bluuebunny/crossref_metadata_2025 huggingface dataset:
Helium reionization from empirical quasar luminosity functions before and after JWST
Authors: Basu Arghyadeep , Garaldi Enrico , Ciardi Benedetta
Published: June 2024

Recently, models of the quasar luminosity function (QLF) rooted on large observational compilations have been produced that, unlike their predecessors, feature a smooth evolution with time. This bypasses the need to assume an ionizing emissivity evolution when simulating helium reionization with observations-based QLF, thus yielding more robust constraints. We combine one such QLF with a cosmological hydrodynamical simulation and 3D multifrequency radiative transfer. The simulated reionization history is consistently delayed in comparison to most other models in the literature. The predicted intergalactic medium temperature is larger than the observed one at $z \lesssim 3$. Through forward modelling of the He ii Lyman $\alpha$ forest, we show that our model produces an extended helium reionization and successfully matches the bulk of the observed effective optical depth distribution, although it overionizes the Universe at $z\lesssim 2.8$ as the effect of small-scale Lyman Limit Systems not being resolved. We thoroughly characterize transmission regions and dark gaps in He ii Lyman $\alpha$ forest sightlines. We quantify their sensitivity to the helium reionization, opening a new avenue for further observational studies of this epoch. Finally, we explore the implications for helium reionization of the large number of active galactic nuclei revealed at $z\gtrsim 5$ by JWST. We find that such modifications do not affect any observable at $z\le 4$, except in our most extreme model, indicating that the observed abundance of high-z AGNs does not bear consequences for helium reionization.
Cosmological forecast of the void size function measurement from the CSST spectroscopic survey
Authors: Song Yingxiao , Xiong Qi , Gong Yan , Deng Furen , Chan Kwan Chuen , Chen Xuelei , Guo Qi , Han Jiaxin , Li Guoliang , Li Ming , Liu Yun , Luo Yu , Pei Wenxiang , Wei Chengliang
Published: June 2024

Void size function (VSF) contains the information of the cosmic large-scale structure (LSS), and can be used to derive the properties of dark energy and dark matter. We predict the VSFs measured from the spectroscopic galaxy survey operated by China’s Space Survey Telescope (CSST), and study the strength of cosmological constraint. We employ a high-resolution Jiutian simulation to get CSST galaxy mock samples based on an improved semi-analytical model. We identify voids from this galaxy catalogue using the watershed algorithm without assuming a spherical shape, and estimate the VSFs at different redshift bins from $z=0.5$ to 1.1. We propose a void selection method based on the ellipticity, and assume the void linear underdensity threshold $\delta _{\rm v}$ in the theoretical model is redshift-dependent and set it as a free parameter in each redshift bin. The Markov Chain Monte Carlo method is adopted to implement the constraints on the cosmological and void parameters. We find that the CSST VSF measurement can constrain the cosmological parameters to a few per cent level. The best-fitting values of $\delta _{\rm v}$ are ranging from $\sim -0.4$ to $-0.1$ as the redshift increases from 0.5 to 1.1, which has a distinct difference from the theoretical calculation with $\delta _{\rm v}\simeq -2.7$ assuming the spherical evolution and using particles as tracer. Our method can provide a good reference for the void identification and selection in the VSF analysis of the spectroscopic galaxy surveys.
SUMO protease and proteasome recruitment at the nuclear periphery differently affect replication dynamics at arrested forks
Authors: Schirmeisen Kamila , Naiman Karel , Fréon Karine , Besse Laetitia , Chakraborty Shrena , Saada Anissia Ait , Carr Antony M , Kramarz Karol , Lambert Sarah A E
Published: June 2024

Nuclear pore complexes (NPCs) have emerged as genome organizers, defining a particular nuclear compartment enriched for SUMO protease and proteasome activities, and act as docking sites for the repair of DNA damage. In fission yeast, the anchorage of perturbed replication forks to NPCs is an integral part of the recombination-dependent replication restart mechanism (RDR) that resumes DNA synthesis at terminally dysfunctional forks. By mapping DNA polymerase usage, we report that SUMO protease Ulp1-associated NPCs ensure efficient initiation of restarted DNA synthesis, whereas proteasome-associated NPCs sustain the progression of restarted DNA polymerase. In contrast to Ulp1-dependent events, this last function is not alleviated by preventing SUMO chain formation. By analyzing the role of the nuclear basket, the nucleoplasmic extension of the NPC, we reveal that the activities of Ulp1 and the proteasome cannot compensate for each other and affect the dynamics of RDR in distinct ways. Our work probes two distinct mechanisms by which the NPC environment ensures optimal RDR, both controlled by different NPC components.
Resolution of ribosomal stalling by EF-P and ABCF ATPases YfmR and YkpA/YbiT
Authors: Takada Hiraku , Fujiwara Keigo , Atkinson Gemma C , Chiba Shinobu , Hauryliuk Vasili
Published: June 2024

