bluuebunny/crossref_metadata_2025 huggingface dataset:
Accelerated electron thermometer: observation of 1D Planck radiation
Authors: Lynch Morgan H , Ievlev Evgenii , Good Michael R R
Published: December 2023

We report on the observation of thermal photons from an accelerated electron via examination of radiative beta decay of free neutrons measured by the RDK II collaboration. The emitted photon spectrum is shown to corroborate a thermal distribution consistent with the dynamical Casimir effect. Supported by a robust chi-squared statistic, we find the photons reside in a 1D Planck spectrum with a temperature predicted by the moving mirror model. Subject Indices: B50 (Electromagnetic processes and properties), D29 (Nuclear decays and radioactivities (including fission)), and E76 (Quantum field theory on curved space)
Controlling chloroform content to a safe level in a pharmaceutical oral solution of chloral hydrate
Authors: McQuillan James T , Hashim Hashim , Woodbridge Nesta , Swaminathan Kalyanaraman
Published: December 2023

Chloral hydrate is a halogenated hydrocarbon with sedative and hypnotic properties and has been used for its medicinal properties for many years. Its solubility and permeability determine it as a Biopharmaceutical Classification System class 1 compound, and as such is ideal to be pharmaceutically presented as an aqueous oral liquid presentation. Its primary route of degradation is by hydrolysis to form formic acid and chloroform and hence licensed pharmaceutical presentations require validated methods to analyse these degradants. The content of the toxic chloroform degradation product was determined via a head-space gas chromatograph with a flame ionisation detector, and its content was controlled to a safe pharmaceutically acceptable level. This can be achieved by solution pH optimisation in the oral solution, incorporating a buffering system to control the rate of this degradation mechanism.

Where other behavioural and pharmacological therapies have failed for the treatment of short-term severe insomnia, a chloral hydrate 500 mg/5 ml oral solution presentation with an optimised safety profile has been developed as a medication for prescription. Extensive analytical and formulation development work has arrived at a room temperature stable oral solution, with a multiyear expiry date.

Key findings: The use of Chloral hydrate in medicinal practice is often associated with high levels of the carcinogen chloroform as a degradation product. The research described herein has shown that the rate of formation of chloroform can be reduced by controlling the impact that the pH has on the stability of the oral solution.

The Ph Eur monograph for Chloral hydrate oral solution (unlicensed medicines) does not include a criterion for chloroform quantification, hence Specials manufacturers of this oral solution are potentially risking the safety of patients without appropriate control of chloroform. This research has used validated analytical techniques to support the detection of chloroform, and other possible impurities, thus ensuring a safe product can be provided to the patient.
Consumers and the green transition between saying and doing: promising consumer empowerment while restricting consumers’ choices is dangerous
Authors: De Almeida Lucila , Esposito Fabrizio
Published: December 2023

To deliver the Green Transition, the European Commission is just asking consumers to make green choices when they want. At the same time, EU legislative measures force consumers to take responsibility by restricting their freedom of making environmentally unsustainable choices. This mismatch is undesirable. The article first shows the existence of this mismatch and then explains why it is undesirable. The mismatch is shown with a discourse analysis of the main Commission’s Communications concerning the Green Transition and a comparison with the related Directives and Regulations and their respective proposals for review. To investigate the negative consequences of this mismatch, the article identifies two mechanisms that reduce the effectiveness of the measures implementing the EU Green Deal because of the mismatch. The article concludes with the modest recommendation of a more transparent explanation of the role consumers have to play to achieve the Green Transition.
Nerve Growth Factor/Tyrosine Kinase A Receptor Pathway Enhances Analgesia in an Experimental Mouse Model of Bone Cancer Pain by Increasing Membrane Levels of δ-Opioid Receptors
Authors: Kan Bu-Fan , Liu Xing-Yun , Han Ming-Ming , Yang Cheng-Wei , Zhu Xia , Jin Yan , Wang Di , Huang Xiang , Wu Wen-Jie , Fu Tong , Kang Fang , Zhang Zhi , Li Juan
Published: December 2023

Background

The role of nerve growth factor (NGF)/tyrosine kinase A receptor (TrKA) signaling, which is activated in a variety of pain states, in regulating membrane-associated δ-opioid receptor (mDOR) expression is poorly understood. The hypothesis was that elevated NGF in bone cancer tumors could upregulate mDOR expression in spinal cord neurons and that mDOR agonism might alleviate bone cancer pain.

Methods

Bone cancer pain (BCP) was induced by inoculating Lewis lung carcinoma cells into the femoral marrow cavity of adult C57BL/6J mice of both sexes. Nociceptive behaviors were evaluated by the von Frey and Hargreaves tests. Protein expression in the spinal dorsal horn of animals was measured by biochemical analyses, and excitatory synaptic transmission was recorded in miniature excitatory synaptic currents.

