bluuebunny/crossref_metadata_2025 huggingface dataset:
Ileal perforation involvement in Wegener granulomatosis comorbid with COVID-19 infection: A case report and review of the literature
Authors: Shao Huijuan , Liu Dong , Zheng Xiaofeng , Zhang Jiucong , Li Wenbo , Chen Peng , Qian Zhen , Yang Jie , Liu Dongmei
Published: February 2024

Rationale:

Granulomatosis with polyangiitis (GPA) is a systematic autoimmune disease. The typical clinical involvement of GPA entails the upper and lower respiratory tracts, and the kidneys. Gastrointestinal (GI) involvement is uncommon and unless detected and treated promptly, may lead to life-threatening complications such as perforation. We aim to review all available publications since the first description in 1982 dealing with GI perforation in patients with Wegener granulomatosis and draw attention to this serious situation.

Patient concerns:

We present a 54-year-old man diagnosed with GPA who presented initially with nasal symptoms and suffered ileal perforation following Corona Virus Disease 2019 infection. We also review previously reported patients with Wegener granulomatosis who had GI perforation to investigate the perforation site and period, pathology, diagnosis, and treatment methods.

Diagnoses and Interventions:

The case of a GPA-diagnosed patient who presented initially with nasal symptoms and suffered ileal perforation following Corona Virus Disease 2019 infection. We recommended a renal puncture biopsy, steroids, and immunosuppressants to improve the patient condition. The patient and his family refused these treatment recommendations.

Outcomes:

Our patient exhibited continued progressive vascular inflammatory changes and eventual irreversible systemic damage. These sequelae were attributed to the patient declining prednisolone and immunosuppressant therapy.

Lessons:

GI perforation is rare in GPA but severe complication. Consequently, we recommend that early diagnosis and treatment with steroid hormones and immunosuppressants for GPA patients with GI perforation.
Diagnosis and evaluation of elderly-onset myasthenia gravis: A case report
Authors: Tachikawa Takako , Takeshima Shinichi , Kawate Nobuyuki
Published: February 2024

Rationale:

Patients with elderly-onset myasthenia gravis can have a good prognosis with appropriate diagnosis and response, although it is difficult to differentiate between exacerbations of myasthenia gravis in elderly patients and age-related changes. Therefore, it is important for physicians to understand the clinical characteristics and safe assessment methods for patients with elderly-onset myasthenia gravis.

Patient concerns:

An 82-year-old male diagnosed with myasthenia gravis 6 months prior had no difficulty in daily living. After falling on a golf course, he was diagnosed with a right femoral neck fracture on the 1st day and underwent right total hip replacement surgery on the 12th day, being transferred to our hospital for rehabilitation therapy on the 32nd day. However, immediately after transfer, the patient showed fatigability during training and difficulty swallowing food.

Diagnoses:

This case was diagnosed as an exacerbation of myasthenia gravis.

Interventions:

Pyridostigmine was initiated with the expectation of immediate effect on the 54th day.

Outcomes:

His symptoms and physical functions improved immediately, and walking distance and food intake increased. From this clinical course, it was judged that immunosuppressive therapy was indicated as a transition to generalized myasthenia gravis. For this reason, he was discharged after arranging postdischarge visits to the department of neurology, accordingly.

Lessons:

A better understanding of the characteristics of elderly-onset myasthenia gravis may allow for relatively safe assessment of the condition and improve its diagnosis and treatment.
Huge uterine abscess after myomectomy: A case report
Authors: Wen Biwei , Yu Xiaomin , Yin Yue , Zhao Runan , Liu Yuhuan
Published: February 2024

Rationale:

Uterine abscess is a rare gynecologic entity and only a few cases have been reported so far. This study aimed to describe our clinical experience in this case. Initially, hematoma was diagnosed without detail previous medical record. Finally, laparotomy was performed due to refractory fever and highly possible diagnosis of uterine abscess. We successfully performed a hysterectomy and the patient had an uneventful recovery.

Patient concerns:

A 44-year-old nulliparous woman underwent myomectomy in the local hospital, 45 days ago. She complained of irregular fever (up to 40 °C) without abdominal pain since the surgery.

Diagnoses:

Due to lack of her detail medical record, equivocal images and her strong intention to preserve uterus, she was misdiagnosed with hematoma and treated with antibiotic treatment. Finally, intraoperative findings revealed that the huge myometrial abscess contained a mass of pus.

Interventions:

Laparotomy was performed due to refractory high-grade fever and highly possible diagnosis of uterine abscess. Total hysterectomy was performed to avoid the possibility of life-threatening sepsis.

Outcomes:

The postoperative course was uneventful and the patient was discharged 10 days after surgery.

