bluuebunny/crossref_metadata_2025 huggingface dataset:
Nondestructive initial-profile-free 3D elemental mapping in multilayer thin film structures based on EDX and a quadratic programming problem
Authors: Hoshina Yutaka , Kubo Yugo , Nakayama Yojiro
Published: August 2023

We have demonstrated a new data analysis method that enables nondestructive depth profiling of a multilayer thin-film sample from energy-dispersive X-ray spectroscopy (EDX) data without the assumption of initial profiles. This method is based on a quadratic programming problem and allows for three-dimensional elemental mapping in the sample without destroying it, by performing depth profiling for all the pixels in the EDX two-dimensional mapping data. In this paper, first nondestructive depth profiling of two samples with different multilayer structures was performed using the proposed method. The results were compared with those obtained by cross-sectional observation to validate the accuracy and usefulness of the proposed method. Next, an example of the three-dimensional elemental mapping based on the proposed method was demonstrated. This method allows us to nondestructively obtain three-dimensional elemental distribution within a sample over a wide area on the order of mm, which is impossible to obtain using other analytical methods. The way to determine the hyperparameters, which significantly affects the calculation results, is fully described in this paper.
Refractory chylothorax after severe vomiting and coughing in a 4-year-old child
Authors: De Pauw Vincent , Daelemans Siel , Depoorter Leontien , Brussaard Carola , Smets Dirk
Published: August 2023

Chylothorax is the accumulation of lymphatic fluid in the pleural space. It is a rare condition with potentially life-threatening disorders. In children, the etiology of chylothorax can be mainly attributed to idiopathic factors, congenital, miscellaneous, trauma and malignancies. Conservative treatments can solve most chylothorax, but refractory chylothorax can be challenging to manage. We herein present the case of a 4-year-old girl with no previous medical history who was admitted to our institution after severe vomiting and right chylothorax. The etiological assessment could not identify specific causes. Initial treatment was conservative but after 14 days, the patient showed no improvement. An exploratory thoracoscopy using indocyanine green showed no active leaks. Pleurodesis was performed and, later on, ligation of the ductus thoracicus. Hereafter, the patient progressed favorably. Even though conservative treatments of chylothorax show a high success rate, the efficacy of additional therapies and the benefits between surgical procedures need further investigation.
A fuzzy structure processing mechanism for graph grammar
Authors: Liu Yufeng , Yang Fan , Liu Jian , Li Song
Published: August 2023

A strict graph-matching mechanism brings normativeness to graph grammar but leads to graph grammar insufficiency when processing fuzzy grammatical structures. To address this issue, the current paper proposes an improved formal framework for graph grammar that enables it to effectively specify the ambiguity of graph models while maintaining normativeness and intuition. First, the improved framework defines the connection probability for edges and classifies the edges based on the connection probability, which is used as the quantitative and qualitative description of the graph grammar structure’s ambiguity. Second, the concepts of credibility threshold, credible subgraphs and candidate subgraphs are defined, and the constraints on the redex are adjusted to increase the fault tolerance of the graph-matching process. Finally, the grammatical operation is redesigned, with a matching weight defined for each redex based on the connection probability and the credibility threshold, thereby providing a theoretical basis and practical guidance for the selection of multiple redexes.
Perspective on receptor-associated immune response to Candida albicans single and mixed infections: Implications for therapeutics in oropharyngeal candidiasis
Authors: Yang Liu , Cheng Ting , Shao Jing
Published: August 2023

Oropharyngeal candidiasis (OPC), commonly known as ‘thrush’, is an oral infection that usually dismantles oral mucosal integrity and malfunctions local innate and adaptive immunities in compromised individuals. The major pathogen responsible for the occurrence and progression of OPC is the dimorphic opportunistic commensal Candida albicans. However, the incidence induced by non-albicans Candida species including C. glabrata, C. tropicalis, C. dubliniensis, C. parapsilosis, and C. krusei are increasing in company with several oral bacteria, such as Streptococcus mutans, S. gordonii, S. epidermidis, and S. aureus. In this review, the microbiological and infection features of C. albicans and its co-contributors in the pathogenesis of OPC are outlined. Since the invasion and concomitant immune response lie firstly on the recognition of oral pathogens through diverse cellular surface receptors, we subsequently emphasize the roles of epidermal growth factor receptor, ephrin-type receptor 2, human epidermal growth factor receptor 2, and aryl hydrocarbon receptor located on oral epithelial cells to delineate the underlying mechanism by which host immune recognition to oral pathogens is mediated. Based on these observations, the therapeutic approaches to OPC comprising conventional and non-conventional antifungal agents, fungal vaccines, cytokine and antibody therapies, and antimicrobial peptide therapy are finally overviewed. In the face of newly emerging life-threatening microbes (C. auris and SARS-CoV-2), risks (biofilm formation and interconnected translocation among diverse organs), and complicated clinical settings (HIV and oropharyngeal cancer), the research on OPC is still a challenging task.
The GMRT archive atomic gas survey – II. Mass modelling and dark matter halo properties across late-type spirals
Authors: Biswas Prerana , Kalinova Veselina , Roy Nirupam , Patra Narendra Nath , Tyulneva Nadezda
Published: August 2023

