bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Concepts in Gender-Affirming Surgery Postgraduate Training
Authors: Khouri Alexander N. , Haley Caleb , MacEachern Mark , Morrison Shane D.
Published: June 2022

Background Recent advocacy efforts and expanded insurance coverage has increased health care utilization among transgender patients. Therefore, it is pivotal that surgical residents are properly trained to care for transgender patients in both clinical and surgical settings. Yet, no formal curriculum or training requirements exist for surgical residents. The aim of this systematic review is to understand the surgical trainee's postgraduate education and training with respect to transgender health and gender-affirming surgeries (GAS).

Methods A Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA)-compliant literature search was performed on December 04, 2020 in PubMed, Elsevier Embase, and Wiley Cochrane Central Register of Controlled Trials. The retrieved hits were screened and reviewed by two independent reviewers.

Results Our literature search identified 186 unique publications, of which 14 surveys and one interventional study from various surgical specialties including plastic surgery, urology, otolaryngology, oral and maxillofacial surgery (OMS), dermatology, and obstetrics and gynecology (OBGYN) were included in this study. The majority of residents and program directors in surgical specialties believe education related to transgender health is important, and the current exposure in surgical training does not sufficiently prepare surgical residents to care for this marginalized population.

Conclusion Current postgraduate surgical training in gender-affirming surgery is nonuniform across surgical specialty, geographical region, and individual program. Incorporating training modules and hands-on experiences into surgical trainee education will better prepare residents for the numerous clinical and surgical interactions with transgender patients. Further research is required to better understand how to best incorporate these experiences into existing surgical curriculums.
Political Budget Cycles in the Context of a Transition Economy: The Case of Albania
Authors: Lami Endrit
Published: June 2022

There is growing research on the political budget cycles in transition economies whose institutions, economies and societies differ significantly from those of developed countries. New democracies are more vulnerable to political budget (fiscal) cycles. Most studies focus on policy instruments (e.g. fiscal policies) rather than on macroeconomic outcomes. In this paper, we analyse the political budget/fiscal cycle in Albania, a transition post-communist country. We analyse monthly data on the budget balance (deficit). The findings show a strong difference in deficits during pre- and post-election quarters, which do not appear when econometric analysis is replicated on annually collapsed data. This paper highlights the importance of distinguishing between types of elections according to their outcomes. Electoral competitiveness (heightened incumbents’ fear of elections loss), lower management efficiency, incumbent’s carelessness about the budget situation during the mandate of political rivals and higher corruption can all be associated with elections that yield rotation (change of the party/coalition in power), thus resulting in a higher budget deficit.
Analysis of fatigue crack propagation mechanism of Ni3Al under supergravity at atomic size
Authors: Ma Lei , Fei Peng , Li Changsheng , Hu Wangyu
Published: June 2022

Mechanisms of fatigue crack propagation of Ni3Al alloy under supergravity are studied by the molecular dynamics method. The initial model of the crack is a [100](010) crack in Ni3Al. Changes in the microstructure evolution, crack growth rate, and stress intensity factor of [100](010) crack are compared and analyzed without and with supergravity. The results show that the deformation mechanisms of the crack tip are slip bands along the a/6[112] direction by dislocation analysis in the absence of supergravity cyclic loading; after adding to supergravity, the mechanisms of crack propagation have changed, multiple voids are formed at the crack tip, and the dislocation lines also grow faster, which cause severe damage to the internal structure of the [100](010) crack in Ni3Al. By tracking the changes in crack length and width, it is found that the supergravity accelerates the growth of crack length and width and reduces the stress intensity factor threshold. Finally, the crack propagation rate increases under supergravity conditions.
Lab-on-PCB: One step away from the accomplishment of μTAS?
Authors: Tseng Hsiu-Yang , Lizama Jose H. , Alvarado Noel A. S. , Hou Hsin-Han
Published: June 2022

The techniques, protocols, and advancements revolving around printed circuit boards (PCBs) have been gaining sustained attention in the realm of micro-total analysis systems (μTAS) as more and more efforts are devoted to searching for standardized, highly reliable, and industry-friendly solutions for point-of-care diagnostics. In this Perspective, we set out to identify the current state in which the field of μTAS finds itself, the challenges encountered by researchers in the implementation of these technologies, and the potential improvements that can be targeted to meet the current demands. We also line up some trending innovations, such as 3D printing and wearable devices, along with the development of lab-on-PCB to increase the possibility of multifunctional biosensing activities propelled by integrated microfluidic networks for a wider range of applications, anticipating to catalyze the full potential of μTAS.
Argumentative Style
Authors: van Eemeren Frans H. , Garssen Bart , Greco Sara , van Haaften Ton , Labrie Nanon , Leal Fernando , Peng Wu
Published: June 2022

