bluuebunny/crossref_metadata_2025 huggingface dataset:
Perinatal outcomes following uterine rupture during a trial of labor after cesarean: A 12‐year single‐center experience
Authors: Amikam Uri , Hochberg Alyssa , Segal Roy , Abramov Shani , Lavie Anat , Yogev Yariv , Hiersch Liran
Published: October 2023

Objective

To determine perinatal outcomes following uterine rupture during a trial of labor after one previous cesarean delivery (CD) at term.

Methods

A retrospective single‐center study examining perinatal outcomes in women with term singleton pregnancies with one prior CD, who underwent a trial of labor after cesarean (TOLAC) and were diagnosed with uterine rupture, between 2011 and 2022. The primary outcome was a composite maternal outcome, and the secondary outcome was a composite neonatal outcome. Additionally, we compared perinatal outcomes between patients receiving oxytocin during labor with those who did not.

Results

Overall, 6873 women attempted a TOLAC, and 116 were diagnosed with uterine rupture. Among them, 63 (54.3%) met the inclusion criteria, and 18 (28%) had the maternal composite outcome, with no cases of maternal death. Sixteen cases (25.4%) had the composite neonatal outcome, with one case (1.6%) of perinatal death. No differences were noted between women receiving oxytocin and those not receiving oxytocin in the rates of maternal composite (35.7% vs 26.5%, P = 0.502, respectively) or neonatal composite outcomes (21.4% vs 26.5%, P = 0.699).

Conclusion

Uterine rupture during a TOLAC entails increased risk for myriad adverse outcomes for the mother and neonate, though possibly more favorable than previously described. Oxytocin use does not affect these risks.
Biomechanical analysis of tendon regeneration capacity of Iberian ribbed newts following transection injury: Comparison to a mouse model
Authors: Sato Fumiya , Masuda Yu , Suzuki Daisuke , Hayashi Toshinori , Iwasaki Tomohito , Kim Jeonghyun , Matsumoto Takeo , Maeda Eijiro
Published: October 2023

Adult mammals are known for their poor ability to regenerate tissues, including tendons. On the other hand, urodeles have become an important model in regenerative studies for their remarkable ability to regenerate various body parts and organs throughout life, such as limbs, retinas, or even the brain. However, little is known about their capacity to regenerate injured tendons. If newts can also repair tendons without scar formation, they may be a suitable animal model for tendon regeneration studies in other adult vertebrates. Therefore, the present study used Iberian ribbed newts to characterize mechanical and structural regeneration of tendons following transection, using tensile tests and multiphoton microscopy. A digital flexor tendon in a hindlimb was transected either partially or completely, and regenerated tendon was examined 6 and 12 weeks after the operation. Tensile strength of regenerated tendons was significantly less than normal at 6 weeks, but was remarkably recovered at 12 weeks, reaching levels comparable to those of uninjured tendons. On the other hand, mouse tendons demonstrated poor recovery of strength even after 12 weeks. Multiphoton microscopy revealed that tendon‐like collagenous tissue bridges residual tendon stubs in newts, but disorganized scar‐like tissue filled the injured location in mice. These findings highlight the remarkable capacity of newts to recover from tendon injury and confirm the utility of newts as a model to study tendon regeneration.
Laboratory‐adapted and wild‐type black soldier flies express differential plasticity in bioconversion and nutrition when reared on urban food waste streams
Authors: Zhang Qi‐Hui , Silvaraju Shaktheeshwari , Unadirekkul Phira , Lim Nicholas Weishou , Heng Chin Wee , Liu Mei Hui , Puniamoorthy Nalini
Published: October 2023

BACKGROUND

The black soldier fly (BSF) offers a potential solution to address shortages of feed and food sources; however, selecting effective rearing substrates remains a major hurdle in BSF farming. In an urban area like Singapore, current practice is based on rearing BSF on homogeneous waste streams (e.g., spent brewery grains or okara) because heterogeneous food wastes (e.g., mixed kitchen/canteen waste or surplus cooked food) present several operational challenges with respect to the standardization of development, nutritional content, and harvesting.

RESULTS

In this study, we compared two genetic strains of BSF larvae (wild‐type and laboratory‐adapted line) in a bioconversion experiment with diverse types of food waste (homogeneous/heterogeneous; plant/meat) and we quantified the phenotypic plasticity. Our results demonstrate different plasticity in bioconversion performance, larval growth and larval nutrition between the two BSF lines. This difference may be attributed to the selective breeding the laboratory‐adapted line has experienced. Notably, larval lipid content displayed little to no genetic variation for plasticity compared with larval protein and carbohydrate content. Despite variation in larval development, heterogeneous food wastes can produce better performance in bioconversion, larval growth, and larval nutrient content than homogeneous food waste. All‐meat diets result in high larvae mortality but larval survival could be rescued by mixing meat with plant‐based food wastes.

CONCLUSION

Overall, we suggest using mixed meals for BSF larvae feeding. Targeted breeding may be a promising strategy for the BSF industry but it is important to consider the selection effects on plasticity in larval nutrition carefully. © 2023 The Authors. Journal of The Science of Food and Agriculture published by John Wiley & Sons Ltd on behalf of Society of Chemical Industry.
Mixed Reality Combined with Surgical Navigation in Resection of Micro‐ and Mini‐Tumors of the Parotid Gland: A Pilot Study
Authors: Tang Zu‐Nan , Hu Lei‐Hao , Yu Yao , Zhang Wen‐Bo , Peng Xin
Published: October 2023

Objective

This study aimed to evaluate the feasibility and outcomes of mixed reality combined with surgical navigation (MRSN) in the resection of parotid micro‐ and mini‐tumors.

