bluuebunny/crossref_metadata_2025 huggingface dataset:
Enantiomeric composition of α-pinene affects catches of bark and wood boring beetles, and associated species, in ethanol-baited multiple-funnel traps
Authors: Miller Daniel R , Mayfield Albert E , Poland Therese M
Published: May 2024

In 2009, we determined the effects of the enantiomeric composition of the kairomone, α-pinene, on trap catches of arboreal beetles (Coleoptera) in stands of eastern pine trees with resin dominated by (+)-α-pinene. We hypothesized that the responses of beetles would correlate with the predominant enantiomer of α-pinene found in host pines. Lures of (+)-, racemic (±), and (−)-α-pinene were added separately to ethanol-baited multiple-funnel traps. Species such as Monarthrum mali (Fitch), Dendroctonus terebrans (Olivier), Ips grandicollis (Eichhoff), and Pachylobius picivorus (Germar) (Coleoptera: Curculionidae) showed a preference for traps co-baited with (–)-α-pinene. α-Pinene enhanced attraction of Hylastes salebrosus Eichhoff, Hylastes porculus Erickson and Hylastes tenuis Eichhoff (Coleoptera: Curculionidae) to ethanol-baited traps with no effects from enantiomeric composition of α-pinene. The attraction of the ambrosia beetles, Xyleborinus saxesenii (Ratzeburg) and Dryoxylon onoharaense (Murayama) (Coleoptera: Curculionidae) to ethanol-baited traps was interrupted by the addition of α-pinene, regardless of enantiomeric composition. Species such as Xylosandrus germanus (Blandford), Cnestus mutilatus (Blandford) and Stenoscelis brevis (Boheman) (Coleoptera: Curculionidae) were unaffected by the presence of α-pinene. Trap catches of some species of longhorn beetles and bark beetle predators (Coleoptera: Cerambycidae, Cleridae, Elateridae, Histeridae, and Trogossitidae) were increased by the addition of α-pinene, although results varied by location. Platysoma spp. (Coleoptera: Histeridae) showed a marked preference for traps co-baited with (+)-α-pinene in Florida and Georgia. In summary, we found that the enantiomeric composition of α-pinene in hosts was not a good predictor of enantiomeric preferences by beetles.
Monitoring the susceptibility of Bemisia tabaci Middle East-Asia Minor 1 (Hemiptera: Aleyrodidae) to afidopyropen, cyantraniliprole, dinotefuran, and flupyradifurone in south Florida vegetable fields
Authors: Dimase Marcelo , Rossitto De Marchi Bruno , Barreto da Silva Felipe , Lahiri Sriyanka , Beuzelin Julien , Hutton Sam , Smith Hugh Adam
Published: May 2024

Bemisia tabaci Middle East-Asia Minor 1 (MEAM1) is a significant pest that damages a wide range of high-value vegetable crops in south Florida. This pest has demonstrated the ability to develop resistance to various insecticide groups worldwide. Monitoring the resistance levels of MEAM1 populations and maintaining baseline susceptibility data are crucial for the long-term effectiveness of insecticide management strategies. We conducted serial dilution bioassays on 15 field populations of MEAM1 collected in south Florida to assess their resistance to 4 key insecticides: afidopyropen, cyantraniliprole, dinotefuran, and flupyradifurone. To quantify resistance levels, resistance ratios (RR) were generated by comparing the LC50 values of field populations to those of a known susceptible MEAM1 colony reared in the laboratory. Our findings reveal that all field-collected populations were susceptible to dinotefuran (RR 1–8) and flupyradifurone (RR 2–8). While over 80% of the populations tested were susceptible to afidopyropen (RR 1–9), 2 populations exhibited low (RR 38) and moderate resistance (RR 51), respectively. In contrast, most of the populations (57%) showed low to moderate resistance to cyantraniliprole (RR 21–78), and the remaining populations were susceptible (RR 3–10). The 2 populations with resistance to afidopyropen also exhibited moderate resistance to cyantraniliprole. Further research in this direction can aid in refining insecticide resistance management programs in Florida and other regions where B. tabaci MEAM1 is a major pest. Exploring the implications of these findings will be essential for insecticide use and integrated pest management strategies in south Florida.
From simple to complex: a sequential method for enhancing time series forecasting with deep learning
Authors: Jiménez-Navarro M J , Martínez-Ballesteros M , Martínez-Álvarez F , Troncoso A , Asencio-Cortés G
Published: May 2024

Time series forecasting is a well-known deep learning application field in which previous data are used to predict the future behavior of the series. Recently, several deep learning approaches have been proposed in which several nonlinear functions are applied to the input to obtain the output. In this paper, we introduce a novel method to improve the performance of deep learning models in time series forecasting. This method divides the model into hierarchies or levels from simpler to more complex ones. Simpler levels handle smoothed versions of the input, whereas the most complex level processes the original time series. This method follows the human learning process where general/simpler tasks are performed first, and afterward, more precise/harder ones are accomplished. Our proposed methodology has been applied to the LSTM architecture, showing remarkable performance in various time series. In addition, a comparison is reported including a standard LSTM and novel methods such as DeepAR, Temporal Fusion Transformer, NBEATS and Echo State Network.
Predicting insurance claims through a variety of data mining techniques: facing lots of missing values and moderate class-imbalanced levels
Authors: Santana-Morales Paola , Tallón-Ballesteros Antonio J
Published: May 2024

