bluuebunny/crossref_metadata_2025 huggingface dataset:
Radiographic Edema Is a Predictor of de Quervain's Tenosynovitis
Authors: Kwan Stephanie A. , Massaglia Joseph E. , Aita Daren J. , Matzon Jonas L. , Rivlin Michael
Published: October 2023

Background de Quervain's tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians.

Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions.

Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior–posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively.

Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%.

Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery.

Level of Evidence Level IV, diagnostic study.
Platelet Contributions to the (Pre)metastatic Tumor Microenvironment
Authors: Roweth Harvey G.
Published: October 2023

Alongside their conventional roles in thrombosis and hemostasis, platelets have long been associated with nonhemostatic pathologies, including tumor cell metastasis. Numerous mechanistic studies have since demonstrated that the direct binding of platelets to intravascular tumor cells promotes key hallmarks of metastasis, including survival in circulation and tumor cell arrest at secondary sites. However, platelets also interact with nonmalignant cells that make up the stromal and immune compartments within both primary and metastatic tumors. This review will first provide a brief historical perspective on platelet contributions to metastatic disease before discussing the emerging roles that platelets play in creating microenvironments that likely support successful tumor cell metastasis.
Electron spin resonance in emerging spin-driven applications: Fundamentals and future perspectives
Authors: Polash Md Mobarak Hossain , Smirnov Alex I. , Vashaee Daryoosh
Published: October 2023

Spin, the intrinsic angular momentum of an electron, is increasingly being recognized as a versatile tool in the development of next-generation technologies, including quantum computing, sensing, and communication, which exploit quantum phenomena. The burgeoning theoretical understanding coupled with technological advancements have catalyzed research efforts aimed at controlling and manipulating the optical, electrical, magnetic, and thermal properties of materials through the modulation of spin states. Among the myriad of techniques available for investigating these spin-dependent properties, Electron Spin Resonance (ESR), sometimes referred to as electron paramagnetic resonance, stands out as one of the most direct and potent methods to probe electron spin dynamics irrespective of the material environment. ESR furnishes insightful data on the states of individual spins and clusters, spin coherence via relaxation time measurements, and inter-spin distances from spin–spin interaction measurements. Additionally, ESR facilitates the manipulation of spin systems by tailoring the Zeeman energy through the modulation of the external magnetic field, and critically, by the remote manipulation of spins via the application of microwave pulses at resonance frequencies. Modern ESR experimental setups are versatile and can be employed across a wide temperature spectrum—from a few Kelvin, where quantum effects are pronounced, to room temperature and beyond. This adaptability enhances the utility of ESR in investigating the spin-dependent properties in condensed matter systems. Notwithstanding the tremendous potential and advantages that ESR offers, it remains underutilized, especially when compared to inelastic neutron scattering (INS) and nuclear magnetic resonance, despite the latter being more expensive and INS being less accessible. In this review, we elucidate the fundamental principles of ESR, with an emphasis on magnetic and spin interactions in solids, and explore the potential of ESR in advancing the understanding of spin properties across a diverse array of materials science disciplines. We commence with a concise introduction to spin-related physics, followed by the application of ESR in characterizing spin systems. As such, this review aims to serve as a valuable resource for a broad audience, ranging from novices to experts, who are keen on unraveling spin phenomena and dynamics in materials science and condensed matter physics.
All polymer microfluidic chips—A fixed target sample delivery workhorse for serial crystallography
Authors: Gu Kevin K. , Liu Zhongrui , Narayanasamy Sankar Raju , Shelby Megan L. , Chan Nicholas , Coleman Matthew A. , Frank Matthias , Kuhl Tonya L.
Published: October 2023

The development of x-ray free electron laser (XFEL) light sources and serial crystallography methodologies has led to a revolution in protein crystallography, enabling the determination of previously unobtainable protein structures and near-atomic resolution of otherwise poorly diffracting protein crystals. However, to utilize XFEL sources efficiently demands the continuous, rapid delivery of a large number of difficult-to-handle microcrystals to the x-ray beam. A recently developed fixed-target system, in which crystals of interest are enclosed within a sample holder, which is rastered through the x-ray beam, is discussed in detail in this Perspective. The fixed target is easy to use, maintains sample hydration, and can be readily modified to allow a broad range of sample types and different beamline requirements. Recent innovations demonstrate the potential of such microfluidic-based fixed targets to be an all-around “workhorse” for serial crystallography measurements. This Perspective will summarize recent advancements in microfluidic fixed targets for serial crystallography, examine needs for future development, and guide users in designing, choosing, and utilizing a fixed-target sample delivery device for their system.
On the momentum resolution limit in solving the discrete Wigner transport equation
Authors: Kim Kyoung-Youm , Kim Jong-Ryeol
Published: October 2023

The Wigner transport equation can take quantum-mechanical effects into account via the Wigner potential performing the non-local potential correlation. The discretization of the Wigner potential in the phase space makes the maximum correlation length finite and inversely proportional to the grid size (or resolution) in the momentum space (Δk). It has been known that the use of too small Δk leads to unphysical simulation results and there has been a lower bound called the momentum resolution limit for getting physically correct results. Here, we show that these numerical artifacts result from the abrupt regime change (quantum to classical or vice versa) across the contact between the simulated device and its boundary. We also demonstrate that its effect can be mitigated by introducing non-rectangular window functions to the Wigner potential.
Effect of source–drain contact and channel length on the performance of vertical thin-film transistors
Authors: Yin Xue-Mei , Lin De-Lang , Yan Yu-Pei , Li Yi , Ma Wei-Min
Published: October 2023

