bluuebunny/crossref_metadata_2025 huggingface dataset:
European randomized controlled trial evaluating differential target multiplexed spinal cord stimulation and conventional medical management in subjects with persistent back pain ineligible for spine surgery: 24‐month results
Authors: Kallewaard Jan W. , Billet Bart , Van Paesschen Raf , Smet Iris , Mendiola Agustin , Peña Isaac , López Pablo , Carceller Javier , Tornero Carlos , Zuidema Xander , Vesper Jan , Lehmberg Jens , Laloo Wim , Cedeño David L. , Vallejo Ricardo
Published: June 2024

Background

Differential target multiplexed spinal cord stimulation (DTM SCS) was shown to be superior to conventional SCS for treating chronic low back pain (CLBP) in subjects with persistent spinal pain syndrome with previous spinal surgery (PSPS‐T2) or ineligible for it (PSPS‐T1). This study reports 24‐month efficacy and safety of DTM SCS vs. conventional medical management (CMM) in PSPS‐T1 subjects across four European countries.

Methods

This is a prospective, multicenter, open‐label, randomized, controlled trial with optional crossover. Subjects randomized 1:1 to DTM SCS or CMM. Primary endpoint was responder rate (% subjects reporting ≥50% CLBP relief) at 6 months. A superiority test compared responder rates between treatments. CLBP and leg pain levels, functional disability, quality of life (QoL), patient satisfaction and global impression of change were evaluated for 24 months. A Composite Responder Index (CRI) was obtained using CLBP relief, disability and QoL. Incidence of study‐related adverse events evaluated safety.

Results

A total of 55 and 57 subjects were randomized to DTM SCS and CMM respectively. DTM SCS was superior, with CLBP responder rates ≥80% and CLBP relief >5.6 cm (>70% reduction) through the 24‐month follow‐up. Improvements with DTM SCS in other outcomes were sustained. The CRI was >80% for DTM SCS through 24 months. Opioid medication intake decreased in subjects treated with DTM SCS. Most patients treated with DTM SCS felt satisfied and improved at the end of the study. Safety was congruent with other studies.

Conclusion

DTM SCS is efficacious and safe during 24 months for the treatment of CLBP and leg pain in PSPS‐T1 patients ineligible for spine surgery.

Significance statement

This randomized controlled trial shows that Differential Target Multiplexed SCS (DTM SCS) is an effective and safe long‐term treatment for PSPS type 1 patients suffering from axial low back pain with or without leg pain and who are ineligible for spinal surgery. Currently, CMM treatments are their only option and provide limited benefits. Besides superior pain relief, DTM SCS provides significant improvements in functional disability, quality of life, high levels of satisfaction and perceived impression of change.
Kirchhoff meets Johnson: In pursuit of unconditionally secure communication
Authors: Basar Ertugrul
Published: June 2024

Noise: an enemy to be dealt with and a major factor limiting communication system performance. However, what if there is gold in that garbage? In conventional engineering, our focus is primarily on eliminating, suppressing, combating, or even ignoring noise and its detrimental impacts. Conversely, could we exploit it similarly to biology, which utilizes noise‐alike carrier signals to convey information? In this context, the utilization of noise, or noise‐alike signals in general, has been put forward as a means to realize unconditionally secure communication systems in the future. In this tutorial article, we begin by tracing the origins of thermal noise‐based communication and highlighting one of its significant applications for ensuring unconditionally secure networks: the Kirchhoff‐law‐Johnson‐noise (KLJN) secure key exchange scheme. We then delve into the inherent challenges tied to secure communication and discuss the imperative need for physics‐based key distribution schemes in pursuit of unconditional security. Concurrently, we provide a concise overview of quantum key distribution schemes and draw comparisons with their KLJN‐based counterparts. Finally, extending beyond wired communication loops, we explore the transmission of noise signals over‐the‐air and evaluate their potential for stealth and secure wireless communication systems.
Pupillary constriction on stimulation of the parietal cortex—A novel finding
Authors: Freund Brin , Nair Dileep , Bulacio Juan , Najm Imad , Taylor Kenneth , Moosa Ahsan N.
Published: June 2024

Pupillary changes can be an important semiologic feature in focal epilepsy. Though the subcortical networks involving pupillomotor function have been described, cortical generators of pupillary dilation and constriction in humans are not well known. In this report, we describe a case of pupillary constriction occurring during seizures in a patient with drug resistant focal epilepsy. On stereoelectroencephalography, onset was noted within the posterior segment of the right intraparietal sulcus and direct cortical electrical stimulation of these electrode contacts reproduced pupillary constriction associated with habitual seizures. This is the first case report to describe ictal pupillary constriction during SEEG with confirmation of the cortical localization by direct cortical electrical stimulation. The posterior segment of the right intraparietal sulcus localization of pupillary constriction may aid in surgical evaluation patients with drug resistant focal epilepsy.
Alterations of apparent diffusion coefficient from ultra high b‐values in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy
Authors: Tang Guixian , Zhou Hailing , Zeng Chunyuan , Jiang Yuanfang , Li Ying , Hou Lu , Liao Kai , Tan Zhiqiang , Wu Huanhua , Tang Yongjin , Cheng Yong , Ling Xueying , Guo Qiang , Xu Hao
Published: June 2024

Objective

Subcortical nuclei such as the thalamus and striatum have been shown to be related to seizure modulation and termination, especially in drug‐resistant epilepsy. Enhance diffusion‐weighted imaging (eDWI) technique and tri‐component model have been used in previous studies to calculate apparent diffusion coefficient from ultra high b‐values (ADCuh). This study aimed to explore the alterations of ADCuh in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy.

