bluuebunny/crossref_metadata_2025 huggingface dataset:
Performance enhancement of optical communication system with cascaded FBGs of varying lengths
Authors: Naga Bhaskar Chaluvadi V , Pal Subhradeep , Pattnaik Prasant Kumar
Published: November 2023

In this paper, an optical communication system constructed with cascaded fiber Bragg gratings or fiber Bragg gratings (FBGs) of varying lengths capable of operating in the C-band is presented. Here, initially, a passive optical device formed with four cascaded FBGs of varying lengths is proposed and analyzed. Subsequently, the proposed device is kept in the optical communication system to reduce the spectral width of the source, thereby enhancing the system’s performance. Analytical formulation based on the transfer matrix method of an optical device is incorporated. The effect of such a device on the system performance at various operating distances is discussed. Further, the system performance is studied with the apodized FBGs in the passive optical device. At the end, we investigated the effect of incorporating the cascaded FBG structure in the system utilizing four-level pulse amplitude modulation or PAM-4 modulation . As per the simulation results, the proposed device has given a maximum reflectivity of 98.39

%

and a minimum FWHM of 0.175 nm for uniform FBGs. But with the apodized FBGs, an FWHM of 0.07 nm with a reflectivity of 59.81

%

has been achieved. Simulation results reveal that the system formed with the proposed device has given better performance up to a distance of 105 km compared to the absence of the device. At the maximum operating distance of the system with apodized FBGs, the Q-factor and bit error rate (BER) are recorded as 6.712 and 9.5321×10−12, respectively. Apart from the Q-factor and BER estimation, eye height is also used to estimate the system performance at various operating distances.
Impact of sulfur content on thermo-capillarity and melt pool dynamics in laser powder bed fusion of 316L powders
Authors: Li Zhiyong , Kan Xinfeng , Yin Yanjun
Published: November 2023

A three-dimensional numerical model is developed to investigate the influence of sulfur content on the transitions of thermo-capillarity and flow dynamics during laser powder bed fusion (LPBF) of 316L powders. The impacts of variations in sulfur contents on thermal behaviors involving heat transfer and solidification characteristics, thermo-capillarity transition, as well as the spatial and directional transitions in flow dynamics, are analyzed through mechanistic modeling techniques. It is observed that transient thermal behaviors, including melt pool profile, track morphology, and solidification processes, are significantly influenced by the contained sulfur concentration. High sulfur concentrations tend to result in finer microstructures and equiaxed grains. Through simulations, it is noted that the transition in the sign of temperature coefficient of surface tension (TCST) is more easily observable in low-sulfur level but disappears as the sulfur concentration is extremely low (0.0001%) With sulfur content increasing, a more homogenized velocity distribution is observed, accompanied with heightened flow complexity denoted by the emergence of additional branch flows and vortices. These findings offer valuable insights into the underlying physics of melt pool dynamics in the LPBF process and present a potential approach for process optimization.
Additively manufactured Ti–Ta–Cu alloys for the next-generation load-bearing implants
Authors: Bandyopadhyay Amit , Mitra Indranath , Ciliveri Sushant , Avila Jose D , Dernell William , Goodman Stuart B , Bose Susmita
Published: November 2023

Highlights

Ti3Al2V demonstrated comparable mechanical performance to Ti6Al4V.

Adding 3 wt.% Cu in Ti3Al2V reduced planktonic bacteria colonies by 78%–86% compared to commercially pure Ti.

Ti3Al2V–10Ta displayed the best in vivo biocompatibility with 3.5-fold higher bone formation than Ti6Al4V.

Ti3Al2V–10Ta–3Cu multifaceted alloy has the potential to replace Ti6Al4V in orthopedic and dental applications with superior early-stage osseointegration and inherent antibacterial performance.
The Generation Problem in Thompson Group 𝐹
Authors: Golan Polak Gili
Published: November 2023

We show that the generation problem in Thompson’s group

F
F

is decidable, i.e., there is an algorithm which decides if a finite set of elements of

F
F

generates the whole

F
F

. The algorithm makes use of the Stallings

2
2

-core of subgroups of

F
F

, which can be defined in an analogous way to the Stallings core of subgroups of a finitely generated free group. Further study of the Stallings

2
2

-core of subgroups of

F
F

provides a solution to another algorithmic problem in

F
F

. Namely, given a finitely generated subgroup

H
H

of

F
F

, it is decidable if

H
H

acts transitively on the set of finite dyadic fractions

D

\mathcal D

. Other applications of the study include the construction of new maximal subgroups of

F
F

of infinite index, among which, a maximal subgroup of infinite index which acts transitively on the set

D

\mathcal D

and the construction of an elementary amenable subgroup of

F
F

which is maximal in a normal subgroup of

F
F

.
Implementing services for pediatric cystic fibrosis treatment in a community hospital
Authors: Grube Paige , Nichols Heather , Ferrell Sarah , Gilham Denise , Gaylor Allyson , Dunkelberger Karen
Published: November 2023

Purpose

Our community hospital was recently charged with providing care for pediatric people with cystic fibrosis (PwCF). Pediatric PwCF generally need a higher level of care than is required by other pediatric patients cared for at our institution. This project aimed to prepare the pharmacy department to care for this specialized population safely and efficiently.

