bluuebunny/crossref_metadata_2025 huggingface dataset:
Effects of sulfur dioxide fumigation on mortality of confused flour beetle (Coleoptera: Tenebrionidae) and rice weevil (Coleoptera: Curculionidae)
Authors: Liu Yong-Biao
Published: July 2024

Sulfur dioxide (SO2) fumigation was studied in laboratory to determine its potential as an alternative treatment for postharvest control of stored product insects, confused flour beetle, Tribolium confusum Jacquelin du Val (Coleoptera: Tenebrionidae), and rice weevil, Sitophilus oryzae (L.) (Coleoptera: Curculionidae). Three-hour fumigations with 0.1%–2.0% SO2 were conducted against eggs, immature stages, and adults of the 2 insects at 20 °C. Effective control of both insects was achieved. However, there were considerable variations between the 2 insects and among different life stages. Confused flour beetle was more susceptible to SO2 fumigation than rice weevil. Complete control of adults and all life stages of confused flour beetle was achieved in 3-h fumigations with 0.5% and 2.0% SO2, respectively. For rice weevil, 3-h fumigation with 1.5% SO2 resulted in 96.5% adult mortality and the fumigation with 2.0% SO2 resulted in 99.27% mortality of adults and 87.5% mortality of immature stages. Three-hour fumigations with 1% SO2 resulted in <5% egg survival to adults. The study demonstrated high efficacy of SO2 fumigation against the insects and suggested that SO2 fumigation has good potential for postharvest pest control on stored products.
Stuck in a whirlpool? The role of hope and despair in dealing with risks during Afghan migration journeys
Authors: Kiriscioglu Eda , Van Heelsum Anja
Published: July 2024

Migration journeys are full of risk, navigated not just by physical obstacles but also by emotional tides. This study explores how the fluctuation of hope and despair plays a role in dealing with risks. Drawing upon in-depth interviews with Afghans in Turkey, this paper demonstrates that hope and despair fluctuate along migration journeys contingent upon three elements: (1) empirical evidence about the future, (2) (un)certainty and potential in the future, and (3) the agency or capability to act. The research finds that hope arises when the future is perceived as uncertain, offering individuals alternative pathways and restoring a sense of agency by transforming uncertainty into potentiality. Conversely, despair sets in when individuals perceive their near future as certain, devoid of alternatives. This sense of certainty about the near future leaves migrants feeling trapped, akin to being stuck in a whirlpool.
The Prosōpon of Jesus’ Soul in Origen’s Homilies on Psalm 15 (16)
Authors: Juge Jean-Paul M
Published: July 2024

Prosopological exegesis was integral to the trinitarian theology of several second- and early third-century Christian theologians who argued that the different divine personae or prosōpa that speak in biblical texts were distinct from one another in reality. Unlike these predecessors, Origen’s use of prosopological exegesis in the Psalms occurs in a less polemical context and gravitates towards Christology and ecclesiology rather than trinitarian theology. In his homilies on Psalm 15 (16), Origen identifies the soul of Jesus as a speaking prosōpon distinct from, and acted upon by, the divine Word. This instance of prosopological exegesis highlights the distinctiveness of Origen’s theological use of this literary practice. In particular, I argue that Origen draws conclusions of soteriological and ecclesiological relevance from his notion of the speaking prosōpon of Jesus’ soul, which mediates a kind of communicatio idiomatum between the human Christ and the Church.
Theoretical study of infrared and ultraviolet spectroscopy in SiP interstellar molecules
Authors: Wang Guosen , Zhang Chuanyu , Cheng Xinlu , Zhang Hong
Published: July 2024

Insufficient theoretical investigation is being conducted on the spectroscopic characteristics within the infrared wavelength range of SiP, an identified interstellar molecule. Using the ic-MRCI method, potential energy functions and dipole moment functions for the ground state (${X^2}\Pi $) and low excited states (${{\rm{A}}^2}{\Sigma ^ + }$) of the SiP molecule were calculated. Based on experimental spectroscopy data, least squares fitting was used for the potential energy functions of the ${X^2}\Pi $ and ${{\rm{A}}^2}{\Sigma ^ + }$ states. By combining these potential energy and dipole moment functions, the one-dimensional Schrödinger equation was solved to obtain the vibronic energy levels and Einstein A coefficients for the electronic states. Partition functions of the SiP molecule from 0.1 to 3000 K and the radiative properties of ${X^2}\Pi \leftrightarrow {X^2}\Pi $ and ${X^{\rm{2}}}\Pi \leftrightarrow {{\rm{A}}^2}{\Sigma ^ + }$ were derived. Infrared spectroscopy of the ${X^2}\Pi $ state and ultraviolet spectroscopy of the ${X^{\rm{2}}}\Pi \leftrightarrow {{\rm{A}}^2}{\Sigma ^ + }$ transition at 100 K, a temperature crucial for astronomical research, were calculated. Results indicate that the spectral-line intensity of the ${X^{\rm{2}}}\Pi \leftrightarrow {{\rm{A}}^2}{\Sigma ^ + }$ transition is greater, making it more suitable for astronomical observation. The obtained computational results in this paper yield spectroscopic parameters for the characterization of the interstellar molecule SiP, furnishing theoretical underpinnings for subsequent experimental observations.
Dark scattering: accelerated constraints from KiDS-1000 with ReACT and CosmoPower
Authors: Carrion Karim , Carrilho Pedro , Spurio Mancini Alessio , Pourtsidou Alkistis , Hidalgo Juan Carlos
Published: July 2024

