bluuebunny/crossref_metadata_2025 huggingface dataset:
Delayed Death Due to Lightning: An Autopsy Case Report Highlighting Diagnostic and Medicolegal Issues
Authors: Khartade Harshwardhan Khushalrao , Shrivastava Shikha , Vashisht Jaya , Phukan Amborish , Palazhy Ponnambily P , Meshram Vikas P
Published: May 2023

The incidences of lightning strikes are not infrequent. The electric discharge of the lightning strike produces extreme heat and high amperage current, but fatality is reported in only about 10% to 30% of lightning cases. The spectrum of injuries due to lightning strikes can vary from no external injuries to typical external injuries. Merely the presence of superficial injuries due to lightning should not be considered sufficient to dismiss the case as non-serious. Rather clinicians should be wary of internal damage due to the effect of the lightning current as well as delayed complications of the lightning which can be fatal. Similarly, during an autopsy, the forensic pathologist should also investigate for the changes/damage in the internal organs due to the effect of lightning current. The present case reports the incidence of death due to delayed complications of a lightning strike which primary doctors initially overlooked. This case also discusses the histopathological changes in the internal organs due to lightning which can be helpful in the autopsy diagnosis of lightning, particularly in cases with no external or nonspecific injuries.
Amphipoda from depths exceeding 6,000 meters revisited 60 years on
Authors: Jamieson Alan J , Weston Johanna N J
Published: May 2023

In the 1950s, the Danish Galathea Expedition undertook one of the first and most comprehensive explorations of our ocean’s hadal zone, depths extending from 6,000 to nearly 11,000 m, and presented a rich collection of the diversity of Amphipoda. The subsequent papers, however, concluded that these established ‘nothing essentially new’ to the existing knowledge of amphipod biology. Since Dahl’s foundational paper in 1959, amphipods, primarily from the superfamilies Lysianassoidea and Alicelloidea, emerged as one of the best-sampled hadal fauna, as these mobile invertebrates are readily recovered by different sampling techniques. Importantly, amphipods have become the model taxon, helping us to unlock knowledge about life in the hadal zone. In this review, we collate the knowledge gained since the Galathea Expedition and summarise the current understanding of how amphipods that appear during hadal exploration survive the trench environments. We discuss population structures across depth, inter-trench distribution and connectivity, applications in hadal microbiology, and, critically, how the hadal zone is being impacted by anthropogenic activity.
Forecasting Value-at-Risk Using Deep Neural Network Quantile Regression
Authors: Chronopoulos Ilias , Raftapostolos Aristeidis , Kapetanios George
Published: May 2023

In this article, we use a deep quantile estimator, based on neural networks and their universal approximation property to examine a non-linear association between the conditional quantiles of a dependent variable and predictors. This methodology is versatile and allows both the use of different penalty functions, as well as high dimensional covariates. We present a Monte Carlo exercise where we examine the finite sample properties of the deep quantile estimator and show that it delivers good finite sample performance. We use the deep quantile estimator to forecast value-at-risk and find significant gains over linear quantile regression alternatives and other models, which are supported by various testing schemes. Further, we consider also an alternative architecture that allows the use of mixed frequency data in neural networks. This article also contributes to the interpretability of neural network output by making comparisons between the commonly used Shapley Additive Explanation values and an alternative method based on partial derivatives.
Diagnostic value of dual-fluorescence staining in bacterial vaginosis
Authors: Li Cui , Duan Zhongliang , Zhang Jing , Gao Jing , Ying Chunmei
Published: May 2023

Objective

The aim of this study was to investigate the epidemiology of bacterial vaginosis (BV) in Shanghai, China, and to explore the value of a dual-fluorescence staining method in the diagnosis of BV.

Methods

Specimens were collected from women with vaginitis at the Obstetrics and Gynecology Hospital of Fudan University from January 2020 to December 2021, and the proportions of various vaginitis types (such as Candida vaginitis, Trichomonas, and bacterial vaginitis) were analyzed statistically. To explore the diagnostic value of dual-fluorescence staining for BV, we first executed a dual-fluorescence staining method to analyze the vaginal secretions of 265 patients, then confirmed our diagnoses by consulting clinical physicians and by using Nugent scoring of Gram staining.

Results

There were 16,905 patients who were diagnosed with vaginitis over the previous 2 years, with a median age of 32 (minimum age of 9 years and maximum of 84 years). Of these patients, we noted 10,887 cases (64.40%) of BV. Our staining results revealed that the dual-fluorescence method was consistent with Gram staining in the diagnosis of BV, with a P value of less than .001 using a χ 2 test and a consistency kappa value of 0.896. Compared with Gram staining, the dual-fluorescence staining method required an acceptable time (2.2 min vs 2.5 min, respectively) and exhibited different visual effects (green and yellow vs purple and red, respectively).

