bluuebunny/crossref_metadata_2025 huggingface dataset:
Technical note: assessing GPS sensor accuracy using real-time kinematic device for livestock tracking
Authors: Zhao Biquan , McDermott Rebecca L , Erickson Galen E , Xiong Yijie
Published: August 2024

The technical aspects of global positioning system (GPS) sensors have been improved substantially over the years, making them valuable and popular tools for livestock tracking. Using GPS sensors allows producers and researchers to locate grazing livestock, monitor their behavior and distribution, and gather referencing information about the health status of the animals and pastures. However, interpreting the behavior of grazing livestock, such as cattle, from GPS data can be difficult due to positioning inaccuracies. Without knowing the positioning accuracy range of GPS sensors, achieving high-level confidence in determining grazing densities and identifying abnormal livestock movement patterns is challenging. In this study, the positioning accuracy of 3 different types of commercial GPS sensors was assessed using a survey-grade real-time kinematics (RTK) device. We outlined the procedures and essential equations and compared the recorded locations from the GPS sensors with reference locations collected from the RTK device. The results demonstrated statistically significant differences (P < 0.05) in positioning accuracy between different types of GPS sensors. The circular error probable (CEP) at 95% probability levels (CEP95) of the 3 sensors ranged from 2.46 to 11.06 m. This accuracy varied among individual sensors within the same brand and across different brands, which underscores the importance of evaluating the positioning accuracy of GPS sensors in livestock tracking. This study provides significant insights for animal scientists, ecologists, and livestock producers engaged in GPS sensor-related research and practices.
Effects of Kinesio Tape on Vascularity, Pliability, and Height of the Hypertrophic Scar in Burns Patients: A Randomized Pilot Clinical Trial
Authors: Albuquerque Ana Karlla Bandeira , Lima Cláudia Fonsêca de , Ribeiro Edlene Lima , Maia Juliana Netto , Rezende Guilherme de Sousa , Souza Alex Sandro Rolland
Published: August 2024

Deep burns damage the reticular dermis and may lead to the formation of hypertrophic scars. Compression therapy reduces local vascularity and realigns collagen fibers, resulting in esthetic and functional improvements. This study evaluated the effect of Kinesio tape compression with maximum mechanical tension on vascularity, pliability, and the height of hypertrophic scars following deep burns. A single-blind, randomized pilot clinical trial was carried out. The elastic compression of Kinesio tape was applied at maximum stretch in the intervention group (n = 11) and no stretch in the sham group (n = 11). Vascularity, pliability, and height (the primary outcomes) were evaluated at 0, 45, and 90 days using the Vancouver Scar Scale (VSS). The association between the VSS scores, the intervention and the evaluation moment were analyzed using linear mixed-effects regression models, while comparisons of means between the groups were performed using the Student’s t-test. Significance was set at 5%. The mean VSS scores were similar between the groups. Significant improvement occurred in both groups when posttreatment and baseline scores were compared. No further improvement was found in the vascularity, pliability, or height of hypertrophic scars resulting from deep burns when an elastic compression of Kinesio tape was used at maximum tension compared to lesser mechanical tension.
Potential insect threats to pennycress, Thlaspi arvense (Brassicales: Brassicaceae), an emerging oilseed cover crop
Authors: Adjeiwaa Ellen O , Ribeiro Arthur V , Koch Robert L
Published: August 2024

Pennycress (Thlaspi arvense L.) is an annual plant in temperate regions that often grows as a weed. Pennycress is being domesticated as a new winter cover crop and oilseed crop for incorporation in the Midwest United States corn-soybean rotation, where it could offer economic and environmental benefits. While pennycress is gaining attention as a promising new crop, there remains a significant gap in understanding its interaction with insect communities and agroecosystems. This review compiles available information on insect herbivores (potential pests) and beneficial insects associated with pennycress growing in the wild (natural areas) or as a weed in agricultural areas. The limited knowledge on the response of pennycress to stressors (defoliation, stem injury and stand loss) similar to injury that could be caused by insects is also compiled here. By shedding light on the insects associated with pennycress and how pennycress might respond to injury from insect pests, this review sets the stage for further research and development of integrated pest management programs for insect pests of this new crop.
Integrative multi-omics characterization of hepatocellular carcinoma in Hispanic patients
Authors: Das Debodipta , Wang Xiaojing , Chiu Yu-Chiao , Bouamar Hakim , Sharkey Francis E , Lopera Jorge E , Lai Zhao , Weintraub Susan T , Han Xianlin , Zou Yi , Chen Hung-I H , Zeballos Torrez Carla R , Gu Xiang , Cserhati Matyas , Michalek Joel E , Halff Glenn A , Chen Yidong , Zheng Siyuan , Cigarroa Francisco G , Sun Lu-Zhe
Published: August 2024

Background

The incidence and mortality rates of hepatocellular carcinoma among Hispanic individuals in the United States are much higher than in non-Hispanic White people. We conducted multi-omics analyses to elucidate molecular alterations in hepatocellular carcinoma among Hispanic patients.

Methods

Paired tumor and adjacent nontumor samples were collected from 31 Hispanic hepatocellular carcinomas in South Texas for genomic, transcriptomic, proteomic, and metabolomic profiling. Serum lipids were profiled in 40 Hispanic and non-Hispanic patients with or without clinically diagnosed hepatocellular carcinoma.