Argumentative Style discusses the various ways in which the defence of a standpoint is given shape in argumentative discourse. In this innovative study the new notion – ‘argumentative style’ – introduced for this purpose is situated in the theoretical framework of the pragma-dialectical approach to argumentation. This means that the choices involved in utilising a particular argumentative style do not only concern the presentational dimension, but also the topical selection and the audience adaptation of the strategic manoeuvring taking place in the discourse. In identifying the functional variety of the argumentative styles utilised in the political, the diplomatic, the legal, the facilitatory, the academic, and the medical domain, the point of departure is that these argumentative styles manifest themselves in the discourse in the argumentative moves that are made, the dialectical routes that are chosen and the strategic considerations that are brought to bear.
Optimal Design of Satellite Antenna Based on Sandwich Structure with a Novel Re-entrant Honeycomb Considering Thermal Load
Authors: He Jiahao , Wang Meng , Zhou Yang , Pan Yi , Sun Beibei
Published: June 2022

In order to optimize the thermal deformation of satellite antenna, a new type of negative thermal expansion metamaterial with the re-entrant honeycomb for sandwich structure was designed and optimized. Coefficient of thermal expansion (CTE), Poisson’s ratio and Young’s modulus of the metamaterial were calculated by finite element method (FEM). After sensitivity analysis, five parameters of the metamaterial were optimized by response surface method (RSM) and multi-island genetic algorithm (MIGA). It is found that the satellite antenna with the optimized re-entrant honeycomb shows better mechanical properties and its thermal deformation is reduced effectively.
TiO2 nanotubes-MoS2/PDA-LL-37 exhibits efficient anti-bacterial activity and facilitates new bone formation under near-infrared laser irradiation
Authors: Jin Mingchao , Zhu Juli , Meng Zhipeng , Jiang Xuesheng , Chen Zhuo , Xu Juntao , Gao Hongliang , Zhu Junkun , Wu Fengfeng
Published: June 2022

Titanium dioxide (TiO2), as one of the titanium (Ti)-based implants, holds a promise for a variety of anti-bacterial application in medical research. In the current study, a functional molybdenum disulfide (MoS2)/polydopamine (PDA)-LL-37 coating on titanium dioxide (TiO2) implant was prepared. Anodic oxidation and hydrothermal treatment was given to prepare TiO2 nanotubes-MoS2/PDA-LL-37 (T-M/P-L). The in vitro osteogenic effect of T-M/P-L was evaluated by measuring mesenchymal stem cell (MSC) adhesion, proliferation, alkaline phosphatase (ALP) activity, extracellular matrix (ECM) mineralization, collagen secretion and osteoblast-specific messenger RNAs (mRNAs) expression. The determination on the anti-bacterial ability of T-M/P-L was followed. Furthermore, the ability of T-M/P-L to promote bone formation in vivo was evaluated. Near-infrared (NIR) laser irradiation exposure enabled the T-M/P-L coating-endowed Ti substrates to hold effective anti-bacterial ability. T-M/P-L promoted the adhesion and proliferation of MSCs. In addition, an increase was witnessed regarding the ALP activity, collagen secretion and ECM mineralization, along with the expression of runt-related transcription factor 2, ALP and osteocalcin in the presence of T-M/P-L. Additionally, T-M/P-L could stimulate endothelial cells to secrete vascular endothelial growth factor (VEGF) and promote capillary-like tubule formation. Upon NIR laser irradiation exposure, T-M/P-L not only exhibited efficient in vivo anti-bacterial activity but also facilitated new bone formation. Collectively, T-M/P-L had enhanced anti-bacterial and osteogenic activity under NIR laser irradiation.
The studies of the Svalbard glacial surfaces albedo by an unmanned aerial vehicle.
Authors: Ivanov B V , Zhuravskiy D M , Prokhorova U V , Bezgreshnov A M , Terekhov A V , Kurapov M V , Paramzin A S , Kashkova V S
Published: June 2022

Experiments related to the use of unmanned aerial vehicle (UAV) for assessing the albedo of Svalbard glaciers is described. Study area - Esmark Glacier (Isfjord Bay) and Aldegonda Glacier (Greenfjord Bay). The main purpose of the experiments is to estimate the surface albedo in the zone of the edge cracks of the outlet glacier (Esmark), where standard ground-based observations are impossible due to safety conditions, as well as to obtain spatial albedo estimates (Aldegonda) when satellite data cannot be used (overcast). The UAV (DJI Phantom 4 Pro) was retrofitted with a sensor that measures reflected solar radiation. The data on the incoming solar radiation at the surface level, measured by a similar sensor, were used to calculate the albedo. The albedo measurements were carried out along several profiles across the Aldegonda Glacier and along one profile above the Esmark Glacier, which was laid from a flat plateau (ice dome) through a zone of cracks to the open water surface of the fiord. For the first time, estimates of the surface albedo of the outlet glacier in the zone of edge cracks were obtained. Ground-based verification observations carried out on the Aldegonda glacier confirmed the results obtained by the UAV.
Transport of biomass burning products from Siberian wildfires into the Arctic
Authors: Sitnov S A , Mokhov I I
Published: June 2022