Conclusion

Dual-fluorescence staining for the detection of bacterial diseases of the vagina exhibited acceptable consistency with Gram staining and performed well with respect to dyeing time, stability, and the interpretation of results. We argue that this method should be used in outpatient services.
Phylogenetic Comparative Analysis of Single-Cell Transcriptomes Reveals Constrained Accumulation of Gene Expression Heterogeneity during Clonal Expansion
Authors: Chen Feng , Li Zizhang , Zhang Xiaoyu , Wu Peng , Yang Wenjing , Yang Junnan , Chen Xiaoshu , Yang Jian-Rong
Published: May 2023

In the same way that a phylogeny summarizes the evolutionary history of species, a cell lineage tree describes the process of clonal expansion, in which gene expression differences between cells naturally accrue as a result of stochastic partitioning and imperfect expression control. How is functional homeostasis, a key factor in the biological function of any population of cells, maintained in the face of such continuous accumulation of transcriptomic heterogeneity remains largely unresolved. To answer this question, we experimentally determined the single-cell transcriptomes and lineage relationships of up to 50% cells in single-HEK293–seeded colonies. Phylogenetic comparative analyses of the single-cell transcriptomes on the cell lineage tree revealed three lines of evidence for the constrained accumulation of transcriptome heterogeneity among cells, including rapid saturation of transcriptomic heterogeneity upon four cell divisions, reduced expression differences within subtrees closer to expression boundaries, and cofluctuations among genes. Our analyses showcased the applicability of phylogenetic comparative methods in cell lineage trees, demonstrated the constrained accumulation of transcriptomic heterogeneity, and provided novel insight into the functional homeostasis of cell populations.
Maternal and infant microbiome: next-generation indicators and targets for intergenerational health and nutrition care
Authors: Gao Shengtao , Wang Jinfeng
Published: May 2023

Microbes are commonly sensitive to shifts in the physiological and pathological state of their hosts, including mothers and babies. From this perspective, the microbiome may be a good indicator for diseases during pregnancy and has the potential to be used for perinatal health monitoring. This is embodied in the application of microbiome from multi body sites for auxiliary diagnosis, early prediction, prolonged monitoring, and retrospective diagnosis of pregnancy and infant complications, as well as nutrition management and health products developments of mothers and babies. Here we summarized the progress in these areas and explained that the microbiome of different body sites is sensitive to different diseases and their microbial biomarkers may overlap between each other, thus we need to make a diagnosis prudently for those diseases. Based on the microbiome variances and additional anthropometric and physical data, individualized responses of mothers and neonates to meals and probiotics/prebiotics were predictable, which is of importance for precise nutrition and probiotics/prebiotics managements and developments. Although a great deal of encouraging performance was manifested in previous studies, the efficacy could be further improved by combining multi-aspect data such as multi-omics and time series analysis in the future. This review reconceptualizes maternal and infant health from a microbiome perspective, and the knowledge in it may inspire the development of new options for the prevention and treatment of adverse pregnancy outcomes and bring a leap forward in perinatal health care.
Narrative Asset Pricing: Interpretable Systematic Risk Factors from News Text
Authors: Bybee Leland , Kelly Bryan , Su Yinan
Published: May 2023

We estimate a narrative factor pricing model from news text of The Wall Street Journal. Our empirical method integrates topic modeling (LDA), latent factor analysis (IPCA), and variable selection (group lasso). Narrative factors achieve higher out-of-sample Sharpe ratios and smaller pricing errors than standard characteristic-based factor models and predict future investment opportunities in a manner consistent with the ICAPM. We derive an interpretation of the estimated risk factors from narratives in the underlying article text.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online
An immunomodulatory antibody–drug conjugate targeting BDCA2 strongly suppresses plasmacytoid dendritic cell function and glucocorticoid responsive genes
Authors: Li Xi , Zhang Yu , Li Bing , Li Jian , Qiu Yang , Zhu Zhongyuan , Hua Haiqing
Published: May 2023

Objectives

Blood dendritic cell antigen 2 (BDCA2) is exclusively expressed on plasmacytoid dendritic cells (pDCs) whose uncontrolled production of type I IFN (IFN-I) is crucial in pathogenesis of SLE and other autoimmune diseases. Although anti-BDCA2 antibody therapy reduced disease activity in SLE patients, its clinical efficacy needs further improvement. We developed a novel glucocorticoid receptor agonist and used it as a payload to conjugate with an anti-BDCA2 antibody to form an BDCA2 antibody–drug conjugate (BDCA2-ADC). The activation of BDCA2-ADC was evaluated in vitro.

Methods

Inhibitory activity of BDCA2-ADC was evaluated in peripheral blood mononuclear cells or in purified pDCs under ex vivo toll-like receptor agonistic stimulation. The global gene regulation in purified pDCs was analysed by RNA-seq. The antigen-dependent payload delivery was measured by reporter assay.

Results

The BDCA2-ADC molecule causes total suppression of IFNα production and broader inhibition of inflammatory cytokine production compared with the parental antibody in human pDCs. Global gene expression analysis confirmed that the payload and antibody acted synergistically to regulate both type I IFN signature genes and glucocorticoid responsive genes in pDCs.

Conclusion

Taken together, these data suggest dual mechanisms of BDCA2-ADC on pDCs and the potential for BDCA2-ADC to be the first ADC treatment for SLE in the world and a better treatment option than anti-BDCA2 antibody for SLE patients.
Serum level of galectin-9 as a potential biomarker for high risk of malignancy in dermatomyositis
Authors: Shih Yanting , Chen Shile , Huang Jie , Chen Yongheng , Zhu Zicong , Zhao Qian , Zhao Xiaoqing , Xue Feng , Xiang Jie , Chen Xiaosong , Zhu Xuemei , Pan Meng , Wu Jun , Zheng Jie , Li Hao , Cao Hua
Published: May 2023

Objectives

Galectin-9, as immune checkpoint protein, plays a role in regulating autoimmunity and tumour immunity. Therefore, we explored the pathophysiological link between galectin-9 and malignancy in cancer-related DM (CRDM).

