bluuebunny/crossref_metadata_2025 huggingface dataset:
Temperament, Life Satisfaction, and the Role of Psychological Flexibility
Authors: Cyniak-Cieciura Maria , Białaszek Wojciech , Dudek Joanna , Ostaszewski Paweł
Published: March 2023

Abstract: Temperament is related to well-being. Establishing mediators of this relationship, especially mediators which can be influenced through psychological interventions, may contribute to tailoring these interventions to people’s needs determined by temperament. Psychological flexibility may be considered such a mediator. This study aims to examine the relationships between temperament traits and structures, satisfaction with life, and psychological flexibility, with the latter as a possible mediator of the relationship between temperament structures and life satisfaction. 538 participants (18–93 years old) took part in the study. They filled a set of self-reported questionnaires. Psychological flexibility explained a significant part of the variance in life satisfaction above and beyond temperament traits. People with harmonized temperament structures and higher stimulation processing capabilities (sanguine) exhibited higher psychological flexibility and satisfaction with life. Three temperament structures: phlegmatic, choleric, and melancholic in comparison to sanguine were found to be linked to lower satisfaction with life through lower psychological flexibility. The results suggest a meaningful role of stimulation processing capabilities in the development of both psychological flexibility and satisfaction with life.
Characterizing Cropland Patterns Across North‐East Africa Using Time Series Vegetation Indices
Authors: Measho Simon , Li Fadong , Chen Gang , Hirwa Hubert
Published: March 2023

The global community faces challenges of agroecosystem sustainability in the face of changing climate and intensified agriculture, particularly in Africa. In this study, annual and seasonal cropland Normalized Vegetation Difference Index (NDVI) trends and phonological variations, and associated key drivers in North‐East Africa were generated using Moderate Resolution Imaging Spectral‐radiometer NDVI of 8‐day satellite images and climate data between 2001 and 2020, which were further analyzed by a modified dynamic threshold method. The results showed that the annual cropland NDVI increased at an average rate of 0.0106 per year. The seasonal cropland NDVI was positive for the most significant changes observed in the boreal autumn season across the region. The start of the season and end of the season cropland NDVI in the boreal autumn season increased at an average rate of 0.015 (13.4% significant, p < 0.05), and 0.0151 × (12.8% significant, p < 0.05), respectively. The findings indicated that the boreal autumn season was getting longer, whereas the boreal summer season was becoming shorter during the last two decades. The most rapid cropland NDVI changes and maximum farmland NDVI variability were observed in the sub‐tropic warm arid and tropic warm semiarid agro‐ecological zones. The land surface temperature was found to be the main driving factor for the cropland NDVI and associated agroecosystem changes. This study provides essential information on the cropland productivity and shifting of greening patterns, which will support climate change mitigation measures at national and regional scales, contributing to sustainable agriculture.
Unraveling the Role of Electron Plateau Distributions in the Power Gap Formation of Chorus Waves: Van Allen Probes Observations
Authors: Chen Huayue , Chen Rui , Gao Xinliang , Lu Quanming , Ke Yangguang , Kong Zhenyu
Published: March 2023

The power gap of chorus waves at ∼0.5fce has been discovered for decades, but its generation mechanism is still under debate. Previous studies have revealed that electron plateau distributions are vitally important for the gap formation. By analyzing over one‐year Van Allen Probes data, we have studied chorus waves with (banded events) and without a power gap (no‐gap events), and their correlations with the electron plateau distribution. Although there is no significant difference in the morphology of velocity distributions in banded and no‐gap events, banded chorus events are typically accompanied by a plateau component with about one order higher number density than no‐gap events. The plateau components can cause severe damping at ∼0.5fce through cyclotron resonance rather than Landau resonance, and the gap frequency is roughly determined by the bulk velocity of plateau components. Our study provides new observational constraints on the generation mechanisms of power gap.
Artificial intelligence evaluation of COVID-19 restrictions and speech therapy effects on the autistic children’s behavior
Authors: Sabzevari Fereshteh , Amelirad Omid , Moradi Zohre , Habibi Mostafa
Published: March 2023

In the present study, we aimed to quantify the effects of COVID-19 restrictions and speech treatment approaches during lockdowns on autistic children using CBCL and neuro-fuzzy artificial intelligence method. In this regard, a survey including CBCL questionnaire is prepared using online forms. In total, 87 children with diagnosed Autism spectrum disorders (ASD) participated in the survey. The influences of three treatment approaches of in-person, telehealth and public services along with no-treatment condition during lockdown were the main factors of the investigation. The main output factors were internalized and externalized problems in general and their eight subcategory syndromes. We examined the reports by parents/caregivers to find correlation between treatments and CBCL listed problems. Moreover, comparison of the eight syndromes rating scores from pre-lockdown to post-lockdown periods were performed. In addition, artificial intelligence method were engaged to find the influence of speech treatment during restrictions on the level of internalizing and externalizing problems. In this regard, a fully connected adaptive neuro fuzzy inference system is employed with type and duration of treatments as input and T-scores of the syndromes are the output of the network. The results indicate that restrictions alleviate externalizing problems while intensifying internalizing problems. In addition, it is concluded that in-person speech therapy is the most effective and satisfactory approach to deal with ASD children during stay-at-home periods.
Analysis of TOPSIS techniques based on bipolar complex fuzzy N‐soft setting and their applications in decision‐making problems
Authors: Mahmood Tahir , Rehman Ubaid ur , Ali Zeeshan , Haleemzai Izatmand
Published: March 2023