Results

Exome sequencing revealed high mutation frequencies of AXIN2 and CTNNB1 in South Texas Hispanic hepatocellular carcinoma patients, suggesting a predominant activation of the Wnt/β-catenin pathway. TERT promoter mutations were also statistically significantly more frequent in the Hispanic cohort (Fisher exact test, P < .05). Cell cycles and liver function were positively and negatively enriched, respectively, with gene set enrichment analysis. Gene sets representing specific liver metabolic pathways were associated with dysregulation of corresponding metabolites. Negative enrichment of liver adipogenesis and lipid metabolism corroborated with a significant reduction in most lipids in serum samples of hepatocellular carcinoma patients (paired t test, P < .0001). Two hepatocellular carcinoma subtypes from our Hispanic cohort were identified and validated with the Cancer Genome Atlas liver cancer cohort. Patients with better overall survival showed higher activity of immune and angiogenesis signatures and lower activity of liver function–related gene signatures. They also had higher levels of immune checkpoint and immune exhaustion markers.

Conclusions

Our study revealed specific molecular features of Hispanic hepatocellular carcinoma and potential biomarkers for therapeutic management. It provides a unique resource for studying Hispanic hepatocellular carcinoma.
Introduction to Articles 1–6 CISG: General questions regarding the sphere of application
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter provides a brief introduction to Articles 1 to 6 of the CISG, also known as Chapter I. The scope of application of the CISG is explored in its first chapter and contains two groups of provisions: Articles 1, 2, 3, and 6 set out which contracts fall within the scope of the CISG; Articles 4 and 5 determine — in an incomplete way — which legal aspects the Convention governs. Article 6 also belongs in the second group in so far as it enables the parties to modify, supplement or exclude the CISG. The CISG’s scope of application is defined by geographical criteria (Article 1 in conjunction with Article 10) and substantive criteria (Article 1(1), Articles 3–5). Its temporal scope is laid down in Article 100. Chapter I is further of eminent importance in regard to the need for gap-filling and the adjustment of the Convention to new developments.
Sales excluded from Convention’s scope
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter turns to Article 2. Article 2 limits the subject matter scope of the CISG. It does so in light of the purpose for which the buyer purchases the goods, the circumstances under which the sales contract was concluded, and the object of the sales contract. The list is exhaustive, and the provision does not apply by analogy to other situations. Due to the exclusion in subparagraph (a) the Convention de facto only applies to business-to-business (B2B) transactions, save for exceptions in rare circumstances. The provision does not create major difficulties in practice. Remaining key issues include whether the CISG despite subparagraph (c) applies to online auctions, which courts so far have denied and the scope of subparagraph (e) when it comes to the sale of smaller boats and similar water vehicles.
Contracts for goods to be manufactured or for services
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter concerns Article 3. According to Article 3(1), the CISG generally applies to contracts for goods to be manufactured but not to contracts for work and materials. Article 3(2) clarifies that the CISG also governs contracts where the supplier of the goods must also render services, as long as they do not make up for the preponderant part of the supplier’s obligations. Some of the controversy around Article 3 is due to differences between the French and the English version of paragraph 1 as well as to the disregard for the history of the provision. The incorrect reading of paragraph 2 at times even corrupts the correct understanding of paragraph 1 and the relationship between the two paragraphs, in that it is sometimes believed that the services to be measured under paragraph 2 is the work necessary to manufacture the goods under paragraph 1. This is entirely incorrect. Both paragraphs address different subject matter questions and the services referred to in paragraph 2 are those rendered as such to the ordering party, but never the works necessary to prepare performance. In light of the disputes revolving around both paragraphs of Article 3, it is highly advisable for the parties to expressly opt for the CISG as the law applicable to their contract.
Usages and practices
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter explores Article 9. Article 9 declares usages and practices, which have arisen between the parties or are customary in international trade to be relevant to the determination of the content of the contract. Both bind the parties as terms implied by custom or practice or usage. Article 9(1) incorporates into the contract all usages and practices agreed upon or established between the parties. In contrast, Article 9(2) only covers international trade usages. Article 9 makes clear that the legal relationship of the parties to the contract is also determined through usages and practices. In particular, the provision correspondingly supplements the content of the contract.
Calculation of time for acceptance; official holidays
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter explores Article 20. Article 20 provides rules of a supplementary nature concerning the calculation of periods of time for acceptance as offerors may (but do not have to) fix in their offer. The legal effect of times for acceptance follows from Article 18(2), sentence 2, because any acceptance is only effective if it reaches the offeror within such a time, should one have been fixed. The calculation of a given period of time for acceptance can therefore decide about the contract’s formation. Article 20 provides rules of interpretation for this purpose, with the aim of removing typical uncertainties that may arise in this context where cross-border contract formations are concerned. Insofar, Article 20 is lex specialis prevailing over Article 8.
