bluuebunny/crossref_metadata_2025 huggingface dataset:
First observations of warm and cold methanol in Class 0/I proto-brown dwarfs
Authors: Riaz B , Thi W-F , Machida M N
Published: May 2023

We present results from the first molecular line survey to search for the fundamental complex organic molecule, methanol (CH3OH), in 14 Class 0/I proto-brown dwarfs (proto-BDs). IRAM 30-m observations over the frequency range of 92–116 and 213–280 GHz have revealed emission in 14 CH3OH transition lines, at upper state energy level, Eupper ∼7–49 K, and critical densities, ncrit of 105–109 cm−3. The most commonly detected lines are at Eupper < 20 K, while 11 proto-BDs also show emission in the higher excitation lines at Eupper ∼21–49 K and ncrit ∼ 105 to 108 cm−3. In comparison with the brown dwarf formation models, the high excitation lines likely probe the warm (∼25–50 K) corino region at ∼10–50 au in the proto-BDs, while the low-excitation lines trace the cold (<20 K) gas at ∼50–150 au. The column density for the cold component is an order of magnitude higher than the warm component. The CH3OH ortho-to-para ratios range between ∼0.3 and 2.3. The volume-averaged CH3OH column densities show a rise with decreasing bolometric luminosity among the proto-BDs, with the median column density higher by a factor of ∼3 compared to low-mass protostars. Emission in high-excitation (Eupper > 25 K) CH3OH lines together with the model predictions suggest that a warm corino is present in ∼78 per cent of the proto-BDs in our sample. The remaining shows evidence of only the cold component, possibly due to the absence of a strong, high-velocity jet that can stir up the warm gas around it.
iMaNGA: mock MaNGA galaxies based on IllustrisTNG and MaStar SSPs – II. The catalogue
Authors: Nanni Lorenza , Thomas Daniel , Trayford James , Maraston Claudia , Neumann Justus , Law David R , Hill Lewis , Pillepich Annalisa , Yan Renbin , Chen Yanping , Lazarz Dan
Published: May 2023

Strengthening the synergy between simulations and observations is essential to test galaxy formation and evolution theories. To achieve this goal, in the first paper of this series, we presented a method to generate mock SDSS-IV/Mapping Nearby Galaxies at Apache Point Observatory (MaNGA) integral-field spectroscopic galaxy observations from cosmological simulations. In this second paper, we build the iMaNGA catalogue consisting of ∼1000 unique galaxies from the TNG50 cosmological simulations, selected to mimic the SDSS-IV/MaNGA-Primary sample selection. Here, we present and discuss the iMaNGA sample and its comparison to the MaNGA Primary catalogue. The iMaNGA sample well recovers the MaNGA-Primary sample in terms of stellar mass versus angular size relation and spatial resolution. The Sérsic index versus angular size relation, instead, is not reproduced well by the simulations, mostly because of a paucity of high-mass elliptical galaxies in TNG50. We also investigate our ability to recover the galaxy kinematics and stellar population properties with full-spectral fitting. We demonstrate that ‘intrinsic’ and ‘recovered’ stellar kinematics, stellar ages, and metallicities are consistent, with residuals compatible with zero within 1σ. Also ‘intrinsic’ and ‘recovered’ star formation histories display a great resemblance. We conclude that our mock generation and spectral fitting processes do not distort the ‘intrinsic’ galaxy properties. Therefore, in the third paper of this series, we can meaningfully test the cosmological simulations, comparing the stellar population properties and kinematics of the iMaNGA mock galaxies and the MaNGA observational results.
ALMACAL – X. Constraints on molecular gas in the low-redshift circumgalactic medium
Authors: Klitsch Anne , Davis Timothy A , Hamanowicz Aleksandra , van de Voort Freeke , Péroux Céline , Zwaan Martin A
Published: May 2023

Despite its crucial role in galaxy evolution, the complex circumgalactic medium (CGM) remains underexplored. Although, it is known to be multiphase, the importance of the molecular gas phase to the total CGM mass budget is, to date, unconstrained. We present the first constraints on the molecular gas covering fraction in the CGM of low-redshift galaxies, using measurements of CO column densities along sightlines towards mm-bright background quasars with intervening galaxies. We do not detect molecular absorption against the background quasars. For the individual, low-redshift, ‘normal’ galaxy haloes probed here, we can therefore rule out the presence of an extremely molecular gas-rich CGM, as recently reported in high-redshift protoclusters and around luminous active galactic nuclei. We also set statistical limits on the volume filling factor of molecular material in the CGM as a whole, and as a function of radius. Interstellar medium-like molecular clouds of ∼30 pc in radius with column densities of N(CO) ≳ 1016 cm−2 have volume filling factors of <0.2 per cent. Large-scale smooth gas reservoirs are ruled out much more stringently. The development of this technique in the future will allow deeper constraining limits to be set on the importance (or unimportance) of molecular gas in the CGM.
Perspectives on Music Healing by Traditional Healers and Music Therapists
Authors: Von Fritschen Charlotte , Dos Santos Andeline
Published: May 2023

