0.001), sex (P = 0.042), mechanism (P = 0.008) and cause of injury (P = 0.002), and specific fractures (eg, isolated angle [P = 0.001]) were more associated with adverse outcomes. The odds of adverse outcomes were higher for patients treated with closed reduction and external fixation or open reduction and internal fixation compared with conservative management (OR, 1.8, 95% CI, 1.0 to 3.2; and OR, 2.1, 95% CI, 1.2 to 3.5, respectively).

Conclusions:

Fracture type, mechanism of injury, and treatment modality in pediatric mandibular fractures are associated with distinct rates and types of adverse outcomes. Large-scale studies characterizing these injuries are critical for guiding physicians in the management of these patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Prevalence of Retinal Venous Malformations in Patients With Cerebral Cavernous or Arteriovenous Malformations
Authors: Chan Kyle S. , Daulton Melanie R. , Reddy Vishruth D. , McComb Erin N. , Lavine Jeremy A.
Published: August 2023

Background:

Cerebral vascular malformations (CVMs) may result in hemorrhage, seizure, neurologic dysfunction, and death. CVMs include capillary telangiectasias, venous malformations, cavernous malformations, and arteriovenous malformations. Cavernous and arteriovenous malformations carry the highest risk of complications. Retinal venous malformations (RVMs) have been proposed as an associated finding. Our objective was to determine the prevalence of RVMs in patients with high-risk CVMs.

Methods:

We retrospectively reviewed patients diagnosed with cerebral cavernous or arteriovenous malformations (high-risk CVMs) who were evaluated by the ophthalmology service at Northwestern University between 2017 and 2020. Patients were stratified into 3 cohorts based on level of certainty: dilated funduscopic examination (DFE), DFE with any form of ocular imaging, and DFE with complete imaging of the macula. We recorded ophthalmic examination abnormalities, ocular imaging findings, and major CVM complications.

Results:

We evaluated 156 patients with high-risk CVMs who had undergone DFE. Ocular imaging of any type was performed in 56 patients, of whom 46 had complete imaging of the macula. Zero RVMs were identified in any cohort (95% confidence interval: 0%–1.9% for the entire cohort, 0%–5.4% for any ocular imaging cohort, and 0%–6.5% for the complete macular imaging cohort). Cerebral hemorrhage or seizure occurred in 15%–33% of patients. Associated visual field defects or cranial nerve palsies were found in 14%–20% of patients.

Conclusions:

Zero RVMs were identified in patients with high-risk CVMs. However, neuro-ophthalmic findings were common. Therefore, we recommend neuroimaging for patients with RVMs and neuro-ophthalmic signs or symptoms. In asymptomatic patients with RVMs, a potential algorithm for neuroimaging is proposed.
Costs and benefits of voluntary attention in crows
Authors: Hahner Linus , Nieder Andreas
Published: August 2023

Behavioural signatures of voluntary, endogenous selective attention have been found in both mammals and birds, but the relationship between performance benefits at attended and costs at unattended locations remains unclear. We trained two carrion crows (
Corvus corone
) on a Posner-like spatial cueing task with dissociated cue and target locations, using both highly predictive and neutral central cues to compare reaction time (RT) and detection accuracy for validly, invalidly and neutrally cued targets. We found robust RT effects of predictive cueing at varying stimulus-onset asynchronies (SOA) that resulted from both advantages at cued locations and costs at un-cued locations. Both crows showed cueing effects around 15–25 ms with an early onset at 100 ms SOA, comparable to macaques. Our results provide a direct assessment of costs and benefits of voluntary attention in a bird species. They show that crows are able to guide spatial attention using associative cues, and that the processing advantage at attended locations impairs performance at unattended locations.
Human group size puzzle: why it is odd that we live in large societies
Authors: David-Barrett Tamas
Published: August 2023