Methods

Twenty‐nine patients with MRI‐negative drug‐resistant epilepsy and 18 healthy controls underwent eDWI scan with 15 b‐values (0–5000 s/mm2). The eDWI parameters including standard ADC (ADCst), pure water diffusion (D), and ADCuh were calculated from the 15 b‐values. Regions‐of‐interest (ROIs) analyses were conducted in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus. ADCst, D, and ADCuh values were compared between the MRI‐negative drug‐resistant epilepsy patients and controls using multivariate generalized linear models. Inter‐rater reliability was assessed using the intra‐class correlation coefficient (ICC) and Bland–Altman (BA) analysis. False discovery rate (FDR) method was applied for multiple comparisons correction.

Results

ADCuh values in the bilateral thalamus, caudate nucleus, putamen, and globus pallidus in MRI‐negative drug‐resistant epilepsy were significantly higher than those in the healthy control subjects (all p < 0.05, FDR corrected).

Significance

The alterations of the ADCuh values in the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy might reflect abnormal membrane water permeability in MRI‐negative drug‐resistant epilepsy. ADCuh might be a sensitive measurement for evaluating subcortical nuclei‐related brain damage in epilepsy patients.

Plain Language Summary

This study aimed to explore the alterations of apparent diffusion coefficient calculated from ultra high b‐values (ADCuh) in the subcortical nuclei such as the bilateral thalamus and striatum in MRI‐negative drug‐resistant epilepsy. The bilateral thalamus and striatum showed higher ADCuh in epilepsy patients than healthy controls. These findings may add new evidences of subcortical nuclei abnormalities related to water and ion hemostasis in epilepsy patients, which might help to elucidate the underlying epileptic neuropathophysiological mechanisms and facilitate the exploration of therapeutic targets.
Operation and decline of the Barbegal mill complex, the largest industrial complex of antiquity
Authors: Passchier Cees W. , Sürmelihindi Gül , Viollet Pierre‐Louis , Leveau Philippe , Spötl Christoph
Published: June 2024

The Roman mill complex of Barbegal in France is the largest preindustrial structure in Europe. Carbonate incrustations that formed from water flowing through basins, over flumes and waterwheels of the mill complex are partly preserved. The largest carbonate fragments are derived from three wooden flumes that once served the wheels of three mills in a train of eight. The deposits formed from the same water as it moved down from mill to mill. The shape, microstratigraphy and stable isotope patterns of the deposits of each flume reveal a unique history of use for each mill during the last 8 years of operation until their final abandonment. The sidewall carbonate deposits of the flumes vary in shape due to differences in the slope of the flumes during operation, associated with different‐size millwheels in different basins. At least one of the flumes must have been mobile and was uplifted to fit a millwheel of a different size. During 8 years, two millwheels were exchanged and one flume was taken out of action. Carbonate deposits from two flumes were subsequently reused for some unknown industrial purpose in a water basin, and one was later embedded as spolia in a building during late antiquity.
Bayesian varying‐effects vector autoregressive models for inference of brain connectivity networks and covariate effects in pediatric traumatic brain injury
Authors: Ren Yangfan , Osborne Nathan , Peterson Christine B. , DeMaster Dana M. , Ewing‐Cobbs Linda , Vannucci Marina
Published: June 2024

In this article, we develop an analytical approach for estimating brain connectivity networks that accounts for subject heterogeneity. More specifically, we consider a novel extension of a multi‐subject Bayesian vector autoregressive model that estimates group‐specific directed brain connectivity networks and accounts for the effects of covariates on the network edges. We adopt a flexible approach, allowing for (possibly) nonlinear effects of the covariates on edge strength via a novel Bayesian nonparametric prior that employs a weighted mixture of Gaussian processes. For posterior inference, we achieve computational scalability by implementing a variational Bayes scheme. Our approach enables simultaneous estimation of group‐specific networks and selection of relevant covariate effects. We show improved performance over competing two‐stage approaches on simulated data. We apply our method on resting‐state functional magnetic resonance imaging data from children with a history of traumatic brain injury (TBI) and healthy controls to estimate the effects of age and sex on the group‐level connectivities. Our results highlight differences in the distribution of parent nodes. They also suggest alteration in the relation of age, with peak edge strength in children with TBI, and differences in effective connectivity strength between males and females.
Pharmacological treatment of depression in patients with brain tumors
Authors: Knabbe Johannes , Kowalski Thomas , Seliger Corinna
Published: June 2024

