bluuebunny/crossref_metadata_2025 huggingface dataset:
From powerful knowledge to capabilities: social realism, social justice, and the Capabilities Approach
Authors: Talbot Daniel
Published: July 2024

This article argues that, as applied to education, the Capabilities Approach pioneered by Amartya Sen and Martha Nussbaum shares a range of philosophical commitments with the work of social realist scholars on the concept of ‘powerful knowledge’. I first trace the history of the concept of powerful knowledge and present critiques put forward by social justice scholars. I then outline the Capabilities Approach, arguing it provides a response to some of these concerns. From here I develop the connection between the two educational paradigms focusing on four areas of affinity. The first is the conceptual similarity between the ‘power’ of powerful knowledge and Nussbaum’s account of a capability. The second is their concern with the reduction of education to technical-instrumentalism, human capital, and other economically driven imperatives. The third is a shared focus on the link between knowledge, human agency, and freedom. The fourth, is a mutual rejection of relativism and embrace of a nuanced universalism. Ultimately, by drawing together these two conceptually rich approaches to the aims and purposes of education, I hope to open a space for theorizing about both capabilities and powerful knowledge that can resolve some of the problems in both. For powerful knowledge, the Capabilities Approach allows a more concrete explication of why access to disciplinary bodies of knowledge is of value to both individuals and society. On the side of the Capabilities Approach, engaging with the concept of powerful knowledge can help give a rationale for how educational knowledge fosters certain centrally important capabilities.
Withholding the letter: Transgender asylum seekers, legal gender recognition, and the UNHCR mandate
Authors: Camminga B
Published: July 2024

In the absence of legal gender recognition (LGR), transgender people carry documents that misrecognize them. The link between LGR’s absence and exposure to violence and exclusion—experiences that often force transgender people to flee—is clarified by scholarship. However, when a trans person seeks asylum, they are often provided with documents that, rather than unambiguously recognizing their bearer, repeat this misrecognition. This incongruence often exposes transgender asylum seekers to greater risk. Previously, I have argued that, at the moment in which they seek international protection, transgender asylum seekers experience a form of statelessness due to the absence of LGR. In this paper, I build on this argument, drawing on a range of empirical studies to suggest that conditions of statelessness already exist prior to fleeing. As a result, I argue that the UNHCR is under obligation to provide documents recognizing their holder, even if this runs counter to state legislation.
Genetically clustered antifungal phytocytokines and receptor protein family members cooperate to trigger plant immune signaling
Authors: Lintz Julie , Goto Yukihisa , Bender Kyle W , Bchini Raphaël , Dubrulle Guillaume , Cawston Euan , Zipfel Cyril , Duplessis Sebastien , Petre Benjamin
Published: July 2024

Phytocytokines regulate plant immunity by cooperating with cell surface proteins. Populus trichocarpa RUST INDUCED SECRETED PEPTIDE 1 (PtRISP1) exhibits an elicitor activity in poplar, as well as a direct antimicrobial activity against rust fungi. The PtRISP1 gene directly clusters with a gene encoding a leucine-rich repeat receptor protein (LRR-RP), that we termed RISP-ASSOCIATED LRR-RP (PtRALR). In this study, we used phylogenomics to characterize the RISP and RALR gene families, and molecular physiology assays to functionally characterize RISP/RALR pairs. Both RISP and RALR gene families specifically evolved in Salicaceae species (poplar and willow), and systematically cluster in the genomes. Despite a low sequence identity, Salix purpurea RISP1 (SpRISP1) shows properties and activities similar to PtRISP1. Both PtRISP1 and SpRISP1 induced a reactive oxygen species (ROS) burst and phosphorylation of mitogen-activated protein kinases (MAPKs) in Nicotiana benthamiana leaves expressing the respective clustered RALR. PtRISP1 also triggers a rapid stomatal closure in poplar. Altogether, these results indicate that plants evolved phytocytokines with direct antimicrobial activities, and that the genes encoding these phytocytokines co-evolved and physically cluster with genes encoding LRR-RPs required to initiate immune signaling.
Atom Probe Tomography Investigation of Clustering in Model P2O5-Doped Borosilicate Glasses for Nuclear Waste Vitrification
Authors: Klupś Przemyslaw , Skerratt-Love Katrina , Kruger Albert A , George Jaime , Bell Anthony Martin Thomas , Bingham Paul A , Moody Michael P , Bagot Paul A J
Published: July 2024

Atom probe tomography (APT) has been utilized to investigate the microstructure of two model borosilicate glasses designed to understand the solubility limits of phosphorous pentoxide (P2O5). This component is found in certain high-level radioactive defence wastes destined for vitrification, where phase separation can potentially lead to a number of issues relating to the processing of the glass and its long-term chemical and structural stability. The development of suitable focused ion beam (FIB)-preparation routes and APT analysis conditions were initially determined for the model glasses, before examining their detailed microstructures. In a 3.0 mol% P2O5-doped glass, both visual inspection and sensitive statistical analysis of the APT data show homogeneous microstructures, while raising the content to 4.0 mol% initiates the formation of phosphorus-enriched nanoscale precipitates. This study confirms the expected inhomogeneities and phase separation of these glasses and offers routes to characterizing these at near-atomic scale resolution using APT.
Spectral redundancy for calibrating interferometers and suppressing the foreground wedge in 21 cm cosmology
Authors: Cox Tyler A , Parsons Aaron R , Dillon Joshua S , Ewall-Wice Aaron , Pascua Robert
Published: July 2024

