bluuebunny/crossref_metadata_2025 huggingface dataset:
Application of CVOFLS method in multi vortex shear flow field
Authors: Cui Liying , Yang Yingge , Ren Cuiping
Published: March 2023

Coupled Volume of Fluid and Level Set method inherits the advantages of VOF and Level Set methods, takes VOF function as the main body to simulate the fluid motion interface, and corrects the normal direction of the interface through Level Set function, so as to effectively overcome the shortcomings of the two methods. The numerical simulation example of multi vortex shear flow field shows that this method can ensure better simulation accuracy of moving interface and higher calculation efficiency.
A Numerical Investigation of Tidal Disruption Rate Enhancement in Post-Starburst galaxies
Authors: Xue Marco Tinyeung , Xie Fuguo
Published: March 2023

Tidal disruption is an uncommon but important phenomenon that occurs when a star’s gravity is overcome by that of the SMBH which it is orbiting. In this process, researchers may gleam various properties of the host galaxy’s nucleic region, such as the accretion process, debris fallback, behavior of active galactic nuclei and quasars, etc. In this work we present a numerical analysis of TDE rates using the loss cone theory, a leading theoretical picture in this field, based on changes to several pivotal variables, such as SMBH mass, stellar mass, velocity dispersion etc. We then extend this to fit the profiles of E+A post starburst galaxies and the occasion of binary black hole systems.
Method of using theodolite’s observation data of fixed star to evaluate INS’s attitude accuracy based on time-delay compensation
Authors: Kong Xianglong , Liu Chenghao , Wu Xingcun , Liu Kecheng , Liang Junhao
Published: March 2023

In order to evaluate the attitude accuracy of the TT&C’s SINS under dynamic condition, a new method of using theodolite’s observation data of fixed star to evaluate SINS’s attitude accuracy based on time-delay compensation is proposed. The detailed design is given, and the influence of the time delay is analyzed based on real data experiments. The data analysis and experimental results shows that the new method can improve the computation accuracy, and it is valuable for engineering application of evaluating SINS’s attitude accuracy under dynamic conditions.
Prediction on the axial water thrust characteristics of pump turbine runner under partial load
Authors: Guo Jianqiang , Bi Huili , Luo Guohu , Wang Zhengwei
Published: March 2023

For the high head pump turbine, the unit instability during its operation mainly dues to the hydraulic vibration inside the machinery, which will cause the mechanical fatigue failure under certain circumstances. In this paper, the flow pattern and the runner axial water thrust in turbine model under partial load were analyzed by numerical simulation. The internal flow field instability and vortex load characteristics of the runner were analyzed to obtain the reasons for the different axial water thrust characteristics of the runner under two different loads. The results showed that due to the reduction of the guide vane opening, the flow rate is smaller at 50% load, and the free flow vortex structure on the high-pressure side of the runner blade inlet strengthens the impact of the water flow on the runner. Moreover, when the pressure difference between the runner blades decreases and the axial water thrust of the blades decreases, the total axial water thrust of the runner decreases and fluctuates frequently with time.
Numerical simulation of steam flooding in offshore heavy oil reservoir after water flooding
Authors: Zhang Qingquan , Sun Xiaofei
Published: March 2023

Steam flooding is an effective method to enhance oil recovery in heavy oil reservoirs. However, the influence factors of steam flooding will affect the development of heavy oil reservoir after the traditional water flooding. So the dynamic prediction of steam flooding needs to be performed before the development scheme is implemented. In this study, the 3D reservoir model was established by the reservoir numerical simulation software CMG; Combined with operating parameters of oilfield, the influence of steam temperature, steam injection timing and steam quality on the development effect of L7 block in offshore heavy oil reservoir was studied by using 3D reservoir model. The results show that compared with traditional water flooding, steam flooding has better development effect, and the cumulative oil production can reach 100.673 × 104m3; With the increase of steam temperature and steam quality, the cumulative oil production, incremental oil production and heat efficiency have an increasing trend; This result also suggests that the development method of higher steam temperature and steam quality conforms to the principle of economic development; For steam injection timing, the earlier the steam injection is more conducive to better development results.
Coupled double-distribution-function lattice Boltzmann model with streaming-collision process
Authors: He Zhuojie , Liang Ruifang
Published: March 2023

A coupled double distribution function lattice Boltzmann model with streaming-collision process is presented. In this model, continuity and momentum equations are recovered by a density distribution function and energy equation is recovered by a total energy distribution function, and the specific-heat ratio and Prandtl number are flexible. At the same time, the streaming-collision process is used as update rule. Couette flow is simulated as a numerical test. The numerical results agreed relatively excellent with the analytical solutions.
Dynamic Load Analysis of an Centrifugal Pump Axle using FSI Simulation
Authors: Cai Biaohua , Zhang Zheng , Chen Yinzhong , Tang Zhou
Published: March 2023

The mechanical characteristics of the impeller are important indicators that determine the working characteristics of the pump. The pump is subjected to periodic hydraulic loads during the working process. This load will cause the dynamic deformation of the impeller and the impeller shaft, thereby further affecting the distribution of the fluid. Liquid-solid coupling is used. Method, the rated operating point of centrifugal pump is analyzed, and it is proved that the dynamic stress of the impeller and the impeller shaft meets the requirements, which lays a foundation for the formulation of the control strategy of the impeller.
Layout of measuring points for flue gas flow velocity in coal-fired power plants based on CFD technology
Authors: Wu Junhao , Liu Chunling
Published: March 2023

