bluuebunny/crossref_metadata_2025 huggingface dataset:
Island remodelling in acute and chronic aortic dissection treated with frozen elephant trunk
Authors: Dohle Daniel-Sebastian , Mattern Leon , Pfeiffer Philipp , Probst Chris , Ghazy Ahmed , Treede Hendrik
Published: February 2023

OBJECTIVES

The island technique for reimplantation of supra-aortic vessels in frozen elephant surgery is commonly used but might be questioned for dissected vessels. This study analyses the remodelling of reimplanted supra-aortic vessels after FET in acute and chronic aortic dissection (CAD).

METHODS

Between June 2017 and April 2021, 133 patients were operated for acute and CAD using the frozen elephant technique. The island technique for reimplantation of the supra-aortic vessels was used in 94/133 patients. In 68 acute and 21 chronic patients, the total vessel lumen (VL), true lumen, false lumen (FL) and perfused FL area were measured in the innominate, right common carotid and left common carotid artery. Relative luminal changes were compared.

RESULTS

In acute aortic dissection, 80% innominate, 40% right carotid and 59% left carotid arteries were dissected preoperatively, but postoperatively FL was only patent in 29%, 12% and 10% (P < 0.001). FL disappearance resulted in >20% total VL reduction in innominate, right carotid and left carotid artery (P < 0.01). In CAD, only 38% innominate, 14% right carotid and 43% left carotid arteries were dissected preoperatively, but postoperatively FL was patent in 19% (ns), 10% (ns) and 5% (P = 0.009).

CONCLUSION

Vascular remodelling is frequently found after the island technique. In acute aortic dissection, the island technique frequently initiates FL disappearance associated with VL decrease. Continuously dissected head vessels show positive remodelling with true lumen increase without VL increase. FL disappearance is frequently found in CAD.
Balloon pulmonary angioplasty followed by pulmonary endarterectomy: Combination treatment for high-surgical-risk patients with chronic thromboembolic pulmonary hypertension
Authors: Shimahara Yusuke , Suzuki Shun , Fujiyoshi Toshiki , Honda Sayaka , Koizumi Nobusato , Yamashita Jun , Sasaki Yuichi , Ito Ryosuke , Takahashi Lisa , Nakai Michikazu , Ogino Hitoshi
Published: February 2023

OBJECTIVES

Our goal was to evaluate the combined effects of balloon pulmonary angioplasty (BPA) followed by pulmonary endarterectomy (PEA) to treat high-surgical-risk patients with chronic thromboembolic pulmonary hypertension (CTEPH).

METHODS

This study included 58 patients with CTEPH who had pulmonary vascular resistance of ≥1000 dyn·s/cm5, mean pulmonary arterial pressure (mPAP) of ≥45 mmHg or mPAP of 38–44 mmHg with comorbidities. Of these, 21 patients underwent the combined therapy of BPA followed by PEA (BPA group) and 37 underwent direct PEA (non-BPA group). Preoperative and postoperative results were compared between the 2 groups. An early postoperative composite event comprised the postoperative use of extracorporeal membrane oxygenation or intra-aortic balloon pump, in-hospital death, rescue BPA, prolonged ventilation, tracheostomy, prolonged stay in the intensive care unit, deep sternal wound infection and cerebral infarction.

RESULTS

Before the first intervention (before BPA or direct PEA), patients in the BPA group had a higher mPAP than those in the non-BPA group. After undergoing BPA before PEA, the BPA group demonstrated significantly decreased mPAP and pulmonary vascular resistance (43 vs 52 mmHg, P < 0.001; 636 vs 965 dyn·s/cm5, P = 0.003, respectively) and significantly increased cardiac output (4.1 vs 3.5 l/min, P = 0.041). Notably, the number of patients with the early postoperative composite event was significantly lower in the BPA group than in the non-BPA group (4.8% vs 35.1%, P = 0.011).

CONCLUSIONS

Compared with direct PEA, the combination therapy of BPA followed by PEA can be a feasible and effective risk-reduction strategy for high-surgical-risk patients with CTEPH.
Extraction of clinical phenotypes for Alzheimer’s disease dementia from clinical notes using natural language processing
Authors: Oh Inez Y , Schindler Suzanne E , Ghoshal Nupur , Lai Albert M , Payne Philip R O , Gupta Aditi
Published: February 2023

Objectives

There is much interest in utilizing clinical data for developing prediction models for Alzheimer’s disease (AD) risk, progression, and outcomes. Existing studies have mostly utilized curated research registries, image analysis, and structured electronic health record (EHR) data. However, much critical information resides in relatively inaccessible unstructured clinical notes within the EHR.

Materials and Methods

We developed a natural language processing (NLP)-based pipeline to extract AD-related clinical phenotypes, documenting strategies for success and assessing the utility of mining unstructured clinical notes. We evaluated the pipeline against gold-standard manual annotations performed by 2 clinical dementia experts for AD-related clinical phenotypes including medical comorbidities, biomarkers, neurobehavioral test scores, behavioral indicators of cognitive decline, family history, and neuroimaging findings.

Results

Documentation rates for each phenotype varied in the structured versus unstructured EHR. Interannotator agreement was high (Cohen’s kappa = 0.72–1) and positively correlated with the NLP-based phenotype extraction pipeline’s performance (average F1-score = 0.65–0.99) for each phenotype.