Fundamental breach of contract
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter expounds on the legal definition of the term ‘fundamental breach of contract’ in Article 25. It mentions how the term has been characterized as the linchpin of the CISG’s system of remedies as it determines whether a sales transaction that has run into difficulties will continue to be performed or terminated. Moreover, Article 25’s vague and less than clear wording had been the main reason for theoretical controversies and difficulties in the provision’s practical application. The chapter looks into the fundamental breach of contract as a unitary concept. It also includes specific cases of breaches of the buyer and seller’s obligations and breach of not party-specific obligations.
Notice of avoidance
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter notes Article 26, wherein a declaration of avoidance of the contract is only effective if the other party knew. It explores the effects of contract avoidance such as release from original obligations and creation of duties to make restitution. Article 26 governs the modalities of contract termination without stating the grounds on which the contract could be avoided. A declaration of avoidance has a highly disruptive effect on the contractual relationship. Thus, a time limit within the right of avoidance must be exercised. The chapter also includes how the party relying on the avoidance of the contract must prove the completion of requirements for avoidance.
Modification of contract; ‘no oral modifications’ clauses
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter discusses the modification of the contract by agreement. Article 29 governs the modification or termination of existing sales contracts through an agreement between the parties. Modifications of sales contracts happen frequently in commercial practice. The chapter notes the applicable provisions of modification as well. It clarifies that Article 29 only tackles the consensual changes to a contract made by both parties. The chapter also explores the agreements to no oral modification (NOM) clauses. Additionally, the burden of proof for an alleged modification, termination, or amendment of a contract is on the party who bases its claim or defence on the allegation.
Buyer’s right to require performance, delivery of substitute goods or repair
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter focuses on the buyer’s right to require performance. If the seller does not perform one of his obligations, Article 46 grants the buyer the remedy of requiring the seller to perform his obligations under the contract, to deliver substitute goods, and to induce repair. The seller carries the burden of proof of delivery and the goods were in conformity when the risk passed. In principle, the burden of proof is reversed once the buyer has accepted the goods as performance without objection. Additionally, Article 46 limits the right to require performance in the case of delivery of non-conforming goods.
Seller’s right to cure after date for delivery
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter discusses the seller’s right to remedy a failure to perform. Article 48(1) covers the basic principle that generally a seller is entitled to perform the contract even after the date for delivery has passed and thereby remedy his breach of contract. The chapter notes the process of remedying a defect and failure to perform at the seller’s own expense. The seller’s right to cure after the delivery date exists only if this does not involve unreasonable delay, inconvenience in performance, or uncertainty of reimbursement of expenses for the buyer. Moreover, derogatory agreements are applicable even if they are included in standard terms of business.
Buyer’s retention of other remedies
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter focuses on Article 84 is an integral part of the rules on restitution, stating that the parties’ duty to account for all benefits have been derived under the contract. The parties are to be reinstated in the economic position in which they were before exchanging performances. It cites Article 84(1), which imposes the duty on the seller to pay interest on the purchase price from the day payment was made, while Article 84(2) states the buyer’s duty to account for all benefits that it has derived from the goods. The chapter explores the distinction made within Article 84(2) between the situation where the buyer is able to make restitution of the goods and the case where it cannot return the goods in an unimpaired condition. The distinction relates to Article 82, which bars the buyer’s right to declare avoidance where the goods cannot be returned.
Restriction to expressly authorized reservations
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter deals with Article 98, which limits the reservations permitted under the CISG to those expressly authorized in the Convention, prohibiting Contracting States from making any other reservations. In doing so, Article 98 provides a clear statement about the admissibility of reservations. It considers Article 98 as a treaty provision in the sense of Article 19(b) of the 1969 Vienna Convention on the Law of Treaties, providing that only specified reservations may be made. The chapter highlights the purpose of Article 98, which is to limit the non-uniformity in the Sales Convention’s application that arises from reservations and preserve the CISG’s unification effect. Article 98 only addresses what reservations States are permitted to make, but not how the authorizing reservation clauses and the reservations declared are to be interpreted by the courts.
Denunciation
Authors: Schwenzer Ingeborg , Schroeter Ulrich G
Published: August 2024