We present constraints on the dark scattering model through cosmic shear measurements from the Kilo Degree Survey (KiDS-1000), using an accelerated pipeline with novel emulators produced with CosmoPower. Our main emulator, for the dark scattering non-linear matter power spectrum, is trained on predictions from the halo model reaction framework, previously validated against simulations. Additionally, we include the effects of baryonic feedback from HMCode2016, whose contribution is also emulated. We analyse the complete set of statistics of KiDS-1000, namely band powers, COSEBIs, and correlation functions, for dark scattering in two distinct cases. In the first case, taking into account only KiDS cosmic shear data, we constrain the amplitude of the dark energy–dark matter interaction to be $\vert A_{\rm ds} \vert \lesssim 20$$\rm b\,GeV^{-1}$ at 68  per cent C.L. Furthermore, we add information from the cosmic microwave background (CMB) from Planck, along with baryon acoustic oscillations (BAO) from 6dFGS, SDSS, and BOSS, approximating a combined weak lensing+CMB+BAO analysis. From this combination, we constrain $A_{\rm ds} = 10.6^{+4.5}_{-7.3}$$\rm b\,GeV^{-1}$ at 68  per cent C.L. We confirm that with this estimated value of $A_{\rm ds}$ the interacting model considered in this work offers a promising alternative to solve the $S_8$ tension.
A kinome drug screen identifies multi-TKI synergies and ERBB2 signaling as a therapeutic vulnerability in MYC/TYR subgroup atypical teratoid rhabdoid tumors
Authors: Golbourn Brian , Ho Ben , Bondoc Andrew , Luck Amanda , Fan Xiaolian , Richardson Elizabeth , Marcellus Richard , Prakesch Michael , Halbert Mathew , Agrawal Nishant , Smith Christian , Huang Annie , Rutka James T
Published: July 2024

Background

Atypical teratoid rhabdoid tumor (ATRT) is a rare, devastating, and largely incurable pediatric brain tumor. Although recent studies have uncovered 3 molecular subgroups of ATRTs with distinct disease patterns, and signaling features, the therapeutic profiles of ATRT subgroups remain incompletely elucidated.

Methods

We examined the effect of 465 kinase inhibitors on a panel of ATRT subgroup-specific cell lines. We then applied multiomics analyses to investigate the underlying molecular mechanism of kinase inhibitor efficacy in ATRT subgroups.

Results

We observed that ATRT cell lines are broadly sensitive to inhibitors of the PI3K and MAPK signaling pathways, as well as CDKs, AURKA/B kinases, and polo-like kinase 1. We identified 2 classes of multikinase inhibitors predominantly targeting receptor tyrosine kinases including PDGFR and EGFR/ERBB2 in MYC/TYR ATRT cells. The PDGFRB inhibitor, Dasatinib, synergistically affected MYC/TYR ATRT cell growth when combined with broad-acting PI3K and MAPK pathway inhibitors, including Rapamycin and Trametinib. We observed that MYC/TYR ATRT cells were also distinctly sensitive to various inhibitors of ERBB2 signaling. Transcriptional, H3K27Ac ChIPSeq, ATACSeq, and HiChIP analyses of primary MYC/TYR ATRTs revealed ERBB2 expression, which correlated with differential methylation and activation of a distinct enhancer element by DNA looping. Significantly, we show the brain penetrant EGFR/ERBB2 inhibitor, Afatinib, specifically inhibited in vitro and in vivo growth of MYC/TYR ATRT cells.

Conclusions

Taken together, our studies suggest combined treatments with PDGFR and ERBB2-directed TKIs with inhibitors of the PI3K and MAPK pathways as an important new therapeutic strategy for the MYC/TYR subgroup of ATRTs.
Atezolizumab plus bevacizumab as first-line systemic therapy for hepatocellular carcinoma: a multi-institutional cohort study
Authors: Storandt Michael H , Zemla Tyler J , Patell Kanchi , Naleid Nikolas , Gile Jennifer J , Tran Nguyen H , Chakrabarti Sakti , Jin Zhaohui , Borad Mitesh , Mahipal Amit
Published: July 2024

Background

Atezolizumab plus bevacizumab is the standard of care for advanced hepatocellular carcinoma (HCC) in the first-line setting, although was only evaluated in patients with Child-Pugh (CP) A liver function in the IMbrave150 trial. We sought to determine the outcomes of these patients based on CP score and ALBI grade in the US population.

Methods

This multicenter cohort study included patients with HCC who received atezolizumab with bevacizumab as first-line systemic therapy between March 2018 and November 2023. Overall survival (OS) was determined using the Kaplan-Meier method and multivariate analyses were performed using Cox proportional hazard regression method.

Results

Among 322 patients, 226, 86, and 10 patients had CP-A, CP-B, and CP-C liver function, respectively. Median age was 66.5 years, 78.6% were male, and 82.6% were White. Median OS (mOS) was 21.6 months for those with CP-A, 9.1 months for those with CP-B7, and 4.7 months for those with CP-B8-C12 (P < .0001). Among patients with CP-A, those with ALBI grade 1 had an mOS of 34.9 months versus 14.2 months in those with grade 2. In multivariate analyses, CP score, ALBI grade, hepatitis B, performance status, and macrovascular invasion were significantly associated with survival.