Results

The authors found that mDOR expression was increased in BCP mice (BCP vs. sham, mean ± SD: 0.18 ± 0.01 g vs. mean ± SD: 0.13 ± 0.01 g, n = 4, P < 0.001) and that administration of the DOR agonist deltorphin 2 (Del2) increased nociceptive thresholds (Del2 vs. vehicle, median [25th, 75th percentiles]: 1.00 [0.60, 1.40] g vs. median [25th, 75th percentiles]: 0.40 [0.16, 0.45] g, n = 10, P = 0.001) and reduced miniature excitatory synaptic current frequency in lamina II outer neurons (Del2 vs. baseline, mean ± SD: 2.21 ± 0.81 Hz vs. mean ± SD: 2.43 ± 0.90 Hz, n = 12, P < 0.001). Additionally, NGF expression was increased in BCP mice (BCP vs. sham, mean ± SD: 0.36 ± 0.03 vs. mean ± SD: 0.16 ± 0.02, n = 4, P < 0.001), and elevated NGF was associated with enhanced mDOR expression via TrKA signaling.

Conclusions

Activation of mDOR produces analgesia that is dependent on the upregulation of the NGF/TrKA pathway by increasing mDOR levels under conditions of BCP in mice.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Early Weightbearing Following Surgical Treatment of Ankle Fractures without Trans-Syndesmotic Fixation is Safe and Improves Short Term Outcomes
Authors: Herbosa Christopher G. , Saleh Hesham , Kadiyala Manasa L. , Solasz Sara , McLaurin Toni M. , Leucht Philipp , Egol Kenneth A. , Tejwani Nirmal C.
Published: December 2023

OBJECTIVES:

To ascertain outcome differences after fixation of unstable rotational ankle fractures allowed to weight bear two weeks postoperatively compared to six weeks.

METHODS:

Design:

Prospective Case-Control Study

Setting:

Academic medical center; Level 1 trauma center

Patient Selection Criteria:

Patients with unstable ankle fractures (OTA:44A-C) undergoing ORIF were enrolled. Patients requiring trans-syndesmotic fixation were excluded. Two surgeons allowed weightbearing at two weeks postoperatively (early weightbearing group (EWB)). Two other surgeons instructed standard non-weightbearing until six weeks postoperatively (NWB group).

Main Outcome Measures and Comparisons: Outcomes included Olerud-Molander, SF-36, and Visual Analog Scale (VAS) at six-weeks, three-months, six-months, 12-months postoperatively, and complications, return to work, range of ankle motion, and reoperations at 12-months.

RESULTS:

107 patients were included. The two cohorts did not differ in demographics or pre-injury scores (p>0.05). Six weeks postoperatively EWB patients had improved functional outcomes as measured by the Olerud-Molander and SF-36 questionnaires. Early weightbearing patients also had better VAS scores (Standardized Mean Difference (SMD) -0.98, 95% Confidence Interval (CI) -1.27 to -0.70, p<0.05) and a greater proportion returning to full capacity work at six weeks (Odds Ratio (OR) = 3.42, 95%CI 1.08 to 13.07, p<0.05). One year postoperatively, EWB had improved pain measured by SF-36 (SMD 6.25, 95%CI 5.59 to 6.92, p<0.01) and VAS scores (SMD -0.05, 95%CI -0.32 to 0.23, p<0.01). There were no differences in complications or reoperation at 12 months (p>0.05).

Conclusions:

EWB patients had improved early function, final pain scores, earlier return to work, without an increased complication rate compared to those kept NWB for six weeks.
Finding Your Job in Orthopaedic Trauma: A Survey Revealing the Cold Hard Facts
Authors: Davis Max E. , Ishmael Chad , Fram Brianna , Light Jonathan J. , Obremskey William T. , Cannada Lisa K.
Published: December 2023

Introduction:

Finding a first job after fellowship can be stressful due to the uncertainty about which resources to utilize, including fellowship program directors (PDs), residency faculty and other sources. There are over 90 orthopaedic trauma fellows seeking jobs annually. We surveyed orthopaedic trauma fellows to determine the job search process.

Methods:

An anonymous 37 question survey was created online and sent to orthopaedic trauma fellows from the five fellowship-cycle years of 2016 – 2021. The primary questions were related to the job search process, current job, and work details. The secondary questions addressed job satisfaction. Data analysis was performed using STATA 17.

Results:

There were 159 responses (40%). Most respondents completed a fellowship at an academic program (84%). Many (50%) took an academic job and 24% were hospital employed. Sixteen percent had a job secured before fellowship and 49% went on 2-3 interviews. Word of mouth was the top resource for finding a job (53%) compared to fellowship PD (46%) and residency faculty (33%). While 82% reported ending up in their first-choice job, 34% of respondents felt they “settled.” The number of trauma cases was important (62%), ranked above compensation (52%) as a factor affecting job choice. Surgeons who needed to supplement their practice (46%) did so with primary and revision total joints (37%).

Conclusions:

Jobs were most often found by word of mouth. Most fellows landed their first job choice, but still a third of respondents reporting settling on a job. Case volume played a significant role in factors affecting job choice.
Vertical versus Pfannenstiel incision modified Stoppa approach in the treatment of acetabular fractures
Authors: Kara Deniz , Elmadag Nuh Mehmet , Ali Jotyar , Misir Abdulhamit , Huzeyfe Cetin  , Demirkiran Cemil Burak , Mraja Hamisi , Pulatkan Anil
Published: December 2023

OBJECTIVES:

To compare the patient and fracture characteristics, radiological, functional, and quality of life outcomes, the need for a lateral window approach and requirement of total hip arthroplasty (THA), and complications in patients with simple and complex acetabular fractures who underwent a modified Stoppa approach through vertical and Pfannenstiel incisions.

