bluuebunny/crossref_metadata_2025 huggingface dataset:
CHAPTER VII
Authors: Woolf Virginia
Published: July 2024

‘And little Augustus Pelham said to me, “It’s the younger generation knocking at the door,” and I said to him, “Oh, but the younger generation comes in without knocking, Mr Pelham.” Such a feeble little joke, wasn’t it, but down it went into...
CHAPTER IX
Authors: Woolf Virginia
Published: July 2024

Katharine disliked telling her mother about Cyril’s misbehaviour quite as much as her father did, and for much the same reasons. They both shrank, nervously, as people fear the report of a gun on the stage, from all that would have to be said...
CHAPTER X
Authors: Woolf Virginia
Published: July 2024

Messrs Grateley and Hooper, the solicitors in whose firm Ralph Denham was clerk, had their office in Lincoln’s Inn Fields, and there Ralph Denham appeared every morning very punctually at ten o’clock. His punctuality, together with other qualities, marked him out among the clerks...
CHAPTER XIV
Authors: Woolf Virginia
Published: July 2024

Mr Clacton was in his glory. The machinery which he had perfected and controlled was now about to turn out its bi-monthly product, a committee meeting; and his pride in the perfect structure of these assemblies was great. He loved the jargon of committee-rooms;...
CHAPTER XX
Authors: Woolf Virginia
Published: July 2024

Happily for Mary Datchet she returned to the office to find that by some obscure Parliamentary manœuvre the vote had once more slipped beyond the attainment of women. Mrs Seal was in a condition bordering upon frenzy. The duplicity of Ministers, the treachery of...
CHAPTER XXIV
Authors: Woolf Virginia
Published: July 2024

The first signs of spring, even such as make themselves felt towards the middle of February, not only produce little white and violet flowers in the more sheltered corners of woods and gardens, but bring to birth thoughts and desires comparable to those faintly...
Chapter III
Authors: Conrad Joseph
Published: July 2024

When General Barrios stopped to address Mrs. Gould, Antonia raised negligently her hand holding an open fan, as if to shade from the sun her head, wrapped in a light lace shawl. The clear gleam of her blue eyes gliding behind the black fringe...
Chapter VIII
Authors: Conrad Joseph
Published: July 2024

After landing from his swim Nostromo had scrambled up, all dripping, into the main quadrangle of the old fort; and there, amongst ruined bits of walls and rotting remnants of roofs and sheds, he had slept the day through. He had slept in the...
Chapter IX
Authors: Conrad Joseph
Published: July 2024

Distracted between doubts and hopes, dismayed by the sound of bells pealing out the arrival of Pedrito Montero, Sotillo had spent the morning in battling with his thoughts; a contest to which he was unequal, from the vacuity of his mind and the violence...
Chapter X
Authors: Conrad Joseph
Published: July 2024

The next day was quiet in the morning, except for the faint sound of firing to the northward, in the direction of Los Hatos. Captain Mitchell had listened to it from his balcony anxiously. The phrase, “In my delicate position as the only consular...
The New Biography
Authors: Woolf Virginia
Published: July 2024

‘The aim of biography,’ said Sir Sidney Lee, who had perhaps read and written more lives than any man of his time, ‘is the truthful transmission of personality,’* and no single sentence could more neatly split up into two parts the...
Leslie Stephen
Authors: Woolf Virginia
Published: July 2024

By the time that his children were growing up the great days of my father’s life were over. His feats on the river and on the mountains had been won before they were born. Relics of them were to be found lying about the...
Oxford Street Tide
Authors: Woolf Virginia
Published: July 2024

Down in the docks one sees things in their crudity, their bulk, their enormity. Here in Oxford Street they have been refined and transformed. The huge barrels of damp tobacco have been rolled into innumerable neat cigarettes laid in silver paper. The corpulent bales...
Why Art Today Follows Politics
Authors: Woolf Virginia
Published: July 2024

I have been asked by the Artists International Association* to explain as shortly as I can why it is that the artist at present is interested, actively and genuinely, in politics. For it seems that there are some people to whom...
Chapter 2
Authors: Lewis Wyndham
Published: July 2024

A great many of Frederick Tarr’s resolutions came from his conversation. It was a tribunal to which he brought his hesitations. An active up-and-coming spirit presided over this department of his life.

Civilized men have for conversation something of the superstitious feeling that ignorant men...
Chapter 4
Authors: Lewis Wyndham
Published: July 2024

The new summer heat drew heavy pleasant ghosts out of the ground, like plants disappeared in winter; spectres of energy, bulking the hot air with vigorous dreams. Or they had entered into the trees, in imitation of pagan gods, and nodded their delicate distant...
Chapter 6
Authors: Lewis Wyndham
Published: July 2024

Anastasya towered bleakly in Kreisler’s mind henceforth as an obstacle in his path, a sort of embodiment of optimism, totally unsought, but since she had been put there she must be dealt with. By all rights and according to the rules of the national...
Chapter 1
Authors: Lewis Wyndham
Published: July 2024

Kreisler pressed the bell. A hoarse low Z-like blast, braying softly into the crowded room, announced him. Kreisler still stood safely outside the door.