Efficiency of protein synthesis on the ribosome is strongly affected by the amino acid composition of the assembled amino acid chain. Challenging sequences include proline-rich motifs as well as highly positively and negatively charged amino acid stretches. Members of the F subfamily of ABC ATPases (ABCFs) have been long hypothesised to promote translation of such problematic motifs. In this study we have applied genetics and reporter-based assays to characterise the four housekeeping ABCF ATPases of Bacillus subtilis: YdiF, YfmM, YfmR/Uup and YkpA/YbiT. We show that YfmR cooperates with the translation factor EF-P that promotes translation of Pro-rich motifs. Simultaneous loss of both YfmR and EF-P results in a dramatic growth defect. Surprisingly, this growth defect can be largely suppressed though overexpression of an EF-P variant lacking the otherwise crucial 5-amino-pentanolylated residue K32. Using in vivo reporter assays, we show that overexpression of YfmR can alleviate ribosomal stalling on Asp-Pro motifs. Finally, we demonstrate that YkpA/YbiT promotes translation of positively and negatively charged motifs but is inactive in resolving ribosomal stalls on proline-rich stretches. Collectively, our results provide insights into the function of ABCF translation factors in modulating protein synthesis in B. subtilis.
Genome-wide polygenic risk scores predict risk of glioma and molecular subtypes
Authors: Nakase Taishi , Guerra Geno A , Ostrom Quinn T , Ge Tian , Melin Beatrice S , Wrensch Margaret , Wiencke John K , Jenkins Robert B , Eckel-Passow Jeanette E ,   Glioma International Case-Control Study (GICC), Bondy Melissa L , Francis Stephen S , Kachuri Linda
Published: June 2024

Background

Polygenic risk scores (PRS) aggregate the contribution of many risk variants to provide a personalized genetic susceptibility profile. Since sample sizes of glioma genome-wide association studies (GWAS) remain modest, there is a need to efficiently capture genetic risk using available data.

Methods

We applied a method based on continuous shrinkage priors (PRS-CS) to model the joint effects of over 1 million common variants on disease risk and compared this to an approach (PRS-CT) that only selects a limited set of independent variants that reach genome-wide significance (P < 5 × 10–8). PRS models were trained using GWAS stratified by histological (10 346 cases and 14 687 controls) and molecular subtype (2632 cases and 2445 controls), and validated in 2 independent cohorts.

Results

PRS-CS was generally more predictive than PRS-CT with a median increase in explained variance (R2) of 24% (interquartile range = 11–30%) across glioma subtypes. Improvements were pronounced for glioblastoma (GBM), with PRS-CS yielding larger odds ratios (OR) per standard deviation (SD) (OR = 1.93, P = 2.0 × 10–54 vs. OR = 1.83, P = 9.4 × 10–50) and higher explained variance (R2 = 2.82% vs. R2 = 2.56%). Individuals in the 80th percentile of the PRS-CS distribution had a significantly higher risk of GBM (0.107%) at age 60 compared to those with average PRS (0.046%, P = 2.4 × 10–12). Lifetime absolute risk reached 1.18% for glioma and 0.76% for IDH wildtype tumors for individuals in the 95th PRS percentile. PRS-CS augmented the classification of IDH mutation status in cases when added to demographic factors (AUC = 0.839 vs. AUC = 0.895, PΔAUC = 6.8 × 10–9).

Conclusions

Genome-wide PRS has the potential to enhance the detection of high-risk individuals and help distinguish between prognostic glioma subtypes.
Personal protective equipment impacts firefighters’ anaerobic fitness
Authors: Papadakis Z , Stamatis A , Beitia P
Published: June 2024

Background

Personal protective equipment (PPE) is vital for firefighters’ safety and effectiveness during daily operations. However, concerns have emerged about its potential impact on firefighters’ anaerobic fitness (AF), which is crucial for their operational readiness. The Physical Ability Test (PAT) is used to assess readiness, but there is inconsistency among fire departments regarding whether PAT is conducted with full PPE or regular exercise clothing. This variation in testing conditions may exacerbate the stress on firefighters’ AF.

Aims

To analyse differences in firefighters’ AF performance while wearing full PPE compared to regular exercise clothing.

Methods

We studied two cohorts totalling 62 firefighters from specific fire departments in South Florida. We conducted occupation-specific AF tests, including handgrip dynamometry (HG), vertical jump (VJ), Margaria–Kalamen (MK), and a 300-yard shuttle run (300YD), both with full PPE (WPPE) and without PPE (NPPE). We adjusted AF variables for body weight (e.g. NPPE) and occupational weight (e.g. WPPE) and used a repeated-measures design in Jamovi (P < 0.05).

Results

Wearing WPPE significantly reduced relative HG strength by 59%, VJ peak power by 11%, and MK mean power by 49%, while increased 300YD completion time by 18%.

Conclusions

The study reveals that PPE substantially impairs firefighters’ anaerobic performance during occupation-specific tests. This emphasizes the need for tailored AF training programs to support the anaerobic system and related performance while wearing PPE, acknowledging the significance of occupational specificity in assessing firefighters’ fitness components.
The Role of Latent Heat Buffering in the Generation of High-Silica Rhyolites
Authors: Tavazzani Lorenzo , Economos R C , Peres Stefano , Demarchi Gabriella , Sinigoi Silvano , Bachmann O
Published: June 2024

