bluuebunny/crossref_metadata_2025 huggingface dataset:
A Description of the Dental Health and Treatment of Ukraine Military at U.S. Army Clinics in Germany
Authors: Mendoza Andres M , Simecek John W , Colthirst Paul M , Mitchener Timothy A
Published: October 2024

Introduction

Since the start of the Russo-Ukrainian war, most reports have focused on trauma and combat conditions. Trauma care is essential; however, disease and nonbattle injuries (DNBIs) also burden armies and reduce combat effectiveness. Dental emergencies (DEs) account for a substantial portion of DNBI, but there is limited information on Ukrainian military dental readiness. In September 2023, investigators were informed that Ukrainian military personnel were treated for DEs at 2 dental clinics in Germany.

Materials and Methods

The investigators requested deidentified data from the Corporate Dental System (CDS), which is a repository for dental treatment records utilized by the U.S. Army. The data request captured DE treatment performed for Ukrainian military personnel in Germany from January 1, 2023, to September 20, 2023. The CDS report on DE encounters included the following: Gender, age, procedure codes, and provider narratives. This study was approved by the U.S. Army Institute of Surgical Research Institutional Review Board as research not involving human subjects and provided Log Number H-24-030nh.

Results

The CDS report captured 408 Ukrainian military DE encounters. A total of 360 Ukrainian military personnel were treated for DE during the 9-month reporting period in 2023. Oral surgery was the most common DE treatment category and accounted for 55.8% (N = 201) of DE procedures. Restorative dentistry procedures accounted for 18.1% of DE procedures. Of the 27 multiple category treatments, 25 had oral surgery procedures as one of the treatments. Restorative dentistry procedures were performed in 19 of the multiple category cases.

Conclusions

The DEs in the Ukrainian military cohort suggest that chronic, untreated dental disease has progressed without routine care for years. The assertion that caries has progressed to a nonrestorable condition is supported by the distribution that 63% of all DE visits included oral surgery treatment. Based on the distribution of dental treatment, US dental officers must be proficient in oral surgery and prosthodontic care.
Development of the Joint Expeditionary Medical Officer
Authors: Henderson Jonathan , Pock Arnyce , Elster Eric
Published: October 2024

The Uniformed Services University is known for its dual mission of preparing military medical officers for operational readiness and leadership roles. The Joint Expeditionary Medical Officer (JEMO) project is a novel internal program that was initiated in 2022 and aims to fortify and evaluate the essential Knowledge, Skills, and Abilities (KSAs) within the School of Medicine’s Molecules to Military Medicine curriculum that are pivotal for the development of a deployment-ready military medical officer. The JEMO-KSA program identifies and deliberately develops a core set of mission-critical skills during the course of students’ undergraduate medical education. This helps ensure that Uniformed Services University graduates attain a strong foundational level of operational readiness across various military medical domains. Currently, 371 distinct KSAs have been integrated into the curriculum, with over 86% being assessed at different time frames. Over time, our goal is to present individual students with a customized JEMO “report card” depicting their readiness level; a document that could be updated and expanded throughout their military medical career. The JEMO project represents a significant stride toward optimizing the readiness of military medical officers by systematically identifying, strengthening, and assessing vital operational skills and abilities. With an ongoing commitment to excellence, the project envisages creating an even more robustly structured curriculum that is continually refined to address current operational readiness, setting a new standard for military medical education. While challenges such as accurately measuring the impact of integrated KSAs and continuously updating them to meet evolving military needs remain, the forward momentum associated with the JEMO project will help facilitate the development of military medical officers who have the KSAs to actively support mission success while simultaneously enhancing the overall effectiveness of military health care.
Spherical collapse approach for non-standard dark matter models and enhanced early galaxy formation in JWST
Authors: Davari Zahra , Ashoorioon Amjad , Rezazadeh Kazem
Published: October 2024

Using the spherical collapse approach, we investigate the impact of two alternative dark matter models, each characterized by distinct non-zero equations of state – one constant and the other time-dependent – on the non-linear regime. Specifically, we compare these models to standard cold dark matter by analysing their influence on the linear density threshold for non-relativistic component collapse and virial overdensity. Additionally, we explore the number count of collapsed objects, or dark matter haloes, analogous to the number count of galaxy clusters. Finally, in light of recent discoveries by the JWST Labbe, et al. 2023, indicating the potential for more efficient early galaxy formation at higher redshifts, we investigate how alternative dark matter assumptions can enhance structure formation efficiency during the early Universe.
Quantifying the impact of AGN feedback on the large-scale matter distribution using two- and three-point statistics
Authors: Saha Bipradeep , Bose Sownak
Published: October 2024

