bluuebunny/crossref_metadata_2025 huggingface dataset:
Feasibility of a 109Cd-based portable XRF device for measuring skin iron concentration in anaemic and β−Thalassaemic patients
Authors: Bangash Sami Ullah Khan , McNeill Fiona E , Farquharson Michael J , Chettle David R
Published: November 2022

Iron is an essential element vital for growth and development. The severe effects on the body due to iron deficiency or overload have prompted sustained research into accurate in vivo iron measurement techniques for the past several decades. X-ray fluorescence (XRF) analysis of iron in the body has been investigated in this work because of the non-invasive nature of the technique. A system has been designed using a silicon drift detector to measure the low-energy iron K
α
x-rays excited in the samples by the silver x-rays from 109Cd of energy 22 keV and 25 keV. The source is contained within a tantalum shielding cap designed to reduce the spectral background. The system was calibrated against 3D printed polylactic acid (PLA) phantoms filled with solutions of iron at various concentrations. The iron x-ray signals were normalized to a nickel x-ray signal which improved the system’s reproducibility. The 3D phantoms and normalisation resulted in a linear calibration line (p < 0.001 and r2 > 0.999). For a real-time measurement of 1800 s, the minimum detectable limit for the system was measured to be 1.35 ± 0.35 ppm which is achieved with a low radiation dose of 1.1 mSv to the skin surface. This low detection limit and low dose mean the system is feasible for application to human measurements in both iron deficiency and overload disease. The system will proceed to post-mortem validation studies prior to in vivo system efficacy testing.
Fuzzy inference system (FIS) - long short-term memory (LSTM) network for electromyography (EMG) signal analysis
Authors: Suppiah Ravi , Kim Noori , Sharma Anurag , Abidi Khalid
Published: November 2022

A wide range of application domains,s such as remote robotic control, rehabilitation, and remote surgery, require capturing neuromuscular activities. The reliability of the application is highly dependent on an ability to decode intentions accurately based on captured neuromuscular signals. Physiological signals such as Electromyography (EMG) and Electroencephalography (EEG) generated by neuromuscular activities contain intrinsic patterns for users’ particular actions. Such actions can generally be classified as motor states, such as Forward, Reverse, Hand-Grip, and Hand-Release. To classify these motor states truthfully, the signals must be captured and decoded correctly. This paper proposes a novel classification technique using a Fuzzy Inference System (FIS) and a Long Short-Term Memory (LSTM) network to classify the motor states based on EMG signals. Existing EMG signal classification techniques generally rely on features derived from data captured at a specific time instance. This typical approach does not consider the temporal correlation of the signal in the entire window. This paper proposes an LSTM with a Fuzzy Logic method to classify four major hand movements: forward, reverse, raise, and lower. Features associated with the pattern generated throughout the motor state movement were extracted by exploring published data within a given time window. The classification results can achieve a 91.3% accuracy for the 4-way action (Forward/Reverse/GripUp/RelDown) and 95.1% (Forward/Reverse Action) and 96.7% (GripUp/RelDown action) for 2-way actions. The proposed mechanism demonstrates high-level, human-interpretable results that can be employed in rehabilitation or medical-device industries.
Application of integrated simulation environment SIEMNED to the analysis of the MEPHIST-0 tokamak operation
Authors: SYCHUGOV D Yu , SOLOVIEV S Yu , ZHILKIN A S , MELNIKOV A V , KRAT S A
Published: November 2022

This paper presents the results of numerical simulation of plasma equilibrium and stability in the MEPHIST-0 tokamak with SIEMNED software and comparison of simulation results with experiments. The determined characteristics of the vacuum chamber show that it significantly affects the entire discharge. For various scenarios of the inductor operation, a comparison of experimental data and simulated currents and magnetic fields induced in the chamber was carried out. For steady-state tokamak operation, a numerical study of equilibrium plasma configurations was carried out depending on the currents in the poloidal magnetic field coils and plasma current. The vertical plasma instability was investigated. The limiting values of plasma ellipticity preventing the vertical plasma instability were numerically determined. Numerical simulations show that plasma equilibrium is supported by induced currents. It was shown numerically that magnetic configuration with ‘zero of higher order’ were obtained before the plasma shot, suggesting consistency between the simulation results and observations.
Photonics design theory enhancing light extraction efficiency in quantum dot light emitting diodes
Authors: Othman Diyar Mousa , Weinstein Julia A , Lyu Quan , Hou Bo
Published: November 2022