Methods

Eighteen patients who underwent parotid tumor resection between December 2020 and November 2022 were included. Six patients were enrolled in MRSN group, and the surgeons performed the surgery with the help of MRSN technology. The surgical procedures include virtual planning, data transfer between mixed reality and surgical navigation, tumor localization and resection assisted by surgical navigation under mixed reality environment. Twelve patients were enrolled in control group, and intraoperative tumor localization and resection were performed according to the experience of the surgeon. Total surgery time and intraoperative bleeding were recorded. Perioperative complications were recorded during follow‐up.

Results

The mean surgery time of MRSN group (76.7 ± 14.0 min) and control group (65.4 ± 21.3 min) showed no significant difference (p = 0.220), so did the intraoperative bleeding of MRSN group (16.0 ± 8.0 mL) and control group (16.7 ± 6.6 mL) (p = 0.825). None of the patient in MRSN group underwent any complication, although one patient in control group suffered temporary facial paralysis. The mean deviation between the virtually marked and the intraoperative actual outermost point of tumor was 3.03 ± 0.83 mm.

Conclusion

MRSN technology can realize real‐time three‐dimensional visualization of the tumor, and it has the potential of enhancing the safety and accuracy of resection of micro‐ and mini‐tumors of parotid gland.

Level of Evidence

4 Laryngoscope, 134:1670–1678, 2024
Juvenile Striped Bass consume diverse prey in Chesapeake Bay tributaries
Authors: Pagenkopp Lohan Katrina M. , Aguilar Robert , DiMaria Ruth , Heggie Keira , Tuckey Troy D. , Fabrizio Mary C. , Ogburn Matthew B.
Published: October 2023

Objective

Anadromous Striped Bass Morone saxatilis are dominant predators in estuaries and coastal areas along the U.S. Atlantic coast, with the potential to exert top-down control on prey populations. Although Striped Bass diets have been studied previously, spatiotemporal patterns of diet across ontogeny remain poorly understood, especially for young fish in shallow nursery habitats.

Methods

We collected and examined gut contents from adult, juvenile, and young-of-year (age-0) Striped Bass from nine rivers across the Maryland and Virginia portions of Chesapeake Bay during summer and fall 2018. We compared the use of traditional morphological inspection and new amplicon-based next-generation sequencing methods for identifying gut contents.

Result

Striped Bass in shallow tributary habitats of Chesapeake Bay had diverse diets that varied strongly with ontogeny and salinity zone. In particular, the diet of age-0 Striped Bass varied greatly from those of juveniles and adults when age-0 fish foraged in freshwater habitats. Although our results on prey consumed aligned with previous surveys, we identified additional taxa as important prey for these young fish, including dipteran insects, Banded Killifish Fundulus diaphanus, Inland Silverside Menidia beryllina, bay barnacle Amphibalanus improvisus, and grass shrimp Palaemon spp. Comparison of methodologies indicated that 40% of prey by weight could not be identified with morphological analysis, while 76% of mitochondrial cytochrome oxidase I sequences could be assigned binomial names, allowing for high-resolution taxonomic comparisons.

Conclusion

This study adds to the growing body of evidence that amplicon-based next-generation sequencing methods are far superior to traditional morphological analyses of gut contents for fine-scale taxonomic resolution of prey.
The LET trilemma: Conflicts between robust target coverage, uniform dose, and dose‐averaged LET in carbon therapy
Authors: Fredriksson Albin , Glimelius Lars , Bokrantz Rasmus
Published: October 2023

Background

Linear energy transfer (LET) is closely related to the biological effect of ionizing radiation. Increasing the dose‐averaged LET (LETd) within the target volume has been proposed as a means to improve clinical outcome for hypoxic tumors. However, doing so can lead to reduced robustness to range uncertainty.

Purpose

To quantify the relationship between robust target coverage, target dose uniformity, and LETd, we employ robust optimization using dose‐based and LETd‐based functions and allow varying amounts of target non‐uniformity.

Methods and Materials

Robust carbon therapy optimization is used to create plans for phantom cases with increasing target sizes (radii 1, 3, and 5 cm). First, the influence of respectively range and setup uncertainty on the LETd in the target is studied. Second, we employ strategies allowing overdosage in the clinical target volume (CTV) or gross tumor volume (GTV), which enable increased LETd in the target. The relationship between robust target coverage and LETd in the target is illustrated by tradeoff curves generated by optimization using varying weights for the LETd‐based functions.

Results

As the range uncertainty used in the robust optimization increased from 0% to 5%, the near‐minimum nominal LETd decreased by 17%–29% (9–21 keV/µm) for the different target sizes. The effect of increasing setup uncertainty was marginal. Allowing 10% overdosage in the CTV enabled 9%–29% (6–12 keV/µm) increased near‐minimum worst case LETd for the different target sizes, compared to uniform dose plans. When 10% overdosage was allowed in the GTV only, the increase was 1%–20% (1–8 keV/µm).