Observations of 21 cm line from neutral hydrogen promise to be an exciting new probe of astrophysics and cosmology during the Cosmic Dawn and through the Epoch of Reionization (EoR) to when dark energy accelerates the expansion of our Universe. At each of these epochs, separating bright foregrounds from the cosmological signal is a primary challenge that requires exquisite calibration. In this paper, we present a new calibration method called nucal that extends redundant-baseline calibration, allowing spectral variation in antenna responses to be solved for by using correlations between visibilities measuring the same angular Fourier modes at different frequencies. By modelling the chromaticity of the beam-weighted sky with a tunable set of discrete prolate spheroidal sequences, we develop a calibration loop that optimizes for spectrally smooth calibrated visibilities. Crucially, this technique does not require explicit models of the sky or the primary beam. With simulations that incorporate realistic source and beam chromaticity, we show that this method solves for unsmooth bandpass features, exposes narrow-band interference systematics, and suppresses smooth-spectrum foregrounds below the level of 21 cm reionization models, even within much of the so-called wedge region where current foreground mitigation techniques struggle. We show that this foreground subtraction can be performed with minimal cosmological signal loss for certain well-sampled angular Fourier modes, making spectral-redundant calibration a promising technique for current and next-generation 21 cm intensity mapping experiments.
Eccentricity and inclination of massive planets inside low-density cavities: results of 3D simulations
Authors: Romanova M M , Koldoba A V , Ustyugova G V , Espaillat C , Lovelace R V E
Published: July 2024

We study the evolution of eccentricity and inclination of massive planets in low-density cavities of protoplanetary discs using three-dimensional (3D) simulations. When the planet’s orbit is aligned with the equatorial plane of the disc, the eccentricity increases to high values of 0.7–0.9 due to the resonant interaction with the inner parts of the disc. For planets on inclined orbits, the eccentricity increases due to the Kozai–Lidov mechanism, where the disc acts as an external massive body, which perturbs the planet’s orbit. At small inclination angles, ${\lesssim}30^\circ$, the resonant interaction with the inner disc strongly contributes to the eccentricity growth, while at larger angles, eccentricity growth is mainly due to the Kozai–Lidov mechanism. We conclude that planets inside low-density cavities tend to acquire high eccentricity if favourable conditions give sufficient time for growth. The final value of the planet’s eccentricity after the disc dispersal depends on the planet’s mass and the properties of the cavity and protoplanetary disc.
IL-13Rα2/TGF-β bispecific CAR-T cells counter TGF-β-mediated immune suppression and potentiate anti-tumor responses in glioblastoma
Authors: Hou Andrew J , Shih Ryan M , Uy Benjamin R , Shafer Amanda , Chang ZeNan L , Comin-Anduix Begonya , Guemes Miriam , Galic Zoran , Phyu Su , Okada Hideho , Grausam Katie B , Breunig Joshua J , Brown Christine E , Nathanson David A , Prins Robert M , Chen Yvonne Y
Published: July 2024

Background

Chimeric antigen receptor (CAR)-T cell therapies targeting glioblastoma (GBM)-associated antigens such as interleukin-13 receptor subunit alpha-2 (IL-13Rα2) have achieved limited clinical efficacy to date, in part due to an immunosuppressive tumor microenvironment (TME) characterized by inhibitory molecules such as transforming growth factor-beta (TGF-β). The aim of this study was to engineer more potent GBM-targeting CAR-T cells by countering TGF-β-mediated immune suppression in the TME.

Methods

We engineered a single-chain, bispecific CAR targeting IL-13Rα2 and TGF-β, which programs tumor-specific T cells to convert TGF-β from an immunosuppressant to an immunostimulant. Bispecific IL-13Rα2/TGF-β CAR-T cells were evaluated for efficacy and safety against both patient-derived GBM xenografts and syngeneic models of murine glioma.

Results

Treatment with IL-13Rα2/TGF-β CAR-T cells leads to greater T-cell infiltration and reduced suppressive myeloid cell presence in the tumor-bearing brain compared to treatment with conventional IL-13Rα2 CAR-T cells, resulting in improved survival in both patient-derived GBM xenografts and syngeneic models of murine glioma.

Conclusions

Our findings demonstrate that by reprogramming tumor-specific T-cell responses to TGF-β, bispecific IL-13Rα2/TGF-β CAR-T cells resist and remodel the immunosuppressive TME to drive potent anti-tumor responses in GBM.
Seawater barium and sulfide removal improved marine habitability for the Cambrian Explosion of early animals
Authors: Wei Wei , Dong Lin-Hui , Xiao Shuhai , Lin Yi-Bo , Xu Lingang , Wei Guang-Yi , Wang Wenzhong , Tian Lan-Lan , Wei Hai-Zhen , Huang Fang
Published: July 2024

An increase in atmospheric pO2 has been proposed as a trigger for the Cambrian Explosion at ∼539–514 Ma but the mechanistic linkage remains unclear. To gain insights into marine habitability for the Cambrian Explosion, we analysed excess Ba contents (Baexcess) and isotope compositions (δ138Baexcess) of ∼521-Myr-old metalliferous black shales in South China. The δ138Baexcess values vary within a large range and show a negative logarithmic correlation with Baexcess, suggesting a major (>99%) drawdown of oceanic Ba inventory via barite precipitation. Spatial variations in Baexcess and δ138Baexcess indicate that Ba removal was driven by sulfate availability that was ultimately derived from the upwelling of deep seawaters. Global oceanic oxygenation across the Ediacaran–Cambrian transition may have increased the sulfate reservoir via oxidation of sulfide and concurrently decreased the Ba reservoir by barite precipitation. The removal of both H2S and Ba that are deleterious to animals could have improved marine habitability for early animals.
Eighteen-Month Outcomes Among Pregnant and Nonpregnant Reproductive-Aged People Hospitalized for Coronavirus Disease 2019
Authors: Bebell Lisa M , Woolley Ann E , James Kaitlyn E , Kim Andy , Joyc Mary-Ruth , Gray Kathryn J , Radford Caitlin , Bassett Ingrid V , Boatin Adeline A , Ciaranello Andrea L , Yawetz Sigal , Edlow Andrea G , Goldfarb Ilona T , Diouf Khady
Published: July 2024

Background

Physiologic and immunologic adaptations in pregnancy may increase the risk of adverse outcomes from respiratory viral infections. However, data are limited on longer-term outcomes after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in pregnancy prior to widespread vaccine availability.