This chapter refers to Article 101(1) that governs the right of Contracting States to denounce the Sales Convention entirely or in part, while Article 101(2) specifies the taking effect of such a denunciation. It considers Article 101 as a standard component of common for uniform commercial law making conventions as it provides States with the theoretical option to rid themselves of their obligation to apply the CISG’s provisions. Article 101 is lex specialis and prevails over the general treaty law provisions on denunciations in Article 42 et seq of the 1969 Vienna Convention on the Law of Treaties. The chapter determines whether Article 101 CISG can be read as an exhaustive regulation intended to preempt general treaty law measures. Article 101 has not yet gained any relevance in practice as no Contracting State has in the past denounced the Sales Convention.
Novel function of U7 snRNA in the repression of HERV1/LTR12s and lincRNAs in human cells
Authors: Plewka Patrycja , Szczesniak Michal W , Stepien Agata , Pasieka Robert , Wanowska Elzbieta , Makalowska Izabela , Raczynska Katarzyna Dorota
Published: August 2024

U7 snRNA is part of the U7 snRNP complex, required for the 3′ end processing of replication-dependent histone pre-mRNAs in S phase of the cell cycle. Here, we show that U7 snRNA plays another function in inhibiting the expression of a subset of long terminal repeats of human endogenous retroviruses (HERV1/LTR12s) and LTR12-containing long intergenic noncoding RNAs (lincRNAs), both bearing sequence motifs that perfectly match the 5′ end of U7 snRNA. We demonstrate that U7 snRNA inhibits LTR12 and lincRNA transcription and propose a mechanism in which U7 snRNA hampers the binding/activity of the NF-Y transcription factor to CCAAT motifs within LTR12 elements. Thereby, U7 snRNA plays a protective role in maintaining the silencing of deleterious genetic elements in selected types of cells.
BRCA1/2 mutations and outcomes among Middle Eastern patients with early-onset breast cancer in Oman
Authors: Al Amri Waleed S , Al Amri Ahmed H , Al Abri Aisha , Hughes Thomas A , Al Lawati Fatma
Published: August 2024

Background

High prevalence of early-onset breast cancer (EOBC) has been reported in Middle Eastern populations. For example, in Oman more than 50% of patients with breast cancer (BC) are under age 45 at diagnosis. Causes for this high incidence are unknown. Germline BRCA gene mutations have been associated with EOBC, however, prevalence of these mutations and how they relate to EOBC in Oman has not been assessed.

Patients and Methods

Clinical data were collected for patients with BC treated at Royal Hospital, Oman between 2010 and 2022. Germline BRCA1/2 gene mutations were identified using sequencing and MLPA. Correlation and Kaplan-Meier survival analyses were performed to test relationships among clinico-pathological features, gene mutations, and outcomes.

Results

Total of 1336 Middle Eastern patients with BC were included; 611 were aged <45 at diagnosis (45.7%). No significant correlation was found between BRCA1/2 mutation status and EOBC (P = .229), and the majority of EOBC cases had no family history of BC. EOBC tumors did, however, differ in clinicopathological features; EOBCs were significantly larger (P < .0001), of higher grade (P < .0001), and included more HER2-enriched, and triple negative subtypes (P = .018) compared with later onset cases. Accordingly, survival analyses revealed that EOBC had significantly worse disease-free survival (P = .002). BRCA gene variants showed a distinct range of mutations including, in BRCA2, 3 previously unreported mutations and 4 potential founder recurrent mutations.

Conclusion

Our findings showed that germline BRCA1/2 mutations were not over-represented in EOBC cases in Oman, and therefore are unlikely to be responsible for high EOBC rates.
Cold mediates maize root hair developmental plasticity via epidermis-specific transcriptomic responses
Authors: Zhou Yaping , Sommer Mauritz Leonard , Meyer Annika , Wang Danning , Klaus Alina , Stöcker Tyll , Marcon Caroline , Schoof Heiko , Haberer Georg , Schön Chris-Carolin , Yu Peng , Hochholdinger Frank
Published: August 2024

Cold stress during early development limits maize (Zea mays L.) production in temperate zones. Low temperatures restrict root growth and reprogram gene expression. Here, we provide a systematic transcriptomic landscape of maize primary roots, their tissues, and cell types in response to cold stress. The epidermis exhibited a unique transcriptomic cold response, and genes involved in root hair formation were dynamically regulated in this cell type by cold. Consequently, activation of genes involved in root hair tip growth contributed to root hair recovery under moderate cold conditions. The maize root hair defective mutants roothair defective 5 (rth5) and roothair defective 6 (rth6) displayed enhanced cold tolerance with respect to primary root elongation. Furthermore, DEHYDRATION RESPONSE ELEMENT-BINDING PROTEIN 2.1 (DREB2.1) was the only member of the dreb subfamily of AP2/EREB transcription factor genes upregulated in primary root tissues and cell types but exclusively downregulated in root hairs upon cold stress. Plants overexpressing dreb2.1 significantly suppressed root hair elongation after moderate cold stress. Finally, the expression of rth3 was regulated by dreb2.1 under cold conditions, while rth6 transcription was regulated by DREB2.1 irrespective of the temperature regime. We demonstrated that dreb2.1 negatively regulates root hair plasticity at low temperatures by coordinating the expression of root hair defective genes in maize.
Climate Volatility, Foundational Freedoms, and the Environment Act 2021: The Transformative Potential of the Principle of Legality
Authors: Cheong Ben Chester
Published: August 2024

The UK Environment Act 2021 presents a valuable case study of the importance and challenges of protecting foundational freedoms in the context of complex and ambiguous environmental legislation. This article argues that the common law principle of legality provides a vital tool for courts to uphold rights imperilled by climate volatility and environmental decline by presuming against rights-infringing interpretations of environmental statutes. Analysing key provisions of the Act and its associated Parliamentary processes, the article focuses on areas such as statutory language clarity, the scope of executive powers, and the framework for public participation. It explores how the principle of legality and other interpretive approaches could help to resolve these issues and ensure the Act is applied in a way that promotes environmental accountability. The article argues that the principle of legality has a crucial role to play in ensuring environmental law delivers on its promise to protect both the environment and foundational freedoms.
Decellularized amniotic membrane hydrogel promotes mesenchymal stem cell differentiation into smooth muscle cells
Authors: Gholami Keykavos , Deyhimfar Roham , Mirzaei Akram , Karimizadeh Zahra , Mashhadi Rahil , Zahmatkesh Parisa , Ghajar Azodian Helia , Aghamir Seyed Mohammad Kazem
Published: August 2024