Lessons:

Complete imaging examinations are recommended prior myomectomy to facilitate the differential diagnosis of postoperative complications. In addition, several measures, such as maintaining aseptic conditions during surgery and postoperative drainage, play a critical role in preventing nosocomial infections. Rare uterine abscess is often mistaken for hematoma with fever. If the patient develops high fever after myomectomy, accompanied by a mass in the myometrium, the possibility of infection or even abscess formation should not be excluded. For women who need to preserve their fertility, the early diagnosis and timely administration of appropriate medication is crucial for preventing uterine loss.
Determinants of body weight changes during Ramadan fasting in India amid COVID-19: A cross-sectional study
Authors: Khan Moien A.B. , Khan Sajjad Ahmed , Annadurai Kalaivani , Parajuli Surya Bahadur , Ahmed Waseem N. , Altamimi Saoud , Ashok Tejaswini , Shah Dhaval , Sayyad Yakub , Dubey Ashish , Tariq Abdullah , Riyaz Romana , Hasan Fayeza , Amiri Sohrab , Faris Moezalislam
Published: February 2024

Ramadan intermittent fasting (RIF) presents unique challenges and opportunities for public health and clinical practice, especially in populations with a high prevalence of non-communicable diseases. This study aims to investigate the impact of RIF on weight change among Indian Muslims and explore the associated demographic, dietary, and behavioral factors. A cross-sectional survey was conducted with a sample of Indian Muslim adults who observed RIF. Participants were asked to report their demographic information, family and personal health history, and dietary and lifestyle behaviors before and during Ramadan month. The primary outcome was body weight change, with secondary outcomes including changes in dietary patterns, physical activity, and other health-related lifestyle behaviors. The study found that during Ramadan, nearly half of the participants (48.5%) self-reported a retained initial weight, while a significant fraction (30.9%) self-reported a modest weight reduction between 0.5 to 2.5 kg at the end of Ramadan. Additionally, self-reported eating practices demonstrated moderately altered by about half (48.4%) of the study participants, with 32.2% reporting minor changes and 8.2% indicating substantial changes. An urban residence was associated with a higher likelihood of weight gain, where urban residents showed 3 times the odds of increased weight compared to rural inhabitants. Employment status emerged as a significant determinant for weight fluctuation, influencing both weight gain and loss. During Ramadan, there was a significant rise in snacking frequency, increasing from 21.7% to 32.6% in comparison with pre-Ramadan. The consumption of large quantities of food more frequently grew from 14.9% to 36%, and the incidence of eating despite not being hungry went up from 17.4% to 33.2%. The study demonstrates that RIF is associated with variable changes in body weight among adult Indian Muslims, influenced by urbanization, employment status, and dietary changes. The findings suggest that clinicians should provide tailored advice about body weight regulation during Ramadan and consider integrating community-based health initiatives within religious settings to improve health outcomes.
Preoperative prediction of microsatellite instability status: development and validation of a pan-cancer PET/CT-based radiomics model
Authors: Wang Menglu , Peng Mengye , Yang Xinyue , Zhang Ying , Wu Tingting , Wang Zeyu , Wang Kezheng
Published: February 2024

Objective

The purpose of this study is to verify the feasibility of preoperative prediction of patients’ microsatellite instability status by applying a PET/CT-based radiation model.

Methods

This retrospective study ultimately included 142 patients. Three prediction models have been developed. The predictive performance of all models was evaluated by the receiver operating characteristic curve and area under the curve values. The PET/CT radiological histology score (Radscore) was calculated to evaluate the microsatellite instability status, and the corresponding nomogram was established. The correlation between clinical factors and radiological characteristics was analyzed to verify the value of radiological characteristics in predicting microsatellite instability status.

Results

Twelve features were retained to establish a comprehensive prediction model of radiological and clinical features. M phase of the tumor has been proven to be an independent predictor of microsatellite instability status. The receiver operating characteristic results showed that the area under the curve values of the training set and the validation set of the radiomics model were 0.82 and 0.75, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the training set were 0.72, 0.78, 0.83 and 0.66, respectively. The sensitivity, specificity, positive predictive value and negative predictive value of the validation set were 1.00, 0.50, 0.76 and 1.00, respectively. The risk of patients with microsatellite instability was calculated by Radscore and nomograph, and the cutoff value was −0.4385. The validity of the results was confirmed by the decision and calibration curves.

Conclusion

Radiological models based on PET/CT can provide clinical and practical noninvasive prediction of microsatellite instability status of several different cancer types, reducing or avoiding unnecessary biopsy to a certain extent.
18F-FDG PET/CT characteristics of IASLC grade 3 invasive adenocarcinoma and the value of 18F-FDG PET/CT for preoperative prediction: a new prognostication model
Authors: Yang Hanyun , Liu Xinran , Wang Lijuan , Zhou Wenlan , Tian Ying , Dong Ye , Zhou Kemin , Chen Li , Wang Meng , Wu Hubing
Published: February 2024

Objective

This study is performed to investigate the imaging characteristics of the International Association for the Study of Lung Cancer grade 3 invasive adenocarcinoma (IAC) on PET/CT and the value of PET/CT for preoperative predicting this tumor.

Materials and methods

We retrospectively enrolled patients with IAC from August 2015 to September 2022. The clinical characteristics, serum tumor markers, and PET/CT features were analyzed. T test, Mann–Whitney U test, χ2 test, Logistic regression analysis, and receiver operating characteristic analysis were used to predict grade 3 tumor and evaluate the prediction effectiveness.