A novel model termed a bipolar complex fuzzy N‐soft set (BCFN‐SS) is initiated for tackling information that involves positive and negative aspects, the second dimension, and parameterised grading simultaneously. The theory of BCFN‐SS is the generalisation of two various theories, that is, bipolar complex fuzzy (BCF) and N‐SS. The invented model of BCFN‐SS helps decision‐makers to cope with the genuine‐life dilemmas containing BCF information along with parameterised grading at the same time. Further, various algebraic operations, including the usual type of union, intersection, complements, and a few others types, are invented. Certain primary operational laws for BCFN‐SS are also invented. Moreover, a technique for order preference by similarity to the ideal solution (TOPSIS) approach is devised in the setting of BCFN‐SS for managing strategic decision‐making (DM) dilemmas containing BCFN‐SS information. Keeping in mind the usefulness and benefits of the TOPSIS approach, two various types of TOPSIS approaches in the environment of BCFN‐SS are devised and then a numerical example for exposing the usefulness of the devised TOPSIS approach is interpreted. To disclose the prominence and benefits of the devised work, the devised approaches with numerous prevailing work are compared.
Des défilés de modes… dans un bus
Authors:   Collectif Scientibus
Published: March 2023

Le « Scientibus » est un autobus transformé en un véritable laboratoire itinérant dans lequel le public peut participer à une grande quantité d’expériences scientifiques dont beaucoup relèvent de la photonique. Dans cet article, nous donnons l’exemple d’un enchaînement de démonstrations sur le thème de la propagation guidée dans les fibres optiques, en allant du phénomène de réflexion totale jusqu’à l’excitation modale sélective d’une fibre faiblement multimodale.
L’endommagement laser sur les lasers de puissance
Authors: Gallais Laurent , Lamaignère Laurent
Published: March 2023

Lorsqu’un fort flux laser traverse ou est réfléchi sur un composant optique, le couplage du rayonnement laser dans la matière (par absorption intrinsèque, par absorption sur des défauts locaux, ou par absorption non-linéaire) peut conduire à des effets irréversibles altérant la fonction optique du composant et pouvant même le rendre inutilisable. Ces modifications permanentes du matériau sont définies comme des « endommagements laser ». C’est un verrou technologique majeur à l’essor des sources lasers à haute puissance ou haute énergie, puisque qu’il limite la densité de puissance ou d’énergie accessible, affecte la durée de vie des composants optiques, ainsi que le coût de maintenance des chaînes laser.
Investigation of the use of infographics to aid second language vocabulary learning
Authors: Alwadei Amjaad Mansour , Mohsen Mohammed Ali
Published: March 2023

People learn and remember more effectively and efficiently through the use of texts and visuals than through texts alone. This paper explores the potential of infographics in aiding vocabulary learning and retention among Arab English as a foreign language (EFL) learners. The paper adopts a quasi-experimental two-group pretest–post-test–delayed test design. A total of 41 Arab EFL learners participated in this study. The experimental group was taught vocabulary using infographics for 10 weeks, whereas the control group was taught using the traditional way of instruction. Infographic materials were designed to teach the students’ course “Vocabulary I,” where the syllabus modules were fully converted into infographics during the whole semester. Vocabulary knowledge was assessed using two recognition vocabulary tests, word definition, and word grammatical measures, that were administered before the intervention, immediately after the learning session’s completion, and at a delayed time (4 weeks after the whole treatment). An oral interview was used to gauge the learners’ production knowledge of vocabulary. In addition, a questionnaire was utilized to examine the learners’ perceptions toward using infographics for learning EFL vocabulary. Results showed a significant difference between the scores of the groups in favor of the experimental group in vocabulary recognition knowledge and vocabulary production knowledge over the immediate run and the long run. Moreover, the participants in the experimental group showed high perceived usefulness of learning with infographics. Pedagogical implications and recommendations for future research were also proposed.
On an injectivity theorem for log-canonical pairs with analytic adjoint ideal sheaves
Authors: Chan Tsz , Choi Young-Jun
Published: March 2023

As an application of the residue functions corresponding to the lc-measures developed by the authors, the proof of the injectivity theorem on compact Kähler manifolds for plt pairs by Matsumura is improved in this article to allow multiplier ideal sheaves of plurisubharmonic functions with neat analytic singularities in the coefficients of the relevant cohomology groups. With the use of a refined version of analytic adjoint ideal sheaves, a plan towards a solution to the generalised version of Fujino’s conjecture (i.e. an injectivity theorem on compact Kähler manifolds for lc pairs with multiplier ideal sheaves) is laid down and, in addition to the result for plt pairs, a proof for lc pairs in dimension

2
2

, which is also an improvement of Matsumura’s result, is given.
Jay Pasachoff
Authors: Mitton Simon
Published: March 2023