There was a rush in the passage within; the hissing and spitting sounds inseparable from the speaking of the german tongue:...
Chapter 3
Authors: Lewis Wyndham
Published: July 2024

Bertha went on turning the bread over in the pan, taking the butter from its paper and dropping it into its earthenware dish: rinsing and wiping cutlery and plates, regulating the gas. Frequent truculent exclamations spluttered out if anything went wrong: ‘Verdammte Zündhölzchen!’ ‘Donnerwetter!’...
Chapter 4
Authors: Lewis Wyndham
Published: July 2024

Bertha’s friends looked for her elsewhere, nowadays, than at her rooms: Tarr was always likely to be found there in impolite possession. She made them come as often as she could; her coquetry as regards her carefully arranged rooms demanded numerous visitors: so it...
Chapter 10
Authors: Lewis Wyndham
Published: July 2024

Bertha made her way home in a roundabout fashion. She did not court at that moment a meeting with anyone she knew. The streets were loftily ignorant of her small affairs. Thank God for bricks and mortar, for strangers, for the indifference of nature...
Chapter 11
Authors: Lewis Wyndham
Published: July 2024

He took a step forward: her room was evidently his destination.

‘Schurke!’ Bertha exclaimed shrilly, at the same time retreating into the passage way. ‘Go!’

Arrived in the room, he did not seem to know what next to do. So far he had been evidently...
Chapter 2
Authors: Lewis Wyndham
Published: July 2024

The following is the manner in which Tarr had become acquainted with Kreisler. Upon his first return from his exile in Montmartre he had arrived at Bertha’s place about seven in the evening. He hung about for a little: in ten minutes’ time he...
Chapter 4
Authors: Lewis Wyndham
Published: July 2024

Tarr left Bertha punctually at seven. She looked very ill. He resolved not to go there any more.

Very low, feeling strangely upset, he made towards Vallet’s; when he reached it, it was full of Americans. He gave all these merry school-children, with their...
Chapter 5
Authors: Lewis Wyndham
Published: July 2024

Tarr soon regretted this last anti-climax stage of his adventure: he would have left Kreisler alone, but he felt that by frequenting him he could save Bertha from something disagreeable. With disquiet and misgiving every night now he sat in front of his prussian...
Chapter 2
Authors: Lewis Wyndham
Published: July 2024

Kreisler’s afternoon encounter with Anastasya and Soltyk had resembled Tarr’s meeting with him and Bertha. Kreisler had seen Anastasya and his new Café friend one day from his window: his reference to possible nose-pulling was accounted for by this. The next day he had...
Chapter 6
Authors: Lewis Wyndham
Published: July 2024

Five days after this, in the morning, Otto Kreisler mounted the steps of the police station of a small town near the german frontier. He was going to give himself up.

Bitzenko had pictured his principal, in the event of a successful outcome to the...
Babbitt
Authors: Lewis Sinclair
Published: July 2024

Amusing and tragic by turn, Sinclair Lewis’s classic novel is a biting satire of middle-American values whose title has entered the language as a byword for smug complacency, conformity, and materialism, and whose suburban targets are still much in evidence. A successful real estate agent, George F. Babbitt is a member of all the right clubs, and unquestioningly shares the same aspirations and ideas as his friends and fellow Boosters. Yet even Babbitt dreams of romance and escape, and when his best friend does something to throw his world upside down, he rebels, and tries to find fulfillment in romantic adventures and liberal thinking. Hilarious and poignant, Babbitt turns the spotlight on middle America and strips bare the hypocrisy of business practice, social mores, politics, and religious institutions. In his introduction and notes Gordon Hutner explores the novel’s historical and literary contexts, and highlights its rich cultural and social references. The book also features an up-to-date bibliography and explanatory notes that document and gloss the rich social history of the period.
Chapter I
Authors: Lewis Sinclair
Published: July 2024

I

The towers of Zenith aspired above the morning mist; austere towers of steel and cement and limestone, sturdy as cliffs and delicate as silver rods. They were neither citadels nor churches, but frankly and beautifully office-buildings.

The mist took pity on the fretted structures...
Chapter III
Authors: Lewis Sinclair
Published: July 2024

I

To George F. Babbitt, as to most prosperous citizens of Zenith, his motor car was poetry and tragedy, love and heroism. The office was his pirate ship but the car his perilous excursion ashore.

Among the tremendous crises of each day none was more...
Chapter V
Authors: Lewis Sinclair
Published: July 2024

I

Babbitt’s preparations for leaving the office to its feeble self during the hour and a half of his lunch-period were somewhat less elaborate than the plans for a general European war.

He fretted to Miss McGoun, “What time you going to lunch? Well, make...
Chapter XV
Authors: Lewis Sinclair
Published: July 2024

I

His march to greatness was not without disastrous stumbling.

Fame did not bring the social advancement which the Babbitts deserved. They were not asked to join the Tonawanda Country Club nor invited to the dances at the Union. Himself, Babbitt fretted, he didn’t “care...
Chapter XVII
Authors: Lewis Sinclair
Published: July 2024

I

There are but three or four old houses in Floral Heights, and in Floral Heights an old house is one which was built before 1880. The largest of these is the residence of William Washington Eathorne, president of the First State Bank.

The Eathorne...
Chapter XXIV
Authors: Lewis Sinclair
Published: July 2024

I

His visit to Paul was as unreal as his night of fog and questioning. Unseeing he went through prison corridors stinking of carbolic acid to a room lined with pale yellow settees pierced in rosettes, like the shoe-store benches he had known as...
In the Hotel Occidental
Authors: Kafka Franz
Published: July 2024

In the hotel Karl was immediately taken into a kind of office in which the Head Cook, a notebook in her hand, was dictating a letter to a young typist. The extremely precise dictation, the controlled and elastic touch on the keys, raced past...
The Magic Violin
Authors: Leroux Gaston
Published: July 2024

Christine Daaé, a victim of machinations to which we shall return, did not subsequently repeat the spectacular success at the Opera that she had enjoyed on the famous night of the gala concert. She was later given an opportunity to sing at the home...
In which Messrs Firmin Richard and Armand Moncharmin have the audacity to stage Faust in an ill-fated theatre with catastrophic results
Authors: Leroux Gaston
Published: July 2024

But when they arrived in their office on the Saturday morning, the Directors found two copies of a letter from the Phantom. It read as follows:

‘Dear Directors,

So is it to be war?