Discussion

We developed an automated NLP-based pipeline to extract informative phenotypes that may improve the performance of eventual machine learning predictive models for AD. In the process, we examined documentation practices for each phenotype relevant to the care of AD patients and identified factors for success.

Conclusion

Success of our NLP-based phenotype extraction pipeline depended on domain-specific knowledge and focus on a specific clinical domain instead of maximizing generalizability.
Transcription-wide impact by RESCUE-induced off-target single-nucleotide variants in mammalian cells
Authors: Li Guo , Zhu Xiaoning , Wang Yihan , Ma Hongru , Wang Yuzhe , Wu Hanyu , Li Xiangyang , Wang Yiling , Gao Jianen , Chen Xuexin , Huang Xingxu , Yao Yuan , Hu Xiaoxiang
Published: February 2023

RNA base editing is a promising tool in precise molecular therapy. Currently, there are two widely used RNA base editors, REPAIR and RESCUE. REPAIR only facilitates A-to-I conversions, while RESCUE performs both A-to-I and C-to-U conversions. Thus, RESCUE can generate twice the number of mutations compared to REPAIR. However, transcription-wide impact due to RESCUE-induced off-target single-nucleotide variants (SNVs) is not fully appreciated. Therefore, to determine the off-target effects of RESCUE-mediated editing, we employed transcription-wide sequencing on cells edited by RESCUE. The SNVs showed different off-target effects on mRNA, circRNA, lncRNA, and miRNA expression patterns and their interacting networks. Our results illustrate the transcription-wide impact of RESCUE-induced off-target SNVs and highlight the need for careful characterization of the off-target impact by this editing platform.
Development of a specific real-time PCR assay for simultaneous detection and differentiation ofCoxiella burnetiistrains from environmental soil samples
Authors: Fernández-Carrillo Juan , del Olmo-Monge Javier , Sellek Ricela E , Ortega-García María Victoria , Cabria-Ramos Juan Carlos , Bassy Olga
Published: February 2023

Coxiella burnetii, the causative agent of Q fever, is a small, coccoid, Gram-negative strict intracellular pathogen. One of the most common ways of acquiring Q fever is through inhalation of aerosols containing the bacteria. Because C. burnetii is highly infectious, spreads easily through the air, and is very resistant to environmental conditions, it is considered a biological threat. This paper presents the development and validation of a specific real-time polymerase chain reaction (real-time PCR or qPCR) assay for the detection of C. burnetii, based on the amplification of a fragment of the isocitrate dehydrogenase (icd) encoding gene. This real-time PCR is highly specific, reproducible, and sensitive, allowing the detection of as few as 5 genome equivalents (GEs) of C. burnetii per reaction. The method enables a rapid preliminary differentiation among strains, based on a point mutation at nucleotide 745 of the icd gene. The assay was successfully evaluated in environmental soil samples; a limit of detection of 3 × 104 colony forming units per 0.5 g of soil (∼3 GEs per reaction) was achieved. The newly developed real-time PCR offers a valuable tool for differential detection of C. burnetii strains in environmental soil samples.
The status of the Jewish temple in modern Hebrew literature (1848–1948): A big-data analysis
Authors: Hershkowitz Isaac
Published: February 2023

Since its final destruction in antiquity, the memory of the temple in Jerusalem has served as the nexus of Jewish liturgy and messianic worldview. This article has sought to examine the ideological and cultural roles played by the image of the Jewish temple in the Hebrew literature of 1848–1948. Toward this end, I formulated a broad corpus comprised of homogeneous genres and authors, namely those which situate the temple as their main focus. The evidence arising from this corpus suggests that the conceptual role of the temple underwent no dramatic transformations; the temple in this literature, taken as a whole, is mostly indistinguishable from the historical, religious, and nationalistic symbol that featured in the Jewish tradition over nearly 2,000 years. The bulk of the present corpus places the temple in conceptual and historical contexts that are familiar and very similar to those of the historical temple in all its contexts, without removing it from the domains of Jewish nationalism or classical religiosity. These findings contravene my initial presupposition that the discourse of the temple had undergone a metamorphosis in the 19th and 20th centuries, the image of the temple had changed into an abstract symbol for world peace, moral perfection, and intellectual and scientific excellence.
The Thousand Pulsar Array program on MeerKAT – IX. The time-averaged properties of the observed pulsar population
Authors: Posselt B , Karastergiou A , Johnston S , Parthasarathy A , Oswald L S , Main R A , Basu A , Keith M J , Song X , Weltevrede P , Tiburzi C , Bailes M , Buchner S , Geyer M , Kramer M , Spiewak R , Krishnan V Venkatraman
Published: February 2023