This paper copes with a real-world classification problem related to the management of claims received in an insurance company. The way to obtain the classifier is not easy due to the high amount of missing values as well as the inherent imbalanced scenario within class labels. Once the data partition has been done, the training set is submitted to an intensive double grid search in order to obtain the most promising type of missing value imputation approach and then a step ahead is done using the best method and it starts the next round of data mining strategies which now falls into data rebalancing umbrella. Again, a grid search from an undersampling and oversampling family with different settings is done taking into account only seen data. The training data obtained after the first grid search are now submitted to the second step according the second grid search in order to get the ready training set for the further classifier training. The main objective of the work is to find the best combination of data mining techniques that suits the data set with a pipeline containing two types of data preparation methods coming from different families. As an outcome, first the problem of the presence of missing values has been addressed and then the data rebalancing techniques has been applied. The study focuses on obtaining classifiers based on Bayesian and lazy approaches as well as decision trees, evaluated on metrics such as the area under the ROC curve (AUC), Cohen’s kappa, Accuracy and the F-measure, among others. The imputation by the mean the mode is preferable to the Expectation Maximization Imputation in the scenario faced in this paper taking into account that the amount of missing values is higher than a forty percent for many features.
Functional regulation of testosterone underlying state transition in seasonal spermatogenesis of Plateau Pika (Ochotona curzoniae)
Authors: Wang Yujun , Duo Hairui , Li Shuang , Zhang Xiaoqian , Tao Haiping , Fang Yougui , Jia Gongxue , Yang Qien
Published: May 2024

Seasonal reproduction is an adaptive strategy that benefits the survival and growth of offspring. However, the regulatory mechanisms affecting spermatogenesis in male seasonal breeders are not well understood. We examined the actions of testosterone on seasonal spermatogenesis of Plateau Pika (Ochotona curzoniae), a typical long-day breeder living on the Qinghai–Tibetan Plateau. The annual dynamics of germ cell development and steroid hormone synthesis were confirmed and were consistent with testicular morphology. Furthermore, a testosterone regulation experiment showed that elevated testosterone stimulated proliferation of spermatogonia and regeneration of advanced spermatogenic cells in reproductively dormant pika, while testosterone suppression induced cell apoptosis both in reproductively active and dormant pikas. Transcriptomic analyses indicated that testosterone-regulated genes related to spermatogonial fate determination by binding to androgen receptors and inducing the production of retinoic acid, which was responsible for the initiation of spermatogonial differentiation. We show that testosterone orchestrates downstream signaling pathways to balance spermatogonial self-renewal and development. These findings provide a new perspective on seasonal regulation of mammalian spermatogenesis.
Annexation Attempts as a Two-Level Game: Israel and the West Bank in 1967 and 2020
Authors: Pinfold Rob Geist , Eiran Ehud
Published: May 2024

Annexation attempts threaten international security and the rules-based world order. Yet, studies of annexation are rare, whilst the scant relevant literature is great-power centric. This article therefore asks why some non-great power annexations succeed, whereas others do not. Applying Putnam's two-level game framework, it analyses an occupier's: (1) domestic politics; (2) international relations; and (3) interactions between these two levels of analysis. It applies this framework to Israeli policy in two specific cases: partial annexation, where Israel annexed East Jerusalem but not the entire West Bank (1967); and Israel's comprehensive but aborted West Bank annexation (2020). This article finds that when the policy would yield maximum domestic returns and minimal global opprobrium, Israel's leaders enacted annexation. They refrained from doing so when this synchronization was absent. These findings illustrate the utility of the two-level game framework for explaining non-great powers’ decision-making and their territorial policies in particular.
Unusual massive venous hemorrhage after pancreatoduodenectomy treated by endovascular approach
Authors: Alfaifi Jaber , Buisset Cyrille , Postillon Agathe , Orry Xavier , Chanty Hervé , Germain Adeline , Ayav Ahmet
Published: May 2024

Most post-pancreaticoduodenectomy hemorrhages (PPH) are of arterial origin, and some studies have suggested that an interventional radiology approach is most effective in reducing mortality. Venous PPH is rare, and identifying its source can be challenging. We report a case of late venous PPH in the context of a pancreatic fistula following pancreaticoduodenectomy. During surgical exploration, the area of ​​potential bleeding was inaccessible due to major inflammatory adhesions aggravated by the presence of pancreatic fistula and the delay of relaparotomy. No intra-abdominal bleeding was detected on imaging studies or during abdominal exploration; only a massive bleeding through the drain orifice, which required packing, was observed. Percutaneous transhepatic portography was performed to localize and treat the origin of the bleeding. The hemorrhage was successfully treated by endovascular approach. We found no reports in the literature on the use of interventional radiology with venous stenting to treat venous PPH, except in cases of gastrointestinal variceal hemorrhage due to portal occlusion.
Traditional Meiyu–Baiu has been suspended by global warming
Authors: Yin Zhicong , Song Xiaolei , Zhou Botao , Jiang Wenhao , Chen Huopo , Wang Huijun
Published: May 2024

More than 1000 years, the Meiyu–Baiu have shaped the uniqueness of natural resources, civilization and culture in the Yangtze River Basin of China and the main islands of Japan. In recent decades, frequent rainstorms and droughts have seemingly diminished the misty features of traditional Meiyu–Baiu rainfall. However, there is still no consensus on whether their traditional nature is suspended. In this study, we quantitatively demonstrate that the Meiyu–Baiu almost completely lost their traditional features during 1961–2023, ∼80% of which can be attributed to anthropogenic warming. Furthermore, in a warmer future, the traditional Meiyu–Baiu will be more unlikely to appear. This study underscores the urgency in adapting to climate shift because destructive extremes are measurably taking the place of mild and maternal rains.
The Contemporary Landscape of Narrations and Jurisprudence: The Legal Imagination and Nomos and Narrative half a century later
Authors: Bobrowicz Ryszard
Published: May 2024