Simon Mitton remembers the famous eclipse follower and outstanding astronomy educator
Paraphyly of the widespread generalist red fox (Vulpes vulpes): introgression rather than recent divergence of the arid-adapted Rüppell’s fox (Vulpes rueppellii)?
Authors: Basuony Ali E , Saleh Mostafa , Sarhan Moustafa , Younes Mahmoud , Abdel-Hamid Fouad , Rodriguez Fernandes Carlos , Vercammen Paul , Aboshaala Faraj , Bounaceur Farid , Chadwick Elizabeth A , Hailer Frank
Published: March 2023

Understanding of the evolutionary history of two closely related canid sister taxa, the geographically restricted, arid-adapted Rüppell’s fox (Vulpes rueppellii) and the widespread generalist red fox (Vulpes vulpes), has been hampered by limited sampling in the biogeographically complex region of North Africa and the Middle East. We sequenced mitochondrial DNA (mtDNA) cytochrome b and D-loop fragments from 116 samples for both species and combined these data with previously published sequences, resulting in 459 haplotypes. Obtained phylogenies showed high support for most branches, including for a newly described ‘Palearctic clade’ that includes North African and Asian individuals from both species. All V. rueppellii individuals fell within the Palearctic clade, forming two previously undescribed subclades that were intermingled with, but not shared with V. vulpes. Our robust placement of V. rueppellii within V. vulpes renders the latter paraphyletic. We propose three scenarios that could explain these observations: (1) rapid, recent speciation of V. rueppellii from V. vulpes, (2) incomplete lineage sorting, or (3) ancient divergence followed by introgression and secondary mtDNA similarity. The third scenario is in best agreement with evidence from the fossil record, and morphometric and ecological distinctiveness between the two taxa, and therefore seems most likely.
A molecular phenology scale of grape berry development
Authors: Tornielli Giovanni Battista , Sandri Marco , Fasoli Marianna , Amato Alessandra , Pezzotti Mario , Zuccolotto Paola , Zenoni Sara
Published: March 2023

Fruit growth and development consist of a continuous succession of physical, biochemical, and physiological changes driven by a genetic program that dynamically responds to environmental cues. Establishing recognizable stages over the whole fruit lifetime represents a fundamental requirement for research and fruit crop cultivation. This is especially relevant in perennial crops like grapevine (Vitis vinifera L.) to scale the development of its fruit across genotypes and growing conditions. In this work, molecular-based information from several grape berry transcriptomic datasets was exploited to build a molecular phenology scale (MPhS) and to map the ontogenic development of the fruit. The proposed statistical pipeline consisted of an unsupervised learning procedure yielding an innovative combination of semiparametric, smoothing, and dimensionality reduction tools. The transcriptomic distance between fruit samples was precisely quantified by means of the MPhS that also enabled to highlight the complex dynamics of the transcriptional program over berry development through the calculation of the rate of variation of MPhS stages by time. The MPhS allowed the alignment of time-series fruit samples proving to be a complementary method for mapping the progression of grape berry development with higher detail compared to classic time- or phenotype-based approaches.
Multifaceted regulatory functions of CsBPC2 in cucumber under salt stress conditions
Authors: Li Shuzhen , Sun Mintao , Miao Li , Di Qinghua , Lv Lijun , Yu Xianchang , Yan Yan , He Chaoxing , Wang Jun , Shi Aokun , Li Yansu
Published: March 2023

BASIC PENTACYSTEINE (BPC) transcription factors are essential regulators of plant growth and development. However, BPC functions and the related molecular mechanisms during cucumber (Cucumis sativus L.) responses to abiotic stresses, especially salt stress, remain unknown. We previously determined that salt stress induces CsBPC expression in cucumber. In this study, Csbpc2 transgene-free cucumber plants were created using a CRISPR/Cas9-mediated editing system to explore CsBPC functions associated with the salt stress response. The Csbpc2 mutants had a hypersensitive phenotype, with increased leaf chlorosis, decreased biomass, and increased malondialdehyde and electrolytic leakage levels under salt stress conditions. Additionally, a mutated CsBPC2 resulted in decreased proline and soluble sugar contents and antioxidant enzyme activities, which led to the accumulation of hydrogen peroxide and superoxide radicals. Furthermore, the mutation to CsBPC2 inhibited salinity-induced PM-H+-ATPase and V-H+-ATPase activities, resulting in decreased Na+ efflux and increased K+ efflux. These findings suggest that CsBPC2 may mediate plant salt stress resistance through its effects on osmoregulation, reactive oxygen species scavenging, and ion homeostasis-related regulatory pathways. However, CsBPC2 also affected ABA signaling. The mutation to CsBPC2 adversely affected salt-induced ABA biosynthesis and the expression of ABA signaling-related genes. Our results indicate that CsBPC2 may enhance the cucumber response to salt stress. It may also function as an important regulator of ABA biosynthesis and signal transduction. These findings will enrich our understanding of the biological functions of BPCs, especially their roles in abiotic stress responses, thereby providing the theoretical basis for improving crop salt tolerance.
A rare association of arteriovenous malformation of the omentum and pseudo-Meigs’ syndrome: case report and scoping review of literature
Authors: Baazeem Mazin S , AlJumah Modhi M , AlSalim Norah F , AlMalki Salman
Published: March 2023