Previous studies showed that the bladder extracellular matrix (B‐ECM) could increase the differentiation efficiency of mesenchymal cells into smooth muscle cells (SMC). This study investigates the potential of human amniotic membrane‐derived hydrogel (HAM‐hydrogel) as an alternative to xenogeneic B‐ECM for the myogenic differentiation of the rabbit adipose tissue‐derived MSC (AD‐MSC). Decellularized human amniotic membrane (HAM) and sheep urinary bladder (SUB) were utilized to create pre‐gel solutions for hydrogel formation. Rabbit AD‐MSCs were cultured on SUB‐hydrogel or HAM‐hydrogel‐coated plates supplemented with differentiation media containing myogenic growth factors (PDGF‐BB and TGF‐β1). An uncoated plate served as the control. After 2 weeks, real‐time qPCR, immunocytochemistry, flow cytometry, and western blot were employed to assess the expression of SMC‐specific markers (MHC and α‐SMA) at both protein and mRNA levels. Our decellularization protocol efficiently removed cell nuclei from the bladder and amniotic tissues, preserving key ECM components (collagen, mucopolysaccharides, and elastin) within the hydrogels. Compared to the control, the hydrogel‐coated groups exhibited significantly upregulated expression of SMC markers (p ≤ .05). These findings suggest HAM‐hydrogel as a promising xenogeneic‐free alternative for bladder tissue engineering, potentially overcoming limitations associated with ethical concerns and contamination risks of xenogeneic materials.
PDCD4 interacting with PIK3CB and CTSZ promotes the apoptosis of multiple myeloma cells
Authors: Liu Liyuan , Feng Xiumei , Fan Chenliu , Kong Dexiao , Feng Xiaoli , Sun Chenxi , Xu Yaqi , Li Binggen , Jiang Yang , Zheng Chengyun
Published: August 2024

The role of programmed cell death 4 (PDCD4) in multiple myeloma (MM) development remains unknown. Here, we investigated its role and action mechanism in MM. Bioinformatic analysis indicated that patients with MM and high PDCD4 expression had higher overall survival than those with low PDCD4 expression. PDCD4 expression promoted MM cell apoptosis and inhibited their viability in vitro and tumor growth in vivo. RNA‐binding protein immunoprecipitation sequencing analysis showed that PDCD4 is bound to the 5′ UTR of the apoptosis‐related genes PIK3CB, Cathepsin Z (CTSZ), and X‐chromosome‐linked apoptosis inhibitor (XIAP). PDCD4 knockdown reduced the cell apoptosis rate, which was rescued by adding PIK3CB, CTSZ, or XIAP inhibitors. Dual luciferase reporter assays confirmed the internal ribosome entry site (IRES) activity of the 5′ UTRs of PIK3CB and CTSZ. An RNA pull‐down assay confirmed binding of the 5′ UTR of PIK3CB and CTSZ to PDCD4, identifying the specific binding fragments. PDCD4 is expected to promote MM cell apoptosis by binding to the IRES domain in the 5′ UTR of PIK3CB and CTSZ and inhibiting their translation. Our findings suggest that PDCD4 plays an important role in MM development by regulating the expression of PIK3CB, CTSZ, and XIAP, and highlight new potential molecular targets for MM treatment.
The ups and downs of weight loss
Authors: Maupin Elizabeth J.
Published: August 2024

Increasing rates of overweight and obesity in the United States have resulted in increasing calls for weight loss. However, weight cycling—repeated weight gain after attempts at weight loss—has been associated with an increased risk of obesity, cardiovascular disease, type 2 diabetes, and all-cause mortality. Clinicians should be aware of the risks associated with weight cycling when recommending weight loss. Lifestyle modifications can reduce risks associated with obesity and are more readily measured.
Mechanical Power in Decelerating Flow versus Square Flow Ventilation in Pediatric Acute Respiratory Distress Syndrome
Authors: Percy Andrew G. , Keim Garrett , Bhalla Anoopindar K. , Yehya Nadir
Published: August 2024

Background:

Mechanical power is a summary variable quantifying the risk of ventilator-induced lung injury. The original mechanical power equation was developed using square flow ventilation. However, most children are ventilated using decelerating flow. It is unclear whether mechanical power differs according to mode of flow delivery. This study compared mechanical power in children with acute respiratory distress syndrome who received both square and decelerating flow ventilation.

Methods:

This was a secondary analysis of a prospectively enrolled cohort of pediatric acute respiratory distress syndrome. Patients were ventilated on decelerating flow and then placed in square flow and allowed to stabilize. Ventilator metrics from both modes were collected within 24 h of acute respiratory distress syndrome onset. Paired t tests were used to compare differences in mechanical power between the modes.

Results:

This study enrolled 185 subjects with a median oxygenation index of 9.5 (interquartile range, 7 to 13) and median age of 8.3 yr (interquartile range, 1.8 to 14). Mechanical power was lower in square flow mode (mean, 0.46 J · min−1 · kg−1; SD, 0.25; 95% CI, 0.42 to 0.50) than in decelerating flow mode (mean, 0.49 J · min−1 · kg−1; SD, 0.28; 95% CI, 0.45 to 0.53) with a mean difference of 0.03 J · min−1 · kg−1 (SD, 0.08; 95% CI, 0.014 to 0.038; P < 0.001). This result remained statistically significant when stratified by age of less than 2 yr in square flow compared to decelerating flow and also when stratified by age of 2 yr or greater in square flow compared to decelerating flow. The elastic contribution in square flow was 70%, and the resistive contribution was 30%.