Methods

Using electronic health record data, we retrospectively compared 6-, 12-, and 18-month outcomes including death and rehospitalization between pregnant and nonpregnant reproductive-aged individuals hospitalized for SARS-CoV-2 infection between 2020 and 2021 at 2 academic referral hospitals.

Results

There were 190 nonpregnant and 70 pregnant participants. Mean age was 31 years for pregnant and 34 years for nonpregnant participants. For pregnant patients, mean gestational age at coronavirus disease 2019 (COVID-19) diagnosis was 36 weeks, 54% delivered by cesarean, and 97% delivered a live birth. Compared to pregnant participants, nonpregnant participants had a higher prevalence of baseline comorbidities and a higher proportion received mechanical ventilation (84% vs 55%). Index hospitalization complications (31% vs 17%) and mortality (3% vs 0%) were more common in nonpregnant participants. Over 18 months following index hospitalization, 39 (21%) nonpregnant and 5 (7%) pregnant participants were readmitted, most for infection (28/44 [64%]). Most readmissions occurred within 6 months. There were no posthospitalization deaths in the pregnant group.

Conclusions

Pregnant people with severe COVID-19 disease had a low rate of severe adverse outcomes after index hospitalization. The low readmission rate is reassuring that pregnant individuals may not be at higher risk for long-term severe adverse health outcomes after COVID-19 compared to the nonpregnant reproductive-aged population, possibly because any increased risk conferred by pregnancy resolves soon after delivery.
Similar Limited Protection Against Severe Acute Respiratory Syndrome Coronavirus 2 Omicron Infection in Vaccinated Individuals With HIV and Comparable Controls
Authors: Verburgh Myrthe L , Boyd Anders , Schim van der Loeff Maarten F , Bakker Margreet , Wit Ferdinand W N M , van der Valk Marc , Grobben Marloes , van Pul Lisa , Tejjani Khadija , van Rijswijk Jacqueline , van Gils Marit J , Kootstra Neeltje A , van der Hoek Lia , Reiss Peter ,   AGEhIV Cohort Study, Reiss P , Wit F W N M , van der Valk M , Boyd A , Verburgh M L , van der Wulp I A J , Vanbellinghen M C , van Eeden C J , Schim van der Loeff M F , Koole J C D , del Grande L , Agard I , Zaheri S , Hillebregt M M J , Ruijs Y M C , Benschop D P , el Berkaoui A , Boyd A , Wit F W N M , Kootstra N A , Harskamp-Holwerda A M , Maurer I , Mangas Ruiz M M , Boeser-Nunnink B D N , Starozhitskaya O S , van der Hoek L , Bakker M , van Gils M J , Dol L , Rongen G , Geerlings S E , Goorhuis A , Hovius J W R , Nellen F J B , Prins J M , van der Poll T , van der Valk M , Wiersinga W J , van Vugt M , de Bree G , Lemkes B A , Spoorenberg V , Wit F W N M , van Eden J , Pijnappel F J J , Weijsenfeld A , Smalhout S , Hylkema - van den Bout I J , Bruins C , Spelbrink M E , Postema P G , Bisschop P H L T , Dekker E , van der Velde N , Franssen R , Willemsen J M R , Vogt L , Portegies P , Geurtsen G J , Visser I , Schadé A , Nieuwkerk P T , van Steenwijk R P , Jonkers R E , Majoie C B L M , Caan M W A , van den Born B J H , Stroes E S G , van Oorspronk S
Published: July 2024

Background

Little is known about the risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron infection in people with human immunodeficiency virus (HIV; PWH) with vaccine-induced or hybrid immunity. We assessed the incidence of Omicron infection in 209 AGEhIV coronavirus disease 2019 substudy participants with well-controlled HIV on antiretroviral therapy and 280 comparable controls, who had received at least the primary vaccination series.

Methods

From September 2020 onward, participants were assessed every 6 months for the incidence of SARS-CoV-2 infection, per SARS-CoV-2 nucleocapsid antibody assay or self-reported positive antigen or polymerase chain reaction test. Between 1 January and 31 October 2022, the cumulative incidence of Omicron infection and associated risk factors were estimated using a conditional risk-set Cox proportional hazards model.

Results

The cumulative incidence of a first Omicron infection was 58.3% by 31 October 2022, not significantly different between groups. HIV status was not independently associated with acquiring Omicron infection. Former and current smoking, as well as an increased predicted anti-spike immunoglobulin G titer were significantly associated with a lower risk of Omicron infection. The majority of infections were symptomatic, but none required hospitalization.

Conclusions

People with well-controlled HIV and controls in our cohort experienced a similarly high proportion of Omicron infections. More booster vaccinations significantly reduced the risk of infection.