Feedback from active galactic nuclei (AGN) plays a critical role in shaping the matter distribution on scales comparable to and larger than individual galaxies. Upcoming surveys such as Euclid and Legacy Survey of Space and Time aim to precisely quantify the matter distribution on cosmological scales, making a detailed understanding of AGN feedback effects essential. Hydrodynamical simulations provide an informative framework for studying these effects, in particular by allowing us to vary the parameters that determine the strength of these feedback processes and, consequently, to predict their corresponding impact on the large-scale matter distribution. We use the EAGLE simulations to explore how changes in subgrid viscosity and AGN heating temperature affect the matter distribution, quantified via two- and three-point correlation functions, as well as higher order cumulants of the matter distribution. We find that varying viscosity has a small impact ($\approx 10~{{\ \rm per\ cent}}$) on scales larger than $1\,{\it h}^{-1}$ Mpc, while changes to the AGN heating temperature lead to substantial differences, with up to 70 per cent variation in gas clustering on small scales ($\lesssim 1\,{\it h}^{-1}$ Mpc). By examining the suppression of the power spectrum as a function of time, we identify the redshift range $z = 1.5{-}1$ as a key epoch where AGN feedback begins to dominate in these simulations. The three-point function provides complementary insight to the more familiar two-point statistics, and shows more pronounced variations between models on the scale of individual haloes. On the other hand, we find that effects on even larger scales are largely comparable.
K2-370 b: a strongly irradiated sub-Neptune transiting a very active solar-type star
Authors: Sozzetti A , Damasso M , Fernández Fernández J , Mortier A , John A Anna , Cubillos P E , Wilson T G , Pinamonti M , Nielsen L , Bonomo A S , Freckelton A V , Cameron A Collier , Armstrong D , Vanderburg A , Bayliss D , Dumusque X , Ghedina A , Keniger M A F , Latham D W , López Morales M , Malavolta L , Osborn A , Pepe F , Rabino R , Strøm P A , Udry S , Wheatley P
Published: October 2024

We report on the detailed characterization of K2-370 b, a transiting sub-Neptune on a 2.14-d orbit around the chromospherically active G-type dwarf HD 284521 ($T_\mathrm{eff} = 5662\pm 44$ K, $\lt \log R^\prime _{\rm HK}\gt =-4.49$). The system parameters are derived based on a global fit to K2, TESS and CHEOPS photometry, and HARPS-N and HARPS radial velocities (RVs). A Gaussian process regression analysis is performed simultaneously to the orbital fit of the RVs of K2-370 to effectively model the strong stellar rotation signal with a period of $13.5\pm 0.05$ d and measure the planetary RV signal with semi-amplitude $K_{\rm b}=5.6\pm 0.7$ m s$^{-1}$. We find that K2-370 b has a radius of $2.67\pm 0.05$ ${\rm R}_{\rm{\oplus }}$ and a mass of $11.1\pm 1.4$ ${\rm M}_{\rm{\oplus }}$. With an estimated equilibrium temperature $T_\mathrm{eq}\sim 1480$ K, K2-370 b is the second-hottest sub-Neptune with a highly precise mass determination around primaries with $T_\mathrm{eff}\gt 5500$ K. The resulting density of $3.2\pm 0.4$ g cm$^{-3}$ implies that K2-370 b either retains a significant ($\sim 2~{{\ \rm per\ cent}}$ by mass) H-rich atmosphere or its interior contains a high ($\sim 40~{{\ \rm per\ cent}}$) water–mass fraction.
Sensitivity of Bayesian 21 cm power spectrum estimation to foreground model errors
Authors: Burba Jacob , Bull Philip , Wilensky Michael J , Kennedy Fraser , Garsden Hugh , Glasscock Katrine A
Published: October 2024

Power spectrum estimators are an important tool in efforts to detect the 21 cm brightness temperature fluctuations from neutral hydrogen at early times. An initial detection will likely be statistical in nature, meaning that it will not be possible to make a coherent map of the brightness temperature fluctuations; instead, only their variance will be measured against a background of noise and residual systematic effects. Optimal quadratic estimator-based methods often apply an inverse covariance weighting to the data. However, inaccurate covariance modelling can lead to reduced sensitivity and, in some cases, severe signal loss. We recently proposed a Bayesian method to jointly estimate the 21 cm fluctuations, their power spectrum, and foreground emission. Instead of requiring a fixed a priori estimate of the covariance, we estimate the covariance as part of the inference. Choices of parametrization, particularly of the foregrounds, are subject to model errors and could lead to biases and other ill effects if not properly controlled. In this paper, we investigate the effects of inaccurate foreground models on 21 cm power spectrum recovery. Using simulated visibilities, we find that, even in the most extreme scenarios tested, our approach is capable of recovering 21 cm delay power spectrum estimates consistent with a known input signal for delays $\gtrsim 300$ ns ($\sim$88 per cent of the available Fourier modes). This is true even when using foreground models derived from modified foreground catalogues containing spatial and spectral perturbations at the quoted level of uncertainty on our foreground catalogues.
Local stability of differential rotation in magnetized radiation zones and the solar tachocline
Authors: Dymott R W , Barker A J , Jones C A , Tobias S M
Published: October 2024

We study local magnetohydrodynamical instabilities of differential rotation in magnetized, stably stratified regions of stars and planets using a Cartesian Boussinesq model. We consider arbitrary latitudes and general shears (with gravity direction misaligned from this by an angle $\phi$), to model radial ($\phi =0$), latitudinal ($\phi =\pm 90^\circ$), and mixed differential rotations, and study both non-diffusive [including magnetorotational instability (MRI) and Solberg–Høiland instability] and diffusive instabilities [including Goldreich–Schubert–Fricke (GSF) and MRI with diffusion]. These instabilities could drive turbulent transport and mixing in radiative regions, including the solar tachocline and the cores of red giant stars, but their dynamics are incompletely understood. We revisit linear axisymmetric instabilities with and without diffusion and analyse their properties in the presence of magnetic fields, including deriving stability criteria and computing growth rates, wave vectors, and energetics, both analytically and numerically. We present a more comprehensive analysis of axisymmetric local instabilities than prior work, exploring arbitrary differential rotations and diffusive processes. The presence of a magnetic field leads to stability criteria depending upon angular velocity rather than angular momentum gradients. We find MRI operates for much weaker differential rotations than the hydrodynamic GSF instability, and that it typically prefers much larger length-scales, while the GSF instability is impeded by realistic strength magnetic fields. We anticipate MRI to be more important for turbulent transport in the solar tachocline than the GSF instability when $\phi \gt 0$ in the Northern (and vice versa in the Southern) hemisphere, though the latter could operate just below the convection zone when MRI is absent for $\phi \lt 0$.
Ice origins of OCS and chemistry of CS2-bearing ice mantles
Authors: Martín-Doménech Rafael , Öberg Karin I , Muñoz Caro Guillermo M , Carrascosa Héctor , Fuente Asunción , Rajappan Mahesh
Published: October 2024