Methods

Serum galectin-9 were quantified via enzyme-linked immunosorbent assay, and its association with serological indices was evaluated using Spearman analysis. Receiver operating characteristic (ROC) analysis was utilized to determine the cut-off value of galectin-9.

Results

Serum levels of galectin-9 were significantly higher in DM patients [23.38 (13.85–32.57) ng/ml] than those in healthy controls (HCs) [6.81 (5.42–7.89) ng/ml, P < 0.0001], and were positively correlated with the cutaneous dermatomyositis disease area severity index activity (CDASI-A) scores (rs=0.3065, P = 0.0172). DM patients with new-onset and untreated cancer (new-CRDM) [31.58 (23.85–38.84) ng/ml] had higher levels of galectin-9 than those with stable and treated cancer (stable-CRDM) [17.49 (10.23–27.91) ng/ml, P = 0.0288], non-cancer-related DM (non-CRDM) [21.05 (11.97–28.02) ng/ml, P = 0.0258], and tumour patients without DM [7.46 (4.90–8.51) ng/ml, P < 0.0001]. Serum galectin-9 levels significantly decreased [27.79 (17.04–41.43) ng/ml vs 13.88 (5.15–20.37) ng/ml, P = 0.002] after anti-cancer treatment in CRDM patients. The combination of serum galectin-9 and anti-transcriptional intermediary factor 1-γ (anti-TIF1-γ) antibody (AUC = 0.889, 95% CI 0.803–0.977) showed the highest predictive value for the presence of cancer in DM.

Conclusion

Increased galectin-9 levels were related to tumor progression in CRDM, and galectin-9 was downregulated upon cancer treatment. Monitoring serum galectin-9 levels and anti-TIF1-γ antibodies might be an attractive strategy to achieve tumour diagnosis and predict CRDM outcome.
Ewes with higher embryo survival rear lambs that grow faster
Authors: Shorten Paul R , O’Connell Anne R , Juengel Jenny L
Published: May 2023

A key economic driver of a meat producing sheep flock is the total kilograms of lamb liveweight at weaning per ewe exposed to the ram. Optimization of key reproductive steps is required to achieve peak performance of a sheep flock. The goal of this paper was to use more than 56,000 records from a commercial flock to investigate the key reproductive steps affecting flock reproductive performance. We also applied a maximum-likelihood based technique to predict the embryo survival and ovulation rate for daughters of individual sires based on measurements of the number of fetuses at midpregnancy (detected by ultrasound-scanning). The model was used to determine how changes in premating liveweight, age, predicted ovulation rate, embryo survival, number of fetuses at midpregnancy, lamb survival, and lamb growth rate affect the total lamb liveweight at weaning per ewe exposed to the ram in the flock. The data from the commercial flock was also used to investigate the role of ewe age and premating liveweight on each reproductive step. Sensitivity analyses were performed to identify the key reproductive steps affecting flock reproductive performance. The elasticity for embryo survival was 80% of that for lamb survival. There was also significant between sire variance in the estimates of ovulation rate and embryo survival. The reproductive performance of daughters of sires with high (top 50%) and low (bottom 50%) embryo survival was investigated. Embryo survival was 0.88 in the high group and 0.82 in the low group (a 6% reduction in embryo survival). The expected total weight of lambs weaned per ewe exposed to the ram was 42 kg in the high embryo survival group and 37 kg in the low embryo survival group (a 12% reduction in the total weight of lambs weaned per ewe exposed to the ram). The proportion of twin litters was 70% in the high group and 60% in the low group, highlighting the potential importance of embryo survival for the rate of twinning in flocks with ovulation rates greater than two ova. Although lamb survival was similar between the high and low embryo survival groups, lamb growth was reduced by 10% in the low embryo survival group for the same litter size (P < 0.001). This novel positive phenotypic association between embryo survival and lamb growth rate can potentially be exploited to improve flock performance.
Multivariate associations between dopamine receptor availability and risky investment decision-making across adulthood
Authors: Green Mikella A , Crawford Jennifer L , Kuhnen Camelia M , Samanez-Larkin Gregory R , Seaman Kendra L
Published: May 2023

Enhancing dopamine increases financial risk taking across adulthood but it is unclear whether baseline individual differences in dopamine function are related to risky financial decisions. Here, thirty-five healthy adults completed an incentive-compatible risky investment decision task and a PET scan at rest using [11C]FLB457 to assess dopamine D2-like receptor availability. Participants made choices between a safe asset (bond) and a risky asset (stock) with either an expected value less than the bond (“bad stock”) or expected value greater than the bond (“good stock”). Five measures of behavior (choice inflexibility, risk seeking, suboptimal investment) and beliefs (absolute error, optimism) were computed and D2-like binding potential was extracted from four brain regions of interest (midbrain, amygdala, anterior cingulate, insula). We used canonical correlation analysis to evaluate multivariate associations between decision-making and dopamine function controlling for age. Decomposition of the first dimension (r = 0.76) revealed that the strongest associations were between measures of choice inflexibility, incorrect choice, optimism, amygdala binding potential, and age. Follow-up univariate analyses revealed that amygdala binding potential and age were both independently associated with choice inflexibility. The findings suggest that individual differences in dopamine function may be associated with financial risk taking in healthy adults.
Bilateral transcranial direct‐current stimulation promotes migration of subventricular zone‐derived neuroblasts toward ischemic brain
Authors: Lei Ruixue , Wang Shu , Liu Anchun , Cheng Jing , Zhang Zhifeng , Ren Jinyang , Yao Xujin , Kong Xiangyi , Ma Wenlong , Che Fengyuan , Chen Juan , Wan Qi
Published: May 2023