Patients with brain tumors suffer from intense psychosocial distress. Although the prevalence of depressive symptoms in patients with brain tumors is high, the pharmacological antidepressant treatment of those patients is not well defined and results from clinical trials are largely missing. In this review, we describe the current standard of evidence and clinical guidelines for the pharmacological treatment of depression in brain tumor patients. We present specific side effects and interactions that should guide treatment decisions. Furthermore, we provide evidence for the diagnosis, screening and risk factors for depression in brain tumor patients and we elaborate on potential antineoplastic effects of antidepressant drugs and ongoing clinical trials. Antidepressant drugs should not be withheld from patients with brain tumors. Future clinical trials should explore the effectiveness and side effects of antidepressants in this specific patient population.
ResTrans‐Unet: A Residual‐Aware Transformer‐Based Approach to Medical Image Segmentation
Authors: Ma Fengying , Wang Zhi , Ji Peng , Fu Chengcai , Wang Feng
Published: June 2024

The convolutional neural network has significantly enhanced the efficacy of medical image segmentation. However, challenges persist in the deep learning‐based method for medical image segmentation, necessitating the resolution of the following issues: (1) Medical images, characterized by a vast spatial scale and complex structure, pose difficulties in accurate edge information extraction; (2) In the decoding process, the assumption of equal importance among different channels contradicts the reality of their varying significance. This study addresses challenges observed in earlier medical image segmentation networks, particularly focusing on the precise extraction of edge information and the inadequate consideration of inter‐channel importance during decoding. To address these challenges, we introduce ResTrans‐Unet (residual transformer medical image segmentation network), an automatic segmentation model based on Residual‐aware transformer. The Transformer is enhanced through the incorporation of ResMLP, resulting in enhanced edge information capture in images and improved network convergence speed. Additionally, Squeeze‐and‐Excitation Networks, which emphasize channel relationships, are integrated into the decoder to precisely highlight important features and suppress irrelevant ones. Experimental validations on two public datasets were carried out to assess the proposed model, comparing its performance with that of advanced models. The experimental results unequivocally demonstrate the superior performance of ResTrans‐Unet in medical image segmentation tasks.
Educational outcomes necessary to enter pharmacy residency training: 2023 update
Authors: Stamm Pamela L. , Haines Stuart T. , Edwards Krystal L. , Fusco Nicholas M. , Havrda Dawn E. , Lee Kelly C. , Papke Jessica L. , Rhoney Denise H. , Sturpe Deborah A. , Knowles Gwendolyn , Baggett Rachel D.
Published: June 2024

The 2023 Educational Affairs Committee reviewed relevant position statements and publications to update the 2014 ACCP position statement on the educational outcomes (EOs) necessary for pharmacy students to enter postgraduate year 1 (PGY1) residency training. The committee initially aligned entry‐level graduate outcomes with current PGY1 residency competencies achieved after postgraduate training. The committee then used these alignments to identify consistencies, insufficiencies, and gaps in preparation. This process revealed that the EOs and entrustable professional activities from curricular outcomes and entrustable professional activities and the North American Pharmacist Licensure Examination blueprint could serve as a partial list of outcomes necessary to enter postgraduate training; however, some of the outcomes necessary to enter residency were not consistently addressed. To improve residency readiness, the committee recommends that both academic programs and the individual learner evaluate and seek opportunities to address any curricular gaps in alignment. The findings also underscore the need for a single set of well‐defined and mutually agreed‐on educational competencies that evolve over time and embrace the knowledge, skills, and attitudes that demonstrate residency readiness.
Identifying program benefits when participation is misreported
Authors: Tommasi Denni , Zhang Lina
Published: June 2024

In cases of noncompliance with an assigned treatment, estimates of causal effects typically rely on instrumental variables (IV). However, when participation is also misreported, the IV estimand may become a nonconvex combination of local average treatment effects that fails to satisfy even a minimal condition for being causal. The aim of our paper is to generalize the MR‐LATE approach. This is an alternative IV estimand that is more robust in cases of noncompliance and nondifferential misclassification of the treatment variable. Our generalization is threefold: First, we incorporate discrete and multiple‐discrete instrument(s); second, we consider the use of instrument(s) under a weaker, partial monotonicity condition; third, we provide a general inferential procedure. Under relatively stringent assumptions, MR‐LATE is either identical to the IV estimand or less biased than the naïve IV estimand. Under less stringent assumptions, the MR‐LATE estimand can identify the sign of the IV estimand. We conclude with the use of a dedicated Stata command, ivreg2m, to assess the return on education in the United Kingdom.
Study of the impact of introducing a multimedia learning tool in podiatric medical courses
Authors: Hoyt Garrik , Adegboyega Samuel , Constantouris Gus , Basu Paramita
Published: June 2024

Background

Medical students face the challenge of learning vast amounts of complex information. Existing research suggests improved learning outcomes using multimedia resources but reports on their impact on podiatric education are scarce. To explore the potential of multimedia‐based learning tools in enriching medical education, this study examined the impact of Osmosis, a platform featuring interactive videos, flashcards, and self‐assessment quizzes on podiatric medical student outcomes.

Methods

This quasi‐experimental study examined the impact of Osmosis, a multimedia learning platform with videos, flashcards, and quizzes, on podiatric medical students' learning outcomes. Two cohorts (T = Osmosis access, N = 86; C = no access, N = 87) took Pharmacology and Podiatric Medicine courses consecutively. Final exam scores, final course grades, platform usage metrics (median weekly videos watched, flashcards, and quizzes), and student experience surveys were analyzed.

