bluuebunny/crossref_metadata_2025 huggingface dataset:
An innovative methodology for monitoring the sacrificial layer removal process in MEMS structures
Authors: Barati Hamed , Barazandeh Farshad , Jabari Alireza , Akbari Mohammad
Published: February 2024

The sacrificial layer is a key component for the fabrication of a released structure in the MEMS sensors and actuators. Wet etching is a practical microfabrication process that minimizes costs compared to dry etching. Since the sacrificial layer exists between the structural layer and the substrate, characterization of the etching process is unavailable to observe and evaluate directly. This research, for the first time, presents a methodology for monitoring sacrificial layer removal. It takes advantage of using a transparent substrate (during process development) to observe the removal process from the backside. This method can be used as a separate test during surface micromachining to monitor and optimize the release process of the MEMS device. To evaluate the efficiency of the method, the copper sacrificial layer was selected. The removal process was investigated for typical structures used in MEMS sensors and actuators including the etch-holes, the cantilever beams, comb fingers, and the pads. The experimental test showed the removal of the sacrificial layer, the non-uniformity of the etching, and all the veritable chemical reactions and phenomena under the structural layer. In addition, the etch-rate were obtained in the order of 0.35–5.5μm min−1for various structural features. The procedure developed in this research is an approach to the process monitoring of the sacrificial layer removal. Therefore, it can be used to organize the quality control in the released structures of MEMS and optimization in batch processing. This method can be adopted for non-metallic sacrificial layers and dry etching as well.
Analytical solutions of equatorial geodesic motion in Kerr spacetime*
Authors: Liu 刘 Yan 岩 , Sun 孙 Bing 兵
Published: February 2024

The study of Kerr geodesics has a long history, particularly for those occurring within the equatorial plane, which are generally well-understood. However, when compared with the classification introduced by one of the authors [Phys. Rev. D 105, 024075 (2022)], it becomes apparent that certain classes of geodesics, such as trapped orbits, still lack analytical solutions. Thus, in this study, we provide explicit analytical solutions for equatorial timelike geodesics in Kerr spacetime, including solutions of trapped orbits, which capture the characteristics of special geodesics, such as the positions and conserved quantities of circular, bound, and deflecting orbits. Specifically, we determine the precise location at which retrograde orbits undergo a transition from counter-rotating to prograde motion due to the strong gravitational effects near a rotating black hole. Interestingly, the trajectory remains prograde for orbits with negative energy despite the negative angular momentum. Furthermore, we investigate the intriguing phenomenon of deflecting orbits exhibiting an increased number of revolutions around the black hole as the turning point approaches the turning point of the trapped orbit. Additionally, we find that only prograde marginal deflecting geodesics are capable of traversing through the ergoregion. In summary, our findings present explicit solutions for equatorial timelike geodesics and offer insights into the dynamics of particle motion in the vicinity of a rotating black hole.
A two-layer Timepix3 stack for improved charged particle tracking and radiation field decomposition
Authors: Smolyanskiy P. , Bacak M. , Bergmann B. , Broulím P. , Burian P. , Čelko T. , Garvey D. , Gunthoti K. , Infantes F.G. , Mánek P. , Manna A. , Mráz F. , Mucciola R. , Pospíšil S. , Sitarz M. , Urban O. , Vykydal Z. , Wender S.A.
Published: February 2024

We characterize a novel instrument designed for radiation field decomposition and particle
trajectory reconstruction for application in harsh radiation environments. The device consists of
two Timepix3 assemblies with 500 µm thick silicon sensors in a face-to-face geometry. These
detectors are interleaved with a set of neutron converters: 6LiF for thermal neutrons,
polyethylene (PE) for fast neutrons above 1 MeV, and PE with an additional aluminum recoil proton
filter for neutrons above ∼4 MeV. Application of the coincidence and anticoincidence
technique together with pattern recognition allows improved separation of charged and neutral
particles, their discrimination against γ-rays and assessment of the overall directionality
of the fast neutron field. The instrument's charged particle tracking and separation capabilities
were studied at the Danish Center for Particle Therapy (DCPT), the Proton Synchrotron, and Super
Proton Synchrotron with protons (50–240 MeV), pions (1–10 GeV/c and 180 GeV/c). After developing
temporal and spatial coincidence assignment methodology, we determine the relative amount of
coincident detections as a function of the impact angle, present the device's impact angle
resolving power (both in coincidence and anticoicidence channels). The detector response to
neutrons was studied at the Czech Metrology Institute (CMI), at n_ToF and the Los Alamos Neutron
Science Center (LANSCE), covering the entire spectrum from thermal up to 600 MeV. The measured
tracks were assigned to their corresponding neutron energy by application of the time of flight
technique. We present the achieved neutron detection efficiency as a function of neutron kinetic
energy and demonstrate how the ratio of events found below the different converters can be used to
assess the hardness of the neutron spectrum. As an application, we determine the neutron content
within a PMMA phantom just behind the Bragg-peak during clinical irradiation condition with
protons of 160 MeV.
A scanning device for spatial quantum efficiency measurements of photomultipliers tubes
Authors: Migliozzi P. , Mollo C.M. , Simonelli A.
Published: February 2024