In 1973, James Boyd White published The Legal Imagination, broadly credited with the foundation of a new discipline, law and literature, which underlined the importance of narratives in legal thinking and practice. A decade later, in an introduction to the review of the 1982 SCOTUS term, Robert Cover identified the need for further discussion regarding the close connection between norms and narratives. ‘Nomos and Narrative’ set a precedent by launching a more in-depth investigation into the role of stories as the foundation of normativity and its participation in dealing with competing normative claims. Since then, various strands of jurisprudence have struggled with the view of law as a set of interpretive commitments. By taking a closer look at both, this article reflects on the relevance and significance of these texts half a century later. As the article argues, despite a significant following among the scholars, the arguments posed by White and Cover did not find broad implementation in the juridico-political systems around the world. On the contrary, the opposite tendencies seem to dominate today. Thus, the article reflects on the contemporary relevance of both texts in critical, constructive, and explorative terms.
REDUCED CHLOROPLAST COVERAGE proteins are required for plastid proliferation and carotenoid accumulation in tomato
Authors: Hu Qun , Zhang Hui , Song Yuman , Song Lijuan , Zhu Lingling , Kuang Hanhui , Larkin Robert M
Published: May 2024

Increasing the amount of cellular space allocated to plastids will lead to increases in the quality and yield of crop plants. However, mechanisms that allocate cellular space to plastids remain poorly understood. To test whether the tomato (Solanum lycopersicum L.) REDUCED CHLOROPLAST COVERAGE (SlREC) gene products serve as central components of the mechanism that allocates cellular space to plastids and contribute to the quality of tomato fruit, we knocked out the 4-member SlREC gene family. We found that slrec mutants accumulated lower levels of chlorophyll in leaves and fruits, accumulated lower levels of carotenoids in flowers and fruits, allocated less cellular space to plastids in leaf mesophyll and fruit pericarp cells, and developed abnormal plastids in flowers and fruits. Fruits produced by slrec mutants initiated ripening later than wild type and produced abnormal levels of ethylene and abscisic acid (ABA). Metabolome and transcriptome analyses of slrec mutant fruits indicated that the SlREC gene products markedly influence plastid-related gene expression, primary and specialized metabolism, and the response to biotic stress. Our findings and previous work with distinct species indicate that REC proteins help allocate cellular space to plastids in diverse species and cell types and, thus, play a central role in allocating cellular space to plastids. Moreover, the SlREC proteins are required for the high-level accumulation of chlorophyll and carotenoids in diverse organs, including fruits, promote the development of plastids and influence fruit ripening by acting both upstream and downstream of ABA biosynthesis in a complex network.
Nonstationary SQM/IST Correspondence and ${\cal CPT/PT}$-Invariant Paired Hamiltonians on the Line
Authors: Berezovoj V P , Nurmagambetov A J
Published: May 2024

We fill some of the existing gaps in the correspondence between supersymmetric quantum mechanics and the inverse scattering transform by extending the consideration to the case of paired stationary and nonstationary Hamiltonians. We formulate the Goursat problem corresponding to the case and explicitly construct the kernel of the nonlocal inverse scattering transform, which solves it. As a result, we find a way of constructing non-Hermitian Hamiltonians from the initially Hermitian ones that leads, in the case of real-valued spectra of both potentials, to pairing of ${\cal CPT/PT}$-invariant Hamiltonians. The relevance of our proposal to quantum optics and optical waveguide technology, as well as to nonlinear dynamics and black hole physics, is briefly discussed.
Rituximab retention rate in systemic sclerosis: a long term real-life multicentre study
Authors: De Luca Giacomo , De Lorenzis Enrico , Campochiaro Corrado , Cacciapaglia Fabio , Del Papa Nicoletta , Zanatta Elisabetta , Airò Paolo , Lazzaroni Maria Grazia , Giuggioli Dilia , De Santis Maria , Alonzi Gabriella , Stano Stefano , Binda Marco , Moccaldi Beatrice , Tonutti Antonio , Cavalli Silvia , Batani Veronica , Natalello Gerlando , Iannone Florenzo , D’Agostino Maria Antonietta , Dagna Lorenzo , Matucci-Cerinic Marco , Bosello Silvia Laura
Published: May 2024

Objectives

To report real-life data on rituximab retention rate as an indicator of safety and efficacy in a multicentric national cohort of systemic sclerosis patients.

Methods

SSc patients treated with rituximab and followed for at least 36 months were included, clinically characterized and longitudinally monitored. A competing risk analysis with sub-hazard ratio (sHR) definition was performed to explore the clinical variables linked to specific cause of rituximab discontinuation.