Results

Grade 3 tumors had a significantly higher maximum standardized uptake value (SUVmax) and consolidation-tumor-ratio (CTR) (P < 0.001), while Grade 1 - 2 tumors were prone to present with air bronchogram sign or vacuole sign (P < 0.001). A stepwise logistic regression analysis revealed that smoking history, CEA, SUVmax, air bronchogram sign or vacuole sign and CTR were useful predictors for Grade 3 tumors. The established prediction model based on the above 5 parameters generated a high AUC (0.869) and negative predictive value (0.919), respectively.

Conclusion

Our study demonstrates that grade 3 IAC has a unique PET/CT imaging feature. The prognostication model established with smoking history, CEA, SUVmax, air bronchogram sign or vacuole sign and CTR can effectively predict grade 3 tumors before the operation.
Evaluation of prostate-specific membrane antigen expression in locally advanced or metastatic breast carcinoma with 68Ga-PSMA-11 positron-emission tomography/computed tomography imaging for potential theranostics
Authors: Parghane Rahul V. , Suralkar Tejal , Nikam Dilip , Basu Sandip
Published: February 2024

Background and aim

Prostate-specific membrane antigen (PSMA) is ubiquitously expressed in tumor-associated neovasculature and may be a potential theranostic in many solid cancers, including breast carcinoma (BC). Herein, we analyzed the presence of PSMA in BC, through qualitative and quantitative parameters on 68Ga-PSMA-11 positron-emission tomography/computed tomography (PET/CT), across various hormonal subtypes.

Methods

This study examined 41 female patients of BC. All underwent 68Ga-PSMA-11 PET/CT. For qualitative analysis, a visual estimation of PSMA expression was performed as per miPSMA scoring system (VISION trial) and a score ≥2 was considered eligible for lutetium-177 (177Lu)-PSMA-617 radioligand therapy (Lu-PRLT). For quantitative analysis, maximum standardized uptake values (SUVmax) were determined and ratios >1 for SUVmax lesion to SUVmax liver were considered eligible for Lu-PRLT. PSMA expression was correlated with hormonal status using Chi-square test. The sensitivity, specificity and area under curve (AUC) of PSMA expression were determined using receiver-operating characteristics analysis (P < 0.05).

Results

A total of 19 patients (46.3%) and 15 patients (36.7%) in stage IV were found eligible for Lu-PRLT based on qualitative and quantitative analyses, respectively. Strong PSMA expression was detected in triple-negative and hormonal receptors-negative/human epidermal growth factor receptor 2-positive status on qualitative PSMA expression analysis. A sensitivity of 65.5%, specificity of 93.3% and AUC of 0.857 for SUVmax 6.5 on 68Ga-PSMA-11 PET/CT were detected for PSMA expression for considering Lu-PRLT.

Conclusion

We found a modest number of BC patients suited for Lu-PRLT, indicating that PSMA PET/CT imaging may be a valuable modality for selecting theranostics in a carefully selected group of breast carcinoma.
Malaria prevention in children: an update
Authors: Friedman-Klabanoff DeAnna J. , Adu-Gyasi Dennis , Asante Kwaku Poku
Published: February 2024

Purpose of review

Malaria cases and deaths decreased from 2000 to 2015 but remain increased since 2019. Several new developments and strategies could help reverse this trend. The purpose of this review is to discuss new World Health Organization (WHO) guidelines and recent research on malaria prevention in children.

Recent findings

Fifteen countries have now rolled out seasonal malaria chemoprophylaxis (SMC) in children at highest risk for severe malaria, and new WHO recommendations provide more flexibility for SMC implementation in terms of target age groups, geographic region, and number of cycles. Recent studies confirm that malaria burden in school aged children, and their contribution to transmission, is high. New guidelines permit expanded chemoprevention options for these children. Two vaccines have been approved for use in malaria endemic countries, RTS,S/AS01E and R21/Matrix-M. Additionally, pyrethroid-chlorfenapyr bed nets are being deployed to combat resistant mosquitoes.

While challenges remain in malaria control towards elimination, new guidelines and recently approved vaccines offer hope. Monitoring for continued vaccine and chemoprevention effectiveness, and for possible epidemiologic shifts in severe malaria presentation and deaths as additional prevention efforts roll out will be paramount.
Nicardipine or Nitroprusside for Postoperative Blood Pressure Control in Infants After Surgery for Congenital Heart Disease: Single-Center Retrospective Noninferiority and Cost Analysis, 2016–2020*
Authors: Wong Rudolph J. , Mruk Allison L. , Grimaldi Lisa M. , Patel Reena , Mirea Lucia , Engelhardt Kevin P.
Published: February 2024

OBJECTIVES:

Postoperative hypertension frequently occurs after surgery for congenital heart disease. Given safety concerns when using calcium channel blockers in infants along with the cost and side-effect profile of nitroprusside, we retrospectively assessed our experience of using nicardipine and nitroprusside for postoperative blood pressure control in infants who underwent surgery for congenital heart disease. We also investigated the cost difference between the medications.

DESIGN:

This study was a single-center retrospective, pre-post chart review of patients who had surgery for congenital heart disease between 2016 and 2020. The primary aim was a noninferiority comparison of achievement of blood pressure goal at 1-hour post-initiation of an antihypertensive agent. Secondary comparisons included achievement of blood pressure goal at 2 hours after medication initiation, Vasoactive-Inotropic Score (VIS), and blood transfusion, crystalloid volume, and calcium needs.

