bluuebunny/crossref_metadata_2025 huggingface dataset:
Verlaufsdiagnostik des Knochenstoffwechsels unter verschiedenen
Therapieformen
Authors: Obermayer-Pietsch Barbara , Fößl Ines
Published: October 2023

Osteoporose ist per se eine chronische Erkrankung, daher sind neben
nichtpharmakologischen Interventionen (z. B. hinsichtlich
Ernährung und Bewegung) vor allem medikamentöse Behandlungen
durch Antiresorptiva, osteoanabole oder dual wirksame Medikamente im
individuellen Kontext für viele Jahre zu planen. Für ein
Langzeit-Monitoring dieser Therapien kommen bildgebende Verfahren wie die
Knochendichtemessung, Risiko-Algorithmen, aber auch die Messung von
Knochenstoffwechselmarkern in Betracht. Während Knochendichtemessungen
aufgrund der nur langsamen Umstellung der Knochenstruktur und -dichte in
mehrjährigen Abständen sinnvoll sind, ermöglichen
Labormessungen als Surrogatmarker eine Momentaufnahme des individuellen
Knochenumsatzes und die Beurteilung der Medikamentenwirkung oder eines Risikos
bei Therapiepause in wesentlich kürzeren Abständen und mit wenig
Aufwand. Im Folgenden werden Labormarker des Knochenstoffwechsels in Hinblick
auf Langzeittherapie, Kombinations- oder Sequenztherapie und das Management von
Therapiepausen hin beleuchtet, um individuelle Behandlungsstrategien für
Osteoporose-Betroffene planen und kontrollieren zu können. Dabei wird
auch auf spezielle Personengruppen bzw. sekundäre Formen von Osteoporose
eingegangen und auf neue Entwicklungen für die Zukunft des
Osteoporose-Monitorings hingewiesen.
Review of the Total Synthesis of the Aromatic Abietane Diterpenoid Ferruginol
Authors: Huang Jian , Chen Yang , Li Mengran , Chen Peng , Liu Haoqi
Published: October 2023

The biological properties and synthesis of ferruginol as a classical abietane-type diterpenoid with an aromatic C ring are reviewed. A strategy overview from 1954 to 2023 toward the total synthesis of ferruginol may provide some references for the future design and synthesis of new diterpenoids natural products.

1 Introduction

2 Biological Activity of Ferruginol

3 Strategies toward the Total Synthesis of Ferruginol

3.1 Bogert–Cook Synthesis

3.2 Robinson Annulation

3.3 Domino Synthesis

3.4 Intramolecular Friedel–Crafts Alkylation

3.5 Oxidative Free-Radical Cyclization

3.6 Polyene Cyclization

4 Conclusion and Perspectives
Bismuth-Centered Radical Species: Access and Applications in ­Organic Synthesis
Authors: Lichtenberg Crispin , Martínez Sebastián
Published: October 2023

Recent advances in the isolation of tamed bismuth radicals and the selective in situ generation of highly reactive bismuth radicals have set the stage for the application of these compounds in organic and organometallic synthesis and catalysis. Here, we provide a summary of the methodological approaches in the field. Important strategies for accessing bismuth radical species are presented and key examples of their applications in organic synthesis are outlined, highlighting how this class of compounds has emerged as new set of valuable tools for synthetic practitioners.

1 Introduction

2 Generation of Bismuth Radical Species by Homolysis

2.1 Temperature-Induced Homolysis

2.2 Light-Induced Homolysis

2.3 Light-/Temperature-Induced Bi–C Homolysis of Polar Oxidative Addition Complexes

3 Applications of Bismuth-Centered Radical Species in Organic Synthesis

3.1 Bismuth-Catalyzed Cycloisomerization of Iodo Olefins

3.2 Controlled Radical Polymerization Reactions

3.3 Bismuth-Promoted Pn–Pn and C–S Coupling

3.4 Bismuth-Catalyzed Dehydrocoupling of Silanes with TEMPO

3.5 Bismuth-Catalyzed C–N Coupling with Redox-Active Electrophiles

3.6 Bismuth-Catalyzed Giese-Type Coupling Reactions

3.7 Oxidative Addition of Aryl Electrophiles to Photoactive Bismuthinidenes

4 Conclusions
Emergency Use Authorization for COVID-19 Vaccines and Practical Considerations for the Future
Authors: Monika S. , R. Kruthika M. , P. Gowrav M. , V. Balamuralidhara
Published: October 2023

An Emergency use authorization (EUA) is a permission granted by the Food and Drug Administration (FDA) under sections of the Federal Food, Drug, and Cosmetic Act as revised and upgraded by numerous Federal legislations, which includes the Pandemic and All-Hazards Preparedness Reauthorization Act of 2013, accumulated by 21 U.S.C. 360bbb-3, to enable the utilization of medicines before approving. Ensuing regulative specialists expanded the scope of testing to which the medication or treatment has been submitted, as well as the class of drugs qualified for thought. The scope and relevance of EUAs are further governed by actual pioneer, which may change the significance of situations classified as general prosperity crises and within which the FDA might release EUAs Considering the COVID-19 flare-up, the HHS (Health and Human Services) Secretary articulated a general prosperity emergency on February 4, 2020, for the brand-new SARS-CoV-2 disorder these consequences in illness COVID-19. In response to the COVID-19 epidemic, the FDA granted EUAs in 2020 for remdesivir, enhanced blood, Fresenius Propoven 2 percent emulsion (propofol), and bamlanivimab. The FDA cancelled the Emergency use authorization (EUA) that drew in the exploratory monoclonal adjusting proficient medicine Bamlanivimab for use without assistance in the treatment of difficult-to-organize COVID-19 in grown-ups and positive pediatric victims on April 16, 2021.
Evaluation of the Results of Septum Extension Batten Graft in Patients Referred for Septorhinoplasty
Authors: Hosnani Hamidreza , Bastaninez Shahin , Golchin Amirbahador , Givzadeh Hamed
Published: October 2023