Results

One-hundred and fifty-two SSc-patients [mean age 47.3 (12.3) years; females 79.6%; diffuse disease 77.6%; anti-topoisomerase-I positivity 63.2%] were evaluated over a median (interquartile range) time of 3.3 (1.7–5.0) years. The primary indications for rituximab were interstitial lung disease (38.8%), worsening skin fibrosis (36.8%) and arthritis (13.8%); 138 patients (90.8%) received more than one rituximab course. The 5-year rituximab retention rate was 59.9% (44.6–64.7%). Clinical response was the most common reason for rituximab discontinuation [5.7; 95% CI: (3.7–8.4) per 100 patient-years] and was associated with a shorter disease duration (sHR 0.8; 95% CI: 0.7, 0.9), anti-topoisomerase-I negativity (sHR 0.4; 95% CI: 0.2, 0.9), previous digital ulcers (sHR 2.6; 95% CI: 1.1, 6.2) and no history of arthritis (sHR 0.3; 95% CI: 0.1, 0.8). Treatment failure was the second cause of rituximab discontinuation [3.7 (95% CI: 2.2, 6.0) per 100 patient-years] and was associated with anti-centromere antibody positivity (sHR 2.8; 95% CI: 1.1, 7.4) and anti-topoisomerase-I negativity (sHR 0.2; 95% CI: 0.1, 0.6). Adverse events (AEs) were the less common cause of discontinuation [3.1 (95% CI: 1.7, 5.2) per 100 patient-years], associated with limited cutaneous subset (sHR 3.4; 95% CI: 1.2, 9.7) and previous mycophenolate mofetil treatment (sHR 4.5; 95% CI: 1.2, 16.3).

Conclusion

Rituximab is a safe and effective treatment in SSc: clinical response emerged as the primary reason for rituximab discontinuation, and AEs had a limited impact on treatment persistence. The identification of specific disease features associated with a response to rituximab will be useful in the management of SSc-patients.
Brains, Breeding, and Knowingness: The Politics of Meritocracy in Mid-Twentieth-Century Britain
Authors: Hill Alex
Published: May 2024

This article re-studies fifty-seven interviews with working-class voters conducted between 1958 and 1960 for Robert McKenzie and Allan Silver’s Angels in Marble: Working Class Conservatives in Urban England (1968). It uses these interview transcripts as a window into aspects of the mid-twentieth-century vernacular, specifically vernacular understandings of the social order. It argues that a powerful meritocratic ideology runs through the interviewees’ responses, articulated through the concept of ‘brains’. This discourse revered academic and professionalized forms of knowledge, arguing that they should form the currency of social mobility and the criterion of good political leadership. Hierarchies premised on class, race, and gender could be reinforced if they were perceived to reward those with ‘brains’ and criticized if they did not. However, this vernacular ideology was circumscribed by two other vernacular concepts: ‘breeding’ and ‘knowingness’. ‘Breeding’ celebrated the knowledge that came from elite experiences associated with family and upbringing. ‘Knowingness’ celebrated the knowledge that came from the experience of working-class life. These two concepts set a limit on the appeal of a vernacular meritocracy that based itself around ‘brains’.
Ferrostatin-1 mitigates cellular damage in a ferroptosis-like environment in Caenorhabditis elegans
Authors: Ferreyra Melisa R , Romero Verónica L , Fernandez-Hubeid Lucia E , Gonzales-Moreno Candelaria , Aschner Michael , Virgolini Miriam B
Published: May 2024

Although iron (Fe) is the most biologically abundant transition metal, it is highly toxic when it accumulates as Fe2+, forming a labile Fe pool and favoring the Fenton reaction. This oxidative scenario leads to a type of caspase-independent programmed cell death, referred to as ferroptosis, where following processes take place: (i) Fe2+ overload, (ii) glutathione peroxidase 4 inactivation, (iii) lipid peroxidation, and (iv) glutathione depletion. The present study sought to evaluate the consequences of Fe2+ administration on ferroptosis induction in Caenorhabditis elegans. We demonstrated higher mortality, increased lipid peroxidation, reduced glutathione peroxidase activity, and morphological damage in dopaminergic neurons upon Fe2+ overload. Pharmacological intervention at the level of lipid peroxidation with ferrostatin-1 (250 μM) mitigated the damage and returned the biochemical parameters to basal levels, revealing the potential of this therapeutical approach. Finally, to assess the relationship between ferroptosis and dopamine in a Parkinsonian background, we evaluated the UA44 worm strain which overexpresses the alpha-synuclein protein in cherry-labeled dopaminergic neurons. We demonstrated that Fe2+ administration reduced lethality associated with similar alterations in biochemical and dopaminergic morphological parameters in wild-type animals. These experiments provide mechanistic-based evidence on the efficacy of a pharmacological approach to mitigate the physiological, biochemical, and morphological consequences of Fe2+ overload. At the same time, they encourage further research on the impact of the combined effects resulting from the genetic background and dopamine signaling in a Parkinsonian phenotype.
Transcription Factor CgSte12 Regulates Pathogenicity by Affecting Appressorium Structural Development in the Anthracnose-Causing Fungus Colletotrichum gloeosporioides
Authors: Li Fuhan , Lu Dongxiao , Meng Fanli , Tian Chengming
Published: May 2024