In view of the existence of 90° bends in the flue after desulfurization in coal-fired power plants and the complicated distribution of flue gas flow velocity, the CFD simulation technology is proposed to simulate and analyze the flow characteristics of the flue flow field, and to find suitable flow velocity measurement points. On this basis, a set of on-line monitoring system for flue gas flow velocity and pollutants is designed by using LabVIEW.
Numerical simulation of gas-liquid interface in high-pressure water-blowing chamber
Authors: Tang Xionghui , Liu Yiou
Published: March 2023

The load on the water chamber increases with the pressure level and blowing rate of the system, and the demand for theoretical and experimental studies related to the quantitative parameters of water chamber blowing safety becomes more and more frequent. In this paper, CFD computational fluid dynamics method is used to carry out the dynamics modeling and simulation of three-dimensional non-constant gas-liquid two-phase internal flow field of the test water chamber and the actual water chamber blowdown process to obtain the dynamic distribution of flow parameters in the water chamber under different working conditions. The results found that to ensure the safety of the water tank, as long as to ensure that the high-pressure air into the water tank at the end of the first two stages, the “bubble” movement process always does not interfere with the bulkhead, you can ensure that the high-pressure air in the water tank in the free expansion and gravity floating state, the water tank pressure will be only slightly higher than “gas - water cross-section” of the static pressure, at this moment the water chamber safety.
Thermal fluid lubrication analysis of hydrodynamic journal bearing based on mass conservation boundary conditions
Authors: Hu Xinliang , Yu Kaiping , Zhang Junxiong
Published: March 2023

The thermal-hydrodynamic lubrication analysis of bearing with different bearing speed and eccentricity was carried out under Reynolds boundary conditions and mass conservation boundary conditions, and the variation of performance parameters such as oil film carrying capacity with speed and eccentricity were analyzed in detail for the calculated results, and the calculation results under the two different boundary conditions were compared and analyzed. The results show that the boundary conditions have a greater influence on the lubrication flow calculation results, the Reynolds boundary conditions have a faster calculation process, and the mass conservation boundary conditions are recommended when focusing on the analysis of lubrication flow.
Comparative analysis of radiant and radiator heating system for a residential building
Authors: Aacharya Ananta , Koirala Robin , Khanal Shuvas , Baral Bivek
Published: March 2023

Energy use for heating and cooling at the household level is rising annually. The residential sector consumes about 69% of energy consumption, out of which the highest percentage is shared by traditional fuel for cooking applications, followed by heating and cooling applications. In such a scenario, the primary goal should be to meet future heating and cooling energy demand through the use of novel technologies such as radiant heating systems (RHS). By utilizing low-temperature fluid flowing through the pipe, the RHS is more efficient than a standard heating system in maintaining the correct interior temperature. These systems are not frequently implemented in Nepal. It is crucial to compare the applicability of the system with technologies like radiator systems. The building provided by Urban Development and Building Construction (UDMC) is used for the study. The radiant and radiator heating system is designed, and the effects of different parameters on the heat transfer coefficient are studied. The maximum heating load is 50kWh for mid of January. A radiant heating system with a panel area of 18.24m2 is sufficient to satisfy the heating demand, while radiator heating requires a panel area of 3.6m2. To meet the same load, the total pipe length for the radiant and radiator heating systems is 300m and 42m, respectively. Radiant and radiator heating systems had a heat transfer coefficient of 7.76W/m2 and 15.34W/m2, respectively. The variation is because the radiator system must provide the same amount of heat to the building while having a smaller surface area than the radiant heating system.
Numerical study of a coil pump and comparison with field measurement
Authors: Pandey A , Bijukchhe P L , Khanal P , Acharya S , Chitrakar S , Neopane H P
Published: March 2023

Rural irrigation could be challenging in regions without proper access to electricity. In many remote places of Nepal, where the irrigation takes place in the vicinity of a river stream, a river water pump or coil pump can be used to supply water from the lower river terrain to the field. Water powered coil pump is a reciprocating pump that operates by rotating a coiled tube, by harnessing the power of a flowing river. A comparison in performance of cylindrical and conical shaped coil pumps was done both experimentally as well as numerically in this work. Under the river velocity of 0.9m/s, the maximum discharge at zero lift condition for the conical pump was 11,500 liters/day while for the cylindrical pump it was 8,600 liters/day. However, the conical pump could not generate lift more than 6.5m while the cylindrical pump performed well even at 11m head. The Numerical study was also carried out in order to visualize the flow patterns and compare the performance of the pumps while varying different parameters. The 3D computation domain of the pump for four cases (two cases varying the number of turns and two cases with change in shape) were generated and numerically studied using OpenFOAM. The interaction, being a multiphase case, interFoam solver was used, and to simplify the simulation laminar turbulence model was taken. The pressure and water volume at the outlet in the simulation were measured and compared between different cases. It was observed that the pressure obtained while using a cylindrical pump was 2.52 % more than that while using the conical pump. The outlet pressure was found to be increasing by 35% while increasing the number of turns from 7 to 15 in cylindrical and 42.5% in case of conical coil pump. The volume flow rate was observed to be more frequent in the case of the conical pump. Due to constraints of computational conditions, the experimental setup could not be totally replicated. However, the outcome showed a similar trend as obtained in the experiment. It was found that the cylindrical pump was better for the higher head, whereas the conical pump had shown better results for higher discharge.
Assessing the performance of a demonstrative hydrogen fuel cell power train in the chassis of an internal combustion engine vehicle
Authors: Shrestha Y. , Subedi A. , Sapkota M. , Paudel P. , Yadav N. K. , Thapa B. S.
Published: March 2023

