bluuebunny/crossref_metadata_2025 huggingface dataset:
A cross‐sectional survey on surgeon retention in the COSECSA region after specialist training: Have things changed?
Authors: Bekele Abebe , Alayande Barnabas Tobi , Iradukunda Jules , Minja Chris , Forbes Callum , Bachheta Niraj , Gulilat Dereje , Munthali James , Muguti Godfrey , Riviello Robert R. , Geraghty James , O’Flynn Eric , Fualal Jane Odubu , Chikoya Laston , Mwachiro Michael M. , Borgstein Eric
Published: January 2024

Background

Increasing surgical specialist workforce density in sub‐Saharan Africa is essential for improving access to surgical care. However, out‐migration creates a significant challenge to attaining provider targets. We aimed to determine the rates and trends of retention of surgeons in the College of Surgeons of East Central and Southern Africa (COSECSA) regions.

Methodology

An online, web‐based survey was distributed to COSECSA surgeons who graduated from 2004 to 2020. Current practice and migration patterns were visualized using descriptive analyses and logistic regression models.

Results

Response rate was 48% (270/557). Most respondents trained as general surgeons and practiced in Ethiopia, Kenya, Zimbabwe, and Zambia. Majority practiced in public hospitals (74%), and were active in research (81%), teaching (84%) and leadership (55%). Overall country (85%), regional (92%) and Africa retention rates (99%) were high with 100% country retention in Rwanda, Botswana, Lesotho, and Namibia. Tanzania had the lowest retention (61%). Highest inter‐regional migration occurred from East to Southern Africa (26%), and continental out‐migration occurred from Zambia, Zimbabwe, and Kenya. On bivariate analysis, out‐migration from training country and region was associated working with a non‐governmental organization (p = 0.002 and 0.0003) or a specialized hospital (p = 0.046 and 0.011). A multiple regression model with type of institution and leadership was a poor fit (McFadden R2 = 0.055; p = 0.082).

Conclusion

Retention rates of surgeons trained by COSECSA in the region remain remarkably high. This can be taken as an indicator of success of the training model to increase surgical workforce density, however, contributory factors need to be qualitatively explored.
Modifiability of surgical timing in postinjury multiple organ failure patients
Authors: Ting Ryan S. , King Kate L. , Lewis Daniel P. , Weaver Natasha A. , Balogh Zsolt J.
Published: January 2024

Background

Postinjury multiple organ failure (MOF) is the leading cause of late trauma deaths, with primarily non‐modifiable risk factors. Timing of surgery as a potentially modifiable risk factor is frequently proposed, but has not been quantified. We aimed to compare mortality, hospital length of stay (LOS), and ICU LOS between MOF patients who had surgery that preceded MOF with modifiable timings versus those with non‐modifiable timings.

Methods

Retrospective analysis of an ongoing 17‐year prospective cohort study of ICU polytrauma patients at‐risk of MOF. Among MOF patients (Denver score>3), we identified patients who had surgery that preceded MOF, determined whether the timing of these operation(s) were modifiable(M) or non‐modifiable (non‐M), and evaluated the change in physiological parameters as a result of surgery.

Results

Of 716 polytrauma patients at‐risk of MOF, 205/716 (29%) developed MOF, and 161/205 (79%) had surgery during their ICU admission. Of the surgical MOF patients, 147/161 (91%) had one or more operation(s) that preceded MOF, and 65/161 (40%) of them had operation(s) with modifiable timings. There were no differences in age (mean (SD) 52 (19) vs 53 (21)years), injury severity score (median (IQR) 34 (26–41)vs34 (25–44)), admission physiological and resuscitation parameters, between M and non‐M‐patients. M patients had longer ICU LOS (median (IQR) 18 (12–28)versus 11 (8–16)days, p < 0.0001) than non‐M‐patients, without difference in mortality (14%vs16%, p = 0.7347), or hospital LOS (median (IQR) 32 (18–52)vs27 (17–47)days, p = 0.3418). M‐patients had less fluids and transfusions intraoperatively. Surgery did not compromise patient physiology.

Conclusion

Operations preceding MOF are common in polytrauma and seem to be safe in maintaining physiology. The margin for improvement from optimizing surgical timing is modest, contrary to historical assumptions.
Prophylactic anti‐reflux procedure for children undergoing laparoscopic gastrostomy: Rethinking of the routine practice
Authors: Fung Adrian Chi Heng , Ooi Yu Ning , Hui Ho Ming , Mok Michelle Kam Yan , Chung Patrick Ho Yu , Wong Kenneth Kak Yuen
Published: January 2024

Aim

Laparoscopic gastrostomy is a frequently performed procedure in children requiring long‐term enteral nutrition. The role of prophylactic anti‐reflux surgery during gastrostomy placements is controversial. The current study aims to evaluate the role of prophylactic anti‐reflux procedures during gastrostomy placement.

Methods

A retrospective single‐center analysis of all children without reflux receiving laparoscopic gastrostomy from January 2005 through December 2021 was performed. Demographics and clinical outcomes were compared between patients receiving gastrostomy placement alone and patients receiving gastrostomy with prophylactic anti‐reflux surgery.