The implementation process was divided into 3 phases to accomplish the larger purpose. These phases were as follows: (1) creating order sets and protocols; (2) providing staff and clinical pharmacists with training and resources; and (3) creating and managing clinical decision support. The central aspect of preparing inpatient pharmacy staff to care for PwCF was the development of antibiotic dosing protocols and order sets comprised of intravenous and oral antibiotics as well as aminoglycoside and vancomycin pharmacokinetic guides. A pharmacokinetic calculator was created to assist with aminoglycoside dosing and monitoring. During phase 2, pharmacist education modules were created to provide guidance on cystic fibrosis and medications commonly used to treat it. As the newly designed protocols were enacted, education was provided on how to use them. Phase 3 occurred concurrently, as clinical decision support was vital to completing phases 1 and 2.

Conclusion

The phased approach was imperative to the project’s success and kept individual components on track. All parts were completed in just over one year.
Dolphins from a prehistoric midden imply long-term philopatry of delphinids around Tokyo Bay
Authors: Kishida Takushi , Namigata Sakiko , Nakanishi Toshimichi , Niiyama Yasukazu , Kitagawa Hiroyuki
Published: November 2023

Cetaceans of the family Delphinidae are widely distributed throughout the global ocean, and it has been suggested that females exhibit philopatry. However, the duration of time that a maternal group of these highly mobile creatures spends inhabiting a particular region remains unknown. The objective of this study is to examine the genetic diversity of delphinids in the past and to shed light on the above question. In this study, we amplified and sequenced the mitochondrial DNA D-loop region from the skeletal remains of delphinids that were excavated from the Shomyoji Midden, a site situated on the western coast of Tokyo Bay and dating to 5000–3000 years before the present. We acquired prehistoric D-loop sequences of seven bottlenose dolphins, six Pacific white-sided dolphins, and a false killer whale. Notably, one or more haplotypes from the prehistoric individuals were detected in the geographically proximate modern conspecific populations across all three species. Whilst the genetic diversity of prehistoric and modern Pacific white-sided dolphin populations appears to be comparable, the modern bottlenose dolphin population demonstrates significantly lower genetic diversity when compared to its prehistoric counterpart in the vicinity of Tokyo Bay. The maternal groups of these species are speculated to have persisted in the same habitat for at least 4000 years.
Characteristic research of regeneration process of particulate filter medium in vibrated fluidized bed
Authors: Liu Bing , He Lixin , Zhao Xianglong , Guo Yi
Published: November 2023

The vibrational fluidized bed is innovatively adopted to regenerate the particulate filter medium for the purification of crude synthesis gas from the coal gasification process. Characteristic research of vibrated fluidized beds during dust-containing particulate filter medium regeneration has been carried out. The ideal transport model of particulate filter medium on the distributor is established and verified by using experiments. The mean residence time of the particulate filter medium can be reduced by 72% from 5.5 to 1.5 min with an increase in the working frequency from 50 to 60 Hz. The thickness of the bed layer is linearly increased with the feeding rate of the particulate filter medium under ideal working conditions. The resistance models of the fluidizing air are built up and validated, and they can be used to calculate the pressure drop of the static bed layer of the particulate filter medium on the fluidizing air distributor, which is the maximum value of the dynamic bed layer with the same thickness. The fluidizing air makes the mean residence time of the particulate filter medium decrease by 50% and reduces the difference in the particulate mean residence time under different feeding-rate conditions. The regeneration effect of dust-containing filter medium particles in a vibrated fluidized bed is evaluated. Fluidizing air with superficial velocity ranging from 0 to 0.6~0.9 m·s–1 makes the regeneration efficiency increase from 29.41% to 70.59~88.24%. This article provides a reference for the industrial application of a vibrated fluidized bed for the particulate filter medium recycling system.
The Opacity of the World: Zadie Smith’s Swing Time
Authors: Nandi Miriam
Published: November 2023

Zadie Smith’s novel Swing Time explores the complex ways in which women relate to each other across cultural difference and generational gaps, as mothers and daughters, as rivals and friends. My article traces the friction between Black feminist group solidarity and aesthetic distance in Swing Time to suggest that the novel can be brought into dialogue with a postcolonial aesthetics of opacity, as coined by Édouard Glissant. The tension between opacity and transparency is the organizing principle of Swing Time, as the novel engages with movement and change, postcolonial spaces, and the mysteries of friendship, while vacillating between ironic narrative commentary and a more elusive aesthetics of concealment. Reading Smith’s work through a Glissantian lens also sheds light on affinities between her essayistic writing and her fiction.
An ingenious musical machine from the imagination of Leonardo da Vinci
Authors: Chinaglia Walter
Published: November 2023

This article is based on a talk I was asked to give during the conference Leonardo, la musica, la scena (Leonardo: the music and the scene) held at the Accademia di Brera, Milan, in November 2019. On that occasion I was able to illustrate my wooden reconstruction of Leonardo’s portative organ, as illustrated on fol.76r of the codex Madrid II. In the article I present and analyse Leonardo’s drawings of this organ in their original context, as well as exploring the distinctive traits of the instrument. With the aim of making possible a historically informed reconstruction, I identify an appropriate interpretative methodology and principles of construction consistent with the historical period in which Leonardo worked, both as musicus and maker of instruments. At the same time I trace an analogy with the portative organ of the late Middle Ages. For this instrument, which works in a very similar way to the late medieval portative organ, some traits have been derived from the portative organ, in particular the scaling of the pipes. Finally, individual parts of Leonardo’s organ design are interpreted and their modern reconstruction illustrated, leading to the presentation of the complete instrument.
Explicating Ageism in the Productive Aging Framework
Authors: Morrow-Howell Nancy , Gonzales Ernest
Published: November 2023