This paper presents a quantum efficiency measurement setup based on a 2D motorized stage, a wide spectrum xenon lamp, a beam splitter system, and two calibrated photo-diodes for measuring the quantum efficiency (QE) of photomultiplier tubes (1 to 10 inches).
We will demonstrate the effectiveness of technical refinements on the measurements procedures over some existing setups already shown in literature.
The large area covered by the 2D stages permit to study the quantum efficiency of PMTs with diameter up to ten inches.
The results obtained will show the high precision and accuracy in characterizing the quantum efficiency versus wavelength over the range of 250 nm to 1100 nm and along the photo-catode surface. The setup monitors the light intensity synchronously with the output current yield from photosensors under test. This ensures the accuracy and repeatability of the measurements. The motorized stage allows precise positioning of the light source with respect to the active area. The emission spectrum of the xenon lamp provides a broad range of illumination in terms of dynamics and wavelength span.
An ecological study of PM2.5 and black carbon and acute hemorrhagic stroke: a long term effect study
Authors: Kongbunkiat Kannikar , Pattanapipitpaisal Pipat , Seoratanaphunt Suphasit , Peansukwech Udomlack , Vorasoot Nisa , Kasemsap Narongrit , Tiamkao Somsak , Chotmongkol Verajit , Nakaphan Thanat , Sawanyawisuth Kittisak
Published: February 2024

Both PM2.5 and black carbon particle are associated with acute ischemic stroke. There is limited data on the correlation of long term effects of PM2.5 and black carbon on acute hemorrhagic stroke with a large sample size. This was an ecological study. Numbers of acute hemorrhagic stroke who were admitted and reimbursed from the national database of Thailand were collected. Data of PM2.5 and black carbon were collected. Poisson regression analysis adjusted by physical factors and regions was used to evaluate the association between PM2.5 and black carbon on acute hemorrhagic stroke. There were 82,389 patients diagnosed as acute hemorrhagic stroke throughout Thailand. The median of PM2.5 of all provinces was 29.19 microgram m−3, while black carbon had the median of 1.17 microgram m−3. PM 2.5 was significantly associated with numbers of acute hemorrhagic stroke with an adjusted coefficient of 0.019 (p < 0.001), while black carbon was also had significant adjusted coefficient of 0.199 (p < 0.001). Both PM2.5 and black carbon particle were associated with acute hemorrhagic stroke in a long term fashion by an ecological study of the national database.
Pledging after nudging improves uptake of plant-based diets: a field experiment in a German university cafeteria
Authors: Thamer Philipp , Banerjee Sanchayan , John Peter
Published: February 2024

Meat-based diets are carbon-intensive and incompatible with Paris climate targets. Reducing meat consumption is essential to mitigate climate change. Behavioural nudges, which present structured choices to citizens, have been increasingly used to reduce meat demand. But they face ethical challenges and limits when scaling up. We test if encouraging people to reflect after nudging improves the effectiveness of a nudge. We design and administer a novel randomised controlled trial in a German university cafeteria, lasting for five weeks (N

participants
= 129,N

meals
= 645). In week 1, we measure baseline dietary behaviours. In week 2, we introduce a labelling nudge in the cafeteria. Subsequently, in weeks 3 & 4, we assign participants randomly to three experimental conditions: a control group that continues to receive the labelling nudge and two treatment groups that get the labelling nudge with an opportunity to reflect, either on the nudge (nudge+ 1) or their own preferences (nudge+ 2). All treatments are discontinued in week 5. In the pooled sample, controlling for period fixed effects, we find that the labelling nudge is not associated with meaningful changes in meat-demand over time. Nonetheless, being encouraged to reflect reduces meat-demand significantly compared to the nudge—the nudge+ 1 reduces chances of buying a meat-based item in the cafeteria by 5% (μ = −0.25, 95% CI = [−0.49,−0.36]) whereas the nudge+ 2 reduces it by 7% (μ = −0.35, 95% CI = [−0.61,−0.08]). These treatment effects attenuate when the interventions are discontinued. We recommend that combining reflection with nudging can improve the uptake of climate-friendly diets, at least in the short-term.
Towards sustainable and ecofriendly polymer composite materials from bast fibers: a systematic review
Authors: Santos Thiago F , Santos Caroliny M , Aquino Marcos S , Suyambulingam Indran , Kamil Hussein Emad , Verma Akarsh , Rangappa Sanjay Mavinkere , Siengchin Suchart , Nascimento J H O
Published: February 2024

This systematic review focuses on the exploration and advancement of sustainable and eco-friendly polymer composite materials derived from bast fibers. Bast fibers, obtained from the phloem of certain plants like flax, hemp, jute, and kenaf, represent a renewable and environmentally benign resource. Their integration into polymer based composites has gained significant attention due to the growing environmental concerns and the need for sustainable material development. The importance of this study lies in its comprehensive examination of bast fibers as viable alternatives to the synthetic fibers in polymer composite materials. By harnessing the natural strength, light weight, and biodegradability of bast fibers, this review contributes to the creation of materials that are not only environmentally sustainable but also possess enhanced mechanical properties suitable for various industrial and domestic applications.
Generalized Laurent monomials in nonrational toric geometry
Authors: Battaglia Fiammetta , Prato Elisa
Published: February 2024

We generalize Laurent monomials to toric quasifolds, a special class of highly singular spaces that extend simplicial toric varieties to the nonrational setting.
Smooth maps on convex sets
Authors: Karshon Yael , Watts Jordan
Published: February 2024