Meigs’ syndrome is defined as a secondary triad of ascites, pleural effusion and benign ovarian tumor, usually fibroma. While pseudo-Meigs’ syndrome is a rare condition that is associated with benign ovarian tumor—other than fibroma—or even malignant. The case presented is a 40-year-old Saudi, nulliparous woman who was referred for precise diagnostic work-up as a case of huge pelvic-abdominal mass, tense ascites and pleural effusion. After further investigations cancer antigen-125 was found to be elevated. An abdominal CT scan revealed significant interval increase in the size of ascites, which cause huge abdominal distention, as well as a significant pleural effusion. Pathology of surgical specimens revealed a giant uterine leiomyoma, whereas the omentum excision surprisingly confirmed multiple disorganized arteries and veins, which resulted in omental arteriovenous malformation. To the best of our knowledge, this is the first reported case in the worldwide literature of two different rare conditions.
Reducing Burden in a Web Survey through Dependent Interviewing
Authors: Engstrom Curtiss , Sinibaldi Jennifer
Published: March 2023

Longitudinal surveys provide valuable data for tracking change in a cohort of individuals over time. Respondents are often asked to provide similar, if not the same, data at multiple time points. One could argue that this unnecessarily increases respondent burden, especially for information that does not change frequently. One way to reduce burden while still capturing up-to-date information may be to implement dependent interviewing (DI), where the respondent is provided information from the last data collection to aid in answering the current survey. If the information is still correct, then no change is needed, but if incorrect, the respondent has the option to change the response. To test this, we implemented two different versions of DI in a self-administered web survey and compared these against a traditional version of the web survey. We examined respondent burden by analyzing timing data and respondent enjoyment by analyzing debriefing questions. To assess the success of the implementation, we looked at timing data and undesirable behavior (missing data and backtracking). Finally, to evaluate measurement error, we looked at the number of meaningful changes. We found that DI is faster, more enjoyable, easily executed by the respondent (more so in one of our experimental formats), and significant measurement error was not introduced. In addition, DI provided consistency in the data, minimizing the noise introduced by nonmeaningful changes. The findings have significant implications for implementing DI in self-administered modes without an interviewer present.
Genome sequence and probiotic potential of newly isolatedEnterococcus duransstrain MN187066
Authors: Enuh Blaise Manga , Gedikli Serap , Aytar Çelik Pınar , Çabuk Ahmet
Published: March 2023

Enterococci are commensals of the human intestinal tract. Their use as probiotics is supported by their ability to confer several health benefits and eliminate foodborne pathogens but is controversial due to the presence of virulence and antibiotic resistance traits. To use them as probiotics requires thorough research to establish their safety. Here, we sequenced the whole genome of a newly isolated Enterococcus durans MN187066 and used a suite of bioinformatics tools to analyze its beneficial probiotic traits as well as antimicrobial resistance and virulence genes. The whole genome had a length of 2 978 152 bp, and an average G + C content of 37.88%. The bopABCD genes involved in biofilm formation were annotated in the genome. However, further analysis showed that these genes are mostly helpful in strengthening their colonization and establishment in the gastrointestinal tract. Also, we identified secondary metabolite gene clusters and the bacteriocins Enterolysin A and Enterocin P. We also identified repUS15 and rep1 replicons and genes that were associated with antimicrobial resistance and virulence. Nevertheless, vancomycin resistance genes were not detected. Our results show that the Ent. durans strain MN187066 can be considered a nontoxigenic strain and produces beneficial metabolites that are critical for their success as probiotics.
Managing neurodiversity in workplaces
Authors: Blackburn Blandina
Published: March 2023

Neurodiversity (ND) should be considered as a variant of ‘normal’. Depending on the symptoms impacting negatively on work, adjustments as required for productivity should be instituted and subsequently reviewed for effectiveness. ND individuals have strengths, e.g. attention to detail, creative thinking, that are needed in current workplaces. Change in perspectives on ND is needed, as work is important for these individuals. They are valuable contributors to communities.
Anatomy and relationships of the bizarre Early Cretaceous pliosaurid Luskhan itilensis
Authors: Fischer Valentin , Benson Roger B J , Zverkov Nikolay G , Arkhangelsky Maxim S , Stenshin Ilya M , Uspensky Gleb N , Prilepskaya Natalya E
Published: March 2023

Pliosaurid plesiosaurians are iconic marine reptiles that regulated marine trophic chains from the Middle Jurassic to the early Late Cretaceous. However, their evolution during the Cretaceous remains poorly documented. Recent discoveries from the Hauterivian–Aptian interval suggest that the radiation of brachaucheniine pliosaurids produced a wide disparity of forms following the Pliosaurus-dominated assemblages of the Late Jurassic. Among the most bizarre of these early brachaucheniines is Luskhan itilensis, from the Hauterivian of Russia. We describe the osteology of this tusked, longirostrine pliosaurid and discuss its possible behaviour by drawing comparisons with other marine amniotes possessing forward-pointing teeth. We take this opportunity to make extensive anatomical comparisons among Cretaceous pliosaurids, including previously overlooked cranial features. Bayesian inference of phylogenetic relationships of plesiosaurians reveals that the internal branches in Late Jurassic–Late Cretaceous pliosaurids have generally low rates of morphological evolution, indicating that the recently described Early Cretaceous pliosaurids have effectively bisected the long branch leading to the ‘classical’ brachaucheniines of the middle Cretaceous (Brachauchenius, Kronosaurus and Megacephalosaurus). Pliosaurids exhibit low evolutionary rates and a dwindling disparity before their extinction, mirroring the events seen, roughly at the same time, for ichthyosaurians.
Establishment and validation of a multigene model to predict the risk of relapse in hormone receptor-positive early-stage Chinese breast cancer patients
Authors: Liu Jiaxiang , Zhao Shuangtao , Yang Chenxuan , Ma Li , Wu Qixi , Meng Xiangzhi , Zheng Bo , Guo Changyuan , Feng Kexin , Shang Qingyao , Liu Jiaqi , Wang Jie , Zhang Jingbo , Shan Guangyu , Xu Bing , Liu Yueping , Ying Jianming , Wang Xin , Wang Xiang
Published: March 2023

