bluuebunny/crossref_metadata_2025 huggingface dataset:
Phosphate in Cardiovascular Disease: From New Insights Into Molecular Mechanisms to Clinical Implications
Authors: Turner Mandy E. , Beck Laurent , Hill Gallant Kathleen M. , Chen Yabing , Moe Orson W. , Kuro-o Makoto , Moe Sharon M. , Aikawa Elena
Published: January 2024

Hyperphosphatemia is a common feature in patients with impaired kidney function and is associated with increased risk of cardiovascular disease. This phenomenon extends to the general population, whereby elevations of serum phosphate within the normal range increase risk; however, the mechanism by which this occurs is multifaceted, and many aspects are poorly understood. Less than 1% of total body phosphate is found in the circulation and extracellular space, and its regulation involves multiple organ cross talk and hormones to coordinate absorption from the small intestine and excretion by the kidneys. For phosphate to be regulated, it must be sensed. While mostly enigmatic, various phosphate sensors have been elucidated in recent years. Phosphate in the circulation can be buffered, either through regulated exchange between extracellular and cellular spaces or through chelation by circulating proteins (ie, fetuin-A) to form calciprotein particles, which in themselves serve a function for bulk mineral transport and signaling. Either through direct signaling or through mediators like hormones, calciprotein particles, or calcifying extracellular vesicles, phosphate can induce various cardiovascular disease pathologies: most notably, ectopic cardiovascular calcification but also left ventricular hypertrophy, as well as bone and kidney diseases, which then propagate phosphate dysregulation further. Therapies targeting phosphate have mostly focused on intestinal binding, of which appreciation and understanding of paracellular transport has greatly advanced the field. However, pharmacotherapies that target cardiovascular consequences of phosphate directly, such as vascular calcification, are still an area of great unmet medical need.
Higher Noncalcified Plaque Volume Is Associated With Increased Plaque Vulnerability and Vascular Inflammation
Authors: Suzuki Keishi , Kinoshita Daisuke , Yuki Haruhito , Niida Takayuki , Sugiyama Tomoyo , Yonetsu Taishi , Araki Makoto , Nakajima Akihiro , Seegers Lena Marie , Dey Damini , Lee Hang , McNulty Iris , Takano Masamichi , Kakuta Tsunekazu , Mizuno Kyoichi , Jang Ik-Kyung
Published: January 2024

BACKGROUND:

Recently, it was reported that noncalcified plaque (NCP) volume was an independent predictor for cardiac events. Pericoronary adipose tissue (PCAT) attenuation is a marker of vascular inflammation and has been associated with increased cardiac mortality. The aim of this study was to evaluate the relationships between NCP volume, plaque vulnerability, and PCAT attenuation.

METHODS:

Patients who underwent preintervention coronary computed tomography angiography and optical coherence tomography were enrolled. Plaque volume was measured by computed tomography angiography, plaque vulnerability by optical coherence tomography, and the level of coronary inflammation by PCAT attenuation. The plaques were divided into 2 groups of high or low NCP volume based on the median NCP volume.

RESULTS:

Among 704 plaques in 454 patients, the group with high NCP volume had a higher prevalence of lipid-rich plaque (87.2% versus 75.9%;
P
<0.001), thin-cap fibroatheroma (38.1% versus 20.7%;
P
<0.001), macrophage (77.8% versus 63.4%;
P
<0.001), microvessel (58.2% versus 42.9%;
P
<0.001), and cholesterol crystal (42.0% versus 26.7%;
P
<0.001) than the group with low NCP plaque volume. The group with high NCP volume also had higher PCAT attenuation than the group with low NCP volume (−69.6±10.0 versus −73.5±10.6 Hounsfield unit;
P
<0.001). In multivariable analysis, NCP volume was significantly associated with thin-cap fibroatheroma and high PCAT attenuation. In the analysis of the combination of PCAT attenuation and NCP volume, the prevalence of thin-cap fibroatheroma was the highest in the high PCAT attenuation and high NCP volume group and the lowest in the low PCAT attenuation and low NCP volume group.

CONCLUSIONS:

Higher NCP volume was associated with higher plaque vulnerability and vascular inflammation. The combination of PCAT attenuation and NCP volume may help identify plaque vulnerability noninvasively.

REGISTRATION:

URL:
https://www.clinicaltrials.gov
; Unique identifier: NCT04523194.
Orthostatic Hypotension in Adults With Hypertension: A Scientific Statement From the American Heart Association
Authors: Juraschek Stephen P. , Cortez Melissa M. , Flack John M. , Ghazi Lama , Kenny Rose Anne , Rahman Mahboob , Spikes Telisa , Shibao Cyndya A. , Biaggioni Italo ,   on behalf of the American Heart Association Council on Hypertension
Published: January 2024