There are several notions of a smooth map from a convex set to a cartesian space. Some of these notions coincide, but not all of them do. We construct a real-valued function on a convex subset of the plane that does not extend to a smooth function on any open neighbourhood of the convex set, but that for eachkkextends to aCkC^kfunction on an open neighbourhood of the convex set. It follows that the diffeological and Sikorski notions of smoothness on convex sets do not coincide. We show that, for a convex set that is locally closed, these notions do coincide. With the diffeological notion of smoothness for convex sets, we then show that the category of diffeological spaces is isomorphic to the category of so-called exhaustive Chen spaces.
Diffeologies and generalized Kadomtsev-Petviashvili hierarchies
Authors: Eslami-Rad Anahita , Magnot Jean-Pierre , Reyes Enrique , Rubtsov Vladimir
Published: February 2024

We present a simplified, but extended proof of the well-posedness of the Kadomtsev-Petviashvili hierarchy of formal pseudo-differential symbols with coefficients in an abstract diffeological differential algebra, and with initial value a formal symbol of arbitrary order.
Secondary Bilateral Cleft Rhinoplasty: Achieving an Aesthetic Result
Authors: Saito Takafumi , Lo Chi-Chin , Tu Junior Chun-Yu , Hattori Yoshitsugu , Chou Pang-Yun , Lo Lun-Jou
Published: February 2024

Background

Secondary rhinoplasty in patients with bilateral cleft lip poses ongoing challenges and requires a reliable method for achieving optimal outcomes.

Objectives

The purpose of this study was to establish a safe and effective method for secondary bilateral cleft rhinoplasty.

Methods

A consecutive series of 92 skeletally matured patients with bilateral cleft lip and nasal deformity were included. All had undergone secondary open rhinoplasty, performed by a single surgeon with a bilateral reverse-U flap and septal extension graft, between 2013 and 2021. Medical records of these 92 patients were reviewed to assess the clinical course. A 3-dimensional (3D) anthropometric analysis and panel assessment of 32 patients were performed to evaluate the aesthetic improvement, with an age-, sex-, and ethnicity-matched normal control group for comparisons.

Results

The methods showed statistically significant improvement in addressing a short columella (columellar height), short nasal bridge (nasal bridge length), de-projected nasal tip (nasal tip projection, nasal dorsum angle), poorly defined nasal tip (nasal tip angle, dome height, and panel assessment), and transversely oriented nostrils (columellar height, alar width, nostril type). Importantly, these improvements were accompanied by a low complication rate of 4%. However, upper lip deficiency over the upper lip angle and labial-columellar angle remained without significant improvement.

Conclusions

In this study we described effective secondary rhinoplasty, which was composed of a bilateral reverse-U flap and septal extension graft, with acceptable outcome. The 3D anthropometric analysis and panel assessment clarified that our rhinoplasty procedure could bring the nasal morphology in these patients closer to the normal data.

Level of Evidence: 3
Neural correlates of object identity and reward outcome in the sensory cortical-hippocampal hierarchy: coding of motivational information in perirhinal cortex
Authors: Fiorilli Julien , Marchesi Pietro , Ruikes Thijs , Huis in ‘t Veld Gerjan , Buckton Rhys , Quintero Mariana D , Reiten Ingrid , Bjaalie Jan G , Pennartz Cyriel M A
Published: February 2024

Neural circuits support behavioral adaptations by integrating sensory and motor information with reward and error-driven learning signals, but it remains poorly understood how these signals are distributed across different levels of the corticohippocampal hierarchy. We trained rats on a multisensory object-recognition task and compared visual and tactile responses of simultaneously recorded neuronal ensembles in somatosensory cortex, secondary visual cortex, perirhinal cortex, and hippocampus. The sensory regions primarily represented unisensory information, whereas hippocampus was modulated by both vision and touch. Surprisingly, the sensory cortices and the hippocampus coded object-specific information, whereas the perirhinal cortex did not. Instead, perirhinal cortical neurons signaled trial outcome upon reward-based feedback. A majority of outcome-related perirhinal cells responded to a negative outcome (reward omission), whereas a minority of other cells coded positive outcome (reward delivery). Our results highlight a distributed neural coding of multisensory variables in the cortico-hippocampal hierarchy. Notably, the perirhinal cortex emerges as a crucial region for conveying motivational outcomes, whereas distinct functions related to object identity are observed in the sensory cortices and hippocampus.
Structural and functional abnormalities in first-episode drug-naïve pediatric idiopathic generalized epilepsy
Authors: Deng Dingmei , Sun Hui , Wang Yuting , Guo Xin , Yuan Yizhi , Wang Jiaojian , Qiu Lihua
Published: February 2024

The aim of this study was to investigate brain structure and corresponding static and dynamic functional connectivity (sFC & dFC) abnormalities in untreated, first-episode pediatric idiopathic generalized epilepsy (IGE), with the goal of better understanding the underlying pathological mechanisms of IGE. Thirty-one children with IGE and 31 age-matched healthy controls (HC) were recruited. Structural magnetic resonance imaging (sMRI) data were acquired, and voxel-based morphometry (VBM) analysis were performed to reveal abnormal gray matter volume (GMV). Moreover, sFC and dFC analyses were conducted using the brain areas exhibiting abnormal GMV as seed regions to explore abnormal functional couplings. Compared to HC, the IGE group exhibited increased GMV in left middle cingulate cortex (MCC) and right parahippocampus (ParaHipp). In addition, the analyses of dFC and sFC with MCC and ParaHipp as seeds revealed more extensive functional connectivity (FC) changes in dFC. Notably, the structurally and functionally abnormal brain areas were primarily localized in the default mode network (DMN). However, our study did not find any significant associations between these altered neuroimaging measurements and clinical outcomes. This study uncovered microstructural changes as well as corresponding sFC and dFC changes in patients with new-onset, untreated pediatric IGE. The affected brain regions were primarily located within the DMN, highlighting the DMN’s crucial role in the development of pediatric IGE.
Primary autonomic failure: a complex case of orthostatic hypotension in a hypertensive elderly patient
Authors: El-Mhadi Samah , Mouine Najat , Benjelloun Halima , Aboudrar Souad , El Bakkali Mustapha
Published: February 2024

Background

Primary autonomic failure (PAF) or Bradbury Eggleston syndrome is a neurodegenerative disorder of the autonomic nervous system characterized by orthostatic hypotension.