The majority of South Africans use both traditional and Western healthcare services. Although traditional healers have long since recognized and utilized the healing power of music, music therapy as a profession in this country is largely aligned with Western medical approaches, as it is regulated by the Health Professions Council of South Africa. This alignment leaves little recognition to traditional health practitioners. In the current study, we explored music therapists’ and traditional healers’ perceptions of their roles and relationships with each other in South African healthcare with the hope of initiating dialogue. Four traditional healers (TH) and four music therapists (MT) participated in interviews within this multiple case study, and thematic analysis was used to interpret the data. We identified eight overarching themes that appeared most salient to the music therapists and traditional healers (framed from their perspectives): (1) Both our practices support wellbeing, with music as a tool; (2) We both seek to enhance general well-being, but with different specializations; (3) We both focus on relational connection; (4) We both emphasize the importance of culture; (5) THs emphasize spirituality; (6) We hold curious, yet cautious regard for each other’s practices; (7) MT may aid in addressing psychosocial needs in South Africa; and (8) We both welcome a pluralism of approaches. Both groups of practitioners envisioned a future healthcare system that embraces multiple modalities while reflecting on the need to engage in issues related to boundaries of scopes of practice. They highlighted the need for greater trust between practitioners from different approaches to serve a diverse population better.
Body condition of larval roundherring,Gilchristella aestuaria(family Clupeidae), in relation to harmful algal blooms in a warm-temperate estuary
Authors: Smit Taryn , Clemmesen Catriona , Lemley Daniel A , Adams Janine B , Bornman Eugin , Strydom Nadine A
Published: May 2023

Eutrophication-driven harmful algal blooms (HABs) can have secondary effects on larval fishes that rely on estuaries as nurseries. However, few studies worldwide have quantified these effects despite the global rise in eutrophication. This study presents a novel approach using biochemical body condition analyses to evaluate the impact of HABs on the growth and body condition of the larvae of an estuarine resident fish. Recurrent phytoplankton blooms of Heterosigma akashiwo occur in the warm-temperate Sundays Estuary on the southeast coast of South Africa. The response in body condition and assemblage structure on larval estuarine roundherring (Gilchristella aestuaria) was measured in conjunction with bloom conditions, water quality and zooplanktonic prey and predators. Larvae and early juveniles were sampled during varying intensity levels, duration and frequency of hypereutrophic blooms. This study demonstrated that extensive HABs could significantly impact larval roundherring, G. aestuaria, by decreasing larval nutritional condition and limiting their growth, resulting in poor grow-out into the juvenile phase. Poor condition and growth may likely affect recruitment success to adult populations, and since G. aestuaria is an important forage fish and zooplanktivore, poor recruitment will hold consequences for estuarine food webs.
Profiling migraine patients according to clinical and psychophysical characteristics: a cluster analysis approach
Authors: Di Antonio Stefano , Arendt-Nielsen Lars , Ponzano Marta , Bovis Francesca , Torelli Paola , Finocchi Cinzia , Castaldo Matteo
Published: May 2023

Aim

This study aims to profile migraine patients according clinical and psychophysical characteristics.

Method

In this observational study, two cohorts of migraine patients(episodic/chronic) were included. Cohort-1: ictal/perictal phase; Cohort-2: interictal phase.

The following variables were assessed: headache frequency; disability; cervical active range of motion(AROM) in flexion, extension, right/left lateral flexion, right/left rotation; pressure-pain threshold(PPT) over: temporalis, two cervical areas(C1/C4 vertebral segments), and two distal pain-free areas(hand/leg). Cluster analysis was performed using the K-means algorithm. Differences across clusters were investigated.

Results

Cohort-1: 100 patients were included, and two clusters were identified. Cluster-1.1 (19%), Cluster-1.2 (81%). Cluster 1.1 had a higher percentage of men (P = .037) and higher disability (P = .003) compared to Clusters 1.2. Cluster 1.2 had reduced AROM in flexion, extension, and left/right lateral flexion (P < .037), and lower PPT value in all areas (P < .001) compared to Cluster 1.1.

Cohort-2: 98 patients were included and three clusters were identified. Cluster-2.1(18%), Cluster-2.2(45%), and Cluster-2.3(37%). Cluster-2.1 had a higher percentage of men compared to clusters-2.2 and 2.3 (P = .009). Cluster-2.3 had higher headache frequency, and disability compared to Cluster-2.2 (P < .006), and higher disability compared to Cluster-2.1 (P = .010). Cluster-2.3 had reduced AROM in all directions compared to Clusters-2.1 and 2.2 (P < .029). Clusters-2.2 and 2.3 have lower PPT values in all areas compared to Cluster-1.1 (P < .001).

Conclusion

In the Ictal/perictal phase, two clusters were identified according to clinical and psychophysical characteristics, with one group showing no psychophysical impairment and one with increased pain-sensitivity and cervical musculoskeletal-dysfunctions.

In the interictal phase, three clusters could be identified, with one group showing no psychophysical impairment, one increased pain-sensitivity, and one increased pain sensitivity and cervical musculoskeletal-dysfunctions.
Mobile Health Pulmonary Rehabilitation Compared to a Center-Based Program for Cost-Effectiveness and Effects on Exercise Capacity, Health Status, and Quality of Life in People With Chronic Obstructive Pulmonary Disease: A Protocol for a Randomized Controlled Trial
Authors: Wootton Sally L , Dale Marita T , Alison Jennifer A , Brown Sarah , Rutherford Hannah , Chan Andrew S L , Varnfield Marlien , Yang Ian A , Cunich Michelle , Dennis Sarah , McKeough Zoe J
Published: May 2023

Objective

The use of digital health is a novel way to improve access to comprehensive pulmonary rehabilitation for people with chronic obstructive pulmonary disease (COPD). This study aims to determine if a home-based pulmonary rehabilitation program supported by mobile health (mHealth) technology is equivalent to center-based pulmonary rehabilitation in terms of improvements in exercise capacity and health status in people with COPD.