Introduction Correction of caudal septal deviations has always been a challenging subject in septorhinoplasty. The septum batten extension graft (SBEG) is a new graft that has potential properties in rhinoplasty. However, few reports have evaluated the surgical outcomes of this technique.

Objective The purpose of this study was to evaluate the effectiveness of SBEG in correcting caudal septal deviation.

Methods This cross-sectional study was conducted on patients with caudal septal deviation undergoing septorhinoplasty using SBEG at 2 different hospitals in 2019. We then retrospectively reviewed medical records and photographs of 50 patients at the preoperative period, as well as at 1-month, and 12-month postoperatively. Gross changes in nasolabial angle, columellar show, nasal tip projection, and dorsal nasal deviation were evaluated by a photographic analysis method, and nasal obstruction was assessed by patient satisfaction with breathing.

Results There was a significant difference between the mean nasolabial angle and columellar show at 1 and 12-months postoperatively, compared with the previous values (p < 0.0001). The nasolabial angles were in a favorable position with an increase of 12 to 15 degrees compared with the preoperative state. The columellar show also improved by an average of 1.2 mm and was in good condition. The postoperative dorsal nasal deviation was significantly reduced, and projection was significantly increased (3.521 ± 0.087 mm vs. 0.719 ± 0.028; p < 0.0001; p < 0.001). Moreover, this method had a significant favorable effect on nasal obstruction (p = 0.049).

Conclusion Our results showed that septorhinoplasty using SBEG is useful for correcting caudal septal deviation, with favorable surgical outcomes, and it has responded well to all five aforementioned criteria.
Constant current pulsed power supply for long pulse arc discharge positive hydrogen ion source
Authors: Motwani Kapil , Ghodke Dharmraj V. , Amban Ajith , Kochunarayanan Murali Krishnan , Ansari M. S. , Prasad Vijendra
Published: October 2023

The simplest way to produce high density hydrogen plasmas is to form an arc between the arcing electrode and the plasma chamber (cathode). For arc-based hydrogen plasma generation, a pulsed power supply that delivers 2 ms-long constant current pulse has been developed. This pulsed power supply employs a high frequency buck converter topology with a nonlinear filter inductor. This paper describes the development and testing of a constant current pulsed power supply that operates at 50 A and 550 V with a pulse width of 2 ms and a pulse repetition rate of 2 Hz. By changing the arc current, the arc impedance and the positive hydrogen ion current were also measured. The extraction of positive hydrogen ions was carried out using a three-electrode extraction design, which results in a current of 80 mA of positive hydrogen ions at an energy of 50 keV.
Generative modeling of time-dependent densities via optimal transport and projection pursuit
Authors: Botvinick-Greenhouse Jonah , Yang Yunan , Maulik Romit
Published: October 2023

Motivated by the computational difficulties incurred by popular deep learning algorithms for the generative modeling of temporal densities, we propose a cheap alternative that requires minimal hyperparameter tuning and scales favorably to high-dimensional problems. In particular, we use a projection-based optimal transport solver [Meng et al.,Advances in Neural Information Processing Systems (Curran Associates, 2019), Vol. 32] to join successive samples and, subsequently, use transport splines (Chewi et al., 2020) to interpolate the evolving density. When the sampling frequency is sufficiently high, the optimal maps are close to the identity and are, thus, computationally efficient to compute. Moreover, the training process is highly parallelizable as all optimal maps are independent and can, thus, be learned simultaneously. Finally, the approach is based solely on numerical linear algebra rather than minimizing a nonconvex objective function, allowing us to easily analyze and control the algorithm. We present several numerical experiments on both synthetic and real-world datasets to demonstrate the efficiency of our method. In particular, these experiments show that the proposed approach is highly competitive compared with state-of-the-art normalizing flows conditioned on time across a wide range of dimensionalities.
Vertical electron cyclotron emission diagnostic on the tokamak à configuration variable
Authors: Tema Biwole A. , Porte L. , Coda S. , Fasoli A. ,   TCV Team
Published: October 2023

In this paper, a diagnostic for the measurement of the electron cyclotron emission (ECE) from non-thermal electrons in magnetically confined fusion plasmas is presented. The diagnostic employs a vertical viewing line of sight that allows us to directly infer the energy of the emitting electrons. Previous incarnations of this diagnostic on other machines have been limited by refraction, which can cause stray radiation to enter the line of sight, polluting the signal. By tuning the toroidal magnetic field on the Tokamak à Configuration Variable, TCV, and by carefully selecting the range of frequencies that are used to measure the ECE spectrum, refraction can be mitigated and background radiation power reduced to below the noise power of the instrumentation. A novel technique for calibrating the diagnostic based on plasma measurements and modeling has been developed. The paper will describe the Vertical ECE (V-ECE) diagnostic on TCV, the calibration method, and the first results from the measurements.
Exploring the nature of high-order cavity polaritons under the coupling–decoupling transition
Authors: Godsi M. , Golombek A. , Balasubrahmaniyam M. , Schwartz T.
Published: October 2023