The physical process of crystal-melt separation is responsible for the accumulation of small to very large volumes (>100 km3) of eruptible rhyolitic melt in the shallow crust. Granitic intrusions, although providing a terminal, time-integrated image of melt segregation processes, host an unmatched record of the physical properties controlling mechanisms and rates of interstitial melt extraction from a crystal-rich source. We applied mass balance calculations and thermodynamic modeling simulations to an extensive bulk rock geochemistry dataset (>150 samples) collected in a Permian upper-crustal granitoid intrusion of the Italian Southern Alps. Textural and geochemical evidence indicate that this intrusion constituted a single, zoned magma body, with a crystal-rich base and a thick (~2 km), high-silica cap (75–77 wt% SiO₂). The large compositional variability of the crystal-rich materials suggests variable degrees of melt extraction efficiency and corresponding terminal porosities. Specifically, the loosely bimodal distribution of porosity values (φ) indicates that at least two distinct melt segregation mechanisms were operating in this system, which produced both high (0.65–0.45) and low terminal porosities (0.45–0.25) in the crystal-rich, cumulate materials. Modeling of latent heat budget shows that coexistence of cumulate products with differing terminal porosity signature can be explained by melt segregation processes taking place at different depths across a thick, interconnected magmatic reservoir with an initial homogenous water content (~4 wt% H2O). Deep in the mush column, low water activities (aH₂O < 0.5) promoted thermal buffering of cooling magma at high crystallinities, enabling residual melt extraction by percolation through a crystalline framework accompanied by compaction. Instead, at shallower depths, high water activities (aH₂O > 0.5) ensured prolonged magma residence at porosities that promoted crystal melt separation via hindered settling. Distinct melt extraction processes, acting synchronously but at different depths in vertically extensive silicic mush columns, can account for the large volumes of residual, haplogranitic melt mobilized during the relatively short lifespan of upper crustal magma reservoirs (~105 years).
The Transatlantic Relationship and the Russia-Ukraine War
Authors: Anghel Veronica , Jones Erik
Published: June 2024

The Russia-Ukraine war triggered a new burst of solidarity across the Atlantic. The reactivation of the battered NATO alliance came easily under the pressure of an external shock. Yet, pulling together to react to Russia's belligerence is not sufficient to announce a new era of transatlantic partnership. The reason lies in the different interests that underpin American and European policies such as reliance on economic sanctions, the promotion of democracy, NATO strategy towards Russia, and economic coordination. Loosely sharing common values is not enough to reinforce the transatlantic relationship. Neither is a decision to stop the atrocities that Russia is committing against Ukrainians. Western leadership requires a coherent vision of Western interests. In the new world order, such coherence cannot be taken for granted.
Can Public Policy Influence Public Opinion? Studying Feedback Effects and Elite Influence Using the Affordable Care Act
Authors: Sances Michael W
Published: June 2024

Political elites often claim that the passage of new public programs will shift the political debate by influencing public opinion. These expectations also motivate elites to engage in messaging that they believe will further shape public opinion toward these new programs. In Stable Condition, Daniel J. Hopkins subjects these beliefs—and their social science analogues of policy feedback and opinion leadership—to rigorous and exhaustive scrutiny in a comprehensive assessment of how the Affordable Care Act (ACA) affected public opinion. Contrary to much of the elite and scholarly consensus, Hopkins finds little or no effect of the ACA or its attendant messaging wars on public opinion. In this essay, I highlight what I see as some of the key contributions of the book to the literature on policy feedbacks. One of these contributions is the strength of the empirical analysis, which convinces me that the author's conclusions about the ACA's limited effects are correct. In the latter part of the review, however, I question how much we can learn about feedback effects in general from this particular case, given the strategic considerations that informed the ACA's passage. Last, I re-evaluate the book's conclusions of opinion stability given longer-term trends in both policy and opinion.
Optimal initial duration of low molecular weight heparin lead-in before direct oral anticoagulants for short-term outcomes of hospitalized patients with non-high-risk acute pulmonary embolism
Authors: Zhao Y , Cheng Y , Yao Q , Qu J , Luo Y , Du H , Sun J , Liu S , Xu M , Wu X , Xiong W
Published: June 2024

Background

There are currently three strategies for the duration of low molecular weight heparin (LMWH) lead-in before direct oral anticoagulants (DOACs) in patients with acute pulmonary embolism (PE): one is at least 5 days, the other is at least 3 days and the last one is less than 3 days. Which one is the best is yet unknown.

Aim

To explore optimal initial duration of LMWH lead-in before DOACs for short-term outcomes of hospitalized patients with non-high-risk acute PE.

Design

Retrospective observational cohort study using propensity score matching.

Methods

We divided non-high-risk PE patients into short-LMWH (LMWH <3 days), intermediate-LMWH (LMWH 3-5 days) and long-LMWH (LMWH >5 days) groups, in a 1:1:2 ratio by using propensity score matching. Primary outcomes were a composite of mortality including all-cause and PE-related mortality, VTE recurrence and major bleeding, as well as each one of them, at 3-month after PE diagnosis.

Results

The short-LMWH group (N = 504) had higher 3-month composite primary outcome (129 [25.6%] vs. 67 [13.3%], P < 0.001), all-cause mortality (112 [22.2%] vs. 39 [7.7%], P < 0.001) and PE-related mortality (48 [9.5%] vs. 17 [3.4%], P < 0.001), than the intermediate-LMWH group (N = 504). The short-LMWH group also had higher 3-month composite primary outcome (129 [25.6%] vs. 151 [15.0%], P < 0.001), all-cause mortality (112 [22.2%] vs. 90 [8.9%], P < 0.001) and PE-related mortality (48 [9.5%] vs. 41 [4.1%], P < 0.001) than the long-LMWH group (N = 1008). The VTE recurrence and major bleeding rates were similar between the short-LMWH and intermediate-LMWH groups, and between the short-LMWH and long-LMWH groups. The intermediate-LMWH and long-LMWH groups had similar 3-month primary outcomes rates in whole or in part with each other.