The external quantum efficiency (EQE) of quantum dot light emitting diodes (QLEDs) needs improvement for more power-efficient devices. One of the main limitations is the low light extraction efficiency (LEE). Generally, only 20% of the light that is generated inside the emissive layer makes its way out of the device into air, with the rest being lost to waveguide and substrate modes and surface plasmon polaritons. Different photonics structures have been previously tested to help extract the light that is trapped inside the device. Here we report a photonics design which is a combination of nanopillars and grating structures for improving the LEE of QLEDs. The effect of changing the nanopillar height, radius and material has been studied. It was found that ZnO nanopillars of 500 nm pitch, 200 nm height and 400 nm width alongside 150 nm width and pitch grating structure can increase the LEE at 460 nm by 50% and at 640 nm by 20%. It was also found that different materials can help extract light at different wavelengths. TiO2 nanopillars increased the extraction efficiency at ∼590 nm region which was not observed by the other materials. As around 19% of the world’s electricity consumption is due to lighting applications, increasing the LEE can significantly reduce the power consumption.
Post-2000 nonlinear optical materials and measurements: data tables and best practices
Authors: Vermeulen Nathalie , Espinosa Daniel , Ball Adam , Ballato John , Boucaud Philippe , Boudebs Georges , Campos Cecília L A V , Dragic Peter , Gomes Anderson S L , Huttunen Mikko J , Kinsey Nathaniel , Mildren Rich , Neshev Dragomir , Padilha Lázaro A , Pu Minhao , Secondo Ray , Tokunaga Eiji , Turchinovich Dmitry , Yan Jingshi , Yvind Kresten , Dolgaleva Ksenia , Van Stryland Eric W
Published: November 2022

In its 60 years of existence, the field of nonlinear optics has gained momentum especially over the past two decades thanks to major breakthroughs in material science and technology. In this article, we present a new set of data tables listing nonlinear-optical properties for different material categories as reported in the literature since 2000. The papers included in the data tables are representative experimental works on bulk materials, solvents, 0D–1D–2D materials, metamaterials, fiber waveguiding materials, on-chip waveguiding materials, hybrid waveguiding systems, and materials suitable for nonlinear optics at THz frequencies. In addition to the data tables, we also provide best practices for performing and reporting nonlinear-optical experiments. These best practices underpin the selection process that was used for including papers in the tables. While the tables indeed show strong advancements in the field over the past two decades, we encourage the nonlinear-optics community to implement the identified best practices in future works. This will allow a more adequate comparison, interpretation and use of the published parameters, and as such further stimulate the overall progress in nonlinear-optical science and applications.
Friction behaviors in the metal cutting process: state of the art and future perspectives
Authors: Liang Xiaoliang , Liu Zhanqiang , Wang Bing , Wang Chunjin , Cheung Chi Fai
Published: November 2022

Material removal in the cutting process is regarded as a friction system with multiple input and output variables. The complexity of the cutting friction system is caused by the extreme conditions existing on the tool–chip and tool–workpiece interfaces. The critical issue is significant to use knowledge of cutting friction behaviors to guide researchers and industrial manufacturing engineers in designing rational cutting processes to reduce tool wear and improve surface quality. This review focuses on the state of the art of research on friction behaviors in cutting procedures as well as future perspectives. First, the cutting friction phenomena under extreme conditions, such as high temperature, large strain/strain rates, sticking–sliding contact states, and diverse cutting conditions are analyzed. Second, the theoretical models of cutting friction behaviors and the application of simulation technology are discussed. Third, the factors that affect friction behaviors are analyzed, including material matching, cutting parameters, lubrication/cooling conditions, micro/nano surface textures, and tool coatings. Then, the consequences of the cutting friction phenomena, including tool wear patterns, tool life, chip formation, and the machined surface are analyzed. Finally, the research limitations and future work for cutting friction behaviors are discussed. This review contributes to the understanding of cutting friction behaviors and the development of high-quality cutting technology.
Experimental and numerical investigation of fracture toughness of hybrid glass/metal fiber reinforced polymer composites
Authors: Agarwal Pankaj , Sharma Ankush , Kumar Mukesh , Patnaik Tapan Kumar , Patnaik Amar
Published: November 2022

In this paper, the usefulness of industrial waste metal fiber as a reinforcement in hybrid glass/metal fiber epoxy composites is investigated. The hybrid composites of four-stacking sequence HSG-1, HSG-2, HSG-3, and HSG-4 were fabricated using the vacuum-assisted resin transfer molding (VARTM) technique under a controlled environment. Mode-I fracture toughness of hybrid glass/metal fiber epoxy composites was examined through an experimental SENB test. For the hybrid composites HSG-4, the stress intensity factor of 425.12 MPa.mm1/2 was maximum during mode-I loading compared to the other stacking sequences. Furthermore, finite element analysis for fracture toughness was also carried out, and the simulation results were compared with those of the experiments. With R2 value of 0.99 the deviation was in the range of 0% to 3%. In light of the evaluated results, this research can be expanded to address marine applications simultaneously, allowing for optimal waste usage to reduce environmental issues.
Energy harvesting properties of the Nafion thin films
Authors: Babu Anjaly , Supraja P , Mishra Siju , Kumar K Uday , Rakesh Kumar R , Haranath D , Thirmal C , Raju N , Rao T Venkatappa , Balaji K , Rajanikanth A
Published: November 2022

In this report, energy harvesting properties of Nafion films were investigated using piezoionic generator (PIOG) and triboelectric generator (TEG) devices. Nafion films were prepared by simple doctor blade deposition of a Nafion ionomer solution onto the aluminum electrode. The Nafion films were characterized for their surface morphology, composition, and crystallinity. Furthermore, the Nafion film exhibited strong substrate adhesion, a smooth surface, and amorphous nature. The deposited Nafion film was used directly as an active layer to fabricate the PIOG and TEG devices with ITO electrodes. Output voltages of ∼450 mV and ∼1.9 V have been observed for the PIOG and TEG devices against biomechanical energy. The maximum instantaneous power produced by these devices is approximately ∼0.205 μW cm−2, and ∼0.128 μW cm−2 for the PIOG and TEG, respectively. The PIOG performance can be further improved using Nafion composite films. Similarly, the TEG performance can be enhanced with other friction layers such as PVDF, PDMS, PMMA, and PVC films instead of ITO. Therefore, the proposed nanogenerators can be used as touch sensors and energy sources for wearable electronic devices in the future.
Ion transport and structural design of lithium-ion conductive solid polymer electrolytes: a perspective
Authors: Tong Bo , Song Ziyu , Wu Hao , Wang Xingxing , Feng Wenfang , Zhou Zhibin , Zhang Heng
Published: November 2022

