bluuebunny/crossref_metadata_2025 huggingface dataset:
Agricultural fallows are the main driver of natural forest regeneration in Tanzania
Authors: Doggart Nike , Mugasha Wilson Ancelm , Mpiri Aloyce , Morgan-Brown Theron , Sallu Susannah M , Spracklen Dominick V
Published: May 2023

Rates and drivers of natural forest regeneration are areas of uncertainty for policy, forest management and climate change mitigation. In this study, the rate of deforestation and the rate and drivers of natural regeneration are described for 56 million hectares of village land in Tanzania, a country undergoing rapid deforestation. To determine the regeneration and deforestation rates, remote sensing (RS) data for 500 randomly selected points were reviewed for a 34 year period from 1987 to 2021 using Google Earth Engine. Over this period, regeneration, involving a transition from forest to non-forest and back to forest was detected on 4.8% of village land (95% CI: 3.1%–7.1%), while 0.8% of land transitioned from non-forest to forest (95% CI: 0.2%–2.04%). 22% of village land was deforested (95% CI: 18.6%–26.1%), equivalent to a mean annual net loss of 0.35 million hectares of forest. Using a combination of RS data, field plots and structured interviews, the land cover change trajectories of 180 regenerating plots, in 10 sampling clusters, were assessed to identify regeneration drivers and assess biomass and tree species accumulation rates. Agricultural fallows are the regeneration driver in 47% of plots (95% CI: 39.8%–54.8%). Other common regeneration drivers include abandonment of cultivated areas for reasons apart from fallowing, conservation and post wood-extraction abandonment in 19% (95% CI: 13.9%–26%), 18.3% (95% CI: 13%–24.8%) and 12.8% (95% CI: 8.3%–18.6%) of plots, respectively. The mean carbon sequestration rate was 1.4 Mg C ha−1 y−1, equivalent to 4.3 Tg C y−1 (95% CI: 3.9–4.7 Tg C y−1) across the 3.15 million hectares of regenerating village land forest. The mean species accumulation rate was 1.08 species y−1 (95% CI: 1.0–1.2). Regeneration time, location and precipitation have the greatest influence on biomass and species richness. The study highlights the potential for natural regeneration to contribute to global and national climate and biodiversity goals and to sustainable, productive forest management. The importance of cooperation and policy-alignment between the forest, agriculture and land sectors are under-scored.
Revised Protocol for Secondary Prevention of Congenital Cytomegalovirus Infection With Valaciclovir Following Infection in Early Pregnancy
Authors: Amir Jacob , Chodick G , Pardo Joseph
Published: May 2023

Background

A previous randomized placebo-controlled study found valaciclovir to be effective in reducing the rate of vertical cytomegalovirus transmission from mother to fetus. The better results in women infected in the first trimester compared to the periconception period were attributed to the timing of treatment. The aim of the present study was to evaluate valaciclovir efficacy in this setting using a revised protocol.

Methods

All pregnant women treated with valaciclovir in 2020–2022 who met the same criteria as in the original study were identified retrospectively from the database of the same medical center. Treatment, however, was initiated earlier: up to 9 weeks or 8 weeks from the presumed time of infection in women infected in the periconception period or the first trimester, respectively. The primary endpoint was rate of vertical cytomegalovirus transmission. Results were compared with the placebo arm in the previous study.

Results

Among 178 women who completed valaciclovir treatment, amniocentesis was positive for cytomegalovirus in 14 women (7.9%), significantly (P < .001) lower compared with 14 of 47 (30%) in the placebo arm in the previous study. The proportion of positive amniocentesis in the valaciclovir was significantly lower than the placebo arm both among women infected in the first trimester (14/119 vs 11/23; odds ratio [OR] = 0.15; 95% confidence interval [CI]: .05–.45, P < .001), as well as among those infected in the periconception period (0/59 vs 3/24, OR = 0; 95% CI 0–.97, P = .02).

Conclusions

This study provides further evidence of the efficacy of valaciclovir in preventing vertical transmission of cytomegalovirus after primary maternal infection. Efficacy is improved with earlier treatment.
Combination of Amoxicillin 3000 mg and Probenecid Versus 1500 mg Amoxicillin Monotherapy for Treating Syphilis in Patients With Human Immunodeficiency Virus: An Open-Label, Randomized, Controlled, Non-Inferiority Trial
Authors: Ando Naokatsu , Mizushima Daisuke , Omata Kazumi , Nemoto Takashi , Inamura Natsumi , Hiramoto Saori , Takano Misao , Aoki Takahiro , Watanabe Koji , Uemura Haruka , Shiojiri Daisuke , Yanagawa Yasuaki , Tanuma Junko , Teruya Katsuji , Kikuchi Yoshimi , Gatanaga Hiroyuki , Oka Shinichi
Published: May 2023

Background

Amoxicillin plus probenecid is an alternative to intramuscular benzathine penicillin G for treating syphilis in the United Kingdom. Low-dose amoxicillin is an alternative treatment option used in Japan.

Methods

We conducted an open-label, randomized, controlled, non-inferiority trial between 31 August 2018, and 3 February 2022, to compare 1500 mg low-dose amoxicillin monotherapy with the combination of 3000 mg amoxicillin and probenecid (non-inferiority margin 10%). Patients with human immunodeficiency virus (HIV) infection and syphilis were eligible. The primary outcome was the cumulative serological cure rate within 12 months post-treatment, measured using the manual rapid plasma reagin card test. Secondary outcomes included safety assessment.