Conclusions

For patients with non-high-risk acute PE, the optimal duration of initial LMWH lead-in before switching to DOACs could be 3–5 days.
Feedback and Learning: The Causal Effects of Reversals on Judicial Decision-Making
Authors: Bhuller Manudeep , Sigstad Henrik
Published: June 2024

Do judges respond to reversals of their decisions? Using random assignment of cases across two stages of the criminal justice system in Norway and a novel dataset linking trial court decisions to reversals in appeals courts, we provide causal evidence on feedback effects in judicial decision-making. By exploiting differences in the tendencies of randomly assigned appeal panels to reverse trial court decisions, we show that trial court judges who receive a reversal of a sentence respond by updating the likelihood of imposing a prison sentence in the direction of the reversal in future cases. Consistent with a Bayesian learning model, we find that the responses are stronger for judges with weaker priors and for reversals corresponding to stronger signals. Our estimates, however, also indicate that judges overreact to reversals compared to Bayes’ rule.
Emerging insights into macrophage extracellular traps in bacterial infections
Authors: Baz Ahmed Adel , Hao Huafang , Lan Shimei , Li Zhangcheng , Liu Shuang , Jin Xiangrui , Chen Shengli , Chu Yuefeng
Published: June 2024

Macrophages possess a diverse range of well‐defined capabilities and roles as phagocytes, encompassing the regulation of inflammation, facilitation of wound healing, maintenance of tissue homeostasis, and serving as a crucial element in the innate immune response against microbial pathogens. The emergence of extracellular traps is a novel strategy of defense that has been observed in several types of innate immune cells. In response to infection, macrophages are stimulated and produce macrophage extracellular traps (METs), which take the form of net‐like structures, filled with strands of DNA and adorned with histones and other cellular proteins. METs not only capture and eliminate microorganisms but also play a role in the development of certain diseases such as inflammation and autoimmune disorders. The primary objective of this study is to examine the latest advancements in METs for tackling bacterial infections. We also delve into the current knowledge and tactics utilized by bacteria to elude or endure the effects of METs. Through this investigation, we hope to shed light on the intricate interactions between bacteria and the host's immune system, particularly in the context of microbicidal effector mechanisms of METs. The continued exploration of METs and their impact on host defense against various pathogens opens up new avenues for understanding and potentially manipulating the immune system's response to infections.
Gallbladder torsion
Authors: Hamblin Hayley M. , Goel Amitabh , Pennington Jared R.
Published: June 2024

Gallbladder torsion is a rare cause of acute surgical abdomen. Early recognition and surgical intervention are important for reducing complications and improving postoperative patient outcomes, but standard imaging and laboratory evaluation typically are indistinguishable from those of acute cholecystitis. This article describes a patient with gangrenous cholecystitis secondary to torsion and summarizes recommendations for evaluation and management.
Mitigating Persistent Symptoms Following Rehabilitation in Musculoskeletal Disorders
Authors: Dupuis Frédérique , Roy Jean-Sébastien , Lachance Anthony , Tougas Arielle , Gagnon Martine , Marier-Deschênes Pascale , Pinard Anne Marie , Massé-Alarie Hugo
Published: June 2024

Background:

The majority of patients with musculoskeletal pain (62% to 64%) achieve their treatment goals upon completing rehabilitation. However, a high re-consultation rate after discharge is frequently reported. Numerous authors have recognized the necessity of secondary prevention programs (after-discharge strategy) to ensure that the gains are maintained or further pursued after the completion of a rehabilitation program. Little is known about the different strategies currently in use, and a detailed review of the existing strategies is needed for future integration into the healthcare systems.

Objective:

This review systematically scopes and synthesizes the after-discharge strategies reported in the literature following rehabilitation for individuals experiencing musculoskeletal pain.

Methods:

Four databases (OVID MEDLINE, EMBASE, Web of Sciences, and OVID PsycInfo) were screened from their inception until May 4, 2023. Literature search, screening, and extraction were performed according to the PRISMA extension for scoping review guidelines.

Results:

Different after-discharge strategies were identified and grouped into 2 main categories: (1) in-person and (2) remote strategies. In-person strategies included (1.1) in-person booster sessions and (1.2) the use of existing community programs after discharge. Remote strategies included remote strategies that (2.1) involve a health care professional service or (2.2) strategies that do not involve any health care professional service.

Discussion:

We identified various after-discharge strategies designed to sustain gains and improve patients’ self-management skills following the completion of a rehabilitation program. The existence of numerous promising strategies suggests their potential suitability for various contexts.
Short-term Outcomes of Pancreatoduodenectomy in Patients with Liver Cirrhosis: A Systematic Review and Meta-analysis
Authors: Hajibandeh Shahab , Hajibandeh Shahin , Puthiyakunnel Saji Alwin , Ashabi Ayman , Brown Christopher , Mowbray Nicholas G , Mortimer Matthew , Shingler Guy , Kambal Amir , Al-Sarireh Bilal
Published: June 2024

Objectives:

The objective of this study was to compare short-term outcomes of pancreatoduodenectomy between patients with and without liver cirrhosis (LC).

Background:

It is not uncommon to encounter a patient with LC and with an indication for pancreatoduodenectomy; however, the knowledge on the outcomes after pancreatoduodenectomy in patients with LC is poorly developed.

Methods:

A systematic review and meta-analysis was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards. Short-term outcomes of pancreatoduodenectomy between patients with and without LC were compared using random effects modeling and the certainty of the evidence was assessed using the GRADE system.