Solid polymer electrolytes (SPEs) possess several merits including no leakage, ease in process, and suppressing lithium dendrites growth. These features are beneficial for improving the cycle life and safety performance of rechargeable lithium metal batteries (LMBs), as compared to conventional non-aqueous liquid electrolytes. Particularly, the superior elasticity of polymeric material enables the employment of SPEs in building ultra-thin and flexible batteries, which could further expand the application scenarios of high-energy rechargeable LMBs. In this perspective, recent progresses on ion transport mechanism of SPEs and structural designs of electrolyte components (e.g. conductive lithium salts, polymer matrices) are scrutinized. In addition, key achievements in the field of single lithium-ion conductive SPEs are also outlined, aiming to provide the status quo in those SPEs with high selectivity in cationic transport. Finally, possible strategies for improving the performance of SPEs and their rechargeable LMBs are also discussed.
Basis for the Management of Schistocerca cancellata (Orthoptera: Acrididae)
Authors: Birkhan Júlia , Carrizo Beatriz , Socías María Guillermina , da Costa Maria Kátia Matiotti , Guedes Jerson Carus , Garcia Flávio Roberto Mello
Published: November 2022

The locust species Schistocerca cancellata Serville, endemic to South America, is known for its ability to form dense swarms, which reach the status of agricultural pest for several crops in southern South America. This article aimed to gather more accurate information about the history, biology, ecology, and control of S. cancellata, because of the 2021 invasions, which threatened to invade the Brazilian territory. During outbreak periods, swarms consume any available vegetation in the occurrence areas of Argentina, Brazil, Paraguay, Uruguay, Chile, and Bolivia. These invasions have been well documented in history, since they left deep marks wherever they went, especially in Argentina, which to this day represents the country that most accounted for agricultural losses from outbreaks. economy’s main current means of control are based on pesticides, whose chemical composition induces a series of damages to health, the environment, and consequently the ecosystem. Knowing about the biological processes of this locust is an important factor in understanding how swarms form, as well as controlling them. The intergovernmental coalition shows positive results in monitoring and controlling the swarms, which, even demonstrating stability, remain under constant surveillance by competent bodies.
Demonstratives and cognitive significance revisited
Authors: Martone Filipe
Published: November 2022

The issue of whether a theory of demonstratives should be able to handle Frege’s Puzzle seems rather old hat, but it was not so much resolved as left hanging. This paper tries to remedy that. I argue that a major problem not previously noticed affects any theory of demonstratives that aims at dealing with Frege’s Puzzle. This problem shows itself in cases in which the cognitive significance of a single demonstrative identity – such as ‘that is that’ – differs for participants of the same context. To accommodate such cases, I argue, we would need an implausible individualistic theory of demonstratives nobody should (or does) endorse. If so, we must look elsewhere for a solution to Frege’s Puzzle.
Polydioxanone Monofilament Mesh: A Safety Net for Complex Breast Implant Revision Surgery
Authors: Chiemi Julia A , Kelishadi S Sean
Published: November 2022

Background

Breast revision surgeries are complex cases requiring greater pocket control than primary surgeries. Intraoperative techniques to maximize pocket integrity are crucial to achieving an aesthetic result in revisions with implants.

Objectives

Uniform utilization of a polydioxanone (PDO) internal support matrix in a high volume of revision-augmentation cases has, to our knowledge, never before been described.

Methods

A high-volume (n = 104) single-surgeon experience followed patient outcomes in consecutive cases from September 2020 to March 2022. Included in this cohort were patients undergoing revision-augmentations with vertical or wise-pattern mastopexies (n = 74), revision-augmentation without mastopexies (n = 25), and revision without implant exchange (n = 5). Each case employed at least 1 sheet of PDO mesh, with a small set (n = 4) receiving 2 sheets. Patients were followed up (range, 3-19 months), with 3 months minimum follow-up to assess outcomes.

Results

The average length of follow-up was 8.8 months. Patients in this cohort had undergone an average of 1.6 prior breast surgeries (range, 1-7). A total 89.4% of patients received an increase in implant volume (average change, +165.2 Cc); 87.5% of patients had favourable aesthetic outcomes, and 12.5% of patients were reoperated on (including reoperations for complications and/or aesthetic reasons). There were 13 complications in the cohort, and no mesh-related complications.

Conclusions

PDO mesh is a safe and effective method of increasing pocket control in breast revision. Supplemental soft-tissue support allowed greater implant volumes to be employed, yielding high rates of patient satisfaction with breast shape, scarring, and long-term aesthetics.