Conclusions:

Mechanical power was marginally lower in square flow than in decelerating flow, although the clinical significance of this is unclear. Upward of 30% of mechanical power may go toward overcoming resistance, regardless of age. This is nearly three-fold greater resistance compared to what has been reported in adults.
Rapid Ventricular Pacing for Clipping of Intracranial Aneurysms: A Single-centre Retrospective Case Series
Authors: Ragulojan Malavan , Krolczyk Gregory , Al Aufi Safa , Wang Alick P. , McIsaac Daniel I. , Hicks Shawn , Sinclair John , Budiansky Adele S.
Published: August 2024

Objective:

Multiple strategies exist to facilitate microdissection and obliteration of intracranial aneurysms during microsurgical clipping. Rapid ventricular pacing (RVP) can be used to induce controlled transient hypotension to facilitate aneurysm manipulation. We report the indications and outcomes of intraoperative RVP for clipping of ruptured and unruptured complex aneurysms.

Methods:

We completed a retrospective review of adult patients who underwent RVP-facilitated elective and emergent microsurgical aneurysm clipping by a single senior neurosurgeon between 2016 and 2023. Intraoperative RVP was performed at a rate of 150 to 200 beats per minute through a transvenous pacing wire and repeated as needed based on surgical requirements. Intraoperative procedural and pacing data and perioperative cardiac and neurosurgical variables were collected.

Results:

Forty patients were included in this study. The median (interquartile range) number of pacing episodes per patient was 8 (5 to 14), resulting in a median mean arterial pressure of 37 (30 to 40) mm Hg during RVP. One patient developed wide complex tachycardia intraoperatively, which resolved after cardioversion. Fifteen out of 36 (42%) patients who had postoperative troponin measurements had at least one troponin value above the 99th percentile upper reference limit. One patient had markedly elevated troponin with anterolateral ischemia in the context of massive postoperative intracranial hemorrhage. There were no other documented intraoperative or postoperative cardiac events.

Conclusions:

This retrospective case series suggests that RVP could be an effective adjunct for clipping of complex ruptured and unruptured aneurysms, associated with transient troponin rise but rare postoperative cardiac complications.
Transphyseal Hemiepiphysiodesis: Is it Truly Reversible?
Authors: Abdelaziz Tarek Hassan , Ghaly Nabil , Fayyad Tamer A. , Elbeshry Shady Samir , Gendy Poula Gad
Published: August 2024

Background:

Although numerous studies reported the efficacy of percutaneous epiphysiodesis using transphyseal screws (PETS) in correcting angular knee deformities, many surgeons refrained from using it in younger children because of a lack of objective evidence of reversibility. Our hypothesis is that PETS is both truly reversible and effective.

Methods:

Twenty-one patients aged 8 to 13 years (36 lower limbs LL) with coronal plane knee deformity were enrolled into this prospective case series from January 2021 to September 2023. Besides the routine monitoring of PETS efficacy, low dose CT knee of 32 treated physes was done 6 months after screw removal. In addition, lower limb length, mechanical lateral distal femur angle (mLDFA), and medial proximal tibial angle (MPTA) were recorded preoperatively and 6 to 17 months after screw removal for 24 LL to investigate physis behavior, technique reversibility, and resumption of bone growth after screw removal.

Results:

The mean mechanical axis deviation (MAD) correction rate was 3.46 mm/mo and 1.78 mm/mo for genu valgum and genu varum patients, respectively. No physeal bony bars could be detected 6 months after screw removal for all patients. Out of 24 physis that underwent computerized radiography (CR) of the whole lower limb, 12 LL resumed their growth, 4 were stationary, while 8 were excluded due to inadequate calibration. A single physis showed rebound deformity, and another showed overcorrection in the genu valgum group.

Conclusions:

In addition to being a highly effective method of hemiepiphysiodesis, PETS was found to be reproducible, safe, and reversible when used in the juvenile and early adolescent pediatric population.

Level of Evidence:

IV—Prospective case series.
Surgically Treated Ischial Tuberosity Avulsion Fractures in Adolescents: Risks and Outcomes of 3 Fixation Constructs
Authors: Williams Brendan A. , Titus Matthew , Chaclas Nathan , Cardin Stefano , Wells Lawrence , Maguire Kathleen J. , Lawrence J. Todd
Published: August 2024

Introduction:

Avulsion fractures of the ischial tuberosity (AFIT) are uncommon injuries that sometimes require operative fixation with screws, suture anchors, or cortical suspensory buttons. This study reviewed a series of surgically managed AFITs at a single institution and compared outcomes among fixation strategies. We hypothesized there would be no difference in outcomes between fixation types.

Methods:

We conducted a retrospective review of all patients treated operatively at a single institution from 2010 to 2022 for AFIT identified by CPT code (27215). We collected patient demographics, injury characteristics, Revised Modified Oxford Bone Score, radiographic measures, fracture classification (type 1—lateral vs. type 2—complete), surgical fixation technique, postoperative complications (Modified Clavien-Dindo-Sink [M-CDS] Complication Classification), and time to return to sport (RTS). Descriptive statistics and univariate analyses were performed.

