bluuebunny/crossref_metadata_2025 huggingface dataset:
DNA methylation changes associated with cannabis use and verbal learning performance in adolescents: an exploratory whole genome methylation study
Authors: Wiedmann Melina , Kuitunen-Paul Sören , Basedow Lukas Andreas , Wolff Max , DiDonato Nataliya , Franzen Julia , Wagner Wolfgang , Roessner Veit , Golub Yulia
Published: August 2022

The association between extent of chronic cannabis use (CCU-extent) and cognitive impairment among adolescents has been the subject of controversial debate. Linking DNA methylation to CCU-extent could help to understand cannabis associated changes in cognitive performance. We analyzed cognitive task performances, CpG methylation in peripheral whole-blood samples and self-reported past-year CCU-extent ofn = 18 adolescents (n = 9 psychiatric outpatients with chronic cannabis use (CCU),n = 9 without) who were matched for age, gender and psychiatric disorders. Patients with CCU were at least 24 h abstinent when cognitive tasks were performed. A Principal Component Analysis (PCA) was carried out to identify group differences in whole genome DNA methylation. Mediation analyses were performed between CCU-extent associated CpG sites and CCU-extent associated variables of cognitive tasks. PCA results indicated large differences in whole genome DNA methylation levels between the groups that did not reach statistical significance. Six CpG sites revealed reduced methylation associated with CCU-extent. Furthermore, CCU-extent was associated with lower scores in verbal learning. All six CpG sites mediated the effects between CCU-extent and verbal learning free recall. Our results indicate that CCU is associated with certain patterns in the methylome. Furthermore, CCU-extent associated impairments in memory function are mediated via differential methylation of the six CCU-associated CpG sits. Six identified CpG are located in genes previously described in the context of neurodegeneration, hippocampus-dependent learning and neurogenesis. However, these results have to be carefully interpreted due to a small sample size. Replication studies are warranted.
ErbB2/Her2-dependent downregulation of a cell death-promoting protein BLNK in breast cancer cells is required for 3D breast tumor growth
Authors: Liu Xiaoyang , Chipurupalli Sandhya , Jiang Peijia , Tavasoli Mahtab , Yoo Byong Hoon , McPhee Michael , Mazinani Sina , Francia Giulio , Kerbel Robert S. , Rosen Kirill V.
Published: August 2022

A significant proportion of breast cancers are driven by ErbB2/Her2 oncoprotein that they overexpress. These malignancies are typically treated with various ErbB2-targeted drugs, but many such cancers develop resistance to these agents and become incurable. Conceivably, treatment of ErbB2-positive cancers could be facilitated by use of agents blocking oncogenic signaling mechanisms downstream of ErbB2. However, current understanding of these mechanisms is limited. The ability of solid tumor cells to resist anoikis, cell death triggered by cell detachment from the extracellular matrix (ECM), is thought to be critical for 3D tumor growth. In an effort to understand the mechanisms of ErbB2-driven breast cancer cell anoikis resistance we found that detachment of non-malignant breast epithelial cells from the ECM upregulates a cell death-promoting tumor suppressor adapter protein BLNK and that ErbB2 blocks this upregulation by reducing tumor cell levels of transcription factor IRF6. We further observed that trastuzumab, a therapeutic anti-ErbB2 antibody, upregulates BLNK in human trastuzumab-sensitive but not trastuzumab-resistant ErbB2-positive breast cancer cells. Moreover, we established that BLNK promotes anoikis by activating p38 MAP kinase and that ErbB2-dependent BLNK downregulation blocks breast cancer cell anoikis. In search for pharmacological approaches allowing to upregulate BLNK in tumor cells we found that clinically approved proteasome inhibitor bortezomib upregulates IRF6 and BLNK in human breast cancer cells and inhibits their 3D growth in a BLNK-dependent manner. In addition, we found that BLNK upregulation in human ErbB2-positive breast cancer cells blocks their ability to form tumors in mice. Furthermore, we used publicly available data on mRNA levels in multiple breast cancers to demonstrate that increased BLNK mRNA levels correlate with increased relapse-free survival in a cohort of approximately 400 patients with ErbB2-positive breast cancer. In summary, we discovered a novel mechanism of ErbB2-driven 3D breast tumor growth mediated by ErbB2-dependent BLNK downregulation.
Structural and dynamic mechanisms of GABAA receptor modulators with opposing activities
Authors: Zhu Shaotong , Sridhar Akshay , Teng Jinfeng , Howard Rebecca J. , Lindahl Erik , Hibbs Ryan E.
Published: August 2022

γ-Aminobutyric acid type A (GABAA) receptors are pentameric ligand-gated ion channels abundant in the central nervous system and are prolific drug targets for treating anxiety, sleep disorders and epilepsy. Diverse small molecules exert a spectrum of effects on γ-aminobutyric acid type A (GABAA) receptors by acting at the classical benzodiazepine site. They can potentiate the response to GABA, attenuate channel activity, or counteract modulation by other ligands. Structural mechanisms underlying the actions of these drugs are not fully understood. Here we present two high-resolution structures of GABAA receptors in complex with zolpidem, a positive allosteric modulator and heavily prescribed hypnotic, and DMCM, a negative allosteric modulator with convulsant and anxiogenic properties. These two drugs share the extracellular benzodiazepine site at the α/γ subunit interface and two transmembrane sites at β/α interfaces. Structural analyses reveal a basis for the subtype selectivity of zolpidem that underlies its clinical success. Molecular dynamics simulations provide insight into how DMCM switches from a negative to a positive modulator as a function of binding site occupancy. Together, these findings expand our understanding of how GABAA receptor allosteric modulators acting through a common site can have diverging activities.
NiPS3 ultrathin nanosheets as versatile platform advancing highly active photocatalytic H2 production
Authors: Ran Jingrun , Zhang Hongping , Fu Sijia , Jaroniec Mietek , Shan Jieqiong , Xia Bingquan , Qu Yang , Qu Jiangtao , Chen Shuangming , Song Li , Cairney Julie M. , Jing Liqiang , Qiao Shi-Zhang
Published: August 2022