Case summary

We report the case of a 76-year-old patient with a history of hypertension, who presented with exercise-induced fatigue. He exhibited systolic hypertension and resting bradycardia in the supine position, with orthostatic hypotension without reactive tachycardia, suggesting dysautonomia. Neurological examination was unremarkable. The patient underwent cardiovascular autonomic testing, revealing evidence of beta-sympathetic deficiency associated with neurogenic orthostatic hypotension. Causes of secondary dysautonomia were excluded. The patient was diagnosed with PAF. Even if managing the combination of supine hypertension and orthostatic hypotension was challenging, significant improvements in functional and haemodynamic status were observed with a personalized management approach.

Discussion

Throughout this case report, we emphasize the critical need for an evaluation of autonomic function and blood pressure’s dynamics in hypertensive patients experiencing orthostatic symptoms, enabling the implementation of tailored therapeutic strategies.
Splicing analysis of 24 potential spliceogenic variants in MMR genes and clinical interpretation based on refined ACMG/AMP criteria
Authors: Bouras Ahmed , Lefol Cedrick , Ruano Eric , Grand-Masson Chloé , Auclair-Perrossier Jessie , Wang Qing
Published: February 2024

Lynch syndrome (LS) is a common hereditary cancer syndrome caused by heterozygous germline pathogenic variants in DNA mismatch repair (MMR) genes. Splicing defect constitutes one of the major mechanisms for MMR gene inactivation. Using RT-PCR based RNA analysis, we investigated 24 potential spliceogenic variants in MMR genes and determined their pathogenicity based on refined splicing-related American College of Medical Genetics and Genomics/Association for Molecular Pathology (ACMG/AMP) criteria. Aberrant transcripts were confirmed in 19 variants and 17 of which were classified as pathogenic including 11 located outside of canonical splice sites. Most of these variants were previously reported in LS patients without mRNA splicing assessment. Thus, our study provides crucial evidence for pathogenicity determination, allowing for appropriate clinical follow-up. We also found that computational predictions were globally well correlated with RNA analysis results and the use of both SPiP and SpliceAI software appeared more efficient for splicing defect prediction.
Mutual legitimation attempts: the United Nations and China's Belt and Road Initiative
Authors: Haug Sebastian
Published: February 2024

The Belt and Road Initiative (BRI) has become a hallmark of China's global rise. While the BRI has unfolded as a global platform focused on bilateral relations, the Chinese government has also tried to expand links between the BRI and international organizations, notably the United Nations. Available evidence about UN–BRI relations suggests, however, that an initial honeymoon phase with mushrooming projects and public endorsements was followed by a sharp decline in engagement. This article argues that a focus on inter-governor legitimation attempts helps understand the rise and fall of UN–BRI relations. Based on publicly available evidence, internal documentation and stakeholder interviews, it shows how legitimation informed motivations on both sides to invest in UN–BRI relations, and how western opposition subsequently led to UN entities reducing their engagement. Empirically, the article contributes to the literature on China's global role, evolving power relations at the UN, and the proliferation of geopolitically motivated flagship initiatives across UN member states. Conceptually, it speaks to the expanding debate about legitimation in world politics through a more systematic engagement with relational legitimation dynamics. A focus on one-sided or mutual legitimation attempts offers a conceptual tool for analysing how interactions among global governors and their audiences unfold, and how international organizations try (and fail) to strengthen their resilience in light of an increasingly polarized membership.
Ketone Supplementation Dampens Subjective and Objective Responses to Alcohol: Evidence From a Preclinical Rat Study and a Randomized, Cross-Over Trial in Healthy Volunteers
Authors: Li Xinyi , Shi Zhenhao , Todaro Dustin R , Pond Timothy , Byanyima Juliana I , Vesslee Sianneh A , Reddy Rishika , Nanga Ravi Prakash Reddy , Kass Gabriel , Ramchandani Vijay , Kranzler Henry R , Vendruscolo Janaina C M , Vendruscolo Leandro F , Wiers Corinde E
Published: February 2024

Background

Previous preclinical and human studies have shown that a high-fat ketogenic diet and ketone supplements (KS) are efficacious in reducing alcohol craving, alcohol consumption, and signs of alcohol withdrawal. However, the effects of KS on alcohol sensitivity are unknown.

Methods

In this single-blind, cross-over study, 10 healthy participants (3 females) were administered a single, oral dose of a KS (25 g of ketones from D-β-hydroxybutyric acid and R-1,3-butanediol) or placebo 30 minutes before an oral alcohol dose (0.25 g/kg for women; 0.31 g/kg for men). Assessments of breath alcohol concentration and blood alcohol levels (BAL) and responses on the Drug Effect Questionnaire were repeatedly obtained over 180 minutes after alcohol consumption. In a parallel preclinical study, 8 Wistar rats (4 females) received an oral gavage of KS (0.42 g ketones/kg), water, or the sweetener allulose (0.58 g/kg) followed 15 minutes later by an oral alcohol dose (0.8 g/kg). BAL was monitored for 240 minutes after alcohol exposure.