Understanding the formation of carbonyl sulfide (OCS) in interstellar ices is key to constrain the sulfur chemistry in the interstellar medium (ISM), since it is the only ice S-bearing molecule securely detected thus far. Two general pathways for OCS formation have been proposed: sulfurization of CO (CO + S) and oxidation of CS (CS + O), but their relative contribution in interstellar ices remains unconstrained. We have evaluated the contribution of both pathways to OCS formation upon energetic processing in isotopically labelled CO$_2$:CS$_2$ and CO:CS$_2$ ice samples at 7$-$50 K. Our results indicated that formation of OCS through the CS + O pathway was more favourable than through the CO + S pathway, as previously suggested by theoretical calculations. In addition, its relative contribution increased at higher temperatures. Therefore, this pathway could play a role in the ice formation of OCS, especially in warm regions where CO is expected to be preferentially in the gas phase. At the same time, we have explored the chemistry of CS$_2$-bearing, CO$_2$-, CO-, and also H$_2$O-rich ices, that could be relevant to the sulfur interstellar chemistry. We observed formation of a variety of S-bearing products in addition to OCS, including SO$_2$, C$_3$S$_2$, and S$_2$. However, a significant fraction of sulfur was not detected at the end of the experiments, and could be locked in long, undetectable sulfur allotropes, one of the potential carriers of the missing sulfur in the dense ISM.
Long-term evolution of spin and other properties of neutron star low-mass X-ray binaries: implications for millisecond X-ray pulsars
Authors: Kar Abhijnan , Ojha Pulkit , Bhattacharyya Sudip
Published: October 2024

A neutron star (NS) accreting matter from a companion star in a low-mass X-ray binary (LMXB) system can spin up to become a millisecond pulsar (MSP). Properties of many such MSP systems are known, which is excellent for probing fundamental aspects of NS physics when modelled using the theoretical computation of NS LMXB evolution. Here, we systematically compute the long-term evolution of NS, binary, and companion parameters for NS LMXBs using the stellar evolution code mesa. We consider the baryonic to gravitational mass conversion to calculate the NS mass evolution and show its cruciality for the realistic computation of some parameters. With computations using many combinations of parameter values, we find the general nature of the complex NS spin frequency ($\nu$) evolution, which depends on various parameters, including accretion rate, fractional mass-loss from the system, and companion star magnetic braking. Further, we utilize our results to precisely match some main observed parameters, such as $\nu$, orbital period ($P_{\rm orb}$), etc., of four accreting millisecond X-ray pulsars (AMXPs). By providing the $\nu$, $P_{\rm orb}$, and the companion mass spaces for NS LMXB evolution, we indicate the distribution and plausible evolution of a few other AMXPs. We also discuss the current challenges in explaining the parameters of AMXP sources with brown dwarf companions and indicate the importance of modelling the transient accretion in LMXBs as a possible solution.
Shear-driven magnetic buoyancy in the solar tachocline: dependence of the mean electromotive force on diffusivity and latitude
Authors: Duguid Craig D , Bushby Paul J , Wood Toby S
Published: October 2024

The details of the dynamo process that is responsible for driving the solar magnetic activity cycle are still not fully understood. In particular, while differential rotation provides a plausible mechanism for the regeneration of the toroidal (azimuthal) component of the large-scale magnetic field, there is ongoing debate regarding the process that is responsible for regenerating the Sun’s large-scale poloidal field. Our aim is to demonstrate that magnetic buoyancy, in the presence of rotation, is capable of producing the necessary regenerative effect. Building upon our previous work, we carry out numerical simulations of a local Cartesian model of the tachocline, consisting of a rotating, fully compressible, electrically conducting fluid with a forced shear flow. An initially weak, vertical magnetic field is sheared into a strong, horizontal magnetic layer that becomes subject to magnetic buoyancy instability. By increasing the Prandtl number we lessen the back reaction of the Lorentz force on to the shear flow, maintaining stronger shear and a more intense magnetic layer. This in turn leads to a more vigorous instability and a much stronger mean electromotive force, which has the potential to significantly influence the evolution of the mean magnetic field. These results are only weakly dependent upon the inclination of the rotation vector, i.e. the latitude of the local Cartesian model. Although further work is needed to confirm this, these results suggest that magnetic buoyancy in the tachocline is a viable poloidal field regeneration mechanism for the solar dynamo.
Determining star formation rates in AGN hosts from strong optical emission lines
Authors: de Mellos Maitê S Z , Riffel Rogemar A , Schimoia Jaderson S , Rembold Sandro B , Riffel Rogério , Storchi-Bergmann Thaisa , Wylezalek Dominika , Ilha Gabriele S , Albán Marco , Dors Oli L , Gatto Lara , Krabbe Angela C , Mallmann Nicolas D , Trevisan Marina
Published: October 2024

