bluuebunny/crossref_metadata_2025 huggingface dataset:
Mining previous acoustic surveys to improve walleye pollock (Gadus chalcogrammus) target strength estimates
Authors: Lauffenburger N , De Robertis A , Williams K
Published: June 2023

Acoustic-trawl surveys are widely used to measure the abundance and distribution of pelagic fish. The echo integration method used in these surveys requires estimates of the target strength (TS, dB re 1 m2) of acoustic scatterers. Here, we present a new automated method to estimate TS from a large volume of previously collected acoustic survey data recorded near trawl sites. By applying a series of selection and filtering methods to echosounder data, single echo measurements representative of fish encountered during surveys can be objectively and reliably isolated from existing survey data. We applied this method to 30 surveys of walleye pollock (Gadus chalcogrammus) conducted in Alaska from 2007 to 2019 and estimated a new length-to-TS relationship. The resulting relationship ($TS = 20.0 \cdot {\log _{10}}\,L - 66.0$) was largely consistent with previous in situ estimates made during dedicated, mostly nighttime TS collection events. Analysis of this sizeable data set (n = 142) indicates that increased fish depth, lower ambient temperature, and summer months may increase pollock TS. The application of a new TS model incorporating these environmental covariates to historic surveys resulted in -16 to +21% changes in abundance relative to the model without environmental covariates. This study indicates that useful TS measurements can be uncovered from existing datasets.
A simulation study on the bias and wavelength dependence of luminescent coupling in top-limited multi-junction solar cells
Authors: He Wan , Chen Benyuan , Lv Qinghua , Lv Hui
Published: June 2023

Luminescent coupling in a top-limited multi-junction solar cell was investigated by employing a 3D circuit model and semiconductor physics. The calculation methods for computing both electro-luminescent and photo-luminescent coupling efficiencies were introduced. Since the calculation processes were circuit independent, they can be applied directly to any form of an equivalent circuit model of a solar cell. Moreover, an external approach to counteract the luminescent coupling effect was provided, and the luminescent coupling process in a top-limited solar cell was illustrated. Finally, the bias and wavelength dependence of luminescent coupling efficiency was applied to the 3D circuit model, and the simulation results were consistent with the measured data.
Adverbs Related to ‘Year’ in Semitic
Authors: Rubin Aaron D
Published: June 2023

In addition to the various nouns meaning ‘year’ attested in the Semitic languages, there exist numerous unique adverbs with reference to years past, present and future. That is to say, besides transparent noun phrases with an adverbial function—phrases that are parallel or similar to English ‘this year’, ‘last year’ and ‘next year’—we also find a number of lexical adverbs with these meanings. This article examines these various adverbs or adverbial phrases in the diverse Semitic languages, both ancient and modern, coming from a variety of semantic developments, some of which are typologically unusual.
An Enigmatic Aramaic-Hebrew-Greek Glossary of The Jerusalem Talmud
Authors: Cherlow Elyashiv
Published: June 2023

This article deals with one manuscript of the Jerusalem Talmud, Tractate Shabbat, discovered in the Cairo Genizah (שבתא in Ginzei Yerushlami). About 30 notes were identified in the margins of this volume, written in Hebrew and Greek. Researchers have considered these notes but have not yet understand their content. This is largely because of their unusual form of writing: the Hebrew notes were written from left to right, while the Greek ones—in most cases—were written from right to left. This paper shows that the notes are interpretive glosses that translate rare words written in the Talmudic text.
Pseudo-Bayesian Small-Area Estimation
Authors: Datta Gauri , Lee Juhyung , Li Jiacheng
Published: June 2023

In sample surveys, a subpopulation is referred to as a “small area” or “small domain” if it does not have a large enough sample that alone will yield an adequately accurate estimate of a characteristic. In small-area estimation, the sample size from various subpopulations is often too small to accurately estimate its mean, and so one borrows strength from similar subpopulations through an appropriate model based on relevant covariates. The empirical best linear unbiased prediction (EBLUP) method has been the dominant frequentist model-based approach in small-area estimation. This method relies on estimation of model parameters based on the marginal distribution of the data. As an alternative to this method, the observed best prediction (OBP) method estimates the parameters by minimizing an objective function that is implied by the total mean squared prediction error. We use this objective function in the Fay–Herriot model to construct a pseudo-posterior distribution for the model parameters under nearly noninformative priors for them. Data analysis and simulation show that the pseudo-Bayesian estimators (PBEs) compete favorably with the OBPs and EBLUPs. The PBE estimates are robust to mean misspecification and have good frequentist properties. Being Bayesian by construction, they automatically avoid negative estimates of standard errors, enjoy a dual justification, and provide an attractive alternative to practitioners.
Elie Wiesel and a Legacy of (Post-)Witnessing
Authors: Zühlke Christin
Published: June 2023

This article explores how the relationship between a victim/survivor in a Shoah testimony and the audience (e.g., the listener, reader, or scholar) is shaped by the account, and inquires how the relationships may evolve when there are no survivors left. I argue that survivor testimonies pass the role of witness to the audience, thus intertwining the processes of witnessing (i.e., experienced by a victim or survivor) and post-witnessing (i.e., experienced through testimonies or other first-person accounts)—especially in the case of scholars. This study uses the survivor Elie Wiesel’s work as a case study to demonstrate that the role of a witness can become a transferable legacy. To examine this topic, I draw on current post-witnessing theories, Affect Theory, a hermeneutic approach to Wiesel’s testimony, and a particularly evocative passage by Primo Levi that depicts gazing on someone which inflicts shame in the one looking.
Galaxy cluster rotation revealed in the MACSIS simulations with the kinetic Sunyaev–Zeldovich effect
Authors: Altamura Edoardo , Kay Scott T , Chluba Jens , Towler Imogen
Published: June 2023