If you still want peace, these are my terms:...
The Masked Ball
Authors: Leroux Gaston
Published: July 2024

The letter was spattered with mud and had no stamp. On it was written: ‘Please forward to the Viscount de Chagny’ and his address in pencil. It had obviously been thrown or dropped in the hope that a passer-by would pick it up and...
A Masterstroke from the King of Traps
Authors: Leroux Gaston
Published: July 2024

Raoul and Christine ran for their lives, fleeing the roof where there were burning eyes which could be seen only in the darkest night. They did not stop until they got to the eighth level down. That evening there was no performance, so the...
The Police Inspector, the Viscount and the Persian
Authors: Leroux Gaston
Published: July 2024

The first thing Inspector Mifroid said as he entered the Directors’ office was to ask if there was any news of the missing diva.

‘Is Christine Daaé here?’

As I told you, a tight-knit group of men followed him in.

‘Christine Daaé? Here? No. Why?’...
Limited waterpower contributed to rise of steam power in British “Cottonopolis”
Authors: Jonell Tara N , Jones Peter , Lucas Adam , Naylor Simon
Published: July 2024

The Industrial Revolution precipitated a pivotal shift from waterpower to coal-fueled steam power in British textile mills. Although it is now widely accepted that steam was chosen to power factories despite the availability of sufficient waterpower resources across most of Britain, the location and suitability of that waterpower during the early 19th century remain underexplored. Here, we employ quantitative fluvial geomorphology alongside historical climate data, factory records, and a catalog of over 26,000 mill sites to reveal that waterpower was abundant for most of early 19th century Britain, except in the central hub of British cotton production: Greater Manchester in the Mersey Basin. Our findings show that surging factory mechanization and overcrowding on key waterways in the Mersey Basin compounded waterpower scarcity arising from a drier 19th century climate. Widespread adoption of coal-fueled steam engines in certain key industrial centers of Britain was a strategy aimed at ameliorating some of the reduced reliability of waterpower. The fact that steam engines were frequently used in water-powered factories in many industrial regions until the third quarter of the 19th century to recirculate water to provide that power, or as a power supplement when waterpower availability was restricted, adds further weight to our argument. Rapid adoption of coal-powered steam engines reshaped the social and structural landscape of industrial work, firmly established Britain's prominence as an industrial powerhouse, and had lasting global industrial and environmental impacts.
Evoked questions and inquiring attitudes
Authors: Willard-Kyle Christopher , Millson Jared , Whitcomb Dennis
Published: July 2024

Drawing inspiration from the notion of evocation employed in inferential erotetic logic, we defend an ‘evoked questions norm’ on inquiring attitudes. According to this norm, it is rational to have an inquiring attitude concerning a question only if that question is evoked by your background information. We offer two arguments for this norm. First, we develop an argument from convergence. Insights from several independent literatures (20th-century ordinary-language philosophy, inferential erotetic logic, inquisitive epistemic logic, and contemporary zetetic epistemology), all converge on the evoked questions norm. Second, we show that suitably interpreted, the evoked questions norm correctly predicts several underappreciated kinds of bad questions. It does this, in part, by recovering versions of previously defended ignorance and knowledge norms. Some of those bad questions cannot be predicted by either norm singly, but only when corporately taken to reflect a common normative category. We identify this category as evocation.
Constraining Spacetime Dimensions in Quantum Gravity by Scale Invariance and Electric–Magnetic Duality
Authors: Morita Takeshi
Published: July 2024

We consider a low-energy effective theory of p-branequaes in a D-dimensional spacetime, and impose two conditions: (1) the theory is scale-invariant, and (2) the electric–magnetic dual $(D-p-4)$-branes exist and they obey the same type of interactions to the p-branes. (We also assume other natural conditions such as Lorentz invariance but not string theory, supersymmetry, supergravity, and so on.) We then ask what values of p and D are consistent with these conditions. Using simple dimensional analysis, we find that only two solutions are possible: $(p,D)=(2,11)$ and $(p,D)=(2n-1,4n+2)$, ($n=1,2,3,\cdots$). The first solution corresponds to M-theory, and the second solutions at $n=1$ and $n=2$ correspond to self-dual strings in little string theory and D3-branes in type IIB superstring theory, respectively, while the second solutions for $n \ge 3$ are unknown but would be higher spin theories. Thus, quantum gravity (massless spin two theory) satisfying our two conditions would only be superstring theories, and the conditions would be strong enough to characterize superstring theories in quantum gravity.
Dissolvable microneedles loaded ginsenoside Rg3 liposome: a transdermal delivery approach for alopecia treatment
Authors: Yang Qin , Guo Peng , Lei Pengkun , Yang Qiaolin , Liu Yuchun , Tian Ya , Shi Wen , Zhu Chunxiao , Lei Min , Zeng Rui , Zhang Chen , Qu Yan
Published: July 2024