Conclusions

CP score is an important prognostic tool for patients with HCC receiving atezolizumab plus bevacizumab, and this regimen remains a viable option for patients with CP-B7 with no additional safety concern, although the benefit is significantly less than those with CP-A. ALBI score has independent predictive value in patients with CP-A liver function.
The lowdown on breakdown: Open questions in plant proteolysis
Authors: Eckardt Nancy A , Avin-Wittenberg Tamar , Bassham Diane C , Chen Poyu , Chen Qian , Fang Jun , Genschik Pascal , Ghifari Abi S , Guercio Angelica M , Gibbs Daniel J , Heese Maren , Jarvis R Paul , Michaeli Simon , Murcha Monika W , Mursalimov Sergey , Noir Sandra , Palayam Malathy , Peixoto Bruno , Rodriguez Pedro L , Schaller Andreas , Schnittger Arp , Serino Giovanna , Shabek Nitzan , Stintzi Annick , Theodoulou Frederica L , Üstün Suayib , van Wijk Klaas J , Wei Ning , Xie Qi , Yu Feifei , Zhang Hongtao
Published: July 2024

Proteolysis, including post-translational proteolytic processing as well as protein degradation and amino acid recycling, is an essential component of the growth and development of living organisms. In this article, experts in plant proteolysis pose and discuss compelling open questions in their areas of research. Topics covered include the role of proteolysis in the cell cycle, DNA damage response, mitochondrial function, the generation of N-terminal signals (degrons) that mark many proteins for degradation (N-terminal acetylation, the Arg/N-degron pathway, and the chloroplast N-degron pathway), developmental and metabolic signaling (photomorphogenesis, abscisic acid and strigolactone signaling, sugar metabolism, and postharvest regulation), plant responses to environmental signals (endoplasmic-reticulum-associated degradation, chloroplast-associated degradation, drought tolerance, and the growth-defense trade-off), and the functional diversification of peptidases. We hope these thought-provoking discussions help to stimulate further research.
Enhancing poststroke hand movement recovery: Efficacy of RehabSwift, a personalized brain–computer interface system
Authors: Darvishi Sam , Datta Gupta Anupam , Hamilton-Bruce Anne , Koblar Simon , Baumert Mathias , Abbott Derek
Published: July 2024

This study explores the efficacy of our novel and personalized brain–computer interface (BCI) therapy, in enhancing hand movement recovery among stroke survivors. Stroke often results in impaired motor function, posing significant challenges in daily activities and leading to considerable societal and economic burdens. Traditional physical and occupational therapies have shown limitations in facilitating satisfactory recovery for many patients. In response, our study investigates the potential of motor imagery–based BCIs (MI-BCIs) as an alternative intervention. In this study, MI-BCIs translate imagined hand movements into actions using a combination of scalp-recorded electrical brain activity and signal processing algorithms. Our prior research on MI-BCIs, which emphasizes the benefits of proprioceptive feedback over traditional visual feedback and the importance of customizing the delay between brain activation and passive hand movement, led to the development of RehabSwift therapy. In this study, we recruited 12 chronic-stage stroke survivors to assess the effectiveness of our solution. The primary outcome measure was the Fugl-Meyer upper extremity (FMA-UE) assessment, complemented by secondary measures including the action research arm test, reaction time, unilateral neglect, spasticity, grip and pinch strength, goal attainment scale, and FMA-UE sensation. Our findings indicate a remarkable improvement in hand movement and a clinically significant reduction in poststroke arm and hand impairment following 18 sessions of neurofeedback training. The effects persisted for at least 4 weeks posttreatment. These results underscore the potential of MI-BCIs, particularly our solution, as a prospective tool in stroke rehabilitation, offering a personalized and adaptable approach to neurofeedback training.
Triadic percolation induces dynamical topological patterns in higher-order networks
Authors: Millán Ana P , Sun Hanlin , Torres Joaquín J , Bianconi Ginestra
Published: July 2024

Triadic interactions are higher-order interactions which occur when a set of nodes affects the interaction between two other nodes. Examples of triadic interactions are present in the brain when glia modulate the synaptic signals among neuron pairs or when interneuron axo-axonic synapses enable presynaptic inhibition and facilitation, and in ecosystems when one or more species can affect the interaction among two other species. On random graphs, triadic percolation has been recently shown to turn percolation into a fully fledged dynamical process in which the size of the giant component undergoes a route to chaos. However, in many real cases, triadic interactions are local and occur on spatially embedded networks. Here, we show that triadic interactions in spatial networks induce a very complex spatio-temporal modulation of the giant component which gives rise to triadic percolation patterns with significantly different topology. We classify the observed patterns (stripes, octopus, and small clusters) with topological data analysis and we assess their information content (entropy and complexity). Moreover, we illustrate the multistability of the dynamics of the triadic percolation patterns, and we provide a comprehensive phase diagram of the model. These results open new perspectives in percolation as they demonstrate that in presence of spatial triadic interactions, the giant component can acquire a time-varying topology. Hence, this work provides a theoretical framework that can be applied to model realistic scenarios in which the giant component is time dependent as in neuroscience.
High alert in the low countries: State-sponsored threat awareness in policing the Dutch port and knowledge sectors
Authors: Eski Yarin , Boelens Mauro , Kok Bibi
Published: July 2024