Results:

Analysis of 18,184 patients from 11 studies suggested LC increased the risk of postoperative mortality (odds ratio [OR]: 3.94, P < 0.00001), major complications (OR: 2.25, P = 0.0002), and pancreatic fistula (OR: 1.73, P = 0.03); it resulted in more blood loss (mean difference [MD]: 204.74 ml, P = 0.0003) and longer hospital stay (MD: 2.05 days, P < 0.00001). LC did not affect delayed gastric emptying (OR: 1.33, P = 0.21), postoperative bleeding (OR: 1.28, P = 0.42), and operative time (MD: 3.47 minutes, P = 0.51). Among the patients with LC, Child-Pugh B or C class increased blood loss (MD: 293.33 ml, P < 0.00001), and portal hypertension increased postoperative mortality (OR: 2.41, P = 0.01); the other outcomes were not affected.

Conclusions:

Robust evidence with high certainty suggests LC of any severity with or without portal hypertension results in at least a fourfold increase in mortality and a twofold increase in morbidity after pancreatoduodenectomy. Whether such risks increase with the severity of the liver disease or decrease with optimization of underlying liver disease should be the focus of future research.
The Role of Routine Pathologic Assessment After Pediatric Osteochondroma Excision
Authors: Wall Lindley B. , Clever David , Wessel Lauren E. , McDonald Douglas J. , Goldfarb Charles A.
Published: June 2024

Background:

Osteochondromas are benign osseous lesions often excised for pain, growth abnormalities, and aesthetic concerns. While characteristic clinical and radiographic features leave little diagnostic ambiguity in most cases of osteochondroma, pathologic analysis to confirm the diagnosis and screen for malignancy is routinely performed following surgical excision. The purpose of this study was to determine the clinical and economic value of routine pathologic analysis after osteochondroma excision in a pediatric population.

Methods:

A retrospective review of clinical records from 2 pediatric orthopaedic hospitals (St. Louis Children’s Hospital and Shriner’s Hospital for Children, St. Louis) identified 426 osteochondroma lesions surgically resected from 201 patients. Patients with solitary and multiple lesions were included. Clinical, radiographic, and surgical data were recorded for each resection surgery. Pathologic reports were evaluated. Costs incurred for routine pathologic assessment was also noted.

Results:

Totally, 132 patients were treated with surgical resection of a solitary osteochondroma lesion, while an additional 291 lesions were resected from 69 patients with multiple lesions. Average age at the time of surgical resection was 13.0 years (2.1 to 17.9). The most common anatomic locations of excised lesions included the distal femur (110, 25.8%), proximal tibia/fibula (95, 22.3%), and distal radius/ulna (58, 13.6%). All resected specimens were sent for pathologic analysis. The average size of the resected lesions was 19.9 mm3 (0.02 to 385.0 mm3). In all cases, the histologic diagnosis confirmed benign osteochondroma. The total charges of pathologic analysis including processing and interpretation fees was ∼$755.00 for each lesion assessed, for a total cohort charge of $321,630.

Conclusion:

We propose that in most cases of pediatric osteochondroma excision procedures, postoperative histologic analysis is not strictly indicated as it rarely, if ever, alters diagnosis or management. We suggest using a “gross only” analysis in these cases. However, we do believe that with preoperative diagnostic ambiguity, or if patients present with concerning features such as rapidly expansile lesions or cortical destruction, have axial skeleton or pelvic involvement, or enlarged cartilaginous caps, full histologic evaluation of the excised lesions will continue to be prudent.

Level of Evidence:

Level IV—case series.
Ideal Lumbar Lordosis Correction in Patients with Adult Spinal Deformity Without Adversely Impacting Pelvic Tilt and Pelvic Incidence Minus Lumbar Lordosis
Authors: Park Se-Jun , Park Jin-Sung , Kang Dong-Ho , Lee Chong-Suh
Published: June 2024

Study Design.

Retrospective study.

Objectives.

To determine the ideal pelvic incidence (PI) – lumbar lordosis (LL) range to prevent pelvic tilt (PT) undercorrection while avoiding PI-LL overcorrection following adult spinal deformity (ASD) surgery.

Summary of Background.

PI-LL and PT are the important sagittal parameters to be restored to an adequate range by surgery. Ideal PI-LL target without causing PI-LL overcorrection and PT undercorrection has not been documented.

Methods.

We included patients with ASD undergoing ≥5-level fusion including the sacrum. Receiver operating characteristic (ROC) curve analysis was performed to calculate the lower limit of the ideal PI-LL without causing PI-LL overcorrection and the upper limit of ideal PI-LL without causing PT undercorrection. The calculated ideal PI-LL was validated in terms of proximal junctional kyphosis and failure (PJK and PJF) rates and clinical outcomes. Analyses were performed according to age subgroups (<70 and ≥70 y).

Results.

In total, 426 patients were included in the study. Female patients were predominant (85.4%), with a mean age of 69.8 years. The lower limits of PI-LL were calculated as 4.9° for all patients, 2.3° for patients aged <70 years, and 7.9° for patients aged ≥70 years. Meanwhile, the upper limits of PI-LL were calculated as 12.7° for all patients, 12.5° for patients aged <70 years, and 13.3° for patients aged ≥70 years. There were no significant differences in the PJK and PJF rates among the new three PI-LL groups. Clinical outcomes were significantly better in patients with the ideal PI-LL group than those in patients with overcorrection or undercorrection groups for all age groups.

Conclusion.