Conclusions

There is an inherent conflict between range uncertainty robustness and high LETd in the target, which is aggravated with increasing target size. For large tumors, it is possible to simultaneously achieve two of the three qualities range robustness, uniform dose, and high LETd in the target.
Education and documentation strategies to improve malnutrition diagnosis in hospitalized children: A quality improvement project
Authors: Rompca Annemarie , McCallister Anne , Cruse Wendy , Webber Emily C. , Vanderpool Charles
Published: October 2023

Background

The Academy of Nutrition and Dietetics/American Society for Parenteral and Enteral Nutrition (AND/ASPEN) published malnutrition guidelines in 2014. In 2015, our institution implemented a quality improvement project focused on malnutrition identification with the goal to improve the diagnosis of malnutrition in hospitalized children.

Methods

Our project included three approaches: education, nutrition assessment, and documentation initiatives. Education initiatives focused on physicians at all levels of training. Nutrition screening was completed on all patients admitted to our institution. Registered dietitians (RDs) conducted nutrition assessments and identified and documented malnutrition based on AND/ASPEN guidelines. Documentation initiatives included development of automatic text and template changes to allow import of RD‐assigned malnutrition diagnosis into physician documentation. We met with members of our clinical documentation integrity team regularly to review the results of these initiatives starting in 2016.

Results

The total diagnosed cases of malnutrition increased from 208 cases in 2016 at the start of our monitoring to >800 cases per year in 2020–2022. Unspecified (no severity assigned) protein calorie malnutrition as a percentage of total malnutrition diagnoses decreased from 36.9% in 2016 to <10% since 2018. Children with severe malnutrition have remained the largest portion of children with a malnutrition diagnosis, with >40% of children with malnutrition diagnosed with severe malnutrition.

Conclusion

Our education and documentation initiatives have led to both improved diagnosis of malnutrition and accurate identification and documentation of malnutrition severity. These initiatives could be utilized to improve malnutrition diagnosis and documentation at other institutions caring for hospitalized children.
Efficient integration of deep neural networks in sequential multiscale simulations
Authors: Tröger Jendrik‐Alexander , Eivazi Hamidreza , Hartmann Stefan , Wittek Stefan , Rausch Andreas
Published: October 2023

Multiscale computations involving finite elements are often unfeasible due to their substantial computational costs arising from numerous microstructure evaluations. This necessitates the utilization of suitable surrogate models, which can be rapidly evaluated. In this work, we apply a purely data‐based deep neural network as a surrogate model for the microstructure evaluation. More precisely, the surrogate model predicts the homogenized stresses, which are typically obtained by the solution of (initial) boundary‐value problems of a microstructure and subsequent homogenization. Furthermore, the required consistent tangent matrix is computed by leveraging reverse mode automatic differentiation. To improve data efficiency and ensure high prediction quality, the well‐known Sobolev training is chosen for creating the surrogate model. This surrogate model is seamlessly integrated into a Fortran‐based finite element code using an open‐source library. As a result, this integration, combined with just‐in‐time compilation, leads to a speed‐up of more than 6000× , as demonstrated in the example of a plate with a hole examined in this work. Furthermore, the surrogate model proves to be applicable even in load‐step size controlled simulations, where it overcomes certain load‐step size limitations associated with the microstructure computations.
miRNAs involvement in the etiology and targeted therapy of bladder cancer: Interaction between signaling pathway
Authors: Sharma Rishav , Malviya Rishabha
Published: October 2023

Bladder cancer (BC) accounts for roughly 3% of all cancer diagnoses in developed countries. The prognosis could be improved significantly if the cancer is detected and classified as either muscle‐invasive bladder cancer (MIBC) or non‐muscle‐invasive bladder cancer (NMIBC) as promptly as possible. A potential ray of hope for the treatment of BC has emerged with the rapid development of nanomedicine and microRNAs (miRNAs), which promise to have fewer adverse effects, more tumor‐inhibitory effects, and decreased drug resistance. The complex interplay between hereditary and environmental variables is the root cause of this malignancy. Gene expression can be regulated by miRNAs, which are small, non‐coding RNAs that can either prevent the translation of protein‐coding genes or cleave RNA transcripts at certain locations. Elevated genomics has enabled a more extensive investigation of miRNAs whose expression is considerably different in BC patients compared to healthy volunteers or between BC tumor tissues and peripheral tissues. miRNAs have recently been discovered to be important regulators of BC cell carcinogenicity. Inaccurate diagnoses and prolonged treatment delays are more likely to occur due to the current diagnostic process such as lack of sensitivity and specificity and poor image quality. Patients now have access to a plethora of treatment options, including but not limited to surgery, chemotherapy, immunotherapy, gene therapy, and other innovative medicines, and in some cases, combination therapies. BC is one of the deadliest and most disabling malignancies affecting the urinary tract. Cancer of the urinary bladder has a terrible propensity for being fatal. BC is an intricate illness whose development can be affected by multiple parameters. Standard treatments for BC increase prognosis and survival, although recurrence is a major concern for patients. miRNAs are naturally occurring, small RNA molecules that have been linked to cancer through their expression being dysregulated. miRNAs modulate many cellular activities including proliferation, migration, differentiation, and apoptosis. MiRNA dysregulation is recognized in BC, and miRNAs are used as diagnostic and prognostic indicators. However, this manuscript discusses the recent progress made in nanomedicine and the function of miRNAs in the pathogenesis and targeted therapy of BC.
Partial Disentanglement in a Multipartite System
Authors: Buks Eyal
Published: October 2023