SETTING:

Academic quaternary-care center.

PATIENTS:

Infants under 1 year old who required treatment for hypertension with nitroprusside (n = 71) or nicardipine (n = 52) within 24 hours of surgery for congenital heart disease.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We failed to identify any difference in proportion of patients that achieved blood pressure control at 1-hour after medication initiation (nitroprusside 52% vs. nicardipine 54%; p = 0.86), with nicardipine noninferior to nitroprusside within a 15% margin. Of patients who did not achieve control at 1-hour post-medication initiation, receiving nicardipine was associated with blood pressure control at 2 hours post-medication initiation (79% vs. 38%; p = 0.003). We also failed to identify an association between antihypertensive types and mean VIS scores, blood transfusion volumes, crystalloid volumes, and quantities of calcium administered. Index cost of using nitroprusside was 16 times higher than using nicardipine, primarily due to difference in wholesale cost.

CONCLUSIONS:

In our experience of achieving blood pressure control in infants after surgery for congenital heart disease (2016–2020), antihypertensive treatment with nicardipine was noninferior to nitroprusside. Furthermore, nicardipine use was significantly less expensive than nitroprusside. Our contemporary practice is therefore to use nicardipine in preference to nitroprusside.
Selective Myectomies Alone versus Selective Myectomies Combined with Neurectomies in Postparetic Synkinesis: Comparing Outcomes
Authors: Sanchez Cristina V. , Gault Natalie A. , Gopalan Tulasi A. , Rozen Shai M.
Published: February 2024

Background:

In postparetic synkinesis, muscle tone imbalance between upper and lower lip depressors and elevators results in the inability to produce an effective smile. Surgical treatments to improve smile focus on restoring tonicity balance between perioral muscles by weakening hypertoned muscles through selective myectomies or selective neurectomies. The goal of this study was to compare objective outcomes between selective myectomies alone with those of selective myectomies combined with selective neurectomies.

Methods:

A retrospective cohort study was performed on postparetic synkinesis patients who underwent depressor anguli oris (DAO) myectomies or DAO and platysma myectomies with selective neurectomies. Objective outcomes included preoperative and postoperative analyses of smile measures (excursion, angle, and dental show) and botulinum toxin type A administration (periorbital and platysmal).

Results:

Thirty-seven patients underwent DAO myectomies only (myectomy group), and 18 patients underwent DAO and platysma myectomies with selective neurectomies (myectomy-neurectomy group). Within-group analyses showed significant angle improvement in both groups (P < 0.05) and improved smile excursion in the myectomy-neurectomy group (P < 0.05). Between-group comparisons showed significant closed mouth smile excursion improvement (difference in means, −1.14 mm; 95% CI, −2.19 to −0.09 mm; P = 0.034) and a significant decrease in platysmal botulinum toxin type A administration (difference in means, 27.36 units; 95% CI, 18.72 to 36.00 units; P < 0.001) in the myectomy-neurectomy group compared with the myectomy group.

Conclusions:

This study suggests that selective myectomies and selective myectomies with selective neurectomies provide overlapping and differing benefits to perioral synkinesis. Selective neurectomies and platysma myectomy provided slightly improved excursion and significantly decreased botulinum injections to the platysma.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Gender-Affirming Surgery Improves Mental Health Outcomes and Decreases Antidepressant Use in Patients with Gender Dysphoria
Authors: Kilmer Lee H. , Chou Jesse , Campbell Christopher A. , DeGeorge Brent R. , Stranix John T.
Published: February 2024

Background:

Patients with gender dysphoria face significant health disparities and barriers to care. Transition-related care includes hormonal therapy, mental health care, and gender-affirming surgery. Studies have described favorable surgical outcomes and patient satisfaction; however, the degree to which these procedures affect mental health conditions is not fully understood. The purpose of this study was to evaluate the effect of gender-affirming plastic surgery on mental health and substance misuse in the transgender population.

Methods:

A national insurance claims–based database was used for data collection. Patients with a diagnosis of gender dysphoria were propensity score–matched for the likelihood of undergoing gender-affirming surgery (no surgery being the control cohort), based on comorbidities, age, and sex. Primary outcomes included postoperative antidepressant use and the prevalence of mental health conditions.

Results:

A total of 3134 patients with gender dysphoria were included in each cohort. Patients in the surgery group had overall lower rates of mental health conditions, substance misuse, and selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor use. There was an absolute decrease of 8.8% in selective serotonin reuptake inhibitor or serotonin and norepinephrine reuptake inhibitor prescription after gender-affirming plastic surgery (P < 0.001), and significant decreases were found in postoperative depression (7.7%), anxiety (1.6%), suicidal ideation (5.2%) and attempts (2.3%), alcohol misuse (2.1%), and drug misuse (1.9%).

Conclusion:

Gender-affirming surgery in appropriately selected patients with gender dysphoria is associated with decreased postoperative rates of SSRI or SNRI use and improved mental health.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Outcomes of Immediate versus Delayed Autologous Reconstruction with Postmastectomy Radiation: A Meta-Analysis
Authors: ElAbd Rawan , Jabori Sinan , Willey Brea , El Eter Leen , Oberoi Michelle K. , Singh Devinder
Published: February 2024

Background:

Postmastectomy autologous breast reconstruction can be immediate or delayed. The safety of performing immediate breast reconstruction (IBR) and the impact of radiation on the newly reconstructed breast is not yet validated.