We present the largest single survey to date of average profiles of radio pulsars, observed and processed using the same telescope and data reduction software. Specifically, we present measurements for 1170 pulsars, observed by the Thousand Pulsar Array programme at the 64-dish SARAO MeerKAT radio telescope, in a frequency band from 856 to 1712 MHz. We provide rotation measures (RM), dispersion measures, flux densities, and polarization properties. The catalogue includes 254 new RMs that substantially increase the total number of known pulsar RMs. Our integration times typically span over 1000 individual rotations per source. We show that the radio (pseudo-) luminosity has a strong, shallow dependence on the spin-down energy, proportional to $\dot{E}^{0.15\pm 0.04}$, that contradicts some previous proposals of population synthesis studies. In addition, we find a significant correlation between the steepness of the observed flux density spectra and $\dot{E}$, and correlations of the fractional linear polarization with $\dot{E}$, the spectral index, and the pulse width, which we discuss in the context of what is known about pulsar radio emission and how pulsars evolve with time. On the whole, we do not see significant correlations with the estimated surface magnetic field strength, and the correlations with $\dot{E}$ are much stronger than those with the characteristic age. This finding lends support to the suggestion that magnetic dipole braking may not be the dominant factor for the evolution of pulsar rotation over the lifetimes of pulsars. A public data release of the high-fidelity time-averaged pulse profiles in full polarization accompanies our catalogue.
The EBLM project X. Benchmark masses, radii, and temperatures for two fully convective M-dwarfs using K2
Authors: Duck Alison , Martin David V , Gill Sam , Armitage Tayt , Rodríguez Martínez Romy , Maxted Pierre F L , Sebastian Daniel , Sethi Ritika , Swayne Matthew I , Cameron Andrew Collier , Dransfield Georgina , Gaudi B Scott , Gillon Michael , Hellier Coel , Kunovac Vedad , Lovis Christophe , McCormac James , Pepe Francesco A , Pollacco Don , Sairam Lalitha , Santerne Alexandre , Ségransan Damien , Standing Matthew R , Southworth John , Triaud Amaury H M J , Udry Stephane
Published: February 2023

M-dwarfs are the most abundant stars in the galaxy and popular targets for exoplanet searches. However, their intrinsic faintness and complex spectra inhibit precise characterization. We only know of dozens of M-dwarfs with fundamental parameters of mass, radius, and effective temperature characterized to better than a few per cent. Eclipsing binaries remain the most robust means of stellar characterization. Here we present two targets from the Eclipsing Binary Low Mass (EBLM) survey that were observed with K2: EBLM J0055-00 and EBLM J2217-04. Combined with HARPS and CORALIE spectroscopy, we measure M-dwarf masses with precisions better than 5 per cent, radii better than 3 per cent, and effective temperatures on order 1 per cent. However, our fits require invoking a model to derive parameters for the primary star and fitting the M-dwarf using the transit and radial velocity observations. By investigating three popular stellar models, we determine that the model uncertainty in the primary star is of similar magnitude to the statistical uncertainty in the model fits of the secondary M-dwarf. Therefore, whilst these can be considered benchmark M-dwarfs, we caution the community to consider model uncertainty when pushing the limits of precise stellar characterization.
Foreground removal of CO intensity mapping using deep learning
Authors: Zhou Xingchen , Gong Yan , Deng Furen , Zhang Meng , Yue Bin , Chen Xuelei
Published: February 2023

Line intensity mapping (LIM) is a promising probe to study star formation, the large-scale structure of the Universe, and the epoch of reionization (EoR). Since carbon monoxide (CO) is the second most abundant molecule in the Universe except for molecular hydrogen H2, it is suitable as a tracer for LIM surveys. However, just like other LIM surveys, CO intensity mapping also suffers strong foreground contamination that needs to be eliminated for extracting valuable astrophysical and cosmological information. In this work, we take 12CO($\it J$ = 1-0) emission line as an example to investigate whether deep learning method can effectively recover the signal by removing the foregrounds. The CO(1-0) intensity maps are generated by N-body simulations considering CO luminosity and halo mass relation, and we discuss two cases with median and low CO signals by comparing different relations. We add foregrounds generated from real observations, including thermal dust, spinning dust, free–free, synchrotron emission, and cosmic microwave background anisotropy. The beam with sidelobe effect is also considered. Our deep learning model is built upon ResUNet, which combines image generation algorithm UNet with the state-of-the-art architecture of deep learning, ResNet. The principal component analysis (PCA) method is employed to preprocess data before feeding it to the ResUNet. We find that, in the case of low instrumental noise, our UNet can efficiently reconstruct the CO signal map with correct line power spectrum by removing the foregrounds and recovering PCA signal loss and beam effects. Our method also can be applied to other intensity mappings like neutral hydrogen 21-cm surveys.
The spectra of IceCube Neutrino (SIN) candidate sources – III. Optical spectroscopy and source characterization of the full sample
Authors: Paiano Simona , Falomo Renato , Treves Aldo , Padovani Paolo , Giommi Paolo , Scarpa Riccardo , Bisogni Susanna , Marini Ester
Published: February 2023

A correlation between astrophysical high-energy neutrinos and blazars has been suggested by various authors. In particular, a likely association between IceCube events and intermediate- and high-energy peaked BL Lac objects has led to a sample of 47 objects having a high probability of being neutrino sources. In the first paper of this series we reported optical spectroscopy of 17 objects, which together with data taken from the literature covered 80 per cent of the sample. Here, we present spectroscopy obtained at large aperture telescopes of a further 17 objects (plus four additional targets), which completes the sample coverage. For 12 objects we are able to determine the redshift (0.07 < z < 1.6), while for the others we set a lower limit on it, based on either the robust detection of intervening absorption systems or on an estimation derived from the absence of spectral signatures of the host galaxy. With these new data we expand and reinforce the main results of our previous papers, namely the fact that in terms of their broad-band properties our sources appear to be indistinguishable from the rest of the blazar population and the relatively large (>34 per cent and possibly as high as 80 per cent) fraction of masquerading BL Lac objects, for which the low equivalent width of the emission lines is due to the brightness of the boosted continuum, rather than being an intrinsic property, in our sample.
On the functional form of the radial acceleration relation
Authors: Desmond Harry , Bartlett Deaglan J , Ferreira Pedro G
Published: February 2023