Clinical Trial Registration. NCT01466582
A Meta-analysis to Quantify the Risk of Disseminated Gonococcal Infection With Porin B Serotype
Authors: Welch Geoffrey , Reed George W , Rice Peter A , Ram Sanjay
Published: July 2024

The escalating rates of gonorrhea globally are associated with higher numbers of disseminated gonococcal infection (DGI). Expression of the PorB1A allele of the major outer membrane porin protein, PorB, is associated with DGI. This meta-analysis shows that the odds of PorB1A strains to disseminate is 20.53 compared to PorB1B isolates.
Baseline C-reactive Protein as a Risk Factor for Cryptococcal Meningitis and Death in HIV-associated Cryptococcal Antigenemia With CrAg Titer as an Effect Modifier
Authors: Skipper Caleb P , Kirumira Paul , Dai Biyue , Wele Abduljewad , Naluyima Rose , Namuli Teopista , Turya Fred , Muhumuza Patrick , Kibengo Freddie , Boulware David R , Meya David B , Nalintya Elizabeth , Rajasingham Radha
Published: July 2024

Background

Persons with HIV and cryptococcal antigenemia are at high risk of progression to cryptococcal meningitis or death. Baseline cryptococcal antigen (CrAg) plasma titer ≥1:160 is a known risk factor for poor outcomes, but other risk factors are unknown. In HIV-associated cryptococcal meningitis, baseline serum C-reactive protein (CRP) concentrations are positively associated with increased mortality. We hypothesized that CRP might also be associated with meningitis or death in persons with cryptococcal antigenemia.

Methods

We measured plasma CrAg titers and CRP concentrations on cryopreserved serum from prospectively enrolled persons with HIV and cryptococcal antigenemia. Using time-to-event analyses, we compared 24-week meningitis-free survival in persons with normal CRP (<8 mg/L) and elevated CRP (≥8 mg/L). Logistic regression was used to assess how CRP concentration and CrAg titer might interact as covariates.

Results

Of the 94 persons with elevated CRP, 19 (20.2%) developed meningitis or death, whereas of the 88 persons with normal CRP, 8 (9.1%) developed meningitis or death (P = .035). Persons with CrAg titer <1:160 and normal CRP had an ∼5% (3/61) event rate, whereas those with CrAg titer <1:160 but elevated CRP had an ∼20% (12/59) event rate. Importantly, we identified a statistically significant interaction effect between CrAg titer and CRP groups, in which elevated CRP increased risk in the low CrAg titer group (odds ratio, 1.54; 95% confidence interval, 1.16–2.04), but this effect was not present in high CrAg titer group (odds ratio, 0.78; 95% confidence interval, .53–1.15).

Conclusions

Our findings demonstrate that CrAg titer may modify the direction of effect of CRP with meningitis-free survival; future studies should account for this interaction.
PICKLE and HISTONE DEACETYLASE6 coordinately regulate genes and transposable elements in Arabidopsis
Authors: Li Wenjuan , Zhang Xiaoling , Zhang Qingche , Li Qingzhu , Li Yanzhuo , Lv Yanfang , Liu Yue , Cao Ying , Wang Huamei , Chen Xiangsong , Yang Hongchun
Published: July 2024

Chromatin dynamics play essential roles in transcriptional regulation. The chromodomain helicase DNA-binding domain 3 chromatin remodeler PICKLE (PKL) and HISTONE DEACETYLASE6 (HDA6) are required for transcriptional gene silencing, but their coordinated function in gene repression requires further study. Through a genetic suppressor screen, we found that a point mutation at PKL could partially restore the developmental defects of a weak Polycomb repressive complex 1 (PRC1) mutant (ring1a-2 ring1b-3), in which RING1A expression is suppressed by a T-DNA insertion at the promoter. Compared to ring1a-2 ring1b-3, the expression of RING1A is increased, nucleosome occupancy is reduced, and the histone 3 lysine 9 acetylation (H3K9ac) level is increased at the RING1A locus in the pkl ring1a-2 ring1b-3 triple mutant. HDA6 interacts with PKL and represses RING1A expression similarly to PKL genetically and molecularly in the ring1a-2 ring1b-3 background. Furthermore, we show that PKL and HDA6 suppress the expression of a set of genes and transposable elements (TEs) by increasing nucleosome density and reducing H3K9ac. Genome-wide analysis indicated they possibly coordinately maintain DNA methylation as well. Our findings suggest that PKL and HDA6 function together to reduce H3K9ac and increase nucleosome occupancy, thereby facilitating gene/TE regulation in Arabidopsis (Arabidopsis thaliana).
Impact of increasing dietary standardized ileal digestible arginine to lysine ratio from 0.85 to 1.15 and water-based arginine supplementation on growth performance and gut integrity of weaned pigs
Authors: Hagen Chloe , Humphrey Dalton , Wileman Caitlyn , Haydon Keith , Greiner Laura
Published: July 2024