Human groups tend to be much larger than those of non-human primates. This is a puzzle. When ecological factors do not limit primate group size, the problem of coordination creates an upper threshold even when cooperation is guaranteed. This paper offers a model of group coordination towards behavioural synchrony to spell out the mechanics of group size limits, and thus shows why it is odd that humans live in large societies. The findings suggest that many of our species' evolved social behaviours and culturally maintained social technologies emerged as solutions to this problem.
Bioactivities of β-mangostin and its new glycoside derivatives synthesized by enzymatic reactions
Authors: Le Tuoi Thi , Trang Nguyen Thu , Pham Van Thuy Thi , Quang Dang Ngoc , Phuong Hoa Le Thi
Published: August 2023

Beta-mangostin is a xanthone commonly found in the genus
Garcinia
. Unlike α-mangostin, to date, there have only been a few studies on the biological activity and derivatization of β-mangostin. In this study, two novel glycosylated derivatives of β-mangostin were successfully synthesized via a one-pot enzymatic reaction. These derivatives were characterized as β-mangostin 6-O-β-
d
-glucopyranoside and β-mangostin 6-O-β-
d
-2-deoxyglucopyranoside by TOF ESI/MS and
1
H and
13
C NMR analyses. Beta-mangostin showed cytotoxicity against KB, MCF7, A549 and HepG2 cancer cell lines, with IC
50
values ranging from 15.42 to 21.13 µM. The acetylcholinesterase and α-glucosidase inhibitory activities of β-mangostin were determined with IC
50
values of 2.17 and 27.61 µM, respectively. A strong anti-microbial activity of β-mangostin against Gram-positive strains (
Bacillus subtilis
,
Lactobacillus fermentum
and
Staphylococcus aureus
) was observed, with IC
50
values of 0.16, 0.18 and 1.24 µg ml
−1
, respectively. Beta-mangostin showed weaker activity against Gram-negative strains (
Salmonella enterica
,
Escherichia coli
and
Pseudomonas aeruginosa
) as well as
Candida albicans
fungus, with IC
50
and MIC values greater than the tested concentration (greater than 32 µg ml
−1
). The new derivatives of β-mangostin showed weaker activities than those of β-mangostin, demonstrating the important role of the hydroxyl group at C-6 of β-mangostin in its bioactivity.
Nasopharyngeal Staphylococcus aureus colonization among HIV-infected children in Addis Ababa, Ethiopia: antimicrobial susceptibility pattern and association with Streptococcus pneumoniae colonization
Authors: Gebre Henok Alemu , Wami Ashenafi Alemu , Kebede Eyerusalem Solomon , Yidnekachew Melaku , Gebre Meseret , Negash Abel Abera
Published: August 2023

Background.

Staphylococcus aureus

and

Streptococcus pneumoniae

are common inhabitants of the nasopharynx of children. HIV-infected children have higher risk of invasive diseases caused by these pathogens. With widespread use of pneumococcal conjugate vaccines and the emergence of methicillin-resistant

S. aureus

, the interaction between S.

aureus

and

S. pneumoniae

is of a particular significance. We sought to determine the magnitude of colonization by methicillin-sensitive and -resistant

S. aureus

and colonization by

S. pneumoniae

; associated risk factors and antimicrobial susceptibility pattern among HIV-infected children in Addis Ababa, Ethiopia.

Method. A prospective observational study was conducted among 183 HIV-infected children at ALERT hospital Addis Ababa, Ethiopia from September 2016 to August 2018.

S. aureus

and

S. pneumoniae

were identified using standard bacteriological techniques, antimicrobial susceptibility testing was performed on

S. aureus

and screening for methicillin resistance was carried out by amplifying the mecA gene. Risk factors were analysed by using binary logistic regression.