Studying the kinematics and mass modelling of galaxies from H i 21 cm data provides valuable insights into the properties of both the baryonic components and the dark matter halo in nearby galaxies. Despite many observational studies, mass modelling of galaxies remains challenging due to different limitations. For example, most of the previous studies involving mass modelling are based on rotation curves derived from 2D velocity fields from H i or H α spectroscopic observation which are often affected by beam smearing and projection effect. However, kinematic modelling done by fitting the ‘Tilted ring model’ to 3D data cube is not affected by these issues. In this study, we present and compare 3D kinematic modelling of a pilot sample of 11 galaxies from the GMRT archive atomic gas survey (GARCIA) using two different publicly available pipelines. We model the observed H i rotation curve using 3.6-μm infrared data and SDSS r-band data for stellar contribution, H i surface density profile for gas, and Navarro–Frenk–White profile for dark matter halo; and employ the Markov chain Monte Carlo optimization method for parameter estimation. Further, to validate our analysis, we revisit important scaling relations, e.g. the Mgas–Mstar relation, Mstar–Mhalo relation, Mgas–Mhalo relation and Baryonic Tully–Fisher relation. The scaling relations from our analysis are broadly consistent with that reported in the literature. A larger sample of galaxies from GARCIA in the near future will allow studying these scaling relations in greater details.
Cosmic variance and the inhomogeneous UV luminosity function of galaxies during reionization
Authors: Dawoodbhoy Taha , Shapiro Paul R , Ocvirk Pierre , Lewis Joseph S W , Aubert Dominique , Sorce Jenny G , Ahn Kyungjin , Iliev Ilian T , Park Hyunbae , Teyssier Romain , Yepes Gustavo
Published: August 2023

When the first galaxies formed and starlight escaped into the intergalactic medium to reionize it, galaxy formation and reionization were both highly inhomogeneous in time and space, and fully coupled by mutual feedback. To show how this imprinted the UV luminosity function (UVLF) of reionization-era galaxies, we use our large-scale, radiation-hydrodynamics simulation CoDa II to derive the time- and space-varying halo mass function and UVLF, from z ≃ 6–15. That UVLF correlates strongly with local reionization redshift: earlier-reionizing regions have UVLFs that are higher, more extended to brighter magnitudes, and flatter at the faint end than later-reionizing regions observed at the same z. In general, as a region reionizes, the faint-end slope of its local UVLF flattens, and, by z = 6 (when reionization ended), the global UVLF, too, exhibits a flattened faint-end slope, ‘rolling-over’ at MUV ≳ −17. CoDa II’s UVLF is broadly consistent with cluster-lensed galaxy observations of the Hubble Frontier Fields at z = 6–8, including the faint end, except for the faintest data point at z = 6, based on one galaxy at MUV = −12.5. According to CoDa II, the probability of observing the latter is $\sim 5~{{\ \rm per\ cent}}$. However, the effective volume searched at this magnitude is very small, and is thus subject to significant cosmic variance. We find that previous methods adopted to calculate the uncertainty due to cosmic variance underestimated it on such small scales by a factor of 2–4, primarily by underestimating the variance in halo abundance when the sample volume is small.
The formation of supermassive black holes from Population III.1 seeds. II. Evolution to the local universe
Authors: Singh Jasbir , Monaco Pierluigi , Tan Jonathan C
Published: August 2023

We present predictions for cosmic evolution of populations of supermassive black holes (SMBHs) forming from Population III.1 seeds, i.e. early, metal-free dark matter minihaloes forming far from other sources, parametrized by isolation distance, diso. Extending previous work that explored this scenario to z = 10, we follow evolution of a $(60\, {\rm {Mpc}})^3$ volume to z = 0. We focus on evolution of SMBH comoving number densities, halo occupation fractions, angular clustering, and 3D clustering, exploring a range of diso constrained by observed local number densities of SMBHs. We also compute synthetic projected observational fields, in particular, a case comparable to the Hubble Ultra Deep Field. We compare Pop III.1 seeding to a simple halo mass threshold model, commonly adopted in cosmological simulations of galaxy formation. Major predictions of the Pop III.1 model include that all SMBHs form by z ∼ 25, after which their comoving number densities are near-constant, with low merger rates. Occupation fractions evolve to concentrate SMBHs in the most massive haloes by z = 0, but with rare cases of SMBHs in haloes down to $\sim 10^8\, M_\odot$. The diso scale at epoch of formation, e.g. $100\,$kpc-proper at z ∼ 30, i.e. $\sim 3\,$Mpc-comoving, is imprinted in the SMBH two-point angular correlation function, remaining discernible as a low-amplitude feature to z ∼ 1. The SMBH 3D two-point correlation function at z = 0 also shows lower amplitude compared to equivalently massive haloes. We discuss prospects for testing these predictions with observational surveys of SMBH populations.
Decomposing galaxies with bang: an automated morphokinematic decomposition of the SDSS-DR17 MaNGA survey
Authors: Rigamonti Fabio , Dotti Massimo , Covino Stefano , Haardt Francesco , Cortese Luca , Landoni Marco , Varisco Ludovica
Published: August 2023