Results

A total of 112 participants were randomized into 2 groups. Serological cure rates within 12 months were 90.6% and 94.4% with the low-dose amoxicillin and combination regimens, respectively. Serological cure rates for early syphilis within 12 months were 93.5% and 97.9% with the low-dose amoxicillin and combination regimens, respectively. Non-inferiority of low-dose amoxicillin compared with amoxicillin plus probenecid overall and for early syphilis was not confirmed. No significant side effects were detected.

Conclusions

This is the first randomized controlled trial to demonstrate a high efficacy of amoxicillin-based regimens for treating syphilis in patients with HIV infection, and the non-inferiority of low-dose amoxicillin compared with amoxicillin plus probenecid was not seen. Therefore, amoxicillin monotherapy could be a good alternative to intramuscular benzathine penicillin G with fewer side effects. However, further studies comparing with benzathine penicillin G in different populations and with larger sample sizes are needed.

Trials Registration

(UMIN000033986).
Timesweeper: accurately identifying selective sweeps using population genomic time series
Authors: Whitehouse Logan S , Schrider Daniel R
Published: May 2023

Despite decades of research, identifying selective sweeps, the genomic footprints of positive selection, remains a core problem in population genetics. Of the myriad methods that have been developed to tackle this task, few are designed to leverage the potential of genomic time-series data. This is because in most population genetic studies of natural populations, only a single period of time can be sampled. Recent advancements in sequencing technology, including improvements in extracting and sequencing ancient DNA, have made repeated samplings of a population possible, allowing for more direct analysis of recent evolutionary dynamics. Serial sampling of organisms with shorter generation times has also become more feasible due to improvements in the cost and throughput of sequencing. With these advances in mind, here we present Timesweeper, a fast and accurate convolutional neural network-based tool for identifying selective sweeps in data consisting of multiple genomic samplings of a population over time. Timesweeper analyzes population genomic time-series data by first simulating training data under a demographic model appropriate for the data of interest, training a one-dimensional convolutional neural network on said simulations, and inferring which polymorphisms in this serialized data set were the direct target of a completed or ongoing selective sweep. We show that Timesweeper is accurate under multiple simulated demographic and sampling scenarios, identifies selected variants with high resolution, and estimates selection coefficients more accurately than existing methods. In sum, we show that more accurate inferences about natural selection are possible when genomic time-series data are available; such data will continue to proliferate in coming years due to both the sequencing of ancient samples and repeated samplings of extant populations with faster generation times, as well as experimentally evolved populations where time-series data are often generated. Methodological advances such as Timesweeper thus have the potential to help resolve the controversy over the role of positive selection in the genome. We provide Timesweeper as a Python package for use by the community.
Prospective Association Between Plasma Concentrations of Fatty Acids and Other Lipids, and Multimorbidity in Older Adults
Authors: Caballero Francisco Félix , Lana Alberto , Struijk Ellen A , Arias-Fernández Lucía , Yévenes-Briones Humberto , Cárdenas-Valladolid Juan , Salinero-Fort Miguel Ángel , Banegas José R , Rodríguez-Artalejo Fernando , Lopez-Garcia Esther
Published: May 2023

Biological mechanisms that lead to multimorbidity are mostly unknown, and metabolomic profiles are promising to explain different pathways in the aging process. The aim of this study was to assess the prospective association between plasma fatty acids and other lipids, and multimorbidity in older adults. Data were obtained from the Spanish Seniors-ENRICA 2 cohort, comprising noninstitutionalized adults ≥65 years old. Blood samples were obtained at baseline and after a 2-year follow-up period for a total of 1 488 subjects. Morbidity was also collected at baseline and end of the follow-up from electronic health records. Multimorbidity was defined as a quantitative score, after weighting morbidities (from a list of 60 mutually exclusive chronic conditions) by their regression coefficients on physical functioning. Generalized estimating equation models were employed to assess the longitudinal association between fatty acids and other lipids, and multimorbidity, and stratified analyses by diet quality, measured with the Alternative Healthy Eating Index-2010, were also conducted. Among study participants, higher concentrations of omega-6 fatty acids [coef. per 1-SD increase (95% CI) = −0.76 (−1.23, −0.30)], phosphoglycerides [−1.26 (−1.77, −0.74)], total cholines [−1.48 (−1.99, −0.96)], phosphatidylcholines [−1.23 (−1.74, −0.71)], and sphingomyelins [−1.65 (−2.12, −1.18)], were associated with lower multimorbidity scores. The strongest associations were observed for those with a higher diet quality. Higher plasma concentrations of omega-6 fatty acids, phosphoglycerides, total cholines, phosphatidylcholines, and sphingomyelins were prospectively associated with lower multimorbidity in older adults, although diet quality could modulate the associations found. These lipids may serve as risk markers for multimorbidity.
Pressure robust SUPG-stabilized finite elements for the unsteady Navier–Stokes equation
Authors: Beirão da Veiga L , Dassi F , Vacca G
Published: May 2023

In the present contribution, we propose a novel conforming finite element scheme for the time-dependent Navier–Stokes equation, which is proven to be both convection quasi-robust and pressure robust. The method is built combining a ‘divergence-free’ velocity/pressure couple (such as the Scott–Vogelius element), a discontinuous Galerkin in time approximation and a suitable streamline upwind Petrov–Galerkin-curl stabilization. A set of numerical tests, in accordance with the theoretical results, is included.
Sparse Kronecker product decomposition: a general framework of signal region detection in image regression
Authors: Wu Sanyou , Feng Long
Published: May 2023