The influence of Active Galactic Nuclei (AGN) on star formation within their host galaxies remains a topic of intense debate. One of the primary challenges in quantifying the star formation rate (SFR) within AGN hosts arises from the prevalent assumption in most methodologies, which attribute gas excitation to young stars alone. However, this assumption does not consider the contribution of the AGN to the ionization of the gas in their environment. To address this issue, we evaluate the use of strong optical emission lines to obtain the SFR surface density ($\Sigma {{\rm SFR_{AGN}}}$) in regions predominantly ionized by an AGN, using a sample of 293 AGN hosts from the MaNGA survey, with SFR measurements available through stellar population fitting. We propose calibrations involving the H$\alpha$ and [O iii]$\lambda$5007 emission lines, which can be used to determine $\Sigma {{\rm SFR_{AGN}}}$, resulting in values consistent with those estimated through stellar population fitting.
Exploring faint white dwarfs and the luminosity function with Subaru HSC and SDSS in Stripe 82
Authors: Qiu Tian , Takada Masahiro , Yasuda Naoki , Tokiwa Akira , Kashiyama Kazumi , Suzuki Yoshihisa , Hotokezaka Kenta
Published: October 2024

We present 5080 white dwarf (WD) candidates selected from stars matching between the multiband imaging data sets of the Subaru Hyper Suprime-Cam (HSC) Survey and the Sloan Digital Sky Survey in the Stripe82 region covering about 165 deg$^2$. We select WD candidates from the ‘reduced proper motion’ diagram by combining the apparent magnitude in the range $i=19$–24 and the proper motion measured from the data sets among a baseline of $\sim$14 yr. We refine the WD candidates by fitting blackbody and template WD atmosphere models to HSC photometries for each candidate, enabling the estimation of distance and tangential velocity ($v_{\rm t}$). The deep HSC data allow us to identify low-temperature ($\lt 4000$ K) and faint WD candidates down to absolute magnitude, $M_{\rm bol}\simeq 17$. We evaluate the selection function of our WD candidates using a mock catalogue of spatial and kinematic distributions of WDs in the (thin and thick) disc and halo regions based on a Galactic model. We construct samples of disc and halo WD candidates by selecting WDs with tangential velocity, $40\lt v_{\rm t}/({\rm km}~{\rm s}^{-1})\lt 80$ and $200\lt v_{\rm t}/({\rm km}~{\rm s}^{-1})\lt 500$, respectively. The total number densities of the disc and halo WDs are $(9.33 \pm 0.89) \times 10^{-3}$ pc$^{-3}$ and $(6.34 \pm 2.90) \times 10^{-4}$ pc$^{-3}$. Our luminosity functions (LFs) extend down to fainter absolute magnitudes compared with previous work. The faint WDs could represent the oldest generation of building blocks over the past $\sim$10 billion years of the assembly history of our Milky Way.
Targeted delivery of napabucasin with radiotherapy improves outcomes in diffuse midline glioma
Authors: Gallitto Matthew , Zhang Xu , De Los Santos Genesis , Wei Hong-Jian , Fernández Ester Calvo , Duan Shoufu , Sedor Geoffrey , Yoh Nina , Kokossis Danae , Angel J Carlos , Wang Yi-Fang , White Erin , Kinslow Connor J , Berg Xander , Tomassoni Lorenzo , Zandkarimi Fereshteh , Chio Iok In Christine , Canoll Peter , Bruce Jeffrey N , Feldstein Neil A , Gartrell Robyn D , Cheng Simon K , Garvin James H , Zacharoulis Stergios , Wechsler-Reya Robert J , Pavisic Jovana , Califano Andrea , Zhang Zhiguo , Wu Cheng-Chia
Published: October 2024

Background

Diffuse midline glioma (DMG) is the most aggressive primary brain tumor in children. All previous studies examining the role of systemic agents have failed to demonstrate a survival benefit; the only standard of care is radiation therapy (RT). Successful implementation of radiosensitization strategies in DMG remains an essential and promising avenue of investigation. We explore the use of Napabucasin, an NAD(P)H quinone dehydrogenase 1 (NQO1)-bioactivatable reactive oxygen species (ROS)-inducer, as a potential therapeutic radiosensitizer in DMG.

Methods

In this study, we conduct in vitro and in vivo assays using patient-derived DMG cultures to elucidate the mechanism of action of Napabucasin and its radiosensitizing properties. As penetration of systemic therapy through the blood-brain barrier (BBB) is a significant limitation to the success of DMG therapies, we explore focused ultrasound (FUS) and convection-enhanced delivery (CED) to overcome the BBB and maximize therapeutic efficacy.

Results

Napabucasin is a potent ROS-inducer and radiosensitizer in DMG, and treatment-mediated ROS production and cytotoxicity are dependent on NQO1. In subcutaneous xenograft models, combination therapy with RT improves local control. After optimizing targeted drug delivery using CED in an orthotopic mouse model, we establish the novel feasibility and survival benefit of CED of Napabucasin concurrent with RT.