Colletotrichum gloeosporioides is the causal agent of poplar anthracnose, which induces major economic losses and adversely affects the ecosystem services of poplar forests. The appressorium serves as a penetration structure for many pathogenic fungi, including C. gloeosporioides. The production of mucilage and the formation of penetration pegs are critically important for the appressorium-mediated penetration of host tissues. We previously found that CgPmk1 is a key protein involved in appressorium formation, penetration, and pathogenicity. Although CgSte12, which is a transcription factor that functions downstream of CgPmk1, regulates the formation of penetration pegs, its role in C. gloeosporioides appressorium development and pathogenicity has not been elucidated. Here, we developed C. gloeosporioides CgSTE12 mutants and characterized the molecular and cellular functions of CgSTE12. The results showed that mycelial growth and morphology were not affected in the CgSTE12 knockout mutants, which produced normal melanized appressoria. However, these mutants had less mucilage secreted around the appressoria, impaired appressorial cone formation, and the inability to form penetration pores and pegs, which ultimately led to a significant loss of pathogenicity. Our comparative transcriptome analysis revealed that CgSte12 controls the expression of genes involved in appressorium development and function, including genes encoding cutinases, NADPH oxidase, spermine biosynthesis-related proteins, ceramide biosynthesis-related proteins, fatty acid metabolism-related proteins, and glycerophospholipid metabolism-related proteins. Overall, our findings indicate that CgSte12 is a critical regulator of appressorium development and affects C. gloeosporioides pathogenicity by modulating the structural integrity of appressoria.
Preoperative N-terminal Pro–B-type Natriuretic Peptide and High-sensitivity Cardiac Troponin T and Outcomes after Major Noncardiac Surgery: A Prospective Cohort Study
Authors: Zhao Bing-Cheng , Lei Shao-Hui , Zhuang Pei-Pei , Yang Xiao , Feng Wei-Jie , Qiu Shi-Da , Yang Huan , Liu Ke-Xuan ,   for the PREVENGE-CB Collaborators
Published: May 2024

Background

Patients undergoing noncardiac surgery have varying risk of cardiovascular complications. This study evaluated preoperative N-terminal pro–B-type natriuretic peptide (NT-proBNP) and high-sensitivity cardiac troponin T to enhance cardiovascular events prediction for major noncardiac surgery.

Methods

This prospective cohort study included adult patients with cardiovascular disease or risk factors undergoing elective major noncardiac surgery at four hospitals in China. Blood samples were collected within 30 days before surgery for NT-proBNP and high-sensitivity troponin T (hs-TnT) measurements. The primary outcome was a composite of any cardiovascular events within 30 days after surgery. Logistic regression models were used to assess associations, and the predictive performance was evaluated primarily using area under the receiver operating characteristics curve (AUC) and fraction of new predictive information.

Results

Between June 2019 and September 2021, a total of 2,833 patients were included, with 435 (15.4%) experiencing the primary outcome. In the logistic regression model that included clinical variables and both biomarkers, the odds ratio for the primary outcome was 1.68 (95% CI, 1.37 to 2.07) when comparing the 75th percentile to the 25th percentile of NT-proBNP distribution, and 1.91 (95% CI, 1.50 to 2.43) for hs-TnT. Each biomarker enhanced model discrimination beyond clinical predictors, with a change in AUC of 0.028 for NT-proBNP and 0.029 for high-sensitivity cardiac troponin T, and a fraction of new information of 0.164 and 0.149, respectively. The model combining both biomarkers demonstrated the best discrimination, with a change in AUC of 0.042 and a fraction of new information of 0.219.

Conclusions

Preoperative NT-proBNP and hs-TnT both improved the prediction for cardiovascular events after noncardiac surgery in addition to clinical evaluation, with their combination providing maximal predictive information.

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Removals and Revisions of Cervical Total Disc Replacement Devices in a Consecutive Series of 1626 Patients Beginning With the First Case Experience in 2003
Authors: Blumenthal Scott L. , Griffin Cody , Courtois Emily C. , Guyer Richard D. , Zigler Jack E. , Shellock Jessica L. , Ohnmeiss Donna D.
Published: May 2024

Study Design.

Retrospective cohort study.

Objective.

The purpose of this study was to investigate the rate of cervical total disc replacement (TDR) device removal or revision.

Background.

Cervical TDR has gained acceptance as an alternative to anterior cervical discectomy and fusion in appropriately selected patients. There have been concerns over device safety, one measure of which is subsequent surgery related to device problems.

Patients and Methods.

A consecutive series of 1626 patients undergoing cervical TDR from 2003 to June 2021 were included, consisting of TDRs up to 3 levels and hybrids (TDR and fusion). TDR removal or revision surgeries and reasons for these surgeries, procedures performed, and duration from index procedure were recorded. Data were analyzed to determine the removal/revision rate and factors possibly related to these events.

Results.

There were 24 removals/revisions (1.48%) in the 1626 patients. Removal was performed in 23 cases (1.41%) and revision in 1 (0.06%). Among removal cases, anterior cervical discectomy and fusion was performed in 18 and TDR was replaced with another TDR in 5. Removals with fusion included 5 cases of osteolysis with/withoutCutibacterium acnes, 4 device displacement/migration, 4 posterior spinal pathology, and one for each of the following: metal allergy, approach-related complications, malpositioning, subsidence, and hypermobility. The revision involved TDR repositioning 3 days after index surgery. There were 66 patients for whom a minimum of 10-year follow-up was confirmed, and none had removal/revision surgery 10 or more years after index surgery. There was no relationship between the occurrence of removal/revision and age, sex, body mass index, or physician experience (learning curve). The removal/revision rate was significantly higher in FDA trialsversuspostapproval (4.1%vs. 1.3%,P< 0.05).

Conclusion.

In this large consecutive series of patients, 1.48% of cervical TDRs were removed/revised. The low rate of removals/revisions over a long period of time provides support for the devices’ safety.

Level of Evidence.