In the present day in the global context, approximately 2 billion internal combustion engines (ICEs) are estimated to be in use. Nearly 7.3 billion metric tons of carbon dioxide (CO2) were released into the atmosphere as per the survey on the transportation sector in 2020, making up 41% of all emissions. To solve pollution challenges related to ICEs, recent advancements of alternatives to ICEs have pushed the globe to establish clean energy sources such as hydrogen fuel cells. The conversion of an ICE vehicle to a fuel cell vehicle is able to add further support to its development besides the 30% emission reduction since the old ICE vehicle would not be discarded. FCEVs are seen as a true replacement between BEVs and ICEs since more energy can be stored in less space as compared to BEVs. The objective of this paper is to analyse the energy consumption of a fuel cell-driven motor in the internal combustion engine vehicle chassis of Maruti 800, through mathematical modelling, then compare the specifications with that of an ICE-driven system. The analysis provides details on the optimization of drive system components to maximise the fuel cell energy consumption efficiency based on fuel cell power source requirements for a range of velocities and road gradients. The modifiable specifications of drive system components in the mathematical model ensure reproducibility for any drive cycles and system scenarios.
Machine learning to predict the antimicrobial activity of cold atmospheric plasma-activated liquids
Authors: Özdemir Mehmet Akif , Özdemir Gizem Dilara , Gül Merve , Güren Onan , Ercan Utku Kürşat
Published: March 2023

Plasma is defined as the fourth state of matter, and non-thermal plasma can be produced at atmospheric pressure under a high electrical field. The strong and broad-spectrum antimicrobial effect of plasma-activated liquids (PALs) is now well known. The antimicrobial effects of PALs depend on many different variables, which complicates the comparison of different studies and determining the most dominant parameters for the antimicrobial effect. The proven applicability of machine learning (ML) in the medical field is encouraging for its application in the field of plasma medicine as well. Thus, ML applications on PALs could present a new perspective to better understand the influences of various parameters on their antimicrobial effects. In this paper, comparative supervised ML models are presented by using previously obtained data to predict the in vitro antimicrobial activity of PALs. A comprehensive literature search was performed, and 12 distinct features related to PAL-microorganism interactions were collected from 33 relevant articles to automatically predict the antimicrobial activity of PALs. After the required normalization, feature encoding, and resampling steps, two supervised ML methods, namely classification and regression, are applied to the data to obtain microbial inactivation (MI) predictions. For classification, MI is labeled in four categories, and for regression, MI is used as a continuous variable. Sixteen different classifiers and 14 regressors are implemented to predict the MI value. Two different robust cross-validation strategies are conducted for classification and regression models to evaluate the proposed method: repeated stratified k-fold cross-validation and k-fold cross-validation, respectively. We also investigate the effect of different features on models. The results demonstrated that the hyperparameter-optimized Random Forest Classifier (oRFC) and Random Forest Regressor (oRFR) provided superior performance compared to other models for classification and regression. Finally, the best test accuracy of 82.68% for oRFC and R
2 of 0.75 for the oRFR are obtained. Furthermore, the determined most important features of predictive models are in line with the outcomes of PALs reported in the literature. An ML framework can accurately predict the antimicrobial activity of PALs without the need for any experimental studies. To the best of our knowledge, this is the first study that investigates the antimicrobial efficacy of PALs with ML. Furthermore, ML techniques could contribute to a better understanding of plasma parameters that have a dominant role in the desired antimicrobial effect. Moreover, such findings may contribute to the definition of a plasma dose in the future.
Overcorrection and undercorrection with fixed dosing of bolus hypertonic saline for symptomatic hyponatremia
Authors: Pelouto Anissa , Refardt Julie C , Christ-Crain Mirjam , Zandbergen Adrienne A M , Hoorn Ewout J
Published: March 2023

Objective

Current guidelines recommend treating symptomatic hyponatremia with rapid bolus-wise infusion of fixed volumes of hypertonic saline regardless of body weight. We hypothesize that this approach is associated with overcorrection and undercorrection in patients with low and high body weight.

Design

Single-center, retrospective cohort study.

Methods

Data were collected on patients treated with ≥1 bolus 100 or 150 mL 3% NaCl for symptomatic hyponatremia between 2017 and 2021. Outcomes were overcorrection (plasma sodium rise > 10 mmol/L/24 h, > 18 mmol/L/48 h, or relowering therapy) and undercorrection (plasma sodium rise < 5 mmol/L/24 h). Low body weight and high body weight were defined according to the lowest (≤60 kg) and highest (≥80 kg) quartiles.