Recently, we predicted theoretically that in cavities that support several longitudinal modes, strong coupling can occur in very different manners, depending on the system parameters. Distinct longitudinal cavity modes are either entangled with each other via the material or independently coupled to the exciton mode. Here, we experimentally demonstrate the transition between those two regimes as the cavity thickness is gradually increased while maintaining fixed coupling strength. We study the properties of the system using reflection and emission spectroscopy and show that even though the coupling strength is constant, different behavior in the spectral response is observed along the coupling–decoupling transition. In addition, we find that in such multimode cavities, pronounced upper polariton emission is observed, in contrast to the usual case of a single-mode cavity. Furthermore, we address the ultrafast dynamics of the multimode cavities by pump–probe spectroscopic measurements and observe that the transient spectra significantly change through the transition.
Quantum bath augmented stochastic nonequilibrium atomistic simulations for molecular heat conduction
Authors: Chen Renai , Dinpajooh Mohammadhasan , Nitzan Abraham
Published: October 2023

Classical molecular dynamics (MD) has been shown to be effective in simulating heat conduction in certain molecular junctions since it inherently takes into account some essential methodological components which are lacking in the quantum Landauer-type transport model, such as many-body full force-field interactions, anharmonicity effects and nonlinear responses for large temperature biases. However, the classical MD reaches its limit in the environments where the quantum effects are significant (e.g. with low-temperatures substrates, presence of extremely high frequency molecular modes). Here, we present an atomistic simulation methodology for molecular heat conduction that incorporates the quantum Bose–Einstein statistics into an “effective temperature” in the form of a modified Langevin equation. We show that the results from such a quasi-classical effective temperature MD method deviates drastically when the baths temperature approaches zero from classical MD simulations and the results converge to the classical ones when the bath approaches the high-temperature limit, which makes the method suitable for full temperature range. In addition, we show that our quasi-classical thermal transport method can be used to model the conducting substrate layout and molecular composition (e.g. anharmonicities, high-frequency modes). Anharmonic models are explicitly simulated via the Morse potential and compared to pure harmonic interactions to show the effects of anharmonicities under quantum colored bath setups. Finally, the chain length dependence of heat conduction is examined for one-dimensional polymer chains placed in between quantum augmented baths.
Adopting a personalized approach to blood monitoring in patients with psoriasis prescribed biologic therapy: a retrospective single-centre review of real-world data
Authors: Hussain Amaani B , Singleton Grace , Ball Stephanie , Weatherhead Sophie C , Reynolds Nick J , Hampton Philip J
Published: October 2023

Six-monthly blood monitoring is frequently carried out for patients prescribed biological therapy for psoriasis in the UK. Through the analysis of blood results from a cohort of such patients, we demonstrated that a more targeted and coordinated approach to blood monitoring could be implemented, which would subsequently reduce carbon emissions, associated healthcare costs and the impact on patients’ employment.
Neurological outcomes in minimally invasive mitral valve surgery: risk factors analysis from the Mini-Mitral International Registry
Authors: Cresce Giovanni Domenico , Berretta Paolo , Fiore Antonio , Wilbring Manuel , Gerdisch Marc , Pitsis Antonios , Rinaldi Mauro , Bonaros Nikolaos , Kempfert Jorg , Yan Tristan , Van Praet Frank , Nguyen Hoang Dinh , Savini Carlo , Lamelas Joseph , Nguyen Tom C , Stefano Pierluigi , Färber Gloria , Salvador Loris , Di Eusanio Marco
Published: October 2023

OBJECTIVES

The aim of this study was to examine the incidence and predictors of stroke after minimally invasive mitral valve surgery (mini-MVS) and to assess the role of preoperative CT scan on surgical management and neurological outcomes in the large cohort of Mini-Mitral International Registry.

METHODS

Clinical, operative and in-hospital outcomes in patients undergoing mini-MVS between 2015 and 2021 were collected. Univariable and multivariable analyses were used to identify predictors of stroke. Finally, the impact of preoperative CT scan on surgical management and neurological outcomes was assessed.

RESULTS

Data from 7343 patients were collected. The incidence of stroke was 1.3% (n = 95/7343). Stroke was associated with higher in-hospital mortality (11.6% vs 1.5%, P < 0.001) and longer intubation time, ICU and hospital stay (median 26 vs 7 h, 120 vs 24 h and 14 vs 8 days, respectively). On multivariable analysis, age (odds ratio 1.039, 95% confidence interval 1.019–1.060, P < 0.001) and mitral valve replacement (odds ratio 2.167, 95% confidence interval 1.401–3.354, P < 0.001) emerged as independent predictors of stroke. Preoperative CT scan was made in 31.1% of cases. These patients had a higher risk profile and EuroSCORE II (median 1.58 vs 1.1, P < 0.001). CT scan influenced the choice of cannulation site, being ascending aorta (18.5% vs 0.5%, P < 0.001) more frequent in the CT group and femoral artery more frequent in the no CT group (97.8% vs 79.7%, P < 0.001). No difference was found in the incidence of postoperative stroke (CT group 1.5, no CT group 1.4%, P = 0.7).