The objective of this experiment was to assess the influence of arginine (Arg) supplementation in water and/or feed on the growth performance and gastrointestinal health of newly weaned pigs. Two hundred and forty pigs (5.06 kg; PIC, Hendersonville, TN) were randomly allocated into 80 mixed-sex pens (3 pigs/pen) and subjected to a 2 × 4 factorial design. Two levels of Arg were supplemented in water (0% or 8% stock, dosed through a 1:128 proportioner) for the first phase (days 0 to 7), and four dietary arginine levels (0.85, 0.95, 1.05, and 1.15) standardized ileal digestible (SID) Arg to Lysine (Lys) ratios for the first two phases (days 0 to 7 and 7 to 21). All treatments were provided a common diet (0.96 SID Arg:Lys) for the last phase days 21 to 42. One pig per pen underwent a dual sugar absorption test of lactulose at 500 mg/kg and mannitol at 50 mg/kg of body weight (BW) via gastric tube on days 7 and 21 postweaning, with blood plasma collected 4 h later. The pig tested on day 7 was subsequently euthanized for intestinal tissue collection. Pen growth performance and feed disappearance were evaluated for 3 phases: days 0 to 7, 7 to 21, and 21 to 42 postweaning. The statistical analysis used linear models to examine the effects of SID Arg:Lys in the feed, Arg level in water, and their interactions, with pen as the experimental unit. Orthogonal contrasts were used to test the linear and quadratic effects of increasing SID Arg:Lys in the diet. Growth performance during the first period exhibited variability, reflected by negative gain-to-feed (G:F) ratios, caused by the enteric health challenge. Consequently, data were analyzed separately for each phase. Increasing dietary SID Arg:Lys caused a linear improvement (P = 0.04) in final BW (18.47 and 21.90 kg, for 0.85 and 1.15 SID Arg:Lys, respectively). A trend (P = 0.09) suggested a linear impact of dietary SID Arg:Lys on average daily gain during days 21 to 42. Arg supplementation, whether administered through water or diet, did not affect lactulose and mannitol absorption on both days 7 and 21, nor did it alter histological measurements in the collected ileum tissues on day 7 postweaning. In conclusion, increasing dietary SID Arg:Lys increased final BW but had no clear impacts on intestinal health within the parameters measured, potentially impacted by the rotavirus diagnosis in the first week post-wean.
Dispute resolution in aircraft finance: question and solutions within the international regulatory context
Authors: Trimarchi Andrea
Published: July 2024

The aviation industry has reached a strategic relevance for countries worldwide such that its impact on the global economy cannot be under-estimated. It might be surprising to hear that, notwithstanding such innate international character, generally, aviation disputes are still solved through national jurisdictional channels. Aircraft finance transactions and disputes not only are highly international in nature but also strongly depend on technical nature and specific financial aspects and are in need of a certain degree of expertise on the side of the adjudicatory body. In this light, there have been ever more instances of aviation-specific arbitration courts being established with the objective to ensure efficiency and time-sensitive and expert dispute settlement mechanisms for aviation finance disputes. This article not only addresses the elements of such aviation courts but also examines the current legal regime and challenges arising from the 2001 Cape Town Convention and national laws.
European Xylella fastidiosa Strains Can Cause Symptoms in Blueberry
Authors: Shantharaj Deepak , Román-Écija Miguel , Velasco-Amo Maria Pilar , Navas-Cortés Juan A. , Landa Blanca B. , De La Fuente Leonardo
Published: July 2024

Strains of the bacterial pathogen Xylella fastidiosa subspecies multiplex (Xfm) and pauca (Xfp) isolated from symptomatic almond and olive plants in Spain and Italy were used in this study. Because of the risk of host jump and considering the importance of southern highbush blueberry production in Spain, we tested a small set of these strains for their potential to infect and cause disease symptoms in blueberries under greenhouse experiments. Xfm IVIA5901 (isolated from almonds in Alicante, Spain) caused symptoms similar to those caused by Xfm AlmaEm3 (isolated from blueberries in Georgia, U.S.A., and used as a reference strain capable of inducing severe symptoms in blueberry). Nevertheless, bacterial populations of Xfm IVIA5901 in planta were significantly lower than those of Xfm AlmaEm3. Xfm ESVL (isolated from almonds, Alicante, Spain) and Xfp XYL1961/18 (isolated from olives, Ibiza Island, Spain) caused limited symptoms, while Xfm XYL466/19 (isolated from wild olives, Mallorca Island, Spain) and Xfm XF3348 (isolated from almonds, Mallorca Island, Spain) and Xfp De Donno (isolated from olives, Puglia, Italy, and representative of the devastating olive quick decline syndrome) did not cause symptoms nor colonize blueberries. This study suggests that certain strains already found in Europe could infect blueberry if conditions conducive for a host jump in this region are met, such as proximity of blueberries to other infected hosts and presence of insect vectors that feed on these crops. Surveys on the presence of X. fastidiosa in blueberries in Spain and other European countries are needed to anticipate possible issues.
Questionnaire to Survey Cosmetic Outcomes in Laparoscopic Surgery for Colorectal Cancer
Authors: Miyo Masaaki , Takemasa Ichiro , Okuya Koichi , Ito Tatsuya , Akizuki Emi , Ogawa Tadashi , Noda Ai , Ishii Masayuki , Miura Ryo , Ichihara Momoko , Toyota Maho , Kimura Akina , Sekimoto Mitsugu
Published: July 2024

Background and objectives:

There has been a steady increase in the use of minimally invasive surgery, including conventional multiport laparoscopic surgery (MLS) and single-site laparoscopic surgery (SLS) for colorectal cancer. We aimed to evaluate how important the cosmetic outcome, one of the advantages of SLS, is to patients and whether SLS reflects social needs.

Methods:

We used a web-based questionnaire to survey nonmedical and medical workers for what factors were considered on the assumption that respondents undergo colorectal cancer surgery and that the most important person for them undergoes. Five items (curability, safety, pain, length of hospital stay, and cosmetic outcomes) were compared. After paired photographs before and after SLS and MLS were shown, perceptions of body image and cosmesis were assessed using a visual analog scale.

Results:

This study included a total of 1352 respondents (990 nonmedical and 362 medical). Curability had the highest score (49.9–53.7 points), followed by safety (23.8–24.7 points). The scores for cosmetic outcomes (6.2–7.1 points) were almost equal to those of the length of hospital stay (6.2–7.1 points), which was associated with medical costs and pain (10.0–11.1 points), one of the main reasons for fear of surgery. Participants who were female, younger, and in the nonmedical group placed great importance on cosmetic outcomes. For all questions regarding body image and cosmesis, SLS had superior scores compared with MLS.