Ischemic insult stimulates proliferation of neural stem cells (NSCs) in the subventricular zone (SVZ) after stroke. However, only a fraction of NSC‐derived neuroblasts from SVZ migrate toward poststroke brain region. We have previously reported that direct‐current stimulation guides NSC migration toward the cathode in vitro. Accordingly, we set up a new method of transcranial direct‐current stimulation (tDCS), in which the cathodal electrode is placed on the ischemic hemisphere and anodal electrode on the contralateral hemisphere of rats subjected to ischemia–reperfusion injury. We show that the application of this bilateral tDCS (BtDCS) promotes the migration of NSC‐derived neuroblasts from SVZ toward the cathode direction into poststroke striatum. Reversing the position of the electrodes blocks the effect of BtDCS on the migration of neuroblasts from SVZ. BtDCS protects against neuronal death and improves the functional recovery of stroke animals. Thus, the migration of NSC‐derived neuroblasts from SVZ toward poststroke brain region contributes to the effect of BtDCS against ischemia‐induced neuronal death, supporting a potential development of noninvasive BtDCS as an endogenous neurogenesis‐based stroke therapy.
Advances in the Management of Cardiogenic Shock
Authors: Jentzer Jacob C. , Pöss Janine , Schaubroeck Hannah , Morrow David A. , Hollenberg Steven M. , Mebazaa Alexandre
Published: May 2023

OBJECTIVES:

To review a contemporary approach to the management of patients with cardiogenic shock (CS).

DATA SOURCES:

We reviewed salient medical literature regarding CS.

STUDY SELECTION:

We included professional society scientific statements and clinical studies examining outcomes in patients with CS, with a focus on randomized clinical trials.

DATA EXTRACTION:

We extracted salient study results and scientific statement recommendations regarding the management of CS.

DATA SYNTHESIS:

Professional society recommendations were integrated with evaluated studies.

CONCLUSIONS:

CS results in short-term mortality exceeding 30% despite standard therapy. While acute myocardial infarction (AMI) has been the focus of most CS research, heart failure-related CS now predominates at many centers. CS can present with a wide spectrum of shock severity, including patients who are normotensive despite ongoing hypoperfusion. The Society for Cardiovascular Angiography and Intervention Shock Classification categorizes patients with or at risk of CS according to shock severity, which predicts mortality. The CS population includes a heterogeneous mix of phenotypes defined by ventricular function, hemodynamic profile, biomarkers, and other clinical variables. Integrating the shock severity and CS phenotype with nonmodifiable risk factors for mortality can guide clinical decision-making and prognostication. Identifying and treating the cause of CS is crucial for success, including early culprit vessel revascularization for AMI. Vasopressors and inotropes titrated to restore arterial pressure and perfusion are the cornerstone of initial medical therapy for CS. Temporary mechanical circulatory support (MCS) is indicated for appropriately selected patients as a bridge to recovery, decision, durable MCS, or heart transplant. Randomized controlled trials have not demonstrated better survival with the routine use of temporary MCS in patients with CS. Accordingly, a multidisciplinary team-based approach should be used to tailor the type of hemodynamic support to each individual CS patient’s needs based on shock severity, phenotype, and exit strategy.
Progression of liver disease and portal hypertension in dyskeratosis congenita and related telomere biology disorders
Authors: Vittal Anusha , Niewisch Marena R. , Bhala Sonia , Kudaravalli Pujitha , Rahman Farial , Hercun Julian , Kleiner David E. , Savage Sharon A. , Koh Christopher , Heller Theo , Giri Neelam
Published: May 2023

Background and Aims:

Dyskeratosis congenita (DC) and related telomere biology disorders (TBD) are characterized by very short telomeres and multisystem organ involvement including liver disease. Our study aimed to characterize baseline hepatic abnormalities in patients with DC/TBD and determine risk factors associated with liver disease progression.

Approach and Results:

A retrospective review was performed on a cohort of 58 patients (39 males) with DC/TBD who were prospectively evaluated at a single institute from 2002 to 2019. The median age at initial assessment was 18 (1.4–67.6) years, and median follow-up duration was 6 (1.4–8.2) years. Patients with autosomal or X-linked recessive inheritance and those with heterozygous TINF2 DC were significantly younger, predominantly male, and more likely to have DC-associated mucocutaneous triad features and severe bone marrow failure compared with autosomal dominant-non-TINF2 DC/TBD patients. Liver abnormality (defined at baseline assessment by laboratory and/or radiological findings) was present in 72.4% of patients with predominantly cholestatic pattern of liver enzyme elevation. Clinically significant liver disease and portal hypertension developed in 17.2% of patients during the 6-year follow-up; this progression was mainly seen in patients with recessive or TINF2-associated DC. Significant risk factors associated with progression included the presence of pulmonary or vascular disease.