The study of the long-range transport of biomass burning products from Siberian wildfires into the Arctic atmosphere during the period of 2000-2019 is presented. An analysis of the characteristics of forest fires over the past 20 years revealed an increase in radiation power of an average Siberian wildfire, which is characterized by a statistically significant linear trend of 1.7 ± 1.0% / year. A joint analysis of fire activity in Siberian forests, as well as the contents of the black carbon (BC) and carbon monoxide (CO) contents in the Arctic atmosphere, indicates that extreme fire events force the development of regional anomalies in BC and CO. Correlation between the anomalies of BC (CO) over the Russian segment of the Arctic and the number of Siberian wildfires is found to be statistically significant at the α = 0.05 level and reach the value r = 0.77 (0.48) during the summer months. Using a linear regression model, an estimate of the sensitivity of changes in the total BC content and in the volume mixing ratio of CO at the 700-hPa level in the 1.910-8 kg⋅m-2 per 1000 fires and 0.4 ppbv per 1000 fires, respectively. The results of a detailed analysis of the long-range BC transport into the Arctic during catastrophic Siberian wildfires in the summer of 2019 are presented. It is shown that the considered episode was conditioned by the features of the large-scale atmospheric circulation characteristic for the atmospheric blocking event.
Influence of air temperature on air composition in Moscow
Authors: Lokoshchenko M A , Bogdanovich A Yu , Elansky N F
Published: June 2022

Empirical relations between T and surface concentrations of CO2and five minor air gases have been studied on a base of hourly data during 12 years. In wide range -6…+15 °C significant changes of minor gases are absent. Real tendencies are increase of O3and, vice versa, fall of NO and NO2with increasing T from +15.+17 to +38 °C. Both effects are a consequence of unstable stratification that enhances vertical mixing. In cool weather -7.-18 °C O3falls whereas nitrogen oxides grow with decreasing T due to frequent inversions and slowing down the NO oxidation rate. At an even lower temperature up to -30 °C NO and NO2, vice versa, decrease with decreasing T – probably, due to strong cold advection of clean Arctic air. Unlike minor gases, CO2decreases with increasing T up to 25 °C due to photosynthesis intensification from winter to summer. Seeming growth of CO at T>27 °C is fully explained by smoky haze during heat waves in 2010 and 2002. The CO2growth in hot weather is also created by heat stress of trees. Thus, except only oxidation rate, any influence of T is indirect as a result of stratification, photosynthesis, smoky haze, advection, etc.
The parameters of internal gravity waves in the atmosphere from the amplitude fluctuations of radio occultation signals
Authors: Kan V , Gorbunov M E , Shmakov A V , Fedorova O V , Sofieva V F
Published: June 2022

We develop a method for the reconstruction of the statistical parameters of internal gravity wave (IGW) in the atmosphere from the amplitude fluctuations of signals acquired in radio occultation observations. We discuss the choice of the model of the IGW spatial spectrum, derive the relationships between the IGW spectra and the amplitude fluctuation spectra, develop the reconstruction algorithm and estimate its uncertainties. The IGW spectrum parameters to be retrieved are the outer (dominant) scale and the structure characteristic, the latter determining the power of saturated IGW. The method was tested on the COSMIC (Constellation Observing System for Meteorology, Ionosphere and Climate) observations acquired in the winter and summer seasons 2011. The IGW parameters were reconstructed in the height range from the upper boundary of the tropopause to 28 km. We show the altitude-latitudinal distributions of the IGW parameters and two integral characteristics: the variances of the temperature fluctuations and the IGW potential energy. We perform a detailed comparison of our results with those obtained from radiosonde and radio occultation observations. The developed method can be applied for the global monitoring of IGW parameters and activity in the middle atmosphere.
Changes of the sea ice and snow cover extent associated with temperature changes in the Northern and Southern Hemispheres in recent decades
Authors: Mokhov I I , Parfenova M R
Published: June 2022

Changes in snow cover and sea ice extents associated with temperature changes in the Northern and Southern Hemispheres for the period 1979-2020 are analysed using monthly-mean satellite and reanalysis data. Quantitative estimates of the relationship between the Antarctic and Arctic sea ice and changes in the surface air temperature were obtained. Overall increase of the Antarctic sea ice extent is associated with the regional manifestation of natural multidecadal climate modes with periods of up to several decades (against the background of global warming and a rapid decrease in the extent of sea ice in the Arctic). The results of correlation and cross-wavelet analyses show significant coherence and negative correlation of the surface air temperature in both Arctic and Antarctic with the respective sea ice extent in recent decades. Seasonal and regional features of the snow cover sensitivity to changes in the temperature regime in the Northern Hemisphere for the past four decades are noted. The features of snow cover variability in Eurasia and North America are presented.
On the reaction of planetary altitudinal frontal zone to climatic changes
Authors: Morozova S V , Denisov K E , Kondakov K S , Polyanskaya E A , Ormeli E I , Kononova N K
Published: June 2022

