bluuebunny/crossref_metadata_2025 huggingface dataset:
The MeerKAT view on Galactic supernova remnants
Authors: Loru S. , Ingallinera A. , Umana G. , Bordiu C. , Buemi C. , Bufano F. , Cavallaro F. , Leto P. , Riggi S. , Trigilio C. , Thompson M. A. , Cotton W. D. , Goedhart S. , Anderson L. D. , Chibueze J. O.
Published: November 2024

Context. The integrated radio spectrum of supernova remnants (SNRs) and the spatial variation of the spectral indices across these extended sources are powerful tools for studying the shocks and particle acceleration processes occurring in different SNR regions. Characterization of these processes requires sensitive flux density measurements and high-resolution images, which are not always available due to observing difficulties.

Aims. We want to show the potentiality of the high-resolution SARAO MeerKAT legacy Galactic Plane Survey (SMGPS) images regarding the morphological and spectral characterization of 29 known galactic SNRs.

Methods. We used the SMGPS data at 1.284 GHz coupled with data from the GaLactic and Extragalactic All-sky Murchison Widefield Array (GLEAM) survey (0.072–0.231 GHz) to characterize the integrated spectrum of each source and search for spatial spectral variation through analysis of sensitive spectral index maps.

Results. We were able to redefine the exact morphology of four SNRs (G024.7–00.6, G051.4+00.7, G348.7+0.3, and G351.9+00.1), distinguishing them from unrelated sources or identifying new emission regions associated with them and never observed before. In many other cases, we identified in the SMGPS images several H II regions overlaid with the remnants, and we were able to estimate their spectral contribution through inspection of the spatial variation of the spectral indices across the remnants. The integrated spectral indices show a more uniform distribution with respect to what is obtained by considering the values reported in the literature.

Conclusions. We show that new sensitive and high-resolution data are crucial to firmly constraining both the integrated and spatially resolved spectrum of SNRs, especially for the less studied objects of the southern hemisphere. The comparison of our SMGPS-GLEAM spectral index maps with IR, molecular, and γ-ray images allowed us to investigate the nature of the peculiar remnant regions.
TODDLERS: A new UV-millimeter emission library for star-forming regions
Authors: Kapoor Anand Utsav , Baes Maarten , van der Wel Arjen , Gebek Andrea , Camps Peter , Smith Aaron , Boquien Médéric , Andreadis Nick , Vicens Sebastien
Published: November 2024

Context. The current generation galaxy formation simulations often approximate star formation, making it necessary to use models of star-forming regions to produce observables from such simulations. In the first paper of this series, we introduced TODDLERS, a physically motivated, time-resolved model for UV–millimeter (mm) emission from star-forming regions, implemented within the radiative transfer code SKIRT. In this work, we use the SKIRT-TODDLERS pipeline to produce synthetic observations.

Aims. We aim to demonstrate the potential of TODDLERS model through observables and quantities pertaining to star-formation. An additional goal is to compare the results obtained using TODDLERS with the existing star-forming regions model in SKIRT.

Methods. We calculated broadband and line emission maps for the 30 Milky Way-like galaxies of the Auriga zoom simulation suite at a redshift of zero. Analyzing far-ultraviolet (FUV) and infrared (IR) broadband data, we calculated kiloparsec (kpc)-resolved IR correction factors, kIR, which allowed us to quantify the ratio of FUV luminosity absorbed by dust to reprocessed IR luminosity. Furthermore, we used the IR maps to calculate the kpc-scale mid-infrared (MIR) colors (8 μm/24 μm) and far-infrared (FIR) colors (70 μm/500 μm) of the Auriga galaxies. We used Hα and Hβ line maps to study the Balmer decrement and dust correction. We verified the fidelity of our model’s FIR fine structure lines as star formation rate (SFR) indicators.

Results. The integrated UV-mm spectral energy distributions (SEDs) exhibit higher FUV and near-ultraviolet (NUV) attenuation and lower 24 μm emission compared to the existing star-forming regions model in SKIRT, alleviating tensions with observations reported in earlier studies. The light-weighted mean kIR increases with aperture and inclination, while its correlation with kpc-resolved specific star-formation rate (sSFR) is weaker than literature values from resolved SED fitting, potentially due to inaccuracies in local energy balance representation. The kpc-scale MIR-FIR colors show an excellent agreement with local observational data, with anti-correlation degree varying by galaxy morphology. We find that the Balmer decrement effectively corrects for dust, with the attenuation law varying with dust amount. The Hα emission attenuation levels in our models are comparable to those observed in the high-density regions of state-of-the-art radiation hydrodynamical simulations. The FIR fine-structure line emission-based luminosity-SFR relations are consistent with global observational relations, with the [C II] line displaying the best agreement.
Seismic differences between solar magnetic cycles 23 and 24 for low-degree modes
Authors: García R. A. , Breton S. N. , Salabert D. , Tripathy S. C. , Jain K. , Mathur S. , Panetier E.
Published: November 2024