Conclusions

As nearly all DMG patients will receive RT as part of their treatment course, our validation of the efficacy of radiosensitizing therapy using CED to prolong survival in DMG opens the door for exciting novel studies of alternative radiosensitization strategies in this devastating disease while overcoming limitations of the BBB.
The out-of-plane contact shield and mA-modulation – the effect on fetal absorbed dose
Authors: Larjava Heli R S , Eneh Chibuzor T M , Saikkonen Aleksi , Parkkola Riitta K
Published: October 2024

The effect of patient shielding on fetal radiation dose was evaluated in computed tomography pulmonary angiography with the out-of-plane shield visible in the localizer but absent in the scan range in chest computed tomography (CT). An anthropomorphic phantom with additional prosthetic pregnancy belly was scanned with different CT scanners using clinical imaging protocols and radiophotoluminescence dosemeters (GD-352 M). The out-of-plane shield decreased the fetal absorbed radiation dose with Siemens Somatom go.Up, Canon Aquilion Prime SP and Canon Aquilion One scanners. The decrease was 3.9%–39.4% (0.01–0.09 mGy). With GE Optima the shield increased the fetal dose by 100% (0.23 mGy), with Canon Aquilion One and GE Optima scanners the abdomen dose increase was 17.5% and 36.4%, respectively (0.61 and 1.38 mGy). Applying an out-of-plane shield outside the scanned volume may increase the fetal radiation dose during CT when using tube current modulation, depending on the make and model of the CT scanner.
From Forced Migration to Displacement?
Authors: Owen David
Published: October 2024

Should the multi-disciplinary field of Forced Migration Studies (FMS) re-orient itself around the concept of “displacement”? This short intervention situates this question against the background of the transition from Refugee Studies to FMS, as well as external developments in the realm of protection. It draws attention to how the concept of displacement has become more central to both policy and academic discussion in FMS before considering what difference such a re-orientation might make conceptually, ethically, and politically. It concludes by suggesting that FMS might be conceived as standing between and across two larger fields of enquiry: Migration Studies and Displacement Studies.
Seasonal changes in hydraulic functions of eight temperate tree species: divergent responses to freeze–thaw cycles in spring and autumn
Authors: Li Zhimin , Luo Dandan , Ibrahim Muhammed Mustapha , Luo Xianzhen , Deng Rufang , Wang Chuankuan , Hou Enqing
Published: October 2024

Freeze–thaw cycles (FTCs) are the major seasonal environment stress in the temperate and boreal forests, inducing hydraulic dysfunction and limiting tree growth and distribution. There are two types of FTCs in the field: FTCs with increasing temperature from winter to spring (spring FTCs); and FTCs with decreasing temperature from autumn to winter (autumn FTCs). While previous studies have evaluated the hydraulic function during the growing season, its seasonal changes and how it adapts to different types of FTCs remain unverified. To fill this knowledge gap, the eight tree species from three wood types (ring- and diffuse-porous, tracheid) were selected in a temperate forest undergoing seasonal FTCs. We measured the branch hydraulic traits in spring, summer, autumn, and early, middle and late winter. Ring-porous trees always showed low native hydraulic conductance (Kbranch), and high percentage loss of maximum Kbranch (PLCB) and water potential that loss of 50% maximum Kbranch (P50B) in non-growing seasons (except summer). Kbranch decreased, and PLCB and P50B increased in diffuse-porous trees after several spring FTCs. In tracheid trees, Kbranch decreased after spring FTCs while the P50B did not change. All sampled trees gradually recovered their hydraulic functions from spring to summer. Kbranch, PLCB and P50B of diffuse-porous and tracheid trees were relatively constant after autumn FTCs, indicating almost no effect of autumn FTCs on hydraulic functions. These results suggested that hydraulic functions of temperate trees showed significant seasonal changes, and spring FTCs induced more hydraulic damage (except ring-porous trees) than autumn FTCs, which should be determined by the number of FTCs and trees’ vitality before FTCs. These findings advance our understanding of seasonal changes in hydraulic functions and how they cope with different types of FTC in temperate forests.
Prevalence of unplanned extubation in a tertiary care neonatal intensive care unit
Authors: García Heladia , Ramos-Soto Dulce Ivonne , Miranda-Novales Guadalupe , Luna-Santos Laura
Published: October 2024

Orotracheal intubation and mechanical ventilation (MV) have become routine practices in intensive care units. Unplanned extubation (UE) is one of the most important complications, particularly in premature infants and critically ill newborns. The objective of this study was to determine the prevalence of UE in a tertiary care neonatal intensive care unit (NICU). In this analytical cross-sectional retrospective study, all data, including perinatal data, indications for ventilatory support, days of MV at the time of UE, work shift, month of the event, reintubation, and postextubation complications, were obtained from the manual review of clinical charts. In total, 151 neonates, who received invasive MV, were included in this study. The prevalence of UE was 2.0/100 days of ventilation. The most affected were premature infants, with a gestational age of ≤ 32 weeks (54.7%) and a birth weight of ≤ 1500 g. The main cause for UE was deficient fixation of the endotracheal tube (ETT) (27.7%). Most UE events occurred during night shifts (48.1%). Reintubation was required in 83.3% of newborns. Immediate complications developed in 96.3% of the UE events, including desaturation (57.7%) and bradycardia (36.5%). The prevalence of UE was high, particularly in premature infants, with a high rate of reintubation and immediate complications. Standardized protocols for ETT care must be implemented to reduce these events.
Multi‐omics characterization of lymphedema‐induced adipose tissue resulting from breast cancer‐related surgery
Authors: Karaman Sinem , Lehti Satu , Zhang Cheng , Taskinen Marja‐Riitta , Käkelä Reijo , Mardinoglu Adil , Brorson Håkan , Alitalo Kari , Kivelä Riikka
Published: October 2024