This article examines the dynamics of the planetary high-altitude frontal zone in two natural climatic periods of the state of the earth's climate system - the stabilization period and the second wave of global warming. A change in the area and intensity of the altitudinal frontal zone in different climatic periods was found. The planetary altitudinal frontal zone area expands and its intensity decreases from the stabilization period to the second wave of global warming. The climatic change in the area of planetary altitudinal frontal zone is opposite to the seasonal dynamics of this characteristic. Climate change in intensity is similar to seasonal change. The mechanism of action of negative feedback (air temperature - dynamics of the planetary altitudinal frontal zone) is discovered and described. For the first time, negative feedback has been applied to predict climate variability at finite time scales.
Anthropogenic impact on arctic near-surface methane: observations and model simulations
Authors: Shtabkin Yu A , Moiseenko K B , Skorokhod A I
Published: June 2022

Impact of climatically significant anthropogenic emissions to seasonal methane (CH4) variations observed at arctic and subarctic background stations in 1999 – 2019 has been quantitatively estimated using GEOS-Chem chemical transport model. It is shown that the formation of a stable continental pollution plume from sources in Western Europe, European Russia and Siberia allows to explain up to 5.5–8.6 % of observed CH4 surface concentration (~104–165 ppb). These atmospheric response values are several times higher than the of the observed annual methane variability amplitude (22–36 ppb), which allows to conclude that regional anthropogenic methane emissions sources play a significant role in regional CH4 balance in arctic and subarctic areas.
Curcuma zedoaria 50% methanol extracts increase adiponectin secretion by enhancing PPARγ mRNA expression in 3T3-L1 cells
Authors: Yamasaki Kazuaki , Kuriyama Isoko , Nakai Reiko , Hosokawa Keizo
Published: June 2022

Curcuma zedoaria is a characteristic species of its genus that contains little to no curcuminoid. Here, we demonstrate that C. zedoaria extracts with 50% methanol increases adiponectin secretion into the media by enhancing PPARγ mRNA expression in 3T3-L1 cells. These results indicate that C. zedoaria may be useful for preventing/improving lifestyle-related diseases such as diabetes and atherosclerosis.
CandidatusNitrosopolaris, a genus of putative ammonia-oxidizing archaea with a polar/alpine distribution
Authors: Pessi Igor S , Rutanen Aino , Hultman Jenni
Published: June 2022

Ammonia-oxidizing archaea (AOA) are key players in the nitrogen cycle of polar soils. Here, we analyzed metagenomic data from tundra soils in Rásttigáisá, Norway, and recovered four metagenome-assembled genomes (MAGs) assigned to the genus ‘UBA10452’, an uncultured lineage of putative AOA in the order Nitrososphaerales (‘terrestrial group I.1b’), phylum Thaumarchaeota. Analysis of other eight previously reported MAGs and publicly available amplicon sequencing data revealed that the UBA10452 lineage is predominantly found in acidic polar and alpine soils. In particular, UBA10452 MAGs were more abundant in highly oligotrophic environments such as mineral permafrost than in more nutrient-rich, vegetated tundra soils. UBA10452 MAGs harbour multiple copies of genes related to cold tolerance, particularly genes involved in DNA replication and repair. Based on the phylogenetic, biogeographic, and ecological characteristics of 12 UBA10452 MAGs, which include a high-quality MAG (90.8% complete, 3.9% redundant) with a nearly complete 16S rRNA gene, we propose a novel Candidatus genus, Ca. Nitrosopolaris, with four species representing clear biogeographic/habitat clusters.
Transcription factor retention through multiple polyploidization steps in wheat
Authors: Evans Catherine E B , Arunkumar Ramesh , Borrill Philippa
Published: June 2022

