bluuebunny/crossref_metadata_2025 huggingface dataset:
Thomson scattering measurements of electron temperature and electron density in laser-driven Gd plasmas
Authors: Pan Yiming , Sunahara Atsushi , Namba Shinichi , Higashiguchi Takeshi , Tomita Kentaro
Published: July 2023

In this study, we demonstrate the laser intensity scaling of electron temperature in Gd laser-produced plasmas (LPPs) through experiment and simulation. The spatial and temporal profiles of electron density ne
and temperature Te
in Gd LPPs were directly measured during a drive laser pulse duration of 7 ns at a laser wavelength of 1064 nm using collective Thomson scattering. We found that the measured maximum Te
value in Gd LPPs increases with increasing laser intensity IL
, with the dependence

T
e

∝

I
L

0.37

, in the IL
range of 1010–

10

11

W

⋅

c
m

−
2

. Radiation-hydrodynamic simulation code of the STAR-2D was performed under identical conditions to those used in the experiment, and extended further to higher laser intensities of up to

6
×

10

11

W

⋅

c
m

−
2

; the simulated Te
was found to be in good agreement with the experimental data over the used IL
range. The simulation indicates that higher overall maximum Te
typically exists 50–70 

μ

m

above the target and modifies the dependence as

T
e

∝

I
L

0.44

. Experiments reveal that a laser intensity of

1.9
×

10

12

W

⋅

c
m

−
2

is required to achieve the optimum condition (

T
e

∼

100 eV and ion charge states

∼

G
d

18
+

, at

n
e

∼
(
2

–

3
)
×

10

19

c
m

−
3

) for efficient beyond extreme ultraviolet (EUV) light source. In addition, two spot sizes (150 and 250

μ

m

in diameter) were used to study the effect of the spot size on the Te
profile. Our experimental findings, supported by the simulations, show that larger spots can create uniform Te
profiles, higher maximum Te
, and larger high-Te
regions in LPPs. The results and scaling laws presented in this study provide important information for developing more powerful and energy-efficient EUV light sources.
A fast approach to determine excitation eigenfrequencies for TD-EIT and FD-EIT
Authors: Li Yang , Wang Nan , Fan Li-Feng , Wang Yong-Qian , Zhao Peng-Fei , Huang Lan , Wang Zhong-Yi
Published: July 2023

Electrical impedance tomography can reconstruct the complex conductivity distribution by injecting a current or voltage at a specific frequency into the target domain. The complex conductivity spectroscopy of numerous biological tissues is frequency-dependent. A suitable excitation frequency is vital to high-quality imaging over a wide frequency range. This paper investigates the relationship between the parameters of the biological tissue impedance model and the impedance spectroscopy. A frequency selection method based on the impedance spectroscopy is proposed, in which the impedance spectroscopy on a specific electrode at the domain boundary to be measured is first scanned. In TD-EIT, the difference between the target’s impedance spectroscopy and the null field is calculated, and the frequency corresponding to its extreme value is used as the excitation signal for TD-EIT. The excitation frequency in FD-EIT is the frequency corresponding to the extreme point in the target impedance spectroscopy, and we have also used this method to image the interior of the maize ear. This study provides a quick and efficient method for determining the excitation frequency for EIT, allowing researchers to find the best excitation frequency for high-quality imaging during actual measurements.
ZnO nanoparticles-copper metal-organic framework composite on 3D porous nickel foam: a novel electrochemical sensing platform to detect serotonin in blood serum
Authors: Mukundan Gopika , Ganapathy Nagarajan , Badhulika Sushmee
Published: July 2023