High-performance and low-cost photocatalysts play the key role in achieving the large-scale solar hydrogen production. In this work, we report a liquid-exfoliation approach to prepare NiPS3 ultrathin nanosheets as a versatile platform to greatly improve the light-induced hydrogen production on various photocatalysts, including TiO2, CdS, In2ZnS4 and C3N4. The superb visible-light-induced hydrogen production rate (13,600 μmol h−1 g−1) is achieved on NiPS3/CdS hetero-junction with the highest improvement factor (~1,667%) compared with that of pure CdS. This significantly better performance is attributed to the strongly correlated NiPS3/CdS interface assuring efficient electron-hole dissociation/transport, as well as abundant atomic-level edge P/S sites and activated basal S sites on NiPS3 ultrathin nanosheets advancing hydrogen evolution. These findings are revealed by the state-of-art characterizations and theoretical computations. Our work for the first time demonstrates the great potential of metal phosphorous chalcogenide as a general platform to tremendously raise the performance of different photocatalysts.
A single-cell atlas of the multicellular ecosystem of primary and metastatic hepatocellular carcinoma
Authors: Lu Yiming , Yang Aiqing , Quan Cheng , Pan Yingwei , Zhang Haoyun , Li Yuanfeng , Gao Chengming , Lu Hao , Wang Xueting , Cao Pengbo , Chen Hongxia , Lu Shichun , Zhou Gangqiao
Published: August 2022

Hepatocellular carcinoma (HCC) represents a paradigm of the relation between tumor microenvironment (TME) and tumor development. Here, we generate a single-cell atlas of the multicellular ecosystem of HCC from four tissue sites. We show the enrichment of central memory T cells (TCM) in the early tertiary lymphoid structures (E-TLSs) in HCC and assess the relationships between chronic HBV/HCV infection and T cell infiltration and exhaustion. We find theMMP9+macrophages to be terminally differentiated tumor-associated macrophages (TAMs) and PPARγ to be the pivotal transcription factor driving their differentiation. We also characterize the heterogeneous subpopulations of malignant hepatocytes and their multifaceted functions in shaping the immune microenvironment of HCC. Finally, we identify seven microenvironment-based subtypes that can predict prognosis of HCC patients. Collectively, this large-scale atlas deepens our understanding of the HCC microenvironment, which might facilitate the development of new immune therapy strategies for this malignancy.
Superconductivity from energy fluctuations in dilute quantum critical polar metals
Authors: Volkov Pavel A. , Chandra Premala , Coleman Piers
Published: August 2022

Superconductivity in low carrier density metals challenges the conventional electron-phonon theory due to the absence of retardation required to overcome Coulomb repulsion. Here we demonstrate that pairing mediated by energy fluctuations, ubiquitously present close to continuous phase transitions, occurs in dilute quantum critical polar metals and results in a dome-like dependence of the superconducting Tc on carrier density, characteristic of non-BCS superconductors. In quantum critical polar metals, the Coulomb repulsion is heavily screened, while the critical transverse optical phonons decouple from the electron charge. In the resulting vacuum, long-range attractive interactions emerge from the energy fluctuations of the critical phonons, resembling the gravitational interactions of a chargeless dark matter universe. Our estimates show that this mechanism may explain the critical temperatures observed in doped SrTiO3. We provide predictions for the enhancement of superconductivity near polar quantum criticality in two- and three-dimensional materials that can be used to test our theory.
Insights into the activity of nickel boride/nickel heterostructures for efficient methanol electrooxidation
Authors: Qi Yanbin , Zhang Yue , Yang Li , Zhao Yuhan , Zhu Yihua , Jiang Hongliang , Li Chunzhong
Published: August 2022

Designing efficient catalysts and understanding the underlying mechanisms for anodic nucleophile electrooxidation are central to the advancement of electrochemically-driven technologies. Here, a heterostructure of nickel boride/nickel catalyst is developed to enable methanol electrooxidation into formate with a Faradaic efficiency of nearly 100%. Operando electrochemical impedance spectroscopy and in situ Raman spectroscopy are applied to understand the influence of methanol concentration in the methanol oxidation reaction. High concentrations of methanol inhibit the phase transition of the electrocatalyst to high-valent electro-oxidation products, and electrophilic oxygen species (O* or OH*) formed on the electrocatalyst are considered to be the catalytically active species. Additional mechanistic investigation with density functional theory calculations reveals that the potential-determining step, the formation of *CH2O, occurs most favorably on the nickel boride/nickel heterostructure rather than on nickel boride and nickel. These results are highly instructive for the study of other nucleophile-based approaches to electrooxidation reactions and organic electrosynthesis.
Metagenome sequencing and 768 microbial genomes from cold seep in South China Sea
Authors: Zhang Huan , Wang Minxiao , Wang Hao , Chen Hao , Cao Lei , Zhong Zhaoshan , Lian Chao , Zhou Li , Li Chaolun
Published: August 2022