Results

Hypertonic saline was administered to 180 patients and caused plasma sodium to rise from 120 mmol/L to 126.4 mmol/L (24 h) and 130.4 mmol/L (48 h). Overcorrection occurred in 32 patients (18%) and was independently associated with lower body weight, weight ≤ 60 kg, lower baseline plasma sodium, volume depletion, hypokalemia, and less boluses. In patients without rapidly reversible causes of hyponatremia, overcorrection still occurred more often in patients ≤ 60 kg. Undercorrection occurred in 52 patients (29%) and was not associated with body weight or weight ≥ 80 kg but was associated with weight ≥ 100 kg and lean body weight in patients with obesity.

Conclusion

Our real-world data suggest that fixed dosing of bolus hypertonic saline may expose patients with low and high body weight to more overcorrection and undercorrection, respectively. Prospective studies are needed to develop and validate individualized dosing models.
Experiential Education About Patient Death Designed for Undergraduate Nursing Students
Authors: Foltz-Ramos Kelly
Published: March 2023

New graduate nurses are unprepared for patient death, leading to a potential negative impact on patient care and an increase in turnover. This study investigated the use of high-fidelity simulation to teach about patient death. Senior nursing students (n = 124) were randomly assigned to rescue or failure-to-rescue scenarios. Outcomes included knowledge and emotional affect. Data analyses included comparative statistics, t-tests, and two-way analysis of variance. Both groups had equal knowledge gain. The failure-to-rescue group had significantly lower emotional affect following simulation but was equal to the rescue group following debriefing.
Heterogeneity analysis of the CEBPAdm AML based on bZIP region mutations
Authors: Hui Yan , Li Shuxin , Zhang Junping , Liu Bingcheng , Mi Yingchang , Wei Hui , Wang Jianxiang
Published: March 2023

Patients with double-mutated CEBPA (CEBPAdm) AML were stratified into favorable risk group, however, few studies have investigated the heterogeneity of different CEBPAdm types in detail. In this study, we analyzed 2211 newly diagnosed AML and identified CEBPAdm in 10.8% of the patients. Within the CEBPAdm cohort, 225 of 239 patients (94.14%) presented with bZIP region mutations (CEBPAdmbZIP) while 14 of 239 patients (5.86%) without bZIP region mutation (CEBPAdmnonbZIP). Analysis of the accompanied molecular mutations showed statistically different incidences of GATA2 mutations between the CEBPAdmbZIP group and the CEBPAdmnonbZIP group (30.29% vs 0%). In the analysis of outcomes, patients with CEBPAdmnonbZIP were associated with shorter overall survival (OS) censored at hematopoietic stem cell transplantation (HSCT) during CR1 compared to those with CEBPAdmbZIP (hazard ratio (HR) = 3.132, 95% confidence interval (CI) = 1.229–7.979, P = .017). Refractory or relapsed AML (R/RAML) patients with CEBPAdmnonbZIP were associated with shorter OS compared to those with CEBPAdmbZIP (HR = 2.881, 95% CI = 1.021–8.131, P = .046). Taken together, AML with CEBPAdmbZIP and CEBPAdmnonbZIP showed different outcomes and might be regarded as distinctive AML entities.
Transforming Dying
Authors: Paige Roberta Lyder
Published: March 2023

When hospice care began in the United States in the mid-1970s, the program at St. Luke's Hospital in New York City stood apart. Its proponents sought a unique initiative—to provide patient-centered care for the dying within the acute care setting. St. Luke's Hospital hospice changed the experience of dying for its patients using a “scatterbed” model and holistic care replicating that of St. Christopher's Hospice in London.
The Efficacy and Safety of Pazopanib Plus Chemotherapy in Treating Recurrent or Persistent Ovarian Cancer
Authors: Zhang Yaping , Fang Hongming , Wang Xiaoyan , Wang Hui , Pan Guoqiang , Chen Jian
Published: March 2023

Background:

Patients with recurrent or persistent ovarian cancer often have poor prognoses, and their optimal treatment regimen remains unclear. Inhibition of angiogenesis is a valuable strategy for treating ovarian cancer, and the drug pazopanib is a potent, multitarget tyrosine kinase inhibitor. However, treatment with pazopanib in combination with chemotherapy remains controversial. We performed a systematic review and meta-analysis to clarify the efficacy and side effects of pazopanib combined with chemotherapy in the treatment of advanced ovarian cancer.

Methods:

The PubMed, Embase, and Cochrane databases were systematically searched for relevant randomized controlled trials published up to September 2, 2022. The primary outcomes of eligible studies included overall response rate (ORR), disease control rate, 1-year progression-free survival (PFS) rate, 2-year PFS rate, 1-year overall survival (OS) rate, 2-year OS rate, and adverse events.

Result:

Outcomes from a total of 518 recurrent or persistent ovarian cancer patients from 5 studies were analyzed in this systematic review. Pooled results showed that pazopanib plus chemotherapy, when compared with chemotherapy alone, significantly improved the ORR (pooled risk ratio=1.400; 95% CI, 1.062-1.846; P = 0.017) but not the disease control rate, 1-year PFS, 2-year PFS, 1-year OS, or 2-year OS. Moreover, pazopanib increased the risk of neutropenia, hypertension, fatigue, and liver dysfunction.