Conclusions:

Our experience shows a high prevalence of cholestatic pattern of liver abnormality with progression to portal hypertension in patients with DC/TBD. Presence of pulmonary and/or vascular disease in patients with recessive or TINF2 DC was an important predictor of liver disease progression, suggesting the need for increased vigilance and monitoring for complications in these patients.
Rare case of multiple neurofibromas of the scalp and trunk in association with intradural extramedullary spinal tumor: a case report
Authors: Shah Aman K. , Dahal Alok , Thapa Nuppur
Published: May 2023

Introduction and importance:

Neurofibromas are tumors of neural connective tissue composed of Schwann cells and fibroblasts. They can occur anywhere in the body, primarily as a solitary mass or as a component of neurofibromatosis. Only 1/4 of the intradural extramedullary spinal tumors are neurofibromas. While most of the neurofibromas are asymptomatic, the authors report a patient with symptomatic multiple neurofibromas of the scalp and trunk that lacked the salient features of neurofibromatosis-1.

Case presentation:

A 63-year-old male from Saptari, Nepal, with multiple insidious swellings in the scalp and trunk region, presented with complaints of weakness of the bilateral lower limb for 6–7 years resulting in difficulties in walking and bleeding from the most significant swelling that was in the occipital area.

Clinical findings and investigations:

Masses were present all over the scalp, averaging about 4×4 cm, with active bleeding from the two swellings. The authors performed the neurological assessment and histopathological and radiological investigations.

Interventions and outcomes:

A confirmed diagnosis of neurofibroma was made with myelography revealing an intradural extramedullary spinal tumor. A laminectomy with total excision of the tumor was performed.

Relevance and impact:

Meningiomas and nerve sheath tumors (schwannomas and neurofibromas) can both develop in the intradural extramedullary spinal compartment. Contrast-enhanced MRI is the most sensitive and specific imaging modality to evaluate possible spinal column lesions. Surgical excision, partial or complete, is the hallmark treatment of neurofibroma.
The Influence of Activities and Functional Social Support on Adult Cochlear Implant Outcomes
Authors: Casazza Julia A. , Yancey Kristen L. , Hunter Jacob B.
Published: May 2023

Objective:

The objective of this study is to assess whether patient participation in specific activities and perceived social support correlate with speech perception following cochlear implantation.

Setting:

Tertiary referral hospital

Methods:

Adult cochlear implantation patients implanted in their poorer hearing ear between January 2019 and December 2020 completed the Functional Social Support Questionnaire (FSSQ) and a modified version of the Victoria Lifestyle Study-Activities Lifestyle Questionnaire (VLS-ALQ). Demographics, FSSQ score, and individual activities were correlated with implanted ear and binaural AzBio scores.

Results:

Twenty-three patients completed the survey and had at least 6 months of follow-up with appropriate speech perception testing. The average age at survey completion was 71.7 (SD, 9.1). Average pure-tone average in the contralateral ear was 70.1 (SD: 20) dB. The majority (N = 21, 91.3%) wore a hearing aid in the contralateral ear following cochlear implantation. Mean AzBioQuiet score improvement was 60.6% (range: 20%–99%) in the implanted ear and 42.6% (range: −2% to 67%) binaurally. Work-related social support correlated positively with improvement in the implanted ear (Pearson’s R = 0.473; 95% CI, 0.075-0.741; P = 0.023). Improvement in the implanted ear correlated positively with creative writing (R = 0.542; 95% CI, 0.167-0.780; P = 0.008), attending films (R = 0.448; 95% CI, 0.044-0.726; P = 0.032), going out with friends (R = 0.423; 95% CI, 0.013-0.711; P = 0.044) listening to audiobooks (R = 0.433; 95% CI, 0.025-0.717; P = 0.039), and public speaking (R = 0.468; 95% CI, 0.069-0.738; P = 0.024). Gains in binaural performance correlated positively with watching TV news (R = 0.819; 95% CI, 0.509-0.941; P < 0.001) and negatively with eating at restaurants (R = −0.532; 95% CI, −0.829 to −0.002; P = 0.05).

Conclusions:

Activities that provide intellectual stimulation and engage auditory faculties correlate with greater speech perception testing improvements in adult cochlear implantation patients.
Healthcare Value in Plastic Surgery Practice
Authors: Yang Alan Z. , Hyland Colby J. , Tsai Thomas C. , Broyles Justin M.
Published: May 2023

Brief Summary:

As value-based care gains traction in response to towering healthcare expenditures and issues of healthcare inequity, hospital capacity, and labor shortages, it is important to consider how a value-based approach can be achieved in plastic surgery. Value is defined as outcomes divided by costs across entire cycles of care. Drawing on previous studies and policies, this paper identifies key opportunities in plastic surgery to move the levers of costs and outcomes to deliver higher-value care. Specifically, outcomes in plastic surgery should include conventional measures of complication rates as well as patient-reported outcome measures in order to drive quality improvement and benchmark payments. Meanwhile, cost reduction in plastic surgery can be achieved through value-based payment reform, efficient workflows, evidence-based and cost-conscious selection of medical devices, and greater use of out-patient surgical facilities. Lastly, we discuss how the diminished presence of third-party payers in aesthetic surgery exemplifies the cost-conscious and patient-centered nature of value-based plastic surgery. To lead in future health policy and care delivery reform, plastic surgeons should strive for high-value care, remain open to new ways of care delivery, and understand how plastic surgery fits into overall health care delivery.
AN ANALYSIS OF TREATMENT CHOICES AMONG WHITE AND AFRICAN AMERICAN MEDICAID PATIENTS WITH CARPAL TUNNEL SYNDROME
Authors: Hooper Rachel C. , Tong Yanlin , Sanders Hayley M. , Wang Lu , Chung Kevin C.
Published: May 2023

Introduction:

Carpal tunnel syndrome (CTS) is the most common compressive neuropathy and has severe long-term effects on hand function if surgery is delayed significantly following diagnosis. We investigated the timespan between diagnosis and surgical intervention for carpal tunnel syndrome among African American and White patients on Medicaid.