Solar magnetic activity follows regular cycles of about 11 years with an inversion of polarity in the poles every ∼22 years. This changing surface magnetism impacts the properties of the acoustic modes. The acoustic mode frequency shifts are a good proxy of the magnetic cycle. In this Letter we investigate solar magnetic activity cycles 23 and 24 through the evolution of the frequency shifts of low-degree modes (ℓ = 0, 1, and 2) in three frequency bands. These bands probe properties between 74 and 1575 km beneath the surface. The analysis was carried out using observations from the space instrument Global Oscillations at Low Frequency and the ground-based Birmingham Solar Oscillations Network and Global Oscillation Network Group. The frequency shifts of radial modes suggest that changes in the magnetic field amplitude and configuration likely occur near the Sun’s surface rather than near its core. The maximum shifts of solar cycle 24 occurred earlier at mid and high latitudes (relative to the equator) and about 1550 km beneath the photosphere. At this depth but near the equator, this maximum aligns with the surface activity but has a stronger magnitude. At around 74 km deep, the behaviour near the equator mirrors the behaviour at the surface, while at higher latitudes, it matches the strength of cycle 23.
The differential on graph operator R(G)
Authors: Hernández Basilio Ludwin Ali , Macías Jesús Leaños , Cayetano Omar Rosario , Sigarreta Almira José María
Published: November 2024

Let G = (V (G), E(G)) be a simple graph with vertex set V (G) and edge set E(G). Let S be a subset of V (G), and let B(S) be the set of neighbours of S in V (G)∖S. The differential ∂(S) of S is the number |B(S)|−|S|. The maximum value of ∂(S) taken over all subsets S ⊆ V (G) is the differential ∂(G) of G. The graph R(G) is defined as the graph obtained from G by adding a new vertex ve for each e ∈ E(G), and by joining ve to the end vertices of e. In this paper we study the relationship between ∂(G) and ∂(R(G)), and give tight asymptotic bounds for ∂(R(G)). We also exhibit some relationships between certain vertex sets of G and R(G) which involve well known graph theoretical parameters.
Optimal decisions in a capital-constrained supply chain under credit guarantee and revenue-sharing contracts
Authors: Hadi Doulabi Nastaran , Rastegar Mohammad Ali
Published: November 2024

This study proposes a novel Supply Chain Finance scheme (CG-RS), integrating credit guarantees (CG), and revenue-sharing contracts (RS). We analyze a three-party Stackelberg game between a capital-constrained retailer, supplier, and bank. We derived equilibrium strategies under both monopolistic and competitive bank markets to investigate the impact of the CG-RS scheme on the financial performance of each party. From the numerical analysis, we find that all parties can benefit from the CG-RS scheme by mitigating default risk and aligning incentives. The supplier’s guarantee coefficient and the retailer’s initial capital significantly influence the scheme’s outcomes, while the revenue-sharing proportion plays a crucial role in balancing interests. Our findings suggest that the CG-RS scheme offers a promising solution for addressing capital constraints and enhancing supply chain performance.
Digitale Lebensstiltherapie bei Diabetes Typ 2 – die App als
Begleiter
Authors: Voggel Jenny
Published: November 2024

Betroffene mit Typ-2-Diabetes ohne Insulintherapie können sich auf Rezept eine
digitale Gesundheitsanwendung verordnen lassen. Sie umfasst als personalisierte
Lebensstiltherapie Ernährung und Bewegung und integriert auch ein
kontinuierliches Glukosemonitoring (CGM). Studienergebnisse zeigen, dass sich
damit der Langzeitblutzucker (HbA1c) und das Körpergewicht klinisch
relevant verbessern, was das Risiko für Folgeerkrankungen senken kann.
Position Paper of the German Society for Interventional Radiology and Minimally Invasive Therapy (DeGIR) and the German Roentgen Society (DRG) on Structural and Professional Requirements in Interventional Oncology
Authors: Isfort Peter , Sommer Christof M , Bruners Philipp , Maiwald Bettina , Kühn Jens-Peter , Radosa Christoph Georg , Kloeckner Roman , Freyhardt Patrick , Franke Mareike , Moche Michael , Hoffmann Ralf-Thorsten , Nikolaou Konstantin , Mahnken Andreas H. , Katoh Marcus
Published: November 2024

Interventional oncology (IO) employs various techniques to enable minimally invasive, image-guided treatment of tumor diseases with both curative and palliative goals. Additionally, it significantly contributes to managing tumor-related and perioperative complications, offering diverse supportive procedures for patients at all stages of their diseases. The execution of IO procedures places unique demands on the equipment, personnel, and structural organization of radiological clinics, necessitating specific expertise from interventional radiologists.

This position paper aims to comprehensively outline the multifaceted aspects of IO and discuss the requisite criteria for hospitals, radiological clinics, and interventional radiologists (IRs). Furthermore, it underscores overarching considerations of quality assurance that clinics and professional societies should prioritize.

The requirements for hospitals, radiological clinics, and IRs are varied and demand not only a high level of proficiency in performing IO procedures but also in-depth knowledge of the differential therapy for various tumor diseases. This expertise is essential for effectively serving as clinical partners in the interdisciplinary treatment of oncologic patients. Additionally, a thorough understanding and safe handling of ionizing radiation technologies, along with proficiency in radiation protection methods, which are fundamental aspects of radiological specialist training, is crucial for ensuring the safety of IO procedures for both patients and staff. The Deutsche Gesellschaft für Interventionelle Radiologie und minimal-invasive Therapie (DeGIR) and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) have long-established dedicated quality management programs, accrediting radiology clinics and certifying IRs. These initiatives aim to uphold the highest standards of care and meet the quality expectations set by politics in healthcare system, particularly in the realm of interventional radiology.
Machine-Learning Applications in Thrombosis and Hemostasis
Authors: Nilius Henning , Nagler Michael
Published: November 2024

