bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical characteristics and course of sporadic non-ampullary duodenal adenomas
Authors: Kanzaki Hiromitsu , Matsueda Kazuhiro , Nakagawa Masahiro , Inaba Tomoki , Takatani Masahiro , Takenaka Ryuta , Yoshioka Masao , Imagawa Atsushi , Inoue Masafumi , Suzuki Seiyuu , Tomoda Jun , Iwamuro Masaya , Kawano Seiji , Kawahara Yoshiro , Tanaka Takehiro , Okada Hiroyuki
Published: October 2021

Sporadic non-ampullary duodenal adenoma (SNADA) is a rare disease, and therefore, its clinical characteristics have not been comprehensively investigated. Furthermore, owing to the high complication rates and severity of endoscopic resection, treatment strategies vary among facilities. In the present study, we aimed to clarify the clinical characteristics and course of SNADA.

We extracted clinical and histological records of SNADA cases diagnosed in 11 hospitals between September 1999 and August 2014. The patients were divided into “no-resection” and “resection” groups based on the initial treatment approach. We investigated the long-term outcome of the “no-resection” group and treatment results of the “resection” group, with particular interest in endoscopic resection.

Overall, 299 patients were diagnosed with SNADA. The median age at diagnosis was 67 years (range, 31–88 years), with approximately twice as many men as women. The median tumor size was 8.0 mm (2–60 mm). In total, 161 patients were initially selected for no-resection and 138 underwent resection. Age >70 years and the presence of either severe illness or poor performance status were significantly related to opting for no-resection. In the no-resection group, 101 patients underwent endoscopic follow-up for at least 1 year. During the observational period (2.5 ± 2.2 years), 27 lesions (27%) disappeared following cold forceps biopsy, and 13 lesions (14%) presented lateral growth. Four lesions (4%) changed to mucosal carcinoma, 3 were treated endoscopically, and 1 was surgically resected. Nineteen patients died; however, no one died of duodenal carcinoma. In the endoscopic resection group, en bloc resection was achieved in 78% of patients. However, the complication rate for perforation was 7%, and endoscopic submucosal dissection was associated with a 36% perforation rate.

With the low incidence of cancer development and no disease specific death, the strategy of initially not performing resection could be considered especially for the older adults, poor-prognosis patients, or small lesions.
A new peak-power estimation equations in 12 to 14 years-old soccer players
Authors: Gülü Mehmet , Akalan Cengiz
Published: October 2021

The aim of this study was to develop an age and soccer-specific regression equation to estimate the peak power of children aged 12–14 from the height of their vertical jumps using a large sample (n = 188). This study included 188 male soccer players (age, 12.6 ± 0.55; height, 153.31 ± 8.38 cm; and body weight, 43.65 ± 7.58 kg). Their actual peak power values obtained from vertical jumps were recorded using a force platform. The body weights of the participants were measured using Tanita. A regression model was developed using body weight and vertical jump values. All data were analyzed with the IBM SPSS (version 21) statistical analysis program. A multiple linear regression model was used to generate the best estimation of peak power. In this regression model, Power = −1714,116 + [(47.788 ∗ body weight (kg)] + [(58,976 ∗ Countermovement jump height (cm)]. Actual peak power is highly predictable for 12–14-year-old football players. In line with the new model, the actual peak power values obtained in this study were close to the estimated peak power values obtained with the Tufano formula. This may be because of the larger sample size and the same branch used for both equation models.
The effectiveness of the problem-based learning in medical cell biology education
Authors: Xu Wei , Ye Tingjie , Wang Xiaoling
Published: October 2021

Background:

Problem-based learning (PBL) was widely adopted in medical cell biology education for Chinese student; however, there was no systematic analysis to prove PBL was much more effective than lecture-based learning (LBL). Our aim is to evaluate the effectiveness of PBL on cell biology curriculum compared with LBL.

Method:

We systematically searched the publications related to PBL teaching approach in cell biology curriculum for medical education from databases until to February 2021. Pooled standard mean differences (SMDs) and risk ratios with their 95% confidence intervals were used to assess the effectiveness of PBL and the satisfaction of students to PBL compared to LBL in meta-analysis. The heterogeneity of the included studies was assessed by statistical I
2 of heterogeneity. Meta-regression and subgroup analysis were performed to analyze the source of heterogeneity. Funnel plots and Egger tests were performed to assess publication bias.

Result:

After initial searching and selection, 9 studies were included for meta-analysis. All of these 9 studies were in high quality. The SMDs (95% confidence intervals) of total examination scores and comprehensive examination scores between PBL and LBL curriculum in cell biology teaching was calculated to be 0.89 (0.52, 1.26) and 0.53 (0.29, 0.78). Meanwhile, the risk ratios of the satisfaction of PBL vs LBL were calculated to be 1.18 (0.96, 1.46). However, there was a heterogeneity among the pooled SMDs of 10 studies with I
2 = 89.7%, P < .001. The factors including the different teachers, the similar or same examination paper and over 100 student numbers among PBL and LBL groups raised the heterogeneity in the pooled SMDs. There is no publication bias in these 10 publications after Egger and Begg test.