This essay argues for a fuller integration of ageism and age discrimination into the productive aging framework. We briefly review the productive aging scholarship and the extent to which ageism has been considered in regard to working, volunteering, education, and caregiving. We suggest that ageism has not been adequately considered, and we identify how it permeates productive engagement in later life. We introduce modifications to the productive aging framework to more directly capture the roles of ageism and age discrimination in activity engagement and the outcomes achieved. We argue for the integration of key concepts from minority stress theory and critical race theory that may yield important insights for an increasingly diverse older population. We conclude with research directions that will guide intervention development to reduce ageism at the societal, organizational, and individual level.
Innovation and the labor market: theory, evidence, and challenges
Authors: Corrocher Nicoletta , Moschella Daniele , Staccioli Jacopo , Vivarelli Marco
Published: November 2023

This paper deals with the complex relationship between innovation and the labor market, analyzing the impact of new technological advancements on overall employment, skills, and wages. After a critical review of the extant literature and the available empirical studies, novel evidence is presented on the distribution of labor-saving automation [namely robotics and artificial intelligence (AI)], based on natural language processing of US patents. This mapping shows that both upstream high-tech providers and downstream users of new technologies—such as Boeing and Amazon—lead the underlying innovative effort.
Assessing the impact of discordant antibiotic treatment on adverse outcomes in community-onset UTI: a retrospective cohort study
Authors: Aryee Anna , Rockenschaub Patrick , Robson John , Ahmed Zaheer , Nic Fhogartaigh Caoimhe , Ball David , Hayward Andrew , Shallcross Laura
Published: November 2023

Objectives

To investigate the risk of adverse outcomes following discordant antibiotic treatment (urinary organism resistant) for culture-confirmed community-onset lower urinary tract infection (UTI).

Methods

Cohort study using routinely collected linked primary care, secondary care and microbiology data from patients with culture-confirmed community-onset lower UTI (COLUTI). Antibiotic treatment within ±3 days was considered concordant if the urinary organism was sensitive and discordant if resistant.

The primary outcome was the proportion of patients experiencing urinary infection-related hospital admission (UHA) within 30 days. Secondary outcomes were the proportion of patients experiencing reconsultation within 30 days, and the odds of UHA and reconsultation following discordant treatment, adjusting for sex, age, risk factors for complicated UTI, previous antibiotic treatment, recurrent UTI and comorbidities.

Results

A total of 11 963 UTI episodes in 8324 patients were included, and 1686 episodes (14.1%, 95% CI 13.5%–14.7%) were discordant. UHA occurred in 212/10 277 concordant episodes (2.1%, 95% CI 1.8%–2.4%) and 88/1686 discordant episodes (5.2%, 95% CI 4.2%–6.4%). Reconsultation occurred in 3961 concordant (38.5%, 95% CI 37.6%–39.5%) and 1472 discordant episodes (87.3%, 95% CI 85.6%–88.8%). Discordant treatment compared with concordant was associated with increased odds of UHA (adjusted OR 2.31, 95% CI 1.77–3.0, P < 0.001) and reconsultation (adjusted OR 11.25, 95% CI 9.66–13.11, P < 0.001) on multivariable analysis. Chronic kidney disease and diabetes mellitus were also independently associated with increased odds of UHA.

Conclusions

One in seven COLUTI episodes in primary care were treated with discordant antibiotics. In higher risk patients requiring urine culture, empirical antibiotic choice optimization could meaningfully reduce adverse outcomes.
Inhibitor activity of Lactiplantibacillus plantarum LP5 on thermotolerant campylobacter with different biofilm-forming capacities
Authors: Ruiz María J , Sirini Noelí E , Stegmayer María Á , Soto Lorena P , Zbrun María V , Olivero Carolina R , Werning María L , Acosta Federico F , Signorini Marcelo L , Frizzo Laureano S
Published: November 2023

Aims

To evaluate the biofilm-forming capacity of thermotolerant Campylobacter (TC) strains from poultry production and to analyse the inhibitory capacity of Lactiplantibacillus plantarum LP5 against TC on different materials.

Methods and results

Biofilm-forming capacity by Campylobacter jejuni and Campylobacter coli was analysed by cell adhesion in polystyrene plates. TC were classified as non-biofilm-forming (NBF, 1.3%), weak biofilm-forming (WBF, 68.4%), moderate biofilm-forming (MBF, 27.6%), and strong biofilm-forming (SBF, 2.7%). The inhibitory capacity of L. plantarum LP5 against TC was tested on stainless-steel, nylon, aluminium, and glass disks (treated group) and compared with biofilm-forming TC (control group). Lactiplantibacillus plantarum LP5 was inoculated, and then TC. Biofilm was removed in both experimental groups and TC and LP5 bacterial counts were performed. The L. plantarum LP5 presence reduced the formation of TC biofilm (P < 0.001). The material type and strain category influenced biofilm formation, with stainless-steel and the SBF strain being the material and TC having the highest adhesion (P < 0.001). Lactiplantibacillus plantarum LP5 formed a similar biofilm on all materials (P = 0.823).