Results

In humans, the intake of KS before alcohol significantly blunted breath alcohol concentration and BAL, reduced ratings of alcohol liking and wanting more, and increased disliking for alcohol. In rats, KS reduced BAL more than either allulose or water.

Conclusion

KS altered physiological and subjective responses to alcohol in both humans and rats, and the effects were likely not mediated by the sweetener allulose present in the KS drink. Therefore, KS could potentially reduce the intoxicating effects of alcohol.
Tissue damage from chronic liver injury inhibits peripheral NK cell abundance and proinflammatory function
Authors: You Zonghao , Ling Shaoxue , Zhao Shuwu , Han Haixing , Bian Yuhong , He Yongzhi , Chen Xi
Published: February 2024

One of the difficulties in the treatment of hepatocellular carcinoma is that it is impossible to eliminate the inhibitory effect of the tumor microenvironment on immune response. Therefore, it is particularly important to understand the formation process of the tumor microenvironment. Chronic inflammation is the core factor of cancer occurrence and the leading stage of inflammation–cancer transformation, and the natural killer cell subsets play an important role in it. Our study confirmed that in the stage of chronic liver injury, the local immunosuppressive microenvironment of the liver (i.e. the damaged microenvironment) has been formed, but this inhibitory effect is only for peripheral natural killer cells and has no effect on tissue-resident natural killer subsets. The markers of damage microenvironment are the same as those of tumor microenvironment.
A novel technique for contained aspiration and irrigation of priapism
Authors: Lopategui Diana M , Delto Joan C , Sidhu Ajaydeep S , Caso Jorge R , Bhandari Akshay , Nieder Alan M , Yanes Rafael E
Published: February 2024

Background

Ischemic priapism is a urological emergency requiring prompt corporal aspiration and irrigation, with risk of blood spillage that can place a significant biological hazard to the urologist and rest of emergency room staff.

Aim

The study sought to develop and validate a method for contained corporal aspiration that minimizes exposure to sharps and occupational hazards.

Methods

We used one large bore needle connected to a vacuum aspiration device and blood draw tubes for corporal aspiration and irrigation of ischemic priapism.

Outcomes

Feasibility of this method was assessed in 18 consecutive patients presenting to the emergency room with ischemic priapism. Clinical characteristics, resolution of priapism, and need for further interventions were documented.

Results

A total of 18 patients were treated using this technique. The mean time from onset to presentation was 12 hours. The etiology in all patients was recreational intracavernosal drug abuse, and 72% were HIV positive. Priapism completely resolved in all 18 patients. No patients required shunt procedures or further interventions to achieve detumescence.

Clinical Implications

This system can be used for safe management of ischemic priapism in any clinical scenario but is particularly beneficial to minimize exposure risk in the setting of increased risk of blood-borne infections.

Strengths and Limitations

This initial trial shows that this technique is safe and effective for cavernosal aspiration of ischemic priapism. Larger trials are required to validate this method.

Conclusion

Contained aspiration and irrigation of priapism can be used for effective management of ischemic priapism while minimizing health risks to urologists and emergency room staff.
Analysis of demographics and the impact of adjuvant radiotherapy on a nationwide cohort of patients with high-grade spinal meningiomas
Authors: El-Hajj Victor Gabriel , Ghaith Abdul Karim , Nguyen Ryan H , Al-Saidi Neil Nazar , Hoang Harry , Graepel Stephen P , Elmi-Terander Adrian , Lehrer Eric J , Brown Paul , Bydon Mohamad
Published: February 2024

Background

Although typically benign, 5% of spinal meningiomas (SMs) present with higher-grade features (World Health Organization grades 2 and 3). High-grade SMs are poorly studied and the role of adjuvant radiotherapy in their management remains controversial. We hence aimed to study the demographic characteristics of this rare tumor and investigate the outcomes associated with the use of surgery with adjuvant therapy in contrast to surgery alone.

Methods

The National Cancer Database was queried for patients with SMs from 2004 to 2017. Basic statistics were used to identify differences between low- and high-grade tumors in terms of baseline characteristics. Surgery with and without adjuvant radiotherapy were compared after (1:1) propensity-score matching. Kaplan–Meier survival analysis was conducted to study overall survival. All analyses were performed on R.

Results

A total of 13 184 patients diagnosed with SMs were included, of whom only 5% (n = 669) had high-grade SMs. Patients with high-grade SMs presented at a younger median age (57 years [IQR: 44–68] versus 65 years [54–75]; P < .001) and were more commonly males (33% vs 20%; P < .001). After propensity-score matching, survival analysis revealed similar overall survival outcomes in patients with high-grade SM undergoing both surgery and radiotherapy as compared to those only receiving surgery (P = .19).