Conclusions:

Understandably, curability, and safety were most important in colorectal cancer surgery. However, medical workers should consider cosmetic outcomes, even in malignant cases.
Surgeon Factors Rather Than Patient Factors Account for Variation in Recommended Treatment Strategy for Patients With Multiligament Knee Injury
Authors: Brinkman Niels , Nunziato Carl , Laverty David , Ring David , Hill Austin , Crijns Tom J.
Published: July 2024

OBJECTIVES:

To seek the factors associated with timing, staging, and type of surgery in the management of multiligament knee injuries.

METHODS:

Design:

Cross-sectional scenario-based experiment.

Setting:

Fifteen fictional patient scenarios with randomized elements.

Participants:

Fracture surgeons of the Science of Variation Group, an international collaborative of musculoskeletal surgeons who studies variation in care, were invited to participate. Surgeons with limited experience treating multiligament knee injuries were asked to self-exclude.

Outcome Measures and Comparisons:

Surgeon recommendations for operative treatment, timing of surgery, and use of open surgery in addition to arthroscopy were measured. Patient factors (age, time from injury, contralateral fracture, knee dislocation, combinations of ruptured ligaments, and preexisting osteoarthritis) and surgeon factors (gender, practice location, years of experience, and supervision of trainees) associated with surgeon recommendations were assessed.

RESULTS:

Eighty-five surgeons participated, of which most were men (89%) and practiced in the United States (44%) or Europe (38%). Operative treatment was less likely among older patients (odds ratio [OR] = 0.051) and preexisting osteoarthritis (OR = 0.32) and more likely in knee dislocation (OR = 1.9) and disruption of anterior cruciate ligament, posterior cruciate ligament, and lateral collateral ligament with or without medial collateral ligament (MCL; OR = 5.1 and OR = 3.1, respectively). Disruption of anterior cruciate ligament, posterior cruciate ligament, and medial collateral ligament was associated with shorter time to surgery (β = −11). Longer time to surgery was associated with contralateral fracture (β = 9.2) and surgeons supervising trainees (β = 23) and practicing in Europe (β = 13). Surgeon factors accounted for more variation in timing than patient and injury factors (5.1% vs. 1.4%, respectively). Open surgery was more likely in patients with lateral collateral ligament injury (OR = 2.9 to 3.3).

CONCLUSIONS:

The observation that surgeons were more likely to operate in younger patients with more severe injury has face validity, while the finding that surgeon factors accounted for more variation in timing of surgery than patient or injury factors suggests that treatment variation is based on opinion more so than evidence.

LEVEL OF EVIDENCE:

Prognostic Level V. See Instructions for Authors for a complete description of levels of evidence.
Recovery of Comfort and Capability After Upper Extremity Fracture Is Predominantly Associated With Mindset: A Longitudinal Cohort From the United Kingdom
Authors: Brinkman Niels , Thomas Jacob E. , Teunis Teun , Ring David , Gwilym Stephen , Jayakumar Prakash
Published: July 2024

OBJECTIVES:

To determine the relative influence of mindset and fracture severity on 9-month recovery trajectories of pain and capability after upper extremity fractures.

METHODS:

Design:

Secondary use of longitudinal data.

Setting:

Single Level-1 trauma center in Oxford, United Kingdom.

Patient selection:

English-speaking adults with isolated proximal humerus, elbow, or distal radius fracture managed operatively or nonoperatively were included, and those with multiple fractures or cognitive deficit were excluded.

Outcome measures and comparisons:

Incapability (Quick-DASH) and pain intensity (11-point rating scale) were measured at baseline, 2–4 weeks, and 6–9 months after injury. Cluster analysis was used to identify statistical groupings of mindset (PROMIS Depression and Anxiety, Pain Catastrophizing Scale, and Tampa Scale for Kinesiophobia) and fracture severity (low/moderate/high based on OTA/AO classification). The recovery trajectories of incapability and pain intensity for each mindset grouping were assessed, accounting for various fracture-related aspects.

RESULTS:

Among 703 included patients (age 59 ± 21 years, 66% women, 16% high-energy injury), 4 statistical groupings with escalating levels of distress and unhelpful thoughts were identified (fracture severity was omitted considering it had no differentiating effect). Groups with less healthy mindset had a worse baseline incapability (group 2: β = 4.1, 3: β = 7.5, and 4: β = 17) and pain intensity (group 3: β = 0.70 and 4: β = 1.4) (P < 0.01). Higher fracture severity (β = 4.5), high-energy injury (β = 4.0), and nerve palsy (β = 8.1) were associated with worse baseline incapability (P < 0.01), and high-energy injury (β = 0.62) and nerve palsy (β = 0.76) with worse baseline pain intensity (P < 0.01). Groups 3 and 4 had a prolonged rate of recovery of incapability (β = 1.3, β = 7.0) and pain intensity (β = 0.19, β = 1.1) (P < 0.02).