Secondary lymphedema (LE) following breast cancer‐related surgery is a life‐long complication, which currently has no cure. LE induces significant regional adipose tissue deposition, requiring liposuction as a treatment. Here, we aimed to elucidate the transcriptional, metabolomic, and lipidomic signature of the adipose tissue developed due to the surgery‐induced LE in short‐ and long‐term LE patients and compared the transcriptomic landscape of LE adipose tissue to the obesity‐induced adipose tissue. Adipose tissue biopsies were obtained from breast cancer‐operated females with LE from the affected and non‐affected arms (n = 20 patients). To decipher the molecular properties of the LE adipose tissue, we performed RNA sequencing, metabolomics, and lipidomics combined with bioinformatics analyses. Differential gene expression data from a cohort of lean and obese patients without LE was used for comparisons. Integrative analysis of functional genomics revealed that inflammatory response, cell chemotaxis, and angiogenesis were upregulated biological processes in the LE arm, indicating a sustained inflammation in the edematous adipose tissue; whereas, epidermal differentiation, cell–cell junction organization, water homeostasis, and neurogenesis were downregulated in the LE arm. Surprisingly, only a few genes were found to be the same in the LE‐induced and the obesity‐induced adipose tissue expansion, indicating a different type of adipose tissue development in these two conditions. In metabolomics analysis, we found reduced levels of a branched‐chain amino acid valine in the LE arm and downregulation of the mRNA levels of its transporter SLC6A15. Lipidomics analyses did not show any significant differences between the LE and non‐LE arms, suggesting that other factors affect the lipid composition of the adipose tissue more than the LE in these patients. Our results provide a detailed molecular characterization of adipose tissue in secondary LE after breast cancer‐related surgery. We also show distinct differences in transcriptomic signatures between LE‐induced adipose tissue and obesity‐induced adipose tissue, but only minor differences in metabolome and lipidome between the LE and the non‐LE arm.
Performance of Artificial Intelligence in Diagnosing Lumbar Spinal Stenosis
Authors: Yang Xuanzhe , Zhang Yuming , Li Yi , Wu Zixiang
Published: October 2024

Study Design.

The present study followed the reporting guidelines for systematic reviews and meta-analyses.

Objective.

Therefore, we conducted this study to review the diagnostic value of AI for various types of LSS and the level of stenosis, offering evidence-based support for the development of smart diagnostic tools.

Summary of Background Data.

Artificial intelligence (AI) is currently being utilized for image processing in clinical practice. Some studies have explored AI techniques for identifying the severity of lumbar spinal stenosis (LSS) in recent years. Nevertheless, there remains a shortage of structured data proving its effectiveness.

Methods.

Four databases (PubMed, Cochrane, Embase, and Web of Science) were searched until March 2024, including original studies that utilized deep learning and machine learning models to diagnose LSS. The risk of bias (RoB) of included studies was assessed using QUADAS-2. The accuracy in the validation set was extracted for a meta-analysis. The meta-analysis was completed in R4.4.0.

Results.

A total of 48 articles were included, with an overall accuracy of 0.885 (95% CI: 0.860-0907) for dichotomous tasks. Among them, the accuracy was 0.892 (95% CI: 0.867-0915) for deep learning (DL) and 0.833 (95% CI: 0.760-0895) for machine learning (ML). The overall accuracy for LSS was 0.895 (95% CI: 0.858-0927), with an accuracy of 0.912 (95% CI: 0.873-0.944) for DL and 0.843 (95% CI: 0.766-0.907) for ML. The overall accuracy for central canal stenosis was 0.875 (95% CI: 0.821-0920), with an accuracy of 0.881 (95% CI: 0.829-0.925) for DL and 0.733 (95% CI: 0.541-0.877) for ML. The overall accuracy for neural foramen stenosis was 0.893 (95% CI: 0.851-0.928). In polytomous tasks, the accuracy was 0.936 (95% CI: 0.895-0.967) for no LSS, 0.503 (95% CI: 0.391-0.614) for mild LSS, 0.512 (95% CI: 0.336-0.688) for moderate LSS, and 0.860 for severe LSS (95% CI: 0.733-0.954).

Conclusions.

AI is highly valuable for diagnosing LSS. However, further external validation is necessary to enhance the analysis of different stenosis categories and improve the diagnostic accuracy for mild to moderate stenosis levels.
Quantifying the Accuracy of Clinician Risk Assessment for Postpartum Hemorrhage
Authors: Lewis Ashley N. , Villela-Franyutti Diego , Domenico Henry J. , Byrne Daniel W. , Farber Michaela K. , Ende Holly B.
Published: October 2024

Objective

To measure the accuracy of postpartum hemorrhage (PPH) risk assessment performed by unaided individual clinicians, to inform future comparison to alternative risk assessment methods.

Methods

Prospective PPH risk assessments were collected from obstetric care team clinicians at two quaternary medical centers in the United States (Vanderbilt University Medical Center, Brigham and Women’s Hospital) from January 2022 to January 2023, following written informed consent from the providers. The data included a cohort of both vaginal and cesarean deliveries (CD). For each assessment, the clinician quantified the patient’s predicted PPH risk on a scale from 0 to 100% and rated their confidence in these assessments using a 5-point Likert scale, ranging from ‘not at all confident’ to ‘completely confident’. Medical records were reviewed 24 hours postpartum to assess the dichotomous outcome of PPH, defined as blood loss ≥1000 mL. The accuracy of these predictions was evaluated using the area under the receiver operating characteristic curve (AUC).

Results

Of 271 patients, 32 (11.8%) experienced PPH, accounting for 11.4% (104/915) of assessments. The overall AUC was 0.64 (95% confidence interval (CI): 0.58–0.71). Prediction accuracy was higher for CD than for vaginal deliveries, with AUCs of 0.82 (95% CI: 0.72–0.91) and 0.56 (95% CI: 0.48–0.63), respectively. No significant differences in the accuracy of assessments were observed according to physician specialty, physician experience level, or confidence level of the assessment.