The use of machine-learning (ML) algorithms in medicine has sparked a heated discussion. It is considered one of the most disruptive general-purpose technologies in decades. It has already permeated many areas of our daily lives and produced applications that we can no longer do without, such as navigation apps or translation software. However, many people are still unsure if ML algorithms should be used in medicine in their current form. Doctors are doubtful to what extent they can trust the predictions of algorithms. Shortcomings in development and unclear regulatory oversight can lead to bias, inequality, applicability concerns, and nontransparent assessments. Past mistakes, however, have led to a better understanding of what is needed to develop effective models for clinical use. Physicians and clinical researchers must participate in all development phases and understand their pitfalls. In this review, we explain the basic concepts of ML, present examples in the field of thrombosis and hemostasis, discuss common pitfalls, and present a methodological framework that can be used to develop effective algorithms.
Large language models (LLMs) in radiology exams for medical students: Performance and consequences
Authors: Gotta Jennifer , Le Hong Quang Anh , Koch Vitali , Gruenewald Leon D. , Geyer Tobias , Martin Simon S. , Scholtz Jan-Erik , Booz Christian , Pinto Dos Santos Daniel , Mahmoudi Scherwin , Eichler Katrin , Gruber-Rouh Tatjana , Hammerstingl Renate , Biciusca Teodora , Juergens Lisa Joy , Höhne Elena , Mader Christoph , Vogl Thomas J. , Reschke Philipp
Published: November 2024

The evolving field of medical education is being shaped by technological advancements, including the integration of Large Language Models (LLMs) like ChatGPT. These models could be invaluable resources for medical students, by simplifying complex concepts and enhancing interactive learning by providing personalized support. LLMs have shown impressive performance in professional examinations, even without specific domain training, making them particularly relevant in the medical field. This study aims to assess the performance of LLMs in radiology examinations for medical students, thereby shedding light on their current capabilities and implications.

This study was conducted using 151 multiple-choice questions, which were used for radiology exams for medical students. The questions were categorized by type and topic and were then processed using OpenAIʼs GPT-3.5 and GPT- 4 via their API, or manually put into Perplexity AI with GPT-3.5 and Bing. LLM performance was evaluated overall, by question type and by topic.

GPT-3.5 achieved a 67.6% overall accuracy on all 151 questions, while GPT-4 outperformed it significantly with an 88.1% overall accuracy (p<0.001). GPT-4 demonstrated superior performance in both lower-order and higher-order questions compared to GPT-3.5, Perplexity AI, and medical students, with GPT-4 particularly excelling in higher-order questions. All GPT models would have successfully passed the radiology exam for medical students at our university.

In conclusion, our study highlights the potential of LLMs as accessible knowledge resources for medical students. GPT-4 performed well on lower-order as well as higher-order questions, making ChatGPT-4 a potentially very useful tool for reviewing radiology exam questions. Radiologists should be aware of ChatGPTʼs limitations, including its tendency to confidently provide incorrect responses.
Antithrombotic Agents after Free Tissue Transfer in the Pediatric and Adolescent Population
Authors: Weiss Jakob B.W. , Kollár Branislav , Eisenhardt Steffen U.
Published: November 2024

Background Even for the experienced microsurgeon, free tissue transfer in pediatric patients is challenging, and large patient series remain scarce in the literature. Moreover, the added value of antithrombotic agents in pediatric free tissue transfer remains unclear.

Methods We conducted a retrospective outcome analysis of pediatric free tissue transfer with respect to postoperative antithrombotic treatment at our tertiary academic center. All patients aged 0 to 18 years who underwent free tissue transfer from 1998 to 2022 were included in the study.

Results Seventy patients received 73 free tissue transfers. The most common indications were facial paralysis, trauma, and tumor (49.3, 21.9, and 20.5%, respectively). The most common recipient sites were the head and neck (56.1%) and lower extremity (32.8%). We observed a flap revision rate of 12.5% of the cases and one flap loss (1.4%). A total of 58.9% of the population received postoperative antithrombotic agents. The rate of flap revision surgery was similar (11.6 and 10.0%, respectively), with and without antithrombotic treatment (p > 0.05). There were no major bleeding complications or deep vein thrombosis.

Conclusion The antithrombotic treatment did not seem to affect the flap revision rate or the bleeding complications in our cohort. Hence, the data do not support the routine administration of antithrombotic treatment in pediatric free flap reconstruction. However, these findings should be solidified in prospective randomized trials.
Further Validating the Robotic Microsurgery Platform through Preclinical Studies on Rat Femoral Artery and Vein
Authors: Cho Jeongmok , Kim Donggeon , Kim Taehyun , Pak Changsik John , Suh Hyunsuk Peter , Hong Joon Pio
Published: November 2024

Background This research aims to validate the proficiency and accuracy of the robotic microsurgery platform using rat femoral vessel model.

Methods A total of 256 rat femoral vessels were performed, half using robotic and the other by manual microanastomosis by eight microsurgeons with less than 5 years of experience given eight trials (rats) each. Vessel demographics, proficiency (duration of suture and Structured Assessment of Robotic Microsurgical Skills [SARMS]), and accuracy (patency and scanning electron microscopic [SEM]) were analyzed between the two groups.

Results Using the robot, an average of four trials was needed to reach a plateau in total anastomosis time and patency. Significant more time was required for each vessel anastomosis (34.33 vs. 21.63 minutes on the eighth trial, p < 0.001) one factor being a higher number of sutures compared with the handsewn group (artery: 7.86 ± 0.51 vs. 5.86 ± 0.67, p = 0.035, vein: 12.63 ± 0.49 vs. 9.57 ± 0.99, p = 0.055). The SARMS scores became nonsignificant between the two groups on the fourth trial. The SEM showed a higher tendency of unevenly spaced sutures, infolding, and tears in the vessel wall for the handsewn group.