From a purely photometric perspective galaxies are generally decomposed into a bulge+disc system, with bulges being dispersion-dominated and discs rotationally supported. However, recent observations have demonstrated that such a framework oversimplifies complexity, especially if one considers galaxy kinematics. To address this issue we introduced with the GPU-based code bang a novel approach that employs analytical potential-density pairs as galactic components, allowing for a computationally fast, still reliable fit of the morphological and kinematic properties of galaxies. Here we apply bang to the SDSS-MaNGA survey, estimating key parameters such as mass, radial extensions, and dynamics, for both bulges and discs of +10 000 objects. We test our methodology against a smaller subsample of galaxies independently analysed with an orbit-based algorithm, finding agreement in the recovered total stellar mass. We also manage to reproduce well-established scaling relations, demonstrating how proper dynamical modelling can result in tighter correlations and provide corrections to standard approaches. Finally, we propose a more general way of decomposing galaxies into ‘hot’ and ‘cold’ components, showing a correlation with orbit-based approaches and visually determined morphological type. Unexpected tails in the ‘hot-to-total’ mass-ratio distribution are present for galaxies of all morphologies, possibly due to visual morphology misclassifications.
Three-dimensional modelling of the shock–turbulence interaction
Authors: Trotta D , Pezzi O , Burgess D , Preisser L , Blanco-Cano X , Kajdic P , Hietala H , Horbury T S , Vainio R , Dresing N , Retinò A , Marcucci M F , Sorriso-Valvo L , Servidio S , Valentini F
Published: August 2023

The complex interaction between shocks and plasma turbulence is extremely important to address crucial features of energy conversion in a broad range of astrophysical systems. We study the interaction between a supercritical, perpendicular shock and pre-existing, fully developed plasma turbulence, employing a novel combination of magnetohydrodynamic and small-scale, hybrid-kinetic simulations where a shock is propagating through a turbulent medium. The variability of the shock front in the unperturbed case and for two levels of upstream fluctuations is addressed. We find that the behaviour of shock ripples, i.e. shock surface fluctuations with short (a few ion skin depths, di) wavelengths, is modified by the presence of pre-existing turbulence, which also induces strong corrugations of the shock front at larger scales. We link this complex behaviour of the shock front and the shock downstream structuring with the proton temperature anisotropies produced in the shock–turbulence system. Finally, we put our modelling effort in the context of spacecraft observations, elucidating the role of novel cross-scale, multispacecraft measurements in resolving shock front irregularities at different scales. These results are relevant for a broad range of astrophysical systems characterized by the presence of shock waves interacting with plasma turbulence.
Why are quasi-periodic eruptions only found in low-mass galaxies?
Authors: King Andrew
Published: August 2023

I consider the current sample of galaxy nuclei producing quasi-periodic eruptions (QPEs). If the quasi-period results from the orbital motion of a star around the central black hole, the dearth of associated black hole masses ≳106 M⊙ places tight constraints on models. It disfavours those assuming wide orbits and small eccentricities, because there is ample volume within pericentre to allow significantly more massive holes in QPE systems than are currently observed. If instead the orbiting star is assumed to pass close to the black hole, the same lack of large black hole masses strongly suggests that the stellar orbits must be significantly eccentric, with 1 − e ≲ few × 10−2. This favours a tidal disruption near-miss picture where QPEs result from repeated accretion from an orbiting star (in practice a white dwarf) losing orbital angular momentum to gravitational radiation, even though this is not assumed in deriving the eccentricity constraint. Given the tight constraints resulting from the current small observed sample, attempts to find QPE systems in more massive galaxies are clearly important.
Chemical recycling of polyolefins: a closed-loop cycle of waste to olefins
Authors: Zou Liang , Xu Run , Wang Hui , Wang Zhiqiang , Sun Yuhan , Li Mingfeng
Published: August 2023

The unsuitable disposal of plastic wastes has caused serious environmental pollution, and finding a green manner to address this problem has aroused wide concern. Plastic wastes, especially polyolefin wastes, are rich in carbon and hydrogen, and chemical recycling shows distinct advantages in their conversion into olefins and realizes a closed-loop cycling of plastic wastes. Plastic wastes should be labeled before disposal. The necessity for, and methods of, pretreatment are introduced in this paper and the whole recycling process of polyolefin wastes is also summarized. As the core technology pyrolysis, including thermal, catalytic and solvolysis processes, is introduced in detail due to its potential for future development. We also briefly describe the feasible strategies of pyrolytic oil refining and life cycle assessment of the chemical recycling process. In addition, suggestions and perspectives concerning the industrial improvement of polyolefin chemical recycling are proposed.
Evaluating the Effectiveness of Mobile Health in Breast Cancer Care: A Systematic Review
Authors: Flaucher Madeleine , Zakreuskaya Anastasiya , Nissen Michael , Mocker Alexander , Fasching Peter A , Beckmann Matthias W , Eskofier Bjoern M , Leutheuser Heike
Published: August 2023