Although orthostatic hypotension (OH) has long been recognized as a manifestation of autonomic dysfunction, a growing body of literature has identified OH as a common comorbidity of hypertension. This connection is complex, related to pathophysiology in blood pressure regulation and the manner by which OH is derived as the difference between 2 blood pressure measurements. While traditional therapeutic approaches to OH among patients with neurodegenerative disorders focus on increasing upright blood pressure to prevent cerebral hypoperfusion, the management of OH among patients with hypertension is more nuanced; resting hypertension is itself associated with adverse outcomes among these patients. Although there is substantial evidence that intensive blood pressure treatment does not cause OH in the majority of patients with essential hypertension, some classes of antihypertensive agents may unmask OH in patients with an underlying autonomic impairment. Practical steps to manage OH among adults with hypertension start with (1) a thorough characterization of its patterns, triggers, and cause; (2) review and removal of aggravating factors (often pharmacological agents not related to hypertension treatment); (3) optimization of an antihypertensive regimen; and (4) adoption of a tailored treatment strategy that avoids exacerbating hypertension. These strategies include countermaneuvers and short-acting vasoactive agents (midodrine, droxidopa). Ultimately, further research is needed on the epidemiology of OH, the impact of hypertension treatment on OH, approaches to the screening and diagnosis of OH, and OH treatment among adults with hypertension to improve the care of these patients and their complex blood pressure pathophysiology.
Intermittent theta burst stimulation with synchronised transcranial alternating current stimulation leads to enhanced frontal theta oscillations and a positive shift in emotional bias
Authors: Briley Paul M , Boutry Clement , Webster Lucy , Veniero Domenica , Harvey-Seutcheu Catherine , Jung JeYoung , Liddle Peter F , Morriss Richard
Published: January 2024

Repetitive transcranial magnetic stimulation (rTMS), delivered to left dorsolateral prefrontal cortex, is an FDA-approved, and NICE-recommended, neuromodulation therapy for major depressive disorder (MDD). However, there is considerable inter-individual variability in rate and extent of clinical response, leading to a focus on approaches for optimising its effectiveness. We present findings from a non-patient study evaluating an approach that combines an efficient type of rTMS—“intermittent theta burst stimulation” (iTBS)—with a second neuromodulation technique—“transcranial alternating current stimulation” (tACS). tACS is delivered in synchrony with the iTBS with the intent of optimising the brain state during stimulation. In four separate sessions, we delivered 3 minutes of iTBS+tACS, iTBS+sham, sham+tACS, or double sham. We measured changes from pre- to post-stimulation in brain theta (4–8 Hz) oscillatory activity using electroencephalography, and we measured emotional bias post-stimulation using a well-studied emotion identification task. Theta activity has previously shown relationships with response to rTMS, and emotional bias has been proposed as a marker of potential antidepressant efficacy. We found that frontal theta power was enhanced following the dual therapy, building up over the 15-minute post-stimulation period to exceed that following either stimulation technique alone or double sham. Emotional bias, measured 20 minutes post-stimulation, was also significantly more positive following dual therapy. These findings indicate that tACS-synchronised iTBS (tsiTBS) holds promise as an augmentation approach for rTMS, which awaits validation in multi-session patient studies.
Meta-modeling the effects of anodal left prefrontal transcranial direct current stimulation on working memory performance
Authors: Wischnewski Miles , Berger Taylor A. , Opitz Alexander
Published: January 2024

Numerous studies have demonstrated the beneficial effects of anodal prefrontal transcranial direct current stimulation (tDCS) on working memory. However, a large variability exists in the applied tDCS parameters and working memory outcome measures. Using a meta-modeling approach, we investigated the relationship between tDCS electric fields in the left prefrontal cortex and improvements in working memory performance. Using this approach, a vector of outcome measures is correlated with the tDCS-related electric fields across several studies. These performance-electric field correlations (PEC) are calculated for each spatial location of the grey matter. Extracting 354 data points from 67 studies, we compared the spatial maps of tDCS effects on I) working memory accuracy and speed (regardless of working memory type and time of assessment), II) verbal and visuospatial working memory (regardless of performance measurement and time of assessment), and III) performance during and after stimulation (regardless of performance measurement and working memory type). We found that accuracy improves when anodal tDCS is applied to inferior frontal regions (Brodmann area 47) while working memory speed benefits from stimulation to dorsolateral and anterior prefrontal areas (Brodmann areas 9/10). Furthermore, the beneficial effects of left prefrontal tDCS are exclusive to verbal working memory, with no improvements in visuospatial working memory. We also observed region-specific effects only for task performance during, but not after, stimulation. The results of this study elucidate the causal involvement of prefrontal regions in working memory and can help guide tDCS placement for therapeutic application in disorders that involve working memory deficits.
Cuphea vazquezii (Lythraceae), a yellow-flowered new species from the Cerro Grande, Sierra de Manantlán, Colima, Mexico
Authors: PADILLA-LEPE JESÚS
Published: January 2024

Cuphea vazquezii (subgen. Cuphea, sect. Archocuphea, Lythraceae), a minute new species from Cerro Grande, Comala, Colima, Mexico, is described and illustrated. It is morphologically similar to C. mimuloides, from which it differs in having a none-rhizomatous habit; mostly alternate leaves and flowers; larger leaf blades; shorter pedicels; spurred floral tubes; two yellow petals; deflexed nectariferous disc; and larger seeds. According to IUCN criteria, the species was assessed as critically endangered (CR).
Rohdea gymnogyna (Asparagaceae), a new species from southern Gansu, China
Authors: FENG HUI ZHE , XU TING , BI MING HUI , ZHAO YAN YING , CHANG CE , WANG YOU JUN
Published: January 2024