We apply a new method for learning equations from data – Exhaustive Symbolic Regression (ESR) – to late-type galaxy dynamics as encapsulated in the radial acceleration relation (RAR). Relating the centripetal acceleration due to baryons, gbar, to the total dynamical acceleration, gobs, the RAR has been claimed to manifest a new law of nature due to its regularity and tightness in agreement with Modified Newtonian Dynamics (MOND). Fits to this relation have been restricted by prior expectations to particular functional forms, while ESR affords an exhaustive and nearly prior-free search through functional parameter space to identify the equations optimally trading accuracy with simplicity. Working with the SPARC data, we find the best functions typically satisfy gobs ∝ gbar at high gbar, although the coefficient of proportionality is not clearly unity and the deep-MOND limit $g_\text{obs}\propto \sqrt{g_\text{bar}}$ as gbar → 0 is little evident at all. By generating mock data according to MOND with or without the external field effect, we find that symbolic regression would not be expected to identify the generating function or reconstruct successfully the asymptotic slopes. We conclude that the limited dynamical range and significant uncertainties of the SPARC RAR preclude a definitive statement of its functional form, and hence that this data alone can neither demonstrate nor rule out law-like gravitational behaviour.
Nephrolithiasis and/or nephrocalcinosis is significantly related to renal dysfunction in patients with primary Sjögren’s syndrome
Authors: Fujisawa Yuhei , Mizushima Ichiro , Suzuki Yasunori , Kawano Mitsuhiro
Published: February 2023

Objective

The present study compared the clinical features of patients with primary Sjögren’s syndrome (pSS) with and without nephrolithiasis and/or nephrocalcinosis to determine factors related to renal dysfunction.

Methods

The clinical features of 68 patients with anti-Sjogren's syndrome antigen A (SSA)/Ro-antibody–positive pSS with and without nephrolithiasis and/or nephrocalcinosis who underwent abdominal computed tomography and/or ultrasonography were retrospectively analysed.

Results

Of the 68 patients with anti-SSA-antibody–positive pSS, 23 (33%) had renal nephrolithiasis and/or nephrocalcinosis, whereas 45 (67%) did not. Fourteen (20%) patients had renal dysfunction at diagnostic imaging. Among five patients who underwent renal biopsy, four patients with renal nephrolithiasis and/or nephrocalcinosis were diagnosed with tubulointerstitial nephritis, and one without nephrolithiasis and/or nephrocalcinosis was diagnosed with minimal change nephrotic syndrome. Estimated glomerular filtration rate at diagnostic imaging was significantly lower in patients with than without nephrolithiasis and/or nephrocalcinosis group (P = 0.010). In addition to nephrolithiasis and/or nephrocalcinosis (odds ratio [OR], 3.467; P = 0.045), the gap between serum sodium and chloride concentrations (OR, 10.400; P = 0.012) and increased urinary β2-microglobulin (OR, 5.444; P = 0.033) were associated with renal dysfunction at the time of diagnostic imaging.

Conclusion

Nephrolithiasis and/or nephrocalcinosis, normal anion gap metabolic acidosis, and tubulointerstitial damage are associated with renal dysfunction in patients with pSS.
Evaluating the intensity, duration and frequency of flexible energy resources needed in a zero-emission, hydropower reliant power system
Authors: Doering Kenji , Anderson C Lindsay , Steinschneider Scott
Published: February 2023

Rapid increases in global temperature are motivating governments to restructure the energy sector towards emissions-free electricity generation. One of the key factors affecting the viability of emissions-free power systems is the joint variability of renewable resources and drivers of energy demand across spatiotemporal scales. This study evaluates the impact of multi-scale hydroclimatic variability on the reliability of a zero-emissions power system in a case study of New York State (NYS), which recently passed the Climate Leadership and Community Protection Act (CLCPA) requiring zero-emissions electricity generation by 2040. We first analyze covariation between renewable energy generation and energy demand, including large-scale hydropower generation on the Great Lakes, and develop a stochastic generator to simulate an ensemble of plausible realizations of this joint variability. Using a simplified energy balance model of the NYS power system, we then quantify resource gaps across spatiotemporal scales that emerge under load and generation scenarios projected under the CLCPA. We focus on the intensity, duration, and frequency of these gaps, which will have to be filled with carbon-free, dispatchable resources not prescribed under the CLCPA. We show that the covariability between load and wind can lead to major short-term resource gaps, which is exacerbated by transmission constraints. We also show that long-duration hydropower droughts increase the likelihood of co-occurring renewable resource deficits and extended periods (weeks to months) of energy shortage. We conclude by discussing the implications of these results on the need for alternative, carbon-free, and dispatchable resources to support zero emission, hydropower-reliant electric grids.
Job Matching with Subsidy and Taxation
Authors: Kojima Fuhito , Sun Ning , Yu Ning Neil
Published: February 2023