Whole-genome duplication is widespread in plant evolutionary history and is followed by nonrandom gene loss to return to a diploid state. Across multiple angiosperm species, the retained genes tend to be dosage-sensitive regulatory genes such as transcription factors, yet data for younger polyploid species is sparse. Here, we analyzed the retention, expression, and genetic variation in transcription factors in the recent allohexaploid bread wheat (Triticum aestivum L.). By comparing diploid, tetraploid, and hexaploid wheat, we found that, following each of two hybridization and whole-genome duplication events, the proportion of transcription factors in the genome increased. Transcription factors were preferentially retained over other genes as homoeologous groups in tetraploid and hexaploid wheat. Across cultivars, transcription factor homoeologs contained fewer deleterious missense mutations than nontranscription factors, suggesting that transcription factors are maintained as three functional homoeologs in hexaploid wheat populations. Transcription factor homoeologs were more strongly coexpressed than nontranscription factors, indicating conservation of function between homoeologs. We found that the B3, MADS-M-type, and NAC transcription factor families were less likely to have three homoeologs present than other families, which was associated with low expression levels and high levels of tandem duplication. Together, our results show that transcription factors are preferentially retained in polyploid wheat genomes although there is variation between families. Knocking out one transcription factor homoeolog to alter gene dosage, using TILLING or CRISPR, could generate new phenotypes for wheat breeding.
The Story of Us: Older and Younger Couples’ Language Use and Emotional Responses to Jointly Told Relationship Narratives
Authors: Wilson Stephanie J , Kiecolt-Glaser Janice K
Published: June 2022

Objectives

Social-emotional well-being is said to improve over adulthood, and studies of couples’ age differences have focused primarily on marital conflict. The way couples discuss their relationship story predicts marital quality among newlyweds and long-married couples alike, yet older and younger couples’ accounts have never been compared. The current study examined age differences in couples’ use of I/we-talk, emotion words, and immediacy (i.e., an urgent and unresolved style) during a relationship history discussion and their subsequent mood reactivity and appraisals.

Method

Married couples (N = 186 individuals within 93 couples, aged 22–77) recounted the story of their relationship then rated the discussion and their negative mood. Mediation models assessed the 3 linguistic features as parallel dyadic mediators linking couple age to negative mood responses and appraisals, controlling for global marital satisfaction, and baseline negative mood. Secondary analyses examined partners’ concordance in language use.

Results

Compared with younger couples, older couples used more positive than negative words and less immediacy which, in turn, was associated with husbands’ and wives’ less negative mood and more positive appraisals, only among husbands. Partners in older couples used more similar I/we-talk and emotional language, but these were unrelated to mood or appraisals.

Discussion

This study extends our understanding of how marital interactions differ by age in the understudied context of relationship history discussions, which may grow increasingly important for couples’ well-being with older age. Findings broadly align with social-emotional aging theories and uncover novel linguistic features relevant to the age-related emotional benefits of joint reminiscing.
Comparison of the Relative Sensitivity of Clinical, Endoscopic, and Histologic Remission for Detection of Treatment Efficacy in Ulcerative Colitis Trials
Authors: Sedano Rocio , Hogan Malcolm , Zou Guangyong , Narula Neeraj , Singh Siddharth , Ma Christopher , Feagan Brian G , Jairath Vipul
Published: June 2022

Lay Summary

This systemic review and quantitative analysis of placebo-controlled ulcerative colitis (UC) induction trials found higher pooled histologic remission rates compared with clinical and endoscopic remission rates at the same timepoint, and no significant differences in pooled relative risks for these outcomes between treatment groups; supporting the concept that histologic remission is not less sensitive than clinical or endoscopic remission.
Lithium-ion battery capacity configuration strategy for photovoltaic microgrid
Authors: Liu Changsheng , Zhang Xingxing
Published: June 2022

For photovoltaic (PV) microgrid, the instability of PV power generation will bring a lot of trouble to the microgrid, it is a good solution to configure lithium-ion battery and the capacity configuration of lithium-ion battery is the key. This paper proposes a simple and feasible capacity configuration strategy for lithium-ion batteries, different from other studies; it optimizes the capacity configuration of batteries by abandoning extreme situations and further optimizes the capacity configuration according to the actual situation of microgrid load and PV. A microgrid consisting of an ~750 m2 factory with 50 kw PV is selected for analysis, the factory works from Monday to Saturday and rests on Sunday and the required battery capacity can be greatly optimized by adjusting the state of charge of the battery. After calculation, the strategy proposed in this paper requires a battery with only 375 kwh compared with the traditional strategy requiring 650 kwh, which can save ~42.3% of the cost and has good economic value.
Safety and risk of febrile recurrence after early antibiotic discontinuation in high-risk neutropenic patients with haematological malignancies: a multicentre observational study
Authors: Paret Raphael , Le Bourgeois Amandine , Guillerm Gaëlle , Tessoulin Benoit , Rezig Schéhérazade , Gastinne Thomas , Couturier Marie Anne , Boutoille David , Lecomte Raphael , Ader Florence , Le Gouill Steven , Ansart Séverine , Talarmin Jean Philippe , Gaborit Benjamin
Published: June 2022

Background

Early antibiotic discontinuation according to the Fourth European Conference on Infections in Leukaemia (ECIL-4) recommendations is not systematically applied in high-risk neutropenic patients with haematological malignancies.