Results

Analyses revealed no statistically significant differences in final exam scores between the groups in Pharmacology and Podiatric Medicine. While the treatment group exhibited a slight upward trend, further research is required for conclusive evidence. Student perceptions of Osmosis were overwhelmingly positive, with 90.2% of students agreeing that it facilitated concept learning and understanding compared to 54.9% for the textbook. Similarly, 80.4% of the treatment group felt that Osmosis enhanced their test performance, exceeding the 54.9% recorded for the textbook. Correlation analysis indicates a plausible connection between platform usage and academic success, as reflected by moderate positive correlations (r = [0.14, 0.28]) with final grades. Logistic regression analysis revealed that students with Osmosis access were 2.88 times more likely to score 90% or higher on the Pharmacology final exam (p < 0.05) and exhibited increased odds of achieving high (90%+) final course grades in Podiatric Medicine (OR = 2.71).

Conclusions

These findings suggest that Osmosis holds promise as a tool to support podiatric medical student learning. While the lack of statistically significant differences in final exam scores warrants further investigation, the positive student perceptions, high engagement rates, and increased odds of high scores in specific areas indicate the potential for Osmosis to positively impact academic outcomes. Therefore, a multimedia‐based resource like Osmosis appears to show promise as a tool to support podiatric medical education. The limitations inherent in the quasi‐experimental design necessitate further studies to confirm its effectiveness and long‐term impact on podiatric medical education.
Reduce, reuse, recycle: Introducing MetaPipeX, a framework for analyses of multi‐lab data
Authors: Fünderich Jens H. , Beinhauer Lukas J. , Renkewitz Frank
Published: June 2024

Multi‐lab projects are large scale collaborations between participating data collection sites that gather empirical evidence and (usually) analyze that evidence using meta‐analyses. They are a valuable form of scientific collaboration, produce outstanding data sets and are a great resource for third‐party researchers. Their data may be reanalyzed and used in research synthesis. Their repositories and code could provide guidance to future projects of this kind. But, while multi‐labs are similar in their structure and aggregate their data using meta‐analyses, they deploy a variety of different solutions regarding the storage structure in the repositories, the way the (analysis) code is structured and the file‐formats they provide. Continuing this trend implies that anyone who wants to work with data from multiple of these projects, or combine their datasets, is faced with an ever‐increasing complexity. Some of that complexity could be avoided. Here, we introduce MetaPipeX, a standardized framework to harmonize, document and analyze multi‐lab data. It features a pipeline conceptualization of the analysis and documentation process, an R‐package that implements both and a Shiny App (https://www.apps.meta-rep.lmu.de/metapipex/) that allows users to explore and visualize these data sets. We introduce the framework by describing its components and applying it to a practical example. Engaging with this form of collaboration and integrating it further into research practice will certainly be beneficial to quantitative sciences and we hope the framework provides a structure and tools to reduce effort for anyone who creates, re‐uses, harmonizes or learns about multi‐lab replication projects.
The simultaneous prediction of yield and maturity date for wheat–maize by combining satellite images with crop model
Authors: Zhao Yanxi , Xiao Dengpan , Bai Huizi
Published: June 2024

BACKGROUND

The simultaneous prediction of yield and maturity date has an important impact on ensuring food security. However, few studies have focused on simultaneous prediction of yield and maturity date for wheat–maize in the North China Plain (NCP). In this study, we developed the prediction model of maturity date and yield (PMMY) for wheat–maize using multi‐source satellite images, an Agricultural Production Systems sIMulator (APSIM) model and a random forest (RF) algorithm.

RESULTS

The results showed that the PMMY model using peak leaf area index (LAI) and accumulated evapotranspiration (ET) has the optimal performance in the prediction of maturity date and yield. The accuracy of the PMMY model using peak LAI and accumulated ET was higher than that of the PMMY model using only peak LAI or accumulated ET. In a single year, the PMMY model had good performance in the prediction of maturity date and yield. The latitude variation in spatial distribution of maturity date for WM was obvious. The spatial heterogeneity for yield of wheat–maize was not prominent. Compared with 2001–2005, the maturity date of the two crops in 2016–2020 advanced 1–2 days, while yield increased 659–706 kg ha−1. The increase in minimum temperature was the main meteorological factor for advance in the maturity date for wheat–maize. Precipitation was mainly positively correlated with maize yield, while the increase in minimum temperature and solar radiation was crucial to the increase in yield.