In markets for indivisible resources such as workers and objects, subsidy and taxation for an agent may depend on the set of acquired resources and prices. This paper investigates how such transfer policies interfere with the substitutes condition, which is critical for market equilibrium existence and auction mechanism performance among other important issues. For environments where the condition holds in the absence of policy intervention, we investigate which transfer policies preserve the substitutes condition in various economically meaningful settings, establishing a series of characterisation theorems. For environments where the condition may fail without policy intervention, we examine how to use transfer policies to re-establish it, finding exactly when transfer policies based on scales are effective for that purpose. These results serve to inform policymakers, market designers, and market participants of how transfer policies may impact markets, so more informed decisions can be made.
Physical Modes of Action of Fungicides Against Apple Scab: Timing Is Everything, but Dose Matters
Authors: Philion Vincent , Joubert Valentin , Trapman Marc , Stensvand Arne
Published: February 2023

The efficacy of currently available fungicides against apple scab, caused by the fungal pathogen Venturia inaequalis, was investigated in relation to when growers spray (ahead, during, or after rain) and how the spray reaches the target. The adaxial surface of individual leaves of potted trees were sprayed and then inoculated with ascospores of V. inaequalis, to establish dose-response curves for each fungicide. Discriminatory doses providing 50 and 90% symptom inhibition (EC50 and EC90, respectively) in sprays mimicking applications ahead of rain were used for experiments imitating alternative spray timings. Sprays were either applied during the spore germination phase or early or late after infection onset (either 336 or 672 degree-hours after inoculation, respectively), corresponding to grower spray schedules. Experiments were also carried out with sprays applied on the abaxial leaf surface to investigate fungicide efficacy through the leaf lamina. For all fungicides, the best efficacy was observed when sprays were applied during germination, followed by applications ahead of inoculation. Some products maintained equal or better efficacy at early infection, while efficacy in late infection dropped for all products, clearly indicating that this spray timing should be avoided. Some products with postinfection efficacy also showed translaminar efficacy. The close relationship found between EC50 of the active ingredients on potted trees and the label rate could help improve spraying decisions and reduce costs.
Impact of COVID-19 on hand surgery transfers at a level-1 trauma center
Authors: Stearns Stephen A. , Beagles Clay B. , Hegermiller Katherine , Harper Carl M.
Published: February 2023

Background:

The COVID-19 pandemic significantly impacted elective surgical volume across the country; however, its effect on urgent transfers is unclear. This study sought to understand the impact of COVID-19 on transfers for hand surgery evaluation at a single quaternary referral center during the initial 3 mo of state mandated restrictions.

Methods:

A retrospective analysis was performed comparing the rate and character of transfers for hand surgery evaluation from March to June of 2020 to a temporally matched cohort averaged across 2018 and 2019. The primary outcome of this study was transfer frequency, with secondary outcomes of treatment rendered and type of disposition.

Results:

The rate of transfer between emergency departments for hand surgery evaluation was not statistically different from before to during COVID (ED-to-ED transfer rate: 4.3% and 5.1% respectively, P=0.68). Patient demographics were similar, with no difference in age (pre-COVID-19 mean 48.6 yr vs. intra-COVID-19 mean 53.2 yr, P=0.31) or type of insurance (P=0.99). Regarding reason for transfer, both cohorts were similar in the number of transfers for trauma versus infection (pre-COVID-19 infection: 11 trauma: 20.5 vs. intra-COVID-19 infection: 4 trauma: 17 P=0.99). We observed similar rates of transfers requiring procedural intervention (pre-COVID-19 69.8% vs. intra-COVID-19 57.1% P=0.19). Lastly, there was no difference in admission patterns, with pre-COVID-19 rates (71.4%) similar to those during COVID-19 (52%) P=0.15.

Conclusions:

Despite the many changes to healthcare in the US during the COVID-19 pandemic, the practice of transferring for evaluation to a Level 1 hand surgery center was similar to pre-pandemic years.

Level VI Evidence:

Presenting a single descriptive study.
Acute Effects of Ketamine on Intracranial Pressure in Children With Severe Traumatic Brain Injury*
Authors: Laws Jennifer C. , Vance E. Haley , Betters Kristina A. , Anderson Jessica J. , Fleishman Sydney , Bonfield Christopher M. , Wellons John C. , Xu Meng , Slaughter James C. , Giuse Dario A. , Patel Neal , Jordan Lori C. , Wolf Michael S.
Published: February 2023

OBJECTIVES:

The acute cerebral physiologic effects of ketamine in children have been incompletely described. We assessed the acute effects of ketamine on intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in children with severe traumatic brain injury (TBI).

DESIGN:

In this retrospective observational study, patients received bolus doses of ketamine for sedation or as a treatment for ICP crisis (ICP > 20 mm Hg for > 5 min). Administration times were synchronized with ICP and CPP recordings at 1-minute intervals logged in an automated database within the electronic health record. ICP and CPP were each averaged in epochs following drug administration and compared with baseline values. Age-based CPP thresholds were subtracted from CPP recordings and compared with baseline values. Trends in ICP and CPP over time were assessed using generalized least squares regression.

SETTING:

A 30-bed tertiary care children’s hospital PICU.

PATIENTS:

Children with severe TBI who underwent ICP monitoring.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We analyzed data from 33 patients, ages 1 month to 16 years, 22 of whom received bolus doses of ketamine, with 127 doses analyzed. Demographics, patient, and injury characteristics were similar between patients who did versus did not receive ketamine boluses. In analysis of the subset of ketamine doses used only for sedation, there was no significant difference in ICP or CPP from baseline. Eighteen ketamine doses were given during ICP crises in 11 patients. ICP decreased following these doses and threshold-subtracted CPP rose.