The war in Ukraine has made clear that we live in a multipolar world where global powers, being the West, Russia, and China, are in continuous geopolitical conflict with one another. It has brought about old and new state-sponsored threats (SSTs), in particular (online) espionage and spreading disinformation, which are instrumentalized by each of these global powers against one another. It altogether puts the national security and economic interests of many more countries at risk. Being heavily dependent on global powers for trade and knowledge building and sharing, small countries seem to be confronted with their powerlessness in the wake of the increasingly threatening multipolar geopolitics. Simultaneously, some of these small countries accommodate important nodes through which international transport and knowledge flow on which global powers, in turn, depend on. In the Netherlands, the port sector (consisting in this study of the Rotterdam and Amsterdam seaports) and the knowledge sector (consisting of several universities, applied universities, and research institutes) form important international nodes for the global transport and knowledge economy. How does the Netherlands position and secure itself through raising awareness of SSTs coming from the global powers it depends on? Based on a study of SST awareness in Dutch ports and higher education, this contribution delivers a possible answer to that question.
Machine learning: implications and applications for ambulatory anesthesia
Authors: Anand Karisa , Hong Suk , Anand Kapil , Hendrix Joseph
Published: July 2024

Purpose of review

This review explores the timely and relevant applications of machine learning in ambulatory anesthesia, focusing on its potential to optimize operational efficiency, personalize risk assessment, and enhance patient care.

Recent findings

Machine learning models have demonstrated the ability to accurately forecast case durations, Post-Anesthesia Care Unit (PACU) lengths of stay, and risk of hospital transfers based on preoperative patient and procedural factors. These models can inform case scheduling, resource allocation, and preoperative evaluation. Additionally, machine learning can standardize assessments, predict outcomes, improve handoff communication, and enrich patient education.

Machine learning has the potential to revolutionize ambulatory anesthesia practice by optimizing efficiency, personalizing care, and improving quality and safety. However, limitations such as algorithmic opacity, data biases, reproducibility issues, and adoption barriers must be addressed through transparent, participatory design principles and ongoing validation to ensure responsible innovation and incremental adoption.
Spinal anesthesia in ambulatory patients
Authors: Ledesma Ignacio , Stieger Andrea , Luedi Markus M. , Romero Carolina S.
Published: July 2024

Purpose of review

To assess current practice in the use of spinal anesthesia in major ambulatory surgery, highlighting its advantages over general anesthesia and identifying potential areas for improvement to facilitate a transition to a sustainable healthcare system.

Recent findings

Spinal anesthesia might be preferred in selected populations when compared to general anesthesia providing the highest standards of healthcare quality.

The use of local anesthetics with short half-life has proven to be efficient in achieving high anesthesia success rates. Spinal anesthesia does not increase perioperative complications; instead, it has shown a reduction in postoperative nausea and vomiting, an improvement in patient comfort, and a favorable economic impact when compared to general anesthesia.

Spinal anesthesia is an appropriate method for anesthesia in ambulatory patients, offering advantages over general anesthesia in selected populations.

The use of spinal anesthesia is expanding to meet surgical needs. Therefore, it is crucial to plan ahead and anticipate organizational failures in the ambulatory setting to maintain safety and efficiency during outpatient procedures and surgeries.
Increased Expression and Prognostic Significance of BYSL in Melanoma
Authors: Wang Zhong-zhi , Yao Guo-tai , Wang Liang-zhe , Zhu Yuan-jie , Chen Jiang-han
Published: July 2024

We evaluated the BYSL content and underlying mechanism in melanoma (SKCM) overall survival (OS). In this study, we used a comprehensive approach combining bioinformatics tools, including miRNA estimation, quantitative real-time polymerase chain reaction (qRT-PCR) of miRNAs, E3 ligase estimation, STRING analysis, TIMER analysis, examination of associated upstream modulators, protein-protein interaction (PPI) analysis, as well as retrospective and survival analyses, alongside clinical sample validation. These methods were used to investigate the content of BYSL, its methylation status, its relation to patient outcome, and its immunologic significance in tumors. Our findings revealed that BYSL expression is negatively regulated by BYSL methylation. Analysis of 468 cases of SKCM RNA sequencing samples demonstrated that enhanced BYSL expression was associated with higher tumor grade. We identified several miRNAs, namely hsa-miR-146b-3p, hsa-miR-342-3p, hsa-miR-511-5p, hsa-miR-3690, and hsa-miR-193a-5p, which showed a strong association with BYSL levels. Furthermore, we predicted the E3 ubiquitin ligase of BYSL and identified CBL, FBXW7, FZR1, KLHL3, and MARCH1 as potential modulators of BYSL. Through our investigation, we discovered that PNO1, RIOK2, TSR1, WDR3, and NOB1 proteins were strongly associated with BYSL expression. In addition, we found a close association between BYSL levels and certain immune cells, particularly dendritic cells (DCs). Notably, we observed a significant negative correlation between miR-146b-3p and BYSL mRNA expression in SKCM sera samples. Collectively, based on the previously shown evidences, BYSL can serve as a robust bioindicator of SKCM patient prognosis, and it potentially contributes to immune cell invasion in SKCM.
Cardiac Manifestations in Inherited Metabolic Diseases
Authors: Javed Mubeena , Goswami Danish Kumar , Raj Hem , Lohana Kiran , Goswami Barkha , Karim Ali , Warayo Allah , Farooqi Palwasha , Alamy Haroon , Ullah Zainab Obaid , Mohammad Aamer , Farooqi Syed Ahmad , Ali Hafsah , Shuja Darab , Malik Jahanzeb , Baloch Zulfiqar Qutrio
Published: July 2024