METHODS:

Design:

Retrospective comparison study

Setting:

Level one trauma center

Patient Selection Criteria:

Patients with acetabular fractures (OTA/AO type 62A-B-C) treated with vertical (Group V) or Pfannenstiel (Group P) incision modified Stoppa approach between 2010 and 2020.

Outcome Measures and Comparisons: Patient characteristics, radiological evaluations (reduction quality and posttraumatic osteoarthritis), patient functional outcomes (SF-12 PCS, SF-12 MCS, HHS, and Merle d'Aubigne Apostel), approach modifications and stratification by fracture type and complications were compared between those treated with vertical or Pfannenstiel incisions.

RESULTS:

104 patients (mean age of 38.5 ±14.3 year) were included. There was no significant difference between the Pfannenstiel or vertical groups regarding patient and fracture characteristics (p = 0.137), postoperative reduction quality (p = 0.130), or the mean functional and quality of life outcome scores at the last follow-up (p = 0.483 for HHS, p = 0.717 for Merle d'Aubigne Apostel score, p = 0.682 for SF-12 PCS, and p = 0.781 for SF-12 MCS). In group P, significantly more patients needed additional lateral incisions (40.8% vs. 10.9%; p 0.001) and total hip replacement procedures (12.2% vs. 1.8%; p = 0.049). The total, early, and late complication rates were significantly higher in group P (p 0.001, p = 0.034, and p = 0.049, respectively).

CONCLUSION:

Pfannenstiel incision was associated with higher complication rates than vertical incision in acetabular fractures treated through a modified Stoppa approach. Fracture complexity is associated with the need for a lateral window approach and THA, as well as a worse functional and radiological outcome regardless of incision type. However, it was not associated with the development of intraoperative or postoperative complications.
Establishing the Satisfactory Patient Symptom State Thresholds for Patient Reported Outcomes After Operatively Treated Tibial Plateau Fractures
Authors: Sato Eleanor H. , Treu Emily A. , Froerer Devin L. , Zhang Chong , O’Neill Dillon C. , Cizik Amy M. , Haller Justin M.
Published: December 2023

OBJECTIVES:

Define patient acceptable symptom state (PASS) thresholds and factors impacting PASS thresholds for Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF) and Knee Injury and Osteoarthritis Outcome Score (KOOS) following operatively treated tibial plateau fractures.

METHODS:

Design:

Retrospective cohort.

Setting:

Single Level I academic trauma center.

Patient Selection Criteria:

All patients (n=159) who underwent fixation of a tibial plateau fracture from 2016-2021 and completed patient reported outcome measurements (PROMs) at minimum one-year follow-up.

Outcome Measures and Comparisons:

PASS thresholds for global outcome (PASS-Global), pain (PASS-Pain), and function (PASS-Function) were determined using anchor-based questions such as “How satisfied are you today with your injured lower extremity?” with answer choices of very satisfied, satisfied, neutral, unsatisfied, and very unsatisfied. PASS thresholds for each PROM were calculated using three methods: 1) 80% specificity, 2) 75th percentile, and 3) Youden Index.

RESULTS:

60% of patients were satisfied with their global outcome and 53% with function. Using 80% specificity, 75th percentile, and Youden Index, PASS-Global thresholds were 48.5, 44.5, and 47.9 for PROMIS-PF and 56.3, 56.2, and 56.3 for KOOS-QOL, respectively. PASS-Pain threshold for KOOS-Pain was 84.4, 80.6, and 80.6. PASS-Function thresholds were 48.9, 46.8, and 48 for PROMIS-PF and 94.1, 90.2, and 86.8 for KOOS-ADL, respectively. Younger patients, those with bicondylar fractures and infections were associated with significantly lower PASS-Pain thresholds. Schatzker II fractures, lateral column involvement, or isolated lateral approach resulted in significantly higher PASS-global and -function thresholds.

CONCLUSIONS:

This study defines global, functional, and pain PASS thresholds for tibial plateau fractures. Patients with bicondylar fractures, infections, and medial column involvement were more often unsatisfied. These thresholds are valuable references to identify patients who have attained satisfactory outcomes and to counsel patients with risk factors for unsatisfactory outcomes following tibial plateau fractures.
Arthroscopic-assisted Tibiotalocalcaneal Arthrodesis Using a Hindfoot Nail for Treatment of Ankle Fractures in Medically Complex Patients: A Technique Guide and Retrospective Case Series
Authors: Washburn Frederic , Ahankoob Niaz , Bonavida Victor , Fang William , Pyle Casey
Published: December 2023

Treatment of ankle fractures in patients with severe medical comorbidities poses a significant challenge, as these patients are at high risk for major complications, including infection and amputation. Tibiotalocalcaneal arthrodesis (TTCA) is gaining popularity for the surgical treatment of ankle fractures in these medically complex patients. This is traditionally performed with open joint preparation or no joint preparation, both of which have associated postoperative complications. We present our technique for arthroscopic-assisted TTCA and provide a retrospective case series of 4 patients undergoing this technique and their outcomes. Our study showed that arthroscopically-assisted joint preparation for TTCA for ankle fractures in patients with severe medical comorbidities shows promise considering 100% limb salvage rate, successful fusion, and restoration of ambulatory status. Complications were minimal requiring only one return to the operating room for symptomatic aseptic loosening of an interlocking screw. Because this is done in a minimally invasive approach, it may be the preferred technique more widely used in the future to decrease the rate of infection and increase the rate of fusion, especially in medically complex patients.