A nonlinear extension to quantum theory giving rise to deterministic partial disentanglement between pairs of subsystems is explored. The extension is based on a modified Schrödinger equation having an added nonlinear term. To avoid conflicts with the principles of causality and separability, it is postulated that disentanglement is active only during the time when particles interact. A butterfly‐like effect is found near highly entangled multipartite vector states.
An Efficient Synthesis of Spirocyclopropanes by [2+1] Annulation of α,β‐Unsaturated Carbonyl Compounds with Nitroacetates
Authors: Peng Yani , Zhang Yuxin , Wu Minyang , Chen Xingyue , Liu Xiaoqin , Liu Yun , Rong Liangce
Published: October 2023

An efficient synthesis of spirocyclopropanes was developed via [2+1] annulation of α,β‐unsaturated carbonyl compounds with nitroacetates. This protocol features advantages such as simple operation, broad substrate scope, high diastereoselectivity and good to excellent yields. Moreover, this work represents the first example of assembling spirocyclopropane derivatives from nitroacetates.
Single‐Molecule Analysis of Genome Uncoating from Individual Human Rhinovirus Particles, and Modulation by Antiviral Drugs
Authors: Valbuena Alejandro , Strobl Klara , Gil‐Redondo Juan Carlos , Valiente Luis , de Pablo Pedro J. , Mateu Mauricio G.
Published: October 2023

Infection of humans by many viruses is typically initiated by the internalization of a single virion in each of a few susceptible cells. Thus, the outcome of the infection process may depend on stochastic single‐molecule events. A crucial process for viral infection, and thus a target for developing antiviral drugs, is the uncoating of the viral genome. Here a force spectroscopy procedure using an atomic force microscope is implemented to study uncoating for individual human rhinovirus particles. Application of an increasing mechanical force on a virion led to a high force‐induced structural transition that facilitated extrusion of the viral RNA molecule without loss of capsid integrity. Application of force to virions that h ad previously extruded the RNA, or to RNA‐free capsids, led to a lower force‐induced event associated with capsid disruption. The kinetic parameters are determined for each reaction. The high‐force event is a stochastic process governed by a moderate free energy barrier (≈20 kcal mol−1), which results in a heterogeneous population of structurally weakened virions in which different fractions of the RNA molecule are externalized. The effects of antiviral compounds or capsid mutation on the kinetics of this reaction reveal a correlation between the reaction rate and virus infectivity.
The effect of volume change and stack pressure on solid‐state battery cathodes
Authors: Liu Boyang , Pu Shengda D. , Doerrer Christopher , Spencer Jolly Dominic , House Robert A. , Melvin Dominic L. R. , Adamson Paul , Grant Patrick S. , Gao Xiangwen , Bruce Peter G.
Published: October 2023

Solid‐state lithium batteries may provide increased energy density and improved safety compared with Li‐ion technology. However, in a solid‐state composite cathode, mechanical degradation due to repeated cathode volume changes during cycling may occur, which may be partially mitigated by applying a significant, but often impractical, uniaxial stack pressure. Herein, we compare the behavior of composite electrodes based on Li4Ti5O12 (LTO) (negligible volume change) and Nb2O5 (+4% expansion) cycled at different stack pressures. The initial LTO capacity and retention are not affected by pressure but for Nb2O5, they are significantly lower when a stack pressure of <2 MPa is applied, due to inter‐particle cracking and solid‐solid contact loss because of cyclic volume changes. This work confirms the importance of cathode mechanical stability and the stack pressures for long‐term cyclability for solid‐state batteries. This suggests that low volume‐change cathode materials or a proper buffer layer are required for solid‐state batteries, especially at low stack pressures.
Diagnosis of systemic lupus erythematosus in a dog with an atypical presentation of pleuritis
Authors: Oh Valerie S. W. , Melega Maverick , Bussey Suzanne , Breheny Craig R. , Starybrat Daria
Published: October 2023

A 3‐year‐old labradoodle presented with prior history of generalised seizures and had recently developed acute pyrexia and shifting leg lameness, with joint effusions in several joints. The dog also later developed pleuritis with an exudative pleural effusion. Cytological findings for all joint effusions were consistent with immune‐mediated polyarthritis. Suspected lupus erythematosus cells were seen in the joints and pleural fluid, which were confirmed with Feulgen staining. Together with a positive antinuclear antibody titre, the dog was diagnosed with systemic lupus erythematosus, which responded to immunosuppressive doses of prednisolone. This case report describes the insidious nature of systemic lupus erythematosus, a rare disease that can imitate many different conditions. It is also the first reported case of lupus erythematosus cells in pleural effusion in veterinary medicine, highlighting the importance of lupus erythematosus cells as a valuable diagnostic aid to further support the diagnosis of systemic lupus erythematosus and enable early treatment to be initiated.
Crystal Structure of and Chemical Bonding in MoNi4
Authors: Armbrüster Marc , Rößner Leonard , Prots Yurii , Akselrud Lev , König Markus , Sheptyakov Denis , Grin Yuri
Published: October 2023