Methods

A retrospective multicentre observational study was conducted over 2 years to evaluate the safety of early antibiotic discontinuation for fever of unknown origin (FUO) during neutropenia after induction chemotherapy or HSCT, in comparison with a historical cohort. We used Cox proportional hazards models, censored on neutropenia resolution, to analyse factors associated with febrile recurrence.

Results

Among 147 included patients in the ECIL-4 cohort, mainly diagnosed with acute leukaemia (n = 104, 71%), antibiotics were discontinued during 170 post-chemotherapy neutropenic episodes. In comparison with the historical cohort of 178 episodes of neutropenia without antibiotic discontinuation, no significant differences were observed regarding febrile recurrences [71.2% (121/170) versus 71.3% (127/178), P = 0.97], admission in ICUs [6.5% (11/170) versus 11.2% (20/178), P = 0.17], septic shock [0.6% (1/170) versus 3.9% (7/178), P = 0.07] and 30 day mortality [1.4% (2/147) versus 2.7% (4/150), P = 0.084]. In the ECIL-4 cohort, the rate of bacteraemia in case of febrile recurrence was higher [27.1% (46/170) versus 11.8% (21/178), P < 0.01] and antibiotic consumption was significantly lower (15.5 versus 19.9 days, P < 0.001). After early antibiotic discontinuation according to ECIL-4 recommendations, enterocolitis was associated with febrile recurrence [HR = 2.31 (95% CI = 1.4–3.8), P < 0.001] and stage III–IV oral mucositis with bacteraemia [HR = 2.26 (95% CI = 1.22–4.2), P = 0.01].

Conclusions

After an FUO episode in high-risk neutropenia, compliance with ECIL-4 recommendations for early antibiotic discontinuation appears to be safe and mucosal damage was associated with febrile recurrence and bacteraemia. Prospective interventional studies are warranted to assess this strategy in high-risk neutropenic patients.
Trehalose decreases mRNA and protein expressions of c-Jun and JunB in human cervical cancer HeLa cells
Authors: Umeda-Miyara Kanae , Miyara Masatsugu , Sanoh Seigo , Kotake Yaichiro
Published: June 2022

Increasing evidence suggests that trehalose, a non-reducing disaccharide, ameliorates disease phenotypes by activating autophagy in animal models of various human diseases, including neurodegenerative diseases. Multiple in vitro studies suggest that activation of transcription factor EB, a master regulator of lysosomal biogenesis and autophagy genes, is a major contributor to trehalose-induced autophagy at later stages of exposure. However, underlying causes of trehalose-induced autophagy possibly occur at the early stage of the exposure period. In this study, we investigated the effects of short-term exposure of HeLa cells to trehalose on several signal transduction pathways to elucidate the initial events involved in its beneficial effects. Phospho-protein array analysis revealed that trehalose decreases levels of phosphorylated c-Jun, a component of the transcription factor activator protein-1, after 6 h. Trehalose also rapidly reduced mRNA expression levels of c-Jun and JunB, a member of the Jun family, within 1 h, resulting in a subsequent decrease in their protein levels. Future studies, exploring the interplay between decreased c-Jun and JunB protein levels and beneficial effects of trehalose, may provide novel insights into the mechanisms of trehalose action.
Malaria in sub-Saharan Africa—a continuing risk for international travellers
Authors: Huits Ralph , Hamer Davidson H
Published: June 2022

International travel volumes are recovering after the COVID-19 pandemic. We highlight the high risk of malaria for travellers to sub-Saharan Africa and the continued need for health practitioners to prescribe and facilitate access to affordable antimalarial chemoprophylaxis and to provide high-quality diagnostic services and therapeutic care for case management.
Introduction to the Examination
Authors: Breeze John , Elledge Ross
Published: June 2022