Methods

This study is a prospective, multicenter, equivalence randomized controlled trial (RCT) with intention-to-treat analysis. A hundred participants with COPD will be recruited from 5 pulmonary rehabilitation programs. Following randomization, participants will be assigned in a concealed manner to receive either home-based pulmonary rehabilitation supported by mHealth or center-based pulmonary rehabilitation. Both programs will be 8 weeks and will include progressive exercise training, disease management education, self-management support, and supervision by a physical therapist. Co-primary outcome measures will be the 6-Minute Walk Test and the COPD Assessment Test. Secondary outcome measures will include the St George’s Respiratory Questionnaire, the EuroQol 5 Dimension 5 Level, the modified Medical Research Council dyspnea scale, the 1-minute sit-to-stand test, the 5 times sit-to-stand test, the Hospital Anxiety and Depression Scale, daily physical activity levels, health care utilization, and costs. Outcomes will be measured at baseline and at the end of the intervention. Participant experience will be assessed through semi-structured interviews at the end of the intervention. Utilization of health care and costs will be measured again after 12 months.

Impact

This study will be the first rigorous RCT to examine the effects of a home-based pulmonary rehabilitation program supported by mHealth technology that includes comprehensive clinical outcome evaluation, assessment of daily physical activity, a health economic analysis, and qualitative analysis. If findings demonstrate that there is equivalence in clinical outcomes, that the mHealth program costs the least amount (and is thus cost-effective), and that the mHealth program is acceptable to participants, such programs should be widely implemented to improve access to pulmonary rehabilitation.
Transmission of SARS-CoV-2 among recruits in a US Army training environment: a brief report
Authors: Hakre Shilpa , Maljkovic-Berry Irina , Hang Jun , Conte Matthew A , Pollio Adam R , Fung Christian K , Gandhi Jaykumar , Peel Sheila A , Lidl Grace M , Huhtanen Mark E , Hall Tara L , Modjarrad Kayvon , Friberg Heather L , O’Connell Robert J , Scott Paul T
Published: May 2023

Background

In 2020, preventive measures were implemented to mitigate the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among 600–700 recruits arriving weekly at a basic combat training (BCT) facility in the southern United States. Trainees were sorted into companies and platoons (cocoons) at arrival, tested, quarantined for 14 days with daily temperature and respiratory-symptom monitoring and retested before release into larger groups for training where symptomatic testing was conducted. Nonpharmaceutical measures, such as masking, and social distancing, were maintained throughout quarantine and BCT. We assessed for SARS-CoV-2 transmission in the quarantine milieu.

Methods

Nasopharyngeal (NP) swabs were collected at arrival and at the end of quarantine and blood specimens at both timepoints and at the end of BCT. Epidemiological characteristics were analyzed for transmission clusters identified from whole-genome sequencing of NP samples.

Results

Among 1403 trainees enrolled from 25 August to 7 October 2020, epidemiological analysis identified three transmission clusters (n = 20 SARS-CoV-2 genomes) during quarantine, which spanned five different cocoons. However, SARS-CoV-2 incidence decreased from 2.7% during quarantine to 1.5% at the end of BCT; prevalence at arrival was 3.3%.

Conclusions

These findings suggest layered SARS-CoV-2 mitigation measures implemented during quarantine minimized the risk of further transmission in BCT.
“Blue balls” and sexual coercion: a survey study of genitopelvic pain after sexual arousal without orgasm and its implications for sexual advances
Authors: Levang Samantha , Henkelman Megan , Neish Robin , Zukerman Wendy , Terrell Blythe , Jackman Victoria , Coyle Shannon , Brahmbhatt Jamin , Pukall Caroline
Published: May 2023

Background

Blue balls/vulva has received increasing interest from the public in recent years, sparking debate about genital physiology, controversy around “sexual release” as a treatment for this type of pain, and sexual consent.

Aim

This cross-sectional, mixed-methods online study aimed to evaluate the general understanding and frequency of blue balls/vulva and whether individuals have ever been pressured to continue sexual activity because of a partner’s fears of experiencing pain without orgasm.

Methods

A total of 2621 individuals with a penis (n = 1483) or vagina (n = 1138) were recruited for an online survey on the experience of “blue balls/vulva.” Quantitative analyses consisted primarily of descriptive statistics and chi-square analyses. Between-group differences were analyzed (based on whether respondents reported having a penis or vagina), and responses to open-ended questions were examined via thematic analysis.

Outcomes

The primary outcomes of interest were reports of the belief in blue balls/vulva, the frequency and pain characteristics of blue balls/vulva, and the incidence of being pressured to continue sexual activity due to a partner’s fears of experiencing pain without orgasm.

Results

Results indicated that significantly more individuals with a penis than a vagina reported believing that blue balls are real, endorsed experiencing pain when they approached orgasm but did not ejaculate, and reported moderate and severe pain. Significantly more individuals with a vagina than a penis reported being pressured into a sexual act due to a partner’s fear of experiencing pain without orgasm. Results from the thematic analysis indicated that participants recognized that those with a vagina are expected to act sexually to prevent their partners’ experience of blue balls, despite agreement that this phenomenon should not be used to coerce or manipulate partners into engaging sexually.