The skin stratum corneum (SC) barrier function will interfere with the absorption of topical treatment and reduce the drug's therapeutic effect on alopecia. Microneedles (MNs) can penetrate the skin barrier and deliver drugs to the dermis. Furthermore, MNs can mechanically stimulate the skin, which promotes hair growth. Thus, we designed a green and dissolvable composite microneedle made of hyaluronic acid (HA) and Bletilla striata polysaccharide (BSP) to encapsulate cholesterol-free ginsenoside Rg3 liposomes (Rg3-LPs) to avoid cholesterol metabolism-producing testosterone to inhibit hair regeneration and minimize the effect of the SC barrier on liposomes absorption. HA and BSP can enhance the mechanical strength of Rg3-MNs to ensure the transport of liposomes to the hair follicle (HF) region while causing minimal skin irritation and guaranteeing cell compatibility. In addition, HA increased hair density and was more conducive to hair regeneration. In telogen effluvium (TE) and testosterone-induced androgenetic alopecia (AGA) animals, Rg3-MNs achieved comparable efficacy to minoxidil with low-frequency treatment and the quality of regenerated hair was higher. Furthermore, quantitative characterization and transcriptome sequencing results showed that Rg3-MNs promoted hair regeneration by promoting the expression of Wnt3a and Wnt10b genes, activating the Wnt/β-catenin pathway. Therefore, Rg3-MNs present broad prospects in the treatment of alopecia.
Effect of forage quality and narasin inclusion on ruminal fermentation, nutrient intake, and total tract digestibility of Nellore steers
Authors: de Paula Matheus Felipe Freitas Viana , Marques Rodrigo S , Pires Alexandre Vaz , Soares Letícia Carolina Bortolanza , Limede Arnaldo Cintra , Ferreira Evandro Maia , Polizel Daniel Montanher
Published: July 2024

The study aimed to evaluate the effects of forage quality and narasin inclusion on intake, digestibility, and ruminal fermentation of Nellore steers. Twenty-eight rumen-cannulated Nellore steers (initial body weight [BW] = 350 ± 32.4 kg) were allocated to individual pens in a randomized complete block design, with 7 blocks, defined according to the fasting BW at the beginning of the experiment. The steers were randomly assigned within blocks to 1 of 4 experimental diets in 2 × 2 factorial arrangements, being the first-factor forage quality (MEDIUM = 81 g of CP/kg of dry matter [DM], and HIGH = 153 g of CP/kg of DM), and the second factor was the inclusion (N13 = diet plus 13 mg/kg of DM of narasin) or not (N0) of narasin (Zimprova; Elanco Animal Health, São Paulo, Brazil). The experiment consisted of a 28-d period with 22 d for adaptation and the last 6 d for data collection. No haylage quality × narasin interaction (P ≥ 0.68) was observed on DM and nutrient intake. Haylage quality affected (P ≤ 0.01) DM intake, with greater values observed for steers fed HIGH compared with MEDIUM haylage. There was an increase (P < 0.001) in OM, NDF, hemicellulose, and CP intake for steers consuming HIGH vs. MEDIUM haylage. Including N13 did not affect (P > 0.39) DM and nutrient intake of steers. No haylage quality × narasin interactions were detected (P ≥ 0.60) for total tract nutrient digestibility. However, steers fed with HIGH haylage showed an increase (P > 0.001) in DM and digestibility of all nutrients compared with MEDIUM. Steers fed a MEDIUM haylage had a greater (P < 0.01) proportion of acetate compared with steers fed HIGH during all evaluated hours. Steers fed HIGH haylage had a greater (P < 0.01) proportion of propionate at 0 h compared with steers consuming MEDIUM, whereas at 12 h, steers consuming MEDIUM hay had a greater (P < 0.01) proportion of propionate vs. HIGH haylage. A haylage quality × narasin and haylage quality × time of collection interactions were detected (P ≤ 0.03) for rumen ammonia concentration, which was reduced (P < 0.03) in N13 vs. N0 steers consuming HIGH haylage. Collectively, high-quality haylage allows increased consumption and digestibility, with more energy-efficient ruminal fermentation. In addition, narasin might be an important nutritional tool in forage-based diets to enhance the ruminal fermentation parameters of Bos indicus Nellore steers.
Building on Strong Foundations: Deploying Enhanced Replicating Effective Programs for evidence-based prevention curriculum adaptation
Authors: Eisman Andria B , Palinkas Lawrence A , Koffkey Christine , Lafta Hajir , Fridline Judy , Harvey Christina , Kilbourne Amy M
Published: July 2024

Schools frequently adopt new interventions for each new public health issue, but this is both time- and resource-intensive. Adversity exposure is an example of a pervasive public health issue that emerged during Coronavirus Disease 2019 (COVID-19) with notable consequences, including an elevated risk of developing substance use disorders and mental illnesses. Adapting existing, universal, evidence-based interventions, such as the Michigan Model for HealthTM (MMH), by incorporating trauma-sensitive content is a promising approach to meet this need. We examined critical steps in promoting MMH adaptability as part of the Enhanced REP (Replicating Effective Programs) implementation strategy during the COVID-19 pandemic. We share usability testing from the 2020 to 2021 school year and describe how we apply the results to inform the group randomized trial pilot study. We applied key steps from implementation adaptation frameworks to integrate trauma-sensitive content as COVID-19 unfolded, documenting the process through field notes. We conducted initial usability testing with two teachers via interviews and used a rapid qualitative analysis approach. We conducted member checking by sharing the information with two health coordinators to validate results and inform additional curriculum refinement. We developed an adapted MMH curriculum to include trauma-sensitive content, with adaptations primarily centered on adding content, tailoring content, substituting content, and repeating/reinforcing elements across units. We designed adaptations to retain the core functional elements of MMH. Building foundational relationships and infrastructure supports opportunities to user-test intervention materials for Enhanced REP that enhance utility and relevance for populations that would most benefit. Enhanced REP is a promising strategy to use an existing evidence-based intervention to meet better the needs of youth exposed to adversity. Building on the foundations of existing evidence-based interventions, is vital to implementation success and achieving desired public health outcomes.
Validity of different scoring systems in prediction of intensive care unit admission and mortality in acute organophosphate poisoning
Authors: Sobeeh Fatma G , Eldayem Yara B Abd , Khalifa Heba K
Published: July 2024