Cold seep microbial communities are fascinating ecosystems on Earth which provide unique models for understanding the living strategies in deep-sea distinct environments. In this study, 23 metagenomes were generated from samples collected in the Site-F cold seep field in South China Sea, including the sea water closely above the invertebrate communities, the cold seep fluids, the fluids under the invertebrate communities and the sediment column around the seep vent. By binning tools, we retrieved a total of 768 metagenome assembled genome (MAGs) that were estimated to be >60% complete. Of the MAGs, 61 were estimated to be >90% complete, while an additional 105 were >80% complete. Phylogenomic analysis revealed 597 bacterial and 171 archaeal MAGs, of which nearly all were distantly related to known cultivated isolates. In the 768 MAGs, the abundant Bacteria in phylum level included Proteobacteria, Desulfobacterota, Bacteroidota, Patescibacteria and Chloroflexota, while the abundant Archaea included Asgardarchaeota, Thermoplasmatota, and Thermoproteota. These results provide a dataset available for further interrogation of deep-sea microbial ecology.
Characterization, stability, and feasibility of long-term use of light-absorbing components of aqueous spinach extract-based photogalvanic electrolyte
Authors: Koli Pooran
Published: August 2022

In the present work, the photogalvanic cells have been studied with respect to the photo-stability and the long-term use of the electrolyte based on crude aqueous spinach extract sensitizer for solar energy harvesting. Further, the nature of chemical components present in the old and photo-decayed electrolyte and their current generation capacity has also not been investigated so far otherwise it is of much significance for durable use of the same electrolyte in cells. In earlier studies, the steady-state photo-generation of current for about two hours from crude spinach extract-based cell has been shown during illumination. But, the data for only two hours of the steady-state current generation is not sufficient to show the feasibility of working with photogalvanic cells. Therefore, to fill this research gap of lack of characterization of sensitizers’ molecules of crude spinach extract and lack of study on long-term use of this electrolyte (crude spinach extract-surfactant-reductant-alkali-water), the present extensive study has been done. The observed spectrum of crude spinach extract resembles that of chlorophyll–protein complex showing it is the main chemical component in extract absorbing light. A strong acid adversely affects the extract’s photogalvanics and high pH is friendly to the physiological and photogalvanic activity of the extract. The spectra of illuminated and very old crude spinach extract-NaOH-Sodium lauryl sulfate (NaLS)-Fructose photogalvanic electrolyte solution show negligible absorbance (540–700 nm) and zero absorbance (at 700 nm) suggesting the absence of chlorophyll due to its photo-degradation. When this photo-degraded electrolyte is again illuminated, the power output obtained is nearly equal to that for the first time illuminated fresh electrolyte. The observed current at zero time and after 2641 h from the same electrolyte used in long term is 50 mA cm−2 and 40 mA cm−2, respectively. It means that the fresh crude spinach extract, as well as the photo-degraded extract at high pH, are almost equally capable of power generation.
Subtle metal(ii) effects of 2D coordination networks on SCSC guest exchange
Authors: Kim Gyeongwoo , Kim Gyeongmin , Kim Dongwon , Jung Ok-Sang
Published: August 2022

The multi-channel crystals consisting of 2-D networks G@[M(NO3)2L] are an unusually efficient, tolerant, and reproducible matrix offering M-dependent adsorption/desorption of various guest molecules in the single-crystal-to-single-crystal mode.
Computational investigation of van der Waals corrections in the adsorption properties of molecules on the Cu(111) surface
Authors: Bartaquim Eduardo O. , Bezerra Raquel C. , Bittencourt Albert F. B. , Da Silva Juarez L. F.
Published: August 2022

Computational investigation on the role of common van der Waals corrections (D2, D3, D3(BJ), TS, TS+SCS, TS+HI, and dDsC) in DFT calculations using PBE functional to improve the description of the interaction between molecules and solid surfaces.
From A3/KA2to AYA/KYA multicomponent coupling reactions with terminal ynamides as alkyne surrogates – a direct, green route to γ-amino-ynamides
Authors: Schlimpen Fabian , Ast Tun , Bénéteau Valérie , Pale Patrick , Chassaing Stefan
Published: August 2022

A copper-catalysed three-component coupling reaction between a carbonyl derivative, a terminal ynamide and an amine has been developed for the one-pot construction of γ-amino-ynamides under mild and environmentally-friendly conditions.
Advances in solid-phase peptide synthesis in aqueous media (ASPPS)
Authors: Jaradat Da'san M. M. , Al Musaimi Othman , Albericio Fernando
Published: August 2022

Technologies to enable Aqueous Solid-Phase Peptide Synthesis (ASPPS).
Tandem Michael addition/elimination – novel reactivity of pyridinium ylides in reaction with electron-deficient alkenes
Authors: Izmest'ev Alexei N. , Motornov Vladimir A. , Vinogradov Dmitry B. , Ioffe Sema L. , Kravchenko Angelina N. , Gazieva Galina A.
Published: August 2022