Clinical Implications

Education on the frequency of this phenomenon and methods to relieve pain alternative to partnered sexual activity should be addressed in patients who present with this condition.

Strengths and Limitations

Although the survey was brief, it provided information from a relatively large sample about whether people believe that this phenomenon exists, how many experience it, how painful it is, and how often it has been used as an excuse for a partner to continue sexual activity.

Conclusion

Results indicated that severe pain exists in a minority of individuals, that solitary sexual and nonsexual activities can help to alleviate the discomfort, and that this pain is not a valid reason to continue unwanted sexual activity.
Early and late implications of COVID-19 on male reproductive health: 3 years of data
Authors: Pellegrino Christopher J , Ye Nancy Y , Chen Irene K , Abdelsayed George A
Published: May 2023

Introduction

COVID-19 (coronavirus disease 2019), caused by SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), has significantly affected global health. Research has shown that the virus can be found at high concentrations in male gonadal tissue. Yet, the virus’s long-term implications on male reproductive health remains relatively unclear.

Objective

A comprehensive narrative review of published literature regarding COVID-19’s short- and long-term implications on male reproductive health.

Methods

A literature search of the PubMed and EMBASE databases was performed for articles ranging from November 2019 to August 2022. Studies that focused on the impact of COVID-19 on male reproductive health were selected for review. Studies were included if they were written in English and reported semen analyses, pathologic gonadal tissue analyses, serum androgen assays, or a combination of these in patients with COVID-19. Moreover, literature was included on COVID-19 vaccinations’ impacts on male reproductive health. Case reports and other narrative reviews were excluded from this review.

Results

SARS-CoV-2 has been detected in cadaveric testicular tissue during the initial stages of infection in fatal cases of the disease, demonstrating marked inflammatory changes and decreased spermatogenesis in patients with COVID-19. Several studies have revealed a negative impact on androgens during acute illness and in the ensuing months, but data on the recovery of androgen levels are confounding and limited in scope. COVID-19 does have significant negative impacts on bulk semen parameters, as confirmed in studies comparing pre- and post–COVID-19 semen samples. Vaccination is a valuable tool for protecting patients from the negative impacts of the virus and has been shown to have no negative impact on male reproductive potential.

Conclusion

Given the virus’s impacts on testicular tissue, androgens, and spermatogenesis, COVID-19 can negatively affect male reproductive health for an extended period. Therefore, vaccinations should continue to be recommended to all eligible patients.
Controlled Ankle Movement (CAM) Boot Provides Improved Outcomes With Lower Complications Than Short Leg Walking Cast in Low-energy Pediatric Lateral Ankle Injuries: A Prospective, Randomized Study
Authors: Beck Jennifer J. , Kang Victoria , Bennett Abbie , Bloom Summer , Jackson Nicholas J.
Published: May 2023

Background:

Low-energy lateral ankle injuries (Salter-Harris 1 distal fibula, distal fibula avulsion fractures, and radiograph-negative lateral ankle injuries) are common in pediatric patients. Patient-based outcomes for the 2 treatment options, short leg walking cast (CAST) and controlled ankle motion (CAM) boot, are unknown. This study aims to determine differences between 2 treatments of low-energy lateral ankle injuries in pediatric patients.

Methods:

A prospective, randomized controlled trial comparing the acute outcomes of CAST and CAM treatment for low-energy lateral ankle injuries in pediatric patients was completed. Patients were evaluated in-person at presentation and 4 weeks for ankle range of motion and Oxford foot and ankle score. A novel survey defining patient and parent satisfaction and time away from school/work was also completed. Treatment complications were documented. Patients were called at 8 weeks postinjury to determine other complications and the final time of return to sport. Mixed effects linear regression models evaluated change over time between the 2 treatment groups.

Results:

After 60 patients were enrolled, 28 patients in the CAST group and 27 patients in the CAM group completed the study. Males comprised 51% (28), with 38 (69%) patients identifying as Hispanic. The patient’s average age was 11.3±2.9 years and the average body mass index was 23.

At the 4-week evaluation, the CAM group had improved range of motion, higher satisfaction scores (5.26 CAM vs. 4.25 CAST,P<0.05), similar pain scores (0.32 CAST vs. 0.41 CAM,P=0.75), and lower complications (0.54/patient CAST vs. 0.04/patient CAM,P<0.0001) than the CAST group. Female patients had improved inversion with CAM treatment than males (P<0.05). Patients over age 12 in the CAST group had significantly decreased plantarflexion at week 4 (P=0.002). Improvement in Oxford scores was similar between the CAST and CAM groups between the initial presentation and 4 weeks, except for increased improvement in CAM group Oxford scores for difficulty running and symptoms with walking/walking. At the 8-week evaluation, patients in the CAST group had a higher rate of continued symptoms than the CAM group (15.4% vs. 0%)

Conclusions:

CAM boot treatment of low-energy lateral ankle injuries in pediatric patients results in improved results and lower complications than CAST treatment.