Conclusions

This trial showed very promising results; L. plantarum LP5 could be incorporated as a bio-protector of TC on different surfaces.
Management of a complex cholecystocutaneous fistula with laparoscopic retrieval of gallstones embedded in the abdominal wall
Authors: Saunders Jada , Kapsampelis Panagiotis , Chouari Tarak , Nip Lawrence , Gerogiannis Ioannis N
Published: November 2023

Cholecystocutaneous fistula is a rare surgical entity caused by an abnormal connection between the gallbladder epithelium and the skin. These complex cases have historically required an open surgical approach and are difficult to manage. We present a rare case of a 65-year-old male patient, with chronic lithiasic cholecystitis and cholecystocutaneous fistula. The patient underwent a laparoscopic subtotal cholecystectomy, dissection of the fistula tract, and removal of the impacted stones from the abdominal wall. With appropriate expertize, a completely laparoscopic approach is acceptable and the technical challenges can be predicted and overcome through careful pre-operative planning.
Receptor-like kinases OsRLK902-1 and OsRLK902-2 form immune complexes with OsRLCK185 to regulate rice blast resistance
Authors: Liang Jiahui , Lu Ling , Zhou Houli , Fang Jianbo , Zhao Yaofei , Hou Hongna , Chen Lizhe , Cao Chang , Yang Dewei , Diao Zhijuan , Tang Dingzhong , Li Shengping
Published: November 2023

Receptor-like kinases (RLKs) are major regulators of the plant immune response and play important roles in the perception and transmission of immune signals. RECEPTOR LIKE KINASE 902 (RLK902) is at the key node in leucine-rich repeat receptor-like kinase interaction networks and positively regulates resistance to the bacterial pathogen Pseudomonas syringae in Arabidopsis. However, the function of RLK902 in fungal disease resistance remains obscure. In this study, we found that the expression levels of OsRLK902-1 and OsRLK902-2, encoding two orthologues of RLK902 in rice, were induced by Magnaporthe oryzae, chitin, and flg22 treatment. osrlk902-1 and osrlk902-2 knockout mutants displayed enhanced susceptibility to M. oryzae. Interestingly, the osrlk902-1 rlk902-2 double mutant exhibited similar disease susceptibility, hydrogen peroxide production, and callose deposition to the two single mutants. Further investigation showed that OsRLK902-1 interacts with and stabilizes OsRLK902-2. The two OsRLKs form a complex with OsRLCK185, a key regulator in chitin-triggered immunity, and stabilize it. Taken together, our data demonstrate that OsRLK902-1 and OsRLK902-2, as well as OsRLCK185 function together in regulating disease resistance to M. oryzae in rice.
Tmem88 plays an essential role in pharyngeal pouch progenitor specification by inhibiting Wnt/β-catenin signaling
Authors: Liu Jingwen , Yang Liping , Lu Zidong , Wang Qiang
Published: November 2023

Pharyngeal pouches, which are endodermal outpockets that segment the pharyngeal arches, play a crucial role in the development of craniofacial skeletons in vertebrate embryos. Our previous study successfully identified pharyngeal pouch progenitors (PPPs) in zebrafish embryos and emphasized the significance of BMP2b signaling in their specification. However, the specific mechanism by which these progenitors originate from endodermal cells remains largely unknown. Here we found that the pharmacological activation of Wnt signaling pathway disrupts the emergence of PPPs and subsequently hinders the formation of pharyngeal pouches. Moreover, we have identified the expression of tmem88a and tmem88b (collectively known as tmem88a/b) in PPPs during the early-somite stages. Furthermore, the deficiency of tmem88a/b leads to an excessive accumulation of β-catenin in both the cytoplasm and nucleus of endodermal cells that are intended to differentiate into PPPs. Importantly, suppressing the hyperactivation of Wnt/β-catenin signaling through pharmacological treatment, the defects in PPP specification in tmem88a/b−/− mutants are successfully rescued. In summary, our findings establish a clear connection between the specification of PPPs and the regulation of Wnt signaling mediated by Tmem88. These results underscore the pivotal role of Tmem88 in the development of pharyngeal pouches.
Neonatal Hyperbilirubinemia Admissions Following Clinical Practice Guideline Implementation
Authors: Smith Morgan , Ridgway Austin , Mullikin Dolores
Published: November 2023

Introduction

Treatment of neonatal hyperbilirubinemia remains one of the most common reasons for readmission following delivery. Revised clinical practice guidelines (CPGs) for the treatment of neonatal hyperbilirubinemia were published on August 5, 2022. This report describes the preliminary outcomes following implementation of the new CPGs at Tripler Army Medical Center.

Materials and Methods

A retrospective chart review was performed for the 12 months prior to implementation and the 5 months post implementation.

Results

Bilirubin admissions decreased from 15.6% of total admissions during the 12 months prior to the new guidelines (69/441) to 4.1% of admissions (8/194) during the 5 months after implementation of the new guidelines (P < 0.001). This corresponds to a 74% reduction (risk ratio = 0.26, 95% confidence interval [CI] 0.13 to 0.54). The decrease in admissions was found to correlate to greater than $140,000 in annual savings.