Conclusion Using the robot, similar patency, accuracy, and proficiency can be reached through a fast but steep learning process within four trials (anastomosis of eight vessels) as the handsewn group. The robotic anastomosis may take longer time, but this is due to the increased number of sutures reflecting higher precision and accuracy. Further insight of precision and accuracy was found through the SEM demonstrating the possibility of the robot to prevent unexpected and unwanted complications.
Fetal Growth Ultrasound in Obese Patients for the Detection of Growth Abnormalities
Authors: Martins Juliana G. , Miller Elizabeth , Horgan Rebecca , Kawakita Tetsuya
Published: November 2024

Objective This study aimed to examine the impact of maternal obesity on fetal growth abnormalities including fetal growth restriction (FGR) and large for gestational age (LGA) fetuses.

Study Design Secondary analysis from the Nulliparous Pregnancy Outcomes Study: Monitoring Mothers-to-be (nuMoM2b). The study excluded individuals with pregestational or gestational diabetes, chronic hypertension, and other major maternal medical conditions. First-trimester ultrasound was performed to establish accurate dating criteria. Ultrasound assessments were performed at 16 to 21 and 22 to 29 weeks of gestation. Our exposure was the presence of pre-pregnancy obesity. Our primary outcome was rates of fetal growth abnormalities identified by ultrasound, defined as FGR (estimated fetal weight [EFW] or abdominal circumference <10th percentile) or LGA (EFW >90th percentile) among obese compared with nonobese women. A secondary analysis was performed after limiting ultrasound performed from 28 to 29 weeks. To estimate adjusted relative risks (aRRs) with 95% confidence intervals (95% CIs), we used generalized linear models with Poisson distribution and log link using robust error variance, adjusting for the predefined covariates.

Results Of 7,354 participants, 1,443 (19.6%) had pre-pregnancy obesity while 5,911 (80.4%) did not. Pre-pregnancy obesity compared with normal weight was associated with an increased risk of fetal growth abnormalities both at 16 to 21 weeks (16.0% vs. 13.2%; aRR 1.23; 95% CI 1.06–1.42) and 22 to 29 weeks (16.0% vs. 12.1%; aRR 1.33; 95% CI 1.14–1.54). Furthermore, pre-pregnancy obesity compared with normal weight was associated with an increased risk of LGA both at 16 to 21 weeks (12.5% vs. 10.3%; aRR 1.24; 95% CI 1.05–1.47) and 22 to 29 weeks (10.6% vs. 6.9%; aRR 1.66; 95% CI 1.38–2.01). In a secondary analysis limited to the ultrasound at 28 to 29 weeks, both fetal growth abnormalities and LGA were associated with the presence of obesity. In any of the analyses, pre-pregnancy obesity was not associated with FGR compared with normal weight.

Conclusion Maternal obesity is associated with an increased risk of fetal growth abnormalities and LGA fetuses.

Key Points
Transition-Metal-Catalyzed Deuteration via Hydrogen Isotope Exchange
Authors: Jiang Zhi-Jiang , Gao Zhanghua , Bai Jian-Fei
Published: November 2024

Direct hydrogen isotope exchange represents a distinctive strategy for deuterium labelling, where the protium is directly replaced by deuterium. In this graphical review, we summarize the progress in deuteration via transition-metal-catalyzed hydrogen isotope exchange. The review is organized according to the mechanism of C–H bond activation relating to the homogeneous catalysis, and heterogeneous catalysis is also discussed according to the catalyst type. Representative mechanistic processes are depicted, and proven cases for tritiation are also highlighted.
Brisk Walking Pace Offsets Venous Thromboembolism Risk Equivalent to Established Monogenic Mutations
Authors: Xian Wenyan , Tao Yifan , You Chong , Sun Ruinan , Ranson Janice M. , Napolioni Valerio , Lau Patrick W.C. , Huang Jie
Published: November 2024

Background Mendelian mutations in the Prothrombin gene (F2) and the factor V Leiden gene (F5) genes are established risk factors for venous thromboembolism (VTE). Walking pace is associated with the risk of coronary artery diseases, but no study has investigated its association with VTE. This study aimed to investigate the association and causality between walking pace and VTE, compare its population risk with established Mendelian mutations, and determine if blood biomarkers mediate its effect.

Methods We followed up 445,261 UK Biobank participants free of VTE at baseline. Self-reported walking pace was collected via touchscreen questionnaire at baseline. The carrier status of two Mendelian mutations in F2 and F5 genes was determined by the genotypes of rs1799963 (G20210A, c.*97 G > A) and rs6025 (p.R534Q), respectively. Cox proportional hazard model was used to estimate the effect of walking pace on incident VTE. We conducted a bidirectional Mendelian randomization (MR) analysis, by using 70 single-nucleotide polymorphisms (SNPs) from a walking pace genome-wide association studies (GWAS) and 93 SNPs from a VTE GWAS as instrumental variables. We used both individual-level data and GWAS summary statistics for mediation analysis.

Results Over a median follow-up period of 12.8 years, 11,155 incident VTE cases were identified. The 10-year incidence rates for brisk and slow walking pace were 1.32% (confidence interval [CI]: 1.27–1.37%) and 3.90% (CI: 3.71–4.09%), respectively. For noncarriers, F2 and F5 carriers, the 10-year incidence rates were 1.70% (CI: 1.66–1.73%), 2.94% (CI: 2.66–3.22%), and 3.62% (CI: 3.39–3.84%), respectively. The overall risk of VTE for F5 mutation carriers with a brisk walking pace (2.65%) was smaller than that for noncarriers with a slow walking pace (3.66%). For F5 mutation carriers, brisk pace (but not steady pace) reduces the risk of VTE (p interaction < 0.05). MR analyses displayed a causal relationship (inverse variance weighted: p = 3.21 × 10−5) from walking pace to VTE incidence. Mediation analysis showed that serum albumin (ALB) and cystatin C (CYS) levels partially mediated the effect of brisk walking pace on the risk of VTE incidence, with mediation proportions of 8.7 to 11.7%, respectively.