Methods:

A PubMed, Embase, and Google scholar search was conducted from inception to September 17, 2023. The authors included comparative studies that assessed complications or aesthetic outcomes of IBR versus delayed breast reconstruction (DBR) in the setting of postmastectomy radiotherapy (PMRT).

Results:

The search identified 2693 articles. Thirteen were eligible for inclusion. A total of 565 patients underwent IBR followed by radiotherapy, whereas 699 had DBR. Mean follow-up time and age for both groups were comparable (P > 0.1). None of the complications—revision surgery, infection, total flap failure, seroma, hematoma, dehiscence, or delayed wound healing—were significantly different across groups (P > 0.1). IBR was found to have a higher risk of flap fibrosis (OR, 28.18; 95% CI, 5.15 to 154.12; P = 0.0001; I
2 = 44%) and skin flap necrosis (OR, 6.12; 95% CI, 2.71 to 13.82; P < 0.0001; I
2 = 27%) but a lower risk of partial flap failure (OR, 0.18; 95% CI, 0.06 to 0.58; P = 0.004; I
2 = 0%) when compared with DBR. Results of fat necrosis should be interpreted with caution. Patient-reported and objective aesthetic outcomes were mostly comparable between groups.

Conclusions:

IBR in the setting of PMRT is increasingly being performed and poses a specific set of challenges that surgeons usually consider. The choice between IBR or DBR in the setting of PMRT should be an individualized decision based on patient risk factors and desires.
People with HIV pioneers of injectable cabotegravir and rilpivirine long acting in Italy: who are they?
Authors: Bartalucci Claudia , Baldi Federico , Ricci Elena , Orofino Giancarlo , Menzaghi Barbara , Ferrara Sergio , Pellicano’ Giovanni Francesco , Squillace Nicola , Sarchi Eleonora , Pontali Emanuele , Cenderello Giovanni , Bargiacchi Olivia , Piccica Matteo , Carleo Maria Aurora , Cascio Antonio , De Socio Giuseppe Vittorio , Bonfanti Paolo , Di Biagio Antonio
Published: February 2024

Injectable cabotegravir and rilpivirine long-acting therapy is a revolutionary new antiretroviral treatment (ART) option for HIV infection in virologically suppressed adults on a stable ART. The aim of this study from SCOLTA multicenter observational prospective database is to describe the first people living with HIV (PWH) who started this regimen in Italy, assessing adherence to eligibility criteria, describing clinical-epidemiological characteristics compared to registration trials-population and describe early treatment-discontinuations.
Infratemporal Fossa Schwannoma Surgery via a Combined Prelacrimal Recess, Caldwell-Luc, and Distal Intraoral Approach
Authors: Cao Zhiwen , Wang Tianyu , Lin Bojian , Cai Boyu , Peng Hu , Liu Huanhai , Liao Jianchun
Published: February 2024

Background:

The deep location of infratemporal fossa (ITF) combined with the abundant vascular plexus in it increased the difficulty of removing the mass in ITF through endoscope surgery approach. However, under appropriate circumstances, the excision of ITF tumors through a combined prelacrimal recess, Caldwell-Luc, and distal intraoral approach can be safely performed with minimal impact on the surrounding tissues.

Case presentation:

The Department of Neurology received a 69-year-old male patient who had been experiencing headache, dizziness, and numbness from the mastoid region of his left ear to the corner of his mouth for a duration of 22 days. Cranial magnetic resonance imaging revealed the presence of a tumor located in the ITF. Following transfer to our department, surgical intervention was performed using a combined approach involving the prelacrimal recess, the anterior wall of maxillary sinus, and lateral ITF to successfully remove the tumor. Postoperative pathologic examination confirmed schwannoma as its nature. The patient was discharged in excellent condition without any functional impairment.

Conclusions:

On the basis of this case, the authors believe that this combined approach can offer a distinct endoscopic perspective and adequate surgical workspace, which is crucial for tumor removal while preserving the integrity of surrounding normal tissues. Moreover, the utilization of multiple small incisions has minimal impact on postoperative recovery.
Nasofacial Groove Pedicled Flap for the Reconstruction of Lateral Alar Defect
Authors: Zeng Qi , Wei Jiao , Dai Chuan-Chang , Yu Bao-Fu
Published: February 2024

Background:

The repair of nasal alar defects is challenging for plastic surgeons, and there is currently no standard operation. Herein, the authors reported the clinical outcomes of a nasofacial groove pedicled flap for the reconstruction of alar defect.

Methods:

This retrospective study included patients who underwent the nasofacial groove pedicled flap for the reconstruction of alar defect between January 2018 and June 2020. Photographs of standard facial postures were taken before and after surgery to record the surgical results of the patients. The patient’s medical history was reviewed retrospectively. Self-reported satisfaction of patients on scar morphology and reconstructive effect were evaluated with a questionnaire survey.