Conclusion

Adhering to the revised CPGs has the potential to increase resource availability at a time when nursing shortages and financial instability are impacting health care systems nationwide. No short-term adverse events were noted; however, long-term follow up will be needed.
Microbiome dynamics in rheumatic diseases
Authors: Wang Yiqing , Wang Zijun , Lu Qianjin
Published: November 2023

Purpose of review

Rheumatic disease are characterized by their autoimmune nature, frequently affecting joints, bones, muscles, blood vessels, and connective tissues. The onset of these conditions typically unfolds gradually and subtly. It is noteworthy that individuals with rheumatic diseases often experience shifts in their microbiome, specifically on mucosal surfaces. The purpose of this review is to delve into the intricate interplay between the microbiome, encompassing bacteria, viruses and fungi, and its role in the development and aggravation of various rheumatic diseases. Additionally, it aims to offer insights into microbiome-centered therapeutic approaches for patients in the field of rheumatology.

Recent findings

The advent of next-generation sequencing has significantly improved our understanding of microbiome changes. Numerous studies have consistently revealed a strong link between rheumatism and the microbiome, especially in the oral and gut microbiota.

A deeper comprehension of the microbiome's connection to rheumatism holds potential for enhancing disease diagnosis and treatment. Targeted therapeutic approaches, including probiotics, fecal microbiota transplantation, and combination therapies with medications, offer promising avenues for disease management.
Volumization and Global Biostimulation Using Calcium Hydroxyapatite Filler: A Dual Approach for Hand Rejuvenation
Authors: Adel Noury
Published: November 2023

The present study was performed to evaluate the efficacy of injecting both nondiluted and diluted calcium hydroxyapatite filler into the dorsal surface of the hands in the same session, in addition to repeating the same approach along two different postoperative intervals (2 and 4 months). The study included 40 female patients who complained about the visibility of the veins and tendons, and loss of skin elasticity in their hands. First, 0.5 mL of nondiluted calcium hydroxyapatite filler was injected in each hand using a cannula through a single entry point (total of 1 mL for both hands), and the next step was injecting a diluted calcium hydroxyapatite. The same protocol was repeated at 2 and 4 months postoperative. All patients were followed up at the following intervals for recording their satisfaction score: 14 days, 2 months, 4 months, and 6 months. Postoperative measurements of the patient satisfaction score at 14 days follow-up showed a significant increase in their satisfaction; this was maintained up to 6 months postoperative. Combining both nondiluted and diluted calcium hydroxyapatite filler injections for hand rejuvenation in the same session may provide more stable results than using each formula alone or in different sessions.
Tendon Transfers to Improve Grip and Pinch in Patients with Sporadic Inclusion Body Myositis
Authors: Hua Catherine , Bhai Salman , Cheng Jonathan , Hinojosa Jose , Wilson Lynn , Lubinus Manuel , Bhashyam Abhiram R.
Published: November 2023

Background:

Sporadic inclusion body myositis (sIBM) is a rare and slowly progressive skeletal muscle disease that can cause hand dysfunction, which is a major source of disability. Tendon transfers have been reliably used to improve function in other neuromuscular settings. Given that sIBM patients often present with flexion impairments and mostly functioning extensors, we investigated the potential opportunity for tendon transfer surgery to improve hand dysfunction in sIBM patients.

Methods:

We conducted a scoping review for studies of sIBM and tendon transfers, extracted descriptions of hand function and surgical technique, and recorded results in terms of hand function. We also conducted an institutional review board–approved survey with 470 participants to determine baseline patient-reported function and to determine participant perceptions and expectations for tendon transfer surgery to improve hand function in sIBM.

Results:

We identified three published case reports on tendon transfers in sIBM patients with subjectively improved grip and pinch strength, but standardized measures of hand function or quality-of-life were not reported. Within the surveyed cohort, half of participants reported that they would consider surgery, yet only 8% had been referred to a hand surgeon. Fifty four percent of participants reported that they would consider surgery if there would be 1–2 years of benefit after surgery. All participants who would consider surgery also had significant upper extremity disability.

Discussion:

Tendon transfer surgery has the potential to improve quality-of-life for sIBM patients, and there is significant patient interest in this approach. To objectively assess its efficacy, we propose conducting a surgical trial.
Benefit and harm of waiting time in liver transplantation for HCC
Authors: van der Meeren Pam Elisabeth , de Wilde Roeland Frederik , Sprengers Dave , IJzermans Jan Nicolaas Maria
Published: November 2023

Liver transplantation is the most successful treatment for limited-stage HCC. The waiting time for liver transplantation (LT) can be a critical factor affecting the oncological prognosis and outcome of patients with HCC. Efficient strategies to optimize waiting time are essential to maximize the benefits of LT and to reduce the harm of delay in transplantation. The ever-increasing demand for donor livers emphasizes the need to improve the organization of the waiting list for transplantation and to optimize organ availability for patients with and without HCC. Current progress in innovations to expand the donor pool includes the implementation of living donor LT and the use of grafts from extended donors. By expanding selection criteria, an increased number of patients are eligible for transplantation, which necessitates criteria to prevent futile transplantations. Thus, the selection criteria for LT have evolved to include not only tumor characteristics but biomarkers as well. Enhancing our understanding of HCC tumor biology through the analysis of subtypes and molecular genetics holds significant promise in advancing the personalized approach for patients. In this review, the effect of waiting time duration on outcome in patients with HCC enlisted for LT is discussed.
CAR-T Cell Therapy for Classical Hodgkin Lymphoma
Authors: Katsin Mikalai , Dormeshkin Dmitri , Meleshko Alexander , Migas Alexandr , Dubovik Simon , Konoplya Natalya
Published: November 2023