The ideal PI-LL correction target without adversely impacting PT and PI-LL was calculated at 2.3°–12.5° for patients aged <70 years and 7.9°–13.3° for patients aged ≥70 years. These guideline parameters may help ensure optimal clinical outcomes without increasing the risk of PJK/F.
Obesity Does Not Negatively Affect Patient-perceived Outcomes After Cervical Disc Replacement for Disc Herniation
Authors: Anwar Fatima N. , Roca Andrea M. , Loya Alexandra C. , Medakkar Srinath S. , Hartman Timothy J. , Nie James W. , MacGregor Keith R. , Oyetayo Omolabake O. , Zheng Eileen , Federico Vincent P. , Massel Dustin H. , Sayari Arash J. , Lopez Gregory D. , Singh Kern
Published: June 2024

Study Design:

Retrospective review.

Objective:

To assess the impact of Body Mass Index (BMI) on patient-reported outcome measures (PROMs) after cervical disc replacement (CDR).

Background:

BMI may affect PROMs after spine surgery.

Methods:

Primary CDR recipients for herniated disc(s) with BMI <40 were retrospectively selected from a single-surgeon registry. Cohorts were divided into non-obese (BMI <30) and obese (BMI ≥30). Intercohort in-hospital complication rates were compared through independent samples t tests. Pre/postoperative PROMs were compared between cohorts through multivariable regression accounting for demographic differences. Final follow-up dates between patients averaged 11.8 ± 9.3 months. PROMs assessed included Patient-reported Outcomes Measurement Information System–Physical Function, Neck Disability Index, Visual Analog Scale–Neck, Visual Analog Scale–Arm, and the 9-item Patient Health Questionnaire. Improvements in PROMs were evaluated and compared at each follow-up within cohorts through paired t tests. The magnitude of improvement in PROMs from preoperative baseline at 6-week follow-up (∆PROM-6W) and final follow-up (∆PROM-FF) along with achievement rates of minimum clinically important differences were compared between cohorts through multivariable regression accounting for demographic differences.

Results:

Of 153 patients, 53 patients were noted as obese. Demographic differences included age, prevalence of hypertension and diabetes, and comorbidity burden scores (P ≤ 0.011, all). No significant variations in in-hospital complications were found. The non-obese cohort demonstrated improvements in all PROMs at 6 weeks and final follow-up periods (P ≤ 0.005, all). The obese cohort demonstrated improvements in all postoperative PROMs besides 9-item Patient Health Questionnaire at 6 weeks (P ≤ 0.015, all). After accounting for age and comorbidity variations, there were no significant intercohort differences in raw PROM scores, ∆PROM-6W, ∆PROM-FF, or minimum clinically important difference achievement rates.

Conclusions:

Regardless of BMI, patients experience significant improvements in physical function, disability, pain, and mental health after CDR for disc herniation. Patients with obesity do not suffer inferior patient-perceived outcomes after CDR. These findings may help surgeons counsel patients in the preoperative period.
Prevalence of chronic diarrhea and its association with obesity in a Chinese community-based population
Authors: Han Ke , Wang Xiangyao , Wang Yan , Niu Xiaotong , Xiang Jingyuan , Ru Nan , Jia Chunxu , Sun Hongyi , He Zhengting , Feng Yujie , Linghu Enqiang
Published: June 2024

Background:

Epidemiological data on chronic diarrhea in the Chinese population are lacking, and the association between obesity and chronic diarrhea in East Asian populations remains inconclusive. This study aimed to investigate the prevalence of chronic diarrhea and its association with obesity in a representative community-dwelling Chinese population.

Methods:

This cross-sectional study was based on a multistage, randomized cluster sampling involving 3503 residents aged 20–69 years from representative urban and rural communities in Beijing. Chronic diarrhea was assessed using the Bristol Stool Form Scale (BSFS), and obesity was determined based on body mass index (BMI). Logistic regression analysis and restricted cubic splines were used to evaluate the relationship between obesity and chronic diarrhea.

Results:

The standardized prevalence of chronic diarrhea in the study population was 12.88%. The average BMI was 24.67 kg/m2. Of all the participants, 35.17% (1232/3503) of participants were classified as overweight and 16.13% (565/3503) as obese. After adjustment for potential confounders, individuals with obesity had an increased risk of chronic diarrhea as compared to normal weight individuals (odds ratio = 1.58, 95% confidence interval: 1.20–2.06). A nonlinear association between BMI and the risk of chronic diarrhea was observed in community residents of males and the overall participant group (P = 0.026 and 0.017, respectively).

Conclusions:

This study presents initial findings on the prevalence of chronic diarrhea among residents of Chinese communities while offering substantiated evidence regarding the significant association between obesity and chronic diarrhea. These findings offer a novel perspective on gastrointestinal health management.
PRAME and Historical Immunohistochemical Antibodies Ki-67, P16, and HMB-45 in Ambiguous Melanocytic Tumors
Authors: Mert Merve , Bozdogan Onder , Bozdogan Nazan , Gamsızkan Mehmet , Safali Mukerrem
Published: June 2024