Inherited metabolic diseases (IMDs) stem from genetic defects affecting enzyme function within specific metabolic pathways, collectively constituting rare conditions with an incidence of less than 1/100,000 births. While IMDs typically manifest with multisystemic symptoms, cardiac manifestations are common, notably hypertrophic cardiomyopathy. Additionally, they can lead to dilated or restrictive cardiomyopathy, as well as noncompacted left ventricular cardiomyopathy. Rhythm disturbances such as atrioventricular conduction abnormalities, Wolff-Parkinson-White syndrome, and ventricular arrhythmias, along with valvular pathologies and ischemic coronary issues, are also prevalent. This study aims to provide a narrative review of IMDs associated with cardiac involvement, delineating the specific cardiac manifestations of each disorder alongside systemic symptoms pivotal for diagnosis.
The Modern Clinician as an “Argonaut” Guiding Through the “Symplegades” of Evidence for PFO Closure in Patients With Migraine
Authors: Beneki Eirini , Dimitriadis Kyriakos , Campens Laurence , Skalidis Ioannis , Pyrpyris Nikolaos , Kostakis Panagiotis , Aggeli Constantina , de Backer Ole , Tsioufis Konstantinos
Published: July 2024

Patent foramen ovale (PFO) has been associated with migraine, especially migraine with aura, and 30–50% of individuals with migraine with aura have a PFO, suggesting it could be more than just an “innocent bystander’’. Observational data showed a reduction of the frequency and severity of migraine attacks, particularly those with aura, following transcatheter PFO closure for established indications. Three small randomized controlled trials have demonstrated significant benefits of PFO closure in most of their secondary endpoints, such as reductions in the mean number of monthly migraine attacks and migraine days. Since a significant proportion of patients experience important side effects from traditional migraine medications and newer highly effective migraine prevention strategies may need to be instituted. PFO closure could in this regard to be a valuable add-on in the armamentarium of migraine treatment, improving the quality of life by alleviating the need for medications. The effect of percutaneous PFO closure on migraine treatment is needed to be clarified. As the underlying pathophysiology remains poorly understood and largely hypothetical, future investigations, focusing on the causal relationship between PFO and migraine, will help to define the subgroup of patients most likely to benefit from PFO closure. More accurate patient recruitment may lead to greater postprocedural benefits and more significant symptom improvement. Additionally, randomized controlled trials need to be reported adequately with more realistic endpoints, sufficient duration of follow-up, and statistical power to detect differences between closure and placebo groups to ensure precise and reliable findings.
Balancing Expectations: Navigating Medically Necessary Torso Procedures with Cosmetic Components in the Military Healthcare System
Authors: Zbar Ross I.S. , Richards Carly R.N. , Durbin Ronald R. , Wellington Jennifer M.
Published: July 2024

Background:

Surgeons performing federal insurance–financed procedures involving medically necessary and cosmetic components must navigate patient expectations to avoid postoperative disappointment. This challenge is amplified in military healthcare, where different surgical specialties concurrently address the same diagnosis, while the Department of Defense policy on cosmetic fees and TRICARE’s definition of excluded services adds further complexity. With the increasing prevalence of elevated body mass index, focus is directed toward diagnoses involving the torso, specifically gynecomastia in male individuals, and diastasis of the rectus abdominis muscles (DRAM) in female individuals.

Methods:

The study involves a team of experienced board-certified surgeons conducting a narrative review of surgical procedures addressing gynecomastia and DRAM. Relevant literature from 2000 to 2023 is reviewed, focusing on patient satisfaction regarding outcome of medically necessary and cosmetic aspects.

Results:

For gynecomastia, distinguishing between true and pseudogynecomastia is critical. A protocol is presented based on the Simon classification, offering evidence-based guidelines for surgical interventions. Similarly, for DRAM, a minimally invasive approach balances deployment readiness and surgical recovery. The presence of a symptomatic panniculus, however, requires more invasive intervention. The downstream ramification of limited Current Procedural Terminology codes for these interventions is discussed.

Conclusions:

In medically necessary procedures funded through federal health plans such as TRICARE, the primary goal is functional improvement, not the final torso contour. Clear communication and preoperative counseling are crucial to managing patient expectations. Providers in military healthcare must navigate the complex landscape of patient expectations, policy guidelines, and duty readiness while maintaining the standard of care.
New Applications of the Anterior Intercostal Artery Perforator Flap for Prosthetic Breast Reconstruction in the Setting of Postoperative Radiotherapy
Authors: Marruzzo Giovanni , Patanè Luca , Lo Torto Federico , Ribuffo Diego
Published: July 2024

Background:

Several studies have reported preliminary experiences with the anterior intercostal artery perforator (AICAP) flap for treating partial breast defects or breast implant exposure following reconstruction. As radiotherapy is commonly administered for breast cancer, some patients may present with heavily damaged skin flaps and chronic radiodermatitis. We describe new applications of a de-epithelialized AICAP flap, used in combination with an implant, for breast reconstruction when other treatment options are unavailable.

Methods:

A retrospective study was conducted, including all patients who underwent implant-based breast reconstruction with the aid of an AICAP flap. A literature review was also performed.