Conclusion:

Pazopanib plus chemotherapy improved patient ORR but did not improve survival; it also increased the occurrence of several adverse events. Further large-sample clinical trials are needed to verify these results to guide pazopanib use in patients with ovarian cancer.
The challenging management of malignant ureteral obstruction: Analysis of a series of 188 cases
Authors: Artiles Medina Alberto , Laso García Inés , González Tello Fernando , Álvarez Rodríguez Sara , Hevia Palacios Manuel , Mata Alcaraz Marina , Mínguez Ojeda César , Arias Funez Fernando , Gómez Dos Santos Victoria , Burgos Revilla Francisco Javier
Published: March 2023

Background

Malignant ureteral obstruction (MUO) is a common condition that complicates the course of advanced malignancies. The aims of this study are to analyze the causes, management, and survival of patients with obstructive nephropathy due to malignant ureteric obstruction and to determine prognostic factors. Furthermore, we studied the complications and outcomes in patients who underwent urinary diversion.

Materials and methods

A retrospective study was conducted on patients with computed tomography–confirmed MUO between January 2016 and November 2020. Demographic, clinical, radiological, laboratory, and management data were collected. Survival curves were estimated using the Kaplan-Meier method, and univariate and multivariate Cox proportional hazards models were used to test the association between parameters and survival.

Results

A total of 188 patients were included. The mean age was 69.01 years (SD, 14.95 years), and the majority (54.8%) were male. The most common mechanism leading to MUO was compression by a pelvic mass (36.9%), and the 3 most frequent tumors causing MUO were prostate (17.6%), bladder (16.5%), and rectal cancer (11.7%).

Forty-seven patients (25%) underwent urinary diversion: 23 (48.9%) underwent double-J stenting and 21 (44.7%) underwent percutaneous nephrostomy. The most common reason for urinary diversion was acute kidney injury (53.3%). Recovery of renal function was observed in 55.8% of the patients after urinary diversion. The most frequently identified complications after urinary diversion were urinary tract infection (24.4%), hematuria (17.0%), and urinary sepsis (14.9%). The median survival after hydronephrosis diagnosis was 6.43 months (interquartile range, 1.91–14.81 months). In patients who underwent urinary decompression, the median survival after urinary diversion was 8.67 months (interquartile range, 2.99–17.28 months). In the multivariate analysis, a lower grade of hydronephrosis and cancer cachexia negatively impacted survival.

Conclusions

Cancer patients with MUO have a poor prognosis; therefore, the risk-benefit ratio of urinary diversion should be carefully considered. Cachexia and hydronephrosis grade can be useful in selecting suitable candidates for urinary diversion.
Impact of CYP3A5 genotype on de-novo LCP tacrolimus dosing and monitoring in kidney transplantation
Authors: Rao Nikhil , Carcella Taylor , Patel Neha , Bartlett Felicia , Posadas Maria Aurora , Casey Michael , Dubay Derek A. , Taber David J.
Published: March 2023

Objectives

LCP tac has a recommended starting dose of 0.14 mg/kg/day in kidney transplant. The goal of this study was to assess the influence of CYP3A5 on perioperative LCP tac dosing and monitoring.

Methods

This was a prospective observational cohort study of adult kidney recipients receiving de-novo LCP tac. CYP3A5 genotype was measured and 90-day pharmacokinetic and clinical were assessed. Patients were classified as CYP3A5 expressors (*1 homozygous or heterozygous) or nonexpressors (LOF *3/*6/*7 allele).

Results

In this study, 120 were screened, 90 were contacted and 52 provided consent; 50 had genotype results, and 22 patients expressed CYP3A5*1. African Americans (AA) comprised 37.5% of nonexpressors versus 81.8% of expressors (P = 0.001). Initial LCP tac dose was similar between CYP3A5 groups (0.145 vs. 0.137 mg/kg/day; P = 0.161), whereas steady state dose was higher in expressors (0.150 vs. 0.117 mg/kg/day; P = 0.026). CYP3A5*1 expressors had significantly more tac trough concentrations of less than 6 ng/ml and significantly fewer tac trough concentrations of more than 14 ng/ml. Providers were significantly more likely to under-adjust LCP tac by 10 and 20% in CYP3A5 expressors versus nonexpressors (P < 0.03). In sequential modeling, CYP3A5 genotype status explained the LCP tac dosing requirements significantly more than AA race.

Conclusion

CYP3A5*1 expressors require higher doses of LCP tac to achieve therapeutic concentrations and are at higher risk of subtherapeutic trough concentrations, persisting for 30-day posttransplant. LCP tac dose changes in CYP3A5 expressors are more likely to be under-adjusted by providers.
Online Patient Reviews of Breast Reconstruction: RealSelf Analysis
Authors: Pham Jason T. , Kim Joshua K. , Hunt Stephen E. , Willette Dominique M. , Tang Cathy J.
Published: March 2023

Background:

RealSelf is an online community that hosts an expansive number of online reviews for cosmetic and reconstructive plastic surgery procedures. The purpose of this study is to analyze patient satisfaction with breast reconstruction procedures from RealSelf to determine factors contributing to a positive or negative patient experience.

Methods:

The breast reconstruction category from RealSelf.com was analyzed using a web crawler-based application built from Python and Selenium. Reviews were collected from May 2009 to November 2021. Information including RealSelf’s inherent “worth it” ranking system, review text, the number of submitted photographs, and the number of readers who found the review helpful was captured. The content of the review was then independently reviewed by the authors and was categorized with key factors that determined positive or negative reviews.