Level of Evidence:

Level IV, retrospective case series.
Wellness and burnout in cardiac surgery: not black and white
Authors: Izumi Aliya , Nwakoby Akachukwu , Verma Raj , Yanagawa Bobby
Published: December 2023

Purpose of review

Despite a growing emphasis on burnout in medicine, there remains a paucity of data in cardiac surgery. Herein, we summarize recent data on cardiac surgeon well being and identify factors for consideration in future burnout inquiries and management.

Recent findings

Overall, 70–90% of cardiothoracic surgeons report job satisfaction in the United States. However, 35–60% still endorse burnout symptoms, and the specialty reports some of the highest rates of depression (35–40%) and suicidal ideation (7%). Such negative experiences are greater among early-stage and female surgeons and may be addressed through targeted, program-specific wellness policies. Canada's single-payer healthcare system might exacerbate surgeon burnout due to lower financial compensation and job autonomy.

Cardiothoracic surgeons appear simultaneously burnt out and professionally fulfilled. They report a high incidence of depression and clock in the most hours, yet the majority would choose this specialty again. These findings reveal a more nuanced state of well being than previously appreciated and speak to ambiguities in how burnout is conceived and measured. A broader examination across surgical and social contexts highlights the hierarchical nature of burnout factors and potential ways forward. Collectively, these insights can inform assessments of burnout in Canadian cardiac surgery that remain absent to date.
Seladelpar treatment reduces IL-31 and pruritus in patients with primary biliary cholangitis
Authors: Kremer Andreas E. , Mayo Marlyn J. , Hirschfield Gideon M. , Levy Cynthia , Bowlus Christopher L. , Jones David E. , Johnson Jeff D. , McWherter Charles A. , Choi Yun-Jung
Published: December 2023

Background and Aims:

Pruritus is a debilitating symptom for many people living with primary biliary cholangitis (PBC). In studies with seladelpar, a selective peroxisome proliferator-activated receptor-delta agonist, patients with PBC experienced significant improvement in pruritus and reduction of serum bile acids. Interleukin-31 (IL-31) is a cytokine known to mediate pruritus, and blocking IL-31 signaling provides relief in pruritic skin diseases. This study examined the connection between seladelpar’s antipruritic effects and IL-31 and bile acid levels in patients with PBC.

Approach and Results:

IL-31 levels were quantified in serum samples from the ENHANCE study of patients with PBC receiving daily oral doses of placebo (n = 55), seladelpar 5 mg (n = 53) or 10 mg (n = 53) for 3 months, and for healthy volunteers (n = 55). IL-31 levels were compared with pruritus using a numerical rating scale (NRS, 0–10) and with bile acid levels. Baseline IL-31 levels closely correlated with pruritus NRS (r= 0.54,p< 0.0001), and total (r= 0.54,p< 0.0001) and conjugated bile acids (up to 0.64,p< 0.0001). Decreases in IL-31 were observed with seladelpar 5 mg (−30%,p= 0.0003) and 10 mg (−52%,p< 0.0001) versus placebo (+31%). Patients with clinically meaningful improvement in pruritus (NRS ≥ 2 decrease) demonstrated greater dose-dependent reductions in IL-31 compared to those without pruritus improvement (NRS < 2 decrease). Strong correlations were observed for the changes between levels of IL-31 and total bile acids (r= 0.63,p< 0.0001) in the seladelpar 10 mg group.

Conclusions:

Seladelpar decreased serum IL-31 and bile acids in patients with PBC. The reductions of IL-31 and bile acids correlated closely with each other and pruritus improvement, suggesting a mechanism to explain seladelpar’s antipruritic effects.
Circulating metabolic markers after surgery identify patients at risk for severe postoperative complications: a prospective cohort study in colorectal cancer
Authors: Montcusí Blanca , Madrid-Gambin Francisco , Pozo Óscar J , Marco Santiago , Marin Silvia , Mayol Xavier , Pascual Marta , Alonso Sandra , Salvans Silvia , Jiménez-Toscano Marta , Cascante Marta , Pera Miguel
Published: December 2023

Background:

Early detection of postoperative complications after colorectal cancer (CRC) surgery is associated with improved outcomes. The aim was to investigate early metabolomics signatures capable to detect patients at risk for severe postoperative complications after CRC surgery.

Materials and methods:

Prospective cohort study of patients undergoing CRC surgery from 2015 to 2018. Plasma samples were collected before and after surgery, and analyzed by mass spectrometry obtaining 188 metabolites and 21 ratios. Postoperative complications were registered with Clavien–Dindo Classification and Comprehensive Complication Index.