Vertical thin-film transistors (V-TFTs) with an InSnO-stabilized ZnO channel were fabricated. The vertical architecture enables devices with submicron channel lengths (≤500 nm) to afford delivering drain current greatly exceeding that of conventional planar TFTs. Due to the submicron length of the V-TFT channel, an on/off state current higher than 107 can be achieved even with a drain voltage of 0.01 V, and the subthreshold swing was kept in the tens of mV/dec range owing to the efficacious device preparation. In order to understand the influence of structures on the device performance, the source–drain (S/D) contact and the channel length of V-TFTs were designed and studied. The results show that the increase in the contact area between the active layer and the S/D region can reduce the S/D contact resistance, thus affecting the drain current across the threshold region. When the channel length is shortened to a deep submicron size, the electrostatic coupling between the source and drain electrodes will lead to a decrease in the S/D barrier. This leads to the leakage-induced barrier reduction effect of V-TFTs.
Quantum generative adversarial networks based on a readout error mitigation method with fault tolerant mechanism
Authors: Zhao 赵 Run-Sheng 润盛 , Ma 马 Hong-Yang 鸿洋 , Cheng 程 Tao 涛 , Wang 王 Shuang 爽 , Fan 范 Xing-Kui 兴奎
Published: October 2023

Readout errors caused by measurement noise are a significant source of errors in quantum circuits, which severely affect the output results and are an urgent problem to be solved in noisy-intermediate scale quantum (NISQ) computing. In this paper, we use the bit-flip averaging (BFA) method to mitigate frequent readout errors in quantum generative adversarial networks (QGAN) for image generation, which simplifies the response matrix structure by averaging the qubits for each random bit-flip in advance, successfully solving problems with high cost of measurement for traditional error mitigation methods. Our experiments were simulated in Qiskit using the handwritten digit image recognition dataset under the BFA-based method, the Kullback–Leibler (KL) divergence of the generated images converges to 0.04, 0.05, and 0.1 for readout error probabilities of p = 0.01, p = 0.05, and p = 0.1, respectively. Additionally, by evaluating the fidelity of the quantum states representing the images, we observe average fidelity values of 0.97, 0.96, and 0.95 for the three readout error probabilities, respectively. These results demonstrate the robustness of the model in mitigating readout errors and provide a highly fault tolerant mechanism for image generation models.
Ultralow-temperature heat transport study of noncentrosymmetric superconductor CaPtAs
Authors: Wan 万 Yimin 一民 , Cheng 程 Erjian 二建 , Chen 陈 Yuxin 宇鑫 , Zhao 赵 Chengcheng 成成 , Tu 涂 Chengpeng 成鹏 , Dai 戴 Dongzhe 东喆 , Yang 杨 Xiaofan 小帆 , Xin 辛 Lu 路 , Xie 谢 Wu 武 , Yuan 袁 Huiqiu 辉球 , Li 李 Shiyan 世燕
Published: October 2023

The noncentrosymmetric superconductor CaPtAs with time-reversal symmetry breaking in its superconducting state was previously proposed to host nodal superconductivity. Here, by employing ultralow-temperature thermal conductivity measurement on CaPtAs single crystal, we study its superconducting gap structure. A negligible residual linear term of thermal conductivity (κ
0/T) in zero magnetic field and the field dependence of κ
0/T indicate that CaPtAs has multiple superconducting gaps with a dominant s-wave component. This is consistent with recent nuclear quadrupole resonance measurements on CaPtAs. Our work puts a strong constraint on the theories to describe the superconducting pairing symmetry of CaPtAs.
Constraining the Orbital Inclination and Companion Properties of Three Black Widow Pulsars Detected by FAST
Authors: Du 杜 Ze-Xin 泽昕 , Yu 俞 Yun-Wei 云伟 , Chen A-Ming , Wang 王 Shuang-Qiang 双强 , Zhou 周 Xia 霞 , Zheng 郑 Xiao-Ping 小平
Published: October 2023

Black widows (BWs) are millisecond pulsars ablating their companion stars. The out-flowing material from the companion can block the radio emission of the pulsar, resulting in eclipses. In this paper, we construct a model for the radio eclipse by calculating the geometry of the bow shock between the winds of the pulsar and companion, where the shock shapes the eclipsing medium but had not been described in detail in previous works. The model is further used to explain the variations of the flux density and dispersion measure of three BW pulsars (i.e., PSR B1957+20, J2055+3829, and J2051−0827) detected by the Five-hundred-meter Aperture Spherical radio Telescope. Consequently, we constrained the parameters of the three BW systems such as the inclination angles and true anomalies of the observer as well as the mass-loss rates and wind velocity of the companion stars. With the help of these constraints, it is expected that magnetic fields of companion stars and even masses of pulsars could further be determined as some extra observation can be achieved in the future.
On the Nature of Long Period Radio Pulsar GPM J1839-10: Death Line and Pulse Width
Authors: Tong H.
Published: October 2023