Breast cancer is affecting millions of people worldwide. If not appropriately handled, the side effects of different modalities of cancer treatment can negatively impact patients’ quality of life and cause treatment interruptions. In recent years, mobile health (mHealth) interventions have shown promising opportunities to support breast cancer care. Numerous studies implemented mobile health interventions aiming to support patients with breast cancer, for example, through physical activity promotion or educational content. Nonetheless, current literature reveals that real-world evidence for the actual benefits remains unclear. In this systematic review, we focus on analyzing the methodology used in recent studies to determine the effects of mHealth applications and wearable devices on the outcome of patients with breast cancer. We followed the PRISMA guideline for the selection, analysis, and reporting of relevant studies found in the databases of Medline, Scopus, Web of Science, and Cochrane Library. A total of 276 unique records were identified, and 20 studies met the inclusion criteria. Study quality was assessed with the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for Quantitative Studies. While many of the studies used standardized questionnaires as patient-reported outcome measures, there was minimal use of objective measurements, such as activity sensors. Adoption, drop-out rates, and usage behavior of users of the mobile health intervention were often not reported. Future work should clearly define the focus and desired outcome of mHealth interventions and select outcome measures accordingly. Greater transparency facilitates the interpretation of results and conclusions about the real-world evidence of mobile health in breast cancer care.
Characteristics of direct-to-consumer platforms offering erectile dysfunction treatment
Authors: Brink Sarah M , Iarajuli Teona , Shin David
Published: August 2023

Background

Due to the sensitivity and potential embarrassment of discussing erectile dysfunction (ED) in person, men are seeking treatment online.

Aims

We sought to compare offerings of direct-to-consumer (DTC) platforms for ED treatment with respect to consultation, pricing, services, and privacy policy.

Methods

Google was queried to identify DTC platforms offering ED treatment with the keywords: “telehealth erectile dysfunction,” “telemedicine erectile dysfunction,” and “online erectile dysfunction.” Inclusion criteria were as follows: serving a majority of U.S. states, existing online only, providing both the consultation and prescription for phosphodiesterase type 5 inhibitors, and delivering the prescription to the patient.

Results

Fifteen DTC platforms met criteria. Ten provided free consultations; 4 bundled the consultation fee with the first month of the prescription, with 1 of these functioning as a subscription service. Fourteen (93%) relied on online intake forms and 10 (67%) advertised review by the prescriber within 2 business days. Only 4 (27%) platforms explicitly advertised physician-only consults. Direct contact with the prescriber would only occur if needed or if required by state law at 8 (53%) platforms. Purchasing sildenafil and tadalafil was advertised on all platforms. Minimum prices of sildenafil ranged from $0.50 to $35/pill (mean $5.16/pill, median $2.65/pill); tadalafil ranged from $0.50 to $9.80/pill (mean $4.70/pill, median $3.21/pill). In addition to ED therapy, 13 (86%) platforms offered treatment for other men’s health issues. All platforms included a website privacy policy, but only 10 (67%) mentioned Health Insurance Portability and Accountability Act compliance, with 2 of these claiming to not be covered entities.

Conclusion

Although DTC platforms are transparent with phosphodiesterase type 5 inhibitor medication and subscription pricing information, few offer direct contact with a physician to further discuss issues related to ED after completion of the online intake form. For comprehensive evaluation of ED in Health Insurance Portability and Accountability Act–compliant settings, in-person or telemedicine visits should be arranged with men’s physicians.
Characterization and Pathogenicity of Fungal Species Associated with Dieback of Apple Trees in Northern Italy
Authors: Martino Ilaria , Agustí-Brisach Carlos , Nari Luca , Gullino Maria Lodovica , Guarnaccia Vladimiro
Published: August 2023

Severe dieback symptoms were recently observed on apple (Malus × domestica) trees in Northern Italy, representing a growing concern for producers. Surveys were conducted over a 3-year period (2019 to 2021), and five apple orchards, from 5 to 12 years old, were monitored. A total of 33 fungal isolates isolated from symptomatic plants was selected for characterization. The species identification was achieved through multilocus phylogenetic analyses performed on sequences of three genomic loci (ITS, tub2, and tef1). Morphological features were assessed, and the average growth rate at different temperatures was determined. Seven species were identified in association with dieback of apple trees: Botryosphaeria dothidea, Cadophora luteo-olivacea, Diaporthe rudis, Diplodia seriata, Eutypa lata, Kalmusia longispora, and Paraconiothyrium brasiliense. All the species were pathogenic when inoculated on healthy apple plants. B. dothidea resulted in the most aggressive infections. This study provides an insight into the fungal species diversity associated with apple dieback and provides basis for further investigations to assess the phytosanitary status of plant materials to recommend and implement effective management strategies.
QuantumpBac: An effective, high‐capacity piggyBac‐based gene integration vector system for unlocking gene therapy potential
Authors: Hua Wei‐Kai , Hsu Jeff C. , Chen Yi‐Chun , Chang Peter S. , Wen Kuo‐Lan Karen , Wang Po‐Nan , Yang Wei‐Cheng , Shen Chia‐Ning , Yu Yi‐Shan , Chen Ying‐Chun , Cheng I‐Cheng , Wu Sareina Chiung‐Yuan
Published: August 2023