CONCLUSIONS:

In this retrospective, exploratory study, ICP did not increase following ketamine administration. In the setting of a guidelines-based protocol, ketamine was associated with a reduction in ICP during ICP crises. If these findings are reproduced in a larger study, ketamine may warrant consideration as a treatment for intracranial hypertension in children with severe TBI.
Impact of Elotuzumab Plus Pomalidomide/Dexamethasone on Health-related Quality of Life for Patients With Relapsed/Refractory Multiple Myeloma: Final Data From the Phase 2 ELOQUENT-3 Trial
Authors: Weisel Katja , Dimopoulos Meletios A. , San-Miguel Jesús , Paner Agne , Engelhardt Monika , Taylor Fiona , Lord-Bessen Jennifer , Yip Christine , Greenwood Mike , Tang Jackson , Cavo Michele
Published: February 2023

Triplet regimens containing immunomodulatory drugs and proteasome inhibitors (PIs) have improved outcomes and extended survival for patients with relapsed/refractory multiple myeloma (RRMM). We evaluated updated health-related quality of life (HRQoL) findings from the phase 2 ELOQUENT-3 clinical trial (NCT02654132) after 4 years of treatment with elotuzumab plus pomalidomide and dexamethasone (EPd) and assessed the impact of the addition of elotuzumab on patients’ HRQoL. HRQoL was assessed as an exploratory endpoint using the MD Anderson Symptom Inventory for Multiple Myeloma (MDASI-MM), which evaluates symptom severity, symptom interference, and HRQoL, and the 3-level EQ-5D, a patient-reported measure of health utility and general health. Statistical analyses included descriptive responder, longitudinal mixed-model, and time-to-first-deterioration (TTD) analyses using prespecified minimally important differences and responder definitions. Of 117 randomized patients, 106 (EPd, n = 55; pomalidomide and dexamethasone [Pd], n = 51) were eligible for inclusion in HRQoL analyses. Completion rates at almost all on-treatment visits were ≥80%. The proportion of patients treated with EPd who improved or maintained stable HRQoL until cycle 13 ranged from 82% to 96% for MDASI-MM total symptom score and 64% to 85% for MDASI-MM symptom interference. Across measurements, there were no clinically meaningful differences in changes from baseline between treatment arms, and TTD was not significantly different for EPd versus Pd. In conclusion, HRQoL was not impacted by the addition of elotuzumab to Pd and did not significantly deteriorate in patients with RRMM previously treated with lenalidomide and a PI in ELOQUENT-3.
Cystic lesions in giant intraventricular meningioma: Two case reports
Authors: Yu Hai , He Junhua , Yang Min
Published: February 2023

Rationale:

Giant meningioma stemming from the intraventricular zone has been reported to be extremely few. Two cases of supersize (>8 cm) intraventricular meningiomas presenting with cystic lesions and their clinical characteristics were collected in our study.

Patient concerns:

One patient was a 56-year-old man who was hospitalized for blunt headache and weakness of the right lower limb along with a defect of the right visual field for 12 months. The other patient is a 22-year-old lady who presented with a slight headache accompanied by right facial numbness for 1 week. None of them had a significant past medical history.

Diagnoses:

Computed tomography and magnetic resonance imaging of both patients revealed a giant heterogeneous, enhancing tumor mainly in the left trigonum with low-density or hypointense cystic lesions located within or around the tumor. The pathological and immunohistochemical staining indicated fibroblastic meningioma (case 1) and atypical meningioma (case 2) respectively, thus the patients’ diagnoses were confirmed.

Interventions:

Total microsurgical resection, including the cystic wall, was performed via a transcortical (transtemporoparietal occipital) approach in both patients, and a ventricular drainage tube was placed for 24 to 48 hours routinely after removed the tumor.

Outcomes:

Postoperatively, both patients recovered free from episodes of symptoms, and imaging examinations confirmed no evidence of regrowth of the meningioma during an average 24 months follow-up.

Lessons:

Cystic lesions may indicate the histopathologic malignancy of intraventricular meningioma. Transcortical approach through the posterior temporal lobe or the parieto-occipital lobe is an effective technology for giant intraventricular meningiomas.
The efficacy of pectoral nerve block for pain control after breast augmentation: A meta-analysis of randomized controlled studies
Authors: Liang Zanjiang , Xu Yang
Published: February 2023

Background:

The efficacy of pectoral nerve block for pain control remains unknown in patients undergoing breast augmentation. This meta-analysis aims to explore the analgesic efficacy of pectoral nerve block for breast augmentation.

Methods:

We systematically searched PubMed, Embase, Web of Science, EBSCO, and Cochrane library databases, and included randomized controlled trials reporting pectoral nerve block versus no block for breast augmentation.

Results:

Five randomized controlled trials were included in this meta-analysis. Compared with control group after breast augmentation, pectoral nerve block was associated with substantially reduced pain scores at 1 hour (standard mean difference [SMD] = −1.63; 95% confidence interval [CI] = −2.81 to −0.44; P = .007), maximal pain scores at 1 to 6 hours (SMD = −1.72; 95% CI = −2.75 to −0.69; P = .001) and 6 to 24 hours (SMD = −2.06; 95% CI = −3.40 to −0.72; P = .003), rescue analgesic (odd ratio = 0.17; 95% CI = 0.05–0.57; P = .004), nausea (SMD = 0.21; 95% CI = 0.08–0.54; P = .001), and vomiting (odd ratio = 0.15; 95% CI = 0.05–0.39; P = .0001).