Conclusion:

The result indicated PBL was better than LBL in improvement of examination scores and comprehensive examination scores in cell biology curriculum to some extent. However, the satisfaction of students to PBL and LBL had no difference. The factors, including the different teachers, the similar or same examination papers and over 100 student numbers, affected the effectiveness of PBL and raised the heterogeneity of the pooled SMDs.
Enhanced liver fibrosis score as a surrogate of liver-related complications and mortality in primary biliary cholangitis
Authors: Fujinaga Yukihisa , Namisaki Tadashi , Takaya Hiroaki , Tsuji Yuki , Suzuki Junya , Shibamoto Akihiko , Kubo Takahiro , Iwai Satoshi , Tomooka Fumimasa , Takeda Soichi , Fujimoto Yuki , Enomoto Masahide , Murata Koji , Ishida Koji , Ogawa Hiroyuki , Takagi Hirotetsu , Ozutsumi Takahiro , Furukawa Masanori , Nishimura Norihisa , Sawada Yasuhiko , Kitagawa Koh , Sato Shinya , Kaji Kosuke , Kawaratani Hideto , Moriya Kei , Noguchi Ryuichi , Akahane Takemi , Mitoro Akira , Yoshiji Hitoshi
Published: October 2021

The presence of bridging fibrosis predicts survival of primary biliary cholangitis (PBC). This study aimed to compare serum parameters for the estimation of liver fibrosis and prediction of clinical outcomes in PBC.

Out of 392 patients with PBC, 102 who underwent liver biopsy and in whom fibrosis indices, platelet count, hyaluronic acid, type IV collagen 7 second domain, procollagen type III amino-terminal peptide, tissue inhibitor of metalloproteinases 1, Mac-2 binding protein glycosylation isomer, N-terminal type III collagen propeptide levels; fibrosis index based on 4 factors, aspartate aminotransferase-to-platelet ratio index, and enhanced liver fibrosis (ELF) score were determined, were included. The correlation of histological stages based on both Scheuer and Nakanuma classifications with fibrosis indices was investigated. The Nakanuma system comprises grading for liver fibrosis and bile duct loss. Diagnostic performances of 10 fibrosis indices were evaluated to identify patients with poor prognosis. Moreover, correlations of those with PBC clinical manifestation and survival were also investigated.

Enhances liver fibrosis (ELF) score had the highest correlation coefficient for liver fibrosis evaluated according to either the Scheuer or Nakanuma classification among 10 serum fibrosis indices. It also had the highest diagnostic performance in estimating Scheuer stage III and Nakanuma fibrosis score 2, both of which represent portal-bridging fibrosis. Patients with an ELF score of ≥10.0 had shorter survival and presented more frequently clinical complications than those with an ELF score of <10.0.

ELF score determines the severity of liver fibrosis and predicts the occurrence of complications and survival in patients with PBC.
The profile analysis of circular RNAs in cervical cancer
Authors: Huang Jinbing , Chen Junying , Huang Qiaoqiao
Published: October 2021

Cervical cancer (CC) is the third most common cancer among women and has a high mortality rate at the advanced stage. The mechanisms underlying the development and progression of CC are still elusive. Circular RNAs (circRNAs) play an important role in various physiological and pathological processes. The aim of this study was to identify the circRNAs significantly associated with cervical squamous cell carcinoma (CSCC), in order to discover novel diagnostic markers and elucidate their mechanistic basis.

The circRNA expression profiles of CSCC and paired para-cancerous cervical tissues was downloaded from the Gene Expression Omnibus. Bioinformatics analysis were used to screen for the differentially expressed circRNAs (DECRs). The expression levels of hsa_circ_0000745, hsa_circ_0084927, hsa_circ_0002762, hsa_circ_0075341, hsa_circ_0007905, hsa_circ_0031027, hsa_circ_0065898, hsa_circ_0070190, and hsa_circ_0078383 were verified in CC and normal cervical tissues by quantitative real-time PCR.

A total of 197 DECRs were identified between the CSCC and normal tissues, including 87 upregulated and 110 downregulated circRNAs. In addition, 37 miRNAs were predicted for the upregulated circRNAs and 39 for the downregulated circRNAs. Functional analysis showed that the DECRs were associated with positive regulation of substrate adhesion-dependent cell spreading, metabolism, positive regulation of GTPase activity, protein regulation, and intercellular adhesion. The MAPK signaling pathway that plays a significant role in the progression of CC, was also enriched. Consistent with the in-silico analysis, hsa_circ_0000745, hsa_circ_0084927, hsa_circ_0002762, hsa_circ_0007905 were upregulated and hsa_circ_0078383 was downregulated in CC tissues (P < .001), whereas hsa_circ_0075341 (P < .001) and hsa_circ_0031027 (P = .001) showed opposite trends.

We identified novel diagnostic and therapeutic biomarkers of CSCC along with the mechanistic basis.
Association between HBs Ag quantification and the risk of hepatocellular carcinoma in patients treated with tenofovir disoproxil fumarate or entecavir
Authors: Lim Jung Hyun , Yu Jung Hwan , Suh Young Ju , Lee Jin-Woo , Jin Young-Joo
Published: October 2021

This study evaluated the clinical implications of hepatitis B surface antigen quantification (qHBs Ag) in chronic hepatitis B (CHB) patients treated with entecavir (ETV) or tenofovir disoproxil fumarate (TDF) and identified the association between qHBs Ag and the risk of hepatocellular carcinoma (HCC) in these patients.