Level of Evidence: 4
EP-175 Two-layer Biodegradable Temporizing Matrix Reconstruction of Abdominal Wall Dermatofibrosarcoma Protuberans
Authors: Shah Rushabh , Kiely Ailbhe , McKirdy Stuart
Published: November 2022

Dermatofibrosarcoma protuberans (DFSP) is a rare, locally invasive dermal sarcoma. The management is generally surgical, with wide local excision (WLE) forming the mainstay of treatment. Large abdominal wall defects are most aesthetically reconstructed using pedicled or free flaps; however, these require tumour-free surgical margins, and can cause donor site morbidity. We describe an alternative, aesthetic, and low-morbidity technique for abdominal wall reconstruction following WLE of DFSP, using 2 layers of a novel synthetic dermal matrix (NovoSorb® BTM).

A 25-year-old women presented with a large DFSP involving the right anterior-abdominal wall. After WLE with 3cm margins, BTM was implanted to the large sub-fascial abdominal wall defect. At 6 weeks, after histological confirmation of tumour-free margins, a second layer of BTM was applied to improve the significant contour deformity of the wound bed. After complete integration by 7 weeks, a split-thickness skin graft was harvested from the right thigh and fixed to the new dermis.

At 14-days postoperatively, the skin graft had fully taken, and donor site healed. By 8 weeks, the scar had started to mature with no obvious contour defect or contracture. Overall, the patient was satisfied with the functional and aesthetic outcome.

To our knowledge, a two-layer reconstruction using an artificial dermal matrix has never been described for abdominal wall reconstruction. We found that double-layer BTM is able to restore the inherent thickness and pliability of skin in complex abdominal wall reconstruction following WLE of DFSP and offers improved durability and cosmesis compared to skin grafting or indeed single layer skin substitutes alone.
634 Future Women in Surgery and the Role of Mentorship
Authors: Haque S
Published: November 2022

Aim

To understand the role of mentorship for female doctors in the decision- making process of pursuing surgery as a specialty or residency training.

Method

A systematic review of literature employing databases such as PubMed, Google Scholar, and EMBASE using the key words ‘Female”, “Surgery'', “Mentorship”. Inclusion criteria included articles in English between 2011–2021 to reflect the contemporary nature. Exclusion criteria include articles that are not in English and outside of the time frame 2011–2021. A thematic analysis was conducted to interpret the findings.

Results

12 studies were included in this study. The results showed that mentorship was a key component in the decision- making process in the pursuit of a surgical career. Common themes showed that work-life balance was an obstacle for women to pursue surgery; a positive role model was pivotal in gaining insights into what a surgical career entail. Increasing use of social media has made mentorship more accessible for women pursuing surgery especially in locations where female role models were deficient. Mentorship was perceived to be a key factor in inspiring junior female doctors to pursue surgery.

Conclusions

Mentorship and positive role models are a crucial factor in encouraging female doctors to pursue surgery. The absence of visibility of female role models in surgery presents a current problem and recommendations would be to encourage more female surgeons to become mentors to encourage the next generation of female surgeons.
152 Assessment of Quality and Readability of Online Patient Education Materials Relating to Dog Bites
Authors: Dadabhoy M , Awal D
Published: November 2022

Aim

Dog bites are common injuries which can result in significant morbidity and comprise a large workload for plastic surgery. We aimed to assess the quality and readability of online patient education resources related to dog bites.

Method

We entered the search term ‘dog bite’ into Google and assessed the top 50 results for quality and readability. Quality was measured using the DISCERN questionnaire, benchmark criteria published by the Journal of the American Medical Association (JAMA), and accreditation by the HONcode (Health On the Net code). Readability was measured with the Flesch-Kincaid reading grade (FKRG), Flesch reading ease score, Gunning's fog index, and the Coleman-Liau index (CLI).

Results

The mean JAMA and DISCERN scores were 2/4 and 35.7/80 respectively suggesting average quality. Only 3 sites were HONcode certified (7%). The mean Flesch reading ease score was 11.3 suggesting that the materials were very difficult to read and best understood by those with tertiary education. This corresponded with the high Gunning's fog score of 14.2. The FKRG and CLI indicated similar results.

Conclusions

Online materials relating to dog bites are of average quality and poor readability, especially in the context of the UK's reading age of 9. Avoidance of medical jargon and use of shorter words and sentences would improve readability. Timely review of websites, improved information on authorship and references could improve quality. Improved quality and readability would make it easier for patients to understand what to do following a dog bite, how to seek help if appropriate and what treatment to expect.
Siblings reduce multiple sclerosis risk by preventing delayed primary Epstein–Barr virus infection
Authors: Rostgaard Klaus , Nielsen Nete Munk , Melbye Mads , Frisch Morten , Hjalgrim Henrik
Published: November 2022

Epstein–Barr virus infection, and perhaps almost exclusively delayed Epstein–Barr virus infection, seems to be a prerequisite for the development of multiple sclerosis. Siblings provide protection against infectious mononucleosis by occasionally preventing delayed primary Epstein–Barr virus infection, with its associated high risk of infectious mononucleosis. Each additional sibling provides further protection according to the age difference between the index child and the sibling. The closer the siblings are in age, the higher the protection, with younger siblings being more protective against infectious mononucleosis than older siblings. If the hypothesis that delayed Epstein–Barr virus infection is necessary for the development of multiple sclerosis is true, then the relative risk of multiple sclerosis as a function of sibship constellation should mirror the relative risk of infectious mononucleosis as a function of sibship constellation. Such an indirect hypothesis test is necessitated by the fact that age at primary Epstein–Barr virus infection is unknown for practically all people who have not experienced infectious mononucleosis.