Novel reactivity of pyridinium ylides in reaction with 4-oxothiazolidin-5-ylidenes as electron-deficient alkenes involving a tandem Michael addition/elimination process was developed to give double bond functionalization products in mild conditions.
Conjugated branch modulated optical characteristics of multibranched push–pull molecules composed of quinoxaline and triphenylamine groups: transition of the conjugated branch from unusual effects to usual effects
Authors: Wang Quan , Liu Jiatian , Gao Xiujun , Sui Ning , Zhang Hanzhuang , Lu Ran , Zhang Jiaqi , Wang Yinghui
Published: August 2022

In order to improve the optoelectronic performance of π-conjugated molecules with electronic donors and electronic acceptors, people often choose multi-branch molecule structures, which can enhance the charge transfer ability.
On representation formulas for optimal control: A Lagrangian perspective
Authors: Kim Yeoneung , Yang Insoon
Published: August 2022

This paper studies the representation formulas for finite‐horizon optimal control problems with or without state constraints, unifying two different viewpoints: the Lagrangian and dynamic programming frameworks. In a recent work by Lee and Tomlin [1], the generalised Lax formula is obtained via dynamic programming for optimal control problems with state constraints and non‐linear systems. We revisit the formula from the Lagrangian perspective to provide a unified framework for understanding and implementing the non‐trivial representation of the value function. Our simple derivation makes direct use of the Lagrangian formula from the theory of Hamilton–Jacobi equations. We also discuss a rigorous way to construct an optimal control using a δ‐net, as well as a numerical scheme for controller synthesis via convex optimisation.
Centralized optimal management of a smart distribution system considering the importance of load reduction based on prioritizing smart home appliances
Authors: Sanaei Salman , Haghifam Mahmud‐Reza , Safdarian Amir
Published: August 2022

The distribution system's economic operation is significantly impacted by the management of distributed generation (DG) resources, energy storage (ES), and controllable loads. The paper employs a smart distribution system that incorporates dispatchable and non‐dispatchable DG resources, as well as battery storage, in addition to the demand response (DR) scheme. New modelling was performed in hourly steps to achieve the optimal unit commitment. In smart homes, appliances are prioritized and classified into four types: adjustable, interruptible, shiftable, and uncontrollable loads. Load reduction in smart homes is also considered based on load prioritization and customer participation in the DR scheme to achieve the proposed scheme's objectives. The proposed method considers costs associated with microturbines (MTs), including manufacturing, start‐up, shutdown, and pollution. Additionally, planning is conducted to purchase or sell electricity to the upstream network. The simulation is run on an IEEE 33‐bus system to demonstrate the proposed method's effectiveness. The system is assumed to be capable of operation in both island and grid‐connected modes. The results demonstrate the proposed approach's efficacy in load reduction, operation cost, and execution time.
An integral backstepping controller design for compensated distribution networks with rapid earth fault current limiters in bushfire prone areas
Authors: Roy Tushar Kanti , Mahmud Md Apel , Roy Naruttam Kumar
Published: August 2022

This paper presents a nonlinear integral backstepping controller (I‐BSC) design scheme for a T‐type residual current compensation (RCC) inverter used in compensated distribution networks with rapid earth fault current limiters (REFCLs). The major control task for the proposed scheme is to reduce the fault current to a value suitable for the mitigation of powerline bushfires due to single phase‐to‐ground faults in compensated distribution networks. The key distinct feature of the proposed I‐BSC over the traditional backstepping controller (T‐BSC) is that it introduces an integral action for analyzing the dynamic of the tracking error which minimizes its steady‐state value and ensures better dynamic performance. In order to prove the global asymptotic stability of the RCC inverter with the proposed integral backstepping controller (I‐BSC), the Lyapunov function‐based theory is used. Finally, the performance of the I‐BSC is analyzed on the MATLAB/Simulink environment and compared with a T‐BSC. The performance of both I‐ and T‐BSCs is assessed in terms of transient behaviors of the injected current to the neutral, fault current, and line‐to‐ground voltage of the faulty phase to ensure the standard operational criteria for self‐extinguishing powerline bushfires. Simulation results clearly demonstrate that both controllers fulfill operational standards for REFCL‐compensated networks though the I‐BSC archives better transient behaviors while comparing with the T‐BSC. Results from the processor‐in‐loop (PIL) validations are also included to further justify the applicability of the newly proposed scheme in the real‐time environment.
Opportunistic offloading scheme for content delivery service using electro‐mobility networks
Authors: Kyung Yeunwoong , Kim Eunchan , Song Taewon
Published: August 2022

Vehicular caching (VC) in electro‐mobility networks has become promising for supporting the needs of low end‐to‐end service delays and reducing the load of networks (i.e. edge caching [EC]) for content delivery service. However, since VCs are available only when they are in the vicinity of the user, intermittent connectivity should be considered. In this paper, the opportunistic offloading scheme for content delivery service is proposed, and a decision is made regarding whether to use VC or EC for the content delivery service. In the proposed scheme, when VC is not available, the user determines whether to choose VC or EC for the content download. If VC is chosen, the user delays the content download to increase the VC utilization according to the expectation of VC contacts. This results in the delayed service completion but can reduce the EC load (i.e. offloading gain). If EC is chosen, the user can download the content without any delay or service interruption. To find the optimal policy, this paper formulates a Markov decision process (MDP) problem and uses the value iteration algorithm to solve the problem. The evaluation results show that the proposed scheme outperforms the comparison schemes based on the expected reward.
Optimal control for a bone metastasis with radiotherapy model using a linear objective functional
Authors: Camacho A. , Díaz-Ocampo E. , Jerez S.
Published: August 2022