Results:

Between November 2022 and August 2023, four pedicled AICAP flaps were harvested in four patients. The indications were breast implant coverage in cases of chronic dermatitis of the mastectomy skin flaps (two unilateral flaps) and inferolateral coverage of partially submuscular expanders for immediate breast reconstruction (two unilateral flaps). All four flaps were based on one perforator. The mean harvesting time was 40 minutes. Complete flap survival was achieved, with no complications at the donor site.

Conclusions:

The AICAP flap is a safe and reliable technique for difficult cases of breast reconstruction when no other options are available. Moreover, this technique can easily provide additional coverage for the breast implant when needed.
A Supraorbital V-Y Myocutaneous Perforator Flap for Forehead Reconstruction
Authors: Feinendegen Dominik L. , Feinendegen Sandra Y. , Keller Martin
Published: July 2024

V-Y flaps vascularized by perforators have gained great popularity in the last years. The advantages over randomized local flaps are the significantly greater arc of rotation and transfer length as well as less lymphatic congestion. We introduce a supraorbital V-Y myocutaneous perforator flap for forehead reconstruction. The vascular basis of this flap are the perforators from the ophthalmic artery passing through the supraorbital foramen and incisura frontalis.
Athlete-Specific Considerations of Cartilage Injuries
Authors: Meta Fabien , Clark Sean C. , Tagliero Adam J. , Hevesi Mario , Saris Daniel B.F. , Krych Aaron J.
Published: July 2024

Cartilage injuries can present in a diverse setting of anatomic locations, with varying severity, and can impact athletes of all ages and competition levels. Moreover, the timing of when an injury presents introduces an additional dimension to treatment decision-making. Frequently, the level of competition, in conjunction with career trajectory and short-term and long-term athlete goals, will dictate whether a temporary or definitive treatment strategy is ideal. Although indicating the correct therapeutic regimen may prove challenging, understanding the athlete-specific considerations can be essential to meeting the goals of the athlete and other stakeholders involved in the athlete’s career. The purpose of this review is to comprehensively present the deliberations a treating physician must consider in managing cartilage injuries within a spectrum of athletic levels ranging from youth to professional levels, with a secondary focus on the presentation of temporizing treatment strategies and associated outcomes.
Treatment of Knee Chondral Defects in Athletes
Authors: Thacher Ryan R. , Pascual-Leone Nico , Rodeo Scott A.
Published: July 2024

Cartilage lesions of the knee are a challenging problem, especially for active individuals and athletes who desire a return to high-load activities. They occur both through chronic repetitive loading of the knee joint or through acute traumatic injury and represent a major cause of pain and time lost from sport. They can arise as isolated lesions or in association with concomitant knee pathology. Management of these defects ultimately requires a sound understanding of their pathophysiologic underpinnings to help guide treatment. Team physicians should maintain a high index of suspicion for underlying cartilage lesions in any patient presenting with a knee effusion, whether painful or not. A thorough workup should include a complete history and physical examination. MRI is the most sensitive and specific imaging modality to assess these lesions and can provide intricate detail not only of the structure and composition of cartilage, but also of the surrounding physiological environment in the joint. Treatment of these lesions consists of both conservative or supportive measures, as well as surgical interventions designed to restore or regenerate healthy cartilage. Because of the poor inherent capacity for healing associated with hyaline cartilage, the vast majority of symptomatic lesions will ultimately require surgery. Surgical treatment options range from simple arthroscopic debridement to large osteochondral reconstructions. Operative decision-making is based on numerous patient- and defect-related factors and requires open lines of communication between the athlete, the surgeon, and the rest of the treatment team. Ultimately, a positive outcome is based on the creation of a durable, resistant repair that allows the athlete to return to pain-free sporting activities.
Adolescents With a High Burden of New-Onset Mood Symptoms After Sport-Related Concussion Benefit From Prescribed Aerobic Exercise, a Secondary Analysis of 2 Randomized Controlled Trials
Authors: Castellana Matthew C. , Burnett George J. , Gasper Andrew , Nazir Muhammad S. Z. , Leddy John J. , Master Christina L. , Mannix Rebekah C. , Meehan William P. , Willer Barry S. , Haider Mohammad N.
Published: July 2024

Objective:

Approximately 20% of students with sport-related concussion (SRC) report new symptoms of anxiety and depression which may be associated with delayed recovery and increased risk for developing a mood disorder. Early prescribed aerobic exercise facilitates recovery in athletes with concussion-related exercise intolerance. We studied the effect of aerobic exercise treatment on new mood symptoms early after SRC.

Design:

Exploratory secondary analysis of 2 randomized controlled trials (RCT).

Setting:

Sports medicine clinics associated with UB (Buffalo, NY), CHOP (Philadelphia, PA), and Boston Children’s Hospital (Boston, MA).

Participants:

Male and female adolescents (aged 13-18 years) diagnosed with SRC (2-10 days since injury).

Interventions:

Participants were randomized to individualized targeted heart rate aerobic exercise (n = 102) or to a placebo intervention designed to mimic relative rest (n = 96).

Main Outcome Measures:

Incidence of Persisting Post-Concussive Symptoms (PPCS, symptoms ≥28 days).

Results:

First RCT recruited from 2016 to 2018 and the second from 2018 to 2020. Of 198 adolescents, 156 (79%) reported a low burden (mean 1.2 ± 1.65/24) while 42 (21%) reported a high burden (mean 9.74 ± 3.70/24) of emotional symptoms before randomization. Intervention hazard ratio for developing PPCS for low burden was 0.767 (95% CI, 0.546-1.079; P = 0.128; β = 0.085) and for high burden was 0.290 (95% CI, 0.123-0.683; P = 0.005; β = 0.732).