Methods:

Using the using the MarketScan Truven Database Medicaid Supplement 2009-2020, we identified patients with CTS. Demographic data and time intervals between diagnosis and treatment were collected and analyzed using Chi-squared test and regression models.

Results:

361,942 African American and White Medicaid patients with a diagnosis of CTS were included in the study. Overall, 21.4% of Whites compared to 13.6% of African Americans chose surgery as their first and only option, p<0.001. A greater proportion of Whites underwent surgery at < 6 months after diagnosis compared to African Americans, 75.5% and 67.7% respectively; p < 0.001. African American women underwent surgery at a significantly lower rate compared to White women, 13.8% and 21.8% respectively, p<0.001. Despite the increase in rates of surgery among both groups, the gap in utilization of surgery widened from a 6.6% difference in 2009 to a 9.5% in 2020 between racial groups.

Conclusions:

African American race and female sex are significantly correlated with choice of treatment and time to surgery among Medicaid patients with CTS. Identification of the relationship between healthcare disparities and the decision to undergo surgery is the first step in the development of strategies to mitigate underutilization of this quality of life improving procedure.
Modified Deep-Plane Face Lift and Lower Midface Lifting Using Deep Fat Compartment Mobilization and Zygomaticus Major Muscle Plication
Authors: Kim Sung Ho , Choi Bong Gyu , Chung Kyu-Jin
Published: May 2023

Background:

Most face-lift techniques greatly improve the lower face; however, techniques for lifting the midface are limited and difficult. Original deep-plane face lift is a way to lift the superficial musculoaponeurotic system and skin as a compound unit. Although it minimizes tear of the superficial musculoaponeurotic system during dissection, damage to the vascular system, and the incidence of skin necrosis, and can be easily used in secondary cases, the deep-plane face lift does not adequately improve nasolabial fold. The authors perform a modified and enhanced deep-plane face lift to improve the midface. In this article, the authors explain the effects and procedures of the method.

Methods:

This retrospective study included patients (n = 632) on whom deep-plane face lift (DPF group; n = 299) and modified deep-plane face lift (M-DPF group; n = 333) was performed by a single surgeon from January of 2014 to January of 2017, and from February of 2017 to December of 2020, respectively, at a local clinic. The degree of improvement in wrinkles in the patients’ nasolabial fold was assessed using the five-grade Wrinkle Severity Rating Scale (WSRS).

Results:

The preoperative WSRS score was 2.95 ± 0.89 in the DPF group and 2.89 ± 0.92 in the M-DPF group. There was no significant difference in the preoperative WSRS score between the two groups (P = 0.058). The postoperative WSRS score was 1.81 ± 0.68 in the DPF group, which was significantly greater than the 1.65 ± 0.66 found in the M-DPF group.

Conclusion:

This method developed by the authors that combines deep-plane face lift with deep fat compartment mobilization and zygomaticus major muscle plication is safe and directly improves the nasolabial fold and promotes a smiling expression for rejuvenation effects.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Vibration-Assisted Volume Optimization Mammaplasty: An Alternative Approach for Large-Volume Fat Grafting to the Breast
Authors: Afifi Ahmed M. , Seitz Allison J. , Albano Nicholas J.
Published: May 2023

Fat grafting has become an integral part of aesthetic and reconstructive breast surgery. However, the ideal method for harvesting and injecting the fat remains unclear. The authors describe an alternative approach for large-volume fat grafting in the breast, vibration-assisted volume optimization mammaplasty, that builds on the experience of other authors with using the power-assisted liposuction machine for fat injection. The authors implemented this approach in 138 breasts over 2 years and found low rates of complications (4%). This new approach substantially reduces the time required to inject the fat graft and is simpler and faster to set up than previously described techniques. The authors believe vibration-assisted volume optimization mammaplasty can be used to perform large-volume fat grafting safely and efficiently in the breast with an acceptable rate of complications.
Initial report on special operations clinical training at a civilian academic medical center
Authors: Oury Jeffrey , Reed Benjamin L. , Donovan James , Abbas Kamil , Wilson Alison , Grabo Daniel
Published: May 2023

BACKGROUND

Military-civilian partnerships for combat casualty care skills training have mostly focused on traditional, combat surgical team training. We sought to better understand US Special Forces (SF) Medics' training at West Virginia University in Morgantown, West Virginia, a Level 1 trauma center, via assessments of medical knowledge, clinical skills confidence, and technical performance.

METHODS

Special Forces Medics were evaluated using posttraining medical knowledge tests, procedural skills confidence surveys (using a 5-point Likert scale), and technical skills assessments using fresh perfused cadavers in a simulated combat casualty care environment. Data from these tests, surveys, and assessments were analyzed for 18 consecutive SF medic rotations from the calendar years 2019 through 2021.