Results

A total of 79 patients had a confirmed absence of reflux by a 24‐h pH/impedance study before operation. Thirty‐six of these patients underwent prophylactic anti‐reflux surgery (PAR) while 43 received gastrostomy (PG) alone. The operative time and conversion rate were significantly higher in the PAR group (140.5 ± 67.5 vs. 80.2 ± 66.8 min, p = 0.0001 and 8.3% vs. 0%, p = 0.04). There were no major complications in either group. De novo reflux was detected in five patients (11.6%) in the PG group. None of these patients progressed to require anti‐reflux surgery.

Conclusion

The occurrence of de novo reflux after laparoscopic gastrostomy was low and could be managed without anti‐reflux surgery. A routine pre‐operative pH study is helpful for appropriate patient selection to avoid unnecessary anti‐reflux surgery, which lengthens operative time and increases the conversion rate.
Gravitational action for a massive Majorana fermion in 2d quantum gravity
Authors: de Lacroix Corinne , Erbin Harold , Lahoche Vincent
Published: January 2024

Abstract

We compute the gravitational action of a free massive Majorana fermion coupled to two-dimensional gravity on compact Riemann surfaces of arbitrary genus. The structure is similar to the case of the massive scalar. The small-mass expansion of the gravitational yields the Liouville action at zeroth order, and we can identify the Mabuchi action at first order. While the massive Majorana action is a conformal deformation of the massless Majorana CFT, we find an action different from the one given by the David-Distler-Kawai (DDK) ansatz.
Minimizing operator exposure: field data analysis of three closed transfer systems for pesticide mixing and loading
Authors: Sasturain Juan , Blaschke Udo , Stauber Franz , Oteyza Tirso , Huby Jean-Pierre , Adham Sarah , Morgan Neil , Vinck Anne-Kim , Kicinski Michal , Hewitt Nicola J. , Kuster Christian J.
Published: January 2024

Three Closed Transfer Systems (CTS) were evaluated for their reduction of operator exposure to plant protection products during mixing and loading: the inverted extraction systems, easyFlow M and easyconnect, and the probe extraction system, GoatThroat®. Exposure data were generated for gloves, hands, head, inner and outer body dosimeters generated in 4 European countries for high rate (Sorbitol) and low rate (Xylitol) surrogate products used by 12 operators. Exposure values were compared with predicted data using the Agricultural Operator Exposure Model as a benchmark for open pour loading (used in the EFSA Guidance). The CTS types conformed with the ISO 21191 standard for CTS performance, and their potential to significantly reduce operator exposure was confirmed in this study. There was no statistical difference in potential (naked) or actual (one layer of clothing) operator exposure using both inverted CTS types; allowing these data to be pooled. The inverted CTS types resulted in higher mean protection (> 98% potential exposure and > 95% actual exposure) than GoatThroat® (> 80% potential exposure and > 95% actual exposure). These data can be used to derive reduction factors that could be used in the AOEM model for calculations involving mitigation e.g., 0.05 for inverted CTS since they reduced exposure by > 95% and 0.3 for probe extraction CTS types. All 3 CTS significantly reduced operator exposure to products during M&L. These and future CTS types which comply with ISO 21191 standards could be considered as mitigation devices. These findings will help to build confidence of farmers to use CTS routinely, resulting in safer pesticide handling.
Parabolicity on Graphs
Authors: Martínez-Pérez Álvaro , Rodríguez José M.
Published: January 2024

Large scale properties of Riemannian manifolds, in particular, those properties preserved by quasi-isometries, can be studied using discrete structures which approximate the manifolds. In a sequence of papers, M. Kanai proved that, under mild conditions, many properties are preserved by a certain (quasi-isometric) graph approximation of a manifold. One of these properties isp-parabolicity. A manifoldM(respectively, a graphG) is said to bep-parabolic if all positivep-superharmonic functions onM(resp.G) are constant. This is equivalent to not havingp-Green’s function (i.e. a positive fundamental solution of thep-Laplace-Beltrami operator). Herein we study directly thep-parabolicity on graphs. We obtain some characterizations in terms of graph decompositions. Also, we give necessary and sufficient conditions for a uniform hyperbolic graph to bep-parabolic in terms of its boundary at infinity. Finally, we prove that if a uniform hyperbolic graph satisfies the (Cheeger) isoperimetric inequality, then it is non-p-parabolic for every$$1<p<\infty $$1<p<∞.
Skeletal muscle TET3 promotes insulin resistance through destabilisation of PGC-1α
Authors: Liu Beibei , Xie Di , Huang Xinmei , Jin Sungho , Dai Yangyang , Sun Xiaoli , Li Da , Bennett Anton M. , Diano Sabrina , Huang Yingqun
Published: January 2024

Aim/hypothesis

The peroxisome proliferator-activated receptor-γ coactivator α (PGC-1α) plays a critical role in the maintenance of glucose, lipid and energy homeostasis by orchestrating metabolic programs in multiple tissues in response to environmental cues. In skeletal muscles, PGC-1α dysregulation has been associated with insulin resistance and type 2 diabetes but the underlying mechanisms have remained elusive. This research aims to understand the role of TET3, a member of the ten-eleven translocation (TET) family dioxygenases, in PGC-1α dysregulation in skeletal muscles in obesity and diabetes.