Results:

There were 26 eligible patients enrolled, and all patients were followed up for more than 1 year after surgery. All flaps were free of ischemia and necrosis and healed well. No patient experienced restricted nostril ventilation. Eight patients underwent reoperation to trim the flap pedicle and the scar. Eight patients (8/26) reported “very satisfied,” and 17 patients (17/26) reported “satisfied” with the repair effect and scar morphology. One patient went through multiple laser treatments to improve her scars but still remained visible hyperpigmentation. She was dissatisfied with postoperative flap pigmentation but was satisfied with the correction effect.

Conclusions:

The clinical results indicated that the nasal groove flap was safe for the treatment of the lateral alar defect, and the patients were satisfied with the clinical results. The authors believe that this flap can be used as an alternative method for repairing the lateral alar defect.

Level of Evidence:

Level —IV, therapeutic study.
The Influence of Traffic Lights Presentation of Dementia Risk Screening Information on Older Adults’ Motivations for Risk Reduction in Primary Care Settings
Authors: Matovic Diana , Ahern Malene , Lei Xiaojing , Wuthrich Viviana M.
Published: February 2024

Objective:

This study assessed older adults’ preferences for how to communicate dementia risk information to maximize motivation for behavior change.

Method:

Eighty-nine community-dwelling older adults (aged 61 to 92 years, M=72.93, SD=6.36, 76% women) received dementia risk factor information in 2 formats: “traffic lights” (green=risk absent, amber=risk emerging, and red=risk present) or red/risk-only. Participants reported motivation to change risk-related behaviors, motivation to maintain good health behaviors, liking of the formats, categorical preference for traffic lights versus risk-only formats, reasons for preferences (open-ended), total applicable risks, and Motivation to Change Lifestyle and Health Behaviour for Dementia Risk Reduction.

Results:

Traffic lights presentation was more motivating (Z=4.16,P<0.001), more liked (Z=4.80,P<0.001), and preferred, NTraffic=71, NRed=14, χ2(1)=38.22,P<0.001, over risk-only. Self-efficacy and motivation to maintain good health behaviors were significant unique predictors of motivation to change risk-related behaviors following traffic lights presentation over age, sex, education, total applicable risks, perceived susceptibility, cues to action, and liking of the traffic lights presentation format. Themes indicated (1) traffic light presentation is informative and clear, and (2) green-light information increases self-efficacy.

Conclusions:

Traffic light presentation increases patient motivation to reduce dementia risk. Green-light information increases self-efficacy. Maximizing motivation through information presentation can decrease dementia prevalence.
Mycobacterium tuberculosis-THP-1 like macrophages protein-protein interaction map revealed through dual RNA-seq analysis and a computational approach
Authors: Hkimi Chaima , Kamoun Selim , Khamessi Oussema , Ghedira Kais
Published: February 2024

Introduction. Infection caused by Mycobacterium tuberculosis (M. tb) is still a leading cause of mortality worldwide with estimated 1.4 million deaths annually.

Hypothesis/Gap statement. Despite macrophages' ability to kill bacterium, M. tb can grow inside these innate immune cells and the exploration of the infection has traditionally been characterized by a one-sided relationship, concentrating solely on the host or examining the pathogen in isolation.

Aim. Because of only a handful of M. tb–host interactions have been experimentally characterized, our main goal is to predict protein–protein interactions during the early phases of the infection.

Methodology. In this work, we performed an integrative computational approach that exploits differentially expressed genes obtained from Dual RNA-seq analysis combined with known domain–domain interactions.

Results. A total of 2381 and 7214 genes were identified as differentially expressed in M. tb and in THP-1-like macrophages, respectively, revealing different transcriptional profiles in response to infection. Over 48 h of infection, the host–pathogen network revealed 25 016 PPIs. Analysis of the resulting predicted network based on cellular localization information of M. tb proteins, indicated the implication of interacting nodes including the bacterial PE/PPE/PE_PGRS family. In addition, M. tb proteins interacted with host proteins involved in NF-kB signalling pathway as well as interfering with the host apoptosis ability via the potential interaction of M. tb TB16.3 with human TAB1 and M. tb GroEL2 with host protein kinase C delta, respectively.

Conclusion. The prediction of the full range of interactions between M. tb and host will contribute to better understanding of the pathogenesis of this bacterium and may provide advanced approaches to explore new therapeutic targets against tuberculosis.
The role of ultradian rhythms in post-deprivation rebounds and diurnal rhythms of sleep and wakefulness in rats
Authors: Lim Joonbum , Stephenson Richard
Published: February 2024

The temporal organization of ultradian rhythms in sleep and wakefulness during post-sleep deprivation (TSD) rebound were investigated in 15 rats under contant bright light (LL). Following baseline recordings, rats were subjected to TSD using gentle manual stimulation. Post-TSD rebounds in cumulative wakefulness (WAKE), rapid eye movement sleep (REM) and non-REM sleep (NREM) were analyzed in WAKE-dominant (υw) and sleep-dominant (υs) ultradian phases. Rebounds in WAKE and NREM were present only when data were analyzed on a full ultradian cycle basis, and were absent in υsand υwphases alone. These rebounds were approximately 50% complete and not proportional to TSD excess/deficit. Rebounds in REM were present in full ultradian cycles and partially expressed in υsbut absent in υw. REM rebounds fully compensated for REM deficit. Rebounds were mediated mainly by a reduction in the duration of the υwultradian phase, and by decreased probability of arousal in the υsultradian phase. These mechanisms were also found to partially mediate diurnal rhythms in 10 rats under a 12:12 h LD cycle.