CONCLUSIONS

Mini-MVS is associated with a low incidence of stroke, but when it occurs it has an ominous impact on mortality. Preoperative CT scan affected surgical cannulation strategy but did not led to improved neurological outcomes.
Optimal management of cardiac surgery patients using direct oral anticoagulants: recommendations for clinical practice
Authors: Heuts Samuel , Ceulemans Angelique , Kuiper Gerhardus J A J M , Schreiber Jan U , van Varik Bernard J , Olie Renske H , Ten Cate Hugo , Maessen Jos G , Milojevic Milan , Maesen Bart
Published: October 2023

OBJECTIVES

Literature is scarce on the management of patients using direct oral anticoagulants (DOACs) undergoing elective, urgent and emergency surgery. Therefore, we summarize the current evidence and provide literature-based recommendations for the management of patients on DOACs in the perioperative phase.

METHODS

A general literature review was conducted on the pharmacology of DOACs and for recommendations on the management of cardiac surgical patients on DOACs. Additionally, we performed a systematic review for studies on the use of direct DOAC reversal agents in the emergency cardiac surgical setting.

RESULTS

When surgery is elective, the DOAC cessation strategy is relatively straightforward and should be adapted to the renal function. The same approach applies to urgent cases, but additional DOAC activity drug level monitoring tests may be useful. In emergency cases, idarucizumab can be safely administered to patients on dabigatran in any of the perioperative phases. However, andexanet alfa, which is not registered for perioperative use, should not be administered in the preoperative phase to reverse the effect of factor Xa inhibitors, as it may induce temporary heparin resistance. Finally, the administration of (activated) prothrombin complex concentrate may be considered in all patients on DOACs, and such concentrates are generally readily available.

CONCLUSIONS

DOACs offer several advantages over vitamin K antagonists, but care must be taken in patients undergoing cardiac surgery. Although elective and urgent cases can be managed relatively straightforwardly, the management of emergency cases requires particular attention.
1. The Philosophical Foundations of Human Rights
Authors: Langlois Anthony J.
Published: October 2023

This chapter covers the philosophical foundations of human rights. It highlights the importance of human rights history to the understanding of debates and problems when theorizing about human rights. The human rights language has been globally recognized as a response to injustice. However, philosophers from the spectrum of conservatism, liberalism, utilitarianism, and socialism attacked the idea of natural rights, while the radicals criticized the rights of man for being the rights of bourgeois man. The Universal Declaration of Human Rights is the defining text of the human rights movement, which is correlated to history and philosophy. The chapter also looks into the philosophical justification and universalism of modern human rights. It explores the concepts of cultural relativism and human rights imperialism. Additionally, the types of human rights revolve around liberty and welfare rights.
4. Feminist Approaches to Human Rights1
Authors: Parisi Laura
Published: October 2023

This chapter tackles feminist approaches to human rights. It starts with how contemporary feminism criticized liberalism on the conception of formal legal equality in international human rights laws being derived from the goal of dismantling hierarchies. Contemporary views on women's rights revolve around the issues of globalization, democracy, culture, sexual orientation, and gender identity. The chapter then expounds on the evolution of the international women's human rights discourse and frameworks. It also discusses the establishment of the Convention on the Elimination of Discrimination Against Women (CEDAW), which addressed all forms of discrimination against women by the principle of structural indivisibility.
7. Human Rights Claiming as a Performative Practice
Authors: Zivi Karen
Published: October 2023

This chapter analyses the politics of human rights from a performative perspective. It starts with identifying rights claiming as one of the most common ways to highlight and demand redress for injustice across the world. The practice and promise of human rights have a clear gap as human rights violations remain a global issue despite the years of political activism, international human rights standards, and human rights theories. Indeed, several scholars are sceptical about the power of human rights in bringing an end to injustice and inequality. The chapter then covers the ideology of performativity correlating to a theory of language, gender, and politics. It explains that rights claiming may employ non-traditional forms of political engagement and depend on the state to secure the desired change.
10. Transitional Justice
Authors: Quinn Joanna R.
Published: October 2023

This chapter covers transitional justice, which is correlated with the principle of universality, human rights violation, and impunity. It explores the social implications of brutal conflict. Retributive justice, restorative justice, and reparative justice have been enumerated as the three approaches to transitional justice that differ from their goals and mechanisms such as trials, truth commissions, and apologies. The three paradigms of transitional justice represent perspectives on how a society can be rebuilt. The chapter then references the case study regarding the civil conflict in Uganda to highlight the difficulty of resolving the social implications of prolonged violent conflicts by putting the aforementioned paradigms into practice.
12. Political Democracy and State Repression
Authors: Davenport Christian
Published: October 2023

This chapter looks at the correlation between political democracy and state repression. It notes how political democracy and economic development diminish human rights violations. Democracy mitigates repressions due to policymakers being aware of the repercussions of hurting citizens. Moreover, different aspects of democracy matter with regard to the influence on levels of repressions. The chapter then discusses the case studies on democracy and repression amidst the history of the Jim Crow laws and the Trump administration in the United States. It also considers possible future research into the democracy-repression nexus, which highlights the importance to look beyond state authorities when studying repression.
How the notion of epistemic injustice can mitigate polarization in a conversation about cultural, ethnic, and racial categorizations
Authors: Åberg Ingvill Bjørnstad
Published: October 2023