Single‐phase MoNi4 was prepared by multi‐step long‐term thermal treatment. The crystal structure was re‐evaluated by single‐crystal and powder X‐ray as well as powder neutron diffraction resulting in space group I4/m and lattice parameters of a=5.7300(6) Å and c=3.5649(6) Å. Despite the formation by complex solid‐state reaction, the crystal structure of MoNi4 is fully ordered, whereby the single‐crystalline micro‐domains feature sizes below 20 μm. The ordering is supported by the strong charge transfer from Mo to Ni hindering the formation of anti‐sites. Two types of four‐atomic bonds stabilize the crystal structure. The bonding is isotropic, allowing cleavage in different crystallographic directions with mostly nickel atoms on the surface. In combination with the negative effective charge of the nickel species, this enables to shed more light on the behaviour of MoNi4 in catalytic processes.
Grammatical Cohesion in Indonesian-Speaking Preschoolers’ Narrative
Authors: Herningtias Editia , Kushartanti Bernadette
Published: October 2023

This chapter discusses the use of Indonesian grammatical cohesive devices in preschoolers’ narrative productions. The participants of this study are three- to six-year-old children (N = 60). All children live in Jabodetabek area and use Indonesian as the first language. We use a wordless picture book to elicit the use of reference, ellipsis, substitution, and conjunction in children's storytelling. Cohesive devices in children’s narration of the picture story are identified and analyzed with quantitative and qualitative approaches. The result indicates a tendency of increasing use of reference, ellipsis, substitution, and conjunction in older children, especially in lexical variation. We also find that children still use inappropriate cohesive devices. We also find correlations between reference, ellipsis, and substitution; when participants did not use reference, they preferred to omit the character from the story. Nevertheless, there is no significant difference between the age groups.
Gender and Grammatical Cohesion in Indonesian Preschoolers’ Narrative
Authors: Ferhadija Fitriana , Kushartanti Bernadette
Published: October 2023

This study compares Indonesian-speaking boys’ and girls’ narrative ability, focusing on grammatical cohesive devices in the production. The subjects are children aged 4–6 years attending a kindergarten (TK) in Bogor, West Java. We use elicited production task to obtain data of children's utterances. Twenty-eight children in total participated in the study. The main data for the study are stories narrated by the children, elicited from a wordless picture storybook. Children are interviewed individually at school. The analysis is also supported by parental questionnaires on factual information distributed to and filled out by parents. Children's personal information obtained from school. Comparison of the use of cohesive devices, namely reference, ellipsis, substitution, and conjunction, based on gender difference, is analyzed quantitatively. The result shows that both genders have the same ability in using grammatical cohesive devices. This study reaffirms the result of previous studies, which essentially state that gender does not significantly affect the language skills.
Species entropy and thermodynamics
Authors: Cribiori Niccolò , Lüst Dieter , Montella Carmine
Published: October 2023

Abstract

We analyse particle species and the species scale in quantum gravity from a thermodynamic perspective. In close analogy to black hole thermodynamics, we propose that particle species have an entropy and a temperature, which is determined by the species scale. This is identical to the Bekenstein-Hawking entropy of a corresponding minimal black hole and agrees with the number of species in a given tower of states. Through the species entropy, we find that certain entropy bounds are connected to recent swampland constraints. Moreover, the concept of species entropy and temperature allow us to formulate the laws of species thermodynamics, which are argued to govern the variations of moduli in string theory. They can be viewed as general rules that imply certain swampland conjectures, and vice versa.
Combined effects of salinization and temperature on microbial-mediated oak decomposition and invertebrate consumption
Authors: Simões S. , Augusto T. , Oliveira R. , Gonçalves A. L. , Canhoto C.
Published: October 2023

Water salinization is a recognized growing threat to freshwaters, whose consequences on streams’ function, per se or concomitantly with other stressors, are still far from clear. This microcosm study evaluated the combined effect of salinization (0 and 4 g/l NaCl) and temperature (5, 15, and 20 °C) on microbial-mediated oak leaf litter decomposition, with fungal biomass, sporulation, and microbial respiration as microbial descriptors. Invertebrate consumption was also assessed using the common shredder Sericostoma vittatum (Trichoptera, Sericostomatidae). Mass loss was affected by temperature and interaction between salinity and temperature. Under salt conditions, mass loss was higher at 15 °C and reduced (~ 10%) at 20 °C. Microbial activity was lower at 5 °C and higher at 15 and 20 °C, irrespective of salinity. Fungal biomass was affected by both temperature (5 < 20 < 15 °C) and salinity (4 < 0 g/l NaCl), although the interaction between both was not significant. The interaction of both variables affected the production of spores: salt addition strongly reduced sporulation rates at all temperatures despite a significant increase in conidial production with temperature. Invertebrate leaf consumption was significantly reduced only by salinization. Overall, our results seem to indicate that temperature may modulate the effect of salinization (at least at ≥ 4 g/l NaCl) on stream leaf decomposition. While stronger salinization effects may be observed at higher temperatures, a consistent strong inhibition of shredders’ feeding behavior promoted by salt, regardless of temperature, may anticipate important repercussions on streams’ secondary production throughout the year.
Impact of preoperative pelvic floor muscle function on the success of surgical treatment of pelvic organ prolapse
Authors: Szymański Jacek Krzysztof , Starzec-Proserpio Małgorzata , Bartosińska-Raczkiewicz Dorota , Krawczyk Agata , Kukulski Piotr , Jakiel Grzegorz
Published: October 2023

Introduction and hypothesis

The objective of this study was to identify the potential characteristics of pelvic floor muscles (PFM) in the preoperative assessment that could be associated with post-surgical prolapse severity. We hypothesized that the same variables, if identified, could be addressed in preoperative rehabilitation to improve surgical results.