Conclusions

This study reveals major demographic differences between high- and low-grade SMs. There were no benefits associated with the use of adjuvant radiotherapy. However, due to confounding, overall survival outcomes between patients receiving surgery alone and those receiving surgery with adjuvant radiotherapy are not causally interpretable.
A Multicenter Assessment of the Outcomes and Toxicities of Foscarnet for Treatment of Acyclovir-Resistant Mucocutaneous Herpes Simplex in Immunocompromised Patients
Authors: Hammond Sarah P , Rangaraju Manickam , Sumner Melanie , Timmler Burkhard , Chandrasekar Pranatharthi , Avery Robin K
Published: February 2024

Background

Acyclovir-resistant mucocutaneous herpes simplex virus (HSV) infection is an uncommon problem typically seen in immunocompromised hosts. Systemic treatment options are limited. The performance of foscarnet and its toxicities in this population are poorly characterized.

Methods

This was a multicenter retrospective study of adults treated with foscarnet for HSV infection between January 2012 and December 2017. Relevant data were collected including demographics, baseline conditions, previous anti-HSV medications, concomitant medications, HSV outcomes, and adverse events. Acyclovir-resistant HSV infection was defined based on genotypic or phenotypic testing results; refractory infection was defined as infection not improving after 5 days of treatment-dosed antiviral therapy in those not tested for resistance.

Results

Twenty-nine patients had 31 episodes of HSV (15/18 resistant; among episodes without resistance testing, 7/10 refractory; 3 not evaluable) treated with foscarnet. All patients were immunocompromised including 19 (66%) with hematologic malignancy and 9 (31%) with HIV. Median duration of foscarnet was 16 days (range, 6–85 days). Fifteen episodes (48%) healed by the end of or after foscarnet. Median time to healing among those with resolution was 38 days (range, 9–1088 days). At least 1 adverse event during therapy was reported in 26 (84%) treatment episodes including 23 (74%) that were considered drug related. Common adverse events were electrolyte disturbance (20 [65%]) and kidney dysfunction (13 [42%]). Foscarnet was discontinued in 10 episodes (32%) due to an adverse event, including 6 due to kidney dysfunction.

Conclusions

Among 31 episodes of HSV treated with foscarnet, only half resolved with treatment, and adverse events were common.
Hypertension Among Cohort of Persons With Human Immunodeficiency Virus Initiated on a Dolutegravir-Based Antiretroviral Regimen in Ghana
Authors: Lartey Margaret , Torpey Kwasi , Ganu Vincent , Ayisi Addo Stephen , Bandoh Delia , Abdulai Marijanatu , Akuffo Golda , Kenu Ernest
Published: February 2024

Background

Dolutegravir (DTG), a new antiretroviral drug, is being integrated into antiretroviral regimens for people with human immunodeficiency virus (PWH) in Ghana. There is little evidence of the effect of DTG on blood pressure (BP) levels in sub-Saharan Africa, especially West Africa. Our aim was to assess the incidence and predictors of hypertension (HTN) among PWH initiated on a DTG-based antiretroviral regimen in Ghana.

Methods

An observational multicenter longitudinal study was conducted among PWH in Ghana from 2020 to 2022. BPs of nonhypertensive patients with BP ≤120/80 mm Hg at baseline were measured at 3, 6, 12, and 18 months post–DTG initiation. The primary outcome of the study was incidence of HTN, defined as BP ≥140/90 mm Hg. Kaplan-Meier estimator was used to estimate risk of developing HTN. Cox proportional hazards model with robust standard errors was used to estimate hazard ratios (HRs).

Results

HTN prevalence among PWH screened was 37.3% (1366/3664). The incidence of de novo HTN among nonhypertensive PWH at 72 weeks was 598.4 per 1000 person-years (PY) (95% confidence interval [CI], 559.2–640.3) with incidence proportion of 59.90 (95% CI, 57.30–62.44). A quarter of those with de novo HTN developed it by month 6. Obesity (adjusted HR [aHR], 1.27 [95% CI, 1.05–1.54]), abnormal serum urea (aHR, 1.53 [95% CI, 1.27–1.85]), and low high-density lipoprotein (aHR, 1.45 [95% CI, 1.22–1.72]) were risk factors for HTN.

Conclusions

Incidence of HTN was high among PWH on DTG. There is a need to monitor BP for HTN in adult PWH as well as traditional risk factors to reduce the burden of HTN and its complications.
Multiple intra-articular injections of autologous stromal vascular fractions for the treatment of multicompartmental osteoarthritis in both the tibiofemoral and patellofemoral joint: a single-blind randomized controlled study
Authors: Zhang Shengyang , Chen Jianmo , Zhang Hualiang , Hu Songfeng , Tong Peijian , Shen Jianzeng
Published: February 2024

Background

Multicompartmental osteoarthritis (MOA) in both tibiofemoral and patellofemoral joints is a more commonly occurring, but neglected, clinical condition, and we examined the short-term safety and efficacy of autologous stromal vascular fractions (SVFs) for MOA using a single-blind, prospective, randomized, placebo-controlled trial.

Methods

Seventy MOA patients were recruited and randomly assigned to the SVF group and hyaluronic acid (HA) group (control group). The scores of visual analog scale, the Western Ontario and McMaster University Osteoarthritis Index, and the Samsung Medical Center patellofemoral scoring system were assessed and compared between the two groups 3, 6 and 12 months after treatment.

Results

The SVF group had significantly better visual analog scale scores than the HA group at 6 and 12 months after treatment and had better Western Ontario and McMaster University Osteoarthritis Index scores than the HA group only at 6 months after treatment. For Samsung Medical Center patellofemoral scoring system of the patellofemoral joint, the SVF group had significantly better scores than the control group at all postoperative time points. The proportion of patients whose visual analog scale and Western Ontario and McMaster University Osteoarthritis Index scores were above the minimal clinically important improvement was higher in the SVF group than in the HA group in the majority of assessments. The improvement of bone marrow by SVF treatment was significantly better than that of the HA group as observed by pre- and postoperative Magnetic resonance imaging (MRI).