In this opening chapter we discuss the rationale behind a revision book for the FRCS(OMFS) exit examination and explore the theory underpinning modern assessment techniques in medical education. Through a deeper understanding of these techniques, we hope you can get under the skin of the examiners and understand exam development. Through such an understanding, the FRCS(OMFS) can seem a far less daunting prospect and hopefully it can be appreciated that SBA answering technique can be as important as pure knowledge. An understanding of methods of standard setting and quality assurance will provide you with assertions that the assessment technique selected for this initial part of the FRCS(OMFS) is a robust one. We set out our intentions for the book as a whole and our aim to make you the very best candidate you can be.
Orthognathic Surgery
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 25 questions on the subject of orthognathic surgery. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of dentofacial disproportion and asymmetric and congenital orthognathic cases. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. The chapter is predicated on evidence-based practice at the time of writing, with reference to the wider scientific literature. Links to further reading for this chapter are included at the start of the book and appropriate scientific references provided within the chapter when required.
Skin Cancer
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 25 questions on the subject of skin cancer. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of skin cancer presenting in the head, face, and neck region. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery in the contemporary management of such complex cases. It should be borne in mind that there is no “one size fits all” approach to cutaneous malignancy and whilst guidelines exist, the excellent clinician uses judgment and views patients holistically, knowing when to employ non-surgical management and involved the wider multi-disciplinary team.
Bone Disease
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 15 questions on the subject of maxillofacial bone disease. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of conditions such as keratocystic odontogenic tumours and ameloblastoma, as well as osteonecrosis derived from medications or iatrogenic radiotherapy. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. The conditions in this section often do not fit “neatly” into other categories, as there may be congenital, infective, neoplastic and idiopathic aetiopathogenesis at play in their development.
Oral Medicine
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 30 questions on oral medicine. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of pathological conditions affecting the oral mucosa including ulceration, lichen planus, and leukoplakia, as well as pemphigoid and pemphigus. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. As the interface between medicine and surgery, the area is a standalone specialty in its own right and can all too easily be overlooked in the course of preparation for the FRCS (OMFS) examination.
Craniofacial Surgery
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 20 questions on the subject of craniofacial surgery. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with knowledge in the assessment and treatment of congenital conditions presenting in the craniofacial region. These include craniosynostosis and predisposing conditions, hemifacial microsomia, and vascular anomalies. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. The chapter is predicated on evidence-based practice at the time of writing, with reference to the wider scientific literature. Links to further reading for this chapter are included at the start of the book and appropriate scientific references provided within the chapter when required.
Cleft Surgery
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 15 questions on the subject of cleft surgery. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and treatment of presentations such as cleft lip and palate as well as modalities of treatment, including types of cleft lip repair. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. The chapter is predicated on evidence-based practice at the time of writing, with reference to the wider scientific literature. Links to further reading for this chapter are included at the start of the book and appropriate scientific references provided within the chapter when required.
Reconstructive Maxillofacial Surgery
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 15 questions on the subject of reconstructive maxillofacial surgery. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in reconstruction of mandibular and maxillary defects including free flap design and microvascular anastomosis. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. The chapter is predicated on evidence-based practice at the time of writing, with reference to the wider scientific literature. Links to further reading for this chapter are included at the start of the book and appropriate scientific references provided within the chapter when required.
Oral Implantology
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains ten questions on the subject of oral implantology. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment of alveolar ridge deficiency and treatment using bone grafts and osseointegrated implants. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. The chapter is predicated on evidence-based practice at the time of writing, with reference to the wider scientific literature. Links to further reading for this chapter are included at the start of the book and appropriate scientific references provided within the chapter when required.
Aesthetic Facial Surgery
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains 15 questions on the subject of aesthetic facial surgery. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment of aesthetic conditions such as a dorsal nasal hump and prominent ears. It will focus on types of treatment such as fillers, lasers, and a brow lift. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex cases. Above and beyond the surgical techniques is the decision making of what techniques to apply as well as when not to operate that forms the crux of the more challenging questions in this set.
Perioperative Care
Authors: Breeze John , Elledge Ross
Published: June 2022

This chapter contains ten questions on the subject of perioperative care pertaining to patients undergoing surgery to the head, face, and neck. This will provide candidates sitting the Oral and Maxillofacial Surgery FRCS examination with practical knowledge in the assessment and immediate management of the airway and of haematological abnormalities, as well as in consent. It will also provide insight for clinicians in allied specialties, such as otolaryngology and plastic surgery, in the contemporary management of such complex scenarios. The chapter is predicated on evidence-based practice at the time of writing, with reference to the wider scientific literature. Links to further reading for this chapter are included at the start of the book and appropriate scientific references provided within the chapter when required.
A woman who didn’t realize she couldn’t see half the world
Authors: Meltzer Ethan
Published: June 2022

This case focuses on a woman with visual deficits with the added twist that she is unaware of her deficits. When encountering a patient with abnormal vision, the first categories of localization to consider include primary ocular disorders versus neurologic disorders. Many of these patients see their primary care physician, emergency room physician, or ophthalmologist before they see a neurologist. Because of that, the patient population that neurologists see with abnormal vision are pre-screened and more likely to have a neurologic disorder. If vision is abnormal due to a neurologic disorder, is it dysfunction of the afferent or efferent visual system?
A man who appeared jumpy
Authors: Meltzer Ethan
Published: June 2022

In this case, a man presents with abnormal movements on one side of his body. Although movement disorders are common in neurology, his presentation is fairly uncommon. When evaluating a patient with a movement disorder it is critical to accurately describe the specific movement disorder to help localize the lesion and narrow down the differential diagnosis. This case explores how the nervous system modulates movement through what we refer to as the extrapyramidal system, and what happens when this system goes awry. When there is dysfunction of the extrapyramidal system, there can either be too little or too much movement, which one occurs is dependent on the specific localization of the lesion within either the direct or indirect pathways.
A woman who only ate fast food
Authors: Meltzer Ethan
Published: June 2022