Results. The prevalence of nasopharyngeal

S. aureus

, MRSA and

S. pneumoniae

colonization were 27.3, 2.7 and 43.2 %, respectively. Multivariable analysis indicated an inverse association between

S. aureus

and

S. pneumoniae

nasopharyngeal colonization [aOR, 0.49; CI, (0.24, 0.99); P=0.046]. The highest level of resistance in both methicillin-sensitive

S. aureus

(MSSA) and MRSA was observed against tetracycline.

Conclusions. We found an inverse association between

S. aureus

and

S. pneumoniae

colonization among HIV-infected children. Continued assessment of the impact of pneumococcal conjugate vaccines and antiretroviral therapy on nasopharyngeal bacterial ecology is warranted.
Prediction of Homologous Recombination Deficiency from Oncomine Comprehensive Assay Plus Correlating with SOPHiA DDM HRD Solution
Authors: Kang Jun , Na Kiyong , Kang Haeyoun , Cho Uiju , Kwon Sun Young , Hwang Sohyun , Lee Ahwon ,   The Molecular Pathology Study Group of Korean Society of Pathologists
Published: August 2023

Objective Poly(ADP-ribose) polymerase (PARP) inhibitors are used for targeted therapy for ovarian cancer with homologous recombination deficiency (HRD). In this study, we aimed to develop a homologous recombination deficiency prediction model to predict the genomic integrity (GI) index of the SOPHiA DDM HRD Solution from the Oncomine Comprehensive Assay (OCA) Plus. We also tried to a find cut-off value of the genomic instability metric (GIM) of the OCA Plus that correlates with the GI index of the SOPHiA DDM HRD Solution. Methods We included 87 cases with high-grade ovarian serous carcinoma from five tertiary referral hospitals in Republic of Korea. We developed an HRD prediction model to predict the GI index of the SOPHiA DDM HRD Solution. As predictor variables in the model, we used the HRD score, which included percent loss of heterozygosity (%LOH), percent telomeric allelic imbalance (%TAI), percent large-scale state transitions (%LST), and the genomic instability metric (GIM), provided by the OCA Plus. To build the model, we employed a penalized logistic regression technique. Results The final model equation is -21.77 + 0.200 x GIM + 0.102 x %LOH + 0.037 x %TAI + 0.261 x %LST. To improve the performance of the prediction model, we added a borderline result category to the GI results. Cases with predicted values between -3 and 3 were classified as borderline. The accuracy of our HRD status prediction model was 0.947 for the training set and 0.958 for the test set. The accuracy of HRD status using GIM with a cut-off value of 16 was 0.911. Conclusions The Oncomine Comprehensive Assay Plus provides a reliable biomarker for homologous recombination deficiency.
Advanced Hemodynamic and Cluster Analysis for Identifying Novel RV function subphenotypes in Patients with Pulmonary Hypertension
Authors: Janowski Alexandra M , Ravellette Keeley S , Insel Michael , Garcia Joe G , Rischard Franz P , Vanderpool Rebecca R
Published: August 2023

Background

Quantifying right ventricular (RV) function is important to describe the pathophysiology of in pulmonary hypertension (PH). Current phenotyping strategies in PH rely on few invasive hemodynamic parameters to quantify RV dysfunction severity. The aim of this study was to identify novel RV phenotypes using unsupervised clustering methods on advanced hemodynamic features of RV function.

Methods

Participants were identified from the University of Arizona Pulmonary Hypertension Registry (n=190). RV-pulmonary artery coupling (Ees/Ea), RV systolic (Ees) and diastolic function (Eed) was quantified from stored RV pressure waveforms. Consensus clustering analysis with bootstrapping was used to identify the optimal clustering method. Pearson correlation analysis was used to reduce collinearity between variables. RV cluster subphenotypes were characterized using clinical data and compared to pulmonary vascular resistance (PVR) quintiles.