Results:

One hundred forty-six patients were included. Surgery substantially modified metabolome and metabolic changes after surgery were quantitatively associated with the severity of postoperative complications. The strongest positive relationship with both Clavien–Dindo and Comprehensive Complication Index (β=4.09 and 63.05, P<0.001) corresponded to kynurenine/tryptophan, against an inverse relationship with lysophosphatidylcholines (LPCs) and phosphatidylcholines (PCs). Patients with LPC18:2/PCa36:2 below the cut-off 0.084 µM/µM resulted in a sevenfold higher risk of major complications (OR=7.38, 95% CI: 2.82–21.25, P<0.001), while kynurenine/tryptophan above 0.067 µM/µM a ninefold (OR=9.35, 95% CI: 3.03–32.66, P<0.001). Hexadecanoylcarnitine below 0.093 µM displayed a 12-fold higher risk of anastomotic leakage-related complications (OR=11.99, 95% CI: 2.62–80.79, P=0.004).

Conclusion:

Surgery-induced phospholipids and amino acid dysregulation is associated with the severity of postoperative complications after CRC surgery, including anastomotic leakage-related outcomes. The authors provide quantitative insight on metabolic markers, measuring vulnerability to postoperative morbidity that might help guide early decision-making and improve surgical outcomes.
Characterization changes and research waste in randomized controlled trials of global bariatric surgery over the past 20 years: cross-sectional study
Authors: Huang Ze-ning , Qiu Wen-Wu , He Qi-Chen , Zhang Zhi-quan , Xu Binbin , Zheng Chang-yue , Zheng Chao-Hui , Xie Jian Wei , Wang Jia-Bin , Lin Jian-Xian , Chen Qi-yue , Cao Long-Long , Huang Chang-ming , Lu Jun , Li Ping
Published: December 2023

Background:

The results of several large randomized controlled trials (RCTs) have changed the clinical practice of bariatric surgery. However, the characteristics of global RCTs of bariatric surgery have not been reported internationally and whether there was research waste in these RCTs is unknown.

Methods:

Search ClinicalTrials.gov for bariatric surgery RCTs registered between January 2000 and December 2022 with the keywords ‘Roux-en-Y gastric-bypass’ and ‘Sleeve Gastrectomy’. The above analysis was conducted in January 2023.

Results:

A total of 326 RCTs were included in this study. The number of RCTs registered for sleeve gastrectomy and gastric bypass surgery increased year by year globally. Europe has always accounted for the largest proportion, Asia has gradually increased, and North America has decreased. A total of 171 RCTs were included in the analysis of waste, of which 74 (43.8%) were published. Of the 74 published RCTs, 37 (37/74, 50.0%) were judged to be adequately reported and 36 (36/74, 48.6%) were judged to have avoidable design defects. In the end, 143 RCTs (143/171, 83.6%) had at least one research waste. Body weight change as the primary endpoint (OR: 0.266, 95% CI: 0.103–0.687, P=0.006) and enrolment greater than 100 (OR: 0.349, 95% CI: 0.146–0.832, P=0.018) were independent protective factors for research waste.

Conclusions:

This study for the first time describes the characteristic changes of the mainstream RCT of bariatric surgery globally in the last 20 years and identifies a high research waste burden and predictive factor in this area, which provides reference evidence for carrying out bariatric surgery RCTs more rationally.
Ophthalmology and oculoplastics for the rhinologist
Authors: Stefko S. Tonya , Terrarosa Anna K.
Published: December 2023

Purpose of review

As the management of ophthalmic and sinus disease advances, it is important to stay abreast of all current management options. This involves knowledge of adjacent anatomy and disease processes, and collaboration between multiple specialties. The authors provide a review of relevant ophthalmic and oculoplastic topics for the rhinologist.

Recent findings

The scope and surgical skills of oculoplastic and rhinologist specialists have grown in conjunction with medical and technological advancements. Familiarity with the presentations of sinus disease in the orbit can decrease the time to disease recognition, and improve morbidity and mortality. Collaborative approaches provide improved access to areas of interest throughout the orbit and sinuses. Multiportal, transorbital, and endoscopic techniques can improve patient morbidity and mortality compared to conventional open approaches. Familiarity with all medical and surgical treatment options can help tailor treatments to patients’ needs.

Multidisciplinary approaches to sinus and orbit disease and the incorporation of new surgical technologies can improve patient options and outcomes.
Management of aggressive variants of papillary thyroid cancer
Authors: Lee Ying Ki , Rovira Aleix , Carroll Paul V. , Simo Ricard
Published: December 2023

Purpose of review

The aim of this study was to provide a timely and relevant review of the latest findings and explore appropriate management of aggressive variants of papillary thyroid cancer (AVPTC).

Recent findings

In general, AVPTCs tend to exhibit more invasive characteristics, a lack of responsiveness to radioiodine, increased occurrences of regional spreading, distant metastases and higher mortality rates. Meanwhile, each variant showcases unique clinical and molecular profiles.

Given the elevated risk of recurrence postsurgery, a more aggressive strategy may be necessary when suspected preoperatively, particularly for those presenting with invasive features. Decision on the extent of surgical treatment and adjuvant therapy is individualized and made by experienced clinicians and multidisciplinary teams based on the clinical presentation, presence of aggressive features and molecular profile. Future studies on development of personalized medicine and molecular target therapy may offer tailored treatment options.
Benign bony lesions of paranasal sinuses and skull base: from osteoma to fibrous dysplasia
Authors: Papargyriou Georgia Evangelia , Oostra Amanda , Georgalas Christos
Published: December 2023

Purpose of review

Benign bony lesions of the craniofacial complex are relatively common. However, their location close to critical neurovascular structures may render their treatment, if required, highly challenging.