Recent advances in gene therapy have brought novel treatment options for cancer. However, the full potential of this approach has yet to be unlocked due to the limited payload capacity of commonly utilized viral vectors. Virus‐free DNA transposons, including piggyBac, have the potential to obviate these shortcomings. In this study, we improved a previously modified piggyBac system with superior transposition efficiency. We demonstrated that the internal domain sequences (IDS) within the 3′ terminal repeat domain of hyperactive piggyBac (hyPB) donor vector contain dominant enhancer elements. Plasmid‐free donor vector devoid of IDS was used in conjunction with a helper plasmid expressing Quantum PBase™ v2 to generate an optimal piggyBac system, Quantum pBac™ (qPB), for use in T cells. qPB outperformed hyPB in CD20/CD19 CAR‐T production in terms of performance as well as yield of the CAR‐T cells produced. Furthermore, qPB also produced CAR‐T cells with lower donor‐associated variabilities compared to lentiviral vector. Importantly, qPB yielded mainly CD8+ CAR‐TSCM cells, and the qPB‐produced CAR‐T cells effectively eliminated CD20/CD19‐expressing tumor cells both in vitro and in vivo. Our findings confirm qPB as a promising virus‐free vector system with an enhanced payload capacity to incorporate multiple genes. This highly efficient and potentially safe system will be expected to further advance gene therapy applications.
Delivery Strategies for Postpartum Care
Authors: Saldanha Ian J. , Adam Gaelen P. , Kanaan Ghid , Zahradnik Michael L. , Steele Dale W. , Chen Kenneth K. , Peahl Alex F. , Danilack-Fekete Valery A. , Stuebe Alison M. , Balk Ethan M.
Published: August 2023

OBJECTIVE:

To systematically review the effects of postpartum health care–delivery strategies on health care utilization and maternal outcomes.

DATA SOURCES:

We searched Medline, EMBASE, CENTRAL, CINAHL, and ClinicalTrials.gov for studies in the United States or Canada from inception to November 16, 2022.

METHODS OF STUDY SELECTION:

We used duplicate screening for studies comparing health care–delivery strategies for routine postpartum care on health care utilization and maternal outcomes. We selected health care utilization, clinical, and harm outcomes prioritized by stakeholder panels.

TABULATION, INTEGRATION, AND RESULTS:

We found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). For general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (summary effect size 1.36, 95% CI 1.13–1.64) (moderate strength of evidence). Location of breastfeeding care did not affect hospitalization, other unplanned care utilization, or mental health symptoms (all low strength of evidence). Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3–6 months (summary effect size 1.10–1.22) but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months (summary effect size 1.43, 95% CI 1.07–1.91) but not exclusive breastfeeding (all moderate strength of evidence). Use and nonuse of information technology for breastfeeding care were associated with comparable rates of breastfeeding (moderate strength of evidence). Testing reminders for screening or preventive care were associated with greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A1c testing (moderate strength of evidence).

CONCLUSION:

Various strategies have been shown to improve some aspects of postpartum care, but future research is needed on the most effective care delivery strategies to improve postpartum health.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022309756.
SGLT2 Inhibitor-pretreated Macrophage Transplantation Improves Adverse Ventricular Remodeling After Acute Myocardial Infarction
Authors: Chen Rundu , Zhang Yingqian , Zhou Hao , Hu Yingyun , Chen Yundai
Published: August 2023

Macrophages play an important role in the progression of acute myocardial infarction (AMI). Studies have shown that sodium-dependent glucose transporter 2 inhibitor (SGLT2i) after AMI could increase the proportion of M2 type/M1 macrophages and reduces adverse ventricular remodeling (AVR) post-AMI. This study aimed to investigate whether SGLT2i-pretreated macrophage transplantation could reduce AVR after AMI and the underlying mechanisms. C57BL/6 mice were used to establish an AMI model by ligating the coronary arteries. Dynamic observation of transplanted bone marrow-derived macrophages (BMDMs) was performed using an in vivo imaging system. Cardiac function was assessed using echocardiography. The fibrosis ratio was measured using Masson's trichrome staining. Cardiomyocyte (CM) apoptosis was measured using the TUNEL assay. Macrophage subtypes were measured using flow cytometry. We detected the expression of inflammatory factors in the myocardium and serum using enzyme-linked immunosorbent assay and reverse transcription-polymerase chain reaction. The in vivo imaging system revealed that transplanted SGLT2i-pretreated BMDMs were present in the infarcted myocardium for 7 days. Flow cytometry revealed that SGLT2i-pretreated BMDMs promoted the conversion of native-derived macrophages to the M2 type. SGLT2i-pretreated BMDMs also reduced inflammatory factors (IL-6, TNFα, and IL-1β) in the infarcted myocardium and serum. At 28 days post-AMI, SGLT2i-pretreated BMDMs increased cardiac function and vascular density, but reduced CM hypertrophy. SGLT2i-pretreated BMDMs could reduce CM apoptosis and fibrotic area ratio. In conclusion, transplanted SGLT2i-pretreated BMDMs were present in the infarcted myocardium for 7 days and improved AVR by reducing inflammation and modulating the conversion of native mice-derived macrophages to M2-type macrophages.
Predictive Patient Characteristics and Surgical Variables That Influence Postoperative Complications following Bilateral Reduction Mammoplasty
Authors: Dow Todd , Crawley Emma , Selman Tamara , Al Youha Sarah , Bendor-Samuel Richard , Brennan Michael , Williams Jason
Published: August 2023

Background:

Breast hypertrophy is known to be a source of both physical and psychosocial health deficits. Therefore, the ability to relieve these symptoms with surgical treatment is an important consideration for patients. The primary objective of this study was to assess the impact of patient body mass index (BMI) on postoperation complications. The secondary objective of this study was to assess patient demographics, surgical techniques, and patient comorbidities for their impact on specific postoperative complications.