The kinetic Sunyaev–Zeldovich (kSZ) effect has now become a clear target for ongoing and future studies of the cosmic microwave background (CMB) and cosmology. Aside from the bulk cluster motion, internal motions also lead to a kSZ signal. In this work, we study the rotational kSZ effect caused by coherent large-scale motions of the cluster medium using cluster hydrodynamic cosmological simulations. To utilize the rotational kSZ as a cosmological probe, simulations offer some of the most comprehensive data sets that can inform the modelling of this signal. In this work, we use the MACSIS data set to investigate the rotational kSZ effect in massive clusters specifically. Based on these models, we test stacking approaches and estimate the amplitude of the combined signal with varying mass, dynamical state, redshift, and map-alignment geometry. We find that the dark matter, galaxy and gas spins are generally misaligned, an effect that can cause a suboptimal estimation of the rotational kSZ effect when based on galaxy motions. Furthermore, we provide halo-spin–mass scaling relations that can be used to build a statistical model of the rotational kSZ. The rotational kSZ contribution, which is largest in massive unrelaxed clusters (≳100 $\mu$K), could be relevant to studies of higher order CMB temperature signals, such as the moving lens effect. The limited mass range of the MACSIS sample strongly motivates an extended investigation of the rotational kSZ effect in large-volume simulations to refine the modelling, particularly towards lower mass and higher redshift, and provide forecasts for upcoming cosmological CMB experiments (e.g. Simons Observatory, SKA-2) and X-ray observations (e.g. Athena/X-IFU).
#3430 MORTALITY AND RISK FACTORS IN VERY ELDERLY PATIENTS WHO START HAEMODIALYSIS: KOREAN RENAL DATA SYSTEM (KORDS), 2016-2020
Authors: Park Ji Hyeon , Cho Ajin , 김 현경
Published: June 2023

Background and Aims

The number of elderly patients with end-stage renal disease (ESRD) is increasing worldwide. However, decision-making about elderly patients with ESRD remains complex because of the lack of studies, especially in very elderly patients (≥75 years). We examined the characteristics of very elderly patients starting haemodialysis (HD) and the associated mortality and prognostic factors.

Method

Data were analysed retrospectively using a nationwide cohort registry, the Korean Renal Data System. Patients who started HD between January 2016 and December 2020 were included and divided into three groups according to age at HD initiation (<65, 65–74, and ≥75 years). The primary outcome was all-cause mortality during the study period. Risk factors for mortality were analysed using Cox proportional hazard models.

Results

In total, 22,024 incident patients were included with 10,006, 5,668, and 6,350 in each group (<65, 65–74, and ≥75 years, respectively). Among the very elderly group, women had a higher cumulative survival rate than men (91.2% vs. 90.3% at 1 year and 56.4% vs. 51.9% at 3 years, respectively) (Figure 1a). The survival rate was lower in patients with vascular access via a catheter than in those with an arteriovenous fistula or graft (72.0% vs. 95.1% at 1 year and 23.8% vs. 60.7% at 3 years, respectively) (Figure 1b). Very elderly patients with more comorbid diseases had a significantly lower survival rate that those with fewer comorbidities (log-rank: p < 0.001) (Figure 2).

Conclusion

Preparation of an arteriovenous fistula or graft when starting HD should be considered in very elderly patients with fewer comorbid diseases.
Thrombopoietin Receptor Agonists for Thrombocytopenia Secondary to HER2-Targeted Antibody Drug Conjugates
Authors: Rainone Michael , Kasparian Saro , Nguyen Tina , Talwar Neel , Yuan Yuan , Mei Matthew , Mortimer Joanne E , Waisman James R , Patel Niki , Pullarkat Vinod
Published: June 2023

Trastuzumab emtansine and trastuzumab deruxtecan are widely used in breast cancer and other solid tumor malignancies. Thrombocytopenia is a common adverse event associated with the use of these agents that can lead to a treatment delay, reduction in dose intensity, and discontinuation. The role of thrombopoietin receptor agonists (TPO-RA) remains unknown in this setting. We report a case series of 6 individuals with breast cancer that experienced dose-reductions and therapy delays due to thrombocytopenia secondary to trastuzumab emtansine or trastuzumab deruxtecan therapy and received intervention with TPO-RA. All 6 were able to resume therapy with TPO-RA support.
An anthropomorphic body phantom for the determination of calibration factor in radionuclide treatment dosimetry
Authors: Kovan Bilal , Demir Bayram , Işık Emine Göknur , Has Şimşek Duygu , Özkan Zeynep Gözde , Kuyumcu Sekan , Türkmen Cüneyt , Şanlı Yasemin
Published: June 2023