This article reviews the current literature on their pathophysiology, diagnosis, natural course and treatment, with a focus on most recent findings.

Recent findings

A new classification has been suggested concerning endoscopic resectability. The ratio of lateral frontal to interorbital distance can accurately and reliably predict the endoscopic reach to lateral frontal sinus, while orbital transposition can assist us in reaching lateral frontal sinus when anatomy is unfavorable. New and combined endoscopic transnasal and transorbital approaches are now in the surgical armamentarium. Prophylactic optic nerve decompression in fibrous dysplasia is absolutely contraindicated as it leads to worse visual outcomes. Radiotherapy of such lesions is of no benefit and may lead to a higher risk of malignant transformation. The presence of Guanine Nucleotide binding protein Alpha Stimulating (GNAS) mutation in chromosome 20 is universally present in fibrous dysplasia and can differentiate them from ossifying fibromas.

Diagnosis and therapeutic management of benign craniofacial bone lesions remains challenging. If surgical treatment is contemplated, the morbidity of the intervention should always be weighed against the potential benefits. Evolution of extended endoscopic endonasal and transorbital surgery means that more lesions can be reached purely endoscopically with better oncological and cosmetic results.
Implementation of a Decedent Affairs Office to Improve Outcomes
Authors: Brown Jac'Kel S. , Kingsley-Mota William , Kaplow Roberta
Published: December 2023

Healthcare facilities are committed to providing high-quality care throughout patients' treatment trajectories. That same obligation continues when patients die. Handling of patients and their belongings safely and respectfully is essential. Despite recognition of this aspect of care, facilities struggle and are confronted with a number of barriers. This article describes the implementation of a Decedent Affairs Office at Emory University Hospital.
Evidence-Based Practice Implementation
Authors: Kawar Lina Najib , Fangonil-Gagalang Evangeline , Failla Kim Reina , Aquino-Maneja Emma , Vaughn Stephanie , Mestler Loos Nancy
Published: December 2023

OBJECTIVE

This study was conducted to determine the benefits, facilitators, and barriers of implementing evidence-based practice (EBP) into organizational culture.

BACKGROUND

Implementing EBP leads to higher quality of patient outcome care, improved patient outcomes, and decreased healthcare costs. Nurse leader (NL) influence is essential for successful EBP implementation.

METHODS

Data were collected using a descriptive qualitative approach with focus group interviews using 2 open-ended questions. Participants included NL attendees at the 2022 Association of California Nurse Leaders Annual Program/Conference. Data were analyzed and themes were identified using Sandelowski's method.

RESULTS

Two overarching themes emerged: capacity (the amount something can produce) and capabilities (the power or ability to do something).

CONCLUSIONS

Healthcare organizations need to invest in building NLs' capacity to implement EBP and allocate resources to strengthen the organization's capabilities in supporting EBP.
The impact of obesity on doravirine exposure in people with HIV
Authors: Zino Leena , van Bussel Lianne P.M. , Greupink Rick , Marneef Manon , Burger David M. , Colbers Angela
Published: December 2023

Obesity incidence is increasing among people with HIV. Doravirine is a recommended first-line antiretroviral drug in many countries with no data from people with obesity. This study investigates the exposure of doravirine 100 mg standard dose in obese versus normal weight patients using clinical data combined with physiologically based pharmacokinetic modelling. Results from both approaches showed an elevated doravirine exposure during obesity, yet within the safety range of doravirine with no need for dose modification.
Using Machine Learning (XGBoost) to Predict Outcomes following Infrainguinal Bypass for Peripheral Artery Disease
Authors: Li Ben , Eisenberg Naomi , Beaton Derek , Lee Douglas S. , Aljabri Badr , Verma Raj , Wijeysundera Duminda N. , Rotstein Ori D. , de Mestral Charles , Mamdani Muhammad , Roche-Nagle Graham , Al-Omran Mohammed
Published: December 2023

Objective:

To develop machine learning (ML) algorithms that predict outcomes following infrainguinal bypass.

Summary Background Data:

Infrainguinal bypass for peripheral artery disease (PAD) carries significant surgical risks; however, outcome prediction tools remain limited.

Methods:

The Vascular Quality Initiative (VQI) database was used to identify patients who underwent infrainguinal bypass for PAD between 2003-2023. We identified 97 potential predictor variables from the index hospitalization (68 pre-operative [demographic/clinical], 13 intra-operative [procedural], and 16 post-operative [in-hospital course/complications]). The primary outcome was 1-year major adverse limb event (MALE; composite of surgical revision, thrombectomy/thrombolysis, or major amputation) or death. Our data were split into training (70%) and test (30%) sets. Using 10-fold cross-validation, we trained 6 ML models using pre-operative features. The primary model evaluation metric was area under the receiver operating characteristic curve (AUROC). The top-performing algorithm was further trained using intra- and post-operative features. Model robustness was evaluated using calibration plots and Brier scores.