Level IV.
Negative Pressure Wound Therapy versus Conventional Dressing in Lower Limb Fractures: Systematic Review and Meta-analysis
Authors: Alves André S. , Martineau Jérôme , Scampa Matteo , Kalbermatten Daniel F. , Oranges Carlo M.
Published: May 2024

Gustilo 3 lower limb fractures represent a significant challenge because of high complication risk. Two management strategies are commonly used for wound coverage until final closure: negative pressure wound therapy (NPWT) and conventional wound dressing (CWD), also described as standard wound coverage without subatmospheric pressure. Understanding their relative effectiveness is essential to improve patient outcomes. The aim of this systematic review and meta-analysis was to compare the efficacy of NPWT and CWD in Gustilo 3 lower limb fracture management, with a focus on overall rates, superficial infection, and deep infection rates. A systematic review of medical research databases was conducted in accordance with PRISMA guidelines. Studies comparing NPWT with CWD for Gustilo 3 fractures were included. Data extraction and quality assessment were performed. Treatment with CWD was associated with significantly higher rates of overall infection [pooled risk ratio (RR): 0.33; 95% confidence interval (CI): 0.14–0.51] and pooled risk difference (RD: 0.27; 95% CI: 0.15–0.38), superficial infection (pooled RR: 0.35; 95% CI: 0.04–0.66), and deep infection (pooled RR: 0.20; 95% CI: 0.02–0.38) compared with NPWT treatment. Overall infection rate remained significantly higher in the CWD group after analyzing only open tibia fractures (pooled RR: 0.35; 95% CI: 0.21–0.48). Nonunion rate was significant higher in the CWD group (pooled RR: 0.30; 95% CI: 0.00–0.59). Flap failure rate was similar in both groups (pooled RR: 0.09; 95% CI: −0.05 to 0.23). NPWT appears to be a reasonable option for wound management in Gustilo 3 lower limb fractures in terms of infection rates.
Dextran-40 Reduces Partial Flap Failure: A Systematic Review and Meta-analysis for Antithrombotics after Free Flaps
Authors: Lin Yi-En , Chen Mei-Chun
Published: May 2024

Background:

Antithrombotic agents are used after free-flap surgery to prevent thrombus formation and improve flap outcomes. However, the reports vary. Therefore, this meta-analysis aimed to elucidate the need for antithrombotic agents in this context.

Methods:

We searched for studies that compared the outcomes of patients undergoing free-flap surgery with or without postoperative antithrombotic agents in the PubMed, Cochrane, and ClinicalTrials.gov databases. The primary outcome was total flap failure, with secondary outcomes including partial flap failure, pedicle thrombosis, and bleeding/hematoma. The relative risks (RRs) of outcomes with or without antithrombotic use were evaluated.

Results:

Fifteen studies (n = 6755 cases) were included. Antithrombotic agents did not reduce flap failure or pedicle thrombosis risks but increased bleeding and hematoma risks (RR, 1.535). Subgroup analyses by antiplatelet and anticoagulant use demonstrated results similar to those of antithrombotic use. The RR of bleeding/hematoma was 1.761 and 2.740 in the antiplatelet and anticoagulant groups, respectively. Postoperative dextran-40 administration reduced the risk of partial flap failure, with an RR of 0.535.

Conclusions:

Postoperative antithrombotic, antiplatelet, or anticoagulant use did not change the risk of total/partial flap failure or pedicle thrombosis but increased the risk of hematoma/bleeding. Postoperative use of dextran-40 reduced the risk of partial flap failure. Increased intraflap blood flow may decrease the risk of partial flap failure. However, dextran-40 may cause severe pulmonary distress. Further prospective studies are required to evaluate the effects of these agents on thrombus formation, intraflap blood flow, and partial flap failure risk.
Free Flaps in Patients with Advanced Arteriosclerosis of the Tibial Vessels: Mini Vein Graft to the Peroneal Artery
Authors: Haumer Alexander , Speck Nicole E. , Kurlander David E. , Wolff Thomas , Mujagic Edin , Lunger Alexander , Haug Martin D. , Schaefer Dirk J. , Ismail Tarek
Published: May 2024

Lower extremity reconstruction with free flaps in patients with only peroneal artery runoff remains a challenge. Here, we present a novel technique for reconstruction of medial defects in the distal leg using a medial approach to the peroneal artery and a short interposition vein graft anastomosed end to side to the peroneal artery. A retrospective, single-center study was performed including all patients who underwent lower extremity reconstruction with free flaps anastomosed to the peroneal artery using a mini vein graft from November 2020 to March 2022. The primary outcome measure was limb salvage. Secondary endpoints were flap survival and postoperative complications. Seven patients received lower extremity free flap reconstruction with a mini vein graft to the peroneal artery. Flap loss rate was 0%. Limb salvage was achieved in five patients (71%). At 6-month follow-up, all patients were ambulatory. One patient died 1 month after surgery due to heart failure. Mini vein graft to the peroneal artery allows reliable and safe free flap reconstruction of distal leg defects in patients with only peroneal artery runoff.
Characteristics of Patients with Clinical Signs and Symptoms of Carpal Tunnel Syndrome but Negative Diagnostic Testing
Authors: Latario Luke D. , Fowler John R.
Published: May 2024

Background:

Carpal tunnel syndrome (CTS) is a clinical diagnosis involving numerous confirmatory diagnostic tools, including patient questionnaires, ultrasound (US), and electrodiagnostic studies (EDX.) Patients may experience clinical symptoms of CTS with false negative diagnostic testing. The purpose of this study was to identify characteristics of patients with clinical symptoms of CTS with negative diagnostic testing.