Herein, we report a simple non-enzymatic electrochemical sensor for the detection of serotonin (5-HT) in blood serum using ZnO oxide nanoparticles-copper metal-organic framework (MOF) composite on 3D porous nickel foam, namely, ZnO-Cu MOF/NF. The x-ray diffraction analysis reveals the crystalline nature of synthesized Cu MOF and Wurtzite structure of ZnO nanoparticles, whereas SEM characterization confirms the high surface area of the composite nanostructures. Differential pulse voltammetry analysis under optimal conditions yields a wide linear detection range of 1 ng ml−1 to 1 mg ml−1 to 5-HT concentrations and a LOD (signal to noise ratio = 3.3) of 0.49 ng ml−1, which is well below the lowest physiological concentration of 5-HT. The sensitivity of the fabricated sensor is found to be 0.0606 mA ng−1 ml−1.cm2, and it exhibited remarkable selectivity towards serotonin in the presence of various interferants, including dopamine and AA, which coexist in the real biological matrix. Further, successful determination of 5-HT is achieved in the simulated blood serum sample with a good recovery percentage from ∼102.5% to ∼99.25%. The synergistic combination of the excellent electrocatalytic properties and surface area of the constituent nanomaterials proves the overall efficacy of this novel platform and shows immense potential to be used in developing versatile electrochemical sensors.
Controversy is inevitable
Authors: Gordin Michael D.
Published: July 2023

T chapter draws more general conclusions from the diversity of fringe doctrines regarding the conduct of mainstream science. Two features are important to understand both the ubiquity of “fringing” and the inevitability of controversies. First, the structure of science in the modern period is adversarial, meaning that every time there is an advance, there is also a doctrine that is discarded. These losing notions are the source of vestigial sciences. Second, science is a very expensive activity, and society has allocated a finite quantity of resources to conduct it. There will always be competition for access to those resources, and therefore scientists must make decisions about which ideas to pursue and which to abandon. This necessarily fringes out some ideas. Several examples are explored: polywater, water memory, cold fusion, and N-Rays, as well as allegations of scientific fraud (a related phenomenon).
The role of imaging in the selection of patients for HFpEF therapy
Authors: Baron Tomasz , Gerovasileiou Spyridon , Flachskampf Frank A
Published: July 2023

Heart failure with preserved ejection fraction (HFpEF) traditionally has been characterized as a form of heart failure without therapeutic options, in particular with a lack of response to the established therapies of heart failure with reduced ejection fraction (HFrEF). However, this is no longer true. Besides physical exercise, risk factor modification, aldosterone blocking agents, and sodium-glucose cotransporter 2 inhibitors, specific therapies are emerging for specific HFpEF etiologies, such as hypertrophic cardiomyopathy or cardiac amyloidosis. This development justifies increased efforts to arrive at specific diagnoses within the umbrella of HFpEF. Cardiac imaging plays by far the largest role in this effort and is discussed in the following review.
Unusual case report of malignant pheochromocytoma presenting with STEMI
Authors: Demir Muhammed , Özbek Mehmet , Güzel Tuncay , Aktan Adem
Published: July 2023

Background

Pheochromocytomas (PHEOs) are a group of tumours that leads to multiple symptoms and can induce hypercoagulability and promote thrombosis. Pheochromocytomas may also present without elevated serum and urinary markers. We aimed to provide tips and tricks for the diagnostic and therapeutic management of an unusual case of PHEOs.

Case summary

Thirty-four-year-old woman with the unremarkable medical history presented with epigastric pain and dyspnoea. Electrocardiogram showed ST-segment elevation in the inferior limb leads. She underwent an emergency coronary angiogram, which showed a high thrombus burden in the distal right coronary artery. A subsequent echocardiogram demonstrated a 31 × 33 mm right atrial mass adhering to the inferior vena cava and abdominal computed tomography (CT) scan revealed a 113 × 85 mm necrotic mass in the left adrenal bed, with tumour thrombus extending proximally to the confluence of hepatic veins immediately inferior to the right atrium and distally to iliac vein bifurcation. Blood parameters, thrombophilia panel, vanillylmandelic acid, 5 hydroxy indole acetic acid, and homovanillic acid levels were normal. Tissue sampling confirmed the diagnosis of PHEOs. The surgical procedure was not planned due to the presence of metastatic foci on imaging, including positron emission tomography (PET)–CT. Anticoagulation with rivaroxaban and treatment with 177Lu-DOTATATE-based peptide receptor radionuclide therapy (PRRT) was initiated.