Conclusion On the population scale, the protective effect of brisk walking pace offsets the risk of VTE caused by Mendelian mutations. We provided preliminary evidence that a brisk walking pace causally reduces the risk of VTE. Serum ALB and CYS partially mediate this effect.
Diagnosis and Management of Mitral Valve Disease in the Elderly
Authors: Kumar Preetham , Aedma Surya , Varadarajan Padmini , Pai Ramdas G.
Published: November 2024

Calcific mitral stenosis, commonly seen in the elderly in developed countries, occurs primarily due to mitral annular calcification, and its prevalence is increasing secondary to an aging population. Mitral regurgitation, commonly seen across all age groups, occurs primarily due to anatomical or functional impairment of one or more components of the mitral apparatus or the left ventricle that are necessary for normal valve function, and its prevalence is increasing secondary to an increasing number of patients with heart failure. The current review discusses the diagnosis of and treatment options (medical, surgical, and transcatheter) for mitral valve disease, including the associated challenges, specifically in the elderly.
Hand Rejuvenation by Autologous Fat Grafting in Post-Hansen's Hand Atrophy: Aesthetic and Psychological Implications
Authors: Yamani Venkata Ramana , Gurindagunta Swamy Vivek , Raju Rama Linga , Kumar Shree , Valluri Mukesh Krishna , Sharma Mrigya
Published: November 2024

Introduction Contemporary medical science has been using fat grafting in aesthetic and reconstructive procedures, consistently achieving successful outcomes. Hansen's disease, caused by Mycobacterium leprae, leads to hand deformities due to peripheral neuropathy, resulting in soft-tissue atrophy, volume loss, and compromised hand function. Tendon transfer surgery is a common remedy for functionality, but it often does not address aesthetic concerns and the patient's psychological impact of living with an atrophic hand. Autologous fat grafting can effectively address these concerns.

Materials and Methods This prospective study evaluates the efficacy of fat grafting for hand rejuvenation in patients with Hansen's disease posttendon transfer surgery, focusing on aesthetic and psychological outcomes. We recorded data from 12 patients who underwent the procedure between 2015 and 2024. Using the Coleman technique, fat was harvested from the paraumbilical region of the abdomen and injected into various hand regions.

Results Autologous fat grafting showed high patient satisfaction with significant improvements in hand contour, skin texture, and psychological health. The benefits of the procedure included improved self-esteem, enhanced quality of life, reduced social stigma, and psychological well-being.

Conclusion Autologous fat grafting is a safe and effective technique for hand rejuvenation in patients with Hansen's disease, after functional treatment addressing both physical deformities and their psychological impacts. It could be considered one of the components in the comprehensive management of Hansen's disease–related hand deformities, significantly enhancing patients' overall quality of life.
An Unusual Case of Alarming Lactic Acidosis: Brain Metabolic Cross-Talk
Authors: R. Sivakumar , Chowdhury Sumit Roy , Bhutia Karma Ongmu , Sokhal Suman
Published: November 2024

A 39-year-old male with a BMI of 30.8 kg/m2 and a normal medical history underwent excision of a left orbito-cavernal hemangioma (4 × 2 × 2 cm) under general anesthesia. Balanced anesthesia and fluid management guided by pulse pressure variation (kept below 12%) were employed. Despite stable hemodynamics and normal blood sugar levels, arterial blood gas (ABG) analysis revealed a progressive rise in lactate levels, reaching 10.6 mmol/L, accompanied by acidemia. Systemic hypoperfusion was ruled out by maintaining mean arterial pressure between 70-80 mm Hg, ensuring a capillary refill time of less than 3 seconds, and confirming a central venous oxygen saturation of 72%. With a total blood loss of 800 mL, one unit of packed red blood cells was transfused due to concerns about decreased microcirculation and tissue hypoxia. After 10 hours of surgery, sodium bicarbonate (NaHCO3) was administered to mitigate metabolic acidosis and its potential impact on intracranial pressure. Postoperatively, lactate levels remained elevated (8-9 mmol/L), but with continued NaHCO3 infusion, lactate reduced to 6.4 mmol/L, allowing extubation. The patient's lactate normalized by the evening, and recovery was uneventful. This case highlights the significant metabolic disturbances, particularly lactic acidosis, that can arise during brain tumor surgery due to prolonged operative times, large tumor size, higher BMI, and stress-induced metabolic derangements. Awareness and prompt management of these disturbances are crucial for successful patient outcomes.
Distinct Care Needs and Episodes of Care: Comparing Medical versus Orthopaedic Readmissions after Elective Primary Total Knee Arthroplasty
Authors: Turan Oguz , Ramos Michael S. , Pasqualini Ignacio , Piuzzi Nicolas S. ,   Cleveland Clinic Adult Reconstruction Research Group
Published: November 2024

Hospital readmissions after primary total knee arthroplasty (TKA) significantly drive health care expenditure and resource utilization. Recent studies have suggested differences between medical and orthopaedic readmissions after TKA and their episodes of care (EOCs) but lack patient-level data reporting. This study aimed to compare EOCs for medical and orthopaedic-related readmissions regarding initial readmission wards, services consulted, intensive care unit (ICU) admissions, blood transfusions, surgical interventions, length of stay, and discharge disposition.