The aim of this study is to create an inhomogeneous human-like phantom, whose attenuation and scattering effects are similar to the human body, as an alternative to the homogeneous phantoms traditionally used in calibration factor (CF) determination. The phantom was designed to include the thorax, abdomen and upper pelvis regions sized to represent a 75-kg male with a body mass index of 25. Measurements using Lu-177 with 50- and 100-mL lesion volumes were performed using inhomogeneous anthropomorphic body phantom (ABP) and homogeneous NEMA PET body phantom. There was a difference of 5.7% of Calibration Factor including attenuation and scatter effect between ABP and NEMA PET body phantom. Because it better reflects the attenuation and scatter effect, it is recommended to use a human-like inhomogeneous phantom for determination of CF instead of a homogeneous phantom.
North–South research funding dynamics of collaborative projects: researchers’ appropriation strategies of agencies’ project frameworks
Authors: Alom Bartrolí Montserrat
Published: June 2023

North–South research funding dynamics have been progressively marked by the rise of project-based funding responding to agencies’ predefined research topics. Still, Southern researchers’ behaviour to cope with Northern agencies’ project frameworks remains an understudied question. This article addresses this gap by examining Southern applicants’ practices when preparing proposals for collaborative research for development projects in the social sciences, in particular their strategies to appropriate Northern donors’ frameworks. Findings single out that the appropriation process leads to the co-creation of a new cognitive framework accommodating both researchers’ and funders’ interests expressed in different agendas. This article also contributes to shedding light on Southern researchers’ active role in the face of asymmetric relationships. Finally, findings inform research management about the importance of defining relatively large frameworks that include applicants’ knowledge, competences, and contextual features to enhance local relevance while contributing to the policy debate on project-based funding impact on contemporary research.
Resolving Marine–Freshwater Transitions by Diatoms Through a Fog of Gene Tree Discordance
Authors: Roberts Wade R , Ruck Elizabeth C , Downey Kala M , Pinseel Eveline , Alverson Andrew J
Published: June 2023

Despite the obstacles facing marine colonists, most lineages of aquatic organisms have colonized and diversified in freshwaters repeatedly. These transitions can trigger rapid morphological or physiological change and, on longer timescales, lead to increased rates of speciation and extinction. Diatoms are a lineage of ancestrally marine microalgae that have diversified throughout freshwater habitats worldwide. We generated a phylogenomic data set of genomes and transcriptomes for 59 diatom taxa to resolve freshwater transitions in one lineage, the Thalassiosirales. Although most parts of the species tree were consistently resolved with strong support, we had difficulties resolving a Paleocene radiation, which affected the placement of one freshwater lineage. This and other parts of the tree were characterized by high levels of gene tree discordance caused by incomplete lineage sorting and low phylogenetic signal. Despite differences in species trees inferred from concatenation versus summary methods and codons versus amino acids, traditional methods of ancestral state reconstruction supported six transitions into freshwaters, two of which led to subsequent species diversification. Evidence from gene trees, protein alignments, and diatom life history together suggest that habitat transitions were largely the product of homoplasy rather than hemiplasy, a condition where transitions occur on branches in gene trees not shared with the species tree. Nevertheless, we identified a set of putatively hemiplasious genes, many of which have been associated with shifts to low salinity, indicating that hemiplasy played a small but potentially important role in freshwater adaptation. Accounting for differences in evolutionary outcomes, in which some taxa became locked into freshwaters while others were able to return to the ocean or become salinity generalists, might help further distinguish different sources of adaptive mutation in freshwater diatoms.
Environmental and Edaphic Factors that Influence Spring Dead Spot Epidemics
Authors: Hutchens W. J. , Henderson C. A. , Straw C. M. , Goatley J. M. , Kerns J. P. , Nita M. , Sullivan D. , McCall D. S.
Published: June 2023

Spring dead spot (SDS) ( Ophiosphaerella spp.) is a soilborne disease of warm-season turfgrasses grown where winter dormancy occurs. The edaphic factors that influence where SDS epidemics occur are not well defined. A study was conducted during the spring of 2020 and repeated in the spring of 2021 on four ‘TifSport’ hybrid bermudagrass ( Cynodon dactylon × transvaalensis) golf course fairways expressing SDS symptoms in Cape Charles, VA, U.S.A. SDS within each fairway was mapped from aerial imagery collected in the spring of 2019 with a 20 MP CMOS 4k true color sensor mounted on a DJI Phantom 4 Pro drone. Three disease intensity zones were designated from the maps (low, moderate, high) based on the density of SDS patches in an area. Disease incidence and severity, soil samples, surface firmness, thatch depth, and organic matter measurements were taken from 10 plots within each disease intensity zone from each of the four fairways ( n = 120). Multivariate pairwise correlation analyses ( P < 0.1) and best subset stepwise regression analyses were conducted to determine which edaphic factors most influenced the SDS epidemic within each fairway and each year. Edaphic factors that correlated with an increase in SDS or were selected for the best fitting model varied across holes and years. However, in certain cases, soil pH and thatch depth were predictors for an increase in SDS. No factors were consistently associated with SDS occurrence, but results from this foundational study of SDS epidemics can guide future research to relate edaphic factors to SDS disease development.
What’s New in Pediatric Septic Arthritis? A Review of Pertinent Clinical Questions
Authors: Hachem Ahmad , Copley Lawson A.B.
Published: June 2023

Background:

The evaluation and treatment of children with septic arthritis (SA) is challenging and requires an organized approach to address the spectrum of pathogens which appear to aggregate in age-specific groups. Although evidence-based guidelines have recently been published for the evaluation and treatment of children with acute hematogenous osteomyelitis, there is a relative dearth of literature devoted exclusively to SA.

Methods:

Recently published guidance for the evaluation and treatment of children with SA was reviewed and evaluated with respect to pertinent clinical questions to summarize what is new in this area of practice for pediatric orthopaedic surgeons.