Between January 2007 and December 2018, the qHBs Ag and clinical data of 183 CHB patients who initially received ETV (n = 45, 24.6%) or TDF (n = 138, 75.4%) were analyzed.

The mean follow-up period of the 183 CHB patients was 45.3 months, of which 59 (32.2%) patients showed a reduction in qHBs Ag by >50% after 1 year of antiviral treatment (ETV or TDF). The HCC development (P = .179) or qHBs Ag reduction (P = .524) were similar in the ETV and TDF groups. Patients with a ≥50% decrease in qHBs Ag had a significantly lower incidence of HCC or decompensated cirrhosis complications (P = .005). Multivariate analysis showed that a >50% reduction of qHBs Ag (hazard ratio 0.085, P = .018) and the presence of cirrhosis (hazard ratio 3.32, P = .016) were independent factors predicting the development of HCC.

Patients whose qHBs Ag value decreased >50% at 1 year after antiviral treatment for CHB showed a significant decrease in HCC or decompensated cirrhosis events. A reduction in qHBs Ag could be used as a predictive factor of HCC development or critical complications in CHB patients treated with TDF or ETV.
Robotic live donor hysterectomy
Authors: Dahm-Kähler Pernilla , Kvarnström Niclas , Brännström Mats
Published: October 2021

Purpose of review

Donor hysterectomy for live donor uterus transplantation was from the start performed by laparotomy, but minimal invasive surgery has entered the scene. In particular robotic-assisted laparoscopy is used since robotics is advantageous in the complex donor hysterectomy surgery in narrow space. This review covers the development and benefits of robotics and the published robotic donor hysterectomy experiences.

Recent findings

Robotic donor hysterectomy publications are scarce with eight cases in Sweden, five in USA, and one each in China and Spain. Robotics have been performed for either the entire donor hysterectomy or with conversion to laparotomy for the last steps of the surgical procedure. The total operative times are in line with open surgery, although a decrease is expected in the future. The estimated blood loss and hospital stays are less than at open surgery. The complication panorama includes hydronephrosis, ureteric fistula and pressure alopecia. Live births with healthy babies have been reported.

In uterus transplantation, robotic live donor hysterectomy has proven to be feasible, safe and associated with successful live births. The robotic donor hysterectomy is a low-volume procedure and an international registry to gather collective information is crucial for further evaluation and development.
Paediatric Gastrointestinal, Hepatic and Pancreatic Inflammatory Myofibroblastic Tumours, A Single Centre Experience
Authors: Couper Michael Richard , Eldredge Jessica Allison , Kirby Maria , Kirby Christopher , Moore David , Hammond Paul , Manton Nick , Glynn Andrea , Couper Richard Thomas
Published: October 2021

Inflammatory myofibroblastic tumours (IMTs) are rare soft tissue tumours. Reports of gastrointestinal tract, liver and pancreas tumours are limited. The objective of this study is to identify presenting features, contributing prognostic / etiological factors and any variability in outcomes in the context of different historical treatments. We retrospectively reviewed the records of seven children treated at our hospital between 2006 and 2019 and assessed the demographic, presentation, treatment, immunohistochemistry, and outcomes of their tumours. Age range at presentation was 4 months–15 years with a male predominance. Presentations were typically due to local mass effect or incidental discovery. Systemic symptoms were rare. Outcomes were good with six out of seven stable or in remission irrespective of treatment. Surgical resection where possible is the treatment of choice. Medical therapy had good outcomes with chemotherapy acting as first line treatment when required. The only negative prognostic factor identified was local spread at the time of presentation.
Rapid Point-of-Care Testing for Genital Tract Inflammatory Cytokine Biomarkers to Diagnose Asymptomatic Sexually Transmitted Infections and Bacterial Vaginosis in Women: Cost Estimation and Budget Impact Analysis
Authors: Kairu Angela , Masson Lindi , Passmore Jo-Ann S. , Cunnama Lucy , Sinanovic Edina
Published: October 2021

Background

Screening for genital inflammation can reveal asymptomatic cases of sexually transmitted infections (STIs) and bacterial vaginosis (BV), useful in settings where only syndromic management is available. This study aimed to estimate the incremental cost of screening using a new cytokine biomarker rapid test and determine the budget impact of providing this service in primary health facilities in South Africa.

Methods

Costs of adding genital inflammation screening to existing family planning services were estimated for women (15–49 years) attending 3 different family planning clinics in US $2016. The predicted unit cost per patient screened from a provider's perspective was calculated using bottom-up and top-down approaches and was used to analyze the budget impact of scaling up and providing this service in primary health facilities countrywide. Univariate sensitivity analyses tested the robustness of the findings.

Results

The incremental cost per woman screened for genital inflammation ranged between US $3.19 and US $4.79. The scaled-up costs ranged between US $7,245,775 and US $22,212,636 countrywide, annually. This was based on the number of women of reproductive age currently seeking contraceptive care at all primary health care facilities, as a proxy for those most susceptible to asymptomatic STIs/BV. The cost estimates were sensitive to changes in personnel costs, utilization rate, and population coverage rates.