All patients enrolled in a prospective data collection system at a tertiary medical center undergoing elective, unilateral, primary TKA from 2016 to 2020 and readmitted within 90 days of discharge were included. Readmissions were categorized as related to medical or orthopaedic causes. Patients' electronic medical records were reviewed to collect demographic and clinical information about EOC associated with the readmission hospital course.

In total, 82.4% (580/704) of 90-day readmissions after elective, primary TKA were related to medical causes, with the remaining 17.6% (124/704) of readmissions due to orthopaedic causes. Medical readmissions most often pertained to gastrointestinal complaints, while wound complications accounted for most orthopaedic readmissions. Most readmissions (63.1%, 444/704) occurred within the first 30 days after TKA. Patients with medical and orthopaedic readmissions had differences in EOC, such that more medical readmissions required ICU care (10.6 vs. 1.6%, p < 0.001), and more patients with orthopaedic readmissions needed a surgical intervention (65.4 vs. 6.7%, p < 0.001).

By understanding differences in EOC for medical and orthopaedic readmissions after TKA, targeted initiatives can be developed to deliver more efficient, cost-effective orthopaedic surgical care, as the orthopaedic surgical community continues to provide value-based care.
British Skull Base Society Consensus on Vestibular Schwannoma Surveillance
Authors: Sethi Mantegh , Borsetto Daniele , Tysome James , Buttimore Juliette , Gamazo Nicola , Mannion Richard , Guilfoyle Matthew , Bance Manohar , Obholzer Rupert , Das Tilak , Scoffings Dan , Minett Thais , Jones Jonathan , Joshi Yogish , Scott Francis , Matys Tomasz , Freeman Simon , Lloyd Simon , Rutherford Scott , Potter Gillian , Siripurapu Rekha , Abdulla Sarah , Laitt Roger , Saloojee Ziyad , Summers David , Saeed Shakeel R. , Bandino Fabrizio , MacKeith Samuel , Jeyaretna Sanjeeva , Philpott Carl , Shah Jagrit , Robertson Iain , Thomas Sebastian , Hattangadi Nameet , Paluzzi Alessandro , Kay Andrew , Awan Bushra , Rhys Rhian , Muthu Senthil , Clamp Philip J , Nannapaneni Ravi , Hayhurst Caroline , Gurusinghe Nihal , Alalade Andrew , Gilkes Catherine , Munir Nazia , Yousseff Ahmed , Patel Parag , Hampton Susanne , Hammerbeck-Ward Charlotte , Saunders Nick , Irving Richard , Monksfield Peter , Thomas Nicholas , Kitchen Neil , Barazi Sinan , Maratos Eleni , Connor Steve , Leonard Colin , Dawe Nicholas , Mohamed Hassan , Axon Patrick , Donnelly Neil
Published: November 2024

Objective Surveillance plays a crucial role in managing patients with vestibular schwannomas (VSs). Consensus is lacking on the optimal duration, frequency, and modality of imaging. Standardizing this approach would ensure safe and effective care, reduce patient distress, and promote consistency in management decisions among clinicians.

Methods In July 2022, a multi-disciplinary Delphi consensus was conducted at the British Skull Base Society Meeting. Expert United Kingdom-based skull-base surgeons and neuroradiologists were presented semi-systematic literature reviews summarizing current evidence on VS management. Anonymized opinions were collated and discussed to reach a majority vote, which was deemed the final consensus opinion.

Results Recommendations for VS managed by surveillance are: (1) surveillance frequency should decrease over time; (2) surveillance may be discontinued when the remaining lifetime risk of VS growth is <0.5% (∼8.5 years); (3) factors such as age, VS size, VS location, and cystic components should be considered. Surveillance after surgery or radiotherapy has limited evidence but recommendations are: (4) surveillance should be adjusted based on residual tumor size or nodular enhancement. Imaging modality and sequences are recommended to be (5) high-resolution magnetic resonance imaging with T1, T2, FIESTA/CISS multiplanar sequences, contrast is not required in untreated cases, and linear reporting of measurements is pragmatically sufficient.

Conclusion This consensus and literature review provides an evidence and expert opinion–based guide to help clinicians with the surveillance of patients with VS. Further research should focus on better understanding the dynamic nature of growth risks and the growth characteristics of postintervention VS to enable personalized growth risk stratification.
Using Indocyanine Green Fluorescence Angiography to Evaluate the Impact of Surgical and Patient Factors on Posterior Septal Artery Perfusion in Endoscopic Skull Base Surgery
Authors: Daum Rachel , Grimm David , Yong Michael , Hosseinzadeh Farideh , Lee Christine K. , Fernandez-Miranda Juan C. , Nayak Jayakar V. , Patel Zara M. , Hwang Peter H. , Chang Michael T.
Published: November 2024

Background Nasoseptal flaps (NSF), perfused by the posterior septal artery (PSA), are heavily utilized in endonasal skull base surgery (ESBS). We use indocyanine green (ICG) fluorescence angiography to assess PSA perfusion.

Methods A prospective study of adult ESBS patients assessed PSA perfusion using intraoperative ICG. PSA ICG fluorescence intensities (FIs) were quantified. Factors analyzed included demographics, comorbidities, prior sinonasal surgery, surgical approach, concurrent septoplasty, NSF harvest timing, and flap-related complications. t-Tests compared significant ICG baseline differences and changes from baseline. ICG enhancement was compared with postoperative magnetic resonance imaging (MRI).