Methods

This was a single-center prospective observational study that included women who underwent surgical pelvic organ prolapse repair between 2020–2022. Genital prolapse was evaluated according to the Pelvic Organ Prolapse Quantification (POP-Q) system. All the participants underwent a PFM assessment, including a vaginal digital assessment and manometry (Peritron™ 9300 V) before surgery and at 1-, 3-, and 6-month follow-ups. Several PFM variables were recorded: vaginal resting pressure, vaginal pressure during maximal voluntary contraction (MVC), area under the curve during a 10-second MVC, ability to correctly contract the PFMs, and reflexive activation during cough and relaxation. The primary endpoint of the analysis was objective surgical success defined as POP-Q 0 or 1 at the 6-month follow-up. Additionally, a change in pelvic floor muscle function was recorded during postoperative visits.

Results

A total of 106 females were included in the study. Fifty-one were lost during the 6-month follow-up, which is a major limitation of the study. None of the examined parameters evaluating PFM were associated with surgical success. No statistically significant difference was found in MVC and PFM endurance before and after surgery. Post-surgery, a significant change was observed in the vaginal resting pressure and the ability to correct PFM activation and relaxation.

Conclusions

Preoperative PFM function is not associated with surgical success 6 months after surgery.
Novel clinically meaningful scores for the ICIQ-UI-SF and ICIQ-FLUTS questionnaires in women with stress incontinence
Authors: Nipa Shamima Islam , Cooper David , Mostafa Alyaa , Hagen Suzanne , Abdel-Fattah Mohamed
Published: October 2023

Aim

To establish, for the first time, the clinically important differences for the ICIQ-UI-SF and ICIQ-FLUTS questionnaires following surgical and conservative treatments for stress-predominant urinary incontinence in women.

Methods

Data from the SIMS and OPAL randomised controlled trials were analysed using an anchor-based method. Clinically important difference (CID; score change indicating a successful outcome) and minimal important difference (MID; score change indicating the smallest noticeable difference) were estimated using the PGI-I scale as the anchor.

Results

For ICIQ-UI-SF, following surgical management, CIDs were 5.0 (95%CI 4.3, 5.6) at 1 year and 4.9 points (95%CI 4.2, 5.5) at 3 years, while following conservative management, CIDs were 4.0 (95%CI 3.4, 4.5) at 1 year and 4.6 points (95%CI 4.0, 5.2) at 2 years. For ICIQ-FLUTS, the CID was 3.4 points (95%CI 2.9, 4.0) at 1 year for both surgical and conservative management. MIDs for ICIQ-UI-SF, after surgical treatment, were 4.7 (95% CI 3.2, 6.1) at 1 year and 1.6 points (95%CI –0.2, 3.0) at 3 years, and after conservative treatment they were 1.7 (95% CI 1.0, 2.5) at 1 year and 1.9 points (95%CI 1.1, 2.7) at 2 years. For ICIQ-FLUTS, MIDs were 1.8 (95% CI 0.6, 3.1) at 1 year and 3.2 points (95%CI 2.0, 4.4) at 2 years after surgical treatment, and 1.3 (95%CI 0.6, 1.9) at 1 year and 1.9 points (95%CI 1.1, 2.6) at 2 years after conservative treatment.

Conclusion

Our study is the first to establish the CID for the ICIQ-UI-SF and ICIQ-FLUTS that women would associate with a successful outcome 3-years post-surgery and 2-years post-conservative treatment of stress-predominant urinary incontinence. The MID was lower following conservative compared to surgical treatment.
Rosuvastatin, but not atorvastatin, enhances the antihypertensive effect of cilostazol in an acute model of hypertension
Authors: Hamdy Ahmed , El-Bassossy Hany M. , Elshazly Shimaa M. , El-Sayed Shaimaa S.
Published: October 2023

Purpose

Hypertensive emergency, a sudden and severe increase in blood pressure, necessitates immediate intervention to avoid end-organ damage. Cilostazol, a selective phosphodiesterase-III inhibitor, has vasodilator effect. Here, we investigated the effect of two commonly used statins, atorvastatin or rosuvastatin, on cilostazol antihypertensive activity in acute model of hypertension.

Methods

Hypertensive emergency was induced via angiotensin II intravenous infusion (120 ng.kg−1.min−1). Rats were subjected to real-time arterial hemodynamics and electrocardiogram recording while investigated drugs were injected slowly at cumulative doses 0.5, 1, and 2 mg.kg−1, individually or in combination, followed by baroreflex sensitivity (BRS) analysis and serum electrolytes (Na+ and K+) and vasomodulators (norepinephrine (NE), and nitric oxide (NO)) assessment.

Results

Cilostazol reduced systolic blood pressure (SBP), while co-injection with rosuvastatin augmented cilostazol SBP-reduction up to 30 mmHg. Compared to atorvastatin, rosuvastatin boosted the cilostazol-associated reduction in peripheral resistance, as evidenced by further decrease in diastolic, pulse, and dicrotic-notch pressures. Rosuvastatin co-injection prevented cilostazol-induced changes of ejection and non-ejection durations. Additionally, rosuvastatin coadministration produced better restoration of BRS, with an observed augmented increase in BRS indexes from spectral analysis. Greater reduction in sympathetic/parasympathetic ratio and serum NE upon rosuvastatin coadministration indicates further shift in sympathovagal balance towards parasympathetic dominance. Additionally, rosuvastatin coinjection caused a greater decrease in serum sodium, while more increase in NO indicating augmented reduction of extracellular volume and endothelial dysfunction.