Conclusions

This screening tool is likely to increase case detection, contributing to better STI/BV management and control, in addition to reducing women's risk of HIV acquisition. The incremental cost estimates could make implementation affordable.
Benefits of 1-Yr Home Training With Functional Electrical Stimulation Cycling in Paraplegia During COVID-19 Crisis
Authors: Fattal Charles , Schmoll Martin , Le Guillou Ronan , Raoult Berengère , Frey Alain , Carlier Robert , Azevedo-Coste Christine
Published: October 2021

The purpose of this observational study was to report the experience of a 1-yr home training with functional electrical stimulation cycling of a person with T4 American Impairment Scale A paraplegia for 9 yrs, homebound due to the COVID-19 health crisis. The 40-yr-old participant had a three-phase training: V1, isometric stimulation; V2, functional electrical stimulation cycling for 3 sessions/wk; and V3, functional electrical stimulation cycling for 2–4 sessions/wk. Data on general and physical tolerance, health impact, and performance were collected. Borg Scale score relating to fatigue was 10.1 before training and 11.8 after training. The average score for satisfaction at the end of sessions was 8.7. Lean leg mass increased more than 29%, although total bone mineral density dropped by 1.6%. The ventilatory thresholds increased from 19.5 to 29% and the maximum ventilatory peak increased by 9.5%. Rosenberg’s Self-esteem Scale score returned to its highest level by the end of training. For the only track event on a competition bike, the pilot covered a distance of 1607.8 m in 17 mins 49 secs. When functional electrical stimulation cycling training is based on a clear and structured protocol, it offers the person with paraplegia the opportunity to practice this activity recreationally and athletically. In times of crisis, this training has proven to be very relevant.
Utility of Dynamic Hepatobiliary Scintigraphy in Identifying a Duct of Luschka Bile Leak
Authors: Crowley Connor , Elojeimy Saeed , Rieter William J.
Published: October 2021

Hepatobiliary scintigraphy is a sensitive tool for the detection of a suspected bile leak following cholecystectomy. Traditionally, it has been used to identify, but not localize the source of the leak. Herein we present a case of a bile leak related to a duct of Luschka injury that was identified on dynamic hepatobiliary scintigraphy, but was less evident on a concurrently acquired MRI. This case highlights the scintigraphic features of a bile leak from an accessory duct and underscores the importance of reviewing early dynamic images to potentially identify the source of a leak.
Monitoring of Programmed Cell Death Ligand-1 Blockade Using FDG PET/CT for Microsatellite Instability-High Metastatic Breast Cancer
Authors: Kawamata Ayumi , Sasada Shinsuke , Emi Akiko , Masumoto Norio , Kadoya Takayuki
Published: October 2021

Microsatellite instability-high/mismatch repair deficiency is one of biomarkers predicting the response to pembrolizumab, an immune checkpoint inhibitor for metastatic solid tumors. A 44-year-old woman with stage IIIC right breast cancer was treated with mastectomy and axillary node dissection after primary systemic chemotherapy followed by radiation, chemotherapy, and hormonal therapy. Eighteen months after surgery, recurrent diseases were revealed and refractory to multiple treatments. The recurrent site biopsy showed microsatellite instability-high, and programmed cell death ligand-1 inhibitor pembrolizumab was administrated. FDG PET/CT showed complete metabolic response over 12 months and is useful to monitor the response of active immunotherapy.
Imaging Considerations and Thoracic Diseases in Females
Authors: Walkoff Lara , Zagurovskaya Marianna
Published: October 2021

Females have unique physiological considerations that must be considered during image acquisition and interpretation. Familiarity with imaging of pregnant and lactating patients requires modifications from standard protocols to mitigate radiation-induced risk to both the mother and the fetus. Manifestations in the chest related to conception, pregnancy, and gynecologic pathologies are female-specific. Furthermore, there are a number of conditions that exclusively or disproportionately affect females, including diffuse lung diseases. Here, we review the expected normal findings and variant appearances of diseases in female patients on chest imaging to help the radiologist arrive at the correct diagnosis and avoid diagnostic pitfalls. In addition, the general principles of thoracic imaging in women of reproductive age are discussed.
Endoscopic Browlift in Patients With Receding Hairlines
Authors: Boonipat Thanapoom , Hebel Nathan , Lin Jason , Frank Konstantin , Möllhoff Nicholas , Cotofana Sebastian , Bradley Elizabeth , Shapiro Daniel , Mardini Samir
Published: October 2021

Patients with receding or high hairlines have traditionally been considered unfavorable candidates for endoscopic brow lift as this can further lengthen the hairline. We analyzed outcomes in patients that underwent a novel endoscopic brow lift technique with placement of incisions and anchoring Endotine Forehead Devices (CoApt Systems Inc, Palo Alto, CA, USA) directly at the natural forehead crease lines, in an effort to minimize elevation of the hairline, whereas providing well-hidden scars. We retrospectively reviewed all patients who underwent this new Endotine and incision placement between 2016 and 2020. Preoperative and postoperative photographs of all patients were analyzed to determine the postoperative changes in brow elevation and forehead length proportion (defined as length from cranium to chin).

The forehead length proportion was unchanged pre- and post-operatively, with no statistically significant differences noted (P = 0.48). The average brow position elevation ranged from 2.78 mm in the medial location to 5.05 mm in the lateral location. All patients were happy with their appearance and had improved visual fields postoperatively. The forehead scars healed well and were well hidden in forehead rhytids at long term follow-up.