Recently another long period radio pulsar GPM J1839−10 has been reported, similar to GLEAM-X J162759.5−523504.3. Previously, the energy budget and rotational evolution of long period radio pulsars had been considered. This time, the death line and pulse width for neutron star and white dwarf pulsars are investigated. The pulse width is included as the second criterion for neutron star and white dwarf pulsars. It is found that: (1) PSR J0250+5854 and PSR J0901−4046 etc. should be normal radio pulsars. They have narrow pulse width and they lie near the radio emission death line. (2) The two long period radio pulsars GLEAM-X J162759.5−523504.3 and GPM J1839−10 are unlikely to be normal radio pulsars. Their possible pulse width is relatively large. They lie far below the fiducial death line on the

P
−

P

̇

diagram. (3) GLEAM-X J162759.5−523504.3 and GPM J1839−10 may be magnetars or white dwarf radio pulsars. At present, there are many parameters and uncertainties in both of these possibilities.
Simulation-based study of noise, vibration, and harness of BLDC motor for energy level variation with frequency
Authors: Kardile Balasaheb Annasaheb , Pathan Khizar Ahmed
Published: October 2023

The energy spectrum measurements in noise, vibration, and harness analysis with power spectrum response is a very ancient concept. The work and energy approaches for analyzing Noise, Vibration, and Harmonics (NVH) features are increasing rapidly in recent years. The primary focus is on evaluating imparted energy due to the NVH using an FFT spectrum against the input energy in motors. The simulation depicts the input energy spectra of the kinetic energy, absorbed energy, and dissipated energy very clearly. Earlier the smoothed Fourier amplitude spectrum approach was used for plotting the energy dissipation due to the NVH effect. However, most of the part of accountable energy goes to waste with noise, vibration, and harmonics generated due to harness in motor design. This experiment is conducted in support of Sir Nikola Tesla’s statement “If you wish to understand the universe think in terms of energy, frequency, and vibration”. The ripples an induced in phase current because of the step change of the speed. The predominant frequency in phase current waveform creates the collapsing vibratory waves that create the sound. Sound frequencies above 20 dB are considered unwanted sound known as noise. The energy level variation with NVH influence in BLDCM is measurable for its performance analysis. This research can be further enhanced by designing NVH-free BLDC motors.
A short proof of a strong form of the three dimensional Gaussian product inequality
Authors: Herry Ronan , Malicet Dominique , Poly Guillaume
Published: October 2023

We prove a strong form of the Gaussian product conjecture in dimension three. Our purely analytical proof simplifies previously known proofs based on combinatorial methods or computer-assisted methods, and allows us to solve the case of any triple of even positive integers which remained open so far.
Erythropoietic protoporphyria and afamelanotide: a patient’s perspective
Authors: O’Reilly Marese , McGuire Vicky A , Dawe Robert S
Published: October 2023

The patient explores the profound impact of erythropoietic protoporphyria (EPP) on her life to date. The clinician’s comment reviews the symptoms and diagnostic criteria for EPP, as well as the novel treatment afamelanotide for EPP.
Parallel evolution of the G protein-coupled receptor GrlG and the loss of fruiting body formation in the social amoeba Dictyostelium discoideum evolved under low relatedness
Authors: Walker Laura M , Sherpa Rintsen N , Ivaturi Sindhuri , Brock Debra A , Larsen Tyler J , Walker Jason R , Strassmann Joan E , Queller David C
Published: October 2023

Aggregative multicellularity relies on cooperation among formerly independent cells to form a multicellular body. Previous work with Dictyostelium discoideum showed that experimental evolution under low relatedness profoundly decreased cooperation, as indicated by the loss of fruiting body formation in many clones and an increase of cheaters that contribute proportionally more to spores than to the dead stalk. Using whole-genome sequencing and variant analysis of these lines, we identified 38 single nucleotide polymorphisms in 29 genes. Each gene had 1 variant except for grlG (encoding a G protein-coupled receptor), which had 10 unique SNPs and 5 structural variants. Variants in the 5′ half of grlG—the region encoding the signal peptide and the extracellular binding domain—were significantly associated with the loss of fruiting body formation; the association was not significant in the 3′ half of the gene. These results suggest that the loss of grlG was adaptive under low relatedness and that at least the 5′ half of the gene is important for cooperation and multicellular development. This is surprising given some previous evidence that grlG encodes a folate receptor involved in predation, which occurs only during the single-celled stage. However, non-fruiting mutants showed little increase in a parallel evolution experiment where the multicellular stage was prevented from happening. This shows that non-fruiting mutants are not generally selected by any predation advantage but rather by something—likely cheating—during the multicellular stage.
Cannabinoids function in defense against chewing herbivores in Cannabis sativa L.
Authors: Stack George M , Snyder Stephen I , Toth Jacob A , Quade Michael A , Crawford Jamie L , McKay John K , Jackowetz John Nicholas , Wang Ping , Philippe Glenn , Hansen Julie L , Moore Virginia M , Rose Jocelyn K C , Smart Lawrence B
Published: October 2023