This paper aims to present the first Frequentist framework on signal region detection in high-resolution and high-order image regression problems. Image data and scalar-on-image regression are intensively studied in recent years. However, most existing studies on such topics focussed on outcome prediction, while the research on region detection is rather limited, even though the latter is often more important. In this paper, we develop a general framework named Sparse Kronecker Product Decomposition (SKPD) to tackle this issue. The SKPD framework is general in the sense that it works for both matrices and tensors represented image data. Our framework includes one-term, multi-term, and nonlinear SKPDs. We propose nonconvex optimization problems for one-term and multi-term SKPDs and develop path-following algorithms for the nonconvex optimization. Under a Restricted Isometric Property, the computed solutions of the path-following algorithm are guaranteed to converge to the truth with a particularly chosen initialization even though the optimization is nonconvex. Moreover, the region detection consistency could also be guaranteed. The nonlinear SKPD is highly connected to shallow convolutional neural networks (CNN), particularly to CNN with one convolutional layer and one fully-connected layer. Effectiveness of SKPD is validated by real brain imaging data in the UK Biobank database.
Complete Genome Sequence Resource for Cercospora apii Causing Leaf Spot of Celery
Authors: Yang Lijuan , Gao Guoxun , Gao Wei , Zhang Chunxiang , Wu Feng , Huo Jianfei , Wang Yong
Published: May 2023

Cercospora apii is an important seedborne pathogenic fungus causing severe Cercospora leaf spot of celery worldwide. Here, we first present a complete genome assembly of C. apii QCYBC from celery, based on Illumina paired-end and PacBio long-read sequencing data. The high-quality genome assembly contains 34 scaffolds with a 34.81 Mb genome size, 330 interspersed repeat genes, 114 noncoding RNAs, and 12,631 protein-coding genes. The benchmarking universal single-copy ortholog (BUSCO) analysis indicated that 98.2% of the BUSCOs were complete, whereas 0.3, 0.7, and 1.1% were duplicated, fragmented, and missing, respectively. Based on annotation, 508 carbohydrate-active enzymes, 243 cytochromes P450 enzymes, 1,639 translocators, 1,358 transmembrane proteins, and 1,146 virulence genes were identified. This genome sequence provides a valuable reference for future studies to improve understanding of the C. apii–celery pathosystem.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Flagella-Driven Motility Is Critical to the Virulence of Xanthomonas fragariae in Strawberry
Authors: Liang Xia , Wei Feng , Yang Hongliang , Fan Li , Cai Xiaolin , Ma Yangyang , Shi Jiancheng , Xing Kun , Qiu Lijuan , Li Xixuan , Lu Lijuan , Ji Jie , Wen Yingqiang , Feng Jiayue
Published: May 2023

Xanthomonas fragariae (X. fragariae) is the causal agent of angular leaf spots (ALS) in strawberry plants. Recently, a study in China isolated X. fragariae strain YL19, which was observed to cause both typical ALS symptoms and dry cavity rot in strawberry crown tissue; this was the first X. fragariae strain to have both these effects in strawberry. In this study, from 2020 to 2022, we isolated 39 X. fragariae strains from diseased strawberries in different production areas in China. Multilocus sequence typing (MLST) and phylogenetic analysis showed that X. fragariae strain YLX21 was genetically different from YL19 and other strains. Tests indicated that YLX21 and YL19 had different pathogenicities toward strawberry leaves and stem crowns. YLX21 did not cause ALS symptoms, rarely caused dry cavity rot in strawberry crown after wound inoculation, and never caused dry cavity rot after spray inoculation, but it did cause severe ALS symptoms after spray inoculation. However, YL19 caused more severe symptoms in strawberry crowns under both conditions. Moreover, YL19 had a single polar flagellum, while YLX21 had no flagellum. Motility and chemotaxis assays showed that YLX21 had weaker motility than YL19, which may explain why YLX21 tended to multiply in situ within the strawberry leaf rather than migrate to other tissues, causing more severe ALS symptoms and mild crown rot symptoms. Taken together, the new strain YLX21 helped us reveal critical factors underlying the pathogenicity of X. fragariae and the mechanism by which dry cavity rot in strawberry crowns forms.
2023 Chinese Expert Consensus on the impact of COVID-19 on the management of cardiovascular diseases
Authors:   Branch of Cardiovascular Physicians of Chinese Medical Doctor Association
Published: May 2023

The primary site of infection in COVID-19 exhibit is the respiratory system, but multiple organ systems could be affected. The virus could directly invade cardiomyocytes. Alternatively, cytokine storm could lead to myocardial injury. More importantly, the management of existing cardiovascular diseases must be re-examined in COVID-19 due to, for example, interaction between antiviral agents and with a wide variety of pharmacological agents. The Branch of Cardiovascular Physicians of Chinese Medical Doctor Association organized a panel of experts in cardiovascular and related fields to discuss this important issue, and formulated the “2023 Chinese Expert Consensus on the Impact of COVID-19 on the Management of Cardiovascular Diseases.” The Consensus was drafted on the basis of systematic review of existing evidence and diagnosis and treatment experience, and covers three major aspects: myocardial injury caused by COVID-10 and COVID-19 vaccine, the impact of COVID-19 on patients with cardiovascular disease, and the impact of COVID-19 on the cardiovascular system of healthy people, and rehabilitation guidance recommendations. The Consensus involves 11 core clinical issues, including incidence, pathogenesis, clinical manifestations, treatment strategies, prognosis, and rehabilitation. It is our hope that this Consensus will provide a practical guidance to cardiologists in the management of cardiovascular diseases in the new era of COVID-19 pandemic.
Facilitators of palliative care quality improvement team cohesion
Authors: Connell Natalie B. , Zupanc Sophia N. , Lorenz Karl A. , Bhatnagar Sushma , Fereydooni Soraya , Gamboa Raziel C. , Ganesh Archana , Satija Aanchal , Singh Nainwant , Spruijt Odette , Giannitrapani Karleen F.
Published: May 2023