In this retrospective cohort study using nationwide registers, we followed all Danes born during the period 1971–2018 (n = 2 576 011) from 1977 to 2018 for hospital contacts with an infectious mononucleosis diagnosis (n = 23 905) or a multiple sclerosis diagnosis (n = 4442), defining two different end points. Relative risks (hazard ratios) of each end point as a function of sibship constellation were obtained from stratified Cox regression analyses.

The hazard ratios of interest for infectious mononucleosis and multiple sclerosis could be assumed to be identical (test for homogeneity P = 0.19), implying that having siblings, especially of younger age, may protect a person against multiple sclerosis through early exposure to the Epstein–Barr virus. Maximum protection per sibling was obtained by having a 0–2 years younger sibling, corresponding to a hazard ratio of 0.80, with a 95% confidence interval of 0.76–0.85. The corresponding hazard ratio from having an (0–2 years) older sibling was 0.91 (0.86–0.96).

Our results suggest that it may be possible essentially to eradicate multiple sclerosis using an Epstein–Barr virus vaccine administered before the teenage years. Getting there would require both successful replication of our study findings and, if so, elucidation of why early Epstein–Barr virus infection does not usually trigger the immune mechanisms responsible for the association between delayed Epstein–Barr virus infection and multiple sclerosis risk.
Quantitation of Venetoclax in Human Plasma by High-Performance Liquid Chromatography with Ultraviolet Detection
Authors: Fukuda Natsuki , Kobayashi Takahiro , Sato Honami , Akamine Yumiko , Takahashi Naoto , Miura Masatomo
Published: November 2022

A simple, highly sensitive and specific method based on high-performance liquid chromatography (HPLC) with ultraviolet detection was developed for the measurement of venetoclax concentrations in plasma samples. The chromatographic method employed a mobile phase of acetonitrile: 0.5% KH2PO4 (pH 3.5) (80/20, v/v) on a CAPCELL PAK C18 UG120 column at a flow rate of 0.5 mL/min. The quantitative method was validated based on standards described in “Bioanalytical Method Validation: Guidance for Industry” published by the US Food and Drug Administration. The separation of venetoclax and the internal standard R051012 was satisfactory, and the chromatograms were free of interfering peaks from the biological matrix. The intra- and inter-day coefficients of variation for venetoclax assays were <12.9%, whereas intra- and inter-day accuracies were within 13.6%. Only 100 μL of human plasma was required to detect a lower limit of quantification of 10 ng/mL for venetoclax. The recoveries of venetoclax extracted with an Oasis HLB cartridge were between 81 and 85%. The developed HPLC method was successfully applied to the determination of venetoclax concentrations in plasma of acute myeloid leukemia patients taking venetoclax. The degree of drug interactions between venetoclax and CYP3A4 inhibitors can be determined by this HPLC assay.
Histological Features Associated With Human Mpox Virus Infection in 2022 Outbreak in a Nonendemic Country
Authors: Chalali Faris , Merlant Marie , Truong Audrey , Ghosn Jade , Phung Bao-Chau , Mollo Bastien , Perrineau Ségolène , Rahi Mayda , Fidouh-Houhou Nadhira , Ferré Valentine Marie , Brunet-Possenti Florence , Descamps Vincent , Bouscarat Fabrice , Yazdanpanah Yazdan , Deschamps Lydia , Bertin Chloé
Published: November 2022

Skin histology of papules and pustules from 5 men having sex with men with mpox infection showed viral intracytoplasmic cytopathic changes, interface dermatitis, marked inflammatory dermic infiltrate including superficial neutrophils and perivascular and periadnexal deep lymphocytes. Histologic description of mpox lesions improves our understanding about clinical presentations and may have some therapeutic implications.
Successful Treatment of Prolonged, Severe Coronavirus Disease 2019 Lower Respiratory Tract Disease in a B cell Acute Lymphoblastic Leukemia Patient With an Extended Course of Remdesivir and Nirmatrelvir/Ritonavir
Authors: Ford Emily S , Simmons William , Karmarkar Ellora N , Yoke Leah H , Braimah Ayodale B , Orozco Johnnie J , Ghiuzeli Cristina M , Barnhill Serena , Sack Coralynn L , Benditt Joshua O , Roychoudhury Pavitra , Greninger Alexander L , Shapiro Adrienne E , Hammond Jennifer L , Rusnak James M , Dolsten Mikael , Boeckh Michael , Liu Catherine , Cheng Guang-Shing , Corey Lawrence
Published: November 2022

A patient with B-cell acute lymphoblastic leukemia (ALL) and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) had persistent, progressive pneumonia with viremia after 5 months of infection despite monoclonal antibodies, intravenous (IV) remdesivir and prolonged oral steroids. Twenty days of nirmatrelvir/ritonavir and 10 days of IV remdesivir led to full recovery.
Fertility and Assisted Reproductive Technologies Outcomes of Women with Non-surgically Managed Inflammatory Bowel Diseases: A Systematic Review
Authors: Vieujean Sophie , De Vos Michel , Paridaens Kristine , Daftary Gaurang S , Danese Silvio , Peyrin-Biroulet Laurent
Published: November 2022

Background and Aim

In view of their frequent onset during childbearing years, the impact of inflammatory bowel diseases [IBD] on reproductive health is of important concern to young women and to the IBD physician. This study aims to assess the fertility and assisted reproductive technologies outcomes in non-surgically treated IBD females.