Methods

TET expression levels in skeletal muscles were analysed in humans with or without type 2 diabetes, as well as in mouse models of high-fat diet (HFD)-induced or genetically induced (ob/ob) obesity/diabetes. Muscle-specific Tet3 knockout (mKD) mice were generated to study TET3’s role in muscle insulin sensitivity. Genome-wide expression profiling (RNA-seq) of muscle tissues from wild-type (WT) and mKD mice was performed to mine deeper insights into TET3-mediated regulation of muscle insulin sensitivity. The correlation between PGC-1α and TET3 expression levels was investigated using muscle tissues and in vitro-derived myotubes. PGC-1α phosphorylation and degradation were analysed using in vitro assays.

Results

TET3 expression was elevated in skeletal muscles of humans with type 2 diabetes and in HFD-fed and ob/ob mice compared with healthy controls. mKD mice exhibited enhanced glucose tolerance, insulin sensitivity and resilience to HFD-induced insulin resistance. Pathway analysis of RNA-seq identified ‘Mitochondrial Function’ and ‘PPARα Pathway’ to be among the top biological processes regulated by TET3. We observed higher PGC-1α levels (~25%) in muscles of mKD mice vs WT mice, and lower PGC-1α protein levels (~25–60%) in HFD-fed or ob/ob mice compared with their control counterparts. In human and murine myotubes, increased PGC-1α levels following TET3 knockdown contributed to improved mitochondrial respiration and insulin sensitivity. TET3 formed a complex with PGC-1α and interfered with its phosphorylation, leading to its destabilisation.

Conclusions/interpretation

Our results demonstrate an essential role for TET3 in the regulation of skeletal muscle insulin sensitivity and suggest that TET3 may be used as a potential therapeutic target for the metabolic syndrome.

Data availability

Sequences are available from the Gene Expression Omnibus (https://www.ncbi.nlm.nih.gov/geo/) with accession number of GSE224042.

Graphical Abstract
Reducing hand radiation during renal access for percutaneous nephrolithotomy: a comparison of radiation reduction techniques
Authors: Chen Ricky , Joo Eun Hye , Baas Catalina , Hartman John , Amasyali Akin S. , Shete Kanha , Belle Joshua D. , Ritchie Cayde , Baldwin Elizabeth A. , Okhunov Zhamshid , Farkouh Ala’a , Baldwin D. Duane
Published: January 2024

Percutaneous nephrolithotomy confers the highest radiation to the urologist’s hands compared to other urologic procedures. This study compares radiation exposure to the surgeon’s hand and patient’s body when utilizing three different techniques for needle insertion during renal access. Simulated percutaneous renal access was performed using a cadaveric patient and separate cadaveric forearm representing the surgeon’s hand. Three different needle-holding techniques were compared: conventional glove (control), a radiation-attenuating glove, and a novel needle holder. Five 300-s fluoroscopy trials were performed per treatment arm. The primary outcome was radiation dose (mSv) to the surgeon’s hand. The secondary outcome was radiation dose to the patient. One-way ANOVA and Tukey’s B post-hoc tests were performed with p < 0.05 considered significant. Compared to the control (3.92 mSv), both the radiation-attenuating glove (2.48 mSv) and the needle holder (1.37 mSv) reduced hand radiation exposure (p < 0.001). The needle holder reduced hand radiation compared to the radiation-attenuating glove (p < 0.001). The radiation-attenuating glove resulted in greater radiation produced by the C-arm compared to the needle holder (83.49 vs 69.22 mGy; p = 0.019). Patient radiation exposure was significantly higher with the radiation-attenuating glove compared to the needle holder (8.43 vs 7.03 mSv; p = 0.027). Though radiation-attenuating gloves decreased hand radiation dose by 37%, this came at the price of a 3% increase in patient exposure. In contrast, the needle holder reduced exposure to both the surgeon’s hand by 65% and the patient by 14%. Thus, a well-designed low-density needle holder could optimize radiation safety for both surgeon and patient.
Transcriptional response of Saccharomyces cerevisiae to lactic acid enantiomers
Authors: Drozdova Polina , Gurkov Anton , Saranchina Alexandra , Vlasevskaya Anastasia , Zolotovskaya Elena , Indosova Elizaveta , Timofeyev Maxim , Borvinskaya Ekaterina
Published: January 2024

The model yeast, Saccharomyces cerevisiae, is a popular object for both fundamental and applied research, including the development of biosensors and industrial production of pharmaceutical compounds. However, despite multiple studies exploring S. cerevisiae transcriptional response to various substances, this response is unknown for some substances produced in yeast, such as D-lactic acid (DLA). Here, we explore the transcriptional response of the BY4742 strain to a wide range of DLA concentrations (from 0.05 to 45 mM), and compare it to the response to 45 mM L-lactic acid (LLA). We recorded a response to 5 and 45 mM DLA (125 and 113 differentially expressed genes (DEGs), respectively; > 50% shared) and a less pronounced response to 45 mM LLA (63 DEGs; > 30% shared with at least one DLA treatment). Our data did not reveal natural yeast promoters quantitatively sensing DLA but provide the first description of the transcriptome-wide response to DLA and enrich our understanding of the LLA response. Some DLA-activated genes were indeed related to lactate metabolism, as well as iron uptake and cell wall structure. Additional analyses showed that at least some of these genes were activated only by acidic form of DLA but not its salt, revealing the role of pH. The list of LLA-responsive genes was similar to those published previously and also included iron uptake and cell wall genes, as well as genes responding to other weak acids. These data might be instrumental for optimization of lactate production in yeast and yeast co-cultivation with lactic acid bacteria.