In the decades since the first cannabinoids were identified by scientists, research has focused almost exclusively on the function and capacity of cannabinoids as medicines and intoxicants for humans and other vertebrates. Very little is known about the adaptive value of cannabinoid production, though several hypotheses have been proposed including protection from ultraviolet radiation, pathogens, and herbivores. To test the prediction that genotypes with greater concentrations of cannabinoids will have reduced herbivory, a segregating F2 population of Cannabis sativa was leveraged to conduct lab- and field-based bioassays investigating the function of cannabinoids in mediating interactions with chewing herbivores. In the field, foliar cannabinoid concentration was inversely correlated with chewing herbivore damage. On detached leaves, Trichoplusia ni larvae consumed less leaf area and grew less when feeding on leaves with greater concentrations of cannabinoids. Scanning electron and light microscopy were used to characterize variation in glandular trichome morphology. Cannabinoid-free genotypes had trichomes that appeared collapsed. To isolate cannabinoids from confounding factors, artificial insect diet was amended with cannabinoids in a range of physiologically relevant concentrations. Larvae grew less and had lower rates of survival as cannabinoid concentration increased. These results support the hypothesis that cannabinoids function in defense against chewing herbivores.
A Priori Estimates for Finite-Energy Sign-Changing Blowing-Up Solutions of Critical Elliptic Equations
Authors: Premoselli Bruno
Published: October 2023

We prove sharp pointwise blow-up estimates for finite-energy sign-changing solutions of critical equations of Schrödinger–Yamabe type on a closed Riemannian manifold $(M,g)$ of dimension $n \ge 3$. This is a generalisation of the so-called $C^{0}$-theory for positive solutions of Schrödinger–Yamabe-type equations. To deal with the sign-changing case, we develop a method of proof that combines an a priori bubble-tree analysis with a finite-dimensional reduction, and reduces the proof to obtaining sharp a priori blow-up estimates for a linear problem.
The influence of habitat conditions on abundance and selected individual traits of Arum alpinum in the communities Populetum albae and Tilio cordatae–Carpinetum betuli (Western Carpathians)
Authors: Wójcik Tomasz , Kostrakiewicz-Gierałt Kinga
Published: October 2023

Studies of selected habitat conditions, as well as spatiotemporal variability of the number and selected traits of individuals of the species Arum alpinum were carried out in 2020–2021 in the foothills of the Western Carpathians. The investigations were conducted in permanent patches located in the Golesz nature reserve (Patch I), near the village of Markowce (Patch II), in the Kozigarb nature reserve (Patch III), and near the village of Żółków (Patch IV). Patches I and III were established in a Tilio cordatae–Carpinetum betuli oak–hornbeam forest with undergrowth dominated by low-growth vegetation with narrow leaves, whereas Patches II and IV were established in a Populetum albae riparian forest with undergrowth dominated by broad-leaved species. The most abundant population of A. alpinum was noted in Patch I, but substantial numbers of both vegetative and reproductive individuals were also present in Patches II and IV. The occurrence of temporal variability of individual traits increased from its lowest level in Patch IV, through Patches I and II, to its highest level in Patch III. The significant positive correlation in all populations between length of petioles and blade dimensions, as well as between length of generative stems and infructescence traits confirmed previous findings. Moreover, we showed that A. alpinum was not closely affiliated with a specific forest community. Significant shading and moist nutrient-rich soils are suitable for this species, while dry soils and excessive insolation may limit the flowering and fruiting of individuals.
The WISDOM of power spectra: how the galactic gravitational potential impacts a galaxy’s central gas reservoir in simulations and observations
Authors: Gensior Jindra , Davis Timothy A , Bureau Martin , Kruijssen J M Diederik , Cappellari Michele , Ruffa Ilaria , Williams Thomas G
Published: October 2023

Observations indicate that the central gas discs are smoother in early-type galaxies than their late-type counterparts, while recent simulations predict that the dynamical suppression of star formation in spheroid-dominated galaxies is preceded by the suppression of fragmentation of their interstellar media. The mass surface density power spectrum is a powerful tool to constrain the degree of structure within a gas reservoir. Specifically here, we focus on the power spectrum slope and aim to constrain whether the shear induced by a dominant spheroidal potential can induce sufficient turbulence to suppress fragmentation, resulting in the smooth central gas discs observed. We compute surface density power spectra for the nuclear gas reservoirs of fourteen simulated isolated galaxies and twelve galaxies observed as part of the mm-Wave Interferometric Survey of Dark Object Masses (WISDOM) project. Both simulated and observed galaxies range from disc-dominated galaxies to spheroids, with central stellar mass surface densities, a measure of bulge dominance, varying by more than an order of magnitude. For the simulations, the power spectra steepen with increasing central stellar mass surface density, thereby clearly linking the suppression of fragmentation to the shear-driven turbulence induced by the spheroid. The WISDOM observations show a different (but potentially consistent) picture: while there is no correlation between the power spectrum slopes and the central stellar mass surface densities, the slopes scatter around a value of 2.6. This is similar to the behaviour of the slopes of the simulated galaxies with high central stellar mass surface densities, and could indicate that high shear eventually drives incompressible turbulence.
Planet migration in massive circumbinary discs
Authors: Teasdale Matthew , Stamatellos Dimitris
Published: October 2023