Results A total of 54 patients were studied. Of these, 35 NSFs were harvested, while the remaining 19 underwent cuts for rescue flaps. Mean PSA FI changed from baseline 118.1 ± 28.6 to 114.4 ± 32.3 following reconstruction. Tobacco users had lower baseline FI compared with non-tobacco users (78.3 ± 62.8 vs. 118.4 ± 29.1, p = 0.003). Transpterygoid approaches showed greater decrease from baseline (−25.8 ± 58.9 vs. −3.8 ± 32.1, p = 0.035) than transsphenoidal. No other studied factors, including revision case, timing of flap harvest, flap side, division of palatosphenoidal artery, or concurrent septoplasty, had a significant influence on ICG intensity. In total, 34 of 35 NSFs were viable. ICG fluorescence had a 100% sensitivity, 0% specificity, and 96.6% positive predictive value (PPV) for NSF viability, while MRI enhancement had a 100% sensitivity, 100% specificity, and 100% PPV for NSF viability.

Conclusion ICG angiography may provide an intraoperative assessment of flap viability with comparable PPV as postoperative MRI. Tobacco use and transpterygoid approaches may be associated with decreased PSA perfusion.
Combined Percutaneous Lithotripsy and Transjejunal Stone Extraction for Intrahepatic Bile Duct Stones
Authors: Garg Parul , Sharma Malay
Published: November 2024

This case report describes the treatment of intrahepatic duct stones in a 21-year-old woman, who developed these stones as a long-term complication after undergoing choledochal cyst excision and hepaticojejunostomy at the age of 3 years. The calculi were fragmented by combining percutaneous SpyGlass laser lithotripsy and percutaneous transjejunal crushing and retrieval of stones using a lithotripter and endoscopic retrograde cholangiopancreatography balloon extraction catheter. This case reminds us of long-term complications of stone formation after choledochal cyst surgery with biliary-enteric anastomosis and emphasizes the use of combined methods we can utilize for treating these stones.
Nanotechnology in retinal diseases: From disease diagnosis to therapeutic applications
Authors: Kaur Geetika , Bisen Shivantika , Singh Nikhlesh K.
Published: November 2024

Nanotechnology has demonstrated tremendous promise in the realm of ocular illnesses, with applications for disease detection and therapeutic interventions. The nanoscale features of nanoparticles enable their precise interactions with retinal tissues, allowing for more efficient and effective treatments. Because biological organs are compatible with diverse nanomaterials, such as nanoparticles, nanowires, nanoscaffolds, and hybrid nanostructures, their usage in biomedical applications, particularly in retinal illnesses, has increased. The use of nanotechnology in medicine is advancing rapidly, and recent advances in nanomedicine-based diagnosis and therapy techniques may provide considerable benefits in addressing the primary causes of blindness related to retinal illnesses. The current state, prospects, and challenges of nanotechnology in monitoring nanostructures or cells in the eye and their application to regenerative ophthalmology have been discussed and thoroughly reviewed. In this review, we build on our previously published review article in 2021, where we discussed the impact of nano-biomaterials in retinal regeneration. However, in this review, we extended our focus to incorporate and discuss the application of nano-biomaterials on all retinal diseases, with a highlight on nanomedicine-based diagnostic and therapeutic research studies.
Ultrathin visible-light OCT endomicroscopy for in vivo ultrahigh-resolution neuroimaging in deep brain
Authors: Xu Chao , Zhang Tinghua , Abbasi Syeda Aimen , Liu Peng , Yan Bryan P. , Ng Sze Hang Calvin , Yuan Wu
Published: November 2024

Deep-brain neuroimaging, a task that demands high-resolution imaging techniques for visualizing intricate brain structures, assessing deep-seated disease histopathology, and offering real-time intervention guidance, is challenged by the resolution-depth trade-off of current methods. We propose an optical coherence tomography (OCT) endomicroscopy device for high-resolution in vivo imaging of deep brain microstructures and histopathology. A unique liquid shaping technique enables the direct fabrication of a microlens on the fiber tip of the imaging probe, optimizing imaging performance parameters, such as longitudinal focal shift, focused spot size, and working distance. In addition, a broadband visible-light source enhances axial resolution and OCT imaging contrast. As a result, the first monolithic visible-light OCT (vis-OCT) endomicroscope, with a submillimeter outer diameter (∼0.4 mm), is presented, achieving an ultrahigh resolution of 1.4 μm axial × 4.5 μm transverse in air. This compact probe allows minimally invasive in vivo deep-brain imaging in mice at a depth of 7.2 mm. Key regions in the mouse deep brain, such as the isocortex, corpus callosum, and caudate putamen, were successfully identified using our vis-OCT endomicroscope. In addition, we examined the myeloarchitectures and cytoarchitectures in the isocortex. Our findings demonstrate that the vis-OCT endomicroscope offers enhanced visualization of myelinated axon fibers and nerve fiber bundles compared to its 800 nm counterpart. This vis-OCT endomicroscope, overcoming resolution and imaging depth limitations of conventional methods, offers a novel tool for minimally invasive, ultrahigh-resolution in vivo deep brain neuroimaging.
Detection of electron paramagnetic resonance of two electron spins using a single NV center in diamond
Authors: Ren Yuhang , Takahashi Susumu
Published: November 2024