Methods:

A retrospective chart review of all patients who received bilateral breast reduction surgery in Nova Scotia over the past 10 years was performed. A total of 1022 patients met the inclusion criteria of the study. Logistic regression modeling was performed to identify demographic factors, surgical techniques, and patient comorbidities that impact the risk of developing specific postoperative complications.

Results:

Our study population had a total complication incidence of 37.7%. BMI was not significantly different between patients who developed complications and those who did not. Logistic regression modeling showed a significant relationship that with each unit increase in BMI above the mean (25.9 kg/m2) the relative risk of patient-reported postoperative asymmetry increased by 6%.

Conclusions:

The findings of this study suggest that BMI has several nonsignificant relationships to postoperative complications following bilateral breast reduction. These trends do not translate to significantly increased complaints of asymmetry, scarring‚ or revision surgeries. This study also provides valuable information on the timeline of postoperative complications and when they can commonly be identified.
Sacral Defect Reconstruction Using Double Pedicled Gracilis Muscle Flap combined with Gluteal Fasciocutaneous Rotation Flap
Authors: Triolo Julie C. , Buchs Nicolas C. , Tessitore Enrico , Hannouche Didier , Dominguez Dennis E. , Kalbermatten Daniel F. , Oranges Carlo M.
Published: August 2023

Several reconstructive approaches have been described for reconstruction after sacral chordomas, classically myocutaneous flaps. Recently, postural muscle preservation techniques are preferred whenever possible. We present the case of a 70-year-old man who underwent en-bloc resection of a sacral chordoma resulting in a large three-dimensional defect. To reconstruct the pelvic floor, an acellular dermal matrix and a double pedicled muscle gracilis flap were used to avoid herniation of the abdominal cavity organs. The overlying soft tissue defect was reconstructed with a unilateral gluteal fasciocutaneous rotation flap partially deepithelialized. No surgical complications were observed. Aesthetic and functional outcomes were both satisfying at 9-months postoperative follow-up. The ambulatory functions were not compromised. This combined flap reconstruction associated with a dermal matrix offers a reliable and effective option for sacral reconstruction while minimizing the morbidity.
NAC Plaster Lifting Technique for the Management of Skin Redundancy in Severe Gynecomastia
Authors: Ramasamy Karthik , Jagadish Kiran Appaka C.V. , Jesudass Joyce , Raj Sunitha
Published: August 2023

Background:

Gynecomastia is found to be a common cosmetic problem. Many techniques are currently available for the surgical treatment of gynecomastia, reported to be effective, with limited scar formation. The main objective of our unique reproducible nipple-areola complex (NAC) lifting technique is the management of skin redundancy in severe gynecomastia and positioning the NAC at an aesthetically pleasing site on the chest, for men.

Methods:

A retrospective study was conducted in 30 gynecomastia surgeries of grade III and IV done from January 2019 to December 2020. All these patients were treated by using the NAC lifting technique in our centre, and the results were assessed with patient and surgeon satisfaction scores. This lifting plaster technique is used after the skin closure of the Webster incision. The U slit in the lifting plaster prevents the wrinkling of the NAC and also avoids the second stage surgery for most of the cases of severe gynecomastia.

Results:

A retrospective analysis showed that all patients were satisfied with the technique and none of the patients returned for the second stage surgery. Minimal residual skin redundancy was observed, but it was not severe to necessitate a secondary procedure. All patients were satisfied and comfortable with the final outcome.There was no incidence of contour deformity after the procedure.

Conclusion:

This technique takes advantage of the elastic recoiling property of the skin and helps in re-draping the redundant skin on the chest wall and in positionining the NAC at an aesthetically pleasing position on the chest.
Combined Treatment with Lymphaticovenular Anastomosis and Ethanol Sclerotherapy for Cystic Lymphangioma in a Limb
Authors: Yoshida Shuhei , Imai Hirofumi , Roh Solji , Mese Toshiro , Koshima Isao
Published: August 2023

Several treatment options, including sclerotherapy and surgical excision, are available for the management of cystic lymphangioma. Lymphaticovenular anastomosis (LVA) has recently garnered attention in the field of microsurgery as a minimally invasive surgical reconstruction strategy. Combined treatment using surgical excision and LVA for large or persistent cystic lymphatic malformations has been reported but can be very invasive. This case report describes use of a combination of LVA and sclerotherapy to treat cystic lymphatic malformations with satisfactory results. This combination could be a complementary minimally invasive treatment for extensive cystic lymphatic malformations. The patient was an 18-year-old woman with a cystic lymphangioma from the axilla to the subclavicular area beneath pectoralis major and pectoralis minor. The size was a diameter of 12 cm and a maximum depth of 8 cm. The cystic lymphangioma was managed by combined treatment of LVA and ethanol sclerotherapy. The patient had subsequent resolution of the lymphangioma without any symptoms of lymphedema or recurrence. LVA is thought to be a less invasive treatment option when the lymphatics flowing into a cyst are detectable or can be targeted. However, this is not always the case, especially if the cyst is large, persistent, or infected. Combination of LVA with sclerotherapy is a relatively less invasive method with closure of the dead space using sclerotherapy without further exacerbation or occurrence of lymphedema. Therefore, combined treatment using LVA with sclerotherapy can be a complementary minimally invasive treatment option for a large or persistent lymphocele.
Bilateral Transposition Flap for Postoperative Anal Stenosis after Reconstruction for Paget Disease
Authors: Nakatsuka Kengo , Karakawa Ryo , Fuse Yuma , Yoshimatsu Hidehiko , Yano Tomoyuki
Published: August 2023