CONCLUSION

The simultaneous prediction of yield and maturity can be used to guide agricultural production and ensure food security. © 2024 Society of Chemical Industry.
How much can assisted natural regeneration contribute to ecological restoration in arid lands?
Authors: del Mar González Florencia , Pérez Daniel Roberto
Published: June 2024

In many arid shrubland lands around the world, such as the Monte Desert of Argentina, ecological restoration efforts often prioritize direct seeding or outplantings. Another restorative intervention with lower costs, such as assisted natural regeneration (ANR) through soil tillage, are poorly studied and implemented. In this context, we selected 16 abandoned petroleum drilling platforms that were scarified with furrows to evaluate the natural establishment of vegetation. An equal number of neighboring sites were chosen as ecological reference sites. Five years after scarification, an analysis was conducted on the similarity, richness, diversity of species, plant coverage, density, and soil in soil‐scarified petroleum drilling platforms and ecological reference sites. Similarity, diversity, plant coverage, and density were low between degraded and reference sites. However, 40% of the total species found in the ecological reference colonized one or more of the degraded sites studied. The species found in degraded sites belonged to various life forms (shrubs, perennial, and annual herbs). Additionally, the colonization exhibited notable differences with the typical succession sequence of pioneer, intermediate, and mature species. Many of them were considered typical of climax states in previous studies, such as the case of Larrea divaricata and Larrea cuneifolia. The discussion addresses the succession process in arid lands and highlights the importance of considering ANR with more emphasis on restoration efforts.
Long‐term impact of inorganic fertilizers and farmyard manure on soil quality and productivity in subtropical Vertisols under a soybean‐wheat cropping system
Authors: Bangre Jyoti , Sinha Nishant Kumar , Mohanty Manoranjan , Jayaraman Somasundaram , Sahoo Rabi Narayan , Dwivedi Anuj Kumar , Singh Deepak , Mishra Alok , Kumar Saral , Wanjari Ravi , Jha Pramod , Kumar Dhiraj , Mishra Rahul , Mandloi Subhash , Singh Umesh Kumar , Chaudhary Ranjeet , Reddy Kotha Sammi , Prabhakar Mathyam , Singh Vinod Kumar , Rao Cherukumalli Srinivasa
Published: June 2024

The quality of soil plays a crucial role in sustainable agriculture. To better understand the changes in soil quality across different agroecosystems, long‐term experiments are considered as the most effective approach. Moreover in spite of their significance, there is paucity of information pertaining to long‐term impact of fertilizer and manure application on soil quality in Vertisols of Central India. Thus, the present study aimed to assess the soil quality in an ongoing 46‐year long‐term fertilizer experiment conducted in central India, where a soybean‐wheat cropping system (SWCY) was implemented on a Vertisol. The experiment involved the application of inorganic and integrated nutrient treatments, including farmyard manure (FYM). By analyzing various biological and physiochemical properties of the soil, a soil quality index (SQI) was developed. The SQI encompassed treatments with both optimal and suboptimal nutrient dosages, revealing the range of soil quality variations resulting from different nutrient applications over the long term. The study found a significant correlation between the SQI values and the grain yields of soybean (R2 = 0.85**) and wheat (R2 = 0.85**). The main indicators identified for assessing soil quality were large macro‐aggregates, dehydrogenase activity, microbial biomass nitrogen and carbon, and available nitrogen. Overall, the findings highlighted the importance of soil biological and physiochemical properties in determining soil quality, emphasizing the significance of integrating both inorganic and organic sources of nutrients for improving soil quality and crop productivity of soybean and wheat sequence in Vertisols of Central India.
Full‐Phase Parameter Modulation with Arbitrary Polarization Combination via Bidirectional Asymmetric Transmission Meta‐Devices
Authors: Li Hongmei , Yu Axiang , Pang Cheng , Wang Yuzhong , Qi Jiaran
Published: June 2024

The bidirectional asymmetric transmission (BAT) meta‐devices have attracted widespread attention as an emerging display, encryption, and information storage platform. Generally, the multiplexing capability of BAT meta‐devices determines the upper limit of the loading capacity of multi‐task integrated systems. However, existing BAT meta‐devices still depend on structural properties and the arrangement of meta‐atoms, limiting the number of manipulated channels, operating frequency, and polarization combinations. Herein, a universal BAT meta‐device, enabling bidirectional eight‐phase‐channel asymmetric transmission, composed of bilayer spatially cascaded birefringent metasurfaces (BMs) is proposed to allow for arbitrary polarization combination via the inverse design method and validated in the microwave region. In addition, the polarization multiplexing capabilities of BAT meta‐devices are further extended via a Lego‐like physical mechanism. The proposed design strategy may facilitate BAT meta‐devices functional innovation and advanced application deployment in holographic images, duplex communication, and secret‐key‐sharing data encryption.
Solidification of Polyurethane Model Foams via Catalyst Drainage from a Secondary Foam
Authors: Jouanlanne Manon , Egelé Antoine , Drenckhan Wiebke , Farago Jean , Hourlier‐Fargette Aurélie
Published: June 2024

Due to their unique mechanical and thermal properties, polyurethane foams are widely used in multiple fields of applications, including cushioning, thermal insulation or biomedical engineering. However, the way polyurethane foams are usually manufactured ‐ via chemical foaming ‐ produces samples where blowing and gelling occur at the same time, resulting in a morphology control achieved by trial and error processes. Here, a novel strategy is introduced to build model homogeneous polyurethane foams of controlled density with millimetric bubbles from liquid templates. By producing a polyurethane foam via physical bubbling without a catalyst and gently depositing a secondary foam containing catalyst on the top of this first foam, it is possible to take advantage of drainage mechanisms to trigger the solidification of the bottom foam. The characterization of the samples performed by X‐ray microtomography allows to study quantitatively the structure of the final solid foam, at the global and at the local scale. Using the tomographic 3D images of the foam architectures, the superimposed foam technique introduced in this article is shown to be promising to produce foams with a good homogeneity along the vertical direction, with a density controlled by varying the concentration of catalyst in the secondary foam.
Mitochondrial Parkinsonism: A Practical Guide to Genes and Clinical Diagnosis
Authors: Lopriore Piervito , Palermo Giovanni , Meli Adriana , Bellini Gabriele , Benevento Elena , Montano Vincenzo , Siciliano Gabriele , Mancuso Michelangelo , Ceravolo Roberto
Published: June 2024