Radiation is known to cause genetic damage to highly proliferative cells such as cancer cells. However, the radiotherapy effects to bone cells is not completely known. In this work we present a mathematical modeling framework to test hypotheses related to the radiation-induced effects on bone metastasis. Thus, we pose an optimal control problem based on a Komarova model describing the interactions between cancer cells and bone cells at a single site of bone remodeling. The radiotherapy treatment is included in the form of a functional which minimizes the use of radiation using a penalty function. Moreover, we are interested to model the ‘on’ and the ‘off’ time states of the radiation schedules; so we propose an optimal control problem with a L
1-type objective functional. Bang-bang or singular arc solutions are the obtained optimal control solutions. We characterize both solutions types and explicitly give necessary optimality conditions for them. We present numerical simulations to analyze the different possible radiation effects on the bone and cancer cells. We also evaluate the more significant parameters to shift from a bang-bang solution to a singular arc solution and vice versa. Additionally, we study a fractionated radiotherapy model that yields an output solution that resembles intermittent radiotherapy scheduling.
Hidden Cardiovascular Anatomy in “Saint John the Baptist” by Leonardo da Vinci
Authors: Keshelava Grigol
Published: August 2022

Leonardo da Vinci conducted many anatomical studies during his life. Today, almost the complete set of these anatomical drawings and comments is owned by the British Crown and resides in the Royal Library at Windsor Castle, United Kingdom.

Through the program Paint X, we moved two details on the painting “Saint John the Baptist.” The moving details are circled along the faint contour by Leonardo da Vinci himself. We obtained heart and aortic arch imaging.
Homograft Versus Valves and Valved Conduits for Extensive Aortic Valve Endocarditis with Aortic Root Involvement/Destruction: A Systematic Review and Meta-Analysis
Authors: Williams Michael L. , Brookes John D. L. , Jaya Joseph S. , Tan Eren
Published: August 2022

Aortic valve infective endocarditis is a life-threatening condition. Patients frequently present profoundly unwell and extensive surgery may be required to correct the underlying anatomical deficits and control sepsis. Periannular involvement occurs in more than 10% of patients with aortic valve endocarditis. Complex aortic valve endocarditis has a mortality rate of 10 to 40%. Longstanding surgical dogma suggests homografts represent the optimal replacement option in complex aortic valve endocarditis; however, there is a paucity of evidence and lack of consensus on the optimal replacement choice. A systematic review and meta-analysis was performed utilizing EMBASE, PubMed, and the Cochrane databases to review articles describing homografts versus aortic valve replacement and/or valved conduit graft implantation for complex aortic valve endocarditis. The outcomes of interest were mortality, reinfection, and reoperation. Eleven studies were included in this meta-analysis, contributing 810 episodes of complex aortic valve endocarditis. All included reports were cohort studies. There was no statistically significant difference in overall mortality (risk ratio [RR] 0.99; 95% confidence interval [CI], 0.61–1.59; p = 0.95), reinfection (RR 0.89; 95% CI, 0.45–1.78; p = 0.74), or reoperation (RR 0.91; 95% CI, 0.38–2.14; p = 0.87) between the homograft and valve replacement/valved conduit graft groups. Overall, there was no difference in mortality, reinfection, or reoperation rates between homografts and other valve or valved conduits in management of complex aortic endocarditis. However, there is a paucity of high-quality evidence in the area, and comparison of valve types warrants further investigation.
Multiple Parallel Grafts for Urgent Endovascular Repair of a Ruptured Mycotic Aortic Aneurysm
Authors: Xodo Andrea , Piazza Michele , Taglialavoro Jacopo , Zavatta Marco , Grego Franco , Antonello Michele
Published: August 2022

A 73-year-old woman underwent urgent endovascular repair of a ruptured mycotic aortic aneurysm. A thoracic stent graft was employed as the main endograft, while the celiac trunk and superior mesenteric artery were revascularized by the chimney technique and the renal arteries through the periscope technique. Postoperative computed tomography revealed a Type A1 gutter, treated by detachable coils and peripheral occlusion devices. Six-month follow-up revealed patency of the stent grafts, without endoleak or stent graft infection signs.
Geometric Analysis of Complex Endovascular Treatment of a Successfully Completed Residual Post-Type A Aortic Dissection
Authors: Finotello Alice , Pane Bianca , Di Bartolo Mauro , Del Pizzo Rachele , Mambrini Simone , Pratesi Giovanni , Spinella Giovanni
Published: August 2022

We describe a case of complex multistep endovascular treatment of a post-Type A thoracoabdominal dissected aneurysm. Volume analysis documents true and false lumen improvements during follow-up. Centerline tortuosity of the aorta and of the iliac arteries straightens after endovascular treatment completion. In addition, analysis of stent-graft remodeling reveals the stent-graft tendency to spring back to its original status together with a caudal migration of the fenestrated body.
Clinical Experience with “Stand-Alone” Elephant Trunk Procedure for Descending Aortic Aneurysms
Authors: Kumbasar Ulas , Zafar Mohammad A. , Ziganshin Bulat A. , Elefteriades John A.
Published: August 2022

Background Both open and endovascular treatments of descending thoracic aortic aneurysms require a secure proximal landing zone. This may be difficult to achieve when the dilatation extends proximally to the left subclavian level. Clamping above the aneurysm may be difficult. In the case of an endovascular approach, achieving a suitable landing zone may require extensive extra-anatomic debranching, which is not without complications and limitations.