Methods

A systematic review was conducted using MEDLINE, SCOPUS, and EMBASE [until March 2022] to identify studies assessing fertility and assisted reproductive technologies outcomes in women with non-operated IBD, compared with non-IBD patients. Two reviewers independently selected studies, assessed risk of bias, and extracted study data.

Results

A total of 14 studies encompassing 18 012 patients with ulcerative colitis [UC] and 14 353 patients with Crohn’s disease [CD] were included for analysis. The fertility rate in UC patients and in the general population was comparable, but UC patients tended to have fewer children, mainly by choice. On the contrary, the fertility of CD patients appeared to be reduced. Although a deliberate component cannot be not excluded, the disease itself could affect fertility. Disease activity was associated with reduced fertility in both UC and CD patients. In CD, the colonic involvement of the disease and perianal damage could be associated with subfertility, but data are less consistent. According to the only study reporting the assisted reproductive technologies outcomes, pregnancy rates after in vitro fertilization in subfertile non-operated UC patients and non-IBD patients were similar.

Conclusions

There is low-quality evidence from observational studies that patients with CD and relapsing UC may have impaired fertility. After assisted reproductive technologies, pregnancy rates of subfertile non-operated UC patients were similar to those of the general population, although this observation requires further scrutiny in larger studies that should include UC and CD patients.
Association of Neutrophil Extracellular Traps with Fistula Healing in Patients with Complex Perianal Fistulizing Crohn’s Disease
Authors: Cao Dongxing , Qian Keyu , Zhao Ying , Hong Jie , Chen Haoyan , Wang Xiaohui , Yang Nailin , Zhang Cheng , Cao Jingkai , Jia Keyu , Wu Guangyu , Zhu Mingming , Shen Jun , Zhang Ye , Cui Zhe , Wang Zheng
Published: November 2022

Background and Aims

Perianal fistulizing Crohn’s disease [pfCD] is a disabling phenotype of Crohn’s disease [CD] with suboptimal outcomes. We assessed neutrophil extracellular traps [NETs] in perianal fistulas and implicated their roles in pfCD healing.

Methods

Patients with complex pfCD who developed preplaced seton drainage were recruited during the verified maintenance of remission in CD. Fistula tracts were sampled during definitive surgery plus seton removal. Patient demographics, CD classification, medication strategy and healing of pfCD were recorded. RNA sequencing was applied for transcriptomic profile analysis. NET components, including myeloperoxidase [MPO], neutrophil elastase [NE] and citrullinated histone H3 [CitH3], were identified using immunofluorescence. Serum infliximab [IFX], anti-IFX antibodies, and tissue levels of IFX, adalimumab [ADA], MPO and CitH3 were determined using enzyme-linked immunosorbent assays. Peptidyl arginine deiminase IV [PAD4], tumour necrosis factor [TNF]-α, and NE were detected using immunohistochemistry. Gene expression levels of PAD family members were assessed with quantitative PCR.

Results

Twenty-one patients were included, 15 of whom adopted IFX as maintenance treatment. RNA-sequencing revealed differences in neutrophil associated pathways between unhealed and healed fistulas. NET components [MPO/NE/CitH3] were detectable in the fistulas and were parallel with the levels of PAD4. Eleven of 21 [52%] patients experienced complete healing of the pfCD 108 weeks post-operatively. Fistula NETs were significantly increased in patients with unhealed pfCD. Increased NETs were associated with abundant TNF-α production and the absence of IFX in fistulas.

Conclusions

NETs exist in pfCD fistulas, which are associated with unhealed post-operative fistulas in pfCD, suggesting their prognostic roles in pfCD.
Acute myocardial infarction in a patient with congenitally corrected transposition of the great arteries and complex coronary anatomy—a case report
Authors: Asaad Fahd , Sörensson Peder , Rück Andreas , Nagy Edit , Jurga Juliane , Ståhlberg Marcus
Published: November 2022

Background

Congenitally corrected transposition of the great arteries (ccTGA) is a rare congenital heart anomaly with atrioventricular and ventriculoarterial discordance that is often associated with other cardiac and coronary artery anomalies. Here, we report a case of a patient with ccTGA and non-ST elevation myocardial infarction (NSTEMI) with challenging coronary anatomy that was treated with stress-perfusion cardiac magnetic resonance imaging (spCMR) guided percutaneous coronary intervention (PCI).