Results:

Evidence suggests that there is a profound difference between children with primary SA and those who have contiguous osteomyelitis. This disruption of the commonly accepted paradigm of a continuum of osteoarticular infections has important implications in the evaluation and treatment of children with primary SA. Clinical prediction algorithms have been established to help determine the applicability of magnetic resonance imaging during the evaluation of children suspected to have SA. Antibiotic duration for SA has been recently studied with some evidence in favor of short-course parenteral followed by short-course oral therapy may be successful if the pathogen is not methicillin-resistant Staphylococcus aureus.

Conclusion:

Recent studies of children with SA have provided better guidance for evaluation and treatment to improve diagnostic accuracy, processes of evaluation, and clinical outcomes.

Level of Evidence:

Level 4.
Trend in Clinical Trial Participation During COVID-19: A Secondary Analysis of the I-SPY COVID Clinical Trial
Authors: Yang Philip , Dickert Neal W. , Haczku Angela , Spainhour Christine , Auld Sara C. ,   the I-SPY COVID Consortium
Published: June 2023

OBJECTIVES:

To analyze the temporal trend in enrollment rates in a COVID-19 platform trial during the first three waves of the pandemic in the United States.

DESIGN:

Secondary analysis of data from the I-SPY COVID randomized controlled trial (RCT).

SETTING:

Thirty-one hospitals throughout the United States.

PATIENTS:

Patients who were approached, either directly or via a legally authorized representative, for consent and enrollment into the I-SPY COVID RCT.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Among 1,338 patients approached for the I-SPY COVID trial from July 30, 2020, to February 17, 2022, the number of patients who enrolled (n = 1,063) versus declined participation (n = 275) was used to calculate monthly enrollment rates. Overall, demographic and baseline clinical characteristics were similar between those who enrolled versus declined. Enrollment rates fluctuated over the course of the COVID-19 pandemic, but there were no significant trends over time (Mann-Kendall test, p = 0.21). Enrollment rates were also comparable between vaccinated and unvaccinated patients. In multivariable logistic regression analysis, age, sex, region of residence, COVID-19 severity of illness, and vaccination status were not significantly associated with the decision to decline consent.

CONCLUSIONS:

In this secondary analysis of the I-SPY COVID clinical trial, there was no significant association between the enrollment rate and time period or vaccination status among all eligible patients approached for clinical trial participation. Additional studies are needed to better understand whether the COVID-19 pandemic has altered clinical trial participation and to develop strategies for encouraging participation in future COVID-19 and critical care clinical trials.
Muscle Ultrasound Changes and Physical Function of Critically Ill Children: A Comparison of Rectus Femoris Cross-Sectional Area and Quadriceps Thickness Measurements
Authors: Ong Chengsi , Lee Jan Hau , Leow Melvin K. S. , Puthucheary Zudin A.
Published: June 2023

IMPORTANCE:

Quadriceps thickness (QT) and rectus femoris cross-sectional area (RFCSA) are both used to evaluate muscle changes in critically ill children. However, their correlation and association with physical function has not been compared.

OBJECTIVES:

To compare QT with RFCSA changes, and their association with physical function in critically ill children.

DESIGN, SETTING, AND PARTICIPANTS:

Secondary analysis of a prospective cohort study of children 0–18 years old admitted to a tertiary mixed PICU between January 2015 and October 2018 with PICU stay greater than 48 hours and greater than or equal to one organ dysfunction.

MAIN OUTCOMES AND MEASURES:

Ultrasound QT and RFCSA were measured at PICU admission, PICU discharge, hospital discharge, and 6 months post-discharge. QT and RFCSA changes from baseline were compared with each other and with change in motor function, physical ability, and physical health-related quality of life (HRQOL).

RESULTS:

Two hundred thirty-seven images from 66 subjects were analyzed. RFCSA change was not significantly different from QT change at PICU (–8.07% [interquartile range (IQR), –17.11% to 4.80%] vs –4.55% [IQR, –14.32% to 4.35%]; p = 0.927) or hospital discharge (–5.62% [IQR, –15.00% to 9.42%] vs –8.81% [IQR, –18.67% to 2.39%]; p = 0.238) but was significantly greater than QT change at 6 months (32.7% [IQR, 5.74–109.76%] vs 9.66% [IQR, –8.17% to 25.70%]; p < 0.001). Motor function change at PICU discharge was significantly associated with RFCSA change (adjusted β coefficient, 0.02 [95% CI, 0.01–0.03]; p = 0.013) but not QT change (adjusted β coefficient, –0.01 [95% CI, –0.02 to 0.01]; p = 0.415). Similar results were observed for physical HRQOL changes at hospital discharge (adjusted β coefficient for RFCSA change, 0.51 [95% CI, 0.10–0.92]; p = 0.017 and adjusted β coefficient for QT change, –0.21 [–0.76 to 0.35]; p = 0.458). Physical ability was not significantly associated with RFCSA or QT changes at 6 months post-discharge.

CONCLUSIONS AND RELEVANCE:

Ultrasound derived RFCSA is associated with PICU motor function and hospital discharge physical HRQOL changes, unlike QT, and may be more useful for in-hospital muscle monitoring in critically ill children.
Diabetes mellitus and adverse outcomes after carotid endarterectomy: A systematic review and meta-analysis
Authors: Li Fengshi , Zhang Rui , Di Xiao , Niu Shuai , Rong Zhihua , Liu Changwei , Ni Leng
Published: June 2023

Background:

There is still uncertainty regarding whether diabetes mellitus (DM) can adversely affect patients undergoing carotid endarterectomy (CEA) for carotid stenosis. The aim of the study was to assess the adverse impact of DM on patients with carotid stenosis treated by CEA.