Classical Hodgkin lymphoma (cHL) is a malignancy characterized by the presence of Hodgkin and Reed-Sternberg (HRS) cells within a complex tumor microenvironment (TME). Despite advances in conventional therapies, a subset of cHL patients experience relapse or refractory disease, necessitating the exploration of novel treatment strategies. Chimeric antigen receptor T cell (CAR-T cell) therapy has emerged as a promising approach for the management of cHL, harnessing the power of genetically modified T cells to recognize and eliminate tumor cells. In this article, we provide an overview of the pathogenesis of cHL, highlighting the key molecular and cellular mechanisms involved. Additionally, we discuss the rationale for the development of CAR-T cell therapy in cHL, focusing on the identification of suitable targets on HRS cells (such as CD30, CD123, LMP1, and LMP2A), clonotypic lymphoma initiating B cells (CD19, CD20), and cells within the TME (CD123, CD19, CD20) for CAR-T cell design. Furthermore, we explore various strategies employed to enhance the efficacy and safety of CAR-T cell therapies in the treatment of cHL. Finally, we present an overview of the results obtained from clinical trials evaluating the efficacy of CAR-T cell therapies in cHL, highlighting their potential as a promising therapeutic option. Collectively, this article provides a comprehensive review of the current understanding of cHL pathogenesis and the rationale for CAR-T cell therapy development, offering insights into the future directions of this rapidly evolving field.
Ultra-widefield Imaging Detection Rate in Identifying Peripheral Retinal Tears in Single versus Montage of Peripheral Sweeps
Authors: Jung Jesse J. , Lim Shen Yi , Chan Xavier , Yee Yeoh Clarice Hsin , Smolyar Karina , Oribello Alexander , Dizon Anne Grace , Hoang Quan V.
Published: November 2023

Purpose:

To compare the detection rate of orthogonal, directed peripheral steering, and auto-montaged images with ultra-widefield (UWF) imaging and the factors influencing the ability to identify retinal breaks.

Design:

Retrospective cohort study

Methods:

376 treatment-naïve eyes (349 patients) that underwent laser retinopexy for retinal breaks between 2015-2021. Pre-treatment UWF orthogonal, peripheral steering, and auto-montage were cross-referenced to scleral-depressed examination to determine whether images successfully visualized all retinal breaks. Total retinal area visualized was divided by its optic disc area (pixels) to calculate relative retinal area (RRA). Potential associations were assessed by linear regression analysis.

Results:

162 eyes (154 patients) met inclusion criteria. Orthogonal, peripheral steering, and auto-montage images showed detection rates of 47.5%, 90.7%, and 80.0% respectively. RRA increased from orthogonal versus montage by 34.7%

26.5% (mean

SD), which increased detection rate by 90.8% (p=0.006). In linear probability models, vertical meridian tears decreased probability of identification in orthogonal, peripheral steering, and auto-montage by -26.6%, -86.2% and -68.7% respectively (p-values<0.001), and horizontal meridian tears increased the probability by 62.2%, 92.9%, and 85.5% (p-values<0.001). Tears posterior to the equator in orthogonal images increased the probability (91.4%,p<0.001). Artifacts such as lids/lashes, reflection, and faceguard decreased the probability in directed peripheral steering by -28.6%, -50.0%, and -66.7% respectively, (p=0.020, p=0.049 and p=0.016).

Conclusions:

Utilizing directed peripheral steering and auto-montage increases RRA and detection rate of identifying peripheral retinal breaks. Tears in horizontal meridians or posterior to the equator increase the probability of identification. Common UWF imaging artifacts can significantly limit the probability of identifying retinal tears.
A novel surgical technique for transscleral Gore-Tex suture-assisted rescue of dislocated CZ70BD intraocular lenses using 27-gauge instrumentation.
Authors: Thanos Aristomenis , Todorich Bozho
Published: November 2023

Background and Objective:

To report a novel technique for refixation of dislocated CZ70BD intraocular lens (IOL).

Methods:

Vitrectomy trocars are placed along the horizontal meridian 5mm apart. A CV-8 Gore-Tex suture is introduced through a bare sclerotomy into the mid vitreous cavity. Under chandelier illumination, a 27G broad platform forceps is threaded through the eyelet of the dislocated CZ70BD IOL. Using another pair of intraocular forceps, the free intraocular end of the Gore-Tex is fed to the broad platform forceps and externalized, thus repositioning the IOL. Particular attention is drawn to pass the suture in an over and under configuration to avoid IOL tilt. An identical procedure is repeated for the other eyelet if the IOL is completely dislocated. The 23 or 25 gauge instruments should not be used for this technique as they do not fit loosely through the eyelets of the IOL.

Results:

Three eyes were successfully operated on using this technique with at least 6 months of follow up. There was significant improvement in best corrected visual acuity (BCVA) after the operation. Postoperative IOL centration and alignment were satisfactory.