Case summary

A 46-year-old male smoker with ccTGA, dyslipidaemia, diabetes Type 2 managed with dietary restrictions and a family history of premature myocardial infarction, presented with typical chest pain, elevated cardiac troponin levels and ECG-changes indicative of ischaemia. The patient was diagnosed with NSTEMI and underwent initial urgent coronary angiography (CA) without apparent significant stenosis, although the right coronary artery (RCA) could not be selectively investigated. The patient had coronary anatomy 1R-2LCX according to the Leiden convention, which is the usual anatomy in patients with ccTGA. Despite this, CA was challenging due to the different anatomy compared with individuals with normally positioned great vessels. The patient remained highly symptomatic with chest pain at moderate exertion. To improve identification of the anatomic location and extent of ischaemia, we performed spCMR with adenosine. This revealed a limited septal infarction (likely embolic) in the right ventricle and reversible ischaemia in two inferior right ventricular segments. A second angiography, selectively investigating RCA demonstrated a significant stenosis in the distal RCA that was successfully treated with a drug-eluting stent. Fractional flow reserve (FFR) measurements of the left coronary arteries demonstrated hemodynamically non-significant stenosis. The patient’s symptoms resolved, and he remained asymptomatic at one month follow-up.

Discussion

This ccTGA patient had multiple risk factors for coronary artery disease and presented with NSTEMI. Diagnosis and treatment were challenging due to complex cardiac anatomy and associated different origins of the coronary arteries. We highlight the importance of careful evaluation of the coronary anatomy and functional testing using for example spCMR and FFR to target the culprit coronary vessel(s) in ccTGA complicated by NSTEMI.
The multidisciplinary management of a mechanical mitral valve thrombosis in pregnancy: a case report and review of the literature
Authors: Wright Jennifer M , Bottega Natalie , Therrien Judith , Hatzakorzian Roupen , Buithieu Jean , Shum-Tim Dominique , Wou Karen , Ghandour Amale , Pelletier Patricia , Li Pi Shan William , Kaufman Ian , Brown Richard , Malhamé Isabelle
Published: November 2022

Background

The management of anticoagulation for mechanical heart valves during pregnancy poses a unique challenge. Mechanical valve thrombosis is a devastating complication for which surgery is often the treatment of choice. However, cardiac surgery for prosthetic valve dysfunction in pregnant patients confers a high risk of maternofetal morbidity and mortality.

Case summary

A 39-year-old woman in her first pregnancy at 30 weeks gestation presented to hospital with a mechanical mitral valve thrombosis despite therapeutic anticoagulation with low-molecular-weight heparin. She underwent an emergent caesarean section followed immediately by a bioprosthetic mitral valve replacement. This occurred after careful planning and organization on the part of a large multidisciplinary team.

Discussion

A proactive, rather than reactive, approach to the surgical management of a mechanical valve thrombosis in pregnancy will maximize the chances of successful maternal and fetal outcomes.
Advanced HIV disease and associated attrition after re-engagement in HIV care in Myanmar from 2003 to 2019: a retrospective cohort study
Authors: Mesic Anita , Homan Tobias , Lenglet Annick , Thit Phone , Mar Htay Thet , Sabai Saw Myat , Thandar Moe Pyae , Thwe Thin Thin , Kyaw Aung Aung , Decroo Tom , Spina Alexander , Ariti Cono , Ritmeijer Koert , Van Olmen Josefien , Oo Htun Nyunt , Lynen Lutgarde
Published: November 2022

Background

The burden of advanced HIV disease (AHD) and predictors of outcomes among people living with HIV (PLHIV) re-engaging in care are not well known.

Methods

We conducted a retrospective cohort study of PLHIV who re-engaged in care after being lost to follow-up (LFU), from 2003 to 2019, in Myanmar. We calculated the incidence rates of attrition after re-engagement and performed Cox regression to identify risk factors for attrition.

Results

Of 44 131 PLHIV who started antiretroviral treatment, 12 338 (28.0%) were LFU at least once: 7608 (61.6%) re-engaged in care, 4672 (61.4%) with AHD at re-engagement. The death and LFU rates were 2.21-fold (95% CI 1.82 to 2.67) and 1.46-fold (95% CI 1.33 to 1.61) higher among patients who re-engaged with AHD (p>0.001). Death in patients who re-engaged with AHD was associated with male sex (adjusted HR [aHR] 2.63; 95% CI 1.31 to 5.26; p=0.006), TB coinfection (aHR 2.26; 95% CI 1.23 to 4.14; p=0.008) and sex work (aHR 7.49, 95% CI 2.29 to 22.52; p<0.001). History of intravenous drug use was identified as a predictor of being LFU.

Conclusions

Re-engagement in HIV care in Myanmar is frequent and those who re-engage carry a high burden of AHD. As AHD at re-engagement is associated with higher attrition rates, implementation of differentiated interventions that enable earlier linkage to care and prompt identification and management of AHD in this population is necessary.
N-fertilization of tropical pastures improves performance but not methane emission of Nellore growing bulls
Authors: Lima Lais de Oliveira , Ongaratto Fernando , Dallantonia Erick Escobar , Leite Rhaony Gonçalves , Argentini Gabriella Patrício , Fernandes Marcia Helena Machado da Rocha , Reis Ricardo Andrade , Vyas Diwakar , Malheiros Euclides Braga
Published: November 2022