Background:

Breast cancer patients who are positive for hormone receptor typically exhibit a favorable prognosis. It is controversial whether chemotherapy is necessary for them after surgery. Our study aimed to establish a multigene model to predict the relapse of hormone receptor-positive early-stage Chinese breast cancer after surgery and direct individualized application of chemotherapy in breast cancer patients after surgery.

Methods:

In this study, differentially expressed genes (DEGs) were identified between relapse and nonrelapse breast cancer groups based on RNA sequencing. Gene set enrichment analysis (GSEA) was performed to identify potential relapse-relevant pathways. CIBERSORT and Microenvironment Cell Populations-counter algorithms were used to analyze immune infiltration. The least absolute shrinkage and selection operator (LASSO) regression, log-rank tests, and multiple Cox regression were performed to identify prognostic signatures. A predictive model was developed and validated based on Kaplan–Meier analysis, receiver operating characteristic curve (ROC).

Results:

A total of 234 out of 487 patients were enrolled in this study, and 1588 DEGs were identified between the relapse and nonrelapse groups. GSEA results showed that immune-related pathways were enriched in the nonrelapse group, whereas cell cycle- and metabolism-relevant pathways were enriched in the relapse group. A predictive model was developed using three genes (CKMT1B, SMR3B, and OR11M1P) generated from the LASSO regression. The model stratified breast cancer patients into high- and low-risk subgroups with significantly different prognostic statuses, and our model was independent of other clinical factors. Time-dependent ROC showed high predictive performance of the model.

Conclusions:

A multigene model was established from RNA-seq data to direct risk classification and predict relapse of hormone receptor-positive breast cancer in Chinese patients. Utilization of the model could provide individualized evaluation of chemotherapy after surgery for breast cancer patients.
Low-Grade Hidradenocarcinoma of the Foot With Metastasis to a Lymph Node
Authors: Roman Jorge , Chung Catherine G. , Sangueza Martin , Plaza Jose A.
Published: March 2023

Hidradenocarcinoma (HAC) is a rare adnexal tumor associated with the potential for locoregional recurrence and systemic metastasis. The clinical appearance of HAC is nonspecific, frequently presenting as a solitary firm subcutaneous nodule or plaque on the head and neck region or distal extremities. These tumors show histomorphologic heterogeneity, as they can be low and high grade. Distinguishing HAC from hidradenoma, especially the low-grade variant of HAC, can be challenging as both tumors can show histologic overlapping features. In this article, we describe a case of a 33-year-old patient presenting with a low-grade HAC of the plantar foot who was subsequently found to have lymph node metastasis.
EBP on the Go! An Education Case Report
Authors: Conley Anissa L. , Smith Diane
Published: March 2023

In an era when resources, time, and attention spans are limited, nursing education must be delivered in a manner that is economical and convenient while retaining the ability to hold consumers accountable for their learning. This article highlights one organization's solution to a gap in evidence-based practice education. Professional development practitioners utilized their own creative acumen to develop high-quality, organization-specific resources that provide education in an engaging, portable, and user-friendly format.
A Quest for Better Strategy in Pediatric Intraosseous Placement Using Radiographic Measurements in Patients Younger Than 2 Years
Authors: Chung SunHee , Phelps Andrew , Chan Daniela K. I.
Published: March 2023

Intraosseous (IO) needles are used to obtain vascular access in pediatric patients during emergent situations. Recent literature has raised concern about high rates of IO malposition in younger children. Despite the widespread use of IO access in the pediatric population, there is scarce evidence regarding the ideal needle length or optimal access site. This study uses a radiographic approach to determine the appropriate IO needle length and access site to minimize the risk of malposition in children younger than 2 years. Radiographs of the lower extremities were obtained from the electronic database from a single tertiary care center. Using lateral views, anteroposterior measurements were obtained at 2 axial planes, located 1 cm superior to distal femur physis and 1 cm inferior to distal tibia physis. Based on the measurements, we calculated the probable needle tip positions if the needle was placed to the hub at the skin level using the EZ-IO (Teleflex Ltd, Wayne, PA) preset needle sizes. For subjects younger than 6 months, the 25-mm needle minimized malposition in the femur site with a 45.7% appropriate position rate, and the 15-mm needle minimized malposition in the tibia site with a 57.1% appropriate position rate. For the older age groups, we did not find a standard needle that would consistently minimize malposition in the femur site. For the tibia site, the 25-mm needle minimized malposition risk, with appropriate position rates of 81.0%, 87.5%, and 91.1% in the 6- to 12-month, 13- to 18-month, and 19- to 24-month groups, respectively.
Optimizing Prepectoral Implant Placement and Concomitant Fat Grafting After Tissue Expansion
Authors: Girard Alisa O. , Lopez Christopher D. , Ambrosino Christina M. , Broderick Kristen P.
Published: March 2023

Background

Prepectoral implant-based breast reconstruction is often supplemented by autologous fat grafting to optimize aesthetic outcomes. This usually entails several rounds of modest fat transfer to minimize risk of necrosis; however, the limits of fat grafting at expander exchange are not known.