Rohdea gymnogyna, a new species from southern Gansu Provinces in northwestern China, is described and illustrated. It is apparently most closely related to R. rotiformis described from Sichuan, southwestern China. These two species share a smooth annular ledge appendage at the throat of the perianth tube. It is, however, readily distinguishable mainly by the lanceolate perianth lobes which strongly curved into a "W" shape in longitudinal section, the very short and bowl-shaped perianth tube, the ovary extends beyond the perianth tube. The taxonomic relationships of the new species to R. urotepala and R. lichuanensis also with an annular ledge appendage were also briefly discussed.
Unveiling the Elemental Composition and Categorization of Sikkim Hot-Spring Water with Laser-Induced Breakdown Spectroscopy and Advanced Analytical Techniques
Authors: Sharma Parsu Ram , Rawat Rajesh , Pradhan Puja , Thakur Nagendra , Tiwari Archana , Pathak A. P. , Tripathi Ajay
Published: January 2024

The research investigates the elemental composition of hot-spring water in Sikkim, specifically in Yumthang, Tarum, and Reshi, using laser-induced breakdown spectroscopy. This technique involves exciting the sample with a high-energy laser pulse, causing it to emit light that can be
analyzed to determine its elemental composition. The results of the study indicate that the hot-spring water in Sikkim is of meteoric origin, meaning it originated from precipitation. To understand the abundance of elements in the hot-spring water samples, the Sulphur/Nitrogen, Chlorine/Nitrogen,
and Sulphur/Chlorine ratios were calculated using the ratiometric method. These ratios were then used to classify the samples using univariate and multivariate statistical tools. The box plot was used for the univariate analysis, while the bivariate normal distribution method was used for
the multivariate analysis. We have also discussed the limitations of overlapping emission peaks on the classification of the samples. The study found that the abundance of nitrogen in the samples played a significant role in their classification. Principal component analysis was also employed
to classify the samples. This technique involves identifying the most significant variables contributing to the variation in the data and using them to classify the samples. Overall, the study provides important insights into the elemental composition of hot-spring water in Sikkim and highlights
the usefulness of laser-induced breakdown spectroscopy in analyzing such samples.
Ice Crystal Alignment: A Concept for High-Temporal-Resolution Monitoring Using Polarimetric Phased Array Radar
Authors: Weber Mark , Zrnic Dusan , Zhang Pengfei , Mansell Edward
Published: January 2024

This article describes a concept whereby future operational polarimetric phased array radars (PPAR) routinely monitor ice crystal alignment regions caused by thundercloud electric fields with volume scan updates (∼12 min−1) sufficient to resolve the temporal variation due to lightning and subsequent rapid electric field regeneration in nonsevere thunderstorms. Routine observations of crystal alignment regions may enhance thunderstorm nowcasting through comparison of their temporal and spatial structure with other polarimetric signatures, integration with lightning detection data, and assimilation into convection resolving numerical weather prediction models. If crystal alignment observations indicate strong electrification well in advance of the first lightning strike and likewise reliably indicate the decay of strong electric fields at the end of a storm, this capability may improve warning for lightning-sensitive activities such as airport ramp operations and space launch. Experimental observations of crystal alignment volumes in central Oklahoma severe storms and their relation to those storms’ structures are presented and used to motivate discussion of possible PPAR architectures. In one case—a tornadic supercell—these observations illustrate an important limitation. Even the hypothesized 12 min−1 volume scan update rate would not resolve the temporal variation of the crystal alignment regions in such storms, suggesting that special, adaptive scanning methods may be appropriate for such storms. We describe how future operational phased array radars could support a crystal alignment measurement mode via parallel, time-multiplexed processing and discuss potential impacts on the radar’s primary weather observation mission. We conclude by discussing research needed to better understand technical challenges and operational benefits.
European Summer Wet-Bulb Temperature: Spatiotemporal Variations and Potential Drivers
Authors: Ma Qiyun , Chen Yumeng , Ionita Monica
Published: January 2024

Heat stress is projected to intensify with global warming, causing significant socioeconomic impacts and threatening human health. Wet-bulb temperature (WBT), which combines temperature and humidity effects, is a useful indicator for assessing regional and global heat stress variability and trends. However, the variations of European WBT and their underlying mechanisms remain unclear. Using observations and reanalysis datasets, we demonstrate a remarkable warming of summer WBT during the period 1958–2021 over Europe. Specifically, the European summer WBT has increased by over 1.0°C in the past 64 years. We find that the increase in European summer WBT is driven by both near-surface warming temperatures and increasing atmospheric moisture content. We identify four dominant modes of European summer WBT variability and investigate their linkage with the large-scale atmospheric circulation and sea surface temperature anomalies. The first two leading modes of the European WBT variability exhibit prominent interdecadal to long-term variations, mainly driven by a circumglobal wave train and concurrent sea surface temperature variations. The last two leading modes of European WBT variability mainly show interannual variations, indicating a direct and rapid response to large-scale atmospheric dynamics and nearby sea surface temperature variations. Further analysis shows the role of global warming and changes in midlatitude circulations in the variations of summer WBT. Our findings can enhance the understanding of plausible drivers of heat stress in Europe and provide valuable insights for regional decision-makers and climate adaptation planning.