Methods:

Eligible studies published between 1 January 2000 and 30 March 2023 were selected from the PubMed, EMBASE, Web of Science, CENTRAL, and ClinicalTrials databases. The short-term and long-term outcomes of major adverse events (MAEs), death, stroke, the composite outcomes of death/stroke, and myocardial infarction (MI) were collected to calculate the pooled effect sizes (ESs), 95% confidence intervals (CIs), and prevalence of adverse outcomes. Subgroup analysis by asymptomatic/symptomatic carotid stenosis and insulin/noninsulin-dependent DM was performed.

Results:

A total of 19 studies (n = 122,003) were included. Regarding the short-term outcomes, DM was associated with increased risks of MAEs (ES = 1.52, 95% CI: [1.15–2.01], prevalence = 5.1%), death/stroke (ES = 1.61, 95% CI: [1.13–2.28], prevalence = 2.3%), stroke (ES = 1.55, 95% CI: [1.16–1.55], prevalence = 3.5%), death (ES = 1.70, 95% CI: [1.25–2.31], prevalence =1.2%), and MI (ES = 1.52, 95% CI: [1.15–2.01], prevalence = 1.4%). DM was associated with increased risks of long-term MAEs (ES = 1.24, 95% CI: [1.04–1.49], prevalence = 12.2%). In the subgroup analysis, DM was associated with an increased risk of short-term MAEs, death/stroke, stroke, and MI in asymptomatic patients undergoing CEA and with only short-term MAEs in the symptomatic patients. Both insulin- and noninsulin-dependent DM patients had an increased risk of short-term and long-term MAEs, and insulin-dependent DM was also associated with the short-term risk of death/stroke, death, and MI.

Conclusions:

In patients with carotid stenosis treated by CEA, DM is associated with short-term and long-term MAEs. DM may have a greater impact on adverse outcomes in asymptomatic patients after CEA. Insulin-dependent DM may have a more significant impact on post-CEA adverse outcomes than noninsulin-dependent DM. Whether DM management could reduce the risk of adverse outcomes after CEA requires further investigation.
Risk of prolonged sedation with the use of chlordiazepoxide in alcohol withdrawal treatment
Authors: Reiter Nanna , Andersen Charlotte U. , Thomsen Karen L. , Wamberg Christian A. , Petersen Tonny S. , Dalhoff Kim
Published: June 2023

The use of chlordiazepoxide in the treatment of alcohol withdrawal symptoms poses a risk of prolonged sedation with the need of weeks lasting antidote treatment, and extended hospitalization due to active metabolites with very long half-lives.

We present four case stories to elucidate this issue. One patient received 800 mg chlordiazepoxide and was treated with flumazenil for 42 days. Another patient was treated with 100 mg chlordiazepoxide. 5 days after administration of chlordiazepoxide, concentrations of chlordiazepoxide and its active metabolite demoxepam, were within therapeutic range, the patient was treated with flumazenil for 6 days. He died after palliative care.

The great individual variation in the clinical effect of chlordiazepoxide depends on the activity of the CYP P450 system, especially CYP3A4/A5 and CYPS2C19, which can be impaired in cirrhotic and elderly patients.
Long-term Results of the Treatment of Scapholunate Instability with Dynamic Extensor Carpi Radialis Brevis Tenodesis
Authors: Nienstedt Frank , Huber Stefan , Mariacher Markus , Vorhauser Erika , Berger Wilhelm
Published: June 2023

Background:

Scapholunate dissociation is the most common form of carpal instability. This retrospective case series aimed to assess long-term results obtained by treating scapholunate instability with dynamic tenodesis using the entire extensor carpi radialis brevis tendon, which is detached from the base of the third metacarpal, rerouted in the third extensor compartment, and fixed at the distal portion of the scaphoid to maintain reduced rotatory subluxation.

Methods:

Nine patients with scapholunate instability were treated. We reviewed eight patients with a mean follow-up of 12 years. One subgroup of four patients was affected by static scapholunate instability, and the other by dynamic scapholunate instability. Disability of the Arm, Shoulder, and Hand score, Patient Rated Wrist Evaluation score, modified Mayo score, and radiographs were used to determine functional and anatomical outcomes.

Results:

Excellent functional results did not correlate with radiological outcome in patients with static scapholunate instability. In this subgroup, scapholunate angle and gap and radiolunate angle improved in average but remained in the pathologic range. In only one of these patients, osteoarthritis was observed. In the subgroup of patients affected by dynamic instability, very good functional outcomes correlate with radiological results, except in one patient who developed arthritic changes.

Conclusions:

Dynamic tethering of the scaphoid with the extensor carpi radialis brevis tendon might be indicated in the treatment not only in patients affected by dynamic scapholunate instability but also in patients with static instability. Prospective studies with a larger number of patients are required to evaluate this method.
Plastic Surgery Training: Trends in Hand Surgery Fellowship in the Setting of a Pandemic
Authors: Tuaño Krystle R. , Fisher Marlie H. , Woodall Jhade , Iorio Matthew L.
Published: June 2023

Background:

Given the diminishing presence of hand surgeons trained in plastic surgery, we evaluated the associated trends in annual hand meeting educational content and postgraduate job offerings, and analyzed the effect of the coronavirus disease 2019 (COVID-19) pandemic on trainees in hand surgery.