An interacting spin system is an excellent testbed for fundamental quantum physics and applications in quantum sensing and quantum simulation. For these investigations, detailed information on the interactions, e.g., the number of spins and their interaction strengths, is often required. In this study, we present the identification and characterization of a single nitrogen vacancy (NV) center coupled to two electron spins. In the experiment, we first identify a well-isolated single NV center and characterize its spin decoherence time. Then, we perform NV-detected electron paramagnetic resonance (EPR) spectroscopy to detect surrounding electron spins. From the analysis of the NV-EPR signal, we precisely determine the number of detected spins and their interaction strengths. Moreover, the spectral analysis indicates that the candidates of the detected spins are diamond surface spins. This study demonstrates a promising approach for the identification and characterization of an interacting spin system for realizing entangled sensing using electron spin as quantum reporters.
How to cook pasta? Physicists view on suggestions for energy saving methods
Authors: Toultchinski Phillip , Vilgis Thomas A.
Published: November 2024

Physics Nobel laureate Giorgio Parisi recently proposed a novel approach to cooking pasta that is more energy-efficient: Bring the water to a boil, add the pasta, cover the pot with a lid, and turn off the heat source. This heat-off-lid-on (hofflon) method saves energy. Other suggestions recommend soaking dried pasta in cold water to shorten the cooking process. However, there is a paucity of research examining the impact of different cooking methods on pasta texture and quality. In order to gain a deeper understanding of the effects of different cooking methods on the texture and strength of the pasta, a series of experiments were conducted. The experiments demonstrated significant variations in mechanical properties, adhesiveness, and cohesion. The hofflon method requires a longer cooking time due to the gradual decline in temperature. The process of soaking increases the water content of the pasta prior to cooking, which subsequently affects the behavior of proteins and starch when heated. These effects influence the manner in which proteins undergo alteration, the formation of cross-links, and the gelatinization of starch. Pasta prepared using the hofflon method exhibits reduced cohesion and softness, resulting in a texture that is softer and more mushy than that of al dente pasta. Presoaked samples display increased stickiness and a mushy texture when compared to pasta prepared using the classic method and hofflon pasta. The results of this study indicate the promise of developing straightforward models to illuminate the unique roles of proteins and starch during the structural transformation.
Strain engineering for the interfacial thermal resistance of few-layer graphene with porous defects
Authors: Zhang Bin , Xue Yixuan , Jiang Jin-Wu
Published: November 2024

As electronic devices continue to advance toward higher integration, thermal management issues have become a bottleneck, limiting device performance at the nanoscale. In this study, we reveal the bistable structural characteristics of circular hole defects in few-layer graphene, exhibiting both adhered and separated states, through molecular dynamics simulations. We propose a mechanical model that considers the interplay between the bending energy and cohesive energy to determine the critical size of the hole defect, at which the structure transits between the adhered and separated states. We further demonstrate that strain engineering can adjust the interfacial thermal resistance by more than fivefolds, which drives the structure transit between bistable states. The strain effect on the interfacial thermal resistance of the structure can be accurately described using analytical models. These findings illustrate that strain engineering is an effective method for precisely controlling the interfacial thermal resistance in few-layer graphene and provide new insights into possible thermal switch applications.
3D printing for sodium batteries: From material design to integrated devices
Authors: Dai Shuge , Lin Zhuanglong , Hu Hao , Wang Ye , Zeng Longhui
Published: November 2024

Additive manufacturing, commonly known as 3D printing, is an innovative technique for fabricating batteries with arbitrary architectures. Understanding the intricacies of 3D printing designs in sodium battery materials is crucial for optimizing their electrochemical properties and unlocking the full potential of 3D printed sodium batteries. This review provides a comprehensive overview of the key aspects involved in the fabrication of 3D printed sodium batteries, encompassing material selectivity criterion, design considerations, and optimization strategies. Challenges and prospects for the fabrication of high-performance 3D printed sodium batteries are outlined, aiming to provide valuable insights into new conception and theoretical guidance for the design and performance optimization of composites by 3D printing for the practical application of sodium batteries in the future.
On the mechanism for work function change of gold electrodes by ultrathin polyethyleneimine (PEI) films: Effect of molecular order
Authors: Ferreira Claudia S. G. , Sousa Marcos S. , Günther Florian S. , Miranda Paulo B.
Published: November 2024

Polyethyleneimine (PEI) is a widely used cationic polyelectrolyte. In organic electronics, it is a universal surface modifier for shifting the electrode work function (Φ) and improving charge injection into electronic devices. This effect may depend on the conformation and dipolar order of the PEI ultrathin film, but their detailed experimental evaluation has not yet been reported. Thus, we used sum-frequency generation (SFG) spectroscopy to probe the net orientation of polar groups of PEI films on glass and gold. The films were fabricated by spin-coating from alcoholic solutions or by dip-coating from aqueous solutions of various pH values, with both branched (b-PEI) and linear (l-PEI) structures. The obtained SFG spectra and atomic force microscopy (AFM) images indicated that the conformational ordering of the PEI layers increases over the period of 14 days after fabrication, being slightly more pronounced for l-PEI vs b-PEI, and for dip-coating vs spin coating fabrication. Furthermore, both the pH of the dip-coating solutions and the substrate nature influence the final morphology and order of the adsorbed films. On glass, they are optimized at an intermediate pH 5, while on gold, the greatest homogeneity is observed at pH 2 and the largest dipolar order is observed at pH 10. The pH dependence of changes in the work function of gold by PEI (|ΔΦ|) suggests that the electronic contribution is dominant. Nevertheless, the evolution of the PEI dipolar ordering was accompanied by small variations of |ΔΦ|, suggesting that it does have a significant contribution, especially at conditions for which the electronic contribution is reduced.