Key points

• We present the first dataset on yeast transcriptional response to DLA.

• Differential gene expression was correlated with yeast growth inhibition.

• The transcriptome response to DLA was richer in comparison to LLA.
Discovery and biocatalytic characterization of opine dehydrogenases by metagenome mining
Authors: Telek András , Molnár Zsófia , Takács Kristóf , Varga Bálint , Grolmusz Vince , Tasnádi Gábor , Vértessy Beáta G.
Published: January 2024

Enzymatic processes play an increasing role in synthetic organic chemistry which requires the access to a broad and diverse set of enzymes. Metagenome mining is a valuable and efficient way to discover novel enzymes with unique properties for biotechnological applications. Here, we report the discovery and biocatalytic characterization of six novel metagenomic opine dehydrogenases from a hot spring environment (mODHs) (EC 1.5.1.X). These enzymes catalyze the asymmetric reductive amination between an amino acid and a keto acid resulting in opines which have defined biochemical roles and represent promising building blocks for pharmaceutical applications. The newly identified enzymes exhibit unique substrate specificity and higher thermostability compared to known examples. The feature that they preferably utilize negatively charged polar amino acids is so far unprecedented for opine dehydrogenases. We have identified two spatially correlated positions in their active sites that govern this substrate specificity and demonstrated a switch of substrate preference by site-directed mutagenesis. While they still suffer from a relatively narrow substrate scope, their enhanced thermostability and the orthogonality of their substrate preference make them a valuable addition to the toolbox of enzymes for reductive aminations. Importantly, enzymatic reductive aminations with highly polar amines are very rare in the literature. Thus, the preparative-scale enzymatic production, purification, and characterization of three highly functionalized chiral secondary amines lend a special significance to our work in filling this gap.

Key points

• Six new opine dehydrogenases have been discovered from a hot spring metagenome

• The newly identified enzymes display a unique substrate scope

• Substrate specificity is governed by two correlated active-site residues
Methanogenic partner influences cell aggregation and signalling of Syntrophobacterium fumaroxidans
Authors: Doloman Anna , Besteman Maaike S , Sanders Mark G , Sousa Diana Z
Published: January 2024

For several decades, the formation of microbial self-aggregates, known as granules, has been extensively documented in the context of anaerobic digestion. However, current understanding of the underlying microbial-associated mechanisms responsible for this phenomenon remains limited. This study examined morphological and biochemical changes associated with cell aggregation in model co-cultures of the syntrophic propionate oxidizing bacterium Syntrophobacterium fumaroxidans and hydrogenotrophic methanogens, Methanospirillum hungatei or Methanobacterium formicicum. Formerly, we observed that when syntrophs grow for long periods with methanogens, cultures tend to form aggregates visible to the eye. In this study, we maintained syntrophic co-cultures of S. fumaroxidans with either M. hungatei or M. formicicum for a year in a fed-batch growth mode to stimulate aggregation. Millimeter-scale aggregates were observed in both co-cultures within the first 5 months of cultivation. In addition, we detected quorum sensing molecules, specifically N-acyl homoserine lactones, in co-culture supernatants preceding the formation of macro-aggregates (with diameter of more than 20 μm). Comparative transcriptomics revealed higher expression of genes related to signal transduction, polysaccharide secretion and metal transporters in the late-aggregation state co-cultures, compared to the initial ones. This is the first study to report in detail both biochemical and physiological changes associated with the aggregate formation in syntrophic methanogenic co-cultures.

Keypoints

• Syntrophic co-cultures formed mm-scale aggregates within 5 months of fed-batch cultivation.

• N-acyl homoserine lactones were detected during the formation of aggregates.

• Aggregated co-cultures exhibited upregulated expression of adhesins- and polysaccharide-associated genes.

Graphical abstract
An apoptosis-inducing factor controls programmed cell death and laccase expression during fungal interactions
Authors: Fang Junnan , Zhou Gang , Zhao Huifang , Xie Dengdeng , Zhang Jingna , Kües Ursula , Xiao Yazhong , Fang Zemin , Liu Juanjuan
Published: January 2024

Apoptotic-like programmed cell death (PCD) is one of the main strategies for fungi to resist environmental stresses and maintain homeostasis. The apoptosis-inducing factor (AIF) has been shown in different fungi to trigger PCD through upregulating reactive oxygen species (ROS). This study identified a mitochondrial localized AIF homolog, CcAIF1, from Coprinopsis cinerea monokaryon Okayama 7. Heterologous overexpression of CcAIF1 in Saccharomyces cerevisiae caused apoptotic-like PCD of the yeast cells. Ccaif1 was increased in transcription when C. cinerea interacted with Gongronella sp. w5, accompanied by typical apoptotic-like PCD in C. cinerea, including phosphatidylserine externalization and DNA fragmentation. Decreased mycelial ROS levels were observed in Ccaif1 silenced C. cinerea transformants during cocultivation, as well as reduction of the apoptotic levels, mycelial growth, and asexual sporulation. By comparison, Ccaif1 overexpression led to the opposite phenotypes. Moreover, the transcription and expression levels of laccase Lcc9 decreased by Ccaif1 silencing but increased firmly in Ccaif1 overexpression C. cinerea transformants in coculture. Thus, in conjunction with our previous report that intracellular ROS act as signal molecules to stimulate defense responses, we conclude that CcAIF1 is a regulator of ROS to promote apoptotic-like PCD and laccase expression in fungal-fungal interactions. In an axenic culture of C. cinerea, CcAIF1 overexpression and H2O2 stimulation together increased laccase secretion with multiplied production yield. The expression of two other normally silent isozymes, Lcc8 and Lcc13, was unexpectedly triggered along with Lcc9.