Grazing management and N-fertilizer have been reported to improve tropical forage productivity and quality, however, their effect on methane emission of grazing animals remains uncertain. Therefore, this study aimed to assess the effects of increasing application rates of nitrogen (N) fertilization of Marandu palisadegrass under continuous stocking on intake, digestibility, nitrogen balance, and enteric methane emissions of Nellore growing bulls. We hypothesized that changes in the forage nutritive value caused by N fertilization of pastures combined with adequate grazing management (e.g., greater crude protein [CP] and digestibility) would lead to an increase in animal productivity (e.g., greater average daily gain [ADG] and gain per area), and then, to a decrease in methane emission intensity. Treatments consisted of different annual application rates of nitrogen fertilization: 0, 75, and 150 kg N/ha using ammonium nitrate (32% N) as the nitrogen source. The experimental design was completely randomized, with three treatments and four replications (12 paddocks). Intake, digestibility, N balance, and methane emissions were measured in eight animals per treatment. CP intake, digestibility and N balance increased linearly with the increase in N fertilization (P < 0.05). In addition, stocking rate (SR) and ADG linearly increased from 1.75 animal unit (AU = 450 kg)/ha and 0.62 kg/d (0 kg N/ha) to 3.75 AU/ha and 0.82 kg/d (150 kg N/ha), respectively. Individual methane emissions nor methane emission intensity were affected by treatment with an average of 164.7 g/d and 199.7 g/kg ADG (P > 0.05). Annual N fertilization with ammonium nitrate between 75 and 150 kg N/ha in palisadegrass pastures under continuous stocking enhances animal performance per unit area yet not affecting neither methane production nor intensity.
Treatment of Hypertrophic Scars with Corticoid-Embedded Dissolving Microneedles
Authors: De Decker Ignace , Szabó Anna , Hoeksema Henk , Speeckaert Marijn , Delanghe Joris R , Blondeel Phillip , Van Vlierberghe Sandra , Monstrey Stan , Claes Karel E Y
Published: November 2022

Hypertrophic scarring (HTS) is frequently observed after deep dermal and full-thickness skin defects. Local drug delivery in HTS has been shown more effective compared to other (minimally) invasive treatments. Disadvantages being operator-dependency and non-uniform drug distribution. Moreover, injections are painful and difficult when confronted with extensive scars or HTS in children. Corticoid-embedded dissolving microneedles (CEDMN) were developed that provide painless skin penetration and direct dermal drug delivery. Hyaluronic acid-based DMN and CEDMN patches were utilized. Structural analysis was performed via nuclear magnetic resonance (NMR) spectroscopy while gel permeation chromatography (GPC) was applied to determine chain length (molar mass) and dispersity of hyaluronic acid. Mechanical properties were evaluated by compression testing. Five burn victims with HTS were included. For each individual, three comparable scars were chosen. One control scar was left untreated. Two scars were treated with either 600 or 800 µm CEDMN patches. Patients were treated monthly for 4 months. Treatment with 800 µm CEDMN was initiated after 8 weeks. Assessor-blinded POSAS was registered. Hydration, evaporation, color and elasticity were recorded. The physico-chemical characterization suggests that the mechanical properties enable skin penetration and adequate drug delivery. Patients experienced the therapy as painless. According to the POSAS, all scars improved over time. However, the scars that were treated with CEDMN patches improved faster and with increased increment. The 800 µm CEDMN ensured the fastest POSAS-decrease. Hyaluronic acid-based CEDMN patches are valuable alternatives to intracicatrical injections, as they offer a painless and effective method for administering corticosteroids in HTS.
Breast Cancer Screening in Women With Dense Breasts: Current Status and Future Directions for Appropriate Risk Stratification and Imaging Utilization
Authors: Miles Randy C , Chou Shinn-Huey , Vijapura Charmi , Patel Amy
Published: November 2022

Breast density continues to be a prevailing topic in the field of breast imaging, with continued complexities contributing to overall confusion and controversy among patients and the medical community. In this article, we explore the current status of breast cancer screening in women with dense breasts including breast density legislation. Risk-based approaches to supplemental screening may be more financially cost-effective. While all advanced imaging modalities detect additional primarily invasive, node-negative cancers, the degree to which this occurs can vary by density category. Future directions include expanding the use of density-inclusive risk models with appropriate risk stratification and imaging utilization. Further research is needed, however, to better understand how to optimize population-based screening programs with knowledge of patients’ individualized risk, including breast density assessment, to improve the benefit-to-harm ratio of breast cancer screening.
High-quality approximation of log-aesthetic curves based on the fourth-order derivative
Authors: Tsuchie Shoichi , Yoshida Norimasa
Published: November 2022

We propose a new method for approximating log-aesthetic curves ${\boldsymbol C}_{\mathrm{LA}}$ using high-degree Bézier curves. By leveraging the property that higher order derivatives are more sensitive to the quality of approximation, the method minimizes an objective function based on the fourth-order derivative; consequently, ${\boldsymbol C}_{\mathrm{LA}}$ is approximated with high accuracy. In addition, the proposed method is composed of two steps to ensure stable optimization so as not to be negatively affected because of a local minimum and to evaluate the fourth-order derivative. Furthermore, we reveal the difficulty in sufficiently approximating ${\boldsymbol C}_{\mathrm{LA}}$ with Bézier curves from two aspects. One aspect entails the uncertainty of how accurately the low-degree Bézier curves can approximate ${\boldsymbol C}_{\mathrm{LA}}$. The other aspect is the existence of a subset of ${\boldsymbol C}_{\mathrm{LA}}$ that is inherently difficult to approximate with such conventional parametric curves. The experimental results and comparisons demonstrated the validity of the proposed method.