Most stars are in multiple systems, with the majority of those being binaries. A large number of planets have been confirmed in binary stars and, therefore, it is important to understand their formation and dynamical evolution. We perform simulations to investigate the migration of wide-orbit giant planets (semimajor axis 100 au) in massive circumbinary discs (mass $0.1\, {\rm M}_{\odot }$) that are marginally gravitationally unstable, using the three-dimensional Smoothed Particle Hydrodynamic code seren. We vary the binary parameters to explore their effect on planet migration. We find that a planet in a massive circumbinary disc initially undergoes a period of rapid inward migration before switching to a slow outward migration, as it does in a circumstellar disc. However, the presence of the binary enhances planet migration and mass growth. We find that a high binary mass ratio (binary with equal mass stars) results in more enhanced outward planet migration. Additionally, larger binary separation and/or higher binary eccentricity results to a faster outward planet migration and stronger planet growth. We conclude that wide-orbit giant planets attain wider final orbits due to migration around binary stars than around single stars.
On the damping of tidally driven oscillations
Authors: Dewberry Janosz W , Wu Samantha C
Published: October 2023

Expansions in the oscillation modes of tidally perturbed bodies provide a useful framework for representing tidally induced flows. However, recent work has demonstrated that such expansions produce inaccurate predictions for secular orbital evolution when mode damping rates are computed independently. We explore the coupling of collectively driven modes by frictional and viscous dissipation, in tidally perturbed bodies that are both non-rotating and rigidly rotating. This exploration leads us to propose an alternative approach to treating the damping of tidally driven oscillations that accounts for dissipative mode coupling, but which does not require any information beyond the eigenfunctions and eigenfrequencies of adiabatic modes.
Calcinosis in systemic sclerosis
Authors: Davuluri Srijana , Lood Christian , Chung Lorinda
Published: October 2023

Purpose of review

To provide updated information on the prevalence, pathogenesis, diagnostics, and therapeutics of calcinosis cutis associated with systemic sclerosis (SSc).

Recent findings

Observational studies show ethnic and geographical differences in the prevalence of calcinosis. In addition to clinical and serological associations, biochemical studies and in-vivo models have attempted to explain theories behind its pathogenesis, including prolonged state of inflammation, mechanical stress, hypoxia, and dysregulation in bone and phosphate metabolism. Long-term use of proton pump inhibitors may increase the risk for calcinosis in SSc. Few single center observational studies have shown mild benefit with minocycline and topical sodium thiosulfate.

Calcinosis cutis is the deposition of insoluble calcium in the skin and subcutaneous tissues. It affects up to 40% of SSc patients and causes significant morbidity. Long disease duration, features of vascular dysfunction, and osteoporosis have been associated with calcinosis. Altered levels of inorganic pyrophosphate and fibroblast growth factor-23 have been implicated in dysregulated phosphate metabolism that may lead to calcinosis in SSc. Plain radiography can help with diagnosis and quantifying the calcinosis burden. Surgical treatment remains the most effective therapy when feasible. At present, no medical therapies have proven efficacy in large randomized controlled trials.
Rare immune-related adverse events in a patient with metastatic melanoma: a case report highlighting sarcoidosis-like reactions triggered by immune-checkpoint inhibitors
Authors: Cao Yuanzhen , Afzal Muhammad Zubair , Gutmann Edward J. , Shirai Keisuke
Published: October 2023

Pembrolizumab and ipilimumab/nivolumab (ipi/nivo) combination are FDA-approved immune checkpoint inhibitor (ICI) therapies for metastatic melanoma. ICIs could result in various inflammation responses known as immune-related adverse events (IRAEs). We report a patient with metastatic melanoma who developed multiple IRAEs including sarcoidosis-like reaction (SLR), diabetic ketoacidosis (DKA), and worsening hypothyroidism on ICIs. A 71-year-old man with stage IIIC melanoma and lymph node metastasis began adjuvant therapy with pembrolizumab in May 2021. A surveillance positron emission tomography–computed tomography (PET-CT) scan four months later showed diffuse nodal uptake indicating potential metastases although the patient remained asymptomatic. His treatment was temporarily switched to ipi/nivo before biopsy was obtained for definitive diagnosis, which revealed non-caseating granulomas consistent with SLR. After resuming pembrolizumab, he developed DKA and worsening hypothyroidism in November 2021, both of which were attributed to IRAEs. His surveillance PET scan in March 2022 again revealed new hypermetabolic activity in several bones, subcutaneous tissue, and the left inguinal lymph node. Left inguinal node biopsy showed disease recurrence, while biopsies of hypermetabolic subcutaneous nodules and bone demonstrated non-caseating granulomas. Our case described a patient on ICIs who developed several IRAEs. SLR is often asymptomatic but remains a diagnostic challenge due to its indistinguishable appearance on imaging studies compared to metastasis. Better understanding of IRAEs and improved surveillance strategies are needed for optimal patient outcomes.
Pharmacogenetics to prevent hypersensitivity reactions to antiepileptic drugs: is testing performed when indicated?
Authors: Bui Vy L. , Alvarez-Arango Santiago , Stevenson James M.
Published: October 2023