Conclusion

Rosuvastatin boosted cilostazol’s antihypertensive actions through effects on peripheral resistance, BRS, sympathovagal balance, endothelial dysfunction, and electrolytes balance, while atorvastatin did not demonstrate a comparable impact.
Dynamic assessment of scapholunate ligament status by real-time magnetic resonance imaging: an exploratory clinical study
Authors: Wilms Lena Marie , Radke Karl Ludger , Abrar Daniel Benjamin , Frahm Jens , Voit Dirk , Thelen Simon , Klee Dirk , Grunz Jan-Peter , Müller-Lutz Anja , Nebelung Sven
Published: October 2023

Objective

Clinical-standard MRI is the imaging modality of choice for the wrist, yet limited to static evaluation, thereby potentially missing dynamic instability patterns. We aimed to investigate the clinical benefit of (dynamic) real-time MRI, complemented by automatic analysis, in patients with complete or partial scapholunate ligament (SLL) tears.

Material and methods

Both wrists of ten patients with unilateral SLL tears (six partial, four complete tears) as diagnosed by clinical-standard MRI were imaged during continuous active radioulnar motion using a 1.5-T MRI scanner in combination with a custom-made motion device. Following automatic segmentation of the wrist, the scapholunate and lunotriquetral joint widths were analyzed across the entire range of motion (ROM). Mixed-effects model analysis of variance (ANOVA) followed by Tukey’s posthoc test and two-way ANOVA were used for statistical analysis.

Results

With the increasing extent of SLL tear, the scapholunate joint widths in injured wrists were significantly larger over the entire ROM compared to those of the contralateral healthy wrists (p<0.001). Differences between partial and complete tears were most pronounced at 5°–15° ulnar abduction (p<0.001). Motion patterns and trajectories were altered. Complete SLL deficiency resulted in complex alterations of the lunotriquetral joint widths.

Conclusion

Real-time MRI may improve the functional diagnosis of SLL insufficiency and aid therapeutic decision-making by revealing dynamic forms of dissociative instability within the proximal carpus. Static MRI best differentiates SLL-injured wrists at 5°–15° of ulnar abduction.
A Prospective, Observational Cost Comparison of Laparoscopic and Open Appendicectomy in Three Tertiary Hospitals in Nigeria
Authors: Adisa Adewale , Kachapila Mwayi , Ekwunife Christopher , Alakaloko Felix , Olanrewaju Balogun , Kadir Bryar , Nepogodiev Dmitri , Aderounmu Adewale , Igwilo Innocent , Omar Omar , Oppong Raymond , Simoes Joana , Bhangu Aneel , Ademuyiwa Adesoji ,   the NIHR Global Health Research Unit on Global Surgery
Published: October 2023

Background

The clinical benefits of laparoscopic appendicectomy are well recognized over open appendicectomy. However, laparoscopic procedures are not frequently conducted in many low‐and middle‐income countries (LMICs) for several reasons, including perceived higher costs. The aim of this study was to assess the feasibility and cost of laparoscopic appendicectomy compared to open appendicectomy in Nigeria.

Methods

A multicenter, prospective, cohort study among patients undergoing appendicectomy was conducted at three tertiary hospitals in Nigeria. Data were collected from October 2020 to February 2022 and analyses compared the average healthcare costs at 30 days after surgery. Quantile regression was conducted to identify variables that had an impact on the costs, reported in Nigerian Naira (Naira) and US dollars ($), with standard deviations (SD).

Findings

This study included 105 patients, of which 39 had laparoscopic appendicectomy and 66 had open appendicectomy. The average healthcare cost of laparoscopic appendicectomy (147,562 Naira (SD: 97,130) or $355 (SD: 234)) was higher than open appendicectomy (113,556 Naira (SD: 88,559) or $273 (SD: 213)). The average time for return to work was shorter with laparoscopic than open appendicectomy (mean: 8 days vs. 14 days). At the average daily income of $5.06, laparoscopic appendicectomy was associated with 9778 Naira or $24 cost savings in return to work. Further, 5.1% of laparoscopic appendicectomy patients had surgical site infections compared to 22.7% for open appendicectomy. Regression analysis results showed that laparoscopic appendicectomy was associated with $14 higher costs than open appendicectomy, albeit non‐significant (p = 0.53).

Interpretation

Despite selection bias in this real‐world study, laparoscopic appendicectomy was associated with a slightly higher overall cost, a lower societal cost, a lower infection rate, and a faster return to work, compared to open appendicectomy. It is technically and financially feasible, and its provision in Nigeria should be expanded.
Role of Microbiome in the Outcomes Following Surgical Repair of Perianal Fistula: Prospective Cohort Study Design and Preliminary Results
Authors: Bertucci Zoccali Marco , Moallem Dalia H. , Park Heekuk , Uhlemann Anne‐Catrin , Church James M. , Kiran Ravi P.
Published: October 2023

Background

Anal fistulae are common, predominantly cryptoglandular, and almost invariably require surgical treatment. Recurrences are common for procedures other than fistulotomy regardless of technique and adequacy of repair. Growing evidence supports the pivotal role of specific intestinal bacteria in anastomotic failures after bowel resection. Anal crypts harbor colonic microbiota suggesting that similar mechanisms to anastomotic healing might prevail after anal fistula repair and hence influence healing. This study aims at assessing the potential role of the intestinal microbiome in the clinical outcomes after surgical repair of cryptoglandular anal fistula.