One of the complications of anal surgery or disease is anal stenosis. To release the tension of the anus, a tension-releasing incision in the perianal skin and various anoplasty procedures are usually considered. The aim of this article is to describe a straightforward technique with local flaps for severe anal stenosis after anal reconstruction. A 57-year-old man presented to the clinic with diverticulitis secondary to severe anal stenosis, and reported difficulty with defecation after perianal skin resection around the anus and surgery to create a V-Y advancement flap for perianal primary Paget disease 9 months previously. After improvement of the diverticulitis using antibiotics, bilateral transposition flaps were transferred to release the anal stenosis. The surgical treatment for severe anal stenosis has been known to entail several complications, including infection, incontinence, anal mucosal ectropion, pruritus, wound dehiscence, and restenosis. In this severe case, because the scars were situated at the 6 o’clock and 12 o’clock positions on the anus due to the previous V-Y advancement flap, bilateral rotation flaps were transferred from the 3 o’clock and 9 o’clock positions of the anus to prevent wound dehiscence and partial flap necrosis. Three months later, the size of the anus was unchanged, but additional surgery was performed at the patient’s request. A bilateral transposition flap procedure was used, with flaps designed and elevated from the 6 o’clock and 12 o’clock positions. The postoperative course was uneventful, and the anal stenosis was improved.
Pulmonary Rehabilitation for Post-COVID-19
Authors: Aljazeeri Jafar , Almusally Rayyan , Wert Yijin , Abdelhalim Mostafa , Klinger Cathleen , Ramesh Navitha , Rahman Taj
Published: August 2023

Purpose:

Patients with COVID-19 often report persistent respiratory symptoms. Limited data exist on how to mitigate long-term sequelae of exercise intolerance and dyspnea. We aimed to study the role of pulmonary rehabilitation (PR) in patients with post-COVID-19.

Methods:

This was an observational study. Consecutive patients with post-COVID-19, admitted to three separate outpatient PR programs, were enrolled. The program consisted of 8-12 wk of PR sessions (3 times/wk). Data were gathered at the initial visit and discharge. The primary outcome was the change in the 6-min walk test (6MWT) distance. Secondary outcomes included the Shortness of Breath Questionnaire (SOBQ), modified Borg dyspnea scale, Patient Health Questionnaire-9 (PHQ-9), and Lung Information Needs Questionnaire (LINQ).

Results:

A total of 56 patients completed the PR program (age 62.8 ± 14.7 yr, 57% were men). At baseline, the mean 6MWT was 313.3 ± 193.8 m. On average, the 6MWT improved by 84.3 m after PR (P < .0001). Apart from the modified Borg dyspnea scale, there was improvement across secondary outcomes: SOBQ (−16.9 points), PHQ-9 (−2.6 points), and LINQ (−4.2 points); all P < .05.

Conclusion:

Pulmonary rehabilitation showed a promising positive effect on patients with with post-COVID-19. It improved exercise capacity, perception of dyspnea, depressive symptoms, and patient knowledge needed to manage their lung disease. Pulmonary rehabilitation should be considered for post-COVID-19 patients.
Neurotrophic Keratopathy After Slow Coagulation Transscleral Cyclophotocoagulation
Authors: Sayed Mohamed S. , Khodeiry Mohamed M. , Elhusseiny Abdelrahman M. , Sabater Alfonso L. , Lee Richard K.
Published: August 2023

Purpose:

Decreased corneal sensation and subsequent neurotrophic keratopathy (NK) is an uncommon complication after transscleral cyclophotocoagulation (TSCPC). Post-TSCPC NK has been rarely reported in the literature, predominantly after traditional, “pop technique” continuous-wave TSCPC or micropulse CPC. The authors report the first case series of NK after slow-coagulation TSCPC (SC-TSCPC).

Methods:

This was a respective chart review of patients who developed NK after SC-TSCPC. The collected data included demographic data, type of glaucoma, risk factors for corneal anesthesia in addition to the number of laser spots, and the extent of the treated area.

Results:

Four eyes experienced NK after SC-TSCPC. The median time for the development of NK was 4 weeks. At the final visit, 2 patients had a resolution of NK, 1 had a persistent corneal ulcer, and 1 had worsening NK and corneal perforation.

Conclusions:

NK is a rare but a vision-threatening complication that can develop after SC-TSCPC in patients with risk factors for decreased corneal sensation. Early diagnosis and proper management are crucial to reducing the risk of vision loss and improving the prognosis of these cases.
The safety and efficacy between remimazolam and propofol in intravenous anaesthesia of endoscopy operation: a systematic review and meta-analysis
Authors: Zhao Mei-ji , Hu Hai-feng , Li Xin-lei , Li Xiao-ming , Wang Da-chuan , Kuang Ming-jie
Published: August 2023

Background:

Propofol is the most widely used intravenous anesthetic in endoscopic surgery, but is associated with several adverse reactions. Public research has shown that remimazolam, a safe general anesthetic, is increasingly being used as a substitute for propofol in clinical operations. Our meta-analysis aimed to analyze whether the adverse reaction rate of remimazolam in endoscopic surgery is acceptable and whether the surgical success rate is not lower than that of propofol.