Conclusion

Overall unaided clinician performance in predicting PPH was moderate, with an AUC of 0.64. Predictions were more accurate for patients undergoing CD. Further study is needed to understand how clinician performance compares to other modalities of risk prediction.
Hierarchical Classification of Factors Associated With Noninvasive Prenatal Testing Failures and Its Impact on Pregnancy Outcomes
Authors: Xie Jieqiong , Jiang Yu , Zhou Yulin , Jin Dandan , Lu Xingxiu , Ge Yunsheng
Published: October 2024

Objective

To conduct a hierarchical classification analysis of the nonreportable results of noninvasive prenatal testing in an attempt to reduce failure rates and provide pregnant women with accurate information to alleviate their anxiety.

Methods

In this study, 30,039 singleton pregnancies who underwent noninvasive prenatal testing in a single center from May 2019 to April 2022 were collected, and 811 samples with initial noninvasive prenatal testing failure were retrospectively analyzed. Grouping was based on the reasons for initial test failure; tracking the noninvasive prenatal testing results and prenatal diagnosis results (if any) of the “z-scores in the gray area” group and analyzing the possible influencing factors of the “low fetal fraction” group in the pre-experimental and experimental period by using one-way analysis of variance, Mann-Whitney U test, and χ2
test; and tracking the pregnancy outcomes of the test failures samples to analyze the risk of perinatal complications and adverse pregnancy outcomes of the different types of test failures.

Results

None of the samples' initial inconclusive results because of z-scores in the gray area were found to have chromosomal aneuploidy. However, pregnancy complications (P = 0.018) and a high likelihood of adverse pregnancy outcomes (P = 0.048) may still occur. Maternal gestational age (P < 0.001), body mass index (P < 0.001), library concentration (P < 0.001), and fetal gender (P < 0.001) were considered to be the associated factors for the initial low fetal fraction results. This may be associated with pregnancy complications (P < 0.001) and a high likelihood of adverse pregnancy outcomes (P = 0.034). The body mass index (P = 0.015) and time between draws (P = 0.001) were associated with the second test’s success. The incidence of low fetal fraction samples was more frequent with blood collection tubes of the G type than with the K type (P < 0.001).

Conclusion

Initial inconclusive results because of z-scores in the gray area did not imply an increased risk of aneuploidy, but vigilance is needed for an increased risk of pregnancy complications and adverse pregnancy outcomes. Because of the low fetal fraction, the initial absence of results may be related to the assay method, as well as the effect of blood collection tubes and the need to be alert to the risk of pregnancy complications and adverse pregnancy outcomes.
Blended Phenotypes From a SERPINA 11 Pathogenic Variant Over Underlying Immune Fetal Hydrops: A Rare Case Report and Literature Review
Authors: Beck Manisha M. , Luke Noel D. , Anand Reena Sakte , Navaneethan Preethi , Athiyarath Rekha , Danda Sumita
Published: October 2024

Fetal hydrops can stem from immune or nonimmune causes. Immune causes often involve red cell alloimmunization, whereas nonimmune causes encompass structural malformations, aneuploidy, infections, lymphatic system disorders, genetic syndromes, and more. In a rare and complex case, we encountered a fetal hydrops presentation characterized by blended phenotypes, indicating both a genetic and an underlying immune etiology. The mother, Rhesus negative, presented with a history of adverse obstetric events. At 21 weeks, the current fetus was diagnosed with hydrops. Maternal blood tests unveiled Rhesus alloimmunization, featuring a positive indirect Coombs test at a 1:512 dilution and the presence of anti-D, anti-C, and anti-E antibodies. Fetal blood sampling revealed an O-positive blood group with a hemoglobin level of 10 gm/dL. Despite administering intrauterine transfusion to the fetus, there was no improvement; instead, the fetal hydrops worsened, accompanied by the emergence of nuchal and axillary masses. Exome sequencing of fetal DNA revealed the fetus was homozygous for a pathogenic variant in the SERPINA11 gene and compound heterozygous for a pathogenic variant in the PIEZO1 gene. Furthermore, the combination of pathogenic variants in SERPINA11 and PIEZO1 genes has not been described in cases of fetal hydrops before. This case posed significant challenges in management due to the concurrent presence of both immune and nonimmune hydrops. We describe some of the diagnostic challenges faced in clinical management of this case.
Postpartum Glucose Follow-up Screening Among Women With Gestational Diabetes Mellitus: A Retrospective Cohort Study
Authors: Zhang Jiani , Xu Tingting , Cao Qi , Mao Chihui , Zhou Fan , Wang Xiaodong
Published: October 2024

Objective

To evaluate the impact of pre-gestational and gestational characteristics on postpartum glucose follow-up screening (PGFS) compliance in women diagnosed with gestational diabetes mellitus (GDM) in southwest China.

Methods

This retrospective cohort study was conducted in West China Second Hospital, Sichuan University. Pre-gestational and gestational factors were extracted from hospital records and compared between women who completed PGFS and those who did not. The screening method chosen was the 75g oral glucose tolerance test (OGTT), performed 4–12 weeks postpartum. Univariate analysis, logistic regression analysis, and Cochran-Armitage test were used to assess associations between maternal characteristics and PGFS compliance.