Significance Statement

Wet-bulb temperature, which takes into account the combined effect of temperature and humidity, is a good indicator for assessing heat stress. In the context of global warming, heat stress is anticipated to escalate, posing significant risks to human health and causing socioeconomic losses. However, variations in wet-bulb temperature and the associated physical mechanisms have received limited attention. This study aims to improve our understanding of the temporal and spatial variations and the potential driving mechanisms of summer wet-bulb temperature across Europe in recent decades. We have observed a noteworthy increase in summer wet-bulb temperature, indicating a regional intensification of heat stress, particularly within the last 10 years. We further investigate the connections between variations in summer wet-bulb temperature, large-scale atmospheric circulation, and sea surface temperature. Additionally, we explore their associations with global warming and changes in midlatitude atmospheric circulation. The outcomes of this study not only contribute to establishing a scientific basis for evaluating heat-related risks in Europe but also facilitate preparedness for future climate adaptation and mitigation at both regional and local scales.
Multiple-Time-Scale Variations of the Record-Breaking Pre-Summer Rainfall over South China in 2022
Authors: Li Xiuzhen , Wang Donghai , Zhou Wen
Published: January 2024

South China encountered an exceptionally heavy pre-summer rainy season in 2022 with the regional precipitation ranking first in the past 44 years. This study aims to analyze the multiple-time-scale variations of precipitation in this pre-summer rainy season to shed light on the complex dynamics influencing pre-summer precipitation over South China. The findings reveal that the variation of precipitation was dominated by the 10–20-day oscillation during April–May, while interannual variation and trend during May–June. The 10–20-day oscillation of precipitation in pre-summer rainy season in South China demonstrates a strong association with cold-air activity, which can be traced back to the propagation of disturbances along a teleconnection, which represents the dominant mode of intraseasonal atmospheric circulation over Eurasia in high latitudes during April–May. This teleconnection plays a crucial role in facilitating cold-air invasion and triggering precipitation over East China and South China. The interannual component of abnormal precipitation is strong during May–June of 2022. It is primarily attributed to the abnormal highs in the lower troposphere over the subtropical western North Pacific and Japan. These abnormal highs are likely stimulated by the combined influences of Eurasian teleconnection propagation and cooling sea surface temperature anomalies (SSTAs) over the tropical central and eastern Pacific in the third year of a consecutive La Niña event. However, the universality of the impact of Eurasian teleconnection propagation on the abnormal high over Japan on interannual scale necessitates further investigation. Furthermore, there is a significant upward trend in pre-summer rainfall over South China, accounting for 38% of the total anomaly observed in 2022.
Tidal Intrusion Fronts, Surface Convergence, and Mixing in an Estuary with Complex Topography
Authors: Bo Tong , Ralston David K. , Garcia Adrian Mikhail P. , Geyer W. Rockwell
Published: January 2024

Observations from a tidal estuary show that tidal intrusion fronts occur regularly during flood tides near topographic features including constrictions and bends. A realistic model is used to study the generation of these fronts and their influence on stratification and mixing in the estuary. At the constriction, flow separation occurs on both sides of the jet flow downstream of the narrow opening, leading to sharp lateral salinity gradients and baroclinic secondary circulation. A tidal intrusion front, with a V-shaped convergence zone on the surface, is generated by the interaction between secondary circulation and the jet flow. Stratification is created at the front due to the straining of lateral salinity gradients by secondary circulation. Though stratification is expected to suppress turbulence, strong turbulent mixing is found near the surface front. The intense mixing is attributed to enhanced vertical shear due to both frontal baroclinicity and the twisting of lateral shear by secondary circulation. In the bend, flow separation occurs along the inner bank, resulting in lateral salinity gradients, secondary circulation, frontogenesis, and enhanced mixing near the front. In contrast to the V-shaped front at the constriction, an oblique linear surface convergence front occurs in the bend, which resembles a one-sided tidal intrusion front. Moreover, in addition to baroclinicity, channel curvature also affects secondary circulation, frontogenesis, and mixing in the bend. Overall in the estuary, the near-surface mixing associated with tidal intrusion fronts during flood tides is similar in magnitude to bottom boundary layer mixing that occurs primarily during ebbs.
Exploring Ensemble Forecast Sensitivity to Observations for a Convective-Scale Data Assimilation System over the Dallas–Fort Worth Testbed
Authors: Gasperoni Nicholas A. , Wang Xuguang , Brewster Keith A. , Carr Frederick H.
Published: January 2024

Forecast sensitivity to observation (FSO) methods have become increasingly popular over the past two decades, providing the ability to quantify the impacts of various observing systems on forecasts without having to conduct costly data denial experiments. While adjoint- and ensemble-based FSO are employed in many global operational systems, their use for regional convection-allowing data assimilation (DA) and forecast systems have not been fully examined. In this study, ensemble FSO (EFSO) is explored for high-frequency convective-scale DA for a severe weather case study over the Dallas–Fort Worth testbed. This testbed, originally established by the Collaborative Adaptive Sensing of the Atmosphere (CASA) project, aims to improve high-resolution DA systems by assimilating a variety of existing state and regional mesoscale observing systems to fill gaps of conventional observing networks. This study utilizes EFSO to estimate relative impacts of nonconventional surface observations against conventional observations, and further incorporates assimilated radar observations into EFSO. Results show that, when applying advected localization and a neighborhood upscale averaging technique, EFSO estimates remain correlated and skillful with the actual error reduction of all assimilated observations for the duration of 2-h forecasts. The ability for EFSO to verify against other metrics (surface T, u, υ, q) beside energy norms is also demonstrated, emphasizing that EFSO can be used to evaluate impacts of specific parts of the forecast system rather than integrated quantities. Partitioned EFSO revealed that while conventional and radar observations contributed to most of the total energy, nonconventional observations contributed a significant percentage (up to 25%) of the total impact to surface thermodynamic fields.
Analysis of Preoperative Risk Factors for Early Recurrence in Patients After Hepatic Resection for Intrahepatic Cholangiocarcinoma
Authors: Akaoka Munetoshi , Haruki Koichiro , Furukawa Kenei , Tsunematsu Masashi , Ishizaki Shunta , Okui Norimitsu , Shirai Yoshihiro , Yanagaki Mitsuru , Onda Shinji , Ikegami Toru
Published: January 2024