Aim:

This meta-analysis examined the adverse events and efficacy of remimazolam vs. propofol during endoscopic surgery.

Method:

MEDLINE, EMBASE, ClinicalTrials.gov, and Google Scholar were comprehensively searched. Seven studies comparing remimazolam and propofol were included in our meta-analysis. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and Cochrane manual were used to assess the quality of the results published in all included studies to ensure that our meta-analysis results are reliable and worthwhile.

Results:

Compared to propofol, the use of remimazolam reduced postoperative injection pain [Relative Risk (RR)=0.06, 95% confidence interval (CI): 0.03–0.12, P<0.00001], postoperative hypotension (RR=0.45, 95% CI: 0.28–0.73, P=0.001), and postoperative respiratory depression (RR=0.20, 95% CI: 0.08–0.47, P=0.0002); however, it also slightly reduced the success rate of the operation [Risk Difference (RD)=−0.02, 95% CI: −0.04–−0.01, P=0.0007]. There were no significant differences in the occurrence of bradycardia symptoms after the operation (RD=−0.01, 95% CI: −0.03–0.01, P=0.35), recovery time after the operation [STD Mean Difference (SMD)=0.68, 95% CI: −0.43–1.80, P=0.23] or discharge time (SMD=0.17, 95% CI: −0.58–0.23, P=0.41). We also performed a subgroup analysis of each corresponding outcome.

Conclusion:

Our analysis showed that remimazolam may be a safer shock option than propofol for endoscopic surgery. However, further research is required to determine their utility.
Effect of body weight support training on lower extremity motor function in patients with spinal cord injury: a systematic review and meta-analysis
Authors: Huang Lei , Huang Hai liang , Dang Xiao wen , Wang Ya jie
Published: August 2023

Objective

To systematically evaluate the effect of body weight support training (BWST) on lower extremity motor functions in patients with spinal cord injury (SCI) and to compare the effect differences among three BWST methods.

Design

PubMed, Web of Science, Cochrane Library, EMBASE, CNKI, CBM, VIP, and Wan Fang databases were searched until December 31, 2022. Meta-analysis and network meta-analysis were conducted using RevMan 5.4 and ADDIS 1.16.8.

Results

Nineteen RCTs involving 864 patients were included. The meta-analysis showed that BWST could improve lower extremity motor scores (LEMSs) according to the ISCNCSCI standard (mean difference [MD] = 6.38, 95% confidence interval [CI] = 3.96, 8.80; P < 0.05), walking speed (SMD = 0.77, 95% CI = 0.52, 1.02; P < 0.05), and modified Barthel index (MBI) scores (MD = 9.85, 95% CI = 8.39, 11.30; P < 0.05). The network meta-analysis showed no significant difference among the three BWST methods for improving LEMSs in patients with SCI. The best probability ranking of the BWST methods for improving LEMSs in patients with SCI was robot-assisted gait training (RAGT) (P = 0.60), followed by aquatic exercise (P = 0.21) and BWST (P = 0.19).

Conclusions

BWST can improve lower extremity motor function in patients with SCI. No significant difference was observed among the three BWST methods, but RAGT may produce the best effect.
Wide-Awake Carpal Tunnel Release in the United States: Trends in Volume and Reimbursement by Operative Setting
Authors: Kammien Alexander J. , Kim Samuel , Mookerjee Vikram G. , Williams Mica C. G. , Prsic Adnan , Grauer Jonathan N. , Colen David L.
Published: August 2023

Background:

Office-based surgery can increase logistical and financial efficiency for patients and surgeons. The current study compares wide-awake, office-based carpal tunnel release to wide-awake operations performed in the operating room in terms of volume, financial burden, narcotic prescriptions, and adverse events.

Methods:

Operations performed under local-only anesthesia from 2010 to 2020 were identified in a national administrative database (PearlDiver). Patients were grouped by surgical setting and matched based on age, sex, comorbidity burden, and geographic region. Primary endpoints included total disbursement and physician reimbursement, and 30-day narcotics prescriptions, emergency department (ED) visits, and surgical site infections (SSIs).

Results:

Before matching, there were 303,741 operating room operations and 5463 office operations. From 2010 to 2020, the percentage of operations in the office increased from 1.2% to 3.4%. Matched cohorts included 21,835 operating room operations and 5459 office operations. Office surgery was associated with lower total disbursement and physician reimbursement for patients with commercial insurance, Medicaid, and Medicare. Linear regression modeling indicated that office-based surgery was significantly associated with lower total disbursement and physician reimbursement. Fewer office patients filled narcotic prescriptions and visited the ED, and there was no difference in SSIs.

Conclusions:

Compared with operating room surgery, office surgery was associated with lower financial burden, fewer narcotics prescriptions and ED visits, and a similar incidence of SSIs. These findings, together with literature showing greater efficiency in the office, suggest that office-based operations are safe and cost-effective and should continue to grow.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.