Extensive scientific evidence consistently demonstrates the clinical validity and utility of HLA-B*15:02 pre-screening in averting severe cutaneous adverse reactions (SCARs), namely Stevens-Johnson syndrome and toxic epidermal necrolysis, associated with carbamazepine or oxcarbazepine usage. Current practice guidelines and drug labeling actively advocate for pharmacogenetic pre-screening before initiating these antiepileptic drugs (AED), with particular emphasis on patients of Asian descent. However, there is a potential need to strengthen compliance with these recommendations. This retrospective study aimed to describe the pharmacogenetic pre-screening, documentation, and SCARs incidence for patients of Asian ancestry initiated on carbamazepine or oxcarbazepine at a large Northeastern USA healthcare system. Between 1 July 2016 and August 1, 2021, 27 patients with documented Asian heritage in the electronic health record (EHR) were included. The overall rate of HLA-B*15:02 pre-screening before carbamazepine or oxcarbazepine initiation was 4%. None who underwent pharmacogenetic pre-screening carried the associated HLA-B risk allele, and no SCARs were reported. Notably, pharmacogenetic results were not discretely entered into the EHR, and the results were only found as attached documents in the miscellaneous section of the EHR. There remains a significant opportunity for improving HLA-B*15:02 pre-screening for patients starting carbamazepine and oxcarbazepine to prevent SCARs in the USA.
RETINAL MICROVASCULAR CHANGES AND RISK FOR CORONARY HEART DISEASE: A Systematic Review and Meta-analysis
Authors: Zhang Wenyi , Guo Xinying , Jiang Xue , Liu Jian , Han Xuejie , Guo Caixia
Published: October 2023

Purpose:

To quantify associations between various retinal microvascular changes and the risk for the development of coronary heart disease (CHD).

Methods:

PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched for cohort studies on the association between retinal microvascular changes and incident CHD up to July 31st, 2023. The summary risk estimates were estimated using random-effects models. Subgroup and sensitivity analyses were performed to investigate the potential source of heterogeneity.

Results:

We identified twenty-one studies that met the inclusion criteria of this meta-analysis through database searching. The study yielded significant associations between retinal microvascular changes, including arteriolar narrowing, venular widening, vessel occlusion, and other retinal vascular signs, and the risk of CHD, with pooled adjusted hazard ratios of 1.20 (95% confidence interval [CI]: 1.13-1.27). In gender- and age-stratified analyses, retinal microvascular changes were associated with a greater risk of developing CHD in females and younger adults.

Conclusion:

A range of retinal microvascular changes was associated with the risk of CHD, particularly in females and younger ages. The results of our study support the concept that retinal microvascular abnormalities may be markers for future CHD. Non-invasive retinal microvascular assessments may be helpful in screening patients with increased CHD risk.
High CRP-albumin ratio is associated high thrombus burden in patients with newly diagnosed STEMI
Authors: Kaplangoray Mustafa , Toprak Kenan , Aslan Ramazan , Deveci Edhem , Gunes Ahmet , Ardahanli İsa
Published: October 2023

In patients undergoing primary percutaneous coronary intervention (pPCI) due to ST-segment elevation myocardial infarction (STEMI), an increased intracoronary thrombus burden is a strong predictive factor for adverse cardiovascular events. The C-reactive protein (CRP)-serum albumin (SA) ratio (CAR), used as an inflammatory marker, is closely associated with thrombogenicity. In this study, we investigated the relationship between coronary thrombus burden and CAR in patients undergoing pPCI due to newly diagnosed STEMI. A total of 216 patients who underwent pPCI due to STEMI were retrospectively included for the study. Angiographic thrombus burden was assessed according to thrombolysis in myocardial infarction (TIMI) grading, and those with grade 1, 2, 3 were classified as low thrombus burden (n = 120) and those with grade 4, 5 were classified as high thrombus burden (HTB) (n = 96). CAR was calculated as the ratio of CRP to SA. The average age of the patients was 60 ± 9.8, and the male ratio was 61.1. Compared to the LTB group, the HTB group had higher CAR, age, SYNTAX score, baseline cTnT, peak cTnT, CRP, glucose, WBC, and NLR while the LVEF and SA levels were lower (P < .05). Spearman’s correlation analysis revealed a significant correlation between thrombus burden and CAR. The multivariable logistic regression analysis revealed that CAR (odds ratio: 10.206; 95% confidence interval: 2.987–34.872, P < .001) was a independent risk factor for HTB. According to the receiver operating characteristic (ROC) analysis, when the cutoff value for CAR was taken as ≥1.105 CAR could predict HTB with a sensitivity of 70.8% and specificity of 67.7%. Our data indicate that CAR an independent risk factor for thrombus burden.
Tongxinluo capsule in combination with conventional therapies for stable angina pectoris: A meta-analysis and systematic review
Authors: Feng Ruli , Lin Qian , Wei Dawei , Li Yan , Zhang Rong , Jiang Kaixin , Li Yuxuan , Xie Long , Xia Junyan , Zheng Peixun , Ji Xiang , Wang Wujiao , Qu Xinyan , Gao Qun , Pan Yi , Liu Jing
Published: October 2023

Background:

This study aimed to assess the efficacy and safety of Tongxinluo capsule (TXLC) in combination with conventional therapies for treating stable angina pectoris (SAP) through a comprehensive meta-analysis and systematic review.