This study implicates an ultradian timing mechanism in the control of post-TSD rebounds and suggests that rebounds in all three states are mainly mediated by post-TSD adjustments in WAKE-promoting mechanisms. Ultradian rhythms should be taken into account to avoid errors in data analysis.

Highlights

Sleep-wake state exhibits circadian rhythms and ultradian rhythms.

These rhythms interact with rebounds after sleep deprivation.

Circadian amplitude and sleep rebound are partially mediated by ultradian timing.

Arousal-related processes control these sleep-wake patterns in both states.

Measuring ultradian rhythms is necessary for accurate analysis of data.
CRISPR Gene Editing of a Virulent Bacteriophage
Authors: Camilli Andrew
Published: February 2024

Genome editing by site-directed mutagenesis is an important tool in biological research. CRISPR gene editing is the latest such tool developed, and one that is widely applicable to study organisms from all kingdoms of life. Here, I introduce a method for making site-directed, defined mutations in a virulent bacteriophage (a bacterial virus) using CRISPR gene editing. The ability to precisely edit the genomes of virulent phages will facilitate the study of their gene requirements for infection of host bacteria and advance our ability to engineer phages for use as therapeutic agents to combat bacterial infections. The protocol introduced here was developed as part of Cold Spring Harbor's Advanced Bacterial Genetics course.
How do cicadas emerge together? Thermophysical aspects of their collective decision-making
Authors: Goldstein Raymond E. , Jack Robert L. , Pesci Adriana I.
Published: February 2024

Periodical cicadas exhibit life cycles with durations of 13 or 17 years, and it is now accepted that large prime cycles arose to avoid synchrony with predators. Less well explored is , in the face of intrinsic biological and environmental noise, insects within a brood emerge together in large successive swarms from underground during springtime warming. Here, we consider the decision-making process of underground cicadas experiencing random, spatially correlated thermal microclimates such as those in nature. Introducing short-range communication between insects leads to an Ising model of consensus building with a quenched, spatially correlated random magnetic field and annealed site dilution, which displays the kinds of collective swarms seen in nature. These results highlight the need for fieldwork to quantify the spatial fluctuations in thermal microclimates and their relationship to the spatiotemporal dynamics of swarm emergence.

Published by the American Physical Society
2024
Path integral quantum algorithm for simulating non-Markovian quantum dynamics in open quantum systems
Authors: Walters Peter L. , Wang Fei
Published: February 2024

Research in open quantum system dynamics has received growing interest in recent years, and its ongoing investigation has uncovered many intriguing physics departing from closed systems. A particularly useful application of the open quantum system theory is to simulate quantum dynamical processes in condensed phase materials. As the quantum degree of freedom is constantly under the influence of its thermal environment, the accurate description of the dynamics often requires non-Markovian time evolution at finite temperature. Such calculation is usually quite challenging on classical computers as extensive memory storage is required. In this work, we focus on a quantum system linearly coupled to its harmonic bath and present a path integral based quantum algorithm that time-evolves the reduced density matrix under finite temperature non-Markovian dynamics. To treat the nonunitary time evolution, the Sz.-Nagy dilation scheme is used for the conversion to unitary dynamics that can be implementable on gate-based quantum computers. The modified Hadamard test is then used to retrieve all the information of the reduced density matrix. Complexity analysis shows that the memory requirement has exponential reduction on the quantum machine whereas the runtime complexity stays roughly the same as for the classical computer. It points to the possibility of using this algorithm to simulate multilevel and multisite non-Markovian quantum dynamics that are beyond the reach of classical computers. The algorithm makes no ad hoc assumptions and extends naturally beyond Markovian and weak coupling regimes. We validated the algorithm on the quantum simulator with the spin-boson model and demonstrated its excellent agreement with the classical computer benchmark.

Published by the American Physical Society
2024
Operational Metric for Quantum Chaos and the Corresponding Spatiotemporal-Entanglement Structure
Authors: Dowling Neil , Modi Kavan
Published: February 2024

Chaotic systems are highly sensitive to a small perturbation and are ubiquitous throughout the biological sciences, the physical sciences, and even the social sciences. Taking this as the underlying principle, we construct an operational notion for quantum chaos. Namely, we demand that the future state of a many-body isolated quantum system is sensitive to past multitime operations on a small subpart of that system. By “sensitive,” we mean that the resultant states from two different perturbations cannot easily be transformed into each other. That is, the pertinent quantity is the complexity of the effect of the perturbation within the final state. From this intuitive metric, which we call the butterfly-flutter fidelity, we use the language of multitime quantum processes to identify a series of operational conditions on chaos; in particular, the scaling of the spatiotemporal entanglement. Our criteria already contain the routine notions, as well as the well-known diagnostics for quantum chaos. This includes the Peres-Loschmidt echo, dynamical entropy, tripartite mutual information, and local-operator entanglement. We hence present a unified framework for these existing diagnostics within a single structure. We also go on to quantify how several mechanisms, such as evolution generated from random circuits, lead to quantum chaos. Our work paves the way to systematically study many-body dynamical phenomena such as many-body localization, measurement-induced phase transitions, and Floquet dynamics.