Background

Organophosphate compounds (OPCs) pose significant health risks, especially in developing countries with limited resources. Predicting outcomes in OPCs poisoning is crucial for guiding clinical management and reducing mortality rates. The aim of this study to evaluate the validity of different scoring systems Rapid Emergency Medicine Score, Multiple Organ Dysfunction Score, Acute Physiology and Chronic Health Evaluation Score, and Poison Severity Score in prediction of intensive care unit (ICU) admission and mortality of acute OPCs poisoning patients.

Methods

A cross-sectional study was conducted on 103 patients admitted to Xx Poison Control Center between May 2022 and June 2023. Scoring systems were applied at admission, and their performance in predicting the need for ICU admission and mortality was evaluated using receiver operating characteristic (ROC) curve analysis.

Results

Most patients survived (92.2%). Only 13.6% of the patients required ICU admission. Significant differences in median scores were observed between survivors and non-survivors and between patients requiring ICU admission and those who did not. Multiple Organ Dysfunction Score exhibited the highest discriminatory power for predicting both ICU admission (AUC = 0.983) and mortality (AUC = 0.999).

Conclusion

The findings highlight the importance of utilizing scoring systems, particularly Multiple organ dysfunction score, for prediction of poor outcomes of acute OPCs poisoning.
XVIINew Literatures
Authors: Ang Ann , Crockett Talia , Gall Adam , Ho Hannah Ming Yit , Manzo Kerry , Mcneill Dougal , Miller Benjamin , Niblett Michael , Nivesjö Sanja , Okunlola Theophilus , Onah Chijioke , Raja Ira , Sharrad Paul , Zirra Maria
Published: July 2024

This chapter has seven sections: 1. Africa; 2. Australia; 3. Canada; 4. The Caribbean; 5. New Zealand; 6. South Asia: India and Sri Lanka; 7. Southeast Asia. Section 1 is by Kerry Manzo, Sanja Nivesjö, Theophilus Okunlola, Chijioke Onah, and Maria Zirra; section 2 is by Adam Gall, Benjamin Miller, and Paul Sharrad; section 3 is by Talia Crockett and Dougal McNeill; section 4 is by Michael Niblett; section 5 is by Dougal McNeill; section 6 is by Ira Raja; section 7 is by Ann Ang and Hannah Ming Yit Ho.
The axial biomechanics of Trigonosaurus pricei (Neosauropoda: Titanosauria) and the importance of the cervical–dorsal region to sauropod high-browser feeding strategy
Authors: Vidal Luciano S , Bergqvist Lílian P , Candeiro Carlos R A , Bandeira Kamila L N , Tavares Sandra , Brusatte Stephen L , Pereira Paulo V L G C
Published: July 2024

Trigonosaurus pricei is a small to medium-sized sauropod dinosaur (Sauropoda: Titanosauria) from the Late Cretaceous Bauru Group of Brazil that is known from a significant amount of recovered axial elements [four cervical vertebrae, 10 dorsal vertebrae, sacrum (MCT 1488-R), and 10 caudal vertebrae (MCT 1719-R)]. In this biomechanical work, we approach the hypothesis of the cartilaginous neutral pose and the range of motion of the axial series of Trigonosaurus. The results show that this sauropod could be capable of high elevation of the neck resulting from morphological adaptations of the cervicodorsal region on dorsal (D) vertebrae D2 and D3 (e.g. postzygapophyses of D2 positioned over the vertebral centrum and prezygapophyses of D3 over the anterior vertebral centrum). This implies that D2 articulates (cartilaginous neutral posture) with D3 only at a strong dorsally directed angle, resulting in a shift in the direction of the neck to a more elevated posture. Furthermore, the tail attributed to Trigonosaurus as a paratype could be oriented in the horizontal ‘direction’ and presented a sigmoidal ‘shape’. This work contributes generally to the understanding of variation in the body plan of sauropods and, more specifically, to the feeding strategy of small and medium-sized titanosaurs from semi-arid regions of Gondwana.
Pharmacokinetics in regional anesthesia
Authors: Leite-Moreira André M. , Correia André , Vale Nuno , Mourão Joana B.
Published: July 2024

Purpose of review

Pharmacokinetics of local anesthetics are one of the main determinants of success and safety of regional anesthesia and comprise local and systemic distribution phases. This review aims to summarize the latest research findings on this topic in the context of various regional blocks performed for different surgeries and patient populations.

Recent findings

Research into local kinetics and systemic absorption of local anesthetics has chiefly been focused on novel fascial plane blocks, especially the erector spinae plane block, as these are increasingly adopted for regional anesthesia and pain management. As their clinical efficacy is very dependent on injection of large volumes of local anesthetic, doses over typically recommended limits are often administered.