RESULTS

A total of 108 SF Medics' tests, surveys, and assessments were reviewed. These SF Medics had an average of 5.3 years of active military service; however, deployed experience was minimal (73% never deployed). Review of knowledge testing demonstrated a slight increase in mean test score between the precourse (80% ± 14%; range, 50–100%) when compared with the postcourse (82% ± 14%; range, 50–100%). Skills confidence scores increased between courses, specifically within the point of injury care (p = 0.09) and prolonged field care (p < 0.001). Technical skills assessments included cricothyroidotomy, chest tube insertion, and tourniquet placement.

CONCLUSION

This study provides preliminary evidence supporting military-civilian partnerships at an academic Level 1 trauma center to provide specialty training to SF Medics as demonstrated by increase in medical knowledge and confidence in procedural skills. Additional opportunities exist for the development technical skills assessments.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Pre-exposure Prophylaxis with Tixagevimab-cilgavimab did not Reduce Severity of COVID-19 in Lung Transplant Recipients with Breakthrough Infection
Authors: Sindu Devika , Razia Deepika , Grief Katherine , Cherrier Lauren , Omar Ashraf , Walia Rajat , Tokman Sofya
Published: May 2023

Background.

Lung transplant recipients (LTRs) have an increased risk of COVID-19–related morbidity and mortality. Tixagevimab-cilgavimab (tix-cil) is a long-acting monoclonal antibody combination granted Emergency Use Authorization approval by the US Food and Drug Administration for COVID-19 pre-exposure prophylaxis (PrEP) in immunocompromised patients. We sought to determine whether tix-cil 300–300 mg reduced the incidence and disease severity of severe acute respiratory syndrome coronavirus 2 infection in LTRs during the Omicron wave.

Methods.

We performed a retrospective, single-center cohort study of LTRs who had received a COVID-19 diagnosis between December 2021 and August 2022. We compared baseline characteristics and clinical outcomes after COVID-19 between LTRs who received tix-cil PrEP and those who did not. We then conducted propensity-score matching based on baseline characteristics and therapeutic interventions and compared clinical outcomes between the 2 groups.

Results.

Of 203 LTRs who received tix-cil PrEP and 343 who did not, 24 (11.8%) and 57 (16.6%), respectively, developed symptomatic COVID-19 (hazard ratio [HR], 0.669; 95% confidence interval [CI], 0.415-1.079; P = 0.099). The hospitalization rate of LTRs with COVID-19 during the Omicron wave trended lower in the tix-cil group than in the non–tix-cil group (20.8% versus 43.1%; HR, 0.430; 95% CI, 0.165-1.118; P = 0.083). In propensity-matched analyses, 17 LTRs who received tix-cil and 17 LTRs who did not had similar rates of hospitalization (HR, 0.468; 95% CI, 0.156-1.402; P = 0.175), intensive care unit admission (HR, 3.096; 95% CI, 0.322-29.771; P = 0.328), mechanical ventilation (HR, 1.958; 95% CI, 0.177-21.596; P = 0.583), and survival (HR, 1.015; 95% CI, 0.143-7.209; P = 0.988). COVID-19–related mortality was high in both propensity-score–matched groups (11.8%).

Conclusions.

Breakthrough COVID-19 was common among LTRs despite tix-cil PrEP, possibly due to reduced efficacy of monoclonal antibodies against the Omicron variant. Tix-cil PrEP may reduce the incidence of COVID-19 in LTRs, but it did not reduce disease severity during the Omicron wave.
Development of the ethmoid in a wallaby and implications for the homology of turbinal elements in marsupials
Authors: Macrini Thomas E. , Hopwood Jenna , Herbert Catherine A. , Weisbecker Vera
Published: May 2023

The homologies of the turbinals (scroll bones) of the ethmoid are not well understood, including the potential implication for understanding mammalian phylogeny. Here we examine the postnatal development of this anatomical system in a marsupial mammal because previous work has shown that the adult pattern of five endoturbinals (ethmoturbinals) and two ectoturbinals (frontoturbinals) is conserved. Furthermore, marsupial phylogeny is fairly well resolved and provides a solid evolutionary framework for examining turbinal homologies. In this study, we documented the development of the ethmoid of the tammar wallaby,
Notamacropus eugenii
, using histology and computed tomography imagery of a growth series of pouch young. The pattern of development of the turbinal elements in the wallaby was compared to that in didelphids, as described in previous work. We found that four ethmoturbinals initially develop, followed later in development by an interturbinal; these five elements then develop into the bony endoturbinals found in adults. These data support the idea that endoturbinal III, derived from an interturbinal, has a distinctive development pattern from the other endoturbinals. This is consistent with what is seen in the didelphid marsupials,
Caluromys philander
and
Monodelphis domestica
, suggesting this is a common developmental pattern for marsupials.

This article is part of the theme issue ‘The mammalian skull: development, structure and function’.
A switch in jaw form–function coupling during the evolution of mammals
Authors: Tseng Z. Jack , Garcia-Lara Sergio , Flynn John J. , Holmes Emily , Rowe Timothy B. , Dickson Blake V.
Published: May 2023

The evolutionary shift from a single-element ear, multi-element jaw to a multi-element ear, single-element jaw during the transition to crown mammals marks one of the most dramatic structural transformations in vertebrates. Research on this transformation has focused on mammalian middle-ear evolution, but a mandible comprising only the dentary is equally emblematic of this evolutionary radiation. Here, we show that the remarkably diverse jaw shapes of crown mammals are coupled with surprisingly stereotyped jaw stiffness. This strength-based morphofunctional regime has a genetic basis and allowed mammalian jaws to effectively resist deformation as they radiated into highly disparate forms with markedly distinct diets. The main functional consequences for the mandible of decoupling hearing and mastication were a trade-off between higher jaw stiffness versus decreased mechanical efficiency and speed compared with non-mammals. This fundamental and consequential shift in jaw form–function underpins the ecological and taxonomic diversification of crown mammals.