This novel endoscopic brow lift technique provides an option to utilize a minimally invasive approach in patients with receding hairline. With this technique, visible scars were minimized, whereas still being able to achieve reasonable brow elevation. Thus, our approach enables long term maintenance of brow elevation with inconspicuous scars in the forehead.
Financial Burden of Traumatic Injury Amongst the Privately Insured
Authors: Fu Sue J. , Arnow Katherine , Trickey Amber , Spain David A. , Morris Arden , Knowlton Lisa
Published: October 2021

Objective:

We sought to evaluate the overall financial burden associated with traumatic injury amongst patients with private insurance and assess the effect of high deductible plans on out-of-pocket costs (OOPCs).

Summary of Background Data:

Traumatic injury can be a source of unexpected financial burden for households. However, the effect of increasing participation in higher cost-sharing private health insurance plans remains unknown.

Methods:

We conducted a retrospective cohort observational study, using the Clinformatics Data Mart Database, a nationwide single-payer administrative claims database to identify US adults who required emergency department services or hospital admission for single traumatic injury from 2008 to 2018. A 2-part model using a logistic regression and a generalized linear model with gamma distribution and log link was used to evaluate 12-month OOPCs after traumatic injury. Multivariable logistic regression was used to evaluate the likelihood of catastrophic health expenditure (CHE) after injury.

Results:

Of 426,945 included patients, 53% were male, 71% were white, and median age was 42 years. Patients faced monthly OOPC of $660 at the time of their injury. High deductible plan enrollment was associated with an increase of $1703 in 12-month OOPC after trauma, compared to those covered by traditional health plans. In addition to high deductible health plan enrollment, worsening injury severity and longer hospital stays were also associated with increased 12-month OOPC after trauma. Non-white minorities paid less 12-month OOPC after trauma compared to non-Hispanic white patients, but also used fewer services. Overall, the incidence of CHE was 5%; however high-deductible health plan enrollees faced a 13% chance of CHE.

Conclusions:

Privately insured trauma patients face substantial OOPCs at the time of their injuries. High-deductible health plans are associated with increased financial vulnerability after trauma.
Postpancreatectomy Acute Pancreatitis (PPAP)
Authors: Marchegiani Giovanni , Barreto Savio George , Bannone Elisa , Sarr Michael , Vollmer Charles M. , Connor Saxon , Falconi Massimo , Besselink Marc G. , Salvia Roberto , Wolfgang Christopher L. , Zyromski Nicholas J. , Yeo Charles J. , Adham Mustapha , Siriwardena Ajith K. , Takaori Kyoichi , Hilal Mohammad Abu , Loos Martin , Probst Pascal , Hackert Thilo , Strobel Oliver , Busch Olivier R. C. , Lillemoe Keith D. , Miao Yi , Halloran Christopher M. , Werner Jens , Friess Helmut , Izbicki Jakob R. , Bockhorn Maximillian , Vashist Yogesh K. , Conlon Kevin , Passas Ioannis , Gianotti Luca , Del Chiaro Marco , Schulick Richard D. , Montorsi Marco , Oláh Attila , Fusai Giuseppe Kito , Serrablo Alejandro , Zerbi Alessandro , Fingerhut Abe , Andersson Roland , Padbury Robert , Dervenis Christos , Neoptolemos John P. , Bassi Claudio , Büchler Markus W. , Shrikhande Shailesh V. ,   on behalf of the International Study Group for Pancreatic Surgery
Published: October 2021

Objective:

The ISGPS aimed to develop a universally accepted definition for PPAP for standardized reporting and outcome comparison.

Background: :

PPAP is an increasingly recognized complication after partial pancreatic resections, but its incidence and clinical impact, and even its existence are variable because an internationally accepted consensus definition and grading system are lacking.

Methods:

The ISGPS developed a consensus definition and grading of PPAP with its members after an evidence review and after a series of discussions and multiple revisions from April 2020 to May 2021.

Results:

We defined PPAP as an acute inflammatory condition of the pancreatic remnant beginning within the first 3 postoperative days after a partial pancreatic resection. The diagnosis requires (1) a sustained postoperative serum hyperamylasemia (POH) greater than the institutional upper limit of normal for at least the first 48 hours postoperatively, (2) associated with clinically relevant features, and (3) radiologic alterations consistent with PPAP. Three different PPAP grades were defined based on the clinical impact: (1) grade postoperative hyperamylasemia, biochemical changes only; (2) grade B, mild or moderate complications; and (3) grade C, severe life-threatening complications.

Discussions:

The present definition and grading scale of PPAP, based on biochemical, radiologic, and clinical criteria, are instrumental for a better understanding of PPAP and the spectrum of postoperative complications related to this emerging entity. The current terminology will serve as a reference point for standard assessment and lend itself to developing specific treatments and prevention strategies.
Transthoracic Robotic First and Cervical Rib Resection for Thoracic Outlet Syndrome
Authors: Palivela Nihanth , Burt Bryan M.
Published: October 2021

Introduction:

Neurogenic thoracic outlet syndrome (TOS) is a musculoskeletal condition in which the brachial plexus is dynamically compressed within the scalene triangle, an anatomic space bordered by the anterior and middle scalene muscles and the first rib. In some cases, an offending cervical rib is present. Traditional surgical approaches to first rib resection and scalenectomy are limited by exposure, require retraction of neurovascular structures, and result in morbidity.