Conclusion:

The described surgical technique is effective for transscleral Gore-Tex-assisted refixation of dislocated CZ70BD IOL.
Purposeful Gas Induced Resorption of Submacular Fluid in Macula-off Retinal Detachments (Persimmon Study)
Authors: Adrean Sean D. , Peng Enoch T. , Chaili Siyang , Grant Scott
Published: November 2023

Purpose:

To examine the visual outcomes in patients with macula-off rhegmatogenous retinal detachments (RD) with intentional submacular fluid (SRF) retention following pars plana vitrectomy (PPV) or pars plana vitrectomy/scleral buckle surgery (PPV/SB).

Methods:

Patients with macula-off RDs were included if they had a PPV or PPV/SB without drainage retinotomy or perfluorocarbon liquid (PFCL) to flatten the retina.

Results:

Mean patient age was 65.0 years. The mean presenting vision was 20.0 ETDRS letters. Six months after repair the vision improved to 62.9, 75.4% of patients had 20/40 or better at best achieved VA. Pseudophakic eyes had better vision compared to phakic (p=0.049). Patients younger than 80 had better best achieved vision (p=0.0118) compared to patients 80 or older. Patients with initial vision better than or equal to 20/100 had better best achieved vision (p=0.016) compared to those with initial vision worse than 20/100.

Conclusion:

Leaving SRF after macula-off RD surgery was not detrimental for visual outcomes or anatomic success for RD repair and may lead to better visual outcomes for patients, specifically for those patients younger than 80, that are pseudophakic and have presenting vision 20/100 or better.
Stress and Allostatic Load in Patients With Primary Open Angle Glaucoma
Authors: GC Kiran , Mahalingam Karthikeyan , Gupta Vivek , Angmo Dewang , Gupta Shikha , Dada Tanuj
Published: November 2023

Précis:

This study evaluated the allostatic load (AL) in primary open angle glaucoma (POAG) patients and reported that the AL score was significantly higher in glaucoma patients compared with age-matched controls.

Purpose:

To evaluate the AL in patients with POAG.

Methods:

This case-control study comprised 50 POAG (glaucoma patients) and 50 age-matched controls without glaucoma (controls). AL was estimated based on 13 variables: systolic blood pressure (BP), diastolic BP, homocysteine, triglycerides, total cholesterol, high-density lipoprotein, low-density lipoprotein, body mass index, serum cortisol, glycosylated hemoglobin, albumin, creatinine clearance, and C-reactive protein. High-risk thresholds were determined based on biological cutoffs of each biomarker. One point was assigned for each biomarker reading above cutoff and were summated to obtain AL score; score ≥4 was considered high.

Results:

Mean age of glaucoma patients was 60.82±6.26 and 60.14±6.72 years in controls (P=0.602). All components of AL score (except C-reactive protein) had higher values in glaucoma patients. There was a statistically significant difference in homocysteine (P=0.001), total cholesterol (P=0.037), high-density lipoprotein (P=0.005), and glycosylated hemoglobin (P=0.003). Mean AL score was 4.68±2.09 in glaucoma patients and 3.32±1.34 in controls (P<0.001). There was significant association of high AL score with older age (P=0.006), low socioeconomic status (P=0.020), and glaucoma severity (P=0.001). Negative correlation was seen between AL and retinal nerve fiber layer thickness (Right Eye: r=−0.37, P<0.001; Left Eye: r=−0.298, P<0.001) and visual field mean deviation (Right Eye: r=−0.469, P<0.001; Left Eye: r=−0.520, P<0.001).

Conclusions:

Glaucoma patients exhibited allostatic overload indicating physiological dysregulation to chronic stress although additional research is required to establish causality. A holistic approach with lifestyle modifications to reduce chronic stress should be an integral part of managing glaucoma patients as it would serve both to possibly reduce or prevent disease progression and improve overall health outcomes.
Efficacy and Safety of an Adjustable Glaucoma Drainage Device (eyeWatch System) for Refractory Glaucoma: A 2-Year Prospective Study
Authors: Roy Sylvain , Mermoud André
Published: November 2023

Précis:

In this study, we report a 2-year follow-up after implantation of an adjustable glaucoma drainage device combined with a novel orbital filtering plate. The IOP was efficiently controlled postoperatively with limited complications and an excellent safety profile.

Purpose:

To report the clinical results at 2 years after implantation of an eyeWatch (eW) system, which comprises an adjustable glaucoma drainage device (eW implant) combined with a novel orbital filtering plate (eyePlate), in refractory glaucoma.

Patients and Methods:

Monocentric, prospective, noncomparative clinical trial. Patients suffering from refractory glaucoma after several failed surgeries were operated using the eW system. The primary outcome was the success rate, defined as an IOP ≤18 mm Hg and reduction of more than 20% from baseline, IOP ≥6 mm Hg. Secondary outcomes were mean IOP, visual acuity, the number of antiglaucoma medications, and the number and type of complications.

Results:

Forty-two eyes from 42 patients were included. The mean follow-up time was 22.0±4.0 months. The mean baseline IOP decreased from 23.2±7.2 mm Hg before surgery to 11.9±4.4 mm Hg at 12 months (P<0.001) and 11.5±3.0 at 24 months. The mean number of glaucoma medications decreased from 2.9±0.9 before surgery to 0.7±0.9 at 12 months (P<0.001) and 1.0±0.9 at 24 months. The qualified success rate was 93% at 12 months and 90% at 24 months whereas the complete success rate was 46% and 40% at 12 and 24 months, respectively. Complications occurred in 7 patients.