Background

The Palliative Care: Promoting Access and Improvement of the Cancer Experience (PC-PAICE) initiative is a team-based, palliative care (PC) quality improvement (QI) project working to promote high-quality PC in India. As a PC QI initiative, PC-PAICE implementation relied upon building interdisciplinary teams, providing the ideal context for understanding facilitators of team cohesion that compelled clinical, organizational, and administrative team members to work together. There is an opportunity to leverage the intersection between QI implementation and organizational theory to inform and improve implementation science.

Purpose

As a subaim of a larger implementation evaluation, we aimed to identify facilitators of team cohesion within QI implementation context.

Methodology

A quota sampling approach captured the perspectives of 44 stakeholders across three strata (organizational leaders, clinical leaders, and clinical team members) from all seven sites through a semistructured interview guide informed by the Consolidated Framework for Implementation Research (CFIR). We used a combination of inductive and deductive approaches informed by organizational theory to identify facilitators.

Result

We identified three facilitators of PC team cohesion: (a) balancing formalization and flexibility around team roles, (b) establishing widespread awareness of the QI project, and (c) prioritizing a nonhierarchical organizational culture.

Practice Implications

Leveraging CFIR to analyze PC-PAICE stakeholder interviews created a data set conducive to understanding complex multisite implementation. Layering role and team theory to our implementation analysis helped us identify facilitators of team cohesion across levels within the team (bounded team), beyond the team (teaming), and surrounding the team (culture). These insights demonstrate the value of team and role theories in implementation evaluation efforts.
Surgeons’ mental distress and risks after severe complications following radical gastrectomy in China: a nationwide cross-sectional questionnaire
Authors: He Hongyong , Lin Chao , Li Ruochen , Zang Lu , Huang Xiao , Liu Fenglin
Published: May 2023

Background:

This study was designed to investigate incidences of surgeons’ mental distress following severe complications after radical gastrectomy.

Methods:

A cross-sectional survey was conducted between 1 June 2021 and 30 September 2021 among Chinese general and/or gastrointestinal surgeons who experienced severe complications after radical gastrectomy. The clinical features collected in the questionnaire included: (i) feeling burnout, anxiety, or depression; (ii) avoiding radical gastrectomy or feeling stress, slowing down the process during radical gastrectomy operations; (iii) having physical reactions, including heart pounding, trouble breathing, or sweating while recalling; (iv) having urges to quit being a surgeon; (v) taking psychiatric medications; and (vi) seeking psychological counselling. Analyses were performed to identify risk factors of severe mental distress, which was defined as meeting three or more of the above-mentioned clinical features.

Results:

A total of 1062 valid questionnaires were received. The survey showed that most of the participating surgeons (69.02%) had at least one clinical feature of mental distress following severe complications after radical gastrectomy, and more than 25% of the surgeons suffered from severe mental distress. Surgeons from non-university affiliated hospitals, the junior surgeons, and existing violent doctor–patient conflicts were recognized as independent risk factors for surgeons’ severe mental distress related to the severe complications after radical gastrectomy.

Conclusions:

About 70% of surgeons had mental health problems following severe complications after radical gastrectomy, and more than 25% of the surgeons suffered from severe mental distress. More strategies and policies are needed to improve the mental well-being of these surgeons after such incidences.
Bilateral Robotic Nephrectomy in a Pediatric Female Patient: A Case Report
Authors: Durham Scott , Cheng Nathan , Jain Namrata G. , Stifelman Michael , Schlussel Richard
Published: May 2023

Background:

We present a report of a robotic bilateral native nephrectomy (BNN) performed on a pediatric patient awaiting kidney transplantation. We describe this rarely performed minimally invasive procedure, especially in the pediatric population.

Case Summary:

The procedure was performed on a six-year-old girl suffering from worsening kidney function secondary to focal segmental glomerulosclerosis (FSGS). The patient's disease was refractory to all medical management and incurred many complications throughout her course. Because of the complicated course and worsening proteinuria, it was decided to perform a robotic BNN while the patient awaited kidney transplantation.

Conclusion:

Heavy proteinuria carries a greater risk of severe complications in children with FSGS. Synchronized BNN has significantly reduced these risks, specifically thromboembolisms. In addition, these children could benefit from implementing robotic-assisted BNN with the techniques described. Minimally invasive robotic surgery provides a feasible approach to managing this problematic clinical condition.
Patterns of Relapse and Complications of Immunoglobulin G4–Related Disease
Authors: Kowa Jie-Ying , Kim Tae Kyoung , Khalili Korosh , Elbanna Khaled Y.
Published: May 2023

Background

Immunoglobulin G4–related disease (IgG4-RD) is a multisystemic fibroinflammatory condition potentially resulting in organ dysfunction. We aimed to evaluate imaging characteristics of disease relapse and complications in this cohort of patients.

Methods

This was a cohort study of IgG4-RD patients imaged between 2010 and 2020. Radiological manifestations of disease activity (remission/stability vs. relapse and complications) were correlated with clinical symptoms. Univariate analyses were performed with χ
2, Fisher exact, and Mann-Whitney U tests. Times to relapse and organ atrophy were studied with Kaplan-Meier analyses.