Conclusions:

High burden of mood symptoms early after injury increases risk for PPCS, but the sports medicine model of providing early targeted aerobic exercise treatment reduces it. Nonsports medicine clinicians who treat patients with a high burden of new mood symptoms after concussion should consider prescribing aerobic exercise treatment to reduce the risk of PPCS and a mood disorder.
Technical Pearls and Pitfalls of Facial Feminization Surgery
Authors: Chaya Bachar F. , Laspro Matteo , Trilles Jorge , Brydges Hilliard , Tran David , Rochlin Danielle H. , Cassidy Michael F. , Colon Ricardo Rodriguez , Rodriguez Eduardo D.
Published: July 2024

Background

Facial feminization surgery (FFS) is an emerging practice that falls under the broader umbrella of gender-affirming surgery. Various approaches exist to feminize the face, yet few published articles describe in detail the techniques of each component procedure. Considering the diversity of interventions employed, the objective of this manuscript is to highlight FFS techniques utilized by the senior author and create a corresponding media gallery.

Methods

All patients with the diagnosis of gender dysphoria that were referred to the senior author for FFS consultation between June 2017 and August 2022 were reviewed. Data were retrospectively collected from electronic medical records according to the institutional review board (IRB)–approved study protocol. Data collected and analyzed included demographics, operative documentation, and postoperative follow-up. Multimedia material was collected intraoperatively and postoperatively.

Results

A total of 231 patients underwent 262 operations with a total of 1224 FFS procedures. The average follow-up time was 7.7 ± 11 months. Out of the 262 operations, 24 (9.2%) patients experienced minor complications, including 3 (1.1%) with wound dehiscence, 13 (5.0%) with hematomas, and 14 (5.3%) with postoperative infection requiring antibiotics. Of those, 3 (1.1%) required a return to the operating room for washout or removal of malar implants.

Conclusion

Although there is a consensus on the fundamental surgical principles to achieve adequate feminization of the facial architecture, the specific techniques to do so differ according to individual practices. As techniques diverge, so do their risk profiles and outcomes; techniques must, thus, align with patients' interventional goals. The material presented here is one of many that can support trainees and junior surgeons as they build a gender-affirming practice.
Oncoplastic Surgery Outcomes in the Older Breast Cancer Population
Authors: Gaffney Kerry A. , Karamchandani Manish M. , De La Cruz Ku Gabriel , Wareham Carly , Homsy Christopher , Nardello Salvatore , Chatterjee Abhishek , Persing Sarah M.
Published: July 2024

Background

Oncoplastic breast surgery (OBS) is a form of breast conservation surgery (BCS) that involves a partial mastectomy followed by immediate volume displacement or volume replacement surgical techniques. To date, there are few studies evaluating OBS in older patients. Therefore, we sought to determine if outcomes differed between patients 65 years and older versus younger patients who underwent oncoplastic surgical procedures.

Methods

A retrospective chart review was performed for all oncoplastic breast operations within a single health system from 2015 to 2021. Patients were stratified by age, with patients 65 years and older (OBS65+) identified and then matched with younger patients (OBS <65) based on BMI. Primary outcomes were positive margin rates and overall complication rates; secondary outcomes were locoregional recurrence (LR), distant recurrence (DR), disease-free survival (DFS), overall survival (OS), and long-term breast asymmetry.

Results

A total of 217 patients underwent OBS over the 6-year period, with 22% being OBS65+. Preoperatively, older patients experienced higher American Anesthesia (ASA) scores, Charlson Co-morbidity index (CCI) scores, and higher rates of diabetes mellitus, hypertension, and grade 3 breast ptosis. Despite this, no significant differences were found between primary or secondary outcomes compared to younger patients undergoing the same procedures.

Conclusions

Oncoplastic breast reconstruction is a safe option in patients 65 years and older, with overall similar recurrence rates, positive margin rates, and survival when compared to younger patients. Although the older cohort of patients had greater preoperative risk, there was no difference in overall surgical complication rates or outcomes. Supporting the argument that all oncoplastic breast reconstruction techniques should be offered to eligible patients, irrespective of age.
Evolutionary déjà vu? A case of convergent evolution in an ant–plant association
Authors: Probst Rodolfo S. , Longino John T. , Branstetter Michael G.
Published: July 2024

Obligatory ant–plant symbioses often appear to be single evolutionary shifts within particular ant lineages; however, convergence can be revealed once natural history observations are complemented with molecular phylogenetics. Here, we describe a remarkable example of convergent evolution in an ant–plant symbiotic system. Exclusively arboreal,
Myrmelachista
species can be generalized opportunists nesting in several plant species or obligately symbiotic, live-stem nesters of a narrow set of plant species. Instances of specialization within
Myrmelachista
are known from northern South America and throughout Middle America. In Middle America, a diverse radiation of specialists occupies understory treelets of lowland rainforests. The morphological and behavioural uniformity of specialists suggests that they form a monophyletic assemblage, diversifying after a single origin of specialization. Using ultraconserved element phylogenomics and ancestral state reconstructions, we show that shifts from opportunistic to obligately symbiotic evolved independently in South and Middle America. Furthermore, our analyses support a remarkable case of convergence within the Middle American radiation, with two independently evolved specialist clades, arising nearly simultaneously from putative opportunistic ancestors during the late Pliocene. This repeated evolution of a complex phenotype suggests similar mechanisms behind trait shifts from opportunists to specialists, generating further questions about the selective forces driving specialization.
Multiple novel caliciviruses identified from stoats (Mustela erminea) in the United Kingdom
Authors: Hinds Joseph , Apaa Ternenge , Parry Rhys H. , Withers Amy J. , MacKenzie Laura , Staley Ceri , Morrison Joshua , Bennett Malcolm , Bremner-Harrison Samantha , Chadwick Elizabeth A. , Hailer Frank , Harrison Stephen W.R. , Lambin Xavier , Loose Mathew , Mathews Fiona , Tarlinton Rachael , Blanchard Adam
Published: July 2024