Discussion

The coexistence of arterial and venous thrombosis is extremely rare in patients with PHEOs. Multidisciplinary approaches are required for the care of such patients. Catecholamines likely contributed to the development of thrombosis in our patient. Early recognition of PHEOs is the key point to ameliorate clinical outcomes.
One-week Impella CP support for papillary muscle rupture as a bridge to surgery: a case report
Authors: Kawanami Shodai , Egami Yasuyuki , Nishino Masami , Tanouchi Jun
Published: July 2023

Background

Papillary muscle rupture (PMR) is a catastrophic complication of acute myocardial infarction. However, the best timing and modality of circulatory support for surgery are unknown.

Case Summary

A 75-year-old man presented to the emergency room in our hospital for worsening shortness of breath accompanied by chest pain. Transthoracic echocardiograph showed severe mitral regurgitation (MR) with a flail posterior mitral valve leaflet, and coronary angiography demonstrated distal right coronary artery occlusion. We diagnosed as cardiogenic shock due to subacute myocardial infarction and ischaemic PMR. An Impella CP (Abiomed, Danvers, MA, USA) was introduced to improve haemodynamics. Despite the grade of MR was still severe, the mean blood pressure and pulmonary artery pressure improved 4 h after an Impella CP support. At day 8, the patient underwent elective mitral valve replacement with single coronary artery bypass grafting.

Discussion

PMR is a rare but lethal complication of acute myocardial infarction. Expeditious surgical treatment offers the optimal chance of survival, but the post-operative mortality or morbidity is very high. Therefore, preoperative stabilization can be closely correlated with outcomes in these patients. It was reported that directly unloading the left ventricle by an Impella decreased wall stress, external work, and myocardial oxygen consumption. Therefore, an Impella can be the most suitable mechanical circulatory support for PMR. In conclusion, Impella CP alone can become one of the suitable bridges to surgery in the patients with PMR.
Characteristics of the spiny dogfish (Squalus acanthias) nuclear genome
Authors: Wagner C Isabel , Kopp Martina E L , Thorburn James , Jones Catherine S , Hoarau Galice , Noble Leslie R
Published: July 2023

Sequenced shark nuclear genomes are underrepresented, with reference genomes available for only four out of nine orders so far. Here, we present the nuclear genome, with annotations, of the spiny dogfish (Squalus acanthias), a shark of interest to biomedical and conservation efforts, and the first representative of the second largest order of sharks (Squaliformes) with nuclear genome annotations available. Using Pacific Biosciences Continuous Long Read data in combination with Illumina paired-end and Hi-C sequencing, we assembled the genome de novo, followed by RNA-Seq-supported annotation. The final chromosome-level assembly is 3.7 Gb in size, has a BUSCO completeness score of 91.6%, and an error rate of less than 0.02%. Annotation predicted 33,283 gene models in the spiny dogfish's genome, of which 31,979 are functionally annotated.
Deep neural networks with knockoff features identify nonlinear causal relations and estimate effect sizes in complex biological systems
Authors: Fan Zhenjiang , Kernan Kate F , Sriram Aditya , Benos Panayiotis V , Canna Scott W , Carcillo Joseph A , Kim Soyeon , Park Hyun Jung
Published: July 2023

Background

Learning the causal structure helps identify risk factors, disease mechanisms, and candidate therapeutics for complex diseases. However, although complex biological systems are characterized by nonlinear associations, existing bioinformatic methods of causal inference cannot identify the nonlinear relationships and estimate their effect size.

Results

To overcome these limitations, we developed the first computational method that explicitly learns nonlinear causal relations and estimates the effect size using a deep neural network approach coupled with the knockoff framework, named causal directed acyclic graphs using deep learning variable selection (DAG-deepVASE). Using simulation data of diverse scenarios and identifying known and novel causal relations in molecular and clinical data of various diseases, we demonstrated that DAG-deepVASE consistently outperforms existing methods in identifying true and known causal relations. In the analyses, we also illustrate how identifying nonlinear causal relations and estimating their effect size help understand the complex disease pathobiology, which is not possible using other methods.