Background

Intrahepatic cholangiocarcinoma (ICC) has a poor prognosis even after curative-intent hepatic resection due to a high recurrence rate. The aim of this study was to investigate preoperative risk factors for early recurrence after surgery for ICC, which may help to identify patients who need preoperative chemotherapy.

Methods

We retrospectively analyzed 51 patients who had undergone primary surgery for ICC. We investigated the association of preoperative clinical variables with recurrence within 1 year after resection for ICC. We then created a high-risk ICC score using the identified preoperative factors and investigated the association of the score with disease-free and overall survival.

Results

Recurrence within 1 year after surgery for ICC was significantly associated with poor overall survival ( P < .01). In the multivariate analysis, preoperative tumor size > 5 cm ( P = .03) and elevated C-reactive protein-to-albumin ratio (CAR) ( P = .04) were significantly associated with recurrence within 1 year after surgery. A high-risk ICC score of 2 was associated with poor disease-free survival ( P < .01) and overall survival ( P = .02) compared with a score of 0 or 1.

Conclusions

Our high-risk ICC score, combining preoperative tumor size and CAR, can be an indicator of early recurrence and poor survival in patients after hepatic resection for ICC. Our findings may provide better preoperative risk stratification of patients with ICC, and the high-risk ICC patients may benefit from preoperative therapy.
Prediction of 30-Day Morbidity and Mortality After Conversion of Sleeve Gastrectomy to Roux-en-Y Gastric Bypass: Use of an Artificial Neural Network
Authors: Scott Adam W. , Amateau Stuart K. , Leslie Daniel B. , Ikramuddin Sayeed , Wise Eric S.
Published: January 2024

Background

Conversion of sleeve gastrectomy to Roux-en-Y gastric bypass is indicated primarily for unsatisfactory weight loss or gastroesophageal reflux disease (GERD). This study aimed to use a comprehensive database to define predictors of 30-day reoperation, readmission, reintervention, or mortality. An artificial neural network (ANN) was employed to optimize prediction of the composite endpoint (occurrence of 1+ morbid event).

Methods

Areview of 8895 patients who underwent conversion for weight-related or GERD-related indications was performed using the 2021 MBSAQIP national dataset. Demographics, comorbidities, laboratory values, and other factors were assessed for bivariate and subsequent multivariable associations with the composite endpoint ( P ≤ .05). Factors considered in the multivariable model were imputed into a three-node ANN with 20% randomly withheld for internal validation, to optimize predictive accuracy. Models were compared using receiver operating characteristic (ROC) curve analysis.

Results

39% underwent conversion for weight considerations and 61% for GERD. Rates of 30-day reoperation, readmission, reintervention, mortality, and the composite endpoint were 3.0%, 7.1%, 2.1%, .1%, and 9.1%, respectively. Of the nine factors associated with the composite endpoint on bivariate analysis, only non-white race ( P < .001; odds ratio 1.4), lower body-mass index ( P < .001; odds ratio .22), and therapeutic anticoagulation ( P = .001; odds ratio 2.0) remained significant upon multivariable analysis. Areas under ROC curves for the multivariable regression, ANN training, and validation sets were .587, .601, and .604, respectively.

Discussion

Identification of risk factors for morbidity after conversion offers critical information to improve patient selection and manage postoperative expectations. ANN models, with appropriate clinical integration, may optimize prediction of morbidity.
Missing the Mark: Evaluating the Validity of the Ventral Hernia Screen in Detecting Recurrence
Authors: Talwar Ankoor A. , McGraw J. Reed , Thrippleton Sheri , Broach Robyn B. , Heniford B. Todd , Fischer John P.
Published: January 2024

Purpose

Hernia recurrence is a primary metric in evaluating the success of ventral hernia repair (VHR). Current screening methods for hernia recurrence, including the validated Ventral Hernia Screening (VHS) questionnaire, have not yet been critically evaluated. The purpose of this study was to evaluate the predictive value of the VHS for hernia recurrence.

Methods

This is a retrospective cohort study of adult patients who underwent primary VHR utilizing poly-4-hydroxybutyrate mesh at a single-institution from January 2016 to December 2021 who completed at least one VHS during their postoperative follow-up. All patients who screened positive underwent follow-up diagnostic computed tomography or physical examination for confirmation of hernia recurrence. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were assessed for each item and the VHS as a whole.

Results

A total of 68 patients who completed 119 VHS questionnaires were included. The median time to VHS administration was 3.6 years (range .8-6.3 years). The VHS tool had a sensitivity of 40.0%, specificity of 71.1%, PPV of 5.7%, and NPV of 96.4%. Individual items of the VHS also produced poor screening effects, with sensitivities between 20 and 40%, specificities between 79 and 97%, PPVs between 4 and 25%, and NPVs from 95 to 97%.