In this case, a woman presents with odd behaviors and abnormal cognition, another classic diagnostic dilemma in neurology. The history delves into her evolving cognitive syndrome. Localization of her symptoms requires a thoughtful approach to understanding the complex organization of the brain. Categorizing her various cognitive deficits is critical in arriving at the clinical syndrome and accurate diagnosis. In patients presenting with cognitive syndromes, the history and exam are complementary. The observations by the patient’s family and others of their behavior over time can often be more beneficial than the brief observations and testing done in the clinic or hospital.
A woman whose cruise was cut short
Authors: Meltzer Ethan
Published: June 2022

In this case, a woman presents with a complex constellation of symptoms: weakness, sensory loss, and difficulty walking. This is another case that highlights the need for the history, and the principles of pace and localization, to determine the depth of neurologic exam that must be performed to reach the diagnosis. The components of the neurologic exam that are performed expand and contract like an accordion depending on the history that is obtained. For example, examination of multiple cognitive domains or detailed sensory examination could be unnecessary or critical to establishing the localization and diagnosis depending on the patient’s history.
A man with symptoms that improved throughout the day
Authors: Meltzer Ethan
Published: June 2022

This case follows the course of a man with an odd presentation of headache, imbalance, and vertigo that fluctuate throughout the day. Symptoms that predictably wax and wane can often help localize the lesion and hint at the underlying disorder. This case also explores the limitations of pace and localization when key components of the history and ancillary data are incongruent. As the cases become more challenging, we explore the limitations of the methods detailed in the first chapter, but also how the subtleties of more complex case histories become more important in defining the clinical syndrome to arrive at the diagnosis.
A man who could only see half of La Sagrada Familia
Authors: Meltzer Ethan
Published: June 2022

Some patients present with particularly memorable symptoms. This case reviews the fascinating visual symptoms a young man experienced upon awakening from a coma. These cases are particularly rewarding, in that the patient can describe in detail their experience, and the neurologist needs to do little but facilitate the conversation. Neurology is unique among medical specialties, as the brain is the only organ in the body that can describe what it is experiencing. When it is capable of speaking, sometimes all that is needed is to listen to what it says to solve the problem. Read the history and examination below and think about why certain questions were asked, and what we learn from the way the patient answers the questions.
A woman with loss of consciousness while driving
Authors: Meltzer Ethan
Published: June 2022

This case follows a young woman with recurrent, stereotypical spells of loss of consciousness. A neurology case-based book is an artificial construct, as no non-neurologic disorders are going to be included. In real life, however, patients do not come with labels that say whether a symptom is neurologic or non-neurologic. The job of the neurologist is often to determine whether or not the patient has a neurologic disease. The line that divides a neurologic from a non-neurologic symptom or syndrome is somewhat arbitrary. This case explores the challenges when a patient’s symptoms don’t clearly fit on one side of that line or the other.
A man with difficulty climbing the stairs
Authors: Meltzer Ethan
Published: June 2022

This case describes a man with longstanding pain, erectile dysfunction, and lower extremity dysfunction. Previous cases have tackled variations of these symptoms and their localization. However, he develops symptoms of proximal extremity weakness that may not be related to his initial symptoms. As covered in a previous case, his history hints at the potential for more than one simultaneous disease process. A patient can have more than one lesion related to the same underlying process or multiple underlying processes causing multiple lesions. Using the principles of pace and localization can help easily aggregate symptoms into which symptoms are more likely related to the same underlying etiology.
A man with painful, blurry vision
Authors: Meltzer Ethan
Published: June 2022

This case focuses on a man who develops abnormal vision. There are only a few cases in this book that address symptoms of abnormal vision, not because it is unimportant, rather to truly learn how to localize these lesions takes practice looking at eye movements at the bedside, which a book does not do well. When vision abnormalities are due to a neuro-ophthalmologic disorder, the precise localization of a patient’s symptoms can lead to dramatically different diagnoses. Even though the nerves and muscles running to and from the eyes are in very close geographic proximity, the neurologic disorders that involve various combinations of these nerves and muscles are highly disparate.
A woman with blurry vision and difficulty driving
Authors: Meltzer Ethan
Published: June 2022

The penultimate case of this book introduces a woman with odd episodes of transient neurologic dysfunction. Patients who present with transient neurologic deficits frequently have normal or close-to-normal neurologic exams that provide little insight into the underlying diagnosis. When that is the case, the pace of illness can be crucial in identifying the appropriate syndrome. Most of the effort in the encounter with the patient with transient neurologic deficits is focused on obtaining a precise history, from the patient or any bystanders, and then ensuring that there are no residual deficits apparent on the examination. The resolution of symptoms does not in itself guarantee a benign underlying etiology for the patient’s symptoms.