Conclusions:

Pectoral nerve block benefits to alleviate pain intensity after breast augmentation.
Serum HMGB1 levels and its clinical significance in elderly patients with intertrochanteric fractures after intramedullary fixation surgery
Authors: Zhao Ling , Li Haoran , Zhang Shaohui , Dong Zhanyin , Cui Qing
Published: February 2023

Background:

Intramedullary fixation is a valuable alternative for the treatment of intertrochanteric fractures. However, further development of new biomarkers to predict the prognosis of the patient is still needed for timely and effective treatment and intervention. The present study aimed to explore the serum high-mobility group box 1 (HMGB1) levels in the prognosis of intertrochanteric fracture patients and its correlation with clinical results.

Methods:

The present prospective cohort study recruited 115 intertrochanteric fracture patients who were admitted from January 2015 to December 2019. All patients were evaluated preoperatively and treated (proximal femoral nail antirotation or intramedullary proximal femoral nail) by the same team. The serum HMGB1, interleukin-6, interleukin-1β, tumor necrosis factor α, and C-reactive protein levels were measured by enzyme-linked immunosorbent assay. Demographic and clinical data of all patients were collected. Harris score was used to assess the prognosis of intertrochanteric fracture patients after 6 months of treatment. Statistical analysis was conducted using SPSS software with P < .05 as statistically different.

Results:

The time of the operation and the amount of bleeding in intramedullary proximal femoral nail were remarkably elevated compared with the proximal femoral nail antirotation group (P < .05). The age, proportion of complications and visual analogue score VAS after 72 hours of surgery in the Harris score < 80 group were remarkably increased compared with Harris score ≥ 80 group (P < .05). In addition, we found that the serum HMGB1 levels in Harris score < 80 group were markedly elevated than the patients in Harris score ≥ 80 group at all time points (P < .05). The results showed that the serum HMGB1 levels at postoperative 48 hours had the highest predictive value for predicting poor prognosis in intertrochanteric fracture patients. It was found that HMGB1, age and VAS after 72 hours of surgery were the risk factors for poor prognosis of intertrochanteric fracture patients.

Conclusion:

This study showed that the serum HMGB1 levels was significantly decreased in intertrochanteric fracture patients with bad prognoses. This study may provide a new approach to screening intertrochanteric fracture patients with worse prognoses in advance.
Non-small cell lung cancer (NSCLC): A review of risk factors, diagnosis, and treatment
Authors: Alduais Yaser , Zhang Haijun , Fan Fan , Chen Jing , Chen Baoan
Published: February 2023

Lung cancer remains the leading cause of cancer deaths. Non-small cell lung cancer (NSCLC) is the most frequent subtype of lung cancer. Surgery, radiation, chemotherapy, immunotherapy, or molecularly targeted therapy is used to treat NSCLC. Nevertheless, many patients who accept surgery likely develop distant metastases or local recurrence. In recent years, targeted treatments and immunotherapy have achieved improvement at a breakneck pace. Therapy must be customized for each patient based on the specific medical condition, as well as other variables. It is critical to have an accurate NSCLC sub-classification for tailored treatment, according to the latest World Health Organization standards.
Effects of thoracic paravertebral nerve block on postoperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobectomy
Authors: Dongjie Qiu , Longbiao Zhao , Peng Liu , Li Jia , Hongmeng Xu , Zhiyan Chang , Long Yu
Published: February 2023

Objectives:

To evaluate the effects of ultrasound-guided thoracic paravertebral nerve block on perioperative pain and postoperative delirium in elderly patients undergoing thoracoscopic lobotomy.

Methods:

Patients aged 60 to 80 years who underwent the surgery of thoracoscopic lobectomy were selected; ASA grades I to III and New York Heart Association (NYHA) grades I to II. Patients were randomly divided into two groups: group C (group Compaired) and group T (group Thoracic Paravertebral Nerve Block TPVB). Patients in group T received ultrason-guided TPVB while those in group C didn’t received TPVB. Postoperative patient-controlled intravenous analgesia was administered to all the patients. The consumption of intraoperative opioids, cases of hipoxemia, operative time, and extubation time was also recorded. Pain scores (static and dynamic) were assessed at 2, 4, 6, 24, 48, 72, 96, and 120 hours point after the operation. Pain scores, occurrence of postoperative delirium occurrence, postoperative complications, total amount of analgesic drugs, length of hospital stay, rescue analgesic requirement, and side effects were recorded within 5 days.

Results:

Intraoperative dosages of sufentanil and remifentanil were significantly lower in group T (Table 1). The postoperative recovery time in group T was significantly shortened (Table 1). The VAS pain scores of group T at 2, 4, 6, and 24 hours after surgery were much lower. The consumption of intraoperative opioids, number of rescue analgesic requirements, and the occurrence of postoperative delirium incidence in group T was significantly reduced (Table 2). There were no differences in hipoxemia events, postoperative nausea, vomiting and pulmonary complications between the two groups (Table 2).