Results:

Overall, 59,784 patients underwent infrainguinal bypass and 15,942 (26.7%) developed 1-year MALE/death. The best pre-operative prediction model was XGBoost, achieving an AUROC (95% CI) of 0.94 (0.93-0.95). In comparison, logistic regression had an AUROC (95% CI) of 0.61 (0.59-0.63). Our XGBoost model maintained excellent performance at the intra- and post-operative stages, with AUROC’s (95% CI’s) of 0.94 (0.93-0.95) and 0.96 (0.95-0.97), respectively. Calibration plots showed good agreement between predicted and observed event probabilities with Brier scores of 0.08 (pre-operative), 0.07 (intra-operative), and 0.05 (post-operative).

Conclusions:

ML models can accurately predict outcomes following infrainguinal bypass, outperforming logistic regression.
Blepharospasm Secondary to Deep Brain Stimulation of the Subthalamic Nucleus in Parkinson Disease: Clinical Characteristics and Management Outcomes
Authors: Ting Michelle A. , Manta Alexandra I. , Samia-Aly Emma , Lai Michelle , de Carvalho Emanuel R. , Buttery Philip , Ezra Daniel G.
Published: December 2023

Background:

Deep brain stimulation of the subthalamic nucleus (STN-DBS) is an effective treatment for patients with motor symptoms of Parkinson disease but can be complicated by disabling blepharospasm and apraxia of eyelid opening (ALO). Currently, there is no clear consensus on optimal management, and addressing these issues is further hindered by systemic morbidity and resistance to treatments. We aim to describe the different phenotypes of these eyelid movement disorders, to report our management approach and patient responses to treatment.

Methods:

A retrospective case series of all patients with blepharospasm/ALO secondary to STN-DBS that were treated at a tertiary center between 2011 and 2020. Data collected included date of Parkinson diagnosis, date of DBS surgery, date of development of blepharospasm/ALO symptoms, STN-DBS stimulation settings, and treatment given. Patients' symptoms before and after treatment were measured using the blepharospasm disability index and Jankovic Rating Scale.

Results:

Five patients were identified with eyelid movement disorders secondary to STN-DBS. All patients had moderate-to-severe symptoms at presentation. Four patients received periocular botulinum toxin injections. Three patients underwent surgery in the form of frontalis suspension or direct brow lift with or without upper lid blepharoplasty. All reported an improvement in symptoms following treatment.

Conclusions:

A multimodality, patient-specific approach is required in the treatment of blepharospasm/ALO secondary to STN-DBS. Botulinum toxin injections can be effective, but patients may require surgery if toxin treatment alone becomes ineffective. Tailoring treatment to individual needs can result in a measurable improvement in symptoms.
Public awareness of and opinions on the use of mathematical transmission modelling to inform public health policy in the United Kingdom
Authors: McCabe Ruth , Donnelly Christl A.
Published: December 2023

Mathematical modelling is used to inform public health policy, particularly so during the COVID-19 pandemic. As the public are key stakeholders, understanding the public perceptions of these tools is vital. To complement our previous study on the science-policy interface, novel survey data were collected via an online panel (‘representative’ sample) and social media (‘non-probability’ sample). Many questions were asked twice, in reference to the period ‘prior to’ (retrospectively) and ‘during’ the COVID-19 pandemic. Respondents reported being increasingly aware of modelling in informing policy during the pandemic, with higher levels of awareness among social media respondents. Modelling informing policy was perceived as more reliable during the pandemic than in reference to the pre-pandemic period in both samples. Trust in government public health advice remained high within both samples but was lower during the pandemic in comparison with the (retrospective) pre-pandemic period. The decay in trust was greater among social media respondents. Many respondents explicitly made the distinction that their trust was reserved for ‘scientists’ and not ‘politicians’. Almost all respondents believed governments have responsibility for communicating modelling to the public. These results provide a reminder of the skewed conclusions that could be drawn from non-representative samples.
Mitochondrial replication's role in vertebrate mtDNA strand asymmetry
Authors: Gomes-dos-Santos André , Vilas-Arrondo Nair , Machado André M. , Román-Marcote Esther , Del Río Iglesias Jose Luís , Baldó Francisco , Pérez Montse , Fonseca Miguel M. , Castro L. Filipe C. , Froufe Elsa
Published: December 2023

Mitogenomes are defined as compact and structurally stable over aeons. This perception results from a vertebrate-centric vision, where few types of mtDNA rearrangements are described. Here, we bring a new light to the involvement of mitochondrial replication in the strand asymmetry of the vertebrate mtDNA. Using several species of deep-sea hatchetfish (Sternoptychidae) displaying distinct mtDNA structural arrangements, we unravel the inversion of the coding direction of protein-coding genes (PCGs). This unexpected change is coupled with a strand asymmetry nucleotide composition reversal and is shown to be directly related to the strand location of the Control Region (CR). An analysis of the fourfold redundant sites of the PCGs (greater than 6000 vertebrates), revealed the rarity of this phenomenon, found in nine fish species (five deep-sea hatchetfish). Curiously, in Antarctic notothenioid fishes (Trematominae), where a single PCG inversion (the only other record in fish) is coupled with the inversion of the CR, the standard asymmetry is disrupted for the remaining PCGs but not yet reversed, suggesting a transitory state. Our results hint that a relaxation of the classic vertebrate mitochondrial structural
stasis
promotes disruption of the natural balance of asymmetry of the mtDNA. These findings support the long-lasting hypothesis that replication is the main molecular mechanism promoting the strand-specific compositional bias of this unique and indispensable molecule.
Viscoplastic simple shear at finite strains
Authors: Califano F. , Ciambella J.
Published: December 2023