Level of Evidence:

Level I —randomized, controlled trial with a statistically significant difference.
A Genetic Variant of FAM46A is Associated With the Development of Adolescent Idiopathic Scoliosis in the Chinese Population
Authors: Min Kaixing , Li Yang , Wu Zhichong , Dai Zhicheng , Feng Zhenhua , Qian Zhuang , Sun Xu , Qiu Yong , Xu LeiLei , Zhu Zezhang
Published: May 2023

Study Design.

A genetic case-control study.

Objective.

To replicate recently reported genetic loci associated with adolescent idiopathic scoliosis (AIS) in the Chinese Han population, and to determine the relationship between gene expression and the clinical features of the patients.

Summary of Background Data.

A recent study conducted in the Japanese population identified several novel susceptible loci, which might provide new insights into the etiology of AIS. However, the association of these genes with AIS in other populations remains unclear.

Materials and Methods.

A total of 1210 AIS and 2500 healthy controls were recruited for the genotyping of 12 susceptibility loci. Paraspinal muscles used for gene expression analysis were obtained from 36 AIS and 36 patients with congenital scoliosis. The difference regarding genotype and allele frequency between patients and controls was analyzed by χ2 analysis. The t test was performed to compare the target gene expression level between controls and AIS patients. Correlation analysis was performed between gene expression and phenotypic data, including Cobb angle, bone mineral density, lean mass, height, and body mass index.

Results.

Four SNPs, including rs141903557, rs2467146, rs658839, and rs482012, were successfully validated. Allele C of rs141903557, allele A of rs2467146, allele G of rs658839, and allele T of single nucleotide polymorphism rs482012 showed significantly higher frequency in patients. Allele C of rs141903557, allele A of rs2467146, allele G of rs658839, and allele T of rs482012 could notably increase the risk of AIS patients, with an odds ratio of 1.49, 1.16, 1.11, and 1.25, respectively. Moreover, tissue expression of FAM46A was significantly lower in AIS patients as compared with controls. Moreover, FAM46A expression was remarkably correlated with bone mineral density of patients.

Conclusion.

Four SNPs were successfully validated as novel susceptibility loci associated with AIS in the Chinese population. Moreover, FAM46A expression was associated with the phenotype of AIS patients.
Assessing Treatment of Floating Lateral Mass (FLM) Fractures of the Subaxial Cervical Spine
Authors: Prezelski Kayla , Simon Karissa N. , Nwadike Benjamin A. , Place Howard M.
Published: May 2023

Study design.

Retrospective cohort.

Objective.

The purpose of the study was to evaluate differences across surgical approaches (anterior, posterior, or combined anterior-posterior) in terms of outcomes following treatment for floating lateral mass (FLM) fractures. Furthermore, we sought to determine whether operative approach to FLM fracture treatment remains superior to nonoperative treatment in terms of clinical outcomes.

Background Data.

FLM fractures of the subaxial cervical spine involves separation of the lateral mass from the vertebrae via a disruption of both the lamina and pedicle, resulting in a disconnection of the superior and inferior articular processes. This subset of cervical spine fractures is highly unstable, making proper treatment selection of great importance.

Methods.

In this single-center, retrospective study, we identified patients meeting the definition of an FLM fracture. Radiological imaging from the date of injury was reviewed to ensure presence this injury pattern. Treatment course was assessed to determine nonoperative versus operative treatment. Operative treatment was divided into patients who underwent anterior, posterior, or combined anterior-posterior spinal fusion. We then reviewed postoperative complications among each of the subgroups.

Results.

Forty-five patients were determined to have a FLM fracture over a 10-year span. The nonoperative group had n=25, and evidently, there were no patients that crossed over to surgery due to subluxation of the cervical spine after nonoperative treatment. The operative treatment group had n=20, and consisted of 6 anterior, 12 posterior, and 2 combined approaches. Complications appeared in posterior and combined groups. Two hardware failures were noted in the posterior group, along with two postoperative respiratory complications in the combined group. No complications were observed for the anterior group.

Conclusions.

None of the nonoperative patients in this study required further operation or management of their injury, indicating nonoperative treatment as a potentially satisfactory management for appropriately selected FLM fractures.
Biomechanical Effects of Facet Joint Violation After Single-Level Lumbar Fusion With Transpedicular Screw and Rod Instrumentation
Authors: Wangsawatwong Piyanat , de Andrada Pereira Bernardo , Lehrman Jennifer N. , Sawa Anna G.U. , O’Neill Luke K. , Turner Jay D. , Uribe Juan S. , Kelly Brian P.
Published: May 2023

Study Design.

In vitro biomechanical study.

Objective.

This study aimed to investigate the biomechanical effects of facet joint violation (FV) on mobility and optically tracked intervertebral disc (IVD) surface strains at the upper level adjacent to L4-5 pedicle screw-rod fixation.

Summary of Background Data.

FV is a complication that can occur when placing lumbar pedicle screws; the reported incidence is as high as 50%. However, little is known about how FV affects superior adjacent-level spinal stability, and especially IVD strain, after lumbar fusion.

Methods.

Fourteen cadaveric L3-S1 specimens underwent L4-5 pedicle-rod fixation, 7 in the facet joint preservation (FP) group and 7 in the FV group. Specimens were tested multidirectionally under pure moment loading (7.5 Nm). Colored maps of maximum (ε1) and minimum (ε2) principal surface strain changes on the lateral L3-4 disc were generated, with the surface divided into 4 quarters anterior to posterior (Q1, Q2, Q3, and Q4, respectively) for subregional analyses. Range of motion (ROM) and IVD strain were normalized to intact upper adjacent-level and compared between the groups using analysis of variance. Statistical significance was set at P<0.05.