Ambiguous melanocytic lesions/tumors (AMLs) can be simply described as melanocytic neoplasms that cannot be differentiated as either a melanoma or a nevus. Preferentially expressed antigen in melanoma (PRAME) is a novel antibody that can help differentiate between nevi and melanomas. However, its usefulness remains controversial in AMLs. The aim of this study was to demonstrate the importance of PRAME and diagnostic auxiliary antibodies (Ki-67, p16, HMB-45) in the diagnosis of melanocytic lesions, especially in AMLs. This study included 52 ambiguous melanocytic lesions, 40 nevi, and 40 melanomas. All immunohistochemical studies were performed automatically using the Universal Alkaline Phosphatase Red Detection Kit. Different analytic approaches were used for each antibody based on the literature. Statistically, the multinomial forward stepwise elimination logistic regression analysis was used to create a statistical model to predict the diagnosis of melanocytic lesions based on clinical, morphological, and immunohistochemical data. PRAME positivity was very strong and diffuse in the melanoma group and statistically significantly higher than that of the AML and nevus groups. There was no statistically significant difference between the nevus and AML groups. The Ki-67 proliferation index and HMB-45 staining pattern provided valuable indications for distinguishing between these 3 groups. The P16 antibody was limited in supporting the differential diagnosis. Our statistical model showed that a high mitosis count, central pagetoid spread, and PRAME positivity increased the probability of melanoma against an AML diagnosis. This study showed the advantages of evaluating the PRAME antibody together with morphological features and other immunohistochemical markers (Ki-67 and HMB-45) in the differential diagnosis of melanocytic lesions.
Neuromuscular blocking agent drug challenge: a literature review and protocol proposal with biological evaluation
Authors: Gouel-Chéron Aurélie , Neukirch Catherine , Chollet-Martin Sylvie , Valent Arnaud , Plaud Benoit , Longrois Dan , Nicaise-Roland Pascale , Montravers Philippe , de Chaisemartin Luc
Published: June 2024

BACKGROUND

Drug challenge is the gold standard for identifying causative agents of drug allergies. Although clinical guidelines have recently been published, they do not recommend neuromuscular blocking agent (NMBA) drug challenges. NMBA challenges are rendered difficult by the lack of homogeneity of routine allergy work-ups and the necessity of a specialised setting. Several scenarios support NMBA challenges, such as an ambiguous allergy work-up, a high suspicion of a false-positive skin test or identification of a well tolerated alternative NMBA strategy. Furthermore, routine allergy work-ups may not recognise non-IgE mechanisms, such as IgG or MRGPRX2, whereas drug challenges may reveal them. Finally, if the culprit NMBA is not identified, subsequent anaesthesia regimens will be challenging to implement, resulting in increased risk.

OBJECTIVE(S)

This literature review discusses the indications, strategies, doses, monitoring methods, limitations, and unresolved issues related to drug challenges for NMBAs.

DESIGN

The literature review included randomised controlled trials, observational studies, reviews, case reports, series, and comments on humans.

DATA SOURCES

Studies were retrieved from databases (PubMed) and electronic libraries (OVID, EMBASE, Scopus, etc.).

ELIGIBILITY CRITERIA

All studies that referred to the NMBA challenge were included without publication date limitations.

RESULTS

NMBA challenge may be considered in NMBA anaphylaxis patients with inconclusive or ambivalent IgE diagnostic work-up under controlled conditions (presence of anaesthetists and allergists with continuous monitoring in a secured environment). To illustrate its utility, a case report of a double NMBA challenge in a patient with NMBA cross-reactivity is presented, along with biological explorations to detect subclinical cellular activation, a novel aspect of this procedure.

CONCLUSION

Drug challenges could be implemented during the NMBA allergy work-up under strict safety conditions at specialised centres with close collaboration between anaesthetists and allergists. This could decrease uncertainty and contribute to defining a safer strategy for subsequent anaesthetic drug regimens.
Arterial stiffness assessment by pulse wave velocity in postmenopausal women: comparison between noninvasive devices
Authors: Bohn Lucimere , Rial-Vázquez Jessica , Nine Iván , Rúa-Alonso María , Fariñas Juan , Giráldez-García Manuel Avelino , Mota Jorge , Iglesias-Soler Eliseo
Published: June 2024

Objective

This study aimed to ascertain the accuracy of measure arterial stiffness using the HUAWEI GT 3 Pro smartwatch and pOpmètre device against the SphygmoCor (algorithms: intersect tangent and maximum of the second derivate).

Methods

Twenty-three physically active postmenopausal women (age: 58.9 ± 3.2 years; body mass index: 26.3 ± 4.8 kg/m2) were recruited. Carotid-femoral pulse wave velocity, finger-toe pulse wave velocity, and wrist-finger pulse wave velocity were obtained using SphygmoCor, pOpmètre and HUAWEI GT 3 Pro devices in a randomized order. Additionally, the pulse mean carotid-femoral and finger-toe pulse transit time was registered for SphygmoCor and pOpmètre, respectively.

Results

Lower values of pulse wave velocity were recorded by HUAWEI in comparison with SphygmoCor with both algorithms, whereas no significant differences were detected between SphygmoCor and pOpmètre results. Pulse wave velocity values from SphygmoCor were positively correlated with pOpmètre results (r = 0.464 and r = 0.451 using intersect tangent and second derivative algorithms), whereas this was not the case with those obtained from HUAWEI. Coefficients of bias of Lin's concordance coefficients close to 1 (0.832 and 0.831 for intersect tangent and second derivative algorithm, respectively) and mean bias close to 0 from Bland-Altman analysis suggested an acceptable agreement between pulse wave velocity obtained from SphygmoCor and pOpmètre.