Conclusion

The VHS was a poor positive predictive tool for hernia recurrence, with both a low PPV and sensitivity. Many patients may be unaware of when they truly have hernia recurrence in the long term. More rigorous tools need to be developed to monitor recurrence following VHR.
Bone Anchor Fixation in the Repair of Blunt Traumatic Abdominal Wall Hernias: A Western Trauma Association Multicenter Study
Authors: Harrell Kevin N. , Grimes Arthur D , Gill Harkanwar , Reynolds Jessica K. , Ueland Walker R. , Sciarretta Jason D. , Todd Samual R. , Trust Marc D. , Ngoue Marielle , Thomas Bradley W. , Ayuso Sullivan A. , LaRiccia Aimee , Spalding Chance M. , Collins Michael J. , Collier Bryan R. , Karam Basil S. , de Moya Marc A. , Lieser Mark J. , Chipko John M. , Haan James M. , Lightwine Kelly L. , Cullinane Daniel C. , Falank Carolyne R. , Phillips Ryan C. , Kemp Michael T. , Alam Hasan B. , Udekwu Pascal O. , Sanin Gloria D. , Hildreth Amy N. , Biffl Walter L. , Schaffer Kathryn B. , Marshall Gary , Muttalib Omaer , Nahmias Jeffry , Shahi Niti , Moulton Steven L. , Maxwell Robert A.
Published: January 2024

Background

Blunt traumatic abdominal wall hernias (TAWHs) are rare but require a variety of operative techniques to repair including bone anchor fixation (BAF) when tissue tears off bony structures. This study aimed to provide a descriptive analysis of BAF technique for blunt TAWH repair. Bone anchor fixation and no BAF repairs were compared, hypothesizing increased hernia recurrence with BAF repair.

Methods

A secondary analysis of the WTA blunt TAWH multicenter study was performed including all patients who underwent repair of their TAWH. Patients with BAF were compared to those with no BAF with bivariate analyses.

Results

176 patients underwent repair of their TAWH with 41 (23.3%) undergoing BAF. 26 (63.4%) patients had tissue fixed to bone, with 7 of those reinforced with mesh. The remaining 15 (36.6%) patients had bridging mesh anchored to bone. The BAF group had a similar age, sex, body mass index, and injury severity score compared to the no BAF group. The time to repair (1 vs 1 days, P = .158), rate of hernia recurrence (9.8% vs 12.7%, P = .786), and surgical site infection (SSI) (12.5% vs 15.6%, P = .823) were all similar between cohorts.

Conclusions

This largest series to date found nearly one-quarter of TAWH repairs required BAF. Bone anchor fixation repairs had a similar rate of hernia recurrence and SSI compared to no BAF repairs, suggesting this is a reasonable option for repair of TAWH. However, future prospective studies are needed to compare specific BAF techniques and evaluate long-term outcomes including patient-centered outcomes such as pain and quality of life.
The Picture of Scientific Surgery: John Hunter and the Reynolds Portrait
Authors: Lovasik Brendan P.
Published: January 2024

This historical retrospective examines the famous portrait of John Hunter by Sir Joshua Reynolds, focusing on the man and the objects that were chosen to represent his legacy in anatomy and surgery.
A Cost-Effectiveness Analysis of Wittmann Patch-Assisted Abdominal Closure Compared to Planned Ventral Hernia in Management of the Open Abdomen
Authors: Abosena Wael , Tedesco Alexandra , Han Sam M. , Bugaev Nikolay , Hojman Horacio M. , Johnson Benjamin P. , Kim Woon C. , Bawazeer Mohammed , Bloom Joshua A.
Published: January 2024

Background

Inability to achieve primary fascial closure after damage control laparotomy is a frequently encountered problem by acute care and trauma surgeons. This study aims to compare the cost-effectiveness of Wittmann patch-assisted closure to the planned ventral hernia closure.

Methods

A literature review was performed to determine the probabilities and outcomes for Wittmann patch-assisted primary closure and planned ventral hernia closure techniques. Average utility scores were obtained by a patient-administered survey for the following: rate of successful surgeries (uncomplicated abdominal wall closure), surgical site infection, wound dehiscence, abdominal hernia and enterocutaneous fistula. A visual analogue scale (VAS) was utilized to assess the survey responses and then converted to quality-adjusted life years (QALYs). Total cost for each strategy was calculated using Medicare billing codes. A decision tree was generated with rollback and incremental cost-utility ratio (ICUR) analyses. Sensitivity analyses were performed to account for uncertainty.

Results

Wittmann patch-assisted closure was associated with higher clinical effectiveness of 19.43 QALYs compared to planned ventral hernia repair (19.38), with a relative cost reduction of US$7777. Rollback analysis supported Wittmann patch-assisted closure as the more cost-effective strategy. The resulting negative ICUR of −156,679.77 favored Wittmann patch-assisted closure. Monte Carlo analysis demonstrated a confidence of 96.8% that Wittmann patch-assisted closure was cost-effective.