Results.

Normalized ROM was significantly greater with FV vs. FP in flexion (11% greater; P=0.04), right lateral bending (16% greater; P=0.03), and right axial rotation (23% greater; P=0.04). Normalized L3-4 IVD ε1 during right lateral bending was greater on average for the FV group than the FP group: Q1, 18% greater; Q2, 12% greater; Q3, 40% greater (P<0.001); Q4, 9% greater. Normalized ε2 values during left axial rotation were greater in the FV group, the highest increase being 25% in Q3 (P=0.02).

Conclusions.

Facet joint violation during single-level pedicle screw-rod fixation was associated with increased superior adjacent level mobility and alteration of disc surface strains, with significant increases in selected regions and directions of loading.
Single-Position Prone Lateral Lumbar Interbody Fusion Increases Operative Efficiency and Maintains Safety in Revision Lumbar Spinal Fusion
Authors: Buckland Aaron J. , Proctor Dylan , Thomas J. Alex , Protopsaltis Themistocles S. , Ashayeri Kimberly , Braly Brett A.
Published: May 2023

Study Design.

Multi-centre retrospective cohort study.

Objective.

To evaluate the feasibility and safety of the single-position prone lateral lumbar interbody fusion (LLIF) technique for revision lumbar fusion surgery.

Background Context.

Prone LLIF (P-LLIF) is a novel technique allowing for placement of a lateral interbody in the prone position and allowing posterior decompression and revision of posterior instrumentation without patient repositioning. This study examines perioperative outcomes and complications of single position P-LLIF against traditional Lateral LLIF (L-LLIF) technique with patient repositioning.

Method.

A multi-centre retrospective cohort study involving patients undergoing 1-4 level LLIF surgery was performed at 4 institutions in the USA and Australia. Patients were included if their surgery was performed via either: P-LLIF with revision posterior fusion; or L-LLIF with repositioning to prone. Demographics, perioperative outcomes, complications, and radiological outcomes were compared using independent samples t-tests and chi-squared analyses as appropriate with significance set at P<0.05.

Results.

101 patients undergoing revision LLIF surgery were included, of which 43 had P-LLIF and 58 had L-LLIF. Age, BMI and CCI were similar between groups. The number of posterior levels fused (2.21 P-LLIF vs. 2.66 L-LLIF, P=0.469) and number of LLIF levels (1.35 vs. 1.39, P=0.668) was similar between groups. Operative time was significantly less in the P-LLIF group (151 vs. 206 min, P=0.004). EBL was similar between groups (150 mL P-LLIF vs. 182 mL L-LLIF, P=0.31) and there was a trend toward reduced length of stay in the P-LLIF group (2.7 vs. 3.3 d, P=0.09). No significant difference was demonstrated in complications between groups. Radiographic analysis demonstrated no significant differences in preoperative or postoperative sagittal alignment measurements.

Conclusion.

P-LLIF significantly improves operative efficiency when compared to L-LLIF for revision lumbar fusion. No increase in complications was demonstrated by P-LLIF or trade-offs in sagittal alignment restoration.

Level of Evidence.

Level IV
Evaluating Public Perceptions of Cosmetic Procedures in the Medical Spa and Physician's Office Settings: A Large-scale Survey
Authors: Gibson Juliet , Greif Charlotte , Nijhawan Rajiv I.
Published: May 2023

BACKGROUND

Medical spa and cosmetic procedure markets have grown substantially in recent years. The lack of consistent medical oversight at medical spas raises safety concerns.

OBJECTIVE

To understand how the public views medical spas compared with physician's offices as places to receive cosmetic procedures with a focus on safety.

METHODS

1,108 people were surveyed on an internet platform about their perceptions of the safety of receiving cosmetic procedures at medical spas and physician's offices. Respondents were grouped by their past experiences. Chi-squared and analysis of variance models were used to determine statistically significant differences between groups at the 0.05 level.

RESULTS

Respondents who had only received cosmetic procedures at physician's offices or had never received a cosmetic procedure cared more about being treated by a physician (p < .001) and rated safety as more important (p = .03). Total complication rates were numerically higher at medical spas compared with physician's offices (p = .41). Minimally invasive skin tightening (0.77 vs 0.0, p < .001) and nonsurgical fat reduction (0.80 vs 0.36, p = .04) had higher complication rates at medical spas.

CONCLUSION

There were concerns among the public about the safety of cosmetic procedures at medical spas, and some procedures demonstrated higher complication rates in this setting.
A New Powder Dressing for Management of Chronic Venous Ulcers
Authors: Mahmood Barakat Abdelreheem , ElSayed Emad Hussein , Abd Elghany Salah M. , Elnaggar Dina Farouk , Youssef Hoda A. A. , Abdelmaksoud Saber M.
Published: May 2023

BACKGROUND

A new powder dressing (TPD) is a methacrylate-based powder formulation that transforms in situ into a shape-retentive matrix upon hydration to create optimum moist wound healing conditions. The following randomized, controlled, clinical study aimed to evaluate the role of TPD in the management of chronic venous ulcers (CVU).