Key points

• Mitochondrial CcAIF1 induces PCD during fungal-fungal interactions

• CcAIF1 is a regulator of ROS to trigger the expression of Lcc9 for defense

• CcAIF1 overexpression and H2O2 stimulation dramatically increase laccase production
Reliability of the Harris Hip limping sub-score in patients undergoing total hip arthroplasty
Authors: Rose-Dulcina Kevin , Gasparutto Xavier , Djebara Az-Eddine , Gauthier Morgan , Zingg Matthieu , Lübbeke Anne , Armand Stéphane , Hannouche Didier
Published: January 2024

Purpose

In patients undergoing total hip arthroplasty, limping is a significant symptom, often assessed with the limping sub-score of the Harris Hip Score. However, the reliability of this sub-score has not been specifically investigated. The purpose of this study is to investigate the intra- and inter-rater reliability of this sub-score.

Methods

Thirty patients undergoing THA were recruited and performed a gait analysis before surgery and three months after surgery. In addition, 30 asymptomatic participants were included. In total, 90 visits were analysed in this study. The HHS limping sub-score was assessed for each visit using a video (front and back view side-by-side) of a ten metre walk at a self-selected speed. Two orthopaedic surgeons evaluated the limping of each video in two different grading sessions with a one week delay. To avoid recall bias, the patient’s number identity was randomized and different for each grading session and each rater. The weighted Cohen’s Kappa coefficient was used to quantify the intra- and inter-reliability. The reliability of three components was studied: the presence of limping, its severity, and the compensation type.

Results

For all components, the agreement for intra-rater reliability ranged from moderate to strong and from none to moderate for the inter-rater reliability.

Conclusion

These results do not encourage the use of HHS-limping sub-score for data involving different raters in both clinical and research contexts. It calls for improved consensus on limping definitions or the creation of objective measures.
Relocation of lower pole renal stones helps improve the stone-free rate during flexible ureteroscopy with a low complication rate
Authors: Huang Ru , Chen Jian-chun , Zhou Yong-qiang , Wang Jin-jin , Hui Chu-chu , Jiang Min-jun , Xu Chen
Published: January 2024

Objective

To compare the efficacy and safety of relocating the lower pole stones to a favorable pole during flexible ureteroscopy with in situ lithotripsy for the treatment of 10–20 mm lower pole stone (LPS).

Methods

This study was a prospective analysis of patient outcomes who underwent an FURS procedure for the treatment of 10–20 mm lower pole renal stones from January 2020 to November 2022. The patients were randomized into a relocation group or in situ group. The LPSs were relocated into a calyx, during lithotripsy in the relocation group was performed, whereas the in situ group underwent FURS without relocation. All the procedures were performed by the same surgeon. The patients’ demographic data, stone characteristics, perioperative parameters and outcomes, stone-free rate (SFR), complications, and overall costs were assessed retrospectively.

Results

A total of 90 patients were enrolled and analyzed in this study (45 per group) with no significant differences between the two groups in terms of age, gender, BMI, diabetes, hypertension, stone size, number, laterality, composition, and density. The mean operation time, total energy consumption, postoperative stay, and complications were similar between the groups. Both groups had similar SFR at 1 day postoperative follow-up (p = 0.091), while the relocation group achieved significantly higher SFR 3 months later (97.8% vs 84.4%, p = 0.026). The relocation group also had a significantly higher WisQol score than the in situ group (126.98 vs 110.18, p < 0.001).

Conclusion

A satisfactory SFR with a relatively low complication rate was achieved by the relocation technique during the FURS procedure.
Defining the role of multiparametric MRI in predicting prostate cancer extracapsular extension
Authors: Sanguedolce Francesco , Tedde Alessandro , Granados Luisa , Hernández Jonathan , Robalino Jorge , Suquilanda Edgar , Tedde Matteo , Palou Joan , Breda Alberto
Published: January 2024

Objectives

To identify the predictive factors of prostate cancer extracapsular extension (ECE) in an institutional cohort of patients who underwent multiparametric MRI of the prostate prior to radical prostatectomy (RP).

Patients and methods

Overall, 126 patients met the selection criteria, and their medical records were retrospectively collected and analysed; 2 experienced radiologists reviewed the imaging studies. Logistic regression analysis was conducted to identify the variables associated to ECE at whole-mount histology of RP specimens; according to the statistically significant variables associated, a predictive model was developed and calibrated with the Hosmer–Lomeshow test.

Results

The predictive ability to detect ECE with the generated model was 81.4% by including the length of capsular involvement (LCI) and intraprostatic perineural invasion (IPNI). The predictive accuracy of the model at the ROC curve analysis showed an area under the curve (AUC) of 0.83 [95% CI (0.76–0.90)], p < 0.001. Concordance between radiologists was substantial in all parameters examined (p < 0.001). Limitations include the retrospective design, limited number of cases, and MRI images reassessment according to PI-RADS v2.0.