Background

Primary mitochondrial diseases (PMDs) are the most common inborn errors of energy metabolism, with a combined prevalence of 1 in 4300. They can result from mutations in either nuclear DNA (nDNA) or mitochondrial DNA (mtDNA). These disorders are multisystemic and mainly affect high energy‐demanding tissues, such as muscle and the central nervous system (CNS). Among many clinical features of CNS involvement, parkinsonism is one of the most common movement disorders in PMDs.

Methods

This review provides a pragmatic educational overview of the most recent advances in the field of mitochondrial parkinsonism, from pathophysiology and genetic etiologies to phenotype and diagnosis.

Results

mtDNA maintenance and mitochondrial dynamics alterations represent the principal mechanisms underlying mitochondrial parkinsonism. It can be present in isolation, alongside other movement disorders or, more commonly, as part of a multisystemic phenotype. Mutations in several nuclear‐encoded genes (ie, POLG, TWNK, SPG7, and OPA1) and, more rarely, mtDNA mutations, are responsible for mitochondrial parkinsonism. Progressive external opthalmoplegia and optic atrophy may guide genetic etiology identification.

Conclusion

A comprehensive deep‐phenotyping approach is needed to reach a diagnosis of mitochondrial parkinsonism, which lacks distinctive clinical features and exemplifies the intricate genotype‐phenotype interplay of PMDs.
Long‐term outcomes in virtual surgical planning for mandibular reconstruction: A cost‐effectiveness analysis
Authors: Gardiner Lauren , Smith Brandon , Kubik Mark , Solari Mario , Smith Kenneth , de Almeida John R. , Sridharan Shaum
Published: June 2024

Objective

This study is an economic evaluation comparing virtual surgical planning (VSP) utilization to free hand mandibular reconstruction (FHR) for advanced oral cavity cancer, for which the cost effectiveness remains poorly understood. The proposed clinical benefits of VSP must be weighed against the additional upfront costs.

Methods

A Markov decision analysis model was created for VSP and FHR based on literature review and institutional data over a 35‐year time horizon. Model parameters were derived and averaged from systematic review and institutional experience. VSP cost and surgical time saving was incorporated. We accounted for long‐term risks including cancer recurrence and hardware failure/exposure. We calculated cost in US dollars and effectiveness in quality‐adjusted‐life‐years (QALYs). A health care perspective was adopted, discounting costs and effectiveness at 3%/year. Deterministic and probabilistic sensitivity analyses tested model robustness.

Results

In the base case scenario, total VSP strategy cost was $49,498 with 8.37 QALYs gained while FHR cost was $42,478 with 8.27 QALY gained. An incremental cost‐effectiveness ratio (ICER), or the difference in cost/difference in effectiveness, for VSP was calculated at $68,382/QALY gained. VSP strategy favorability was sensitive to variations of patient age at diagnosis and institutional VSP cost with one‐way sensitivity analysis. VSP was less economically favorable for patients >75.5 years of age or for institutional VSP costs >$10,745. In a probabilistic sensitivity analysis, 55% of iterations demonstrated an ICER value below a $100,000/QALY threshold.

Conclusions/Relevance

VSP is economically favorable compared to FHR in patients requiring mandibular reconstruction for advanced oral cancer, but these results are sensitive to the patient's age at diagnosis and the institutional VSP cost. Our results do not suggest if one “should or should not” use VSP, rather, emphasizes the need for patient selection regarding which patients would most benefit from VSP when evaluating quality of life and long‐term complications. Further studies are necessary to demonstrate improved long‐term risk for hardware failure/exposure in VSP compared to FHR.
Prevalence of cardiovascular implantable electronic devices in children with type 1 myotonic dystrophy
Authors: Meziab Omar , Seckeler Michael D. , Scherer Katalin , Barber Brent J.
Published: June 2024

Introduction/Aims

Type 1 myotonic dystrophy (DM1) is a neuromuscular disorder of multiple organ systems with important electrophysiologic (EP) manifestations, leading to a cumulative incidence of sudden death of 6.6%. Due to genetic anticipation, there is a pediatric subset of this patient population. However, most EP research on DM1 patients has been in adults, making cardiac care for pediatric patients difficult and directed by adult guidelines which often leads to cardiovascular implantable electronic device (CIED) implants. We sought to investigate the prevalence of CIEDs in the pediatric DM1 population.

Methods

The Vizient® Clinical Data Base was queried from October 2019 to October 2023 for admissions with and without ICD‐10 code for myotonic dystrophy (G71.11), with and without codes for presence of a pacemaker or ICD (Z95.0, Z95.810). Patients who were identified were stratified by age: Pediatric (0–21 years) and Adult (22–50 years).