Results:

A total of 3451 breast reconstruction reviews were collected. After the authors analyzed each review, 3225 (94.33%) were identified as positive reviews. The most common factors associated with positive reviews were physician demeanor (n = 2600, 31.7%), aesthetic outcome (n = 1955, 23.8%), or staff (n = 1543, 18.8%), while negative reviews were associated with unfavorable aesthetic outcome (n = 94, 28.9%), physician demeanor (n = 82, 25.2%), or postoperative complications (n = 75, 23.1%).

Conclusions:

Although there are surveys that analyze patient satisfaction for breast reconstruction, there has not been a study that analyzed a large online review database. Predominating factors in both positive and negative reviews were physician demeanor and aesthetic outcome.
Complications following Permanent Filler Injection: A Prospective Cohort Study and Protocol of Management
Authors: Mortada Hatan , Al Saud Nouf , Alaithan Bander , Alhumsi Taghreed
Published: March 2023

Introduction:

Permanent filler (PF) substances are increasingly utilized in aesthetic procedures. Concurrently, complications related to fillers have also risen. This study aims to determine the rate of complications secondary to PF injections and develop a therapeutic approach for treating such complications.

Methods:

This cohort study was conducted by distributing a checklist form among all patients aged 18 years or older who arrived for a new cosmetic consultation between 2015 and 2019. The primary outcome was the occurrence of complications, which are defined as symptoms induced by the PF. The demographics, type of PF, injection site, the time for the complication to occur, and signs and symptoms were recorded and followed up.

Results:

In this study, 325 out of 503 (64.61%) patients presented with PF-related complications. About 92.8% were women. All patients with PF-related complications presented with a lump (n = 325, 100%). In regard to the anatomical area of injection, the most common areas were the cheeks (66.6%). The time it took for the complication to occur most commonly ranged from 1–5 years (39.2%, P < 0.001). Complications were significantly higher among patients who received the injection in a nonmedical facility (P < 0.0002). Seventy-seven cases (15.3%, P < 0.0001) underwent PF removal.

Conclusions:

PF-related complications in the body exhibit a wide range of onset and adverse events. The best method to prevent complications caused by permanent filling materials is to avoid them altogether. When it comes to permanent filling agents, we suggest extreme caution.
Usability and Clinician Acceptance of a Deep Learning-Based Clinical Decision Support Tool for Predicting Glaucomatous Visual Field Progression
Authors: Chen Jimmy S. , Baxter Sally L. , van den Brandt Astrid , Lieu Alexander , Camp Andrew S. , Do Jiun L. , Welsbie Derek S. , Moghimi Sasan , Christopher Mark , Weinreb Robert N. , Zangwill Linda M.
Published: March 2023

Précis:

We updated a clinical decision support tool integrating predicted visual field (VF) metrics from an artificial intelligence model and assessed clinician perceptions of the predicted VF metric in this usability study.

Purpose:

To evaluate clinician perceptions of a prototyped clinical decision support (CDS) tool that integrates visual field (VF) metric predictions from artificial intelligence (AI) models.

Methods:

Ten ophthalmologists and optometrists from the University of California San Diego participated in 6 cases from 6 patients, consisting of 11 eyes, uploaded to a CDS tool (“GLANCE”, designed to help clinicians “at a glance”). For each case, clinicians answered questions about management recommendations and attitudes towards GLANCE, particularly regarding the utility and trustworthiness of the AI-predicted VF metrics and willingness to decrease VF testing frequency.

Main Outcome(s) and Measure(s):

Mean counts of management recommendations and mean Likert scale scores were calculated to assess overall management trends and attitudes towards the CDS tool for each case. In addition, system usability scale scores were calculated.

Results:

The mean Likert scores for trust in and utility of the predicted VF metric and clinician willingness to decrease VF testing frequency were 3.27, 3.42, and 2.64, respectively (1=strongly disagree, 5=strongly agree). When stratified by glaucoma severity, all mean Likert scores decreased as severity increased. The system usability scale score across all responders was 66.1±16.0 (43rd percentile).

Conclusions:

A CDS tool can be designed to present AI model outputs in a useful, trustworthy manner that clinicians are generally willing to integrate into their clinical decision-making. Future work is needed to understand how to best develop explainable and trustworthy CDS tools integrating AI before clinical deployment.
Gray matter volume and pain tolerance in a general population: the Tromsø study
Authors: Melum Tonje Anita , Vangberg Torgil Riise , Johnsen Liv-Hege , Steingrímsdóttir Ólöf Anna , Stubhaug Audun , Mathiesen Ellisiv B. , Nielsen Christopher
Published: March 2023