Methods We describe a modification of the traditional elephant trunk procedure that represents a “stand-alone” elephant trunk. Under deep hypothermic circulatory arrest, the aorta is transected between the left carotid and left subclavian arteries. A simple, noninverted elephant trunk is placed through the distal cut aorta. The two ends are sewn back together, incorporating the lip of the elephant trunk in the anastomosis. We review our experience in five patients who underwent this procedure.

Results All 5 patients (4 males, 1 female) aged 41 to 68 (mean, 57 years) tolerated the Stage 1 stand-alone elephant trunk procedure well, without mortality, stroke, or bleeding. The Stage 2 descending aortic replacements were performed at a mean of 6.7 months after Stage 1. There was no Stage 2 mortality, stroke, or bleeding. One patient died 8 years later of cardiac cause, and the remaining are alive and well.

Conclusion A stand-alone elephant trunk procedure is safe and straightforward and provides an excellent proximal foundation for subsequent open (or potentially endovascular) descending aortic replacement.
Differences in Aortic Histopathology in Patients Undergoing Valve Reimplantation Surgery for Various Clinical Syndromes
Authors: Tucker Nicholas J. , Eitan Tal , Yoon Justin G. , Rosinski Bradley F. , Rodriguez E. Rene , Tan Carmela D. , Svensson Lars G.
Published: August 2022

Objectives The study aims to investigate aortic histopathologic differences among patients undergoing aortic valve reimplantation, suggest different mechanisms of aortic root aneurysm pathogenesis, and identify factors associated with long-term success of reimplantation.

Methods From 2006 to 2017, 568 adults who underwent reimplantation for repair of aortic root aneurysm, including patients with tricuspid aortic valves with no connective tissue disease (TAV/NoCTD, n = 314/568; 55.3%), bicuspid aortic valves (BAVs, n = 86/568; 15.1%), or connective tissue disease (CTD, n = 177/568; 31.2%), were compiled into three comparison groups. Patients with both BAV and CTD (n = 9/568; 1.6%) were omitted to increase study power. Patient records were analyzed retrospectively, focusing on pathology reports, which were available for 98.42% of patients, and were classified based on their descriptions of aortic tissue samples, primarily from the noncoronary sinus. Mean follow-up time available for patients was 2.97 years.

Results Aortitis, medial fibrosis, and smooth muscle loss were more common histopathologic findings in patients with TAV/NoCTD than in patients with BAV and CTD (p < 0.05). Cystic medial degeneration was most often found in patients with CTD, then TAV/NoCTD, and least in BAV (p < 0.01). Increases in mucopolysaccharides were found more often in the BAV group than in the TAV/NoCTD and CTD groups (p < 0.01). There were no differences in the frequency of elastic laminae fragmentation/loss across these three groups. Among all patients, 1.97% (n = 11/559) had an unplanned reintervention on the aortic valve after reimplantation, but no significant demographic or histopathologic differences were identified.

Conclusion Despite some common histopathologic features among patients undergoing aortic valve reimplantation, there were enough distinguishing features among aortic tissue samples of TAV/NoCTD, BAV, and CTD patients to suggest that these groups develop root aneurysms by different mechanisms. No histopathologic features were able to predict the need for late reintervention on the aortic valve.
Comparison of Outcomes of Patients Undergoing Reimplantation versus Bentall Root Procedure
Authors: Svensson Lars G. , Rosinski Brad F. , Tucker Nicholas J. , Gillinov A. Marc , Rajeswaran Jeevanantham , Roselli Eric E. , Johnston Douglas R. , Desai Milind Y. , Griffin Brian P. , Blackstone Eugene H.
Published: August 2022

Background A bioprosthesis- or mechanical-prosthesis–containing polyester graft (composite graft) is standard surgical management for aortic root aneurysms (Bentall procedure), but particularly in the young patient in whom a bioprosthesis is likely to deteriorate and a mechanical prosthesis mandates life-long anticoagulation, valve-sparing procedures have been devised. One such procedure involves reimplantation of the native aortic valve in the polyester graft. With focus on selecting the optimum procedure for young relatively asymptomatic patients, we compared outcomes of reimplantation of the aortic valve versus the Bentall procedure and identified factors influencing outcomes.

Methods From January 2000 to January 2017, 643 adults age ≤ 70 with tricuspid aortic valves underwent elective aortic root replacement with either reimplantation (n = 448/70%) or a composite valve graft (Bentall) procedure (n = 195/30%). Outcomes were compared in 100 propensity-matched pairs.

Results Patients with fewer symptoms, less aortic regurgitation (AR), higher left ventricular ejection fraction, and smaller cross-sectional aortic area/height ratio had a higher likelihood of valve repair with reimplantation (all p < 0.02) versus receiving a Bentall procedure. Operative mortality was 0.16% (reimplantation, 1/448, 0.22%; Bentall 0/195, 0%). After reimplantation, 8-year freedom from severe AR was 95% and 10-year freedom from reintervention was 98%. Ten-year survival was 95%. Higher preoperative AR grade (p < 0.0001) but not larger root diameter (p = 0.3) was associated with higher grade of late regurgitation after a reimplantation procedure. Among propensity-matched patients, reimplantation compared with a Bentall was associated with similar 10-year survival (89% vs. 94%), but more late AR (8-year freedom from severe AR: 93% vs. 99.9%) and greater early reduction in, but similar late, left ventricular mass (104 vs. 105 g•m–2 at 8 years).