Methods:

We describe a novel transthoracic robotic approach to first/cervical rib resection that overcomes these limitations, and we review its early clinical outcomes.

Results:

Robotic first rib resection (FRR) is crystallized into 12 distinct steps, each with detailed video commentary, and nuances specific to neurogenic and venous TOS cases are provided. Published data supports decreased surgical morbidity of robotic FRR compared with open cases.

Conclusions:

Robotic FRR offers advantages over traditional operative approaches including improved exposure and elimination of retraction of neurovascular structures, which result in improved safety.
Combined neuromodulatory approaches in the central nervous system for treatment of spinal cord injury
Authors: Noga Brian R. , Guest James D.
Published: October 2021

Purpose of review

To report progress in neuromodulation following spinal cord injury (SCI) using combined brain and spinal neuromodulation.

Neuromodulation refers to alterations in neuronal activity for therapeutic purposes. Beneficial effects are established in disease states such as Parkinson's Disease (PD), chronic pain, epilepsy, and SCI. The repertoire of neuromodulation and bioelectric medicine is rapidly expanding. After SCI, cohort studies have reported the benefits of epidural stimulation (ES) combined with training. Recently, we have explored combining ES with deep brain stimulation (DBS) to increase activation of descending motor systems to address limitations of ES in severe SCI. In this review, we describe the types of applied neuromodulation that could be combined in SCI to amplify efficacy to enable movement. These include ES, mesencephalic locomotor region (MLR) - DBS, noninvasive transcutaneous stimulation, transcranial magnetic stimulation, paired-pulse paradigms, and neuromodulatory drugs. We examine immediate and longer-term effects and what is known about: (1) induced neuroplastic changes, (2) potential safety concerns; (3) relevant outcome measures; (4) optimization of stimulation; (5) therapeutic limitations and prospects to overcome these.

Recent findings

DBS of the mesencephalic locomotor region is emerging as a potential clinical target to amplify supraspinal command circuits for locomotion.

Combinations of neuromodulatory methods may have additive value for restoration of function after spinal cord injury.
Inevitability of Red Queen evolution driven by organismic complexity and simple feedback via environmental modification
Authors: Fisher Daniel S.
Published: October 2021

Evolution in complex high-dimensional phenotype spaces can be very different than the caricature of uphill evolutionary trajectories in a low-dimensional fitness landscape. And slight modifications of the environment can have large consequences for the future evolution. Here, the simplest approximation of evolution, an almost-always clonal population evolving by small effect mutations under deterministic “adaptive” dynamics, is studied. The complexities of organisms and their interactions with their environments are caricatured by population growth rates being smoothly varying random functions in very high dimensional phenotype spaces. In a fixed environment, there are huge numbers of fitness maxima, yet evolutionary trajectories wander around amongst saddles, gradually slowing down but still wandering widely and without committing to any maximum. But with even very small changes of the environment caused by the phenotypic changes, after an initial transient the evolution continues forever without further slowing down. In this Red Queen “phase” the apparent rate of increase of the fitness saturates (at a feedback strength-dependent rate) and the trajectories perpetually wander over large phenotypic distances. Organismic complexities, caricatured by a large number of constraints on the molecular-level phenotype, together with the simplest possible interactions of the organisms with their environment, are shown to be sufficient to cause such Red Queen dynamics. Arguments are made for the ubiquity of such behavior.
Here’s the twist: How the brain updates the representations of naturalistic events as our understanding of the past changes
Authors: Zadbood Asieh , Nastase Samuel A. , Chen Janice , Norman Kenneth A. , Hasson Uri
Published: October 2021

The brain actively reshapes our understanding of past events in light of new incoming information. In the current study, we ask how the brain supports this updating process during the encoding and recall of naturalistic stimuli. One group of participants watched a movie (“The Sixth Sense”) with a cinematic “twist” at the end that dramatically changed the interpretation of previous events. Next, participants were asked to verbally recall the movie events, taking into account the new “twist” information. Most participants updated their recall to incorporate the twist. Two additional groups recalled the movie without having to update their memories during recall: one group never saw the twist; another group was exposed to the twist prior to the beginning of the movie, and thus the twist information was incorporated both during encoding and recall. We found that providing participants with information about the twist beforehand altered neural response patterns during movie-viewing in the default mode network (DMN). Moreover, presenting participants with the twist at the end of the movie changed the neural representation of the previously-encoded information during recall in a subset of DMN regions. Further evidence for this transformation was obtained by comparing the neural activation patterns during encoding and recall and correlating them with behavioral signatures of memory updating. Our results demonstrate that neural representations of past events encoded in the DMN are dynamically integrated with new information that reshapes our understanding in natural contexts.
Spectral graph theory of brain oscillations – revisited and improved
Authors: Verma Parul , Nagarajan Srikantan , Raj Ashish
Published: October 2021

Mathematical modeling of the relationship between the functional activity and the structural wiring of the brain has largely been undertaken using non-linear and biophysically detailed mathematical models with regionally varying parameters. While this approach provides us a rich repertoire of multistable dynamics that can be displayed by the brain, it is computationally demanding. Moreover, although neuronal dynamics at the microscopic level are nonlinear and chaotic, it is unclear if such detailed nonlinear models are required to capture the emergent meso- (regional population ensemble) and macroscale (whole brain) behavior, which is largely deterministic and reproducible across individuals. Indeed, recent modeling effort based on spectral graph theory has shown that an analytical model without regionally varying parameters can capture the empirical magnetoencephalography frequency spectra and the spatial patterns of the alpha and beta frequency bands accurately.