Fascial plane blocks are the regional anesthesia techniques in need of the most pharmacokinetic characterization, not only to better understand their complex mechanisms of action but also to avoid harm from excessive doses of local anesthetics. Further mapping of risk factors for systemic toxicity from administration in different block sites is crucial. Extremes of age and pregnancy are vulnerable patient populations but in whom regional anesthesia, including novel techniques, has been performed with few complications.
Lumbar transforaminal epidural steroid injections with particulate vs. nonparticulate steroid: an evidence-informed review on shifting gear to a personalized medicine paradigm
Authors: Cohen Steven P. , Ross Jason D.
Published: July 2024

Purpose of review

To provide an evidence-informed review weighing the pros and cons of particulate vs. nonparticulate steroids for lumbar transforaminal epidural steroid injections (TFESI).

Recent findings

The relative use of nonparticulate vs. particulate steroids for lumbar TFESI has risen recently in light of catastrophic consequences reported for the latter during cervical TFESI. Among various causes of spinal cord infarct, an exceedingly rare event in the lower lumbar spine, embolization of particulate steroid is among the least likely. Case reports have documented cases of spinal cord infarct during lower lumbar TFESI with both particulate and nonparticulate steroids, with database reviews finding no difference in complication rates. There is some evidence for superiority of particulate over nonparticulate steroids in well-designed studies, which could lead to increase steroid exposure (i.e. more injections) and treatment failure resulting in surgical and/or opioid management when nonparticulate steroids are utilized.

Similar to a paradigm shift in medicine, a personalized approach based on a shared decision model and the consequences of treatment failure, should be utilized in deciding which steroid to utilize. Alternatives to ESI include high-volume injections with nonsteroid solutions, and the use of hypertonic saline, which possesses anti-inflammatory properties and has been shown to be superior to isotonic saline in preliminary clinical studies.
Keeping patients in the dark: perioperative anesthetic considerations for patients receiving 5-aminolevulinic acid for glioma resection
Authors: Fatima Benish , Licatino Lauren K. , Abcejo Arnoley S.
Published: July 2024

Purpose of review

5-Aminolevulinic acid hydrochloride (5-ALA), available under the trade name Gleolan, is an orally administered fluorophore drug used to enhance visual differentiation of cancerous tissue from healthy tissue, primarily during surgical resection of high-grade gliomas. Although given preoperatively, 5-ALA has important implications for anesthetic care throughout the perioperative period. This article reviews pharmacology, safety concerns, and perioperative considerations for patients who receive oral 5-ALA.

Recent findings

Although approved for clinical use by the United States Food and Drug Administration in 2017, studies and case reports published since then have further delineated side effects of this medication and its mechanisms and pharmacokinetics.

Mitigating the possible side effects of 5-ALA requires an understanding of its basic mechanism as well as focused perioperative planning and communication. Administration of this medication may result in nausea, vomiting, photosensitivity, increase in serum concentration of liver enzymes, and hypotension. Patients who receive 5-ALA must be protected from prolonged light exposure during the first 48 h after consumption and administration of other photosensitizing agents should be avoided (Supplemental Video File/Video abstract).
Elevated Blood Pressure in Pregnancy and Long-Term Cardiometabolic Health Outcomes
Authors: Field Christine , Grobman William A. , Wu Jiqiang , Kuang Alan , Scholtens Denise M. , Lowe William L. , Shah Nilay S. , Khan Sadiya S. , Venkatesh Kartik K.
Published: July 2024

OBJECTIVE:

To examine the association between elevated blood pressure (BP) in the early third trimester and cardiometabolic health 10–14 years after delivery.

METHODS:

This is a secondary analysis from the prospective HAPO FUS (Hyperglycemia and Adverse Pregnancy Outcome Follow-Up Study). Blood pressure in the early third trimester was categorized per American College of Cardiology/American Heart Association thresholds for: normal BP below 120/80 mm Hg (reference), elevated BP 120–129/below 80 mm Hg, stage 1 hypertension 130–139/80–89 mm Hg, and stage 2 hypertension 140/90 mm Hg or higher. Cardiometabolic outcomes assessed 10–14 years after the index pregnancy were type 2 diabetes mellitus and measures of dyslipidemia, including low-density lipoprotein (LDL) cholesterol 130 mg/dL or higher, total cholesterol 200 mg/dL or higher, high-density lipoprotein (HDL) cholesterol 40 mg/dL or lower, and triglycerides 200 mg/dL or higher. Adjusted analysis was performed with the following covariates: study field center, follow-up duration, age, body mass index (BMI), height, family history of hypertension and diabetes, smoking and alcohol use, parity, and oral glucose tolerance test glucose z score.

RESULTS:

Among 4,692 pregnant individuals at a median gestational age of 27.9 weeks (interquartile range 26.6–28.9 weeks), 8.5% (n=399) had elevated BP, 14.9% (n=701) had stage 1 hypertension, and 6.4% (n=302) had stage 2 hypertension. At a median follow-up of 11.6 years, among individuals with elevated BP, there was a higher frequency of diabetes (elevated BP: adjusted relative risk [aRR] 1.88, 95% CI, 1.06–3.35; stage 1 hypertension: aRR 2.58, 95% CI, 1.62–4.10; stage 2 hypertension: aRR 2.83, 95% CI, 1.65–4.95) compared with those with normal BP. Among individuals with elevated BP, there was a higher frequency of elevated LDL cholesterol (elevated BP: aRR 1.27, 95% CI, 1.03–1.57; stage 1 hypertension: aRR 1.22, 95% CI, 1.02–1.45, and stage 2 hypertension: aRR 1.38, 95% CI, 1.10–1.74), elevated total cholesterol (elevated BP: aRR 1.27, 95% CI, 1.07–1.52; stage 1 hypertension: aRR 1.16, 95% CI, 1.00–1.35; stage 2 hypertension: aRR 1.41 95% CI, 1.16–1.71), and elevated triglycerides (elevated BP: aRR 2.24, 95% CI, 1.42–3.53; stage 1 hypertension: aRR 2.15, 95% CI, 1.46–3.17; stage 2 hypertension: aRR 3.24, 95% CI, 2.05–5.11) but not of low HDL cholesterol.