Results:

Study criteria identified 16 patients with surgically treated AFITs during the study period. Patients were predominantly male (88%) with a mean age of 14.8±0.8 years. Injured patients most commonly participated in soccer (38%), with the most common mechanism of injury being running/sprinting (50%). The avulsed fracture fragments were a mean of 42.6 mm in size, with an average maximal displacement of 21.1 mm and predominantly type 1—lateral (75%). Surgical constructs included: screws (4), suture anchors (5), cortical suspensory buttons (6), and combined (1, screw and suture anchor). Postoperative complications occurred in 8 patients (50%) including 7 type 1 and 1 type 3 M-CDS. No statistically significant difference was found between fixation types among the studied outcome variables; however, re-fracture (1 case [M-CDS type 3]) was only observed with a combined (screw and suture anchor) construct.

Conclusions:

This retrospective cohort study demonstrated that postoperative complications after ORIF for AFIT were not infrequent but were largely low in severity. Refracture occurred only with a combined screw and suture anchor construct. Consistent return to sport was achieved across all fixation types, with no significant difference in complication rate between constructs, although the available study sample limited robust analysis. This study is also, of note, one of the first to report outcomes from cortical suspensory buttons (CSB)—a relatively novel intervention for AFIT. Findings from this retrospective case series of multiple surgical techniques serve to bolster the limited literature base regarding the operative treatment of AFITs in adolescents.
Outcomes following two-level Cervical Disc Arthroplasty Relative to two-level Anterior Cervical Discectomy
Authors: Ratnasamy Philip P. , Gouzoulis Michael J. , Jabbouri Sahir S. , Varthi Arya G. , Grauer Jonathan N.
Published: August 2024

Study Design.

Retrospective cohort study

Objective.

To evaluate postoperative adverse events, readmissions, and five-year survival to reoperation for two-level cervical disc arthroplasty (CDA) relative to two-level anterior cervical discectomy and fusion (ACDF).

Background.

CDA and ACDF are both treatment options for degenerative cervical spine pathology. Relative to ACDF, CDA is a relatively novel treatment option, and limited research exists comparing outcomes between two-level CDA and two-level ACDF.

Methods.

Patients undergoing two-level CDA or two-level ACDF were isolated from the PearlDiver M165Ortho database. These two cohorts were matched 1:1 based on patient age, sex, and Elixhauser Comorbidity Index (ECI) scores. The odds of 90-day postoperative adverse events were compared between the two groups by multivariable analysis. Overall cost-of-care for the first 90-days postoperatively, and five-year survival to cervical spine reoperation were then assessed.

Results.

Of the two-level cases identified, only 3.9% had CDA and the rest had ACDF. After matching, there were 4,224 patients in each of the study groups. With controlling for patient age, sex, and ECI on multivariable analysis, two-level CDA patients had significantly lower odds of experiencing 90-day dysphagia (OR 0.60, P<0.0001 driving aggregated any adverse event [OR 0.65, P<0.0001]) and readmission (OR 0.69, P=0.0002). Median 90-day cost of care was greater for two-level ACDF patients ($4,776.00 vs. $3,191.00, P<0.0001). No significant difference in five-year survival to cervical spine reoperation was identified (P=0.7).

Conclusions.

Relative to two-level ACDF patients, two-level CDA patients were found to have significantly lower odds of 90-day readmissions and minor adverse events (dysphagia), while rates of major adverse events (pulmonary embolism, deep vein thrombosis, sepsis, etc.) were comparable between the groups. Further CDA patients had lower cost of overall care, but no difference in five-year survival to cervical spine reoperation. Thus, it may be appropriate to further consider CDA when two-level surgery is pursued.
Practice variations in the surgical treatment of small bowel obstruction in Quebec
Authors: Rancourt Maude , Rioux Antoine , Cheng Oviedo Sonia G. , McFadden Nathalie
Published: August 2024

Background:

Small bowel obstruction (SBO) is a common emergency and selectively requires surgical management. There is growing evidence supporting the use of laparoscopic surgery (LS) compared to open surgery for SBO.

Methods:

An online survey-based cohort study examining surgeon characteristics, patient factors, and clinical situations that impact decision making regarding the use of LS for SBO was sent to the 538 members of the Association Québécoise de Chirurgie and their answers were collected over a 4-month period in 2019.

Results:

The response rate was 27.1% (n=146). The gender, sex or the practice setting did not have an impact on the surgical approach. It was noted that surgeons who were more comfortable with laparoscopy used it more often (P=0.002). The three factors favoring the initial approach by laparotomy were most frequently cited: hostile abdomen, severe abdominal distension, and hemodynamic instability. Young surgeons had more homogenous answers (P=0.03). The surgeons having a practice oriented into LS had different decision criteria compared to those doing more open surgery.