It is a common contention that education done uncritically and unreflectively may serve to sustain and justify the status quo, in terms of mechanisms of cultural or racial privileging and marginalization. This article explores an argument made from within anti-oppressive education theory and advocated by theorist Kevin Kumashiro, namely that transformative education must entail altering harmful citational practices. I see two shortcomings in relation to this argument: first, its focus on discursive practice entails a prerequisite of high discursive literacy. Second, it may lead to a failure to give credit to people’s intentions, risking a conflation of honest mistakes and wilful ignorance, and depriving us of theoretical nuance. While a well-argued and important call, I argue in this article that both shortcomings lead to the risk of a polarized conversation. Focusing on cultural, ethnic, and racial categorization, and using social studies as an illustration, it is suggested that applying notions from the theoretical concept of epistemic injustice may open up a space for granting nuanced credit to people’s intentions, thereby mitigating the risk of polarization. Rather than viewing attention to outcome and attention to intention as oppositional to one another, it is argued that both theoretical perspectives may benefit from the insights of the other. By applying needed context-specificity and nuance to categorizations of dominance and marginalization in individual discursive exchange, this can be done without granting priority to the experience of dominantly situated knowers.
Mutation of the gene encoding the PHD-type transcription factor SAB23 confers submergence tolerance in rice
Authors: Duan Ao , Liu Rui , Liu Changchang , Wu Fei , Su Hang , Zhou Shuangzhen , Huang Min , Tian Xiaohai , Jia Haitao , Liu Ya , Li Manfei , Du Hewei
Published: October 2023

Submergence is a major constraint on rice production in South and Southeast Asia. In this study, we determined that a gene of the Sub1A-binding protein family, SAB23, encodes a plant homeodomain (PHD)-type transcription factor that has a novel function of negatively regulating submergence tolerance in rice. The T-DNA insertion mutant sab23 displayed reduced plant height, delayed seed maturation, and lower percentage seed set. Importantly, this mutant also exhibited enhanced submergence tolerance. In addition, CRISPR/Cas9 knock out of SAB23 resulted in a significant reduction in the content of the gibberellin GA4 and a dramatic increase in the content of GA1 in the plants. SAB23 binds to the promoter of CYTOCHROME P450 714B2 (CYP714B2), which encodes a GA13-oxidase that catalyses the conversion of GA53 to GA19. Disruption of SAB23 function led to increased CYP714B2 transcription, and overexpression of CYP714B2 produced phenotypes similar to those of the SAB23-knockout plants. Taken together, our results reveal that SAB23 negatively regulates rice submergence tolerance by modulating CYP714B2 expression, which has significant potential for use in future breeding.
Identification of Chemicals That Abrogate Folate-Dependent Inhibition of Starch Accumulation in Non-Photosynthetic Plastids of Arabidopsis
Authors: Kawada Yoshihiro , Hayashi Eriko , Katsuragi Yuya , Imamura-Jinda Aya , Hirokawa Takatsugu , Mizukami Tamio , Hayashi Makoto
Published: October 2023

Folate, also known as vitamin B9, is an essential cofactor for a variety of enzymes and plays a crucial role in many biological processes. We previously reported that plastidial folate prevents starch biosynthesis triggered by the influx of sugar into non-starch-accumulating plastids, such as etioplasts, and chloroplasts under darkness; hence the loss of plastidial folate induces the accumulation of starch in plastids. To understand the molecular mechanism underlying this phenomenon, we screened our in-house chemical library and searched their derivatives to identify chemicals capable of inducing starch accumulation in etioplasts. The results revealed four chemicals, compounds #120 and #375 and their derivatives, compounds #120d and #375d, respectively. The derivative compounds induced starch accumulation in etioplasts and suppressed hypocotyl elongation in dark-grown Arabidopsis seedlings. They also inhibited the post-germinative growth of seedlings under illumination. All four chemicals contained the sulfonamide group as a consensus structure. The sulfonamide group is also found in sulfa drugs, which exhibit antifolate activity, and in sulfonylurea herbicides. Further analyses revealed that compound #375d induces starch accumulation by inhibiting folate biosynthesis. By contrast, compound #120d neither inhibited folate biosynthesis nor exhibited the herbicide activity. Protein and metabolite analyses suggest that compound #120d abrogates folate-dependent inhibition of starch accumulation in etioplasts by enhancing starch biosynthesis.
Why Has the Franco-American Security Relationship Been so Semi—Hostile for so Long?
Authors: Williams Andrew J
Published: October 2023

Many people assume that Franco-American relations since 1776 have been far more harmonious than those of the United States’ relationship with Great Britain. After all, France fought on the side of the new aspiring republic in the American War of Independence against a colonial power. Although still a country ruled by a king, France itself became a republic shortly after the American Declaration of Independence was ratified. But in fact, France and the United States (and the colonies that preceded them) have often had poor relations. In his book Sister Republics: Security Relations between America and France, David Haglund asks why security relations between France and the United States been so fractious since the beginning of the American republic, and even well before it. He debunks the generally accepted mythology and its attendant symbology of two sister republics. The French-built and donated Statue of Liberty in New York Harbor and the statue of General Lafayette on the Seine opposite the Quai d’Orsay in Paris are misleading. In truth any special relationship between France and the United States has been special on the whole in its lack of mutual liking, even respect. Haglund traces this difficult, even suboptimal, relationship over three centuries and shows how the weight of history still continues to upset Franco-American relations regularly.
Codesigning Policy-Based Solutions to Discrimination and Harassment in Academic Medicine: An Inclusive Approach
Authors: Sukhera Javeed , Goez Helly , Brown Allison , Haddara Wael , Razack Saleem
Published: October 2023