Conclusion:

Preoperative ultrasound-guided thoracic paravertebral nerve block (TPVB) can obviously decrease the intraoperative and postoperative opioids consumption, shorten the recovery time, reduce the number of rescue analgesia and the incidence of postoperative delirium in elderly patients undergoing thoracoscopic lobotomy.
Penetrating canaloplasty in angle-closure glaucoma secondary to iridocorneal endothelial syndrome following multiple failed filtering surgeries: A case report
Authors: Tian Xuelian , Guo Juan , Liao Jinying , He Meng , Shi Yinwen , Tang Li
Published: February 2023

Rationale:

Angle-closure glaucoma secondary to iridocorneal endothelial syndrome (ICE) is challenging to treat, especially in patients who have already undergone multiple surgical procedures. Long-term success is difficult to achieve with traditional filtration surgery again. This case report describes a novel nonbleb-dependent surgery for managing such a young patient.

Patient concerns:

A 30-year-old male with glaucoma secondary to ICE was referred to West China Hospital, Sichuan University for uncontrolled intraocular pressure following multiple failed filtering surgeries under maximum topical antiglaucoma medications in his right eye.

Diagnoses:

The patient was diagnosed with angle-closure glaucoma secondary to ICE in the right eye based on a series of ophthalmic examinations.

Interventions:

Penetrating canaloplasty was performed to manage glaucoma secondary to ICE in the right eye.

Outcomes:

The patient’s visual acuity improved, the intraocular pressure was reduced to 11 to 15 mm Hg through 30 months of follow-up, and no antiglaucoma medication or additional surgical procedures were needed.

Lessons:

Penetrating canaloplasty could be considered as an option for the treatment of refractory angle-closure glaucoma secondary to ICE with extensive angle adhesion.
Endometrioid adenofibroma of ovary: A case report and review of literature
Authors: Tong Hai-Chao , Li Ying-Chun , Li Le-Yao , Xu Hong-Tao , Ma Shuang , Zhang Wan-Lin , Wildes Tyler , Yang Lian-He , Wang Endi
Published: February 2023

Rationale:

Endometrioid adenofibroma is a benign epithelial neoplasm of the ovary, most of which are often unilateral. The symptoms of endometrioid adenofibroma are often nonspecific and misleading. Therefore, a full understanding of the characteristics, diagnosis, and treatment methods of this disease is of great importance. In this study, we report a 34-year-old woman who was found with an unidentified mass on the right ovary during the physical examination 3 years ago with nosymptoms or signs.

Patient concerns:

A 34-year-old Chinese female was found with an unidentified 6 cm mass on the right ovary for 3 years that presented with no symptoms or signs.

Diagnosis:

Pelvic ultrasound revealed a 6 cm cystic solid mixed mass on the right ovary. Through histological and immunohistochemical examinations, the tumor mass was finally diagnosed as endometrioid adenofibroma of ovary.

Interventions:

To confirm the diagnosis, the ovarian tumor was laparoscopically resected.

Outcomes:

The patient returned to hospital after 3 months with no recurrence or postoperative complications.

Lessons:

Endometrioid adenofibroma is a benign epithelial neoplasm of the ovary. Complete surgical resection is required and rare cases can recur. Postsurgical pathologic and immunohistochemical testing can confirm a diagnosis of endometrioid adenofibroma. It is important to understand of the key points of differential diagnosis of the disease due to the different prognosis and clinical treatment.
Postoperative delirium, neuroinflammation, and influencing factors of postoperative delirium: A review
Authors: Xiao M. Z. , Liu C. X. , Zhou L. G. , Yang Y. , Wang Y.
Published: February 2023

Postoperative delirium (POD) is an acute cognitive dysfunction that is mainly characterized by memory impairment and disturbances in consciousness. POD can prolong the hospital stay and increase the 1-month mortality rate of patients. The overall incidence of POD is approximately 23%, and its prevalence can go up to 50% in high-risk surgeries. Neuroinflammation is an important pathogenic mechanism of POD that mediates microglial activation and leads to synaptic remodeling. Neuroinflammation, as an indispensable pathogenesis of POD, can occur due to a variety of factors, including aseptic inflammation caused by surgery, effects of anesthetic drugs, disruption of the blood-brain barrier, and epigenetics. Understanding these factors and avoiding the occurrence of risk factors may help prevent POD in time. This review provides a brief overview of POD and neuroinflammation and summarizes various factors affecting POD development mediated by neuroinflammation, which may serve as future targets for the prevention and treatment of POD.
Surgery for rare adenosquamous carcinoma of the scrotum: A case report and literature review
Authors: Sun Yexiao , Miao Xihong , Wang Lei , Zhang Yanfeng , Shen Zhihua
Published: February 2023

Rationale:

Adenosquamous carcinoma of the scrotum is a rare cancer associated with poor prognosis. It is diagnosed through the presence of both adenocarcinoma and squamous cell carcinoma.

Patient concerns:

It may be difficult to diagnose at early stages and may have poor survival.

Diagnoses:

We report a case of adenosquamous carcinoma of the scrotum in a 58-year-old male patient who presented with left scrotal mass for >1 year.

Interventions:

This is the first case in the literature of primary adenosquamous carcinoma of the scrotum managed successfully with surgery and post-surgery chemotherapy and radiotherapy.

Outcomes:

The patient remained disease-free for 10 months postoperatively.

Lessons:

The surgery treatment combined with postoperative radiotherapy and chemotherapy can improve the survival of adenosquamous carcinoma.