CONCLUSIONS:

Patients with higher levels of unhelpful thinking and feelings of distress regarding symptoms experienced worse recovery of pain and incapability, with a higher effect size than fracture location, fracture severity, high-energy injury, and nerve palsy. These findings underline the importance of anticipating and addressing mental health concerns during recovery from injury.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Bicortical Compression and Construct Stability With Variable Pitch Locking Screws in Cadaveric Specimens
Authors: Koroneos Zachary A. , Alwine Shelby , Tortora Peter , Pitcher Michaela , Benedict Christian , Wee Hwabok , Kunselman Allen , Aynardi Michael , Lewis Gregory S.
Published: July 2024

OBJECTIVES:

A variable pitch locking screw is intended to provide interfragmentary compression combined with fixed angle stability of locking plate constructs. The objective of this study was to compare variable pitch locking screws (3.5-mm KreuLock Ti locking compression screws, Arthrex Inc., Naples, FL) with standard locking screws (from the same manufacturer) in bicortical fixation scenarios in cadaver bone by assessing (1) interfragmentary compression and plate-bone compression and (2) construct biomechanical stability.

METHODS:

Nine matched pairs of fresh-frozen cadaveric specimens with an average age of 67.2 years (range, 37–83) were used. Interfragmentary compression and plate-bone compression associated with insertion of single bicortical screws were compared between the variable pitch and standard locking screws at increasing levels of torque. The specimens tested were distal tibiae having a simulated longitudinal fracture. Additionally, fibulae were osteotomized to create a stable longitudinal fracture pattern and were fixed with a 5-screw plate construct with either all variable pitch or all standard locking screws. One of the 5 screws was placed across the osteotomy without lagging. Fibulae were tested cyclically with axial with torsional loading to compare displacements, rotation, and loads at failure or tested in 4-point bending to compare construct stiffness and maximum force to failure.

RESULTS:

Interfragmentary and plate-bone compression forces in the distal tibia model varied across specimens but were significantly higher with variable pitch locking screws compared with standard locking screws [512 N (SD = 324 N) vs. 79 N (SD = 64 N), P = 0.002, and 242 N (SD = 119 N) vs. 104 N (SD = 123 N), P = 0.028, respectively]. In cyclic loading of fibula constructs, no significant differences were detected in construct axial displacement or angular displacement (P > 0.05). In 4-point bending, no differences were detected in maximum force or bending stiffness (P > 0.05).

CONCLUSIONS:

Variable pitch locking screws produced interfragmentary compression between cortices and plate-bone compression that was greater than that produced by standard locking screws. In a stable bicortical fibula fixation scenario under external loading, the stability of variable pitch locking screw constructs was similar to constructs with standard locking screws.
Multimodal Deep Learning-based Radiomics Approach for Predicting Surgical Outcomes in Patients with Cervical Ossification of the Posterior Longitudinal Ligament
Authors: Maki Satoshi , Furuya Takeo , Katsumi Keiichi , Nakajima Hideaki , Honjoh Kazuya , Watanabe Shuji , Kaito Takashi , Takenaka Shota , Kanie Yuya , Iwasaki Motoki , Furuya Masayuki , Inoue Gen , Miyagi Masayuki , Ikeda Shinsuke , Imagama Shiro , Nakashima Hiroaki , Ito Sadayuki , Takahashi Hiroshi , Kawaguchi Yoshiharu , Futakawa Hayato , Murata Kazuma , Yoshii Toshitaka , Hirai Takashi , Koda Masao , Ohtori Seiji , Yamazaki Masashi
Published: July 2024

Study Design.

A retrospective analysis.

Objective.

This research sought to develop a predictive model for surgical outcomes in patients with cervical ossification of the posterior longitudinal ligament (OPLL) using deep learning and machine learning (ML) techniques.

Summary of Background Data.

Determining surgical outcomes assists surgeons in communicating prognosis to patients and setting their expectations. Deep learning and ML are computational models that identify patterns from large data sets and make predictions.

Methods.

Of the 482 patients, 288 patients were included in the analysis. A minimal clinically important difference (MCID) was defined as gain in Japanese Orthopaedic Association (JOA) score of 2.5 points or more. The predictive model for MCID achievement at 1 year postsurgery was constructed using patient background, clinical symptoms, and preoperative imaging features (x-ray, CT, MRI) analyzed through LightGBM and deep learning with RadImagenet.

Results.

The median preoperative JOA score was 11.0 (IQR: 9.0-12.0), which significantly improved to 14.0 (IQR: 12.0-15.0) at 1 year after surgery (P < 0.001, Wilcoxon signed-rank test). The average improvement rate of the JOA score was 44.7%, and 60.1% of patients achieved the MCID. Our model exhibited an area under the receiver operating characteristic curve of 0.81 and the accuracy of 71.9% in predicting MCID at 1 year. Preoperative JOA score and certain preoperative imaging features were identified as the most significant factors in the predictive models.

Conclusion.

A predictive ML and deep learning model for surgical outcomes in OPLL patients is feasible, suggesting promising applications in spinal surgery.

Level of evidence.

4
Assessment of Pelvic Tilt in Anteroposterior Radiographs by Area Ratio Based on Deep Learning
Authors: Xian Jianming , Sun Jingwei , Xie Ruimou , Yang Fei , Huang Jiaqi , Yuan Kehong , Pan Yu , Luo Zhendong
Published: July 2024

Study Design.

Diagnostics.

Objectives.

Based on deep learning semantic segmentation model, we sought to assess pelvic tilt by area ratio of the lesser pelvic and the obturator foramen in anteroposterior (AP) radiographs.

Background.

Pelvic tilt is a critical factor in hip and spinal surgery, commonly evaluated by medical professionals through sagittal pelvic radiographs. The inherent pelvic asymmetry, as well as potential obstructions from clothing and musculature in roentgenography, may result in ghosting and blurring artifacts, thereby complicating precise measurement.

Methods.