Academic medicine institutions have historically employed policies as a means to tackle various types of discrimination and harassment within educational and professional settings, thereby affirming their dedication to promoting diversity, equity, and inclusion. However, the implementation and effectiveness of policies are constrained by limitations, including a lack of awareness and barriers to reporting. Due to concerns about accountability and transparency, many groups and individuals experiencing discrimination have lost trust in policy-based solutions to address equity in academic medicine. To address such challenges, the authors offer an evidence-informed policy framework with actionable recommendations. First, policy should be cowritten through meaningful and participatory engagement. Second, organizations should publicly report on metrics of policy effectiveness. Third, to ensure accountability, external organizations or adjudicators should be involved in oversight of policy-based processes. Fourth, leadership commitment is essential for success. Overall, policy can be an effective mechanism to address discrimination and harassment; however, a more inclusive approach is needed.
Bias Reporting in the Clinical Learning Environment: A National Survey of Internal Medicine Clerkship Directors
Authors: Henschen Bruce L. , Pascoe Jennifer , Kisielewski Michael , Duca Nicholas S. , Lang Valerie J. , Levine Diane , Jasti Harish , Blatt Amy
Published: October 2023

Purpose

Bias exists in the internal medicine (IM) clinical learning environment; however, it is unclear how often bias is identified by clerkship directors (CDs), how bias is addressed, and whether best practices exist for identifying or mitigating bias. This study investigated how IM CDs receive and respond to bias reports in the clinical learning environment.

Method

In May 2021, the Clerkship Directors in Internal Medicine (CDIM) created an 18-question survey assessing the frequency of bias reports, macroaggressions and microaggressions, and report outcomes. Of the 152 U.S. medical schools that met study accreditation criteria, the final survey population included 137 CDs (90%) whose medical schools held valid CDIM membership.

Results

Of the 137 surveys sent, 100 were returned (survey response rate, 73%). Respondents reported a median of 3 bias events (interquartile range, 1–4; range, 0–50) on the IM clerkship in the past year. Among 76 respondents who reported 1 or more event, microaggressions represented 43 of the 75 total events (57%). No mechanism emerged as the most commonly used method for reporting bias. Race/ethnicity (48 of 75 [64%]) and gender (41 of 75 [55%]) were cited most as the basis for bias reports, whereas the most common sources of bias were student interactions with attending physicians (51 of 73 [70%]) and residents (40 of 73 [55%]). Of the 75 respondents, 53 (71%) described the frequency of bias event reports as having increased or remained unchanged during the past year. Only 48 CDs (49%) responded that they were “always” aware of the outcome of bias reports.

Conclusions

Bias reports remain heterogeneous, are likely underreported, and lack best practice responses. There is a need to systematically capture bias events to work toward a just culture that fosters accountability and to identify bias events through more robust reporting.
Practical, Privacy and Ethical, and Philosophical Considerations for Using Big Data in Medical Education
Authors: Amiel Jonathan M.
Published: October 2023

In this issue of Academic Medicine, Thelen and colleagues present a thoughtful perspective on the emerging opportunity to use longitudinal educational data to improve graduate medical education and optimize the education of individual residents, and call for the accelerated development of large interinstitutional data sets for this purpose. Such applications of big data to medical education hold great promise in terms of informing the teaching of individuals, enhancing transitions between phases of training and between institutions, and permitting better longitudinal education research. At the same time, there is a tension between whose data they are and consequently how they ought to be used. This commentary proposes some practical, privacy and ethical, and philosophical considerations that need to be explored as early efforts to aggregate data across the medical education continuum mature and new efforts are undertaken.
Causal Associations of Genetically Determined Tinnitus With Neuroimaging Traits: Evidence From a Mendelian Randomization Study
Authors: Sun Jing , Wang Xinghao , Li Jia , Zhang Tingting , Chen Qian , Liu Wenjuan , Cai Linkun , Zhao Pengfei , Yang Zhenghan , Pan Junhua , Wang Zhenchang , Lv Han
Published: October 2023

Objectives:

Potential reverse causality and unmeasured confounding factors are common biases in most neuroimaging studies on tinnitus and central correlates. The causal association of tinnitus with neuroimaging features also remains unclear. This study aimed to investigate the causal relationship of tinnitus with neuroplastic alterations using Mendelian randomization.

Design:

Summary-level data from a genome-wide association study of tinnitus were derived from UK Biobank (n = 117,882). The genome-wide association study summary statistics for 4 global-brain tissue and 14 sub-brain gray matter volumetric traits were also obtained (n = up to 33,224). A bidirectional Mendelian randomization analysis was conducted to explore the causal relationship between tinnitus and neuroanatomical features at global-brain and sub-brain levels.

Results:

Genetic susceptibility to tinnitus was causally associated with increased white matter volume (odds ratio [OR] = 2.361, 95% confidence interval [CI], 1.033 to 5.393) and total brain volume (OR = 2.391, 95% CI, 1.047 to 5.463) but inversely associated with cerebrospinal fluid volume (OR = 0.362, 95% CI, 0.158 to 0.826). A smaller gray matter volume in the left Heschl’s gyrus and right insular cortex and larger gray matter volume in the posterior division of the left parahippocampal gyrus may lead to an increased risk for tinnitus (OR = 0.978, 95% CI, 0.961 to 0.996; OR = 0.987, 95% CI, 0.976 to 0.998; and OR = 1.015, 95% CI, 1.001 to 1.028, respectively).