As pain is processed by an extensive network of brain regions, the structural status of the brain may affect pain perception. We aimed to study the association between gray matter volume (GMV) and pain sensitivity in a general population. We used data from 1522 participants in the seventh wave of the Tromsø study, who had completed the cold pressor test (3°C, maximum time 120 seconds), undergone magnetic resonance imaging (MRI) of the brain, and had complete information on covariates. Cox proportional hazards regression models were fitted with time to hand withdrawal from cold exposure as outcome. Gray matter volume was the independent variable, and analyses were adjusted for intracranial volume, age, sex, education level, and cardiovascular risk factors. Additional adjustment was made for chronic pain and depression in subsamples with available information on the respective item. FreeSurfer was used to estimate vertexwise cortical and subcortical gray matter volumes from the T1-weighted MR image. Post hoc analyses were performed on cortical and subcortical volume estimates. Standardized total GMV was associated with risk of hand withdrawal (hazard ratio [HR] 0.81, 95% confidence interval [CI] 0.71-0.93). The effect remained significant after additional adjustment for chronic pain (HR 0.84, 95% CI 0.72-0.97) or depression (HR 0.82, 95% CI 0.71-0.94). In post hoc analyses, positive associations between standardized GMV and pain tolerance were seen in most brain regions, with larger effect sizes in regions previously shown to be associated with pain. In conclusion, our findings indicate that larger GMV is associated with longer pain tolerance in the general population.
Combination analgesic development for enhanced clinical efficacy (the CADENCE trial): a double-blind, controlled trial of an alpha-lipoic acid–pregabalin combination for fibromyalgia pain
Authors: Gilron Ian , Robb Sylvia , Tu Dongsheng , Holden Ronald R. , Milev Roumen , Towheed Tanveer
Published: March 2023

Drug therapy for fibromyalgia is limited by incomplete efficacy and dose-limiting adverse effects (AEs). Combining agents with complementary analgesic mechanisms—and differing AE profiles—could provide added benefits. We assessed an alpha-lipoic acid (ALA)–pregabalin combination with a randomized, double-blind, 3-period crossover design. Participants received maximally tolerated doses of ALA, pregabalin, and ALA–pregabalin combination for 6 weeks. The primary outcome was daily pain (0-10); secondary outcomes included Fibromyalgia Impact Questionnaire, SF-36 survey, Medical Outcomes Study Sleep Scale, Beck Depression Inventory (BDI-II), adverse events, and other measures. The primary outcome of daily pain (0-10) during ALA (4.9), pregabalin (4.6), and combination (4.5) was not significantly different (P = 0.54). There were no significant differences between combination and each monotherapy for any secondary outcomes, although combination and pregabalin were both superior to ALA for measures of mood and sleep. Alpha-lipoic acid and pregabalin maximal tolerated doses were similar during combination and monotherapy, and AEs were not frequent with combination therapy. These results do not support any additive benefit of combining ALA with pregabalin for fibromyalgia. The observation of similarly reached maximal tolerated drug doses of these 2 agents (which have differing side-effect profiles) during combination and monotherapy—without increased side effects—provides support for future development of potentially more beneficial combinations with complementary mechanisms and nonoverlapping side effects.
Exertional Rhabdomyolysis in Athletes: Systematic Review and Current Perspectives
Authors: Bäcker Henrik C. , Richards John T. , Kienzle Arne , Cunningham John , Braun Karl F.
Published: March 2023

Objective:

Exertional rhabdomyolysis results from a breakdown of skeletal muscle cells after intense exercise in otherwise healthy patients, causing increased levels of creatine kinase (CK) or myoglobin, as well as urine dipstick positive for blood, and may result in kidney insufficiency. The aim of this study was to outline the current perspectives of exertional rhabdomyolysis in athletes and subsequent treatment based on the current literature.

Data Sources:

We searched the MEDLINE/PubMed and Google databases for ([exercise] OR [exertional]) AND rhabdomyolysis following the PRISMA guidelines. All abstracts were reviewed by 2 independent examiners. Inclusion criteria consisted of original articles presenting studies on exertional rhabdomyolysis or exercise-induced rhabdomyolysis with 7 or more cases. All case reports, case series, or editorials were excluded.

Main Results:

A total of 1541-abstracts were screened, leaving 25 studies for final inclusion and analysing 772patients. Especially, young male patients were affected at a mean age of 28.7 years (range 15.8-46.6 years). Most of the athletes performed running, including marathons in 54.3% of cases (n = 419/772), followed by weightlifting in 14.8% (n = 114/772). At the time of presentation, the mean creatine kinase was 31 481 IU/L (range 164-106,488 IU/L). Seventeen studies reported the highest level of CK, which was 38 552 IU/L (range 450-88,496 IU/L). For treatment, hydration was the most common method of choice reported by 8 studies.

Conclusions:

Exertional rhabdomyolysis seems to be underestimated, and it is essential to screen patients who present with muscle soreness/cramps and/or dark urine after heavy endurance events to avoid any further complications.

Level of Evidence:

II; systematic review.
Emergency care considerations for transgender and gender diverse youth: a review to improve health trajectories
Authors: Lillemoe Jenna , Holmstrom Sara E. , Sojar Sakina H.
Published: March 2023

Purpose of review

Transgender and Gender Diverse (TGD) youth represent a growing subset of pediatric patients who are at increased risk for harmful health outcomes. Consideration of these risks during emergency encounters may decrease these undesired, sometimes fatal, adverse events.