METHODS

The randomized controlled prospective study enrolled 60 CVU patients. After randomization, patients in the treatment group (n = 30) were treated with TPD, whereas those in the control group (n = 30) received conventional compression dressing therapy.

RESULTS

After treatment, patients in the TPD group had significantly higher rates of complete ulcer healing at 12 weeks (43.3% vs 10.0%, p = .004) and 24 weeks (86.7% vs 40.0%, p = .001) when compared with conventional dressing group. Moreover, patients in the TP dressing group had significantly shorter time to complete ulcer healing [mean (95% CI): 16.7 (14.1–19.3) versus 37.0 (30.8–43.2) weeks, p = .001]. In addition, patients in the TPD group had significantly fewer number of dressings, less severe pain after dressing, and lower need for systemic analgesics.

CONCLUSION

Use of TPD in management of CVUs was associated with significantly higher healing rates, shorter duration to healing, and lower pain.
Spheno-Orbital Meningioma - Treatment Outcomes and Factors Influencing Recurrence
Authors: Tran Ann Q. , Maniar Arpita , Tooley Andrea A. , North Victoria S. , Sisti Michael B. , Kazim Michael
Published: May 2023

Purpose:

To determine treatment outcomes, recurrence rates, and predictors of recurrence, to inform future therapeutic approaches for spheno-orbital meningiomas (SOM).

Methods:

A retrospective single-center study of SOM treated from 1990 to 2021 was conducted with comprehensive neuro-ophthalmologic follow-up at Columbia University Medical Center (CUMC). Recurrence requiring reintervention was defined clinically as worsening of visual acuity, visual field defect, or ocular motility after an initial period of stabilization or 6 months of improvement following treatment, or radiologically as either a regrowth with an increase in tumor size by 20% at the site of previous growth or a new region of tumor growth.

Results:

In total 46 patients met the inclusion criteria. The mean follow-up was 106 months (range 1–303). Dictated by the phenotype of the disease, patients underwent either gross- (50%), near- (17%), or subtotal resection (26%). Removal of the anterior clinoid process (ACP) was performed in 52% of patients. Nine patients (20%) required an enucleation or exenteration. Radiotherapy was employed at some point of treatment in 50% of cases. Inherited cases (24%) were referred to CUMC for treatment following 1 or more recurrences. The total recurrence rate, including inherited cases, was 54%, occurring at a mean interval of 43 months. The recurrence rate of patients treated solely at CUMC was 40%, occurring at a mean interval of 41 months. A subset of patients (32%) had 2 or more recurrences. Histopathology at the first surgery was WHO grade I (87%) and II (13%) and at the final surgery was WHO grade I (74%), II (21%), and III (4%). A subset of grade I tumors that received radiotherapy (35%) evolved to a higher grade or developed multiple recurrences without a change in histologic grade I. Grade II tumors and treatment with radiotherapy increased the odds of recurrence. Removal of the ACP and gross total resection decreased the odds of recurrence.

Conclusion:

Due to the routinely long interval to tumor recurrence, lifelong surveillance of patients with SOM is prudent. ACP resection and gross total resection, where possible, reduce tumor recurrence and the need for further treatment. Radiotherapy should be reserved for higher-grade meningiomas and select grade I tumors.
Association between Cardiovascular and Musculoskeletal Health in Firefighters
Authors: Ras Jaron , Soteriades Elpidoforos S. , Smith Denise L. , Kengne Andre P. , Leach Lloyd
Published: May 2023

Objective

The aim of the study is to determine the association between cardiovascular health (CVH) and musculoskeletal health in firefighters.

Methods

This cross-sectional study involved 309 full-time firefighters aged 20 to 65 years. Cardiovascular health encompassed cardiovascular disease risk factors, risk scores, CVH metrics, and heart rate variability. Musculoskeletal health was assessed using two validated questionnaires.

Results

Increasing age (P= 0.004), body mass index (P< 0.001), body fat percentage (P< 0.001), diastolic blood pressure (P= 0.003), total cholesterol (P= 0.006), and Framingham risk score (P= 0.011) increased the risk of reporting musculoskeletal injuries (MSIs). Obesity (P= 0.018), hypertension (P= 0.034), and dyslipidemia (P= 0.005) increased the risk of reporting MSIs. Musculoskeletal discomfort was associated with total cholesterol (P= 0.0.34) and low-density lipoprotein (P= 0.014).

Conclusions

Adverse cardiovascular disease risk profile was associated with MSIs and musculoskeletal discomfort in firefighters. Firefighters should maintain an ideal CVH profile, especially as they age.
Survival outcomes of neoadjuvant therapy followed by radical resection versus upfront surgery for stage I–III pancreatic ductal adenocarcinoma: a retrospective cohort study
Authors: Zou Yiping , Gao Song , Yu Xin , Zhou Tianxing , Xie Yongjie , Guo Xiaofan , An Ran , Wang Xiuchao , Zhao Tiansuo , Chang Antao , Gao Chuntao , Yu Jun , Hao Jihui
Published: May 2023

Background:

Neoadjuvant therapy remains controversial in treating resectable pancreatic ductal adenocarcinoma (PDAC) patients. This study aims to assess the impact of neoadjuvant therapy on survival in patients with PDAC according to their clinical stage.