Conclusions:

Genetic susceptibility to tinnitus was causally associated with increased white matter volume and total brain volume. Volume alteration in several cortical regions may indicate a higher tinnitus risk, and further research is recommended for causality inference at the level of sub-brain regions. Our findings provide genetic evidence for elucidating the underlying pathophysiological mechanisms of tinnitus-related neuroanatomical abnormalities.
Nylon cable ties–assisted delay primary closure of fasciotomy wound in patients of forearm compartment syndrome
Authors: Hsieh Chiung Hui , Ho Chun Yee , Roan Tyng Luen , Chang Che Wei
Published: October 2023

Background

Forearm compartment syndrome is a rare condition that requires forearm fasciotomy to release compartment pressure. In most cases, there is little to no skin damage initially, but after the fasciotomy, the skin flap may gradually retract. Traditional methods for reconstructing fasciotomy wounds, such as skin grafts or flaps, often result in an unpleasant appearance and require donor sites.

Materials and Methods

We present a method using nylon cable ties for delayed primary closure of forearm fasciotomy wounds. We retrospectively reviewed patients who underwent fasciotomy of forearms for compartment syndrome and nylon cable ties–assisted closure in a medical center from January 2017 to December 2022.

Results

Of the 7 eligible patients, 4 suffered from compartment syndrome of the forearm because of iatrogenic vascular rupture after procedures, whereas the other reasons included open-type fracture and fasciitis. For all the patients, nylon cable ties were applied for delayed primary wound closure after emergent fasciotomy. Six of them achieved successful wound closure by nylon cable ties without skin grafts or flaps on median day 12 (days 6–19). Only 1 patient required skin graft reconstruction after the application of nylon cable ties for 10 days.

Conclusions

Nylon cable ties, which are inexpensive and readily available, can be adjusted according to the different tension along the wound edges. They provide a simple, effective, and safe way to close difficult forearm fasciotomy wounds, which often result in a retracting skin flap after the procedure.
Robotic versus open surgery for simultaneous resection of rectal cancer and liver metastases: a randomized controlled trial
Authors: Chang Wenju , Ye Qinghai , Xu Donghao , Liu Yu , Zhou Shizhao , Ren Li , He Guodong , Zhou Guofeng , Liang Fei , Fan Jia , Wei Ye , Wang Xiaoying , Xu Jianmin
Published: October 2023

Objective:

This study aimed to compare the short-term and long-term outcomes between robotic-assisted simultaneous resection and open surgery in patients with rectal cancer and liver metastases.

Background:

Open simultaneous resection of colorectal cancer and synchronous liver metastases is widely performed and the potential cure for eligible patients. However, the feasibility of robotic simultaneous resection of primary and secondary liver lesions has not been established as a treatment option for metastatic rectal cancer.

Patients and methods:

A single-center randomized controlled trial was conducted at a hospital in China. Enrolling patients were aged from 18 to 75 years and diagnosed with surgically resectable metastatic rectal cancer (distal extension to ≤15 cm from the anal margin). Patients selected for simultaneous resection were randomly assigned to have robotic or open surgery at a 1:1 ratio. The primary endpoint was the incidence rate of complications within 30 days after surgery. Secondary endpoints were bladder, sexual function, 3-year disease-free survival and overall survival.

Results:

A total of 171 patients were enrolled in this trial with 86 in the robotic group and 85 in the open group. As a result, patients in the robotic group demonstrated fewer complications within 30 days after surgery than those in the open group (31.4% vs. 57.6%, P=0.014) and no mortality seen in either group. Patients in the robotic group had less blood loss (mean [SD], 125.5 [38.3] vs. 211.6 [68.7] mL; P<0·001), faster bowel function recovery (mean [SD], 63.7 [27.4] vs. 93.8 [33.5] hours) P<0·001) and shorter hospital stay (mean [SD], 8.0 [2.2] vs. 10.7 [5.4] days; P<0·001) compared with those in the open group. The robotic group had faster recovery of bladder and sexual function at 3 months after surgery than that of the open group. The 3-year disease-free survival rate (39.5% vs. 35.3%, P=0.739) and the 3-year overall survival rate (76.7% vs. 72.9%, P=0.712) were not statistically significant between the two groups.

Conclusions:

In our randomized clinical trial, robotic simultaneous resection treatment of patients with rectal cancer and liver metastases resulted in fewer surgical complications, and faster recovery to those of open surgery. Oncological outcomes showed no significant difference between two groups.
The predictive value of comorbidities on postoperative complication rates and overall survival in left-sided oncological colorectal resections: a multicentre cohort study
Authors: Schlager Lukas , Monschein Matthias , Schüller Jessica , Bergmann Michael , Krall Christoph , Razek Peter , Stift Anton , Unger Lukas W.
Published: October 2023

Introduction:

Surgical- and non-surgical complications significantly worsen postoperative outcomes, and identification of patients at risk is crucial to improve care. This study investigated whether comorbidities, graded by the Charlson Comorbidity Index (CCI), impact complication rates and impair long-term outcome in a cohort of left-sided colorectal resections.