CONCLUSION:

The frequency of adverse cardiometabolic outcomes at 10–14 years after delivery was progressively higher among pregnant individuals with BP greater than 120/80 in the early third trimester.
Interference with PLA2G16 promotes cell cycle arrest and apoptosis and inhibits the reprogramming of glucose metabolism in multiple myeloma cells by modulating the Hippo/YAP signaling pathway
Authors: Li Hongyan , Zhang Yi , Mou Xiaoyu , Huang Bo , Fan Xiaoqiang
Published: July 2024

Multiple myeloma, which is a clonal plasma cell tumor, derives from a postmitotic lymphoid B-cell lineage and remains untreatable. Group XVI phospholipase A2 (PLA2G16) can either be a tumor suppressor or an oncogene in different types of cancer. This study was intended to explore the role of PLA2G16 in multiple myeloma and to reveal the reaction mechanism. The mRNA and protein expressions of PLA2G16 in human bone marrow stromal cell line HS-5 and multiple myeloma cells were assessed using reverse transcription-quantitative PCR and western blot. The transfection efficacy of sh-PLA2G16 and oe-YAP was examined using reverse transcription-quantitative PCR and western blot. Through cell counting kit-8 assay and 5-ethynyl-2′- deoxyuridine staining, multiple myeloma cell viability and proliferation were detected. Flow cytometry was used to measure cell apoptosis and cell cycle distribution. Oxygen consumption rate, the activities of mitochondrial respiratory chain complexes I–V, and the activity of caspase-3 were estimated with Seahorse XF24 analyzer, oxidative phosphorylation activity assay kit, and caspase-3 assay kit, respectively. Lactate production and glucose consumption were evaluated usingcorresponding assay kits. Western blot was employed to meaure proteins associated with cell cycle, glycolysis, pentose phosphate pathway as well as Hippo/YAP signaling pathway. In this study, PLA2G16 expression was greatly increased in multiple myeloma cells and PLA2G16 silence inhibited cell proliferation, promoted cell apoptosis, facilitated cell cycle arrest, and suppressed the reprogramming of glucose metabolism in multiple myeloma. It was also identified that PLA2G16 depletion inhibited the Hippo/YAP signaling pathway. Further experiments revealed that the overexpression of YAP partially reversed the inhibitory effects of PLA2G16 silence on multiple myeloma cell malignant development and the reprogramming of glucose metabolism. Collectively, PLA2G16 silence impeded multiple myeloma progression and inhibited glucose metabolism reprogramming by blocking the Hippo/YAP signaling pathway.
Relationship Between Low Visual Acuity and Nonfatal Occupational Same-Level Falls in Japanese Female Employees
Authors: Shima Azusa , Kawatsu Yuichiro , Murakami Miki , Morino Ayumi , Okawara Makoto , Hirashima Keiki , Miyamatsu Naomi , Fujino Yoshihisa
Published: July 2024

Objective

The incidence of work-related falls on the same level is increasing, particularly among middle-aged and older female workers. Vision is an important risk factor of falls. We investigated whether objectively measured visual acuity was associated with the incidence of falls.

Methods

This cohort study included 7317 female employees aged 20–69 in Japanese supermarket stores. Monocular acuity measured during health checkups was classified into three levels (≥0.7, 0.3–0.7, <0.3). Incidence rate ratios of work-related falls within 1 year were estimated.

Results

Incidence rate ratios were 1.26 (95%CI: 0.92–1.72) in the 0.3–0.7 group and 2.27 (95%CI: 1.15–4.48) in the <0.3 group.

Conclusions

Risk of work-related fall was higher in those with low visual acuity. Vision correction may contribute to fall prevention in workplaces.
A Study on Nonvibration-Exposed Organs Correlated Indices as Diagnostic Biomarkers of Hand-Arm Vibration Syndrome
Authors: Zhou Kanshou , Zeng Fanfei , Wu Siheng , Zeng Yingshan , Chen Qingsong , Yang Hongyu
Published: July 2024

Objective

The aim of the study is to explore the feasibility of using nonvibration-exposed organ-related indices as vibration-induced white finger (VWF) diagnostic biomarkers.

Methods

Individuals were selected from a factory in China using the judgment sampling method. They were divided into control (con), non-VWF, and VWF groups according to the presence/absence of exposure to hand-transmitted vibration and VWF. Blood samples were collected for ELISA tests.

Results

Analysis of receiver operating characteristic curves was done on six indicators to assess their diagnostic sensitivity for VWF. Area under the receiver operating characteristic curve for insulin was 0.909 and was 0.923 for aspartate aminotransferase.