Results

Prevalence of CIED in pediatric DM1 was 2.1% and in adult DM1 was 15.8%. When comparing to pediatric and adult patients with CIED and without DM1, the odds ratio for CIED in pediatric DM1 was 48.8, compared to 23.3 for CIED in adult DM1.

Discussion

There are pediatric DM1 patients who have received CIED despite a lack of data to inform this decision‐making. Further research will be important to ensure appropriate use of CIED in this population and to develop appropriate guidelines to direct management.
Rapid Production Nasal Osteotomy Simulators With Multi‐Modality Manufacturing: 3D Printing, Casting, and Molding
Authors: Tumlin Parker , Sunyecz Ian , Cui Ruifeng , Armeni Mark , Freiser Monika E.
Published: June 2024

Objective

To expand and improve upon previously described nasal osteotomy models with the goals of decreasing cost and production time while ensuring model fidelity. To assess change in participant confidence in their understanding of and ability to perform nasal osteotomies following completion of the simulation course.

Study Design

Prospective study.

Setting

Simulation training course for otolaryngology residents at West Virginia University.

Methods

A combined methodology of 3D printing, silicone molding, and resin casting was used to design a nasal osteotomy model to address material issues such as print delamination. Multiple models were then used in a simulation lab on performing nasal osteotomies. Model utility and impact on participant confidence was assessed at baseline, postlecture, and postsimulation lab.

Results

Using a combined manufacturing methodology, we achieved a production time reduction of 97.71% and a cost reduction of 82.02% for this polyurethane resin nasal osteotomy model relative to a previously described osteotomy model. Participants in the simulation course were noted to have a significant improvement in confidence in their understanding of and ability to perform nasal osteotomies from baseline and postlecture and also from postlecture and postsimulation lab (P < .05 for all).

Conclusion

By incorporating multiple manufacturing modalities (molding and casting) in addition to 3D printing, this study achieved a large reduction in both production time and cost in fabrication of a nasal osteotomy simulator and addressed material limitations imposed by fused deposition modeling printers. This design methodology serves as an example on how these barriers may be addressed in unrelated simulation projects. Model fidelity was improved with addition of a silicone soft tissue midface. Improvement in participant confidence was noted following completion of the simulation lab.
Her Legacy Lives On: Celebrating the Women Behind Head and Neck Eponyms
Authors: Mosteller Lauretta J. , Yang Alex W. , Tolisano Anthony M.
Published: June 2024

This article profiles 6 notable female scientists who have had eponyms named after them, highlighting their significant contributions to various medical fields and whose scientific endeavors have influenced our practice and understanding of otolaryngology. We discuss Łucja Frey Gottesman and her description of Frey's syndrome; Margaret Dix and the Dix‐Hallpike test; Lotte Strauss and her work defining Churg‐Strauss disease; Dorothy Reed Mendenhall's discovery of Reed‐Sternberg cells in Hodgkin's lymphoma; Edith Louise Potter defining Potter sequence in utero; Denise Louis‐Bar originally characterizing the condition now known as ataxia‐telangiectasia or Louis‐Bar syndrome. Despite the challenges these women faced as pioneering female physicians as well as personal and political turmoil, their contributions greatly advanced the fields of otolaryngology, neurology, neuropathology, perinatology, and pediatric pathology. We aim to honor their stories and medical legacies.
Comprehensive Analysis of Adverse Events Associated With Hypoglossal Nerve Stimulators: Insights From the MAUDE Database
Authors: Bentan Mihai A. , Nord Ryan
Published: June 2024

Objective

This study aims to examine the adverse events associated with hypoglossal nerve stimulator (HNS) implantation for treating obstructive sleep apnea (OSA), drawing data from the Manufacturer and User Facility Device Experience (MAUDE) database. We aim to provide a comprehensive and updated account of these adverse events.

Study Design

Retrospective analysis.

Setting

MAUDE Database review.

Methods

A retrospective analysis was performed on the MAUDE database to collect all HNS‐related reports from May 2014 to December 2023. Variables collected included date of event, event description, nature of event, iatrogenic injuries, required interventions, and, if available, root causes. Each event description was analyzed to classify the adverse event, the postevent intervention, and device model number.

Results

Out of 1178 reports fulfilling the inclusion criteria, 1312 adverse events were identified. Common adverse events included infection (24.0%), pain (19.7%), and hematoma/seroma (10.2%). Approximately 83.1% of these adverse events necessitated medical and/or surgical intervention. The most frequent procedures included explantation (29.4%) and device repositioning (15.8%). Pneumothorax was reported in 50 cases, with 41 (82.0%) requiring a chest tube to be inserted. Three adverse events described overstimulation in the setting of magnetic resonance imaging (MRI) despite the implantation of MRI‐compatible second‐generation internal pulse generators.