Results

Five distinct RV clusters (C1-C5) with distinct RV subphenotypes were identified using k-medoids with a Pearson distance matrix. Clusters 1 and 2 both have low diastolic stiffness (Eed) and afterload (Ea) but RV-PA coupling (Ees/Ea) is decreased in C2. Intermediate cluster (C3) has a similar Ees/Ea as C2 but with higher PA pressure and afterload. Clusters C4 and C5 have increased Eed and Ea but C5 has a significant decrease in Ees/Ea. Cardiac output was high in C3 distinct from the other clusters. In the PVR quintiles, contractility increased and stroke volume decreased as a function of increased afterload. World Symposium PH classifications were distributed across clusters and PVR quintiles.

Conclusions

RV-centric phenotyping offers an opportunity for a more precise-medicine based management approach.
Design and Validation of a Low-Cost, Open-Source, 3D-Printed Otoscope
Authors: Lowe Joshua , Bagha Hamza , Inayat Hamza , Eid Anas , Talarico Frankie , Ni Tiffany , Loubani Tarek
Published: August 2023

The modern otoscope is an indispensable instrument utilized by primary care physicians as the gold standard tool to diagnose an array of otologic diseases and conditions. At present, commercially available, traditional otoscopes remain cost-prohibitive to many potential users despite limited innovation since its invention in the early 19thcentury. In this publication, the design and assembly of a low-cost, open-source, 3D-printed otoscope, the Glia Otoscope V1.0, is outlined. Subsequently, we describe the benchtop evaluation conducted, which measured several outcomes relevant to otoscopy performance against a traditional, gold standard otoscope, the Welch Allyn Rechargeable V3.5 Halogen HPX Otoscope. Measured outcomes included illuminance, correlated color temperature, color rendering index, spatial resolution, field of view, weight, battery life, and cost. Overall, the Glia Otoscope V1.0 demonstrated comparable performance across measured outcomes against the traditional otoscope. Further validation in the clinical setting is warranted as the Glia Otoscope V1.0 and its future iterations hold tremendous potential in improving access and alleviating the burden of otologic disease in lower and middle-income countries. Finally, we present a novel tool, the Otoscope Assessment Tool, which establishes a standard set of performance characteristics for benchtop evaluation of otoscope performance.
Exploring Burn First Aid Knowledge and Water Lavage Practices in Uganda: A Cross-Sectional Study
Authors: Kasagga Brian , Baluku Joseph Baruch , Bongomin Felix , Kasozi Derrick , Muwanguzi Eria , Namazzi Mercy , Sadiq Yusuf , Alenyo Rose , Kalanzi Edris Wamala , Balumuka Darius , Elobu Alex Emmanuel
Published: August 2023

Background

Low- and middle-income countries experience higher burn-related morbidity and mortality compared to high-income countries. Prehospital Burn First Aid (BFA) has been proven effective in reducing such outcomes. This study aimed to assess BFA knowledge and water lavage practices and their associated factors among burn victims and the general population at a tertiary health facility in Uganda.

Methods

A cross-sectional study was conducted at the Burns Unit of Kiruddu National Referral Hospital in Kampala between April and November 2022. Participants included burn patients, caregivers, and visitors. Data on BFA knowledge and practices were collected using an interviewer-administered questionnaire. BFA knowledge was evaluated using 13 questions, with ≥80% score considered adequate. Logistic regression was used to analyze associations.

Results

The study had 404 participants, comprising 68(16.8%) burn victims, 161(39.9%) primary caregivers, and 175(43.3%) visitors. Among all participants, 339(83.9%) had never received BFA information, and 392(97.0%) had no first aid training. Mean BFA knowledge score was 56% (SD 13.9), with only 5.4% demonstrating adequate knowledge. Only 26(27.7%) of current and former burn victims used water lavage as BFA. No statistically significant associations were found between BFA knowledge, water lavage usage, and demographic variables on univariate and multivariate analyses.

Conclusion

This study highlights inadequate BFA knowledge and practices among participants. Addressing these deficiencies through community-based initiatives is crucial to improving burn care in Uganda.