Recent findings

Gender affirmative care of TGD youth is considered a basic healthcare right as noted by several academic societies including the American Academy of Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association [1–3] (Table 1

). Withholding gender affirmative care can lead to undesired health outcomes including but not limited to an increased incidence of mood disorders, self-injurious behavior, suicidal ideation, sexually transmitted diseases, and delayed presentations of treatable illness. TGD youth often access acute care settings, yet many feel apprehensive due to prior negative experiences or fear of discrimination. Practitioners are also often unaware as to how to effectively provide this type of healthcare.

Acute care settings provide a unique and impactful environment to provide evidence-based, gender-affirming care that can make patients feel validated, mitigate future care avoidance, and minimize negative downstream health effects. In this review, we have consolidated high yield health considerations regarding TGD youth for acute care and emergency providers to deliver optimal care for this population.
Percutaneous management of upper tract stones: from mini to maxi percutaneous nephrolithotomy
Authors: Stern Karen L.
Published: March 2023

Purpose of review

Percutaneous nephrolithotomy (PCNL) continues as the gold standard for the surgical management of large renal stones. This short review is intended to highlight recent publications on PCNL of all tract sizes, from mini to standard.

Recent findings

Literature on PCNL in the last 2 years has focused on several main themes – decreasing complications, improving postoperative pain control, and new technology to improve outcomes. Mini-PCNL continues to prove effective and safe, with a new vacuum sheath showing promise of improving stone-free rates and decreasing infections. In terms of infections, preoperative midstream urine culture continues to be a poor indicator of postoperative infection. One of the biggest changes to PCNL practice is the reintroduction of tranexamic acid, which has shown to significantly decrease bleeding and improve outcomes. In terms of postoperative pain control, local blocks are effective and low risk.

There are many options for surgeons when it comes to PCNL from sheath size to pain management to preoperative medication to decrease bleeding. Future research will continue to highlight, which advances are the most beneficial.
Polycystin-2 Associates With Malignancy in Meningiomas
Authors: Assimakopoulou Martha , Christopoulou Maria-Elpida , Karamani Vassiliki , Aletras Alexios J. , Gatzounis George
Published: March 2023

The involvement of polycystin-2 (PC2) in cell survival pathways raises questions about its role in carcinogenesis. Aberrant expression of PC2 has been associated with malignancy in various tumors. No evidence exists referring to PC2 expression in meningiomas. The aim of this study was to investigate the expression levels of PC2 in meningiomas and compare them with normal brain samples including leptomeninges. PC2 immunohistochemical expression was quantitatively analyzed in archival tissue from 60 patients with benign (WHO grade 1) and 22 patients with high-grade (21: WHO grade 2 and 1: grade 3) meningiomas. Specifically, the labeling index [the percentage of positive (labeled) cells out of the total number of tumor cells counted] was determined. PC2 mRNA levels were evaluated by quantitative real-time polymerase chain reaction. PC2 immunostaining was not detected in the leptomeninges. Gene expression analysis revealed increased levels of PC2 in WHO grade 1 (P = 0.008) and WHO grade 2 (P = 0.0007) meningiomas compared with that of normal brains. PC2 expression was significantly associated with an ascending grade of malignancy by both immunohistochemistry and quantitative real-time polymerase chain reaction (P < 0.05). Recurrent meningiomas displayed higher levels of PC2 compared with primary meningiomas (P = 0.008). Although no significant association of PC2 with the overall survival of the patients was found (P > 0.05), it was noticed that the patients with WHO grade 2 meningiomas with low expression of PC2 survived longer compared with the patients with WHO grade 1 meningioma with high expression of PC2 (mean survival 49.5 and 28 months, respectively). The above results indicate a possible association of PC2 with malignancy in meningiomas. However, the mechanisms underlying PC2 implication in meningioma pathogenesis should be further elucidated.
CYP1A1 Is a Useful Diagnostic Marker for Angiofibroma of Soft Tissue
Authors: Uemura Kotaro , Komatsu Masato , Hara Shigeo , Kawamoto Teruya , Bitoh Yuko , Itoh Tomoo , Hirose Takanori
Published: March 2023

Angiofibroma of soft tissue (AFST) is a recently described benign fibroblastic neoplasm composed of uniform bland spindle cell proliferation in fibrous and fibromyxoid stroma with prominent thin-walled small branching vessels. A major recurrent genetic abnormality in AFST is t(5;8)(p15;q13), which results in the rearrangement of AHRR and NCOA2. Owing to a lack of discriminatory IHC markers and potential overlap with other mesenchymal neoplasms, it may be difficult to confirm the diagnosis of AFST in some cases. Triggered by a recent gene expression profile study of AFST, which showed the significant upregulation of AhR/AHRR/ARNT downstream genes (including CYP1A1), we used a mouse monoclonal antibody to explore the diagnostic significance of CYP1A1 expression in histologically confirmed AFST cases along with 224 control cases, consisting of 221 neoplastic mimickers and 3 non-neoplastic lesions. We found moderate to strong cytoplasmic expression of CYP1A1 in 13 of 16 AFST cases (sensitivity, 81.3%). In contrast, the vast majority of other examined histologic mimickers exhibited no expression of CYP1A1 (specificity, 97.3%), except for 3 myxofibrosarcomas (3/31), 2 solitary fibrous tumors (2/22), and 2 neurofibroma (1/27). Our results indicate that CYP1A1 immunohistochemistry may aid in the diagnosis of AFST by distinguishing among various kinds of tumors, particularly those harboring prominent vasculature.