Results

A total of 69 patients had imaging surveillance over a median duration of 47 months. Radiological relapse occurred in 50.7% (35/69) with median time to relapse at 74 months (95% confidence interval, 45–122 months); 42.8% (15/35) of this cohort had different-site relapse with the following recognized primary-secondary patterns: pancreas-hepatobiliary (p = 0.005), hepatobiliary-pancreas (p = 0.013), and periaortitis-mesenteric (p = 0.006). Clinical symptoms were significantly associated with imaging characteristics (p < 0.001). Abdominal complications were detected in 52.2% (36/69) of patients, mostly solid organ atrophy (97.2% [35/36]). New-onset diabetes was more likely in pancreatic IgG4-RD (n = 51) when accompanied by gland atrophy (4/21 vs. 0/30 nonatrophy, p = 0.024).

Conclusion

Radiological relapse of IgG4-RD is common over prolonged imaging surveillance and is significantly associated with symptomatic relapse. A multisystem review to detect new/different sites of disease and abdominal complications may help predict future organ dysfunction.
Circumferential Radical Debridement and Omental Free Flap in the Treatment of Severe Chronic Venous Ulcers
Authors: Cavadas Pedro C. , Padial Beatriz
Published: May 2023

Background

Chronic venous leg ulcers are a significant health care burden with a difficult and unreliable treatment. Free flaps may be needed for wound coverage in severe cases. Incomplete removal of dermatoliposclerosis (DLS) area and/or not addressing the underlying venous dysfunction may contribute to the reported modest long-term results.

Methods

A series of 5 patients with severe chronic venous ulcers of the leg, resistant to conservative treatment and superficial venous surgery, were treated with radical, circumferential, subfascial resection of the DLS skin and coverage with omental free flaps. Delayed arteriovenous (AV) loops were used as recipients. All patients had previous superficial venous surgery and multiple skin grafts. Mean follow-up was 8 years (4–15 years).

Results

One hundred percent of flaps survived completely. No major complications occurred. One patient developed ulceration of the flap at 2 years and healed with basic wound care. At a mean follow-up of 8 years, all patients were ulcer-free. One patient died 15 years after the surgery for unrelated causes.

Conclusions

Radical circumferential resection of DLS area in severe chronic venous leg ulcers and coverage with a free omental flap using staged AV loop provided durable coverage in a series of 5 patients. Complete resection of DLS area, addressing the underlying venous pathology, and draining the flap to a healthy competent vein graft (AV loop) may contribute to these favorable results.
Clinical Evaluation of 310 Abdominoplasties and Measurement of Scar Level
Authors: Swanson Eric
Published: May 2023

Background

Most published studies on abdominoplasty focus on methods to reduce the risk of seromas. These methods include limited dissection (lipoabdominoplasty), quilting sutures, and preservation of the Scarpa fascia. Quantitative evaluation of the aesthetic result has been lacking.

Methods

A retrospective study was undertaken of all patients undergoing abdominoplasty in the author's practice from 2016 to 2022. A full abdominoplasty was performed, usually with liposuction (87%). All patients were treated under total intravenous anesthesia without paralysis or prone positioning. A single closed suction drain was removed 3 or 4 days after surgery. All procedures were performed as outpatients. Ultrasound surveillance was used to detect any deep venous thromboses. No patient received chemoprophylaxis. The operating table was flexed, often to 90°. Deep fascial anchoring sutures were used to attach the Scarpa fascia of the flap to the deep muscle fascia. Measurements of the scar level were made at intervals after surgery up to 1 year.

Results

Three hundred ten patients were evaluated, including 300 women. The mean follow-up time was 1 year. The overall complication rate, which included minor scar deformities, was 35.8%. Five deep venous thromboses were detected. There were no hematomas. Fifteen patients (4.8%) developed seromas that were successfully treated by aspiration. The mean vertical scar level 1 month after surgery was 9.9 cm (range, 6.1–12.9 cm). There was no significant change in scar level at subsequent follow-up times up to 1 year. By comparison, the scar level in published studies ranged from 8.6 to 14.1 cm.

Discussion

Avoidance of electrodissection reduces tissue trauma that causes seromas. Flexed patient positioning during surgery and deep fascial anchoring sutures are effective in keeping the scar low. By avoiding chemoprophylaxis, hematomas can be avoided. Limiting the dissection (lipoabdominoplasty), preserving the Scarpa fascia, and adding quilting (progressive tension) sutures are unnecessary.

Conclusions

Total intravenous anesthesia offers important safety advantages. Avoiding electrodissection is effective in keeping seroma rates at a tolerable level (5%), and the scar low and more easily concealed. Alternative methods present disadvantages that may contribute to a suboptimal aesthetic result and require additional operating time.
A Prospective Cohort Study Re-examining Tissue Oximetry Monitoring in Microsurgical Breast Reconstruction
Authors: Sultan Darren L. , Atamian Elisa , Tarr Joseph , Feingold Randall , Kasabian Armen K. , Tanna Neil , Smith Mark L. , Moon Victor
Published: May 2023

Background

The goal of inpatient monitoring after microsurgical breast reconstruction is to detect vascular compromise before flap loss. Near-infrared tissue oximetry (NITO) is commonly used for this purpose, but recent reports challenge its specificity and utility in current practice. Fifteen years after Keller published his initial study using this technology at our institution, we re-evaluate the role and limitations of this popular monitoring device.