This article is part of the theme issue ‘The mammalian skull: development, structure and function’.
Hantavirus infection in central Sri Lanka: An unusual clinical presentation: a case report
Authors: Pattiyakumbura T T , Pathirathne S H , Muthugala M. A R. V
Published: May 2023

Hantavirus infections are emerging zoonoses. In Asia, the hantavirus commonly manifests as hemorrhagic fever with renal syndrome (HFRS), apparent with fever, thrombocytopenia, and acute kidney injury. There are a few cases with the atypical clinical course with cardiopulmonary symptoms in Asia including Sri Lanka. Here, we report a case of hantavirus infection with an atypical cardiopulmonary syndrome-like illness with serological evidence of the Puumala/ Puumala-like virus.
Ramlibacter paludis sp. nov., isolated from wetland
Authors: Lim Ji-Eun , Jo Jung-Hun , Im Wan-Taek
Published: May 2023

A Gram-stain-negative, non-motile, rod-shaped, aerobic and white-coloured bacterium (designated XY19T) was isolated from a soil sample of wetland from Godeok Ecological Park, Gangdong-gu, Seoul, Republic of Korea. On the basis of 16S rRNA gene sequencing, strain XY19T clustered with species of the genus

Ramlibacter

and appeared closely related to

R

.

ginsenosidimutans

DSM 23480T (98.42 %),

R. alkalitolerans

JCM 32081T (97.68 %) and

R

.

monticola

JCM 31918T (97.66 %). The average nucleotide identity between strain XY19T and three strains (

R. ginsenosidimutans

DSM 23480T,

R. alkalitolerans

JCM 32081T and

R. monticola

JCM 31918T) were 80.7, 81.1 and 81.4 %. And the digital DNA–DNA hybridization (dDDH) calculated between strain XY19T and each of the three strains (

R. ginsenosidimutans

DSM 23480T,

R. alkalitolerans

JCM 32081T and

R. monticola

JCM 31918T) were 24.1, 24.4 and 24.5 %. ANI value and dDDH results were a novel species of the genus

Ramlibacter

. Growth occurs at 10–37 °C on R2A medium in the pressence of 0–1 % NaCl (w/v) and at pH 6.0–8.5. The DNA G+C content of the genomic DNA was 68.7 mol%, and ubiquinone-8 (Q-8) was the major respiratory quinone. The major cellular fatty acids (>5 %) were C16:1
 ω7c and/or C16:1 ω6c (summed feature 3), C16 : 0, C17 : 0 cyclo and C18:1
 ω7c and/or C18:1
 ω6c (summed feature 8). The polar lipids consisted of diphosphatidylglycerol, phosphatidylglycerol, phosphatidylethanolamine, three unidentified lipids and unidentified aminophospholipid. Physiological and biochemical characteristics indicated that strain XY19T represents a novel species of the genus

Ramlibacter

, for which the name Ramlibacter paludis sp. nov. is proposed. The type strain is XY19T (= KACC 22220T = LMG 32190T).
Curtanaerobium respiraculi gen. nov., sp. nov., a novel anaerobic bacterium isolated from human bronchoalveolar lavage fluid
Authors: Sun Yifan , Wang Likun , Han Dexing , Li Jianjie , Liu Yuejiao , Tan Yafang , Pan Zhiyuan , Yang Ruifu , Qu Pinghua , Wang Ziping , Bi Yujing
Published: May 2023

Two related anaerobic strains, designated as SWB101512T and SWB19611, were isolated from the bronchoalveolar lavage fluid of two lung cancer patients. Cells were Gram-stain-positive, non-motile and non-spore-forming. Growth could be observed at 26–45 °C (optimum, 37 °C), pH 5.0–8.5 (optimum, pH 7.0) and with 0.5–2.0 % (v/w) NaCl (optimum, 1.0%). The 16S rRNA gene sequences of SWB101512T and SWB19611 showed the highest similarities to

Denitrobacterium detoxificans

DSM 21843T (91.1 and 91.3 %, respectively). The phylogenetic tree based on the 16S rRNA gene sequences and the core genome sequences demonstrated that the two strains clustered together and formed a distinct lineage within the family

Eggerthellaceae

. The DNA G+C contents of strains SWB101512T and SWB19611 were 62.0 and 61.9 mol%, respectively. The predominant cellular fatty acids of strains SWB101512T and SWB19611 were C16 : 0 DMA (27.8 and 28.8 %, respectively). The respiratory menaquinone in both strains was menaquinone 6 and the polar lipid profile consisted of diphosphatidylglycerol, phosphatidylglycerol, two phospholipids, three glycolipids and three unidentified lipids. Based on evidence from phenotypic, chemotaxonomic and genomic analyses, a new genus and species belonging to the family

Eggerthellaceae

, named Curtanaerobium respiraculi gen. nov., sp. nov. is proposed. The type strain is SWB101512T (=GDMCC 1.2991T=JCM 35330T).