Methods

A single-institution retrospective review from July 2016 to February 2022 was performed of all patients who underwent (1) mastectomy, (2) prepectoral tissue expander placement, (3) expander exchange for implant, and (4) at least one round of autologous fat transfer. Studentttest and χ2test were used.

Results

A total of 82 breasts underwent a single round of fat grafting during implant placement (group 1); 75 breasts underwent fat grafting that occurred in multiple rounds and/or in delay to implant placement (group 2). Group 1 received more fat at the time of implant placement (100 mL; interquartile range, 55–140 mL;P< 0.001) and underwent fewer planned operative procedures compared with group 2 (1.0 vs 2.2,P< 0.001). Total fat volume in group 2 did not significantly exceed that of group 1 until after 3 rounds of fat transfer (128.5 mL; interquartile range, 90–130 mL;P< 0.01). There was no difference in the rate of fat necrosis between groups after the first round (15.9% vs 9.3%,P= 0.2) and final round (15.9% vs 12.0%,P= 0.5) of fat grafting. Complication rates were similar between groups (3.7% vs 8.0%,P= 0.2).

Conclusions

A 2-stage approach of prepectoral tissue expander placement with single round of larger volume fat transfer at expander exchange reduces overall number of operative procedures without increased risks.
A Pilot Study Comparing Sensation in Buried Versus Nonburied Deep Inferior Epigastric Perforator Flaps
Authors: Lu Wang Marcos , Qin Nancy , Chadab Tara M. , Chen Yunchan , Huang Hao , Ellison Angela , Otterburn David M.
Published: March 2023

Background

Neurotized deep inferior epigastic perforator (DIEP) flaps have been shown to improve sensory recovery after mastectomy and reconstruction. With the recent trend toward nipple-sparing mastectomies, sensation likely originates within the buried DIEP flap and then innervates the breast skin. In contrast, for patients undergoing skin-sparing mastectomies, the DIEP flap skin is preserved, brought up to the surface, and directly innervated. In this study, we aim to evaluate inner breast region sensation between patients whose DIEP flap is buried and whose DIEP flap skin is brought to the surface.

Methods

Seventy patients who underwent mastectomy with immediate reconstruction using the DIEP flap were prospectively identified. Of these, 60 patients underwent nipple-sparing mastectomy with buried DIEP flap reconstruction while 10 patients underwent skin-sparing mastectomy with nonburied DIEP flap reconstruction. Patients in both cohorts received nerve grafting using the 70 × 1–2-mm Avance Nerve Graft in identical fashion. Sensitivity evaluation was performed in five inner breast regions (corresponding to the nonburied DIEP flap area).

Results

In the buried DIEP cohort, at 6 months postoperatively, there was a statistically significant difference in inner breast region sensitivity measurements compared with baseline levels (P < 0.001). In contrast, in the nonburied DIEP cohort, at 6 months postoperatively, sensation in the inner breast region was comparable with preoperative baseline levels (P = 0.236). At 24 months postoperatively, inner breast region sensitivity measurements in both cohorts were comparable with preoperative baseline measurements (P > 0.05).

Conclusions

Neurotized DIEP flap skin raised directly to the surface confers earlier sensory recovery than buried DIEP flaps. In patients who undergo skin-sparing mastectomies with nonburied DIEP flap reconstruction, they can expect significantly better sensation in the inner regions of the breast at 6 months postoperatively. In patients who undergo nipple-sparing mastectomies with buried DIEP flap reconstruction, they can expect sensation in the inner breast to return to preoperative baseline levels at a later time point—beginning as early as 24 months postoperatively.
Redefining Multimorbidity in Older Surgical Patients
Authors: Ramadan Omar I , Rosenbaum Paul R , Reiter Joseph G , Jain Siddharth , Hill Alexander S , Hashemi Sean , Kelz Rachel R , Fleisher Lee A , Silber Jeffrey H
Published: March 2023

Background:

Multimorbidity in surgery is common and associated with worse postoperative outcomes. However, conventional multimorbidity definitions (≥2 comorbidities) label the vast majority of older patients as multimorbid, limiting clinical usefulness. We sought to develop and validate better surgical specialty-specific multimorbidity definitions based on distinct comorbidity combinations.

Study Design:

We used Medicare claims for patients aged 66-90 undergoing inpatient general, orthopaedic, or vascular surgery. Using 2016-2017 data, we identified all comorbidity combinations associated with at least 2-fold (general/orthopaedic) or 1.5-fold (vascular) greater risk of 30-day mortality compared to the overall population undergoing the same procedure; we called these Qualifying Comorbidity Sets. We applied these to 2018-2019 data (general=230,410 patients, orthopaedic=778,131, vascular=146,570) to obtain 30-day mortality estimates. For further validation, we tested whether multimorbidity status was associated with differential outcomes for patients at better-resourced (based on nursing skill-mix, surgical volume, teaching status) versus all other hospitals using multivariate matching.