Conclusions

Our results suggest an acceptable concordance of pulse wave velocity values recoded by SphygmoCor and pOpmètre, whereas this was not the case for data obtained from HUAWEI GT 3 Pro smartwatch. Therefore, the pOpmètre may be a viable alternative for assessing arterial stiffness, but measurement via the smartwatch device cannot be recommended.
Sleep disturbance associated with the menopause
Authors: Maki Pauline M. , Panay Nick , Simon James A.
Published: June 2024

Importance and objectives

Sleep disturbance is one of the most common and debilitating symptoms experienced by women during the menopause transition. However, there are currently no therapies specifically approved for sleep disturbance associated with the menopause. Here, we consider how to characterize sleep disturbance associated with the menopause and discuss its etiology, including the latest advances in our understanding of the neuronal circuits that regulate reproduction, body temperature, sleep, and mood; and reflect on its impact on women's health and well-being. We also examine the current treatment landscape and look to the future of treatment for this condition.

Methods

We conducted a review of the literature and combined this with discussion with experts in the fields of sleep and menopause as well as experiences from our own clinical practices.

Discussion and conclusions

Sleep disturbance associated with the menopause is characterized by frequent night-time awakenings and increased awake time after sleep onset. Its impacts are wide-ranging, negatively affecting health as well as personal and social relationships, productivity, and work performance. There is currently an unmet need for effective, safe, and well-tolerated treatments to address this important symptom, and wider recognition of the association between sleep disturbances and the menopause is needed. Sleep disturbances associated with the menopause can result from hormone changes as well as vasomotor and mood symptoms. Growing research has contributed to our knowledge of the role of hypothalamic estrogen-sensitive kisspeptin/neurokinin B/dynorphin neurons. These neurons are thought to integrate the gonadotropin-releasing hormone pathway and the pathways responsible for the homeostatic control of body temperature and the circadian regulation of sleep-wake cycles. Understanding these neurons offers the potential to create treatments that target a key cause of sleep disturbance associated with the menopause. Further research to understand their etiology and characterize the neuronal circuits responsible could benefit the development of these targeted treatment approaches.
Suture Packaging as a Marker for Intraoperative Image Alignment in Augmented Reality on Mobile Devices
Authors: Necker Fabian N. , Cholok David J. , Shaheen Mohammed S. , Fischer Marc J. , Gifford Kyle , Le Castillo Chris , Scholz Michael , Leuze Christoph W. , Daniel Bruce L. , Momeni Arash
Published: June 2024

Preoperative vascular imaging has become standard practice in the planning of microsurgical breast reconstruction. Currently, translating perforator locations from radiological findings to a patient’s abdomen is often not easy or intuitive. Techniques using three-dimensional printing or patient-specific guides have been introduced to superimpose anatomy onto the abdomen for reference. Augmented and mixed reality is currently actively investigated for perforator mapping by superimposing virtual models directly onto the patient. Most techniques have found only limited adoption due to complexity and price. Additionally, a critical step is aligning virtual models to patients. We propose repurposing suture packaging as an image tracking marker. Tracking markers allow quick and easy alignment of virtual models to the individual patient’s anatomy. Current techniques are often complicated or expensive and limit intraoperative use of augmented reality models. Suture packs are sterile, readily available, and can be used to align abdominal models on the patients. Using an iPad, the augmented reality models automatically align in the correct position by using a suture pack as a tracking marker. Given the ubiquity of iPads, the combination of these devices with readily available suture packs will predictably lower the barrier to entry and utilization of this technology. Here, our workflow is presented along with its intraoperative utilization. Additionally, we investigated the accuracy of this technology.
Feasibility of BrainSTORM, a Traumatic Brain Injury Transitional Care Intervention
Authors: Loflin Callan , Cheever C. Ray , You HyunBin , Oyesanya Tolu O.
Published: June 2024

Objective: To investigate the feasibility, acceptability, and clinical outcome measures of a transitional care intervention for patients with traumatic brain injury (TBI) and their family caregivers. Setting: Inpatient and outpatient rehabilitation at a level I trauma center in the Southeastern United States. Participants: Patients (ages 18-75) diagnosed with moderate to severe TBI, receiving rehabilitation, and their family caregivers. Design: Quasi-experimental, single-arm, single-center feasibility study with pre- and post-test design. Participants completed a 4-month transitional care program involving monthly education and social support. Main measures: Feasibility of enrollment, data collection, intervention completion rates, and intervention acceptability. Clinical outcome measures included patient quality of life (QOL) (12-Item Short Form Health Survey (SF-12), primary outcome) and patient and caregiver self-efficacy (Self-Efficacy for Management of Chronic Conditions Scale). Results: Eleven dyads and 1 monad enrolled (N = 23, 12 patients, 11 caregivers). All completed baseline data; 91.3% (n = 21, 11 patients, 10 caregivers) completed 2-month (intervention midpoint) data; and 86% (n = 20, 11 patients, 9 caregivers) completed 4-month (intervention endpoint) data. The intervention completion rate was 91.67%. Participants engaged in a mean of 2.17 (SD = 1.34) monthly educational webinars and 2.42 (SD = 1.51) social support groups during the intervention period. Approximately 70% of participants (n = 16, 9 patients, 7 caregivers) completed acceptability data, indicating positive intervention experiences (patients: mean 9.44/10 [SD = 1.01]; caregivers: mean 9.57/10 [SD = 0.79]). Patient QOL scores did not statistically improve over time; however, patient self-efficacy scores did statistically significantly improve from baseline (mean = 7.03, SD = 1.53; P = .0197) to intervention end point (4 months) (mean = 8.35, SD = 1.71). Conclusion: Brain Injury Support To Optimize Recovering Minds (BrainSTORM) is a promising new TBI transitional care intervention that has potential to enhance care standards for patients with TBI and their family caregivers. Further research is needed to determine its efficacy.