Conclusions

This study demonstrates using the Wittmann patch-assisted closure strategy as a more cost-efficient management of the open abdomen compared to the planned ventral hernia approach.
The Effectiveness of Salvage Hyperbaric Oxygen Therapy Following Combined Steroid Therapy for Refractory Sudden Sensorineural Hearing Loss
Authors: Lee Jung Woo , Kim Hwabin , Kong Soo-Keun , Kim Jia , Choi Sung-Won , Oh Se-Joon
Published: January 2024

Objective:

Hyperbaric oxygen therapy (HBOT) is an accepted treatment option for sudden sensorineural hearing loss (SSNHL), but it is still recommended in combination with corticosteroids. We investigated the efficacy of salvage HBOT in refractory SSNHL that does not respond to corticosteroid combination therapy.

Methods:

Eighty-four patients were included, who had unilateral SSNHL with an improvement of pure-tone average (PTA) less than 10 dB after using intratympanic plus systemic corticosteroids (combined therapy) as the initial therapy. The control group (n = 66) received no further treatment, and the HBOT group (n = 18) received additional treatment with HBOT (10 sessions in total with 2.5 atmospheres absolute for 1 hour).

Results:

No differences in PTA or WDS were found between the 2 groups. However, the mean hearing gain in the HBOT group (16.8 ± 4.49 dB) was significantly higher than that in the control group (4.45 ± 1.03 dB) ( P = .015). The proportion of patients with hearing recovery (hearing gain of 10 dB or more) after treatment was significantly higher in HBOT group (38.9%) than in the control group (10.6%).

Conclusions:

In patients with refractory SSNHL after steroid combined therapy, salvage HBOT showed a significant effect on hearing gain and recovery rate.
The Safety, Tolerability, and Efficacy of DL-Lactic Acid Syrup (Tonsitin) in Children With Recurrent Tonsillitis: A Pilot Study
Authors: Taha Ahmed , Yeheskeli Eyal , Gavriel Haim , Berkovitch Matitiahu , Mizrakli Yuval , Shlamkovitch Natan , Kohn Elkana
Published: January 2024

To evaluate Tonsitin (10% DL-lactic acid) safety, tolerability, and efficacy, as a treatment for recurrent tonsillitis (RT) in children. This is a clinical prospective, randomized, double blind pilot study, to evaluate the safety, tolerability and efficacy of Tonsitin in healthy children with RT. Safety evaluated in terms of adverse events (AEs), tolerability in terms of compliance, and efficacy in terms of tonsils’ size and frequency of tonsillitis, and quality of life. The study included 51 children. The treatment regimen was tolerable among the participants. Six children experienced AEs, but mostly mild. Tonsil size declined in both groups, but these results did not reach statistical significance. Tonsillitis episodes’ frequencies were random and not significant. Tonsitin treatment was found to be feasible in the clinical setup and was well tolerated, and appears to be safe. Study efficacy results did not reach statistical significance.
Inefficiency Analysis of Tax Efforts in Special Category States of India: Evidence from a Stochastic Frontier Model
Authors: Malik Mohd Yousuf , Raza Kulsoom , Ansari Samia
Published: January 2024

The current article examines the tax efforts of India’s main mountainous states that have been accorded special category status by the National Development Council. These states have been under persistent budgetary pressure and are partially reliant on central funds in the form of grants in ‘aid’ and other central transfers. The present article employs the Stochastic Frontier Analysis (SFA) model to assess ‘tax effort’ of special category states. The model results implied that ‘tax effort’ rises with increase in the share of secondary sector, revenue expenditure and road infrastructure. Further, the level of debt lowers ‘tax effort’, whereas the introduction of FRBM and Goods and Service Tax Regime (GST) has raised the inefficiency in own tax mobilization. On the basis of tax effort index, computed through John Drew (JLMS) methodology, this study also indicates that Assam, Uttarakhand, and Jammu and Kashmir are in a far better position in tax efforts score compared to the north eastern special category states.

JEL Codes: H2, H21, H22, H71
A Typology of Family Relationships among Older Adults in Prison
Authors: Avieli Hila
Published: January 2024

Despite the growing interest in older incarcerated persons, the issue of their relationships with their families has been understudied. Therefore, the aim of the present study was to explore the ways in which older adults in prison construct, maintain, and navigate familial relationships with spouses and/or adult children. Interpretive phenomenological analysis was utilized to analyze interviews with 33 incarcerated older adults. Three themes emerged: (1) Keeping in touch; (2) cutting-off, and (3) forming an alternative family. Socioemotional selectivity theory is used to discuss the findings, suggesting that most participants wished to keep in contact with their families.
Metacognition as a Mediator for Posttraumatic Stress Symptoms Following Childhood Stressful Life Events: An Examination of the Construct Validity of the Metacognitions Questionnaire-Posttraumatic Stress Disorder
Authors: Darnell Benjamin C. , Lee Sarah R. , Despotes Andrea M. , Jones Dominoe A. , Valentiner David P.
Published: January 2024