Results:

Compared to conventional multimorbidity definitions, the new definitions labeled far fewer patients as multimorbid: general=85.0% (conventional) versus 55.9% (new) (p<0.0001); orthopaedic=66.6% versus 40.2% (p<0.0001); vascular=96.2% versus 52.7% (p<0.0001). Thirty-day mortality was higher by the new definitions: general=3.96% (conventional) versus 5.64% (new) (p<0.0001); orthopaedic=1.13% versus 1.68% (p<0.0001); vascular=4.43% versus 7.00% (p<0.0001). Better-resourced hospitals offered significantly larger mortality benefits than all other hospitals for multimorbid versus non-multimorbid general and orthopaedic, but not vascular, patients (general surgery difference-in-differences=-0.94% [-1.36%,-0.52%], p<0.0001; orthopaedic=-0.20% [-0.34%,-0.05%], p=0.0087; vascular=-0.12% [-0.69%,0.45%], p=0.6795).

Conclusion:

Our new multimorbidity definitions identified far more specific, higher-risk pools of patients than conventional definitions, potentially aiding clinical decision-making.
Admission Thromboelastography at the Intersection of Traumatic Coagulopathy and Inflammation: A Pragmatic, Randomized Optimal Platelet and Plasma Ratios (PROPPR) Study Sub-Analysis
Authors: Savage Stephanie A , Zarzaur Ben L , Fox Erin E , Wade Charles E , Carney Patrick R , Do Trieu V , Holcomb John B
Published: March 2023

Background:

Acute traumatic coagulopathy (ATC) has many phenotypes and varying morbidity and mortality. The MA-R ratio, calculated from the admission thromboelastogram (TEG), serves as a biomarker to identify one phenotype of ATC and has previously been associated with significant derangements in the inflammatory response. This study evaluates outcomes related to abnormal MA-R ratios, including inflammatory responses, in a heterogeneous patient population.

Study Design:

Patients from the PROPPR dataset were included. The MA-R ratio was calculated from admission thromboelastography, with a CRITICAL ratio was defined as ≤11. Key inflammatory mediators were identified as a priori. Cytokine expression was assessed over 24 hours using multivariable logistic regression.

Results:

Significant elevations in the pro-inflammatory cytokines IL-1b, IL6, and IL 8, as well as in the chemokines eotaxin, IP-10, MCP-1 and MIP-1β persisted over the first 24 hours. CRITICAL patients had significantly lower survival at 1, 3, 6, 12 and 18 hours and demonstrated significantly increased Acute Respiratory Distress Syndrome (ARDS) (1.817 (95% CI 1.082,3.051), p=0.0239). CRITICAL patients had fewer ICU-free (CRITICAL 10 days (IQR 0, 25) v. NORMAL 22 days (4, 26), p <0.0001) and fewer ventilator-free days (CRITICAL 15 (IQR 0, 28) v. NORMAL 26 (9, 28), p < 0.0001). CRITICAL patients were protected against Systemic Inflammatory Response (0.521 (95% CI 0.322, 0.816), p=0.0044).

Conclusions:

The subtype of ATC identified by the low MA-R ratio is associated with significant elevations in multiple pro-inflammatory cytokines at admission. Early mortality remains elevated in the CRITICAL group, in part due to coagulopathy. The MA-R ratio at admission is associated with a particularly morbid type of coagulopathy, associated with significant alterations in the inflammatory response following severe injury in heterogeneous patient populations.
Differential expression of fibroblast activation protein-alpha and lysyl oxidase in subtypes of ameloblastoma
Authors: Vangansewinkel Tim , Driesen Ronald , Olubanwo Agbaje Jimoh , Gervois Pascal , Olumuyiwa Adisa Akinyele , Adenike Olusanya Adeola , Tunde Arotiba Juwon , Wolfs Esther , Lambrichts Ivo , Politis Constantinus
Published: March 2023

Ameloblastomas are benign, mostly intra-osseous, tumours originating from ectodermal odontogenic epithelium and display extracellular matrix remodelling. We determined whether fibroblast activation protein-alpha (FAP-α), a collagenolytic enzyme and lysyl oxidase (LOX), a collagen cross-linker were differentially regulated in ameloblastoma subtypes. Masson’s trichrome staining and immunohistochemistry were performed on human samples from gross mandibular or maxillary ameloblastoma. Co-localization studies in tumorigenic tissue of follicular, plexiform and desmoplastic ameloblastoma showed absence of the mesenchymal cell marker vimentin but high epithelial cell adhesion molecule (EPCAM) expression, an epithelial marker. Strong FAP-α staining was also noted, however, the stellate reticulum of plexiform ameloblastoma contained a higher number of FAP-α positive cells than the follicular subtype. Weak LOX staining was demonstrated in tumorigenic tissue of the follicular subtype but profound reactivity was observed in stromal plexiform and tumorigenic desmoplastic tissue. The desmoplastic staining profile for FAP-α and LOX shared resemblance with the unicystic subtypes. Tumorigenic outgrowths in desmoplastic ameloblastoma were associated with vimentin positive and EPCAM negative cancer-associated fibroblasts suggesting a role in tumour invasion. In conclusion, FAP-α expression in ameloblastoma seems to be involved in tumour growth and invasion whereas LOX expression is differentially regulated in ameloblastoma subtypes offering a new perspective for understanding specific growth patterns of ameloblastoma subtypes.
“Whenever I tell her to wear slippers, she turns a deaf ear. She never listens”: a qualitative descriptive research on the barriers to basic lymphedema management and quality of life in lymphatic filariasis patients in a rural block of eastern India
Authors: Kumar Pragya , Ahmad Shamshad , Bhar Ditipriya , Roy Ria , Singh Bhavna
Published: March 2023