Conclusion

The LCI is the most robust MRI factor associated to ECE; in our series, we found a strong predictive accuracy when combined in a model with the IPNI presence. This outcome may prompt a change in the definition of PI-RADS score 5.
The use of Versius CMR for pelvic surgery: a multicentric analysis of surgical setup and early outcomes
Authors: Sighinolfi Maria Chiara , De Maria Maurizio , Meneghetti Iacopo , Felline Mauro , Ceretti Andrea Pisani , Mosillo Luca , Catalano Chiara , Morandi Alessandro , Calcagnile Tommaso , Panio Enrico , Sangalli Mattia , Turri Filippo , Terzoni Stefano , Assumma Simone , Sarchi Luca , Afonina Margarita , Marconi Annamaria , Bianchi Paolo Pietro , Micali Salvatore , Rocco Bernardo , Gaia Giorgia
Published: January 2024

Introduction

Versius CMR is a novel robotic system characterized by an open surgical console and independent bedside units. The system has potentials of flexibility and versatility, and has been used in urological, gynecological, and general surgical procedure. The aim is to depict a comprehensive analysis of the Versius system for pelvic surgery.

Methods

This is a study involving two Institutions, ASST Santi Paolo and Carlo, Milan, and Apuane Hospital, Massa, Italy. All interventions performed in the pelvic area with the Versius were included. Data about indications, intra-, and post-operative course were prospectively collected and analyzed.

Results

A total of 171 interventions were performed with the Versius. Forty-two of them involved pelvic procedures. Twenty-two had an oncological indication (localized prostate cancer), the remaining had a non-oncological or functional purpose. The mostly performed pelvic procedure was radical prostatectomy (22) followed by annexectomy (9). No intra-operative complication nor conversion to other approaches occurred. A Clavien II complication and one Clavien IIIb were reported. Malfunctioning/alarms requiring a power cycle of the system occurred in 2 different cases. An adjustment in trocar placement according to patients’ height was required in 2 patients undergoing prostatectomy, in which the trocar was moved caudally. In two cases, a pelvic prolapse was repaired concomitant with other gynecological procedures.

Conclusions

Pelvic surgery with the Versius is feasible without major complications; either dissection and reconstructive steps could be accomplished, provided a proper OR setup and trocar placement are pursued. Versius can be easily adopted by surgeons of different disciplines and backgrounds; a further multi-specialty implementation is presumed and long-term oncological and functional outcomes are awaited.
Mid-term results of a cementless hip stem in femoral revision: how much diaphyseal press-fit do we need?
Authors: Herold Dirk , Kuttner Axel , Dreyer Lutz , Eingartner Christoph
Published: January 2024

Introduction

The aim of this retrospective study was to analyze the clinical and functional outcome of a modular tapered revision hip stem after mid-term follow-up with a special focus on the length of the distal bicortical fixation of the cementless hip stem.

Materials and Methods

Follow-up examination was carried out for all patients with implantation of the Prevision hip stem between 2014 and 2019 to collect demographic, functional, and radiographic data.

Results

44 patients with stem in situ were examined, and 61 patients could be included in the Kaplan–Meier survival analysis. Oxford’s hip score was 37.3 at the mean follow-up of 4.0 years. Two hip stem revisions were performed due to periprosthetic infection, which resulted in a hip stem survival rate of 96.7% (CI: 87.4–99.1%) at the final follow-up of 7.5 years. No aseptic hip stem revision was required. The length of bicortical distal fixation was in the interquartile range of 6.8 to 9.0 cm, which was associated with good bone healing and a low rate of subsidence (4.5%). Implant-associated complications were observed in 10 cases (21.7%).

Conclusions

The modular revision hip stem provides promising results at medium-term follow-up, with satisfactory clinical and functional outcomes comparable to other modular revision hip stems. The presented length of bicortical distal fixation shows the practice of the study center and was associated with good implant survival, bone healing and radiological results.

Registration

Clinicaltrials.gov registration: NCT04833634 registered on April 6, 2021
Peritoneal mesometrial resection with lymphadenectomy following prior hysterectomy in intermediate/high-risk endometrial cancer: feasibility and safety
Authors: Buderath Paul , Elgharib Mohamed , Kimmig Rainer
Published: January 2024

Objective

Peritoneal mesometrial resection (PMMR) plus targeted compartmental lymphadenectomy (TCL) aims at removal of the locoregional cancer field in endometrial cancer (EC). Optimal locoregional control without adjuvant radiotherapy should be achieved concomitantly sparing systematic lymphadenectomy (LNE) for most of the patients. However, intermediate/high-risk EC is often definitely diagnosed postoperatively in simple hysterectomy specimen. Our aim was to evaluate feasibility and safety of a completing PMMR + TCL in patients following prior hysterectomy.

Methods

We evaluated data from 32 patients with intermediate/high-risk EC treated with PMMR + TCL or systematic pelvic and periaortic LNE following prior hysterectomy. Perioperative data on disease characteristics and morbidity were collected and patients were contacted for follow-up to determine the recurrence and survival status.

Results

We report data from 32 patients with a mean follow-up of 31.7 months. The recurrence rate was 12.5% (4/32) without any isolated locoregional recurrences. Only 21.9% of patients received adjuvant radiotherapy. Rates of intra- and postoperative complications were 6.3% and 18.8%, respectively.