Conclusion Excellent aortic valve reimplantation results versus Bentall lead us to recommend reimplantation more often in patients who present with even moderately severe or severe AR and significantly enlarged aortic roots.
Effect of Emotional Valence on Working Memory of Psychogenic Non-Epileptic Seizures (PNES) Patients
Authors: Singh Priyesh K. , Chaurasia Rameshwar Nath , Pratap Sujeet , Tiwari Trayambak , Mishra Vijay N. , Singh Tara
Published: August 2022

Background The present study investigated how emotional valence influenced the working memory of patients with psychogenic non-epileptic seizures (PNES) as compared to healthy individuals.

Methods Emotional-N-Back task (E-N-back task) was administered to 15 PNES patients and equal number of healthy individuals. A 2 × 3 one-way analysis of variance (ANOVA) was used. Correct detection (accuracy) and reaction (RT) time were recorded as behavioral performance measures.

Results The ANOVA result of correct detection (accuracy) measure revealed significant difference in the performance of patients with PNES as compared with healthy individual,F(2, 48) = 17.08,p = 0.001. However, on the measure of reaction time (RT), both groups performed equally and there was no significant difference,F(2, 48) = 1.13,p = 0.33. Also the results of present study showed that patients with PNES are quicker in identifying unpleasant picture stimuli, which is evident from their mean comparison: unpleasant (M = 65.55,SD = 15.66), pleasant (M = 58.22,SD = 20.03), and neutral (M = 45.11,SD = 23.13).

Conclusion Conclusively, the finding of the present study shows a significant effect of emotional valence on working memory of patients with PNES on the measure of correct detection (accuracy), but not for second measure, i.e., reaction time this clearly reveals that patients with PNES are poor at emotional–cognitive integration, specifically at working memory level.
A Sporadic Cisternal Cystic Oculomotor Schwannoma—Case Report and Review of Literature
Authors: Murali Sanjay Honavalli , Gohil Jaypalsinh , Easwer H. V.
Published: August 2022

Schwannoma arising from a pure motor cranial nerve in sporadic cases is a rare finding. We report adult female patient presented with a seizure without oculomotor palsy. On evaluation, she was diagnosed with cystic oculomotor schwannoma and underwent surgery. She developed oculomotor palsy postoperatively. Here, we describe a rare sporadic cystic oculomotor schwannoma.
Effect of Preanesthetic Fluid Loading on Postinduction Hypotension and Advanced Cardiac Parameters in Patients with Chronic Compressive Cervical Myelopathy: A Randomized Controlled Trial
Authors: Paul Anto , Sriganesh Kamath , Chakrabarti Dhritiman , Reddy K. R. Madhusudan
Published: August 2022

Purpose Hypotension during the early intraoperative phase is common and can lead to adverse perioperative outcomes. Fluid preloading is one of the methods to limit its occurrence. Patients with chronic compressive cervical myelopathy may have autonomic dysfunction, which can aggravate hemodynamic alterations during anesthesia. This study compared the occurrence of postinduction hypotension and changes in cardiac dynamic indices in patients with and without crystalloid preloading undergoing decompressive cervical spine surgery.

Methods This randomized controlled trial was conducted over 15 months after obtaining patient consent, approval of the institute ethics committee, and trial registration. We compared preanesthetic fluid loading with Ringer's lactate (20 mL/kg over 30 minutes) with no preloading (2 mL/kg/h maintenance) in 60 consecutive patients undergoing cervical spine surgery. The ANSiscope was used to determine baseline cardiac autonomic function. Noninvasive cardiac output monitor was used to assess changes in heart rate, mean arterial pressure, cardiac index (CI), stroke volume variation (SVV), and total peripheral resistance index during study intervention, anesthetic induction, tracheal intubation, and change in position from supine to prone.

Results The incidences of postinduction hypotension were 26.7% (8/30) and 86.7% (26/30) and the median doses of mephentermine used were 0 and 6 mg, respectively, in patients with and without fluid preloading (both p < 0.001). Preloading resulted in improvement in CI, reduction in SVV, and lesser vasopressor use.

Conclusion Preloading reduced the occurrence of postinduction hypotension and vasopressor use, improved CI, and reduced SVV during the early intraoperative period.

Registration number of Clinical Trial The trial was registered with Clinical Trial Registry of India (CTRI/2018/07/014970 on 19/07/2018).
Determinants and Characteristics of the Violent Incidents in a Tertiary-Level Mental Health Care Center
Authors: Chongtham Virtu , Sharma Nitasha , Parashar Kantadorshi , Pandey Chandani
Published: August 2022

Background The Mental Health Care Act of India, 2017 has for the first time focused on violence management interventions, especially restraint and seclusion in psychiatric settings, and recommended important guidelines in this aspect.

Objective This situation has created a strong need to review the prevalence of violence in inpatient settings, associated clinical and social correlates keeping a preventive model in context. Hence, this study was undertaken to fulfill this need. Methods: A retrospective matched case–control chart review design was employed. All patients who exhibited at least one violent incident during their ward stay were included. For each case, the control was selected by individual matching based on age ± 2 years and gender from patients who were admitted during the study period but did not exhibit any violent incident. The information about the characteristics of violent incidents and management was also collected.