In this work, we demonstrate an improved hierarchical, linearized, and analytic spectral graph theorybased model that can capture the frequency spectra obtained from magnetoencephalography recordings of resting healthy subjects. We reformulated the spectral graph theory model in line with classical neural mass models, therefore providing more biologically interpretable parameters, especially at the local scale. We demonstrated that this model performs better than the original model when comparing the spectral correlation of modeled frequency spectra and that obtained from the magnetoencephalography recordings. This model also performs equally well in predicting the spatial patterns of the empirical alpha and beta frequency bands.

Highlights

We show an improved hierarchical, linearized, and analytic spectral graph theory-based model that can capture the frequency spectra obtained from magnetoencephalography recordings

This model also accurately captures the spatial patterns of the empirical alpha and beta frequency bands, requiring only 5-10 graph eigenmodes to do so
16S rRNA gene sequences of Candidatus Methylumidiphilus (Methylococcales), a putative methanotrophic genus in lakes and ponds
Authors: Rissanen Antti J , Buck Moritz , Peura Sari
Published: October 2021

A putative novel methanotrophic genus, Candidatus Methylumidiphilus (Methylococcales), was recently shown to be ubiquitous and one of the most abundant methanotrophic genera in water columns of oxygen-stratified lakes and ponds of boreal and subarctic area. However, it has probably escaped detection in many previous studies using 16S rRNA gene amplicon sequencing due to insufficient database coverage, which is because Ca. Methylumidiphilus lacks cultured representatives and previously analysed metagenome assembled genomes (MAGs) affiliated with it do not contain 16S rRNA genes. Therefore, we screened MAGs affiliated with the genus for their 16S rRNA gene sequences in a recently published lake and pond MAG dataset. Among 66 MAGs classified as Ca. Methylumidiphilus (with completeness over 40% and contamination less than 5%) originating from lakes in Finland, Sweden and Switzerland as well as from ponds in Canada, we could find 5 MAGs each containing one 1532 bp long sequence spanning the V1-V9 regions of the 16S rRNA gene. After removal of sequence redundancy, this resulted in two unique 16S rRNA gene sequences. These sequences represented two different putative species, i.e. Ca. Methylumidiphilus alinenensis (Genbank accession: OK236221) as well as another so far unnamed species of Ca. Methylumidiphilus (Genbank accession: OK236220). We suggest that including these two sequences in reference databases will enhance 16S rRNA gene - based detection of members of this genus from environmental samples.
Accelerating Identification of Chromatin Accessibility from noisy ATAC-seq Data using Modern CPUs
Authors: Chaudhary Narendra , Misra Sanchit , Kalamkar Dhiraj , Heinecke Alexander , Georganas Evangelos , Ziv Barukh , Adelman Menachem , Kaul Bharat
Published: October 2021

Identifying accessible chromatin regions is a fundamental problem in epigenomics with ATAC-seq being a commonly used assay. Exponential rise in single cell ATAC-seq experiments has made it critical to accelerate processing of ATAC-seq data. ATAC-seq data can have a low signal-to-noise ratio for various reasons including low coverage or low cell count. To denoise and identify accessible chromatin regions from noisy ATAC-seq data, use of deep learning on 1D data – using large filter sizes, long tensor widths, and/or dilation - has recently been proposed. Here, we present ways to accelerate the end-to-end training performance of these deep learning based methods using CPUs. We evaluate our approach on the recently released AtacWorks toolkit. Compared to an Nvidia DGX-1 box with 8 V100 GPUs, we get up to 2.27× speedup using just 16 CPU sockets. To achieve this, we build an efficient 1D dilated convolution layer and demonstrate reduced precision (BFloat16) training.
Direct cryopreservation of poultry/avian embryonic reproductive cells: A low-tech, cost-effective and efficient method for safeguarding genetic diversity
Authors: Hu Tuanjun , Taylor Lorna , Sherman Adrian , Tiambo Christian K. , Kemp Stephen J. , Whitelaw Bruce W. , Hawken Rachel J. , Djikeng Appolinaire , McGrew Mike J.
Published: October 2021

Chickens are an important resource for smallholder farmers who raise locally adapted, genetically distinct breeds for eggs and meat. The development of efficient reproductive technologies to conserve and regenerate chicken breeds safeguards existing biodiversity and secures poultry genetic resources for climate resilience, biosecurity, and future food production. The majority of the over 1600 breeds of chicken are raised in low and lower to middle income countries (LMICs) under resource limited, small scale production systems, which necessitates a low tech, cost effective means of conserving diversity is needed. Here, we validate a simple biobanking technique using cryopreserved embryonic chicken gonads. The gonads are quickly isolated, visually sexed, pooled by sex, and cryopreserved. Subsequently, the stored material is thawed and dissociated before injection into sterile host chicken embryos. By using pooled GFP and RFP-labelled donor gonadal cells and Sire Dam Surrogate (SDS) mating, we demonstrate that chicks deriving entirely from male and female donor germ cells are hatched. This technology will enable ongoing efforts to conserve chicken genetic diversity for both commercial and small holder farmers, and to preserve existing genetic resources at poultry research facilities.
Fine scale population structure and extensive gene flow within an Eastern Nearctic snake complex (Pituophis melanoleucus)
Authors: Nikolakis Zachary L. , Orton Richard W. , Crother Brian I.
Published: October 2021