Background

Chronic lymphatic filariasis cases in Bihar, India, need management of lymphedema to live a life free of disability. For patients who have recurrent attacks of acute dermato-lymphangio-adenitis (ADLA), WHO has recommended simple home-based measures that include maintaining hygiene, skin care, and limb movement. But patients in rural areas are unable to adopt them, resulting in a vicious cycle of ADLA attacks. So there might be multiple realities from patients’ and healthcare workers’ perspectives that are unexplored. A qualitative research was deemed best suitable to identify the barriers to practising home-based lymphedema practices that are adversely affecting quality of life.

Methods

The qualitative descriptive study was conducted in two villages in the rural field practice area under a tertiary care hospital in Bihar. Researchers purposively selected ten participants, including patients affected by lymphedema, their caregivers, the grassroots healthcare workers, and the block health manager. In-depth interviews were conducted using a semi-structured interview guide. Data was entered into QDA Miner Lite, where researchers did attribute, in-vivo, process, descriptive, emotion, and holistic coding, followed by content analysis, where categories and themes emerged from the codes.

Results

Three themes emerged: the inherent nature of disease, patient related factors, and healthcare system related factors. Besides low awareness and adherence, low health-seeking behaviour and poor personal hygiene, categories like signs and symptoms, seasonal factors, hampered activities of daily living, hopelessness from not getting cured, psychosocial difficulty, lack of capacity building and receipt of incentives by healthcare workers, unavailability of lab diagnosis and management of complications at the facility, inconsistent drug supply, and no financial assistance were the identified barriers.

Conclusions

Accessibility to WaSH, regular training of home-based care, increasing the capacity and motivation of grassroots workers, and the generation of in-depth awareness among the patients are required to achieve the elimination of filariasis, with MMDP as a key component of that strategy for endemic districts across the whole country.
Dynamic phosphatase-recruitment controls B-cell selection and oncogenic signaling
Authors: Lee Jaewoong , Robinson Mark E. , Sun Ruifeng , Kume Kohei , Ma Ning , Cosgun Kadriye Nehir , Chan Lai N. , Leveille Etienne , Geng Huimin , Vykunta Vivasvan S. , Shy Brian R. , Marson Alexander , Katz Samuel , Chen Jianjun , Paietta Elisabeth , Meffre Eric , Vaidehi Nagarajan , Müschen Markus
Published: March 2023

Initiation of B-cell receptor (BCR)1signaling, and subsequent antigen-encounter in germinal centers2,3represent milestones of B-lymphocyte development that are both marked by sharp increases of CD25 surface-expression. Oncogenic signaling in B-cell leukemia (B-ALL)4and lymphoma5also induced CD25-surface expression. While CD25 is known as an IL2-receptor chain on T- and NK-cells6–9, the significance of its expression on B-cells was unclear. Our experiments based on genetic mouse models and engineered patient-derived xenografts revealed that, rather than functioning as an IL2-receptor chain, CD25 expressed on B-cells assembled an inhibitory complex including PKCδ and SHIP1 and SHP1 phosphatases for feedback control of BCR-signaling or its oncogenic mimics.

Recapitulating phenotypes of genetic ablation of PKCδ10–12, SHIP113,14and SHP114, 15,16, conditional CD25-deletion decimated early B-cell subsets but expanded mature B-cell populations and induced autoimmunity. In B-cell malignancies arising from early (B-ALL) and late (lymphoma) stages of B-cell development, CD25-loss induced cell death in the former and accelerated proliferation in the latter. Clinical outcome annotations mirrored opposite effects of CD25-deletion: high CD25 expression levels predicted poor clinical outcomes for patients with B-ALL, in contrast to favorable outcomes for lymphoma-patients. Biochemical and interactome studies revealed a critical role of CD25 in BCR-feedback regulation: BCR-signaling induced PKCδ-mediated phosphorylation of CD25 on its cytoplasmic tail (S268). Genetic rescue experiments identified CD25-S268tail-phosphorylation as central structural requirement to recruit SHIP1 and SHP1 phosphatases to curb BCR-signaling. A single point mutation CD25S268Aabolished recruitment and activation of SHIP1 and SHP1 to limit duration and strength of BCR-signaling. Loss of phosphatase-function, autonomous BCR-signaling and Ca2+-oscillations induced anergy and negative selection during early B-cell development, as opposed to excessive proliferation and autoantibody production in mature B-cells. These findings highlight the previously unrecognized role of CD25 in assembling inhibitory phosphatases to control oncogenic signaling in B-cell malignancies and negative selection to prevent autoimmune disease.