Methods:

An existing database of 295 hands containing the six-item CTS-6, US of the median nerve, and EDX was queried. Patients with symptoms of carpal tunnel scoring 12.5 or higher on CTS-6 were sorted into those with all positive testing or negative testing.

Results:

In 60 patients, 103 hands had both positive US and EDX and a CTS-6 of 12.5 or higher. Twenty-nine hands in 25 patients had a CTS-6 of 12.5 or higher and both negative ultrasound and EDX. There was a significantly younger average age of 43 (P = 0.007) and lower average BMI of 28 (P < 0.0001) of patients in the negative diagnostic study group, compared with the average age of 53, and a body mass index (BMI) of 34 in the positive diagnostic study.

Conclusions:

In this series, patients with symptoms of carpal tunnel syndrome and negative diagnostic studies were on average younger and had a lower BMI. These patients may warrant more careful consideration of CTS clinical diagnosis and counseling regarding a higher risk of false-negative confirmatory testing. Further studies are needed to determine possible effects of age and BMI on electrodiagnostic studies and ultrasound testing in CTS.
A Qualitative Narrative Study of Rescue and Recovery Workers Responding to the Terrorist Bombing of Oklahoma City’s Murrah Building
Authors: Pollio E. Whitney , Wang Jennifer , Randle Edward , Pollio David E. , North Carol S.
Published: May 2024

Objective

Much of disaster mental health research uses quantitative methods, focusing on numerical prevalence, services, and outcomes.

Methods

Qualitative methods can provide more detailed, rich, and spontaneous insights into personal disaster experiences, yielding important insights beyond deductive methods. This large-scale qualitative narrative study examined experiences of 181 Oklahoma City bombing rescue/recovery workers.

Results

Thematic narrative content of the bombing experience arose from personal accounts of the bomb blast by rescue/recovery workers proceeding chronologically from initial awareness and deployment to harrowing onsite search and rescue/recovery missions to the aftermath with reflections on the bombing.

Conclusions

Beyond disaster recovery/rescue worker stories published in popular media, little other substantive published knowledge on this topic is available, and therefore this research study provides a wealth of new in-depth information that can provide guidance for policy and practice for disaster response.
Establishment and validation of an artificial intelligence web application for predicting postoperative in-hospital mortality in patients with hip fracture: a national cohort study of 52 707 cases
Authors: Lei Mingxing , Feng Taojin , Chen Ming , Shen Junmin , Liu Jiang , Chang Feifan , Chen Junyu , Sun Xinyu , Mao Zhi , Li Yi , Yin Pengbin , Tang Peifu , Zhang Licheng
Published: May 2024

Background:

In-hospital mortality following hip fractures is a significant concern, and accurate prediction of this outcome is crucial for appropriate clinical management. Nonetheless, there is a lack of effective prediction tools in clinical practice. By utilizing artificial intelligence (AI) and machine learning techniques, this study aims to develop a predictive model that can assist clinicians in identifying geriatric hip fracture patients at a higher risk of in-hospital mortality.

Methods:

A total of 52 707 geriatric hip fracture patients treated with surgery from 90 hospitals were included in this study. The primary outcome was postoperative in-hospital mortality. The patients were randomly divided into two groups, with a ratio of 7:3. The majority of patients, assigned to the training cohort, were used to develop the AI models. The remaining patients, assigned to the validation cohort, were used to validate the models. Various machine learning algorithms, including logistic regression (LR), decision tree (DT), naïve bayesian (NB), neural network (NN), eXGBoosting machine (eXGBM), and random forest (RF), were employed for model development. A comprehensive scoring system, incorporating 10 evaluation metrics, was developed to assess the prediction performance, with higher scores indicating superior predictive capability. Based on the best machine learning-based model, an AI application was developed on the Internet. In addition, a comparative testing of prediction performance between doctors and the AI application.

Findings:

The eXGBM model exhibited the best prediction performance, with an area under the curve (AUC) of 0.908 (95% CI: 0.881–0.932), as well as the highest accuracy (0.820), precision (0.817), specificity (0.814), and F1 score (0.822), and the lowest Brier score (0.120) and log loss (0.374). Additionally, the model showed favorable calibration, with a slope of 0.999 and an intercept of 0.028. According to the scoring system incorporating 10 evaluation metrics, the eXGBM model achieved the highest score (56), followed by the RF model (48) and NN model (41). The LR, DT, and NB models had total scores of 27, 30, and 13, respectively. The AI application has been deployed online at https://in-hospitaldeathinhipfracture-l9vhqo3l55fy8dkdvuskvu.streamlit.app/, based on the eXGBM model. The comparative testing revealed that the AI application’s predictive capabilities significantly outperformed those of the doctors in terms of AUC values (0.908 vs. 0.682, P<0.001).