Conclusions:

Implantation of the eW system effectively lowered IOP and reduced glaucoma medications for a 2-year period in patients who had previously failed glaucoma surgery. Persistent hypotony was not observed and the number of complications was low.
Bright Red Papules Do Not Always Have a Bad Prognosis
Authors: Hilts Alexis , Powers Colleen D. , Brodell Robert T. , Nahar Vinayak K.
Published: November 2023

Teledermatology can be used to diagnose dermatologic conditions using telecommunication technology. This is a case of a cherry hemangioma diagnosed using teledermatology.
A Survey of the Prevalence of Impostor Phenomenon Among US Entry-Level Doctor of Physical Therapy Students
Authors: Young Allison , Handlery Kaci , Kahl Dana , Handlery Reed , James Dawn
Published: November 2023

Introduction.

Individuals experiencing impostor phenomenon (IP) report feelings of intellectual phoniness and are unable to internalize their successes. Students experiencing IP may incur barriers to success in their educational and professional careers. The purpose of this study was to investigate the prevalence of IP in entry-level, physical therapist (PT) education programs in the United States.

Review of the Literature.

The prevalence of IP among other students of health care professions has been established. No previous study has investigated the prevalence of IP in Doctor of Physical Therapy (DPT) students.

Subjects.

Five hundred ninety-three US-based, entry-level, DPT students were recruited in the study.

Methods.

An anonymous, electronic survey of demographic data and the Clance Impostor Phenomenon Scale (CIPS) were distributed. Doctor of Physical Therapy students who scored ≥ 62 on the CIPS demonstrated feelings of IP.

Results.

Four hundred thirty-nine (74.03%) respondents demonstrated feelings of IP. Female students (78.9%) experienced greater feelings of IP than male students (59.7%). A smaller proportion of African Americans (59%) demonstrated feelings of IP compared with students of other races (75.1%), although this association was no longer significant when considering gender.

Discussion and Conclusion.

Nearly three-quarters of the DPT students enrolled in US-based, entry-level PT education programs who participated in this study met the criteria for IP, with female students more likely to report IP compared with male students. Doctor of Physical Therapy students reported lack of resources or decreased awareness of resources to support IP. Physical therapist education programs should consider identifying students with IP and develop methods to support student success.
Therapeutic anticoagulation in patients with acute pancreatitis and splanchnic vein thrombosis: a best evidence topic
Authors: Redman Ishtar , Panahi Pedram , Bananis Kyriakos , Drymousis Panagiotis
Published: November 2023

A best evidence topic in general surgery was written according to a structured protocol. The clinical question addressed was: in adult patients with splanchnic vein thrombosis in acute pancreatitis, would administration of therapeutic anticoagulation be advisable considering the rates of vessel recanalization and bleeding complications? Four hundred twenty-four papers were found on Ovid Embase and Medline whilst 222 were found on PubMed using the reported literature search. From these, five articles represented the best evidence to the clinical question. The authors, publication dates, countries, patient groups, study outcomes, and results of these papers were tabulated. There were three systematic reviews with meta-analyses, one systematic review without meta-analysis and one randomized, retrospective study. The authors conclude that among patients with splanchnic vein thrombosis in the context of acute pancreatitis, therapeutic anticoagulation improved the rates of recanalization without increasing the risk of bleeding complications. However, there remains a need for randomized studies to address this clinical dilemma to further increase the quality of available evidence.
Immunological outcomes of autologous hematopoietic stem cell transplantation for multiple sclerosis: a systematic review
Authors: Sai Santhosha Mrudula Alla , Avula Naga L.P. , Ahmed Sanah Kauser , Salian Rishabh B. , Alla Deekshitha , Jagannath Preethi , Polasu Sri S.S.P. , Rudra Pranathi , Issaka Yussif , Khetan Moksh S. , Gupta Trisha
Published: November 2023

Background:

Autologous hematopoietic stem cell transplantation (AHSCT) is an extensive procedure that allows for the depletion of the immune system and its restoration from hemopoietic stem cells. The approach has been modified for the treatment of severe immune-mediated illnesses, including multiple sclerosis (MS), after being initially devised for the treatment of hematological malignancies.

Objective:

This systematic review aims to determine and consolidate the information on the short-term and long-term immunological effects of AHSCT on the cellular level in MS patients.

Methods:

The PubMed, Scopus, and Web of Science servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed.

Results:

A total of 17 studies (10 clinical trials, 6 cohort studies, and 1 case–control study) were included in the final analysis, and 383 MS patients were analyzed. A significant decline in the cell count of CD4 T cells was reported when compared to the CD8 T cells, B cells, and NK cells. B cell count returned to baseline in 71.4% of the studies at the end of 6 months. The NK cell count was found to be above the baseline in 62.5% of studies.

Conclusion:

AHSCT has been proven to be one of the most effective treatment modalities for MS in recent studies. However, debilitating complications due to immunological outcomes of the procedure have led to increased morbidity. Further research into this domain will help boost the success rate and efficacy of AHSCT.