Results

A total of 3047 women with GDM were included, with a PGFS completion rate of 47.2%. Of those who completed PGFS, 430 women (29.9%) presented abnormal results: 1.8% with impaired fasting glucose (IFG), 24.1% with impaired glucose tolerance (IGT), 2.2% with both IFG and IGT 2.2%, and 1.8% with suspected diabetes. Independent factors associated with non-compliance to PGFS included higher pre-gestational BMI (odds ratio (OR): 0.952; 95% confidence interval (CI): 0.922, 0.984), multipara (OR: 0.721; 95% CI: 0.593, 0.877), use of assisted reproduction technology (ART) (OR: 1.427; 95% CI: 1.080, 1.885), excessive gestational weight gain (OR: 0.956; 95% CI: 0.936, 0.977), elevated fasting plasma glucose (FPG) prior to delivery (OR: 0.909; 95% CI: 0.835, 0.988), and undergoing cesarean section (OR: 1.232; 95% CI: 1.017, 1.492) were independent influencing factors of failing to PGFS. PGFS completion rates significantly decreased with increasing pre-gestational BMI and earlier gestational age (P < 0.001).

Conclusions

Establishing dedicated postpartum follow-up teams and targeting women with higher pre-gestational BMI, multiparity, ART use, excessive gestational weight gain, elevated pre-delivery FPG, and those undergoing cesarean section are critical to improving postpartum GDM management.
Extrauterine Causes of Severe and Concealed Postpartum Bleeding: Clinical Aspects and Challenges
Authors: Palacios-Jaraquemada JM , Nieto-Calvache AJ , Basanta AN
Published: October 2024

Objective

To describe the challenges in diagnosing concealed postpartum bleeding, a rare but potentially life-threatening condition, and to highlight key factors in identifying and managing this condition.

Methods

We reviewed clinical cases and diagnostic approaches where concealed postpartum bleeding was suspected, focusing on the role of imaging, serologic markers, and angiography. We examined instances of hemodynamic instability, the utility of pelvic space analysis via computed tomography, and the limitations of digital angiography, particularly in identifying bleeding sources in the posterior iliac internal artery division.

Results

Concealed postpartum bleeding often originates from venous damage or, less commonly, arterial injury. Hemodynamic instability was noted to occur periodically, despite negative findings on vaginal examination and ultrasound, leading to diagnostic delays. Digital angiography often yields negative results when the focus is limited to the anterior division of the internal iliac artery. Bleeding typically arises from damage to the vaginal muscular layer or levator ani muscle, both supplied by branches of the internal pudendal artery (posterior iliac division). In some cases, laparotomy also failed to locate the source due to the bleeding being in the subperitoneal spaces.

Conclusion

Concealed postpartum bleeding presents a diagnostic challenge due to intermittent hemodynamic instability and often negative imaging results. A detailed pelvic space analysis and awareness of posterior iliac internal artery involvement are crucial. Advanced expertise, along with serologic markers of hidden bleeding, is essential for timely diagnosis and management.
Association of periodontal disease with the prognosis of chronic kidney disease: A meta-analysis
Authors: He Tao , Li Xue , Liao Chun-Juan , Feng Xing-Yu , Guo Xiang-Yu
Published: October 2024

Background:

To assess the association between periodontal disease (PD) and the prognosis of chronic kidney disease (CKD).

Methods:

A systematic literature search was conducted using PubMed, Embase, and Cochrane Library to identify eligible cohort studies until April 2023. Relative risk (RR) with a 95% CI was used to evaluate the strength of the relationship between PD and CKD prognosis using the random-effects model.

Results:

Ten cohort studies involving 10 144 patients with CKD were selected for the meta-analysis. The summary results indicated that PD was associated with an increased risk of all-cause mortality in patients with CKD (RR: 1.32; 95% CI, 1.10-1.59; p = 0.003). Although no association was observed between PD and the risk of cardiac death in patients with CKD (p = 0.180), while sensitivity analysis revealed PD may be associated with the risk of cardiac death (RR: 1.31; 95% CI, 1.05-1.64; p = 0.017). In addition, subgroup analyses revealed that the strength of the association of PD with the risks of all-cause mortality and cardiac death varies when stratified by region, sex, and CKD stage.

Conclusion:

PD might exert a harmful effect on the risk of all-cause mortality, with a potential but unconfirmed association with cardiac death in patients with CKD.
Unique Gut Microbiome and Metabolic Profiles in Chinese Workers Exposed to Dust
Authors: Qian Xiaojun , Liu Ying , Wei Xue , Chen Xiaorong , Rong Guangsheng , Hu Xinxin
Published: October 2024

Objectives

This study aimed to identify distinct gut microbiome and serum metabolic features in workers exposed to dust compared to healthy controls.

Methods

A case-control study was conducted with dust-exposed workers without silicosis and age-matched healthy controls. Gut microbiome composition was analyzed using 16S rRNA sequencing, and serum and fecal metabolomic profiles were assessed by LC-MS.

Results

Dust-exposed workers showed higher levels of Blautia and Trichoderma and lower levels of Anaplasma, Aspergillus, Plasmodiophoromycetes, and Escherichia coli-Shigella. Metabolites such as indole-3-acetate and gentamicin C1a were downregulated, while adenine, 2-phenylacetamide, and 4-pyridoxic acid were upregulated.

Conclusions

Blautia spp. were linked to altered metabolites in dust-exposed workers, suggesting microbiome-metabolite interactions that may affect silicosis progression. However, the small sample size and cross-sectional design limit generalizability, and further longitudinal studies are needed.