Conclusions:

The eXGBM model demonstrates promising predictive performance in assessing the risk of postoperative in-hospital mortality among geriatric hip fracture patients. The developed AI model serves as a valuable tool to enhance clinical decision-making.
Recent advances in stem cell therapy: efficacy, ethics, safety concerns, and future directions focusing on neurodegenerative disorders – a review
Authors: Khandia Rekha , Gurjar Pankaj , Priyanka  , Romashchenko Victoria , Al-Hussain Sami A. , Zaki Magdi E.A.
Published: May 2024

Neurodegeneration refers to the gradual loss of neurons and extensive changes in glial cells like tau inclusions in astrocytes and oligodendrocytes, α-synuclein inclusions in oligodendrocytes and SOD1 aggregates in astrocytes along with deterioration in the motor, cognition, learning, and behavior. Common neurodegenerative disorders are Alzheimer’s disease (AD), Parkinson’s disease (PD), amyotrophic lateral sclerosis (ALS), Huntington’s disease (HD), spinocerebellar ataxia (SCA), and supranuclear palsy. There is a lack of effective treatment for neurodegenerative diseases, and scientists are putting their efforts into developing therapies against them. Stem cell therapy has emerged as a hope for neurodegenerative disorders since it is not only the damaged neurons that might be replaced, but other neuromodulators and neuroprotectors are secreted. Stem cell terminal differentiation before implantation ensures the implantation of correct cells and molecular markers like carbonic anhydrase II, CNPase (2′,3′-cyclic nucleotide 3′-phosphohydrolase), myelin basic protein (MBP), and myelin oligodendrocyte glycoprotein (MOG) elucidate the differentiation. Secretion of various growth factors like epidermal growth factor (EGF), keratinocyte growth factor (KGF), vascular endothelial growth factor-α (VEGF-α), transforming growth factor (TGF), and macrophage inflammatory protein (MIP) supports cell survival, cell proliferation, blood vessel formation, axon regeneration, and neuroglial functional connection formation at the site of degeneration. Adverse effects of stem cell therapy, like teratogenicity and differentiation in different cells other than the desired one under the influence of microenvironment, are a few key concerns. Post-transplantation improved synaptic plasticity, apoptosis inhibition, and reduction in tau-phosphorylation and amyloid beta (Aβ) production has been observed in Alzheimer’s patients. A large number of experimental, preclinical, and clinical studies have been conducted, and encouraging results have been obtained. The present review exhaustively discusses various kinds of stem cells, their usage in treating neurodegenerative disorders, limitations and challenges, and ethical issues related to stem cell therapy.
Difficult diagnosis: Disseminated gonorrheal infection manifesting as septic arthritis
Authors: Alleyne Dwayne , Mitchell Sheryl
Published: May 2024

Disseminated gonococcal infection is the causative agent of approximately 0.6%–1.2% of septic arthritis cases in North America and Europe. Typical presentations of this disorder include tenosynovitis, dermatitis, polyarthralgia, or oligoarticular purulent arthritis affecting the distal joints. Diagnosis is contingent on clinical presentation, with urine nucleic acid amplification testing as the preferred diagnostic modality. Synovial fluid cultures, along with imaging, can confirm diagnosis. The recommended treatment is a third-generation cephalosporin, such as intravenous ceftriaxone for 7–14 days and a dose of oral azithromycin.
Heightism, growth hormone treatment, and social functioning: a holistic approach to a persistent clinical challenge
Authors: Kamoun Camilia , Largent Emily A. , Grimberg Adda
Published: May 2024

Purpose of review

Use of recombinant human growth hormone (rhGH) treatment to increase height in children with non-growth hormone deficient short stature is becoming more common. Yet, the evidence to support the notion that augmenting height directly leads to increased well being, specifically psychosocial well being, is inconsistent, with high-quality evidence lacking.

Recent findings

Review of recent studies demonstrates that the association between height augmentation and psychosocial well being is complex. The direct contribution of height to well being may be less than the current model of clinical care of short stature assumes. Rather, the new studies provide evidence to support a role for psychosocial factors, including height-related beliefs, social support, and coping skills, in promoting psychosocial well being, specifically quality of life and self-esteem.

Clinical care of short stature would benefit from incorporating a holistic model of care that considers psychosocial interventions in addition to, or instead of, rhGH treatment.
Prognosis of Second Primary Malignancies in Pediatric Acute Lymphoblastic Leukemia Survivors: A Multicenter Study by the Turkish Pediatric Hematology Society
Authors: Toret Ersin , Aytac Selin , Guzelkucuk Zeliha , Celkan Tiraje , Genc Dildar Bahar , Sezgin-Evim Melike , Cakmakli Hasan Fatih , Bahadir Aysenur , Karapinar Tuba Hilkay , Oren Hale , Pekpak Esra , Karakurt Neslihan , Korkmaz-Unlu Hilal Eda , Yarali Nese , Gunes Adalet Meral
Published: May 2024

The improved survival rates of childhood cancers raise the long-term risk of second primary malignancy (SPM) in childhood and adolescent cancer survivors. The intensity of the treatment protocol used, the use of some groups of chemotherapeutics, and radiotherapy were found to be risk factors for the development of second primary malignancies (SPMs). Forty-one patients who developed acute myelocytic leukemia or any solid organ cancer within 25 years of follow-up, after completion of pediatric acute lymphoblastic leukemia (ALL) treatment, were included in the study. The mean duration of initial ALL diagnosis to SPM was 9.3 ± 6.1 years. The 3 most common SPMs were acute myelocytic leukemia, glial tumors, and thyroid cancer. Thirteen (81%) of 16 patients exposed to cranial irradiation had cancer related to the radiation field. In total 13/41 (32%) patients died, and the 5-year overall survival rate was 70 ± 8%. Patients older than 5 years old at ALL diagnosis had significantly worse overall survival than cases younger than 5 years old. In conclusion, children and adolescents who survive ALL have an increased risk of developing SPM compared with healthy populations, and physicians following these patients should screen for SPMs at regular intervals.