Understanding the processes and mechanisms that promote lineage divergence is a central goal in evolutionary biology. For instance, studies investigating the spatial distribution of genomic variation often highlight biogeographic barriers underpinning geographic isolation, as well as patterns of isolation by environment and isolation by distance that can also lead to lineage divergence. However, the patterns and processes that shape genomic variation and drive lineage divergence may be taxa-specific, even across closely related taxa co-occurring within the same biogeographic region. Here, we use molecular data in the form of ultra-conserved elements (UCEs) to infer the evolutionary relationships and population genomic structure of the Eastern Pinesnake complex (Pituophis melanoleucus) – a polytypic wide-ranging species that occupies much of the Eastern Nearctic. In addition to inferring evolutionary relationships, population genomic structure, and gene flow, we also test relationships between genomic diversity and putative barriers to dispersal, environmental variation, and geographic distance. We present results that reveal shallow population genomic structure and ongoing gene flow, despite an extensive geographic range that transcends geographic features found to reduce gene flow among many taxa, including other squamate reptiles within the Eastern Nearctic. Further, our results indicate that the observed genomic diversity is spatially distributed as a pattern of isolation by distance and suggest that the current subspecific taxonomy do not adhere to independent lineages, but rather, show a significant amount of admixture across the entire P. melanoleucus range.
Real-world size of objects serves as an axis of object space
Authors: Huang Taicheng , Song Yiying , Liu Jia
Published: October 2021

Our mind can represent various objects from the physical world metaphorically into an abstract and complex high-dimensional object space, with a finite number of orthogonal axes encoding critical object features. Previous fMRI studies have shown that the middle fusiform sulcus in the ventral temporal cortex separates the real-world small-size map from the large-size map. Here we asked whether the feature of objects’ real-world size constructed an axis of object space with deep convolutional neural networks (DCNNs) based on three criteria of sensitivity, independence and necessity that are impractical to be examined altogether with traditional approaches. A principal component analysis on features extracted by the DCNNs showed that objects’ real-world size was encoded by an independent component, and the removal of this component significantly impaired DCNN’s performance in recognizing objects. By manipulating stimuli, we found that the shape and texture of objects, rather than retina size, co-occurrence and task demands, accounted for the representation of the real-world size in the DCNNs. A follow-up fMRI experiment on humans further demonstrated that the shape, but not the texture, was used to infer the real-world size of objects in humans. In short, with both computational modeling and empirical human experiments, our study provided the first evidence supporting the feature of objects’ real-world size as an axis of object space, and devised a novel paradigm for future exploring the structure of object space.

Teaser

This work provides the first evidence illuminating the feature of objects’ real-world size as an axis of the object space for object recognition with a mutually-inspired paradigm of computational modelling and biological observation.
Modulation of immunosuppressant drug treatment to improve SARS-CoV-2 vaccine efficacy in mice
Authors: Paschall Amy V. , Ozdilek Ahmet , Briner Sydney L. , Brindley Melinda A. , Avci Fikri Y.
Published: October 2021

The COVID-19 pandemic dramatically demonstrated the need for improved vaccination strategies and therapeutic responses to combat infectious diseases. However, the efficacy of vaccines has not yet been demonstrated in combination with commonly used immunosuppressive drug regimens. We sought to determine how common pharmaceutical drugs used in autoimmune disorders can alter immune responses to the SARS-CoV-2 spike protein vaccination.

We treated mice with five immunosuppressant drugs (cyclophosphamide, leflunomide, methotrexate, methylprednisolone, and mycophenolate mofetil), each with various mechanisms of action prior to and following immunization with SARS-CoV-2 spike protein. We assessed the functionality of antibody responses to spike protein and compared immune cell populations in mice that received no treatment with those that received continuous or temporarily suspended immune suppressive therapy.

All tested immunosuppressants significantly reduced the antibody titers in serum and functional antibody response against SARS-CoV-2 spike protein in immunized mice. Temporarily halting selected immunosuppressants (methylprednisolone and methotrexate, but not cyclophosphamide) improved antibody responses significantly. Through proof-of-principle experiments utilizing a mouse model, we demonstrated that immune suppression in autoimmune disorders through pharmaceutical treatments may impair vaccine response to SARS-CoV-2, and temporary suspension of immunosuppressant treatment may be necessary to mount an effective antibody vaccine response. This work provides feasibility for future clinical assessment of the impact of immunosuppressants on vaccine efficacy in humans.

Significance Statement

Immunosuppressant regimens are widely used as therapies for a variety of diseases, including autoimmune, inflammatory, and cancer. However, immunosuppressants can impair critical immune responses to vaccination. The impact of standard immunosuppressant use on the critical, developing SARS-CoV-2 vaccination strategies has not been well-described. In this study, we use a mouse model to determine how different immunosuppressant drugs that act through different mechanisms can impair the antibody response to SARS-CoV-2 spike protein, and how modulating these drug regimens may restore antibody levels and function.