Methods

A 1-year prospective study was performed for patients undergoing microsurgical breast reconstruction and monitored postoperatively using NITO. Alerts were evaluated, and clinical endpoints relating to an unplanned return to the operating room or flap loss were recorded.

Results

A total of 118 patients reconstructed with 225 flaps were included within the study. There were no cases of flap loss at the time of discharge. There were 71 alerts relating to a drop in oximetry saturation. Of these, 68 (95.8%) were deemed to be of no significance. In 3 cases (positive predictive value of 4.2%), the alert was significant, and there were concerning clinical signs apparent at that point. A sensor in an inframammary fold position was associated with nearly twice the average number of alerts as compared with areolar or periareolar positions (P = 0.01). In 4 patients (3.4%), a breast hematoma required operative evacuation, and these cases were detected by nursing clinical examination.

Conclusions

The monitoring of free flaps after breast reconstruction through tissue oximetry shows a poor positive predictive value for flap compromise and requires clinical corroboration of alerts but missed no pedicle-related adverse events. With a high sensitivity for pedicle-related issues, NITO may be helpful postoperatively, but the exact timeframe for use must be weighed at the institutional level.
A Systematic Review of Pediatric Nonaccidental Burns
Authors: Gasteratos Konstantinos , McCarthy Michelle , Chatziathanasiou Danai , Vradeli Georgia , Vlachopoulos Nikolaos , Voitsidis Pantelis , Goverman Jeremy
Published: May 2023

Background

Inflicted burns on children are a particularly difficult medical and psychosocial issue. Pediatric nonaccidental burns (PNABs) are unfortunately relatively common. In our study, we aim to present the key findings on PNABs with the intention of raising awareness, improving early, and recognizing accurately by identifying red flags, developing triage tools, and establishing prevention strategies for this sensitive issue.

Methods

A computerized literature search was conducted on PubMed, Google Scholar, and Cochrane for articles published until November 2020. The online screening process was performed by 3 independent reviewers with the Covidence tool against set inclusion/exclusion criteria. The protocol was reported using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol. The study was registered with the International Prospective Register of Systematic Reviews (PROSPERO).

Results

A total of 12 studies were included for analysis. Scald burns via forced immersion accounted for the majority of reported PNABs affecting both feet and hands. Complications included wound infection, sepsis, requiring systemic antibiotics, or intensive care. Abused children's parents had a history of mental illness, unemployment, substance abuse, incarceration, and/or low annual income.

Conclusions

Scalds via forced immersion remain the most common mechanism of PNABs. All health care professionals must remain vigilant, be able to recognize subtle signs of abuse, triage patients appropriately, report to police and/or social services, and ensure no further harm is made to the child or children. Repeated abuse with burns can lead to death. Prevention and education are the cornerstones for addressing this social phenomenon.
Effect of Platelet-rich Plasma on the Clinical Success of Alveolar Grafts in Patients With Cleft Lip and Palate: A Systematic Review and Meta-Analysis
Authors: Eslami Neda , Heidarian Miri Hamid , Rastegar Mozhgan , Sabzevari Berahman
Published: May 2023

Objectives:

This study assessed the effect of platelet-rich plasma (PRP) on the clinical success of alveolar grafts in patients with cleft lip and palate.

Materials and Methods:

In this meta-analysis, a search of the literature was conducted in Medline, Scopus, ISI Web of Science, and Cochrane Central Register of Controlled Trials for randomized clinical trials using PRP or platelet-rich fibrin (PRF) along with autogenous bone for alveolar ridge grafts in patients with cleft lip and palate. The methodological quality of the studies was analyzed using Cochrane’s risk of the bias assessment tool. The extracted data underwent meta-analysis using the random-effects model.

Results:

Of a total of 2256 articles retrieved, 12 met the eligibility criteria and were enrolled; out of which 6 did not undergo meta-analysis due to heterogeneous data. The percentage of defects filled by bone graft was 0.648% (95% confidence interval: −0.15 to 1.45), which was not statistically significant (P=0.115). Subgroup analysis showed no significant difference based on the use of PRF or PRP (P=0.28), type of cleft (unilateral/bilateral; P=0.56), or type of radiographic modality (3D/2D; P=0.190). Meta-regression analysis showed that the duration of follow-up and the difference in the mean age of patients did not have a significant effect on the results (R=0, I2: high).

Conclusion:

The application of PRP/PRF in combination with autogenous bone graft did not have a significant effect on the percentage of alveolar cleft filled by a bone graft. Future clinical studies are required to further elucidate the effect of PRP in the regeneration of alveolar clefts.
Multidisciplinary Treatment of a Giant Maxillofacial Congenital Hemangioma With Multiple Severe Complications
Authors: Tian Xiaoyu , Yu Dan , Zhao Xue
Published: May 2023

Giant congenital hemangiomas are rare, especially when combined with multiple complications. This article presents a case of a giant congenital hemangioma of the maxillofacial region in a neonate with combined thrombocytopenia, coagulation dysfunction, and heart failure, which was eventually treated surgically after a multidisciplinary consultation and achieved a good outcome.
Meibomian Gland Dysfunction in Primary Acquired Nasolacrimal Duct Obstruction
Authors: Yoon Sumin , Lee Hyunkyu , Baek Sehyun
Published: May 2023