The Caliciviridae family, comprising positive-sense RNA viruses, is characterised by its non-enveloped, small virions, broad host range, and notable tendency for host switching. These viruses are primarily associated with gastroenteric disease, though they can lead to haemorrhagic or respiratory infections. Our study employed a metagenomics analysis of faecal samples from stoats (Mustela erminea), identifying two novel calicivirus species, named stoat vesivirus and stoat valovirus. Stoat vesivirus was identified in three samples (ST008, ST006, ST004), exhibiting a genome wide nucleotide identity of approximately 92 %. The complete coding sequences of these samples were 8471 (ST004) and 8322 (ST006) nucleotides in length, respectively. Each comprised three open reading frames (ORF), closely resembling the Vesivirus mink calicivirus (China/2/2016), with 70–72 % similarity in ORF1, 61–62 % in ORF2 and 71 % in ORF3. Phylogenetic analysis robustly supported stoat vesivirus as belonging within the Vesivirus genus. The second calivicirus (stoat valovirus), detected solely in sample ST008, was 6527 nucleotides in length and with complete coding sequences present. It shared highest similarity with St-Valérien swine virus and marmot norovirus HT16, showing 39.5 and 38.8 % protein identity with ORF1 and 43.3 and 42.9 % for VP1. Stoat valovirus is borderline for meeting the ICTV criteria for a new genus, demonstrating 60 % divergence in ORF1 compared to the other valovirus’, however it clusters basally within the Valovirus genus, supporting leaving it included in this genus.
Frontal Theta Oscillations and Cognitive Flexibility: Age-Related Modulations in EEG Activity
Authors: Darna Margarita , Stolz Christopher , Jauch Hannah-Sophia , Strumpf Hendrik , Hopf Jens-Max , Seidenbecher Constanze I. , Schott Björn H. , Richter Anni
Published: July 2024

Cognitive flexibility, the ability to adapt one’s behaviour in changing environments, declines during aging. Electroencephalography (EEG) studies have implicated midfrontal theta oscillations in attentional set-shifting, a measure of cognitive flexibility. Little is known about the electrocortical underpinnings of set-shifting in aging. Here, we investigated aging effects on set-shifting performance by analysing theta power in 20 young (mean age: 22.5 ± 2.9 years) and 19 older (mean age: 69.4 ± 6.1 years) adults. While increasing shift difficulty (i.e., intra- vs. extra-dimensional shifts) elicited increased reaction times (RTs) and higher error rates in both age groups, older adults additionally showed an increase in RT variability. Young adults exhibited amplified theta power increases with higher shift difficulty whereas older adults showed overall lower theta power and no task-related power modulation. Our results suggest that set-shifting in older adults occurs without midfrontal theta modulation, indicating potentially distinct underlying neural mechanisms compared to young adults.
Pharmacological rescue of motor circuit dysfunction in aDrosophilamodel of paroxysmal dyskinesia
Authors: Wilson Abigail D. , Jiang Yuyao , Desai Nidhika , Simon-Batsford Nell , Sanderson Angelina , Tolley Isaac , Gao Hao , Jepson James E.C.
Published: July 2024

Background

Paroxysmal dyskinesias (PxDs) are characterised by bouts of involuntary dystonic and choreiform movements. The patho-mechanisms underlying these debilitating disorders remain poorly understood, and drug treatments are often limited. We recently generated aDrosophilamodel of a PxD-linked mutation causing BK potassium channel gain- of-function (BK GOF), and showed that BK GOF perturbs movement inDrosophilaby disrupting neurodevelopment. However, whether locomotor capacity in BK GOF flies can be pharmacologically restored following neurodevelopmental insults has remained unclear.

Objective

To identify pharmacological suppressors of motor defects caused by BK GOF.

Methods

Using adult BK GOF flies, we performed an unbiased, in vivo, locomotion-based screen of 370 FDA-approved drugs. To test the impact of positive hits from this screen on motor circuit activity, we used optical imaging to record the intrinsic rhythmic activity ofDrosophilalarval motor circuits driving peristalsis and turning behaviors.

Results

We found that inhibitors of acetylcholinesterase – a protein that degrades acetylcholine in cholinergic synapses – partially rescued movement defects caused by BK GOF. Inhibition of acetylcholinesterase also partially restored intrinsic activity of motor circuits controlling forward movement and turning in BK GOF larvae.

Conclusions

Our findings indicate that elevating cholinergic tone can reverse motor circuit dysfunction in an animal model of PxD caused by BK GOF. Furthermore, our study provides proof-of-principle thatDrosophilacan be utilised for screens to uncover putative drug treatments for involuntary movement disorders.