Conclusions

Multiple intra-articular injection of autologous SVF reduces pain and improves function in the short term in patients with early or midstage MOA. However, there was heterogeneity in the improvement of overall knee and isolated patellofemoral joint after treatment.
Intersectional Risk and the Significant Gap in Care for Persons With Co-occurring Chronic Pain and Opioid Withdrawal
Authors: Ware Orrin D. , Huhn Andrew S. , Ellis Jennifer D. , Bird H. Elizabeth , Mun Chung Jung , Dunn Kelly E.
Published: February 2024

Objectives

Persons with chronic pain and women tend to enter treatment for opioid use disorder with greater opioid withdrawal severity than persons without chronic pain and men, respectively. This study examined characteristics of facilities with opioid withdrawal treatment, including gender-based services, as a function of whether they reported having a tailored pain management program.

Methods

The National Survey of Substance Abuse Treatment Services 2020 was used to examine 3942 facilities with opioid withdrawal treatment in the United States. Using a multivariable binary logistic regression model, facilities were examined for the presence of a tailored program for individuals with co-occurring pain. Regional location of the facility, ownership status, and availability of tailored gender programs, nonhospital residential services, and outpatient services served as independent variables in the analysis.

Results

A slight majority of the sample had a program for both adult men and adult women (n = 2010, 51.0%). Most facilities had outpatient services (n = 3289, 83.4%) and did not have a tailored program for addressing co-occurring pain (n = 2756, 69.9%). Binary logistic regression analysis showed that among opioid withdrawal facilities, programs with nonhospital residential services, government or private nonprofit funding, or tailored gender programming had higher odds of reporting having a tailored program for pain and substance use disorder. Facilities in the Western United States were most likely to have tailored programs for pain and substance use disorder.

Conclusions

Future research should investigate what support patients may receive and how to better scale access to pain management during opioid withdrawal treatment.
Robot-assisted Temporary Hemiepiphysiodesis With Eight-plates for Lower Extremity Deformities in Children
Authors: Liang Mingqian , Zhang Xuejun , Liu Haonan , Gao Rongxuan , Guo Dong , Yao Ziming
Published: February 2024

Purpose:

This study was performed to compare the radiographic results of robot-assisted and traditional methods of treating lower extremity deformities (LEDs).

Methods:

From January 2019 to February 2022, 55 patients with LEDs were treated by temporary hemiepiphysiodesis with eight-plates. They were divided into a robot group and a freehand group. The fluoroscopy time and operation time were recorded. The accuracy of screw placement was measured after the operation using the following parameters: coronal entering point (CEP), sagittal entering point (SEP), and angle between the screw and epiphyseal plate (ASEP). The limb length discrepancy (LLD) and femorotibial angle (FTA) were measured before the operation, after the operation, and at the last follow-up. Patients were followed up for 12 to 24 months, and the radiographic results of the 2 groups were compared.

Results:

Among the 55 patients with LEDs, 36 had LLD and 19 had angular deformities. Seventy-six screws were placed in the robot group and 85 in the freehand group. There was no difference in the CEP between the 2 groups (P>0.05). The robot group had a better SEP (2.96±1.60 vs. 6.47±2.80 mm) and ASEP (3.46°±1.58° vs. 6.92°±3.92°) than the freehand group (P<0.001). At the last follow-up, there was no difference in the LLD or FTA improvement between the two groups (P>0.05). The incidence of complications was significantly lower in the robot group than in the freehand group (0/27 vs. 5/28, P<0.05).

Conclusion:

Robot-assisted temporary hemiepiphysiodesis with eight-plates is a safe and effective method for treating LEDs in children. Robotic placement of screws is superior to freehand placement with respect to the entering position and direction. Although the correction effect for LLD and angular deformity is similar, screw dislocation is less common when using robot assistance.

Levels of Evidence:

Level—III. Retrospective comparative study.
Nebulized Furosemide for Pulmonary Inflammation in Intubated Patients With COVID-19: A Phase 2 Randomized Controlled Double-Blind Study
Authors: Muscedere John , Maslove David M. , Barden Christopher J. , Weaver Donald F. , Boyd J. Gordon , Sibley Stephanie , Boyd Tracy , Rewa Oleksa , Albert Martin , Roussos Marios , Norman Patrick A. , Day Andrew G. ,   for the Canadian Critical Care Trials Group
Published: February 2024

OBJECTIVES:

Respiratory failure secondary to COVID-19 is associated with morbidity and mortality. Current anti-inflammatory therapies are effective but are given systemically and have significant side effects. Furosemide has anti-inflammatory properties, can be administered by inhalation, and is inexpensive. We investigated the efficacy of nebulized furosemide as an adjunctive therapy for COVID-19 respiratory failure.

DESIGN:

A double-blind, randomized, placebo-controlled trial.

SETTING:

Multicenter ICU study.

PATIENTS:

Adults requiring invasive mechanical ventilation secondary to COVID-19.

INTERVENTION:

Patients were randomized within 48 hours of intubation to receive inhaled furosemide or placebo until day 28, death, or liberation from mechanical ventilation.