This study was designed to investigate the influence of primary nasolacrimal duct obstruction (PANDO) on the structure and function of the Meibomian gland and to examine whether it is related to functional failure after dacryocystorhinostomy surgery. Medical records of patients diagnosed as PANDO from August 2021 to February 2022 were retrospectively studied. Results of slit lamp examination, lacrimal drainage test, tear break-up time, anterior segment optical coherence tomography, and meibography were collected. Tear meniscus height, tear break-up time, meiboscore, and lipid layer thickness of tear membrane were parameters compared between the eyes with complete PANDO and the control group. Medical records of 44 patients, therefore 88 eyes were collected, and there were 28 eyes with complete PANDO (total obstruction group), while normal eyes (control group) were 30. Mean tear meniscus height was significantly higher than that of the control group (P value<0.001), but tear break-up time (P value=0.322), lipid layer thickness (P value=0.755), and meiboscore (P value=0.268) were not significantly different. However, in the cases with moderate and severe meibomian gland destruction, the lipid layer thickness of the total obstruction group was significantly thinner than the control group. Lipid secretion of meibomian glands was less in eyes with PANDO than in eyes without PANDO, under moderate to severe meibomian gland destruction. It can lead to persistent epiphora after dacryocystorhinostomy due to a compensatory response against evaporative dry eye disease. Patients should be educated before the decision to undergo surgeries about the possibilities of persistent epiphora. Further studies are needed to prove the mechanism of meibomian gland function disturbance in PANDO.
Collibacillus ludicampi gen. nov., sp. nov., a new soil bacterium of the family Alicyclobacillaceae
Authors: Jojima Toru , Ioku Yuki , Fukuta Yasuhisa , Shirasaka Norifumi , Matsumura Yoshinobu , Mori Miho
Published: May 2023

A novel moderately thermophilic aerobic bacterium, strain TP075T, was isolated from soil collected from an athletic field in Japan. Strain TP075T is a rod-shaped, aerobic bacterium that forms terminal endospores. The KOH lysis test suggested that the cell wall of the isolate has a Gram-positive structure. For aerobic growth, the optimum pH and temperature were 4.0–5.0 and 47–50 °C, respectively. Draft genome sequencing showed that the G+C content of genomic DNA was 46.5 mol%. Branched-chain fatty acids (iso-C15 : 0, anteiso-C15 : 0 and iso-C16 : 0) were the major components of the cellular fatty acid profile. Phylogenetic analysis based on the 16S rRNA gene sequence revealed that strain TP075T belongs to the family

Alicyclobacillaceae

, with the highest similarity to

Effusibacillus consociatus

CCUG53762T (92.6%) and Tumebacillus soil CAU11108T (92.5%). Genome-based analyses indicated that strain TP075T and the most closely related strain,

Effusibacillus pohliae

DSM 22757T, share an average amino acid identity value of 62.57% and an average nucleotide identity value of 70.86 %. The results obtained in this study suggest that strain TP075T represents a novel species of a novel genus, for which we propose the name Collibacillus ludicampi gen. nov., sp. nov. with type strain TP075T (= JCM 34430T=TBRC 15189T).
AppIndels.com server: a web-based tool for the identification of known taxon-specific conserved signature indels in genome sequences. Validation of its usefulness by predicting the taxonomic affiliation of >700 unclassified strains of Bacillus species
Authors: Gupta Radhey S. , Kanter-Eivin David A.
Published: May 2023

Taxon-specific conserved signature indels (CSIs) in genes/proteins provide reliable molecular markers (synapomorphies) for unambiguous demarcation of taxa of different ranks in molecular terms and for genetic, biochemical and diagnostic studies. Because of their predictive abilities, the shared presence of known taxon-specific CSIs in genome sequences has proven useful for taxonomic purposes. However, the lack of a convenient method for identifying the presence of known CSIs in genome sequences has limited their utility for taxonomic and other studies. We describe here a web-based tool/server (AppIndels.com) that identifies the presence of known and validated CSIs in genome sequences and uses this information for predicting taxonomic affiliation. The utility of this server was tested by using a database of 585 validated CSIs, which included 350 CSIs specific for ≈45

Bacillales

genera, with the remaining CSIs being specific for members of the orders

Neisseriales

,

Legionellales

and

Chlorobiales

, family

Borreliaceae

, and some

Pseudomonadaceae

species/genera. Using this server, genome sequences were analysed for 721

Bacillus

strains of unknown taxonomic affiliation. Results obtained showed that 651 of these genomes contained significant numbers of CSIs specific for the following

Bacillales

genera/families:

Alkalicoccus

, ‘Alkalihalobacillaceae’,

Alteribacter

,

Bacillus

Cereus clade,

Bacillus

Subtilis clade,

Caldalkalibacillus

,

Caldibacillus

,

Cytobacillus

, Ferdinandcohnia,

Gottfriedia

,

Heyndrickxia

,

Lederbergia

,

Litchfieldia

,

Margalitia

,

Mesobacillus

,

Metabacillus

,

Neobacillus

,

Niallia

,

Peribacillus

,

Priestia

,

Pseudalkalibacillus

,

Robertmurraya

,

Rossellomorea

,

Schinkia

,

Siminovitchia

,

Sporosarcina

,

Sutcliffiella

,

Weizmannia

and

Caryophanaceae

. Validity of the taxon assignment made by the server was examined by reconstructing phylogenomic trees. In these trees, all

Bacillus

strains for which taxonomic predictions were made correctly branched with the indicated taxa. The unassigned strains likely correspond to taxa for which CSIs are lacking in our database. Results presented here show that the AppIndels server provides a useful new tool for predicting taxonomic affiliation based on shared presence of the taxon-specific CSIs. Some caveats in using this server are discussed.
From bedside to bench and back: discovery of a novel missense variant in NLRP3 causing atypical CAPS with hearing loss as the primary presentation, responsive to anti-IL-1 therapy
Authors: Birk-Bachar Merav , Cohen Hadar , Sofrin-Drucker Efrat , Kropach-Gilad Nesia , Orenstein Naama , Lidzbarsky Gabriel , Kornreich Liora , Tal Rotem , Amarilyo Gil , Levinsky Yoel , Sokolov Meirav , Raveh Eyal , Gerlic Motti , Harel Liora
Published: May 2023