Methods:

We conducted a systematic search of the China National Knowledge Infrastructure, Wanfang, VIP, PubMed, Embase, and CENTRAL databases for randomized controlled trials investigating the use of TXLC as adjuvant therapy for SAP published up to June 2023. The Cochrane Handbook was used to evaluate the risk of bias. Meta-analysis was performed using Review Manager 5.4.1, and publication bias was assessed using Begg test and Egger test in the Stata SE 12.0 software. GRADEpro was used to assess the quality of the evidence.

Results:

This meta-analysis included 26 randomized controlled trials with a total of 2352 patients. TXLC co-administration demonstrated significant reduction in angina attack frequency (mean difference (MD) −0.91, 95% confidence interval (CI) −0.97 to −0.84, P < .00001) and duration (MD −1.71, 95% CI −2.24 to −1.19, P < .00001), decreased use of nitroglycerin tablets (MD −6.28, 95% CI −7.16 to −5.41, P < .00001), lowered C-reactive protein (MD −1.19, 95% CI −1.35 to −1.03, P < .00001) and low-density lipoprotein cholesterol levels (MD −0.68, 95% CI −0.86 to −0.51, P < .00001). TXLC co-administration did not increase gastrointestinal reactions (RR 1.17, 95% CI 0.38 to 3.57, P = .78). The Begg test and Egger test results indicated no publication bias. The evidence quality was rated as very low for frequency of angina attack, duration of angina attack, and nitroglycerin usage, and low for C-reactive protein, low-density lipoprotein cholesterol levels, and gastrointestinal reaction events.

Conclusion:

This meta-analysis supports TXLC as a beneficial adjunct treatment for SAP.
Alerting network, cognitive flexibility in children with attention deficit hyperactivity disorder and the moderating effect of neuroticism
Authors: Zhang Xiang , Wang Shaoxia , Liu Qianyun , Wu Chujun , Du Yunyun , Wang Yanrong , Fang Jianqun
Published: October 2023

Attention deficit hyperactivity disorder (ADHD) is a prevalent neurodevelopmental disorder, and cognitive flexibility is a sub-component of executive functioning. Studies have shown impairments in cognitive flexibility in ADHD, which is affected by attentional processes. Personality, as a long-standing trait, has a profound effect on ADHD. However, previous studies have not assessed the relationship between attentional function, personality traits, and cognitive flexibility in children with ADHD. This study explored the association between attention networks, personality, and cognitive flexibility in ADHD, filling a gap in the related field. We expect our findings will provide insights into and clues for the prevention and interventional treatment of ADHD. This study primarily aimed to analyze differences in cognitive flexibility between individuals with ADHD and those without and further examine associations between attention networks, personality, and cognitive flexibility in children with ADHD. Overall, 55 children aged 7 to 11 years diagnosed with ADHD and 40 children without ADHD participated in this study. Cognitive flexibility, personality traits, and attentional networks were assessed using the Wisconsin Card Sorting Test, Eysenck Personality Questionnaire, and Attention Network Test, respectively. Additionally, the association between personality traits and strong attentional functioning and cognitive flexibility was investigated using multiple regression analysis. Children with ADHD had significant deficits in cognitive flexibility. A multiple regression analysis revealed that the alerting effect was highly associated with cognitive flexibility at high levels of neuroticism. This association was not salient in individuals with low levels of neuroticism. This study demonstrated that the ADHD group experienced lower cognitive flexibility than the control group. In addition, we showed the effect of neuroticism and alerting networks on cognitive flexibility. These findings may help psychiatrists provide intervention strategies to mitigate the impairment of social functioning in ADHD with cognitive spirituality deficits.
Upper extremity functions and physical activity in chronic maintenance hemodialysis patients: A case-control study
Authors: Aktas Arslan Fatma Cansu , Demirguc Arzu , Ulug Naime
Published: October 2023

Continuous hemodialysis (HD) treatment causes many complications in patients. The aim of this study is to evaluate the upper extremity functional capacity, physical activity level, and physical functions of patients receiving continuous HD treatment. Fifty HD patients and fifty healthy subjects were included in the study. Hand grip strength with Dynamometer, range of motion of upper extremity with Digital Goniometer, functional level of the upper extremity with the Turkish version of the Shoulder, Arm, and Hand Problems Questionnaire (The DASH-T), physical activity levels with international physical activity questionnaire short form and physical functions with the human activity profile (HAP) were evaluated. The mean grip strength of the subjects in the control group was 23.3 ± 1.44 kg, while the mean grip strength of the HD patients with fistula was 15.75 ± 3.08 kg (P < .05). In all joint range of motion measurements; the values of HD patients were significantly lower than the control group (P < .05). The DASH symptom scores of the individuals in the HD group (mean 19.19 ± 1.41) were significantly higher than the control group (mean 5.75 ± 1.41) (P < .05). The number of individuals with low-level activity in the HD group (72%) was higher than the control group (34%) (P < .01). The maximum activity score score of the HAP (mean 68.7 ± 1.4) and the adjusted activity score of the HAP (mean 42.54 ± 3.02) were lower in the HD group (P < .0001). HD treatment adversely affects hand grip strength, the range of motion, upper extremity functions, physical activity, and physical function levels of the patients.
A Novel Chin-Reductive Drawer Genioplasty Using Subapical and Mandibular Contouring Ostectomy
Authors: Wang Yu , Guo Xiaoshuang , Zhang Dong , Jin Xiaolei
Published: October 2023