The equations governing the simple shear deformation of an incompressible inelastic material undergoing finite strain are derived in this paper. The constitutive assumptions are kept in their most general form to allow the incorporation of widely used viscoplastic or viscoelastic models from the literature. It is shown that, while for a hyperelastic material the simple shear problem is completely determined by a single parameter, the amount of shear, in the viscoplastic case, the elastic deformation is the superposition of a triaxial stretch and a simple shear, whose determination requires the solution of three coupled nonlinear evolution equations. We evaluate such a solution for different material models and compare it with three-dimensional finite element simulations to assess its accuracy. We further assess the performance of these models using experimental data from filled rubber, focusing on their ability to capture the observed behaviour, such as the well-known Payne effect. Additionally, we extend our simple shear solution to address torsion and the extension of thin-walled cylinders. These derivations and analyses offer valuable insights for experimentalists engaged in the mechanical characterization of soft materials.
Reduced social function in experimentally evolved
Dictyostelium discoideum
implies selection for social conflict in nature
Authors: Larsen Tyler J. , Jahan Israt , Brock Debra A. , Strassmann Joan E. , Queller David C.
Published: December 2023

Many microbes interact with one another, but the difficulty of directly observing these interactions in nature makes interpreting their adaptive value complicated. The social amoeba
Dictyostelium discoideum
forms aggregates wherein some cells are sacrificed for the benefit of others. Within chimaeric aggregates containing multiple unrelated lineages, cheaters can gain an advantage by undercontributing, but the extent to which wild
D. discoideum
has adapted to cheat is not fully clear. In this study, we experimentally evolved
D. discoideum
in an environment where there were no selective pressures to cheat or resist cheating in chimaeras.
Dictyostelium discoideum
lines grown in this environment evolved reduced competitiveness within chimaeric aggregates and reduced ability to migrate during the slug stage. By contrast, we did not observe a reduction in cell number, a trait for which selection was not relaxed. The observed loss of traits that our laboratory conditions had made irrelevant suggests that these traits were adaptations driven and maintained by selective pressures
D. discoideum
faces in its natural environment. Our results suggest that
D. discoideum
faces social conflict in nature, and illustrate a general approach that could be applied to searching for social or non-social adaptations in other microbes.
Giant baleen whales emerged from a cold southern cradle
Authors: Rule James P. , Duncan Ruairidh J. , Marx Felix G. , Pollock Tahlia I. , Evans Alistair R. , Fitzgerald Erich M.G.
Published: December 2023

Baleen whales (mysticetes) include the largest animals on the Earth. How they achieved such gigantic sizes remains debated, with previous research focusing primarily on when mysticetes became large, rather than where. Here, we describe an edentulous baleen whale fossil (21.12–16.39 mega annum (Ma)) from South Australia. With an estimated body length of 9 m, it is the largest mysticete from the Early Miocene. Analysing body size through time shows that ancient baleen whales from the Southern Hemisphere were larger than their northern counterparts. This pattern seemingly persists for much of the Cenozoic, even though southern specimens contribute only 19% to the global mysticete fossil record. Our findings contrast with previous ideas of a single abrupt shift towards larger size during the Plio-Pleistocene, which we here interpret as a glacially driven Northern Hemisphere phenomenon. Our results highlight the importance of incorporating Southern Hemisphere fossils into macroevolutionary patterns, especially in light of the high productivity of Southern Ocean environments.
Migratory birds are able to choose the appropriate migratory direction under dim yellow narrowband light
Authors: Romanova Nadezhda , Utvenko Gleb , Prokshina Anisia , Cellarius Fyodor , Fedorishcheva Aleksandra , Pakhomov Alexander
Published: December 2023

Currently, it is generally assumed that migratory birds are oriented in the appropriate migratory direction under UV, blue and green light (short-wavelength) and are unable to use their magnetic compass in total darkness and under yellow and red light (long-wavelength). However, it has also been suggested that the magnetic compass has two sensitivity peaks: in the short and long wavelengths, but with different intensities. In this project, we aimed to study the orientation of long-distance migrants, pied flycatchers (
Ficedula hypoleuca
), under different narrowband light conditions during autumn and spring migrations. The birds were tested in the natural magnetic field (NMF) and a changed magnetic field (CMF) rotated counterclockwise by 120° under dim green (autumn) and yellow (spring and autumn) light, which are on the ‘threshold’ between the short-wavelength and long-wavelength light. We showed that pied flycatchers (i) were completely disoriented under green light both in the NMF and CMF but (ii) showed the migratory direction in the NMF and the appropriate response to CMF under yellow light. Our data contradict the results of previous experiments under narrowband green and yellow light and raise doubts about the existence of only short-wavelength magnetoreception. The parameters of natural light change dramatically in spectral composition and intensity after local sunset, and the avian magnetic compass should be adapted to function properly under such constantly changing light conditions.