Conclusion

While HNS implantation has been established as a reliable intervention for OSA in cases of continuous positive airway pressure failure or intolerance, this study highlights several perioperative and postoperative difficulties and complications. Understanding these challenges is essential for refining surgical practices and enhancing patient consent processes, ultimately aiming to improve therapeutic outcomes.
Patient Satisfaction with Nonopioid Postoperative Analgesia in Head and Neck Surgery: A Prospective Randomized Trial
Authors: Perez Hector Andres , Pannu Jaibir Singh , Frank Ethan , Adebowale Adebimpe , Hebert Sara , Watson Wayanne , Lao Wilson , Tian Sisi , Kidd Stephanie , Lee Steve , Inman Jared C. , Walker Paul C. , Simental Alfred A. , Nguyen Khanh K.
Published: June 2024

Objective

To evaluate patients' satisfaction with opioid versus opioid‐sparing postoperative analgesia in patients undergoing outpatient head and neck surgery.

Study Design

Prospective randomized trial.

Setting

Tertiary care academic hospital.

Methods

Adult patients undergoing outpatient head and neck surgery were randomly assigned to 1 of 3 analgesic regimens. First‐ and second‐line medications were the following by group (1) Hydrocodone‐acetaminophen with ibuprofen, (2) ibuprofen with hydrocodone‐acetaminophen, and (3) ibuprofen with acetaminophen. Preoperative counseling was provided to patients regarding expected pain and proper medication use. Postoperative questionnaires were administered to assess satisfaction.

Results

One hundred three patients were enrolled in the study (mean age, 56.5 years; women, 75 [73%]). The mean satisfaction score with the pain regimen assigned was similar between the 3 groups (scale 0‐10, [7.7, 8.3, 8.5, P = .46]). A similar percentage of patients in each group reported that surgery was more painful than anticipated (25%, 32%, 26%, P = .978), and a similar percentage of patients reported willingness to utilize the same analgesic regimen following future surgeries (75%, 83%, 76%, P = .682). Additional questions evaluating the side effect profile, maximum and minimum pain scores, and difficulty of recovery were not statistically different between the 3 groups.

Conclusion

In the postoperative population for outpatient head and neck surgeries, there was no significant difference in patient satisfaction and pain control between the opioid and nonopioid arms. Providers should discuss opioid‐sparing regimens preoperatively with patients and describe them as effective in providing adequate pain control without a significant impact on patient's perception of care.
From intention to action: Enabling sustainable agriculture in emerging economies through decentralized regulations for manure management
Authors: Tou Lulu , Wang Jianhua , Chu May
Published: June 2024

This study contributes to the debate about effective regulatory strategies for environmental regulation in achieving sustainable agriculture, particularly in understudied emerging economies. We leverage the case of swine manure recovery in China to illuminate this crucial but under‐researched context. Building on the theory of planned behavior, which posits a gap between intention and behavior, we investigate how these regulations and their combinations influence swine farmers' intentions and behaviors toward resource recovery. Findings reveal command‐and‐control regulations most effectively stimulate initial intentions, while incentive‐based regulations work best in bridging the gap between intention and action. Information‐based approaches further strengthen this conversion, particularly when combined with incentives. Bridging the disciplines of regulation and behavioral science, this study advances theoretical understanding of the intention‐behavior gap in environmental policy. It informs effective regulation design that promote sustainable agricultural practices in developing countries, ultimately contributing to achieving the Sustainable Development Goals.
Late effects following HSCT for childhood ALL: A national single‐center study using three different modalities of delivery of total body irradiation
Authors: Uhlving Hilde Hylland , Specht Lena , Masmas Tania Nicole , Bernsdorf Mogens , Ifversen Marianne
Published: June 2024

Background

Total body irradiation (TBI) is a pivotal part of conditioning prior to hematopoietic stem cell transplantation (HSCT) for childhood acute lymphoblastic leukemia (ALL), yet evidence is sparse regarding the effect of TBI delivery techniques on acute and late toxicities.

Design

In a national cohort of pediatric HSCT‐recipients, we compared three TBI schedules; 12 Gray (Gy) delivered as (i) 4 Gy daily fractions from 2008 to 2011 (n = 12); (ii) 2 Gy fractions twice daily with two‐dimensional (2D) planning technology from 2012 to 2015 (n = 16); and (iii) 2 Gy twice daily with three‐dimensional (3D) planning intensity‐modulated radiotherapy (IMRT) from 2016 to 2020 (n = 14).

Results

The 5‐year event‐free survival was 75.0%, 81.3%, and 81.3% in Cohorts 1, 2, and 3, respectively. Acute toxicity assessed as maximum ferritin and C‐reactive protein during the first 3 months post HSCT did not differ between cohorts, nor did the time to first hospital discharge (median 28, 32, and 31 days, p = .25). The incidences of acute graft‐versus‐host disease (GvHD) (66%, 56%, 71%) and chronic GvHD (25%, 31%, 14%) were comparable. Pulmonary function assessed by spirometry did not differ significantly. The 5‐year cataract‐free survival was 33.3%, 79%, and 100% in Cohorts 1, 2, and 3, respectively. We found a nonsignificant tendency toward more endocrinopathies in Cohort 1 compared to Cohorts 2 and 3.

Conclusion

The change of modality did not result in more relapses. More fractionation led to improvement with a lower incidence of cataract and a tendency toward fewer endocrinopathies. The effect of 3D‐planning‐IMRT technology requires further evaluation in larger studies.