Methods:

Hand meeting registration and educational content were analyzed over the past 10 years. Current hand surgery job offerings were evaluated for training requirements, and the annual rates of subspecialty certificate in surgery of the hand board certifications were compared across training backgrounds.

Results:

Top categories of annual meeting educational content were “bone/joint,” “other,” and “professional development.” A majority of American Society for Surgery of the Hand presidents had training backgrounds in orthopedics (55%), followed by plastics (23%) and general surgery (22%). The job offerings on the American Society for Surgery of the Hand and Association for Surgery of the Hand websites specified more training requirements in orthopedics than in plastics. Additionally, there were two to three times as many examinees taking the surgery of the hand examination from orthopedic surgery compared with plastics, with an overall higher pass rate. Hand fellowship programs were also predominantly offered for orthopedic surgery (80.8%).

Conclusions:

Optimization of training, society membership, and clinical practice profiles may increase the presence of plastic surgery–trained hand surgeons. The extent of the economic impact of the COVID-19 pandemic is yet to be fully determined, but our analysis suggests that a lucrative market for reconstructive/hand surgery may exist in the face of economic downturn.
Vertical Rectus Abdominis Myocutaneous Flap for Reconstruction of Forequarter Amputation Defect after Shoulder Soft Tissue Sarcoma Resection: Technical Consideration
Authors: Wahyudi Muhammad , Satria Oryza , Aprilya Dina , Nong Ira
Published: June 2023

Forequarter amputations in advanced local malignancy or trauma cases often leave a large defect that is challenging to reconstruct. Options for defect closure are varied. A vertical rectus abdominis myocutaneous (VRAM) flap could be an alternative to close a significantly large defect, which is relatively easier than the more technically demanding free flap. This case presents a 64-year-old man with a soft tissue sarcoma in the left shoulder that was treated by forequarter amputation and subsequent defect closure using a VRAM flap. The VRAM flap was initially used to reconstruct the chest and abdominal walls. There have been no reported uses for the shoulder defect. The repair site defect was viable even with a less aesthetic donor site, and all of the defects were closed without any signs of infection. The VRAM flap is a good option for a large defect closure at the shoulder region, particularly after forequarter amputation.
Estimated glomerular filtration rate-dip after medical target therapy associated with increased mortality and cardiovascular events in patients with primary aldosteronism
Authors: Sheu Jia-Yuh , Wang Shuo-Meng , Wu Vin-Cent , Huang Kuo-How , Tseng Chi-Shin , Lee Yuan-Ju , Tsai Yao-Chou , Lin Yen-Hung , Chueh Jeff S.
Published: June 2023

Objectives:

The correlation of the changes of estimated glomerular filtration rate (eGFR) with long-term cardiovascular complications in patients with primary aldosteronism (PA) following mineralocorticoid receptor antagonists (MRA) treatment remains ambiguous. This prospective study aims to determine factors associated with all-cause mortality and de novo cardiovascular events of PA patients against the eGFR-dip.

Methods:

A total of 208 newly diagnosed PA patients were enrolled from January 2017 to January 2019. MRA was administered with at least a 6-month follow-up. The ‘eGFR-dip’ was defined as the difference between eGFR at 6 months after MRA treatment and respective baseline eGFR divided by the baseline eGFR.

Results:

After a mean 5.7 years follow-up, an eGFR-dip more than 12%, which was detected in 99 (47.6%) of the 208 patients, was a significant independent risk factor predicting composite outcomes (all-cause mortality, de-novo three-point major adverse cardiovascular events, and/or congestive heart failure). Multivariable logistic regression showed that age [odds ratio (OR), 0.94; P = 0.003], pretreatment plasma aldosterone concentration (PAC; OR, 0.98; P = 0.004), and initial eGFR (OR, 0.97; P < 0.001) had a positive linkage with the eGFR-dip more than 12%.

Conclusions:

Nearly half of PA patients had an eGFR-dip more than 12% after 6 months of MRA treatment. They had a higher incidence of all-cause mortality and de novo cardiovascular events. Elder age, higher pretreatment PAC, or higher initial eGFR could be associated with an elevated risk of an eGFR-dip more than 12%.
Complementary and Alternative Medicine Usage and Quality of Life in Patients With Renal Colic Attack
Authors: Şahin Akboğa Özlem , Günaydın Yurdagül , Caniklioğlu Mehmet , Gürtan Emin , Işıkay Levent
Published: June 2023

Decreased quality of life is observed in individuals who fear surgery or experience severe symptoms due to urinary system stone disease (USSD). As a result, some patients seek complementary and alternative medicine (CAM) methods. This research evaluates preoperative CAM usage and its effects on quality of life for patients who experience renal colic (RC) due to USSD. The research was conducted between April 2020 and 2021 in the application and research center of a university. One hundred ten patients who were scheduled to have surgery due to USSD were included in the study. The data were collected using the “personal information form,” “Use of CAM Methods of Individuals,” and 36-item Short-Form Health Survey (SF-36) forms. Of research participants, 47.3% reported using at least one CAM method. The most common methods were exercise combined with phytotherapy (16.4%) and dietary supplements (15.5%). The proportion of participants who reported using 1 or multiple CAM methods for pain was 48.1%. The Social Functioning scores obtained from the SF-36 of the CAM users were statistically significant. For the participants who used a CAM method, the average Role-Emotional score obtained from the SF-36 was statistically significant. Health professionals should know which CAM methods patients may prefer and to what extent various CAM methods affect quality of life. More studies are needed to identify factors affecting the use of CAM methods in patients with RC attacks and to understand the relationship between CAM method(s) and quality of life.
Tenofovir vs entecavir on the prognosis of hepatitis B-Related hepatocellular carcinoma after surgical resection: a randomised controlled trial
Authors: Linye He , Zijing Xia , Xiaoyun Zhang , Zhihui Li , Tianfu Wen , Chuan Li
Published: June 2023