MEASUREMENTS AND MAIN RESULTS:

The study was stopped early due to waning incidence of COVID-19; 39 patients were available for analysis with mean ± sd age of 70.5 (10.8) years, Acute Physiology and Chronic Health Evaluation II 26.1 (7.8) and Fio
2 60.0% (21.9). Baseline characteristics were similar between the groups. For the primary outcome of change in Pao
2/Fio
2 ratio between day 1 and day 6, it was +31.4 (83.5) in the furosemide arm versus +20.1 (92.8) in the control (p = 0.58). For secondary outcomes, furosemide versus control: 60-day mortality was 48% versus 71% (p = 0.20), hospital stay was 25.6 (21.9) versus 27.4 (25.0) days, p = 0.94 and VFD was 6.0 (9.1) versus 3.1 (7.1), p value of equals to 0.28. A post hoc analysis of the hierarchical composite outcome, alive and ventilator-free favored furosemide. There were no adverse events.

CONCLUSIONS:

In this trial of inhaled furosemide for COVID-19 respiratory failure, differences in Pao
2/Fio
2 ratio to day 6 and other clinical outcomes were not significantly different, although the trial was underpowered due to early termination. Given the favorable profile of inhaled furosemide, further study is warranted in disease states where acute pulmonary inflammation contributes to the underlying pathophysiology.
Safety of teriflunomide in Chinese adult patients with relapsing multiple sclerosis: A phase IV, 24-week multicenter study
Authors: Quan Chao , Zhou Hongyu , Yang Huan , Jiao Zheng , Zhang Meini , Zhang Baorong , Tan Guojun , Bu Bitao , Jin Tao , Li Chunyang , Xue Qun , Dong Huiqing , Shi Fudong , Qin Xinyue , Zhang Xinghu , Gao Feng , Zhang Hua , Wang Jiawei , Hu Xueqiang , Chen Yueting , Liu Jue , Qiu Wei
Published: February 2024

Background:

Disease-modifying therapies have been approved for the treatment of relapsing multiple sclerosis (RMS). The present study aims to examine the safety of teriflunomide in Chinese patients with RMS.

Methods:

This non-randomized, multi-center, 24-week, prospective study enrolled RMS patients with variant (c.421C>A) or wild type ABCG2 who received once-daily oral teriflunomide 14 mg. The primary endpoint was the relationship between ABCG2 polymorphisms and teriflunomide exposure over 24 weeks. Safety was assessed over the 24-week treatment with teriflunomide.

Results:

Eighty-two patients were assigned to variant (n = 42) and wild type groups (n = 40), respectively. Geometric mean and geometric standard deviation (SD) of pre-dose concentration (variant, 54.9 [38.0] μg/mL; wild type, 49.1 [32.0] μg/mL) and area under plasma concentration-time curve over a dosing interval (AUCtau) (variant, 1731.3 [769.0] μg∙h/mL; wild type, 1564.5 [1053.0] μg∙h/mL) values at steady state were approximately similar between the two groups. Safety profile was similar and well tolerated across variant and wild type groups in terms of rates of treatment emergent adverse events (TEAE), treatment-related TEAE, grade ≥3 TEAE, and serious adverse events (AEs). No new specific safety concerns or deaths were reported in the study.

Conclusion:

ABCG2 polymorphisms did not affect the steady-state exposure of teriflunomide, suggesting a similar efficacy and safety profile between variant and wild type RMS patients.

Registration:

NCT04410965, https://clinicaltrials.gov.
Suicide bombing and impending mental health disaster in Pakistan
Authors: Shoib Sheikh , Tayyeb Muhammad , Armiya’u Aishatu Yusha’u , Shah Jaffer , Swed Sarya , Chandradasa Miyuru
Published: February 2024

Pakistan grapples with a significant mental health burden, with 10-16% of its population experiencing psychiatric disorders. Depression and anxiety affect 34% of the population, with regional variations. The scarcity of mental health facilities and professionals exacerbates the situation, leading many to seek help from traditional healers. Socioeconomic challenges, terrorism, and internal conflicts contribute to the mental health crisis. Recent suicide bombings, such as the one in Peshawar, highlight the emotional aftermath and challenges faced by survivors. The complex interplay of factors, including sociocultural influences, contributes to the emergence of a martyrdom subculture. Understanding terrorism requires examining the broader sociocultural and political context. The prevalence of mental illness and rising terrorism suggests a potential connection, although causality is complex. Coping with terrorism-induced trauma poses challenges for survivors, necessitating comprehensive mental health support. Recommendations include nationwide studies, school mental health programs, and initiatives to counter misinformation and radicalization through media. Establishing telepsychiatry services and collaboration between mental health experts and religious scholars is crucial for enhancing social cohesion and mental wellbeing in Pakistan.
How to Start a Microsurgery Practice: Success and Sustainability in Academic Practice
Authors: Dickey Ryan M. , Teotia Sumeet S. , Haddock Nicholas T.
Published: February 2024

Starting an academic microsurgery practice is a daunting task for plastic surgery graduates. Despite this, academic practice provides many advantages as a starting point for a career. Microsurgical faculty can make use of several unique benefits within an academic center. These include vast resources of clinical and basic science departments, communications and public affairs divisions, and quality improvement teams. Building a multi-disciplinary microsurgery practice with specific focus will jumpstart research questions and outcome data. Using residents and students to their full potential is both rewarding and efficient as a microsurgeon. Finally, peer faculty in an academic environment provide a stimulating resource for growth and assistance when needed. This special topic provides insight into starting a microsurgery practice for any resident considering a career in academics.