Methods

This is a pilot prospective cohort study enrolling patients with anal fistula undergoing endoanal advancement flap. For microbiome analysis, stool samples are taken via rectal swab before the procedure; additionally, a portion of the fistula is collected intraoperatively after fistulectomy. Samples from groups with treatment failure are compared to samples from patients who healed after surgical repair. Alpha and beta diversities and differential abundance of microbial taxa are determined and compared between groups with DADA2 analytical pipeline.

Results

Five patients have been enrolled to date (one female, four male). At median follow‐up of 6 months (2–11), one patient experienced disease recurrence at 3 months. DNA from the 5 rectal swab and tissue samples was extracted, showing increased relative abundance of Enterococcus faecalis in samples from the patient who developed a recurrent fistula but not in those without recurrence.

Conclusion

These very preliminary data suggest that intestinal microbiome may represent a crucial determinant of the surgical outcomes after anal fistula surgery.
Comparison of traditional and novel tip-flexible suctioning ureteral access sheath combined with flexible ureteroscope to treat unilateral renal calculi
Authors: Zhang Zhaolin , Xie Tianpeng , Li Fangzhi , Wang Xiaoning , Liu Folin , Jiang Bo , Zou Xiaofeng , Zhang Guoxi , Yuan Yuanhu , Xiao Rihai , Wu Gengqing , Qian Biao
Published: October 2023

Objectives

To compare the safety and efficacy of novel tip-flexible suctioning ureteral access sheath (NTFS-UAS) and traditional ureteral access sheath (T-UAS) combined with flexible ureteroscope for treating unilateral renal calculi.

Materials and methods

The clinical data of 214 patients with unilateral renal calculi treated by NTFS-UAS (n = 102) and T-UAS (n = 112) combined with flexible ureteroscope from August 2021 to April 2022 were analyzed retrospectively. Demographic characteristics, stone-related parameters, operative time, stone-free rates (SFR), hospitalization time and complication rate (CR) were analyzed.

Result

No significant difference was observed between the two groups in terms of demographic characteristics, stone-related parameters, intraoperative CR, and hospitalization time. The operative time of NTFS-UAS group was significantly shorter than T-UAS group (55.25 ± 11.42 min vs. 59.36 ± 15.59 min; P = 0.028). The NTFS-UAS group obtained significantly higher SFR on 1 day postoperatively (86.3% vs. 75.0%; P = 0.038), and higher SFR on 30 days postoperatively than T-UAS group (91.2% vs. 81.3%; P = 0.037). The hemoglobin loss of NTFS-UAS group (− 0.54 ± 0.69 g/dl) was significantly lower than T-UAS group (− 0.83 ± 0.66 g/dl; P = 0.002). There was a significantly lower incidence of overall CR (11.8% vs. 22.3%; P = 0.041), and infectious CR (8.8% vs. 18.8%; P = 0.037) in the NTFS-UAS group.

Conclusion

Compared to T-UAS combined with flexible ureteroscope for treating unilateral renal calculi, NTFS-UAS had superiority in higher SFR on 1 day and 30 days postoperatively. Shorter operation time, lower hemoglobin loss, lower incidences of overall and infectious CR were observed in NTFS-UAS group.

Registration number and date

ChiCTR2300070210; April 5, 2023.
Congenital laryngo-tracheo-esophageal clefts: updates from a quaternary care pediatric airway unit
Authors: Ishii Alessandro , Christophel Emeline , Chollet Madeleine , Sandu Kishore
Published: October 2023

Purpose

To review the operative techniques, outcomes, and complications following surgery in pediatric patients with laryngo-tracheo-esophageal clefts (LTEC). We describe a new combined approach to treat long LTECs.

Methods

Twenty-five patients underwent surgical repair for LTEC from March 2012 to July 2022 at our hospital. Every patient underwent a diagnostic endoscopy under general anesthesia and spontaneous ventilation to assess the LTEC and synchronous aero-digestive comorbidities/malformations. All patients underwent at least one surveillance endoscopy after the repair at our institution.

Results

The patients had multiple other malformations, specifically gastro-intestinal, synchronous airway, and cardiac. The cleft distribution according to the modified Benjamin and Inglis classification was type I (n = 5, 20%), type II (n = 6, 24%), type IIIa (n = 8, 32%), type IIIb (n = 4, 16%), and type IVa (n = 2, 8%). The median follow-up was 44.6 months. Five patients (20%) had undergone previous cleft corrective surgery(s). Seven patients (28%) had partial to complete breakdown of the repair, needing additional intervention(s), and two required a combined—open plus endoscopic repair. Preoperatively, most patients (n = 18, 72%) needed a feeding assistance. At latest follow-up, feeding assistance was weaned off in 13 out of 18 patients, which was a 72% improvement. Ten patients (40%) needed ventilation assistance before the surgery. Post-operatively, ventilatory assistance was weaned off in 6 patients, meaning a 60% improvement.

Conclusion

LTEC are rare malformations, and their management needs precise diagnosis, appropriate surgical planning, and execution, and dedicated post-operative care. Primary and revision repair of long clefts with tracheal extension may require a combined approach.