Background:

Nucleot(s)ide analog treatment (entecavir (ETV) and tenofovir (TDF)) is reported to be associated with decreased tumor recurrence and death in HBV-related hepatocellular carcinoma (HCC) patients, yet further work is needed to evaluate the different efficacies of these two agents on the prognosis of early-stage HBV-related HCC patients after curative liver resection.

Material and methods:

From July 2017 to January 2019, 148 patients with HBV-related HCC who underwent curative liver resection were randomized to receive TDF (n=74) or ETV (n=74) therapy. The primary end point was tumor recurrence in the intention-to-treat (ITT) population. Overall survival (OS) and tumor recurrence of patients were compared by multivariable-adjusted Cox regression and competing risk analyses.

Results:

During the follow-up with continued antiviral therapy, 37 (25.0%) patients developed tumor recurrence, and 16 (10.8%) patients died (N=15) or received liver transplantation (N=1). In the ITT cohort, the recurrence-free survival for the TDF group was significantly better than that for the ETV group (P=0.026). In the multivariate analysis, the relative risks of recurrence and death/liver transplantation for ETV therapy were 3.056 (95% confidence interval (CI): 1.015-9.196; P=0.047) and 2.566 (95% CI: 1.264-5.228; P=0.009), respectively. Subgroup analysis of the PP population indicated a better OS and RFS of patients receiving TDF therapy (P=0.048; HR =0.362; 95% CI: 0.132-0.993 and P=0.014; HR =0.458; 95% CI: 0.245-0.856). Additionally, TDF therapy was an independent protective factor against late tumor recurrence (P=0.046; hazard ratio (HR)=0.432; 95% CI: 0.189-0.985) but not against early tumor recurrence (P=0.109; HR =1.964; 95% CI: 0.858-4.494).

Conclusion:

HBV-related HCC patients treated with consistent TDF therapy had a significantly lower risk of tumor recurrence than those treated with ETV after curative treatment.
Bipolar Transurethral Resection of Intravesical Fungal Bezoar Containing Multiple Multidrug Resistant Bacteria in a Chronic Catheter-Dependent Patient
Authors: Driscoll Conor B. , Greenberg Daniel R. , Sharifi Roohollah , Cornfield Joel
Published: June 2023

Fungal bezoar is a very rare clinical entity that usually results from fungemia because of uncontrolled diabetes mellitus or immunosuppression. Most cases present in the upper urinary tract, but there have been less than 10 reported as presenting primarily in the bladder. Treatment is largely medical with antifungal therapies with no documented cases of concomitant bacterial colonization. Rarely, surgical intervention is warranted, but there are no documented surgical approaches with a bipolar cautery loop resectoscope. We present a case of a fungal bezoar of the bladder that was treated with transurethral resection. The presence of multidrug-resistant organisms resulted in postoperative sepsis controlled with intravesical and intravenous antibiotics and fluid resuscitation.
Exploring novel approaches to food allergy management
Authors: Howard-Ruben Josie , Doucette Julianne
Published: June 2023

Nurse practitioners are likely to encounter pediatric and adult patients with symptoms of food allergy who need an accurate diagnosis, emergency treatment plans, and options for management. The pathophysiology of immunoglobulin E (IgE)-mediated food allergy, current and emerging diagnostics, treatment, and emergency management is briefly reviewed, and promising new and potential future treatment options are discussed. Currently, Food and Drug Administration-approved oral immunotherapy (OIT) treatment for peanut allergy, but clinical trials are underway to explore multiple-allergen OIT and alternate routes for IT such as sublingual and epicutaneous. Treatments that modulate the immune system are also potential treatments for food allergies (FAs), including biologic agents. Omalizumab, an anti-IgE therapy, dupilumab, an interleukin-4Ra receptor monoclonal antibody, and etokimab, an anti–IL-33, are all being studied for the treatment of food allergy. There is hope that these novel therapies for FAs will be a viable option translated to the practice setting in the near future, so that strict avoidance is not the only treatment plan for FAs. Nurse practitioners can support their patients with FAs and their families by keeping abreast of progress in food allergy research and assisting patients to consider novel treatment options, when appropriate, using shared decision making.
A case of nontraumatic simultaneous bilateral Achilles tendon rupture
Authors: Horvath David , Horvath Megan
Published: June 2023

Patients with corticosteroid-managed chronic obstructive pulmonary disease (COPD) are at increased risk of Achilles tendon rupture. This risk is further augmented in the setting of an acute COPD exacerbation in which antibiotics may be indicated, namely fluoroquinolones. This case concerns a 76-year-old man who experienced simultaneous nontraumatic bilateral Achilles tendon rupture during an acute COPD exacerbation. Treatment was conservative with analgesics, activity modification, and bilateral controlled ankle movement boots. Surgery was not advised because of his multiple medical comorbidities predisposing him to impaired wound healing and potential amputation. Included is a discussion on the pathophysiology, diagnosis, and treatment of Achilles tendon rupture. There is a need for greater awareness of the risk of Achilles tendon rupture from combined use of corticosteroids and fluoroquinolones. After this report, we hope to raise awareness of this complication and prevent patient suffering.
Physical activity, inactivity and sleep in older patients with coronary artery disease following percutaneous coronary intervention: a longitudinal, observational study
Authors: Charman Sarah J. , Blain Alasdair P. , Trenell Michael I. , Jakovljevic Djordje G. , Kunadian Vijay
Published: June 2023