Conclusion:

This article emphasizes key clinical scenarios and determinants that shape the surgical strategy for SBO treatment. The authors aim for this research to stimulate more discussions and contemplation about using laparoscopic methods for treating SBO in certain patients, thereby potentially elevating the frequency of surgeons adopting this approach. Moreover, considering the existing literature supports LS as a viable and safe method for SBO treatment, and noting the enhanced outcomes for patients, it becomes increasingly vital to advocate for this conversation.
Safety and Patient Experience With Early Mobilization After Transcatheter Aortic Valve Implantation
Authors: Kirk Bettina Højberg , Nørgaard Marianne Wetendorff , Palm Pernille , Norekvål Tone Merete , De Backer Ole
Published: August 2024

Background

Immobilization after transcatheter aortic valve replacement (TAVR) is the standard treatment for preventing access-related complications. However, the length of bed rest varies, and possible complications and patient experience remain unexplored.

Objective

In this pilot study, our aim was to investigate safety and efficacy after bed rest after TAVR.

Methods

This single-center randomized trial included 298 patients. Patients were randomized to standard 6 hours (n = 149) or 3 hours (n = 149) of bed rest after TAVR. The primary safety endpoint was a composite of access-related bleeding (Bleeding Academic Research Consortium type ≥ 2), hematoma (>5 cm), pseudoaneurysm, and vascular complications requiring intervention. The primary efficacy endpoint was patient-reported back pain, rated ≥6 on a numeric rating scale 24 hours post procedure. The secondary endpoints were the individual components of the primary safety endpoint, patient-reported pain, urination problems, and comfort.

Results

The primary safety endpoint occurred in 14 (9.4%) and 12 (8.1%) patients in the 6-hour and 3-hour immobilization groups, respectively (risk ratio, 0.86 [95% confidence interval, 0.41–1.79]; P = .68). There were no significant differences in individual bleeding or vascular complication endpoints. Patients with 3 hours of bed rest reported less back pain (P < .001), fewer urination problems (P < .001), and better comfort (P < .001) than patients with 6 hours of bed rest.

Conclusions

Mobilization as early as 3 hours after TAVR was shown to be safe, not resulting in a higher rate of bleeding or vascular complications as compared with 6 hours of bed rest. However, there was a difference in patient-reported back pain, urination problems, and comfort, favoring early mobilization.
Physician Associate/Assistant Program Medical Directors Are Important Advocates for the Physician Associate/Assistant Profession: Results From a National Pilot Study
Authors: Bouton Marcia , Wild Jennifer , Bolch Charlotte , Mitzel Katherine , Zhou Tian
Published: August 2024

Introduction

This pilot study aimed to evaluate whether and how physician associate/assistant (PA) program medical directors play a role in advocating on behalf of PAs and what factors correlate with this.

Methods

The study used a mixed-methods grounded theory approach and was deemed institutional review board exempt. After literature review, a survey was developed and piloted by study personnel and faculty to affirm validity. Recruits with known email addresses were sent a link to a survey that included demographic information and 10 Likert scale questions. There were 69 respondents, and the response rate was 26%. Fisher's exact test and analysis of variance were performed using the R program. A P-value <.05 indicated significance. Thematic analysis of qualitative data was performed using ChatGPT, followed by iterative analysis by the research team. Consensus was achieved for each response.

Results

Most of the respondents had the following characteristics: MD degree, male, White, practicing clinically, and worked as PA medical directors 8 to 12 hours per week. Participants did not support PA title change, nor had they engaged in legislative efforts to support optimal team practice. Participants were strong PA advocates by promoting PA leadership positions, PA employment, improved attitudes in health care organizations toward PAs, and securing clinical rotations. Many respondents (41%) felt that none of their professional organizations supported them in their role as PA program medical director.

Discussion

Exploring ways to support continued advocacy by our valued PA program medical directors within PA professional organizations could be advantageous to PA program medical directors' professional growth and the PA profession.
A Systematic Review of Interventions Targeting Cancer-Related Financial Hardship: Current Evidence and Implications
Authors: Jia Shumin , Cheung Denise Shuk Ting , Ho Mu-Hsing , Takemura Naomi , Feng Yongshen , Lin Chia-Chin
Published: August 2024

Background

Despite an increasing emphasis on alleviating financial hardship in cancer care delivery, limited knowledge of evidence-based and effective interventions is available.

Objective

This systematic review aimed to identify gaps in the literature and provide insights for future evidence-based interventions targeting financial hardship from both micro and macro perspectives.

Methods

We comprehensively searched the PubMed, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE, and PsycINFO databases from inception to October 2022. Studies examining the effect of an intervention on mitigating cancer-related financial hardship were included.

Results

A total of 24 studies were included. Findings indicate that the most significant positive changes were in the material conditions domain from the micro perspective of financial hardship. From the macro perspective, positive effects were shown for improving access to care, affordability of care, healthcare utilization, and healthcare equity of interventions at the provider or care team level, the community healthcare environment level, and the healthcare system and policy level. Notably, significant heterogeneity was observed among interventions and outcome measurements.

Conclusions

This is the first comprehensive systematic review of interventions targeting cancer-related financial hardship from both micro and macro perspectives. No consistently positive effect of the interventions on all domains was reported. Multidisciplinary approaches and higher-level hierarchical and evidence-based interventions are needed to address financial hardship.

Implications for practice

Health practitioners should screen and manage financial hardship using a standard and comprehensive measurement at the dyadic level of cancer survivors and caregivers.