As the most prominent feature of the lower face, the chin is crucial to human facial morphology, and plays a large role in contributing to facial attractiveness and harmony. Although an increasing number of genioplasty procedures are being introduced for chin augmentation, chin reduction procedures are rarely performed. Because of the inevitable cervicomental angle widening and relaxation of the floor-of-mouth muscles caused by chin shortening and the elevation of the lower edge of the mandible, chin reduction remains a challenging procedure. The authors’ novel drawer-genioplasty approach involves a flexible chin-reducing procedure using subapical and mandibular contouring ostectomy. This technique can effectively shorten various types of long chin for improved facial proportions and maximize floor-of-mouth muscle protection during surgery, thereby avoiding postoperative submental sagging. Several measures, including the ratio between the lower (subnasale to menton distance) and middle facial heights (glabella to subnasale distance) (R1), the ratio between the anterior midline bone heights of the mandible (stomion to menton distance) and maxilla (subnasale to stomion distance) (R2), and the cervicomental angle, were used to evaluate the outcome of the procedure. Comparing the preoperative and postoperative measures revealed that there was a significant decrease in both R1 (1.25 ± 0.15 versus 1.09 ± 0.12) and R2 (1.94 ± 0.24 versus 1.58 ± 0.11). Although cervicomental angle increased from 107.3 ± 8.2 degrees preoperatively to 112.4 ± 7.0 degrees postoperatively, this value was still within the normal range. In addition to providing effective and significant aesthetic improvements, drawer genioplasty is safe and involves no complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Predictors of Post-switch Viremia in People With HIV on Injectable Cabotegravir/Rilpivirine
Authors: Hill Lucas , Kenney Stephanie , Patel Nimish , Yin Jeffrey , Abulhosn Kari , Karim Afsana , Bamford Laura
Published: October 2023

Background:

Predictors of virologic failure in those receiving long-acting injectable (LAI) cabotegravir/rilpivirine (CAB/RPV) have been evaluated; however, factors associated with low-level viremia, including blips and persistent low-level viremia (pLLV), are not well-described.

Methods:

A retrospective cohort study was performed using data from April 2021 through December 2022. Inclusion criteria included treatment with CAB/RPV for at least 3 months, availability of pre- and postswitch HIV RNA values, HIV RNA value of <200 copies/mL (cpm) at the time of switch to CAB/RPV, and at least 1 postswitch HIV RNA collected >21 days after the start of CAB/RPV. Outcomes included incidence of HIV RNA ≥20, ≥50, and ≥200 cpm after switch and factors associated with detectable HIV RNA after switch.

Results:

The median duration of follow-up among 144 participants was 287 days. After switching to CAB/RPV, occurrences of at least 1 HIV RNA ≥20, ≥50, and ≥200 cpm after switch were 34.7%, 15.3%, and 2.8%, respectively. Those with pLLV before switch were significantly more likely to have detectable HIV RNA after switch [hazard ratio 24.39 (8.71–68.34)], and 44.4% of those with pLLV before switch continued with pLLV after switch to LAI CAB/RPV. Body mass index, late injection, and monthly versus every two-month dosing were not associated with detectable viremia after switch.

Conclusions:

Despite virologic suppression at the time of switch and the perceived adherence benefits, participants still experienced blips or pLLV after switch to LAI CAB/RPV. Having detectable HIV RNA on oral therapy before switch was associated with detectable HIV RNA after switching.
Reconstruction of Full-Thickness Helical Defects Using a Superior Auricular Artery-Based Postauricular Chondrocutaneous Flap
Authors: Evin Nuh , Evin Seyda Guray
Published: October 2023

Background

The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes. The aim of this study is to present a new design for a postauricular chondrocutaneous flap to reconstruct the 3-dimensional curve and the folded structures in full-thickness helical defects.

Methods

Nineteen patients with full-thickness helical defects were treated with the superior pedicle chondrocutaneous flap based on the superior auricular artery. The flap was designed on the postauricular area and comprised 3 sections, namely, deepithelialized, chondrocutaneous, and cutaneous sections (proximal to distal). Levels of patient's satisfaction on the final shape and auricular symmetry, and tissue compatibility between the flap and surrounding tissues were evaluated by the patients and objective observers.

Results

The overall dimensions, projections, and curved structures of the defective helix maintained a smooth and contiguous appearance without asymmetry, notching, or trap-door deformities. The color, texture, and thickness of the flaps matched well with the adjacent auricles, and there was a moderate positive correlation between patient (9.47 ± 0.51) and observer (8.68 ± 0.63) correlation scores (r = 0.7485). The vast majority of the patients were very satisfied with the surgical outcome, and there was a statistically significant improvement in patient satisfaction (mean preoperative score, 1.26 ± 0.45; mean 12-month score, 4.79 ± 0.42; P < 0.00001).

Conclusions

Reconstruction of full-thickness helical defects requires “like tissue” characteristics and 3-dimensional cartilage support to avoid depression and notch deformities. The postauricular chondrocutaneous flap based on the superior auricular artery was shown to preserve the helical curve and folded sulcus, retain the size and subunits of the auricle, and ensure a color, texture, and thickness match between the flap and the adjacent tissues.