Objectives

Physical activity presents an important cornerstone in the management and care of coronary artery disease (CAD) patients following percutaneous coronary intervention (PCI) and research in older patients continues to be overlooked. This study evaluated differences in physical activity, inactivity and sleep of CAD patients following PCI for acute coronary syndrome consisting of ST-segment elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) and elective admission of stable angina patients over 12 months.

Methods

This was an observational, longitudinal study. Fifty-eight patients were recruited (STEMI, n = 20, NSTEMI, n = 18 and stable angina, n = 20) and completed 7-day monitoring (physical activity, inactivity and sleep) using wrist-worn tri-axial accelerometers (GENEActiv, ActivInsights Ltd, Kimbolton, Cambridgeshire, UK) upon discharge from a tertiary centre and repeated measurements at 3 months (n = 43), 6 months (n = 40) and 12 months (n = 33).

Results

Following PCI, CAD patients showed a general trend of increasing light and moderate-vigorous physical activity over the 12-month follow-up. Time in inactivity remained high but decreased over time. Sleep duration and sleep efficiency remained consistent. NSTEMI patients spent less time asleep, more time inactive and less time in light and moderate-vigorous physical activity in comparison to STEMI and stable angina patients. Differences between the groups over time were minimal.

Conclusion

These findings suggest that older patients with CAD spend long periods in inactivity but the increasing trend of both light and moderate-vigorous physical activity over time presents a positive change in behaviour in the year following PCI.
Effects of olive oil and flaxseed consumption in a healthy diet on endothelial function, plasma lipids and inflammatory factors of patients with coronary heart disease: a randomized clinical trial
Authors: Khandouzi Nafiseh , Zahedmehr Ali , Asadian Sanaz , Nasrollahzadeh Javad
Published: June 2023

Objectives

A healthy lifestyle, including a healthy diet has been associated with an improvement in cardiovascular risk factors. The aim of the present study was to assess the effect of olive oil and flaxseed consumption as part of a healthy diet on endothelial function, plasma inflammatory factors, and lipid profile in patients with coronary heart disease (CHD).

Method

This randomized nonblinded trial was performed on CHD patients. In the control group, participants received general heart-healthy dietary recommendations while in the intervention group, in addition to these recommendations, the participants consumed 25 ml of olive oil and 30 g of flaxseeds daily for 3 months. At baseline and after 3 months, changes in brachial flow-mediated dilation (FMD), plasma asymmetric dimethyl arginine, interleukin-6 (IL-6), IL-10, high-sensitivity C-reactive protein (hs-CRP), tumor necrosis factor-α (TNF-α), monocyte chemoattractant protein-1 (MCP-1), and lipids and lipoproteins were measured.

Results

A total of 50 patients finished the trial (n = 24 in the intervention and n = 26 in the control groups). Compared to the control group, consumption of flaxseed and olive oil significantly improved brachial artery FMD%, and reduced plasma IL-6, TNF-α, MCP-1, total cholesterol, and tended to reduce hs-CRP, and non-HDL-cholesterol but the concentration of other study indices were not different between the two groups.

Conclusion

Inclusion of olive oil and flaxseed in the diet of CHD patients may contribute to secondary prevention by improving endothelial function and plasma inflammatory factors.
Predictive value of elevated neutrophil gelatinase-associated lipocalin levels for assessment of in-hospital adverse outcomes among myocardial infarction patients
Authors: Ziv-Baran Tomer , Frydman Shir , Khoury Shafik , Itach Tamar , Banai Shmuel , Shacham Yacov
Published: June 2023

Background

Inflammatory biomarkers are known to rise and have predictive value for adverse outcomes in patients with acute coronary ischemia. One of those biomarkers is neutrophil gelatinase-associated lipocalin (NGAL). To date, only very few studies have assessed the prognostic value of NGAL in this setting. We investigated the prognostic utility of elevated NGAL levels on clinical outcomes among ST-elevation myocardial infarction patients.

Methods

High NGAL was defined as values within the 4th quartile. Patients were assessed for major in-hospital adverse clinical events (MACE). Multivariable logistic regression and area under the receiver operating characteristic curve (AUC) were used to further evaluate NGAL association for MACE and discrimination ability.

Results

A total of 273 patients were included. patients with high NGAL were at increased risk for MACE (62% vs. 19%; odds ratio 6.88, 95% confidence interval, 3.77–12.54, P < 0.001). After propensity score matching, the incidence of MACE was significantly higher in patients with high vs. low NGAL levels (69% vs. 6%, P = 0.002). In multivariable regression, high NGAL level was independently associated with MACE. The discrimination ability of NGAL to identify MACE (AUC 0.823), is significantly better than that of other inflammatory markers.

Conclusion

Among ST-segment elevation myocardial infarction patients undergoing primary percutaneous coronary intervention, high NGAL levels are associated with adverse outcomes, independent of traditional inflammatory markers.