Conclusion

Our data suggest that robotic PMMR can be performed following prior hysterectomy when previously unknown risk factors arise, albeit with a moderate increase in morbidity. Moreover, despite a relevant reduction of adjuvant radiotherapy, follow-up data suggest an excellent locoregional control even without adjuvant radiotherapy.
The effectiveness of integrated online health-coaching on physical activity and excessive gestational weight gain: a prospective randomized-controlled trial
Authors: Téoule Julia , Woll Christian , Ray Jana , Sütterlin Marc , Filsinger Barbara
Published: January 2024

Purpose

Low levels of physical activity during pregnancy go along with increased risks for numerous health complications. We investigated whether an integrated lifestyle intervention leads to higher levels of physical activity and reduces the rate of excessive gestational weight gain (EGWG).

Methods

We conducted a randomized-controlled trial on 97 pregnant women, randomly assigned to receive an additional telehealth lifestyle intervention (experimental group, EG; n = 49) or conventional antenatal care (control group, CG; n = 48). The core lifestyle intervention comprised regular video calls, providing integrated personal support and motivation to physical activity. The primary outcome was change in physical activity measured in steps per day. An additional exploratory outcome was the proportion of participants with EGWG.

Results

The mean step count during the third trimester was 6483 steps/day (EG) and 5957 steps/day (CG), respectively (p = 0.078). Repeated-measures ANOVA revealed a significant interaction effect (p = 0.045) reflecting an overall increase of 497 steps per day in the EG vs. a decrease of 300 steps per day in the CG. The proportion of participants who met the IOM recommendation for total weight gain during pregnancy was significantly higher in the EG (p = 0.048) and the ratio of women that gained excessively was higher in the CG (p = 0.026).

Conclusions

We assume that the personalized online intervention supports women in increasing or at least maintaining their level of physical activity during the course of pregnancy. Additionally, it reduces the rate of excessive weight gain.
Porosity generation via spatially uncoupled dissolution precipitation during plagioclase replacement in quartz undersaturated fluids
Authors: Nurdiana Astin , Okamoto Atsushi , Uno Masaoki , Tsuchiya Noriyoshi
Published: January 2024

The replacement of feldspars is commonly characterized by pseudomorphism and reaction-induced pore generation. However, the effects of compositions of feldspars and fluids on porosity generation during alteration are still poorly understood. In this study, we conducted a series of hydrothermal experiments on plagioclase replacement by 2 M KCl or NaCl aqueous solutions at 600 °C and 150 MPa for 1–8 days, using plagioclase with different compositions (anorthite, An96Ab4; labradorite, An66Ab33Or1; albite, An1Ab99) with or without quartz. Albite replacement by K-feldspar was not affected by the presence of quartz, whereas anorthite was unaltered in the quartz-absent fluid. The replacement of labradorite by KCl(aq) showed different results: in the presence of quartz, labradorite was altered by K-feldspar, whereas in the absence of quartz, alteration proceeded significantly with the generation of large pores hosted by secondary anorthite coupled with euhedral K-feldspar overgrowth. Such textural relationship and oxygen isotope-labeled experiments reveal that silica-deficient fluid enhances the uncoupled dissolution reprecipitation process. The Si and Al ions in the reacted aqueous solution diffused outside the labradorite grains and encountered K+-rich solutions to grow K-feldspar. The experiments with polycrystalline rocks composed of amphibole + labradorite using 2 M KCl aqueous solution indicated the replacement of labradorite grains by anorthite and K-feldspar overgrowth, as found in single-crystal experiments. Our results indicate that the silica concentration in the fluids has different influences on the saturation indices of albite, anorthite, and K-feldspars in saline fluids, which significantly affect the replacement textures and porosity generation in crustal rocks.
Are sucking patterns and early spontaneous movements related to later developmental functioning outcomes? A cohort study
Authors: Yardımcı-Lokmanoğlu Bilge N. , Demir Numan , Porsnok Doğan , Sırtbaş-Işık Gülsen , Cengiz Emre , Serel-Arslan Selen , Mutlu Akmer
Published: January 2024

Sucking patterns and early spontaneous movements have an important role in the determination of later developmental problems, but the relationship of the two together with long-term outcomes has not been investigated. The objectives of this study were to (i) examine the relationship between sucking patterns using the Neonatal Oral Motor Assessment Scale (NOMAS) and fidgety movements and other movement patterns using detailed General Movements Assessment (GMA), and (ii) investigate the relationship between these early assessment methods and developmental functioning outcomes at later ages. We analyzed the NOMAS from 34 weeks’ postmenstrual age up to 10 weeks post-term and GMA between 9 and 20 weeks post-term age, and the Bayley Scales of Infant and Toddler Development-Third Edition (Bayley-III) was applied for the developmental functioning outcomes to 62 infants (61%, 62/102) between 12 and 42 months of age. Among 102 infants at-risk, 70 (69%) showed a normal sucking pattern, and 85 (83%) had fidgety movements. The median Motor Optimality Score-Revised (MOS-R), as determined by GMA, of all infants was 24. The NOMAS was related to the MOS-R and its subcategories (p < 0.05) in all infants at-risk. The NOMAS, MOS-R and its subcategories were also related to cognitive, language, and motor development at later ages according to Bayley-III (p < 0.05).

   Conclusion: This longitudinal study showed that the quality of sucking patterns, fidgety movements, and MOS-R were related to later developmental functioning, indicating that abnormal sucking patterns, aberrant fidgety movements, and lower MOS-R might predict developmental disorders.