Conclusions

Insulin and aspartate aminotransferase could be used as indices for the diagnosis of hand-arm vibration syndrome.
Gustatory Function in Patients With Cerebellopontine Angle Masses
Authors: Daskalou Dimitrios , Hsieh Julien W. , Hugentobler Marianne , Macario Sonia , Sipione Rebecca , Voruz François , Guinand Nils , Senn Pascal , Landis Basile N.
Published: July 2024

Objective

To investigate the impact of cerebellopontine angle (CPA) masses on subjective and measured taste function.

Study Design

Retrospective cross-sectional study.

Setting

Tertiary referral center.

Patients

Consecutive adult patients with untreated CPA masses.

Interventions

Gustatory function was psychophysically measured with Taste Strips (range, 0–16) on both sides of the tongue. Subjective taste complaints were assessed using a questionnaire.

Main Outcome Measures

Half-sided taste impairment (hemi-ageusia) was defined as side-to-side asymmetry ≥4 points with <9 points on the side of the CPA mass. We used the Koos classification for vestibular schwannomas (VS) and, in the case of facial nerve palsy, the House–Brackmann grading system.

Results

We included 135 patients (mean [standard deviation (SD)] age, 55.3 ± 14.1 yr; 62 males). The most common CPA mass was VS (77%). Overall, the measured taste function was lower on the affected compared with the healthy side of the tongue (mean score, 9.8 ± 3.3 versus 11 ± 2.9; p < 0.0001). Looking for clinically relevant one-sided taste impairment revealed 18 (13.3%) patients with hemi-ageusia, but only 4 (30.8%) of those subjectively complained of taste dysfunction. Regarding VS, Koos IV masses presented the lowest score on the affected side (mean score, 7.5 ± 3.7). Six patients presented with facial palsy. Having facial palsy did not result in a lower Taste Strips score (p = 0.23).

Conclusion

Before any CPA mass treatment, a measurable ipsilateral decrease in gustatory function is present in many patients. Most patients do not notice this preexisting taste impairment. From a medicolegal standpoint, this warrants consideration. To avoid postoperative claims regarding taste function, a preoperative assessment may be considered.
The impact of long-term (≥5 years) cholecystectomy on gut microbiota changes and its influence on colorectal cancer risk: based on 16S rDNA sequencing analysis
Authors: Zhou Xiecheng , Xu Liang , Zhang Qixing , Chen Wenqi , Xie Hongwei
Published: July 2024

Background

Colorectal cancer (CRC) continues to be a major global health concern. Recent advances in molecular biology have highlighted the gut microbiota’s role in CRC. This study investigates long-term (≥5 years) gut microbiota changes in patients postcholecystectomy, comparing them with CRC patients and healthy controls to assess their impact on CRC development.

Methods

Sixty participants were divided into three groups: 20 healthy controls, 20 postcholecystectomy (PCE) patients, and 20 CRC patients. Demographic data and stool samples were collected. Gut microbiota composition, abundance, and diversity were analyzed using high-throughput 16S rDNA sequencing.

Results

Significant differences in microbial community, α-diversity (P < 0.05) and β-diversity (P = 0.006), were observed among the three groups. At the phylum level, Firmicutes abundance was significantly reduced in PCE and CRC groups compared with the control group (P = 0.002), while changes in other phyla were not significant (P>0.05). At the genus level, Bacteroides, Dialister, and Parabacteroides increased progressively from control to PCE to CRC groups (P = 0.004, 0.001, and 0.002). Prevotella decreased across these groups (P = 0.041). Faecalibacterium and Roseburia abundances were reduced in PCE and CRC groups compared with controls (P = 0.001 and 0.003). The Random Forest algorithm identified Parabacteroides, Bacteroides, Roseburia, and Dialister as key distinguishing genera.

Conclusion

The gut microbiota of long-term (≥5 years) PCE patients significantly differs from that of controls and resembles that of CRC patients, suggesting a potential link between cholecystectomy and CRC development through key microbial changes.
Effectiveness and safety of newly introduced endoscopic submucosal dissection in a Western center: a real-life study
Authors: Sferrazza Sandro , Maida Marcello , Calabrese Giulio , Fiorentino Andrea , Vieceli Filippo , Facciorusso Antonio , Fuccio Lorenzo , Maselli Roberta , Repici Alessandro , Di Mitri Roberto
Published: July 2024

Objectives

Endoscopic submucosal dissection (ESD) is a minimally invasive technique for the resection of superficial gastrointestinal lesions, providing high rates of ‘en bloc’ and R0 resection. East-West differences in ESD quality indicators have been reported. This study aims to assess feasibility, effectiveness, and safety of ESD for the treatment of superficial gastrointestinal (GI) lesions in a Western cohort.

Methods

Consecutive patients undergoing ESD at one Italian endoscopic referral center from September 2018 to March 2020 were included in this prospective study. Primary outcomes were technical success, R0 resection rate, curative resection rate, and adverse events (AEs).

Results

In total 111 patients (111 lesions) undergoing ESD were included. Anatomic site of the lesions was rectum in 56.8%, colon in 13.5%, stomach in 24.3%, and esophagus in 5.4% of cases, respectively. For upper GI procedures, technical success was 100%, and R0 and curative resection rates were 84.8% and 78.8%, respectively. For colorectal procedures, technical success was 98.7%, R0 and curative resection rates were 88.5% and 84.6%, respectively. Major AEs were reported in 12 cases (10.8%).

Conclusion

The introduction of ESD in a Tertiary Center is feasible, effective, and safe, and should be taken into consideration for the treatment of superficial GI lesions requiring ‘en bloc’ resection.