Published by the American Physical Society
2024
Can an apple a day keep COVID-19 away? A cluster analysis of the long-term COVID-19 pandemic’s impact on the consumption of apples in Italy
Authors: Giannetto Carlo , De Pascale Angelina , Di Vita Giuseppe , Lanfranchi Maurizio
Published: February 2024

Purpose

Apples have always been considered a healthy product able to provide curative properties to consumers. In Italy, there is a long tradition of apple consumption and production both as a fresh product and as processed food. However, as with many other products, the consumption of fruits and vegetables and, more specifically apples, has been drastically affected by the first lockdown in 2020. In this project, the authors investigate whether the change in consumption habits had long-lasting consequences beyond 2020 and what are the main eating motivations, food-related behavior and socio-demographic affecting the consumption of fruits and vegetables after the pandemic.

Design/methodology/approach

The authors ran two online surveys with 1,000 Italian consumers across a year (from October 2021 to December 2022). In the study, participants answered questions about their consumption habits and their eating motives. Out of 1,000 consumers, the authors included in the final analysis only the participants who answered both surveys, leaving a final sample of 651 consumers.

Findings

The results show that participants have allocated more budget to fruit and vegetables after the lockdown than before it. Moreover, consumers reported an average increase in the consumption of apples. However, the increase was more pronounced for people aged between 30 and 50 years old and identified as female. After showing the difference across time, a cluster analysis identified three main segments that differ in their eating motives, place of purchase and area of residence.

Practical implications

Overall, the results contribute to a better understanding of how the global pandemic is still affecting people's daily life. Moreover, the findings can be used to guide the marketing and communication strategies of companies in the food sector.

Originality/value

To the best of the authors' knowledge, this is the first study that investigates changes in the consumption of fruits and vegetables, and, more specifically, apples, in Italy more than one year after the beginning of the COVID-19 pandemic. Moreover, the study proposes a classification of consumers based on their habits in a time frame during which the COVID-19 wave was at its bottom which is not currently present in the literature.
Analysis and circuit design of isolated forward SEPIC converter with minimum-phase stability
Authors: Goudarzian Alireza , Pourbagher Rohallah
Published: February 2024

Purpose

Conventional isolated dc–dc converters offer an efficient solution for performing voltage conversion with a large improved voltage gain. However, the small-signal analysis of these converters shows that a right-half-plane (RHP) zero appears in their control-to-output transfer function, exhibiting a nonminimum-phase stability. This RHP zero can limit the frequency response and dynamic specifications of the converters; therefore, the output voltage response is sluggish. To overcome these problems, the purpose of this study is to analyze, model and design a new isolated forward single-ended primary-inductor converter (IFSEPIC) through RHP zero alleviation.

Design/methodology/approach

At first, the normal operation of the suggested IFSEPIC is studied. Then, its average model and control-to-output transfer function are derived. Based on the obtained model and Routh–Hurwitz criterion, the components are suitably designed for the proposed IFSEPIC, such that the derived dynamic model can eliminate the RHP zero.

Findings

The advantages of the proposed IFSEPIC can be summarized as: This converter can provide conditions to achieve fast dynamic behavior and minimum-phase stability, owing to the RHP zero cancellation; with respect to conventional isolated converters, a larger gain can be realized using the proposed topology; thus, it is possible to attain a smaller operating duty cycle; for conventional isolated converters, transformer core saturation is a major concern, owing to a large magnetizing current. However, the average value of the magnetizing current becomes zero for the proposed IFSEPIC, thereby avoiding core saturation, particularly at high frequencies; and the input current of the proposed converter is continuous, reducing input current ripple.

Originality/value

The key benefits of the proposed IFSEPIC are shown via comparisons. To validate the design method and theoretical findings, a practical implementation is presented.
Influencing factors and governance strategies of megaproject complexity based on fuzzy-set qualitative comparative analysis
Authors: Wu Quntao , Bo Qiushi , Luo Lan , Yang Chenxi , Wang Jianwang
Published: February 2024

Purpose

This study aims to obtain governance strategies for managing the complexity of megaprojects by analyzing the impact of individual factors and their configurations using the fuzzy-set qualitative comparative analysis (fsQCA) method and to provide references for project managers.

Design/methodology/approach

With the continuous development of the economy, society and construction industry, the number and scale of megaprojects are increasing, and the complexity is becoming serious. Based on the relevant literature, the factors affecting the complexity of megaprojects are determined through case analysis, and the paths of factors affecting the complexity are constructed for megaprojects. Then, the fsQCA method is used to analyze the factors affecting the complexity of megaprojects through 245 valid questionnaires from project engineers in this study.

Findings

The results support the correlation between the complexity factors of megaprojects, with six histological paths leading to high complexity and seven histological paths leading to low complexity.

Originality/value

It breaks the limitations of the traditional project complexity field through a “configuration perspective” and concludes that megaproject complexity is a synergistic effect of multiple factors. The study is important for enriching the theory of megaproject complexity and providing complexity governance strategies for managers in megaproject decision-making.