Methods:

Patients with resected clinical Stage I–III PDAC from 2010 to 2019 were identified in the surveillance, epidemiology, and end results database. A propensity score matching method was utilized within each stage to reduce potential selection bias between patients who underwent neoadjuvant chemotherapy followed by surgery and patients who underwent upfront surgery. An overall survival (OS) analysis was performed using the Kaplan–Meier method and a multivariate Cox proportional hazards model.

Results:

A total of 13 674 patients were included in the study. The majority of the patients (N=10 715, 78.4%) underwent upfront surgery. Patients receiving neoadjuvant therapy followed by surgery had significantly longer OS than those with upfront surgery. Subgroup analysis revealed that the neoadjuvant chemoradiotherapy group’s OS is comparable to neoadjuvant chemotherapy. In clinical Stage IA PDAC, there was no difference in survival between the neoadjuvant treatment and upfront surgery groups before or after matching. In stage IB-III patients, neoadjuvant therapy followed by surgery improved OS before and after matching compared to upfront surgery. The results revealed the same OS benefits using the multivariate Cox proportional hazards model.

Conclusion:

Neoadjuvant therapy followed by surgery could improve OS over upfront surgery in Stage IB-III PDAC but did not provide a significant survival advantage in Stage IA PDAC.
Association of Angiopoetin-2 and TNF-α With Bleeding During Left Ventricular Assist Device Support: Analysis From the PREVENT Biorepository
Authors: Kim Gene , Sayer Gabriel , Ransom John , Keebler Mary , Katz Jason , Kilic Ahmet , Lindenfeld JoAnn , Egnaczyk Gregory , Shah Palak , Brieke Andreas , Walenga Jeanine , Crandall Daniel , Farrar David J. , Sundareswaran Kartik , Uriel Nir
Published: May 2023

The purpose of this study was to describe the changes in plasma levels of angiogenic and inflammatory biomarkers, specifically Ang-2 and TNF-α, in patients receiving HeartMate II (HMII) left ventricular assist device (LVAD) and correlate them with nonsurgical bleeding. It has been shown that angiopoietin-2 (Ang-2) and tissue necrosis factor-α (TNF-α) may be linked to bleeding in LVAD patients. This study utilized biobanked samples prospectively collected from the PREVENT study, a prospective, multicenter, single-arm, nonrandomized study of patients implanted with HMII. Paired serum samples were obtained in 140 patients before implantation and at 90 days postimplantation. Baseline demographics were as follows: age 57 ± 13 years, 41% had ischemic etiology, 82% male, and 75% destination therapy indication. In the 17 patients with baseline elevation of both TNF-α and Ang-2, 10 (60%) experienced a significant bleeding event within 180 days postimplant compared with 37 of 98 (38%) patients with Ang-2 and TNF-α below the mean (p = 0.02). The hazard ratio for a bleeding event was 2.3 (95% CI: 1.2–4.6) in patients with elevated levels of both TNF-α and Ang-2. In the PREVENT multicenter study, patients with elevations in serum Angiopoietin-2 and TNF-α at baseline before LVAD implantation demonstrated increased bleeding events after LVAD implantation.
Nerve-sparing technique in RPLND for testicular cancer
Authors: Nalavenkata Sunny , Li Thomas , Patel Manish I.
Published: May 2023

Purpose of review

The management of testicular cancer has evolved over time with multimodal therapy. Retroperitoneal lymph node dissection (RPLND), which is a complex and potentially morbid treatment option, remains the mainstay in surgical treatment. This article reviews the surgical template, approach and anatomical considerations with regards to nerve spare in RPLND.

Recent findings

The standard full bilateral RPLND template has evolved over time to include the area between the renal hilum, bifurcation of the common iliac vessels, and the ureters. Morbidity with regards to ejaculatory dysfunction has led to further refinements in this procedure. Advancements in anatomical understanding of the retroperitoneal structures and their relationship to the sympathetic chain and hypogastric plexus has allowed for modification of surgical templates. Further refinements in surgical nerve sparing techniques have improved functional outcomes without sacrificing oncological outcomes. Finally, extraperitoneal access to the retroperitoneum and minimally invasive platforms have been implemented to further reduce morbidity.

RPLND requires strict adherence to oncological surgical principles regardless of template, approach and technique. Contemporary evidence shows that outcomes are best for advanced testis cancer patients when managed at high volume tertiary care facilities with surgical expertise and access to multidisciplinary care.
Effect of Artificial Intelligence Course in Nursing on Students' Medical Artificial Intelligence Readiness
Authors: Taskiran Nihal
Published: May 2023

Background:

It is predicted that artificial intelligence (AI) will transform nursing across all domains of nursing practice, including administration, clinical care, education, policy, and research.

Purpose:

This study examined the impact of an AI course in the nursing curriculum on students' medical AI readiness.

Design and Methods:

This comparative quasi-experimental study was conducted with a total of 300 3rd-year nursing students, 129 in the control group and 171 in the experimental group. Students in the experimental group received 28 hours of AI training. The students in the control group were not given any training. Data were collected by a socio-demographic form and the Medical Artificial Intelligence Readiness Scale.

Results:

An AI course should be included in the nursing curriculum, according to 67.8% of students in the experimental group and 57.4% of students in the control group. The mean score of the experimental group on medical AI readiness was higher (P < .05) and the effect size of the course on readiness was −0.29.

Conclusions:

An AI nursing course positively affects students' readiness for medical AI.