What is Known:• Sucking patterns and early spontaneous movements in which central pattern generators play an important role are related.• Sucking patterns and early spontaneous movements might be used separately to predict developmental outcomes.

What is New:• Sucking patterns and early spontaneous movements, when used together, were related to later developmental functioning, including cognitive, language, and motor development in at-risk infants.• Predictive value of sucking patterns was lower for each developmental functioning outcome than early spontaneous movements.
Biometric systems for identification and verification scenarios using spatial footsteps components
Authors: Iskandar Ayman , Alfonse Marco , Roushdy Mohamed , El-Horbaty El-Sayed M.
Published: January 2024

Humans are distinguished by their walking patterns; many approaches, including using various types of sensors, have been used to establish walking patterns as biometrics. By studying the distinguishing features of a person's footsteps, footstep recognition may be utilized in numerous security applications, such as managing access in protected locations or giving an additional layer of biometric verification for secure admittance into restricted regions. We proposed biometric systems for verifying and identifying a person by acquiring spatial foot pressure images from the values obtained from the piezoelectric sensors using the Swansea Foot Biometric Database, which contains 19,980 footstep signals from 127 users and is the most prominent open-source gait database available for footstep recognition. The images acquired are fed into the ConvNeXt model, which was trained using the transfer learning technique, using 16 stride footstep signals in each batch with an Adam optimizer and a learning rate of 0.0001, and using sparse categorical cross-entropy as the loss function. The proposed ConvNeXt model has been adjusted to acquire 512 feature vectors per image, and these feature vectors are used to train the logistic regression models. We propose two biometric systems. The first biometric system is based on training one logistic regression model as a classifier to identify 40 different users using 1600 signals for training, 6697 signals for validation, and 200 signals for evaluation. The second biometric system is based on training 40 logistic regression models, one for each user, to validate the user's authenticity, with a total number of 2363 training signals, 7077 validation signals, and 500 evaluation signals. Each of the 40 models has a 40-training signal per client and a different number of signals per imposter, a different number of signals for the validation that ranges between 8 and 650 signals, a 5-signal for an authenticated client, and a different number of signals per imposter for evaluation. Independent validation and evaluation sets are used to evaluate our systems. In the biometric identification system, we obtained an equal error rate of 15.30% and 21.72% for the validation and evaluation sets, while in the biometric verification system, we obtained an equal error rate of 6.97% and 10.25% for the validation and evaluation sets.
Efficient CNN-based low-resolution facial detection from UAVs
Authors: Diez-Tomillo Julio , Martinez-Alpiste Ignacio , Golcarenarenji Gelayol , Wang Qi , Alcaraz-Calero Jose M.
Published: January 2024

Face detection in UAV imagery requires high accuracy and low execution time for real-time mission-critical operations in public safety, emergency management, disaster relief and other applications. This study presents UWS-YOLO, a new convolutional neural network (CNN)-based machine learning algorithm designed to address these demanding requirements. UWS-YOLO’s key strengths lie in its exceptional speed, remarkable accuracy and ability to handle complex UAV operations. This algorithm presents a balanced and portable solution for real-time face detection in UAV applications. Evaluation and comparison with the state-of-the-art algorithms using standard and UAV-specific datasets demonstrate UWS-YOLO’s superiority. It achieves 59.29% of accuracy compared with 27.43% in a state-of-the-art solution RetinaFace and 46.59% with YOLOv7. Additionally, UWS-YOLO operates at 11 milliseconds, which is 345% faster than RetinaFace and 373% than YOLOv7.
Antibacterial and clinical effectiveness of a mouthwash with a novel active system of amine + zinc lactate + fluoride: a randomized controlled trial
Authors: Montesani Lorenzo , Montesani Luigi , Mateo Luis , Daep Carlo , Huber Norbert , Isapour Golnaz , Zhang Yun-Po
Published: January 2024

Objectives

To support the daily oral hygiene of patients experiencing gum inflammation, a new mouthwash was developed containing an amine + zinc lactate + fluoride system. In vitro and clinical efficacy was assessed using traditional methods as well as using novel site-specific and subject-specific analyses of the clinical data.

Materials and methods

This mouthwash was evaluated in a 12-h biofilm regrowth assay against a negative control mouthwash and in a 6-month plaque and gingivitis clinical study as compared to a negative control mouthwash. Analyses of healthy versus inflamed sites, visible plaque versus non-visible plaque sites, as well as subject-level evaluations bring new perspectives to the overall performance of this mouthwash and its significance from a patient outcome perspective.

Results

Studies demonstrated that this new mouthwash provided long-term (12-h) antibacterial activity after single application in vitro and reduced clinically all plaque and gingivitis parameters after 3 months and 6 months of use when compared to the negative control mouthwash. Examination of site-level and subject-level data determined that this mouthwash significantly increased the number of healthy sites in the oral cavity and significantly improved the gum health of subjects in the study, as compared to the negative control mouthwash.

Conclusions

In vitro and clinical research has demonstrated the antibacterial and clinical benefits of this mouthwash containing an amine compound + zinc lactate + fluoride system.

Clinical relevance

Our subject-specific and site-specific analyses provide the dental practitioner with tools that can be used to guide patients who suffer from gingivitis toward optimal product selection and use.

Clinical trial registration

The trial was registered at ClinicalTrials.gov (reference no. NCT05821712).