PT directly affects the area ratio of the lesser pelvis to the obturator foramen in AP radiographs. An exponential regression analysis of simulated radiographs from ten male and ten female pelvises in specific tilt positions derived a formula correlating this area ratio with PT. Two blinded investigators evaluated this formula using 161 simulated AP pelvic radiographs. A deep learning semantic segmentation model was then fine-tuned to automatically calculate the area ratio, enabling intelligent PT evaluation. This model and the regression function were integrated for automated PT measurement and tested on a dataset of 231 clinical cases.

Results.

We observed no disparity between men and women in the aforementioned area ratio. The test results from two blinded investigators analyzing 161 simulated radiographs revealed a mean absolute error of 0.19° (SD ±4.71°), with a correlation coefficient between them reaching 0.96. In addition, the mean absolute error obtained from testing 231 clinical AP radiographs using the fine-tuned semantic segmentation model mentioned earlier is −0.58° (SD ±5.97°).

Conclusions.

We found that using deep learning neural networks enabled a more accurate and robust automatic measurement of PT through the area ratio of the lesser pelvis and obturator foramen.
Surgical Margins After Neoadjuvant Radiation for Locally Advanced Vulvar Carcinoma
Authors: Ertel Michelle , Vargo John A. , Weimer Anna , Richman Adam , Beriwal Sushil , Mohammed Mohammed , Lesnock Jaime
Published: July 2024

Objective:

We aim to explore whether the surgical tumor free margin is important for overall survival (OS) and local control in patients who undergo neoadjuvant radiation (RT) for vulvar cancer.

Methods:

A retrospective review from 2004 to 2021 of patients who underwent RT followed by surgical resection was performed. Patients were categorized into groups based on margin status (no residual disease, >8 mm, close margins defined as 1 to 7 mm, or positive). Local control and OS were analyzed using the Kaplan-Meier with log rank test. Multivariate analysis was performed with cox hazards model.

Results:

Eighty-three patients were included. A complete pathologic response (pCR) was found in 56% (n=46) of patients. The median follow-up time was 35 months (range: 4 to 216). The median OS for the entire cohort was 46 months (95% CI: 32.3-59.7). Having a pCR improved both OS and disease-free survival (DFS) compared with residual disease by 81 and 91 months, respectively (P<0.001). In the 2 patients with a margin >8 mm, there was no statistical difference in survival between those with close margins (46 vs. 25 mo, P=0.485). Factors that significantly impacted both OS and DFS were depth of invasion (DOI) and LVSI. On multivariate analysis of those with residual disease, there was no difference in OS or DFS by margin status but having a DOI >9 mm showed decreased OS (HR: 3.654; 95% CI: 1.317-10.135).

Conclusions:

In this cohort, response to RT, not margin status drives survival and recurrence. Given residual disease, the optimal margin is not clear, as there were only 2 patients with >8 mm margins. A close or positive margin had no impact on OS or local recurrence. A DOI >9 mm significantly impacts both OS and local recurrence even when accounting for other factors.
CD73 Is an Immunometabolic Biomarker of Poor Prognosis in Patients With Primary Cutaneous Squamous Cell Carcinoma and Hematologic Malignancy
Authors: Saeidi Vahide , Jackson Cullison Stephanie R. , Doudican Nicole A. , Carucci John A. , Stevenson Mary L.
Published: July 2024

BACKGROUND

Impaired immunity may drive the increased incidence and aggression of cutaneous squamous cell carcinoma (cSCC) in patients with hematologic malignancy; however, precise mechanisms and prognostic biomarkers remain undefined. CD73 maintains elevated immunosuppressive adenosine levels and is associated with poor prognosis in several tumor microenvironments.

OBJECTIVE

Identify poor outcome biomarkers in patients with cSCC and hematologic malignancy.

MATERIALS AND METHODS

Differentially expressed genes in tumors from patients with hematologic malignancy experiencing good (n = 8) versus poor (n = 7) outcomes were identified by NanoString analysis. Results were validated at the protein level using CD73 immunohistochemistry in cSCC patients with (n = 38) and without (n = 29) hematologic malignancy.

RESULTS

Forty-eight genes were differentially expressed in tumors from patients with hematologic malignancy experiencing good versus poor outcomes. CD73 gene expression was >2-fold higher in patients with poor versus good outcomes or normal skin. Significantly increased CD73 protein levels were observed in cSCC tumors with poor versus good outcomes from patients with hematologic malignancies (p < .01), whereas no differences were noted in tumors with poor versus good outcomes from patients without hematologic malignancies (p = .49).

CONCLUSION

CD73 is highly expressed in poor prognosis cSCC from patients with hematologic malignancy and may represent a useful biomarker and potential therapeutic target.
Mohs for Melanoma: A Review of MART-1 Frozen Section Interpretation
Authors: Contestable James J. , Lim Geoffrey F. S. , Willenbrink Tyler , Zitelli John A. , Brodland David G.
Published: July 2024

BACKGROUND

Mohs surgery for melanoma has been performed for many decades, but advances in the use of immunohistochemistry with frozen sections during Mohs surgery have allowed for more accurate, reliable, and efficient margin assessment with improved local control of the disease.

OBJECTIVE

To describe the use of MART-1 in treating melanoma with Mohs surgery and serve as a primer for the Mohs surgeon adding melanoma cases to their repertoire.

MATERIALS AND METHODS

Review of the literature and discussion of experience with Mohs for melanoma.

RESULTS

Practical approach and pitfalls when assessing margins using MART-1 immunohistochemistry during Mohs surgery for the treatment of melanoma.

CONCLUSION

Mohs for melanoma is an expanding field—education of Mohs surgeons and increasing the practice of this technique has the potential to improve patient outcomes.