Both cognitive and metacognitive theories implicate posttraumatic metacognition as an important factor in the maintenance of posttraumatic stress symptoms (PTSS) following stressful life events (SLEs). The Metacognitions Questionnaire-posttraumatic stress disorder (MCQ-PTSD; Wells, 2009) was previously developed to assess for metacognitions specific to SLEs and resulting PTSS. This study aimed to examine the construct validity of this measure in the context of childhood SLEs specifically. First, we confirmed the factor structure underlying the MCQ-PTSD in our sample. We then assessed whether the MCQ-PTSD would function as expected based on a theoretical model in which, controlling for posttraumatic cognitions, posttraumatic metacognitions were expected to mediate the relationship between childhood SLEs and PTSS. Using data from a racially diverse sample of undergraduate psychology students ( N = 402; Agemean = 19.38 ± 1.81) at a large Midwestern university, the two-factor structure of the MCQ-PTSD was confirmed. Among participants who endorsed clinically significant experience of childhood SLEs ( n = 203; Agemean = 19.49 ± 1.94), negative metacognitions mediated the relationships of emotional and sexual abuse with PTSS, when controlling for other posttraumatic cognitions. These relationships were not observed for positive metacognitions. These results are consistent with a metacognitive model for PTSD and suggest that the MCQ-PTSD may be a valid measure of posttraumatic metacognitions following childhood SLEs.
Sex Stereotypes and Child Physical Abuse: Mediating Effects of Attitudes on Beliefs about Consequences for Abusive Parents
Authors: Leone Christopher , Hawkins LouAnne , Geary Mary , Bolanos Valentina
Published: January 2024

We hypothesized that (a) sex stereotypes would influence individuals’ attitudes toward and beliefs about physically abusive parents and (b) these attitudes would mediate the connection between sex stereotypes and beliefs. Participants read one of four scenarios in which (a) sex of parents and sex of children were systematically varied while (b) holding constant the actions of parents and children as well as surrounding circumstances. Participants then expressed their attitudes about those parents and their beliefs about appropriate consequences for these parents. As expected, participants held more unfavorable attitudes about fathers than mothers and believed lenient consequences were more appropriate for mothers than fathers. Moreover, the linkage between parents’ sex and participants’ beliefs was mediated by participants’ attitudes such that the effects of sex stereotypes on beliefs were all indirect rather than direct. Limitations (e.g., cross-sectional design, sample representativeness) and future directions (e.g., alternative parental and child behaviors, individual differences as moderators) are discussed.
The Mediating Role of Self-Esteem in the Relationship Between Perceived Ethnic Discrimination and Continuance Commitment of Migrant Workers
Authors: Yücel İlhami , Gomes Daniel Roque , Ribeiro Neuza , Özlok Kasım Kağan
Published: January 2024

This study aims to examine the relationship between perceived ethnic discrimination by migrant workers (applicants for international protection) and continuance commitment, and to analyze whether this relationship is mediated by self-esteem. In addition, it aims to contribute to the literature on the organizational outcomes of perceived ethnic discrimination. This research was conducted through a questionnaire survey of 411 migrants who applied for international protection in Turkey. As a result of the study, perceived ethnic discrimination was found to be a predictor of continuance commitment and self-esteem. In addition, it was observed that self-esteem has a mediating role in the relationship between perceived ethnic discrimination and continuance commitment. The results offer important implications for organizations and organization managers on how migrant workers should be managed and which issues require specific attention. The application of the study on migrant workers and the examination of these variables provide important contributions and practical implications to the literature. In addition, this is a rare study that examines the mediator model with the variables specified in the model using social identity theory, which has not yet been widely covered in existing literature.
Surveillance for Unexplained Deaths of Possible Infectious Etiologies During the COVID-19 Pandemic—Minnesota, 2020-2021
Authors: Firestone Melanie J. , Thorell Linnea , Kollmann Leslie , Fess Lydia , Ciessau Greta , Strain Anna K. , Danila Richard , Lynfield Ruth , Holzbauer Stacy ,   the UNEX Surveillance Team
Published: January 2024

Objectives:

Surveillance systems for unexplained deaths that might have an infectious etiology are rare. We examined the Minnesota Department of Health Unexplained Deaths and Critical Illnesses of Possible Infectious Etiology and Medical Examiner Infectious Deaths (UNEX/MED-X) surveillance system,—a system that expanded postmortem surveillance for infectious diseases during the COVID-19 pandemic by leveraging standard (medical examiner [ME]) and expanded (mortuary) surveillance to identify COVID-19–related deaths.

Methods:

MEs, coroners, or morticians collected postmortem swabs from decedents with an infectious prodrome or with SARS-CoV-2 exposure before death but with no known recent infectious disease testing. The Minnesota Department of Health Public Health Laboratory used nucleic acid amplification, viral culture, and standard algorithms to test specimens collected postmortem for SARS-CoV-2, influenza virus, and other infectious pathogens. We reviewed UNEX/MED-X data from March 2, 2020, through December 31, 2021, and characterized decedents by location of swab collection (ie, ME or mortuary).

Results:

From March 2, 2020, through December 31, 2021, the UNEX/MED-X surveillance system received samples from 182 decedents from mortuaries and 955 decedents from MEs. Mortuary decedents were older than ME decedents (median age, 78 vs 46 y). Seventy-three mortuary decedents (40.1%) and 197 ME decedents (20.6%) had SARS-CoV-2 detections. The UNEX/MED-X system identified 212 COVID-19–related deaths, representing 2.0% of total COVID-19–related deaths in Minnesota. Eighty-nine decedents (42.0%) were from racial and ethnic minority populations, representing 6.1% more COVID-19–related deaths among people from racial and ethnic minority populations than would have been detected without this surveillance system.

Practice Implications:

Expanded and standard UNEX/MED-X surveillance builds capacity and flexibility for responding to emerging public health threats. Similar programs should be considered elsewhere as resources allow.