Methods:

Retrospective analysis of patients undergoing oncological left-sided colorectal resections due to colorectal cancer between 01/2015 and 12/2020 in two referral centres in Austria using electronic medical records and national statistical bureau survival data. Patients with recurrent disease, peritoneal carcinomatosis, and emergency surgeries were excluded. Comorbidities were assessed using the CCI, and complication severity was defined by the Clavien Dindo classification (CDC). Logistic regression analysis was performed to identify factors influencing the risk for postoperative complications, and overall survival was assessed using data from the national statistics bureau.

Results:

A total of 471 patients were analysed. Multinominal logistic regression analysis identified a CCI ≥6 (P=0.049; OR 1.59, 95% CI 1.10-2.54) and male sex (P=0.022; OR 1.47 95%, CI 1.21-2.98) as independent risk factors for major complications. While patients with a high CCI had the worst postoperative survival rates, perioperative complications only impacted on overall survival in patients with low CCIs, but not in patients with high CCIs.

Conclusion:

Although a high CCI is a risk factor for major postoperative complications, the presence of comorbidities should not result in withholding surgery.
Defining and predicting textbook outcomes for perihilar cholangiocarcinoma: analysis of factors improving of achievement of desired post-operative outcomes. retrospective cohort study
Authors: Clocchiatti Lucrezia , Marino Rebecca , Ratti Francesca , Pedica Federica , Casadei Gardini Andrea , Lorenzin Dario , Aldrighetti Luca
Published: October 2023

Background:

Definition of Textbook Outcome (TO), defined as a single indicator combining the most advantageous short-term outcomes, is still lacking for Perihilar Cholangiocarcinoma (PHC). The primary endpoint of the present study is to analyse the rate of achievement of a disease-specific textbook outcome for peri-hilar cholangiocarcinoma within a high volume tertiary referral center. Secondary endpoints are to identify predictive factors of TO achievement and to analyze the impact of achieving textbook outcome on long-term results.

Methods:

Between 2010 and 2022, a total of 237 patients undergoing combined liver and biliary resection for PHC at tertiary referral center were included. Disease-specific TO were defined as: no 90-days mortality, no postoperative complications, no readmission, no intraoperative transfusions and R0 margins. A logistic regression model was developed to identify predictors associated with TO achievement. Kaplan-Meier curves were designed to determine TO’s impact on survival.

Results:

TO was achieved in 60 (25.3%) patients. At multivariate logistic regression, preoperative biliary drainage (OR 2.90 (1.13 – 3.40), P=0.026), high prognostic nutritional index (OR 7.11 (6.71 – 9.43), P=0.007) and minimally-invasive approach (OR 3.57 (2.31 – 3.62), P=0.013) were identified as independent predictors of TO. High ASA score (OR 0.38 (0.17 – 0.82), P=0.013) decreased the odds of TO. A significant improvement in both overall survival and disease-free survival was associated to TO fulfilment.

Conclusion:

Since the achievement of textbook outcome correlates with better disease-free and overall survival, every effort should be made to ameliorate modifiable aspects prior to surery: management within referral centers with dedicated experience in biliary tract cancer and preoperative optimization protocol may positively contribute to improve postoperative outcomes, increasing the chance to obtain TO. Moreover, the implementation of advanced minimally invasive programs plays as well.
Magnetic resonance-guided laser interstitial thermal therapy vs. open surgery for drug-resistant mesial temporal lobe epilepsy: A propensity score matched retrospective cohort study
Authors: Mo Jiajie , Guo Zhihao , Wang Xiu , Zhang Jianguo , Hu Wenhan , Shao Xiaoqiu , Sang Lin , Zheng Zhong , Zhang Chao , Zhang Kai
Published: October 2023

Background:

Magnetic resonance-guided laser interstitial thermal therapy (MRgLITT) and traditional open surgery (OS) are effective and safe options for patients with drug-resistant mesial temporal lobe epilepsy (DR-mTLE). However, their superiority in seizure control and preservation of functional abilities remains unclear. This study aimed to compare the surgical outcomes of MRgLITT and OS.

Materials and Methods:

This multicenter retrospective cohort study included patients with DR-mTLE who underwent MRgLITT or OS at three centers between 2015 and 2023. The data on patient demographics, presurgical non-invasive evaluation, stereoelectroencephalography (SEEG) implantation, memory alteration, and seizure outcomes were collected. A propensity score matching (PSM) analysis was conducted to minimize selection bias, facilitating a comparison of seizure control and functional preservation between two surgical approaches.

Results:

Of the 244 individuals who met the study criteria, 33 underwent MRgLITT and 211 OS. The median (IQR) age at seizure onset was 22.0 (13.0) and 12.3 (10.0) years in the MRgLITT and OS groups, respectively. The first PSM, based on demographic and non-invasive information, resulted in 26 matched pairs for the primary analysis. There were no significant differences in memory preservation (P = .95) or surgical outcomes (P = .96) between the groups. The second PSM, based on demographics and SEEG implantation, yielded 32 matched pairs for the sensitivity analysis, showing similar results. Subset analysis of early and late MRgLITT cases revealed no statistically significant differences in the proportion of patients with memory decline (P = .42) or seizure control (P = 1.00). Patients who underwent SEEG implantation were 96% less likely to achieve seizure freedom after MRgLITT (P = .02).

Conclusion:

Minimally invasive MRgLITT is associated with memory preservation and seizure control, similar to traditional OS. MRgLITT is effective and safe for DR-mTLE and is relevant for future prospective randomized trials on dominant-side mTLE, providing practical implications for guiding neurosurgeons in the selection of surgical approaches.