Cryopyrin-associated periodic syndromes (CAPS) also known as NLRP3-associated auto-inflammatory diseases, are a spectrum of rare auto-inflammatory diseases caused by gain-of-function mutations in the NLRP3 gene, resulting in inflammasome hyper-activation and dysregulated release of Interleukin-1β(IL-1β). Many patients with CAPS develop progressive sensorineural hearing loss (SNHL) due to cochlear auto-inflammation which, in rare cases, may be the sole manifestation. This study was undertaken to establish the suspected diagnosis of CAPS in a family presenting autosomal dominant progressive/acute SNHL and a novel missense variant in the NLRP3 gene of unknown significance (NM_001079821:c.1790G>A, p.Ser597Asn). To do so, we conducted an ex vivo functional assessment of the NLRP3 inflammasome in carries (n=10) and healthy family members (n=5). The assay revealed hyper-activation of the inflammasome among carriers, supporting the hypothesis that this missense variant is a pathogenic gain-of-function mutation. Administration of anti-IL-1 therapy resulted in a substantial clinical improvement among pediatric patients, who exhibited near resolution of hearing impairment within 1-3 months of treatment. Our findings highlight the crucial role of early diagnosis and treatment of hearing loss due to hyperactivation of the inflammasome with an anti-IL-1 agent in reversing cochlear damage. Furthermore, our results suggest that high and ultrahigh frequency ranges need to be included in the auditory assessment to enable early detection of subclinical SNHL. Finally, incorporating functional inflammasome assessment as part of the clinical evaluation could establish the diagnosis in inconclusive cases.
A multiadjuvant polysaccharide-amino acid-lipid (PAL) subunit nanovaccine generates robust systemic and lung-specific mucosal immune responses against SARS-CoV-2 in mice
Authors: Pandey Bhawana , Wang Zhengying , Jimenez Angela , Bhatia Eshant , Jain Ritika , Beach Alexander , Maniar Drishti , Hosten Justin , O’Farrell Laura , Vantucci Casey , Hur David , Noel Richard , Ringuist Rachel , Smith Clinton , Ochoa Miguel A. , Roy Krishnendu
Published: May 2023

Existing parenteral SARS-CoV-2 vaccines produce only limited mucosal responses, which are essential for reducing transmission and achieving sterilizing immunity. Appropriately designed mucosal boosters could overcome the shortcomings of parenteral vaccines and enhance pre- existing systemic immunity. Here we present a new protein subunit nanovaccine using multiadjuvanted (e.g. RIG-I: PUUC, TLR9: CpG) polysaccharide-amino acid-lipid nanoparticles (PAL-NPs) that can be delivered both intramuscularly (IM) and intranasally (IN) to generate balanced mucosal-systemic SARS-CoV-2 immunity. Mice receiving IM-Prime PUUC+CpG PAL- NPs, followed by an IN-Boost, developed high levels of IgA, IgG, and cellular immunity in the lung, and showed robust systemic humoral immunity. Interestingly, as a purely intranasal vaccine (IN-Prime/IN-Boost), PUUC+CpG PAL-NPs induced stronger lung-specific T cell immunity than IM-Prime/IN-Boost, and a comparable IgA and neutralizing antibodies, although with a lower systemic antibody response, indicating that a fully mucosal delivery route for SARS-CoV-2 vaccination may also be feasible. Our data suggest that PUUC+CpG PAL-NP subunit vaccine is a promising candidate for generating SARS-CoV-2 specific mucosal immunity.
Signal recovery in single cell batch integration
Authors: Zhang Zhaojun , Mathew Divij , Lim Tristan , Mason Kaishu , Martinez Clara Morral , Huang Sijia , Wherry E. John , Susztak Katalin , Minn Andy J. , Ma Zongming , Zhang Nancy R.
Published: May 2023

Data integration to align cells across batches has become a cornerstone of single cell data analysis, critically affecting downstream results. Yet, how much biological signal is erased during integration? Currently, there are no guidelines for when the biological differences between samples are separable from batch effects, and thus, data integration usually involve a lot of guesswork: Cells across batches should be aligned to be “appropriately” mixed, while preserving “main cell type clusters”. We show evidence that current paradigms for single cell data integration are unnecessarily aggressive, removing biologically meaningful variation. To remedy this, we present a novel statistical model and computationally scalable algorithm, CellANOVA, to recover biological signal that is lost during single cell data integration. CellANOVA utilizes a “pool-of-controls” design concept, applicable across diverse settings, to separate unwanted variation from biological variation of interest. When applied with existing integration methods, CellANOVA allows the recovery of subtle biological signals and corrects, to a large extent, the data distortion introduced by integration. Further, CellANOVA explicitly estimates cell- and gene-specific batch effect terms which can be used to identify the cell types and pathways exhibiting the largest batch variations, providing clarity as to which biological signals can be recovered. These concepts are illustrated on studies of diverse designs, where the biological signals that are recovered by CellANOVA are shown to be validated by orthogonal assays. In particular, we show that CellANOVA is effective in the challenging case of single-cell and single-nuclei data integration, where the recovered biological signals are replicated in an independent study.