Results 8.80% of patients exhibited at least one incident of violence and a total of 186 violent incidents were recorded during the study period. Variables including involuntary admission, history of the previous admission, history of violence, impulsivity, lack of insight, and irritability at the time of admission significantly predicted the likelihood of violent incidents. The use of chemical restraining was the most common method of management of violent incidents.

Conclusion Violent incidents in psychiatric inpatient settings are still common. Efforts should be made to understand the risk as well as antecedent factors well in time. Verbal de-escalation should be employed and chemical and physical restraint should be used only as a last resort after exhausting the least restrictive interventions.
Nuances of Septal Deviation Repair
Authors: Abrol Anish , Lu G. Nina
Published: August 2022

Septoplasty is one of the most common procedures performed by facial plastic surgeons. Surgical decision-making surrounding septal deviation repair centers around the location of deviation and need for dorsal and/or caudal septal correction. Endonasal approaches are often adequate and external approaches are utilized for significant L-strut involvement. For severe deformities, extracorporeal septoplasty and anterior septal reconstruction can be utilized. We present an overview of septal deviation repair with technical nuances and advanced reconstruction techniques.
Embolization of the Middle Meningeal Artery for the Treatment of Chronic Subdural Hematoma: A Path Less Travelled So Far
Authors: Sarma Pragyan , Garg Manish , Prem Prashant , Gupta Rahul
Published: August 2022

Introduction Chronic subdural hematoma (CSDH) is relatively common and usually encountered in elderly population. With steady increase in life expectancy, incidence of CSDH also is bound to increase proportionately. Though surgery is the treatment of choice and relatively a simpler procedure, recurrence is a cause of concern. Embolization of the middle meningeal artery (MMA) is a newly evolving treatment modality in CSDH and offers hope in some of the recently published case series.

Materials and Methods Five cases of CSDH were subjected to embolization of MMA over a period from October 2019 to July 2020. Among them, it was employed for treatment in four cases after at least two recurrences following surgery, and in one case, it was done as the patient was not fit for surgery. All procedures were done under general anesthesia and polyvinyl alcohol (PVA) particles were used for embolization. Follow-up of the patients were done with computed tomography brain at 4 weeks and after 6 months of the procedure.

Results There was no incidence of recurrence in our series. Furthermore, embolization per se did not cause any complication or side effect which could be directly attributable to the procedure itself.

Conclusion In carefully selected patients based on clinical profile and angiographic findings, MMA embolization can be an effective modality for the treatment in CSDH.
Cranial Screw Migration along the Subdural Peritoneal Shunt Catheter in a Pediatric Patient
Authors: Baykoca-Arslan Buse , Belirgen Muhittin
Published: August 2022

Craniotomy is a common surgery used to expose the brain by removing a part of the bone from the skull. During surgery, bone flaps can be fixed by using variety of materials that can migrate in the long term. A 7-year-old boy presented several years after the craniotomy and subdural peritoneal (SP) shunt surgeries. It was decided to remove the shunt catheter, and during the diagnostic tests, we saw that a loosened titanium screw has migrated along the SP shunt catheter from the skull into the abdominal wall. To the best of our knowledge, this is the first case in the reported electronic literature for a pediatric patient with a subcutaneous migration of a screw along the shunt catheter.
Spectrum of Surgically Resected Lesions of the Cavernous Sinus: A Neuropathologic Audit
Authors: Nagaraja Chandrashekhar T. , Ramalingaiah Arvinda H. , Arimappamagan Arivazhagan , Mitra Saikat , Shukla Dhaval , Srinivas Dwarakanath , Krishna Shankar S. , Mahadevan Anita
Published: August 2022

Background The cavernous sinus is a complex space composed of extradural venous plexus within dural folds. Several important structures like the carotid artery, cranial nerves, and sympathetic nerve fibers traverse through this space. Radiological diagnosis may not be definitive and in the context of discordance between clinical and neuroimaging diagnosis, histopathological evaluation becomes essential for diagnosis and management. Literature on the pathological spectrum of lesions is scarce as, with a shift in the treatment paradigm, most small lesions of cavernous sinus are treated with radiosurgery. However, surgical management still plays a role for larger lesions and in radiologically ambiguous cases for planning the definitive management.

Materials and Methods We retrospectively reviewed all surgically resected lesions of the cavernous sinus over the last two decades (1998–2019). The clinical presentation, neuroimaging features, and histopathological findings were reviewed. Lesions extending from sella and other adjacent areas were excluded.

Results Thirty-eight cases of isolated cavernous sinus mass lesions were diagnosed over the last two decades (1998–2019). Cavernous hemangiomas (19 cases, 50%) constituted the most frequent pathology, followed by aspergilloma, meningioma, schwannoma, metastatic adenocarcinoma, chondrosarcoma, and chordoma. Overall, 29.4% (10/34) could not be accurately diagnosed on neuroimaging. Of these, four cases of cavernous hemangiomas were mistaken for either meningioma (three cases) or schwannoma (one case). Neither chordoma nor chondrosarcoma was suspected.

Conclusion This is the first study in literature, enumerating the pathological and imaging spectrum of surgically resected cavernous sinus lesions. Cavernous hemangiomas, metastases and chordomas, and chondrosarcoma posed the greatest difficulty in diagnosis on neuroimaging and the reasons for the same are analyzed. In the context of clinical and neuroimaging discordance in diagnosis, pathological characterization becomes essential for appropriate and timely management.