Conclusions

With these advantages, the application of DAG-deepVASE can help identify driver genes and therapeutic agents in biomedical studies and clinical trials.
Training Infrastructure as a Service
Authors: Rasche Helena , Hyde Cameron , Davis John , Gladman Simon , Coraor Nate , Bretaudeau Anthony , Cuccuru Gianmauro , Bacon Wendi , Serrano-Solano Beatriz , Hillman-Jackson Jennifer , Hiltemann Saskia , Zhou Miaomiao , Grüning Björn , Stubbs Andrew
Published: July 2023

Background

Hands-on training, whether in bioinformatics or other domains, often requires significant technical resources and knowledge to set up and run. Instructors must have access to powerful compute infrastructure that can support resource-intensive jobs running efficiently. Often this is achieved using a private server where there is no contention for the queue. However, this places a significant prerequisite knowledge or labor barrier for instructors, who must spend time coordinating deployment and management of compute resources. Furthermore, with the increase of virtual and hybrid teaching, where learners are located in separate physical locations, it is difficult to track student progress as efficiently as during in-person courses.

Findings

Originally developed by Galaxy Europe and the Gallantries project, together with the Galaxy community, we have created Training Infrastructure-as-a-Service (TIaaS), aimed at providing user-friendly training infrastructure to the global training community. TIaaS provides dedicated training resources for Galaxy-based courses and events. Event organizers register their course, after which trainees are transparently placed in a private queue on the compute infrastructure, which ensures jobs complete quickly, even when the main queue is experiencing high wait times. A built-in dashboard allows instructors to monitor student progress.

Conclusions

TIaaS provides a significant improvement for instructors and learners, as well as infrastructure administrators. The instructor dashboard makes remote events not only possible but also easy. Students experience continuity of learning, as all training happens on Galaxy, which they can continue to use after the event. In the past 60 months, 504 training events with over 24,000 learners have used this infrastructure for Galaxy training.
Beyond demonstrations: implementing a primary care hybrid payment model in Medicare
Authors: Berenson Robert A , Shartzer Adele , Pham Hoangmai H
Published: July 2023

The National Academies of Sciences, Engineering, and Medicine's (NASEM’s) 2021 report on primary care called for a hybrid payment approach—a mix of fee-for-service and population-based payment—with performance accountability to strike the proper balance for desired practice transformation and to support primary care's important and expanding role. The NASEM report also proposed substantial increases to primary care payment and reforms to the Medicare Physician Fee Schedule. This paper addresses pragmatic ways to implement these recommendations, describing and proposing solutions to the main implementation challenges. The urgent need for primary care payment reform calls for adopting a hybrid model within the Medicare fee schedule rather than engaging in another round of demonstrations, despite legal and practical obstacles to adoption. The paper explores reasons for adopting a roughly 50:50 blend of fee-for-service and population-based payment and addresses other design features, presenting reasons why spending accountability should rely on utilization measures under primary care control rather than performance on total cost of care, and proposes a fresh approach to quality, emphasizing that quality measures should be parsimonious, focused on important outcomes with demonstrated quality improvement.
South Korea's role conceptions and the liberal international order
Authors: Ryu Yongwook
Published: July 2023

Despite South Korea's general support of the liberal international order (LIO), its actions often deviate from or weaken the practices and values of the LIO. Applying role theory, the article argues that this apparent contradiction in South Korea's foreign policy arises from a situation of role conflict due to its multiple and conflicting role conceptions. Following an analysis of leaders’ speeches and official policy statements, the article contends that it is the interpretation of the past, not just the past per se, that matters for role conception and contestation. For South Korea, the experience and differing interpretations of the Korean War have simultaneously produced both LIO-supporting role conceptions (‘responsible international citizen’, ‘middle power’ and ‘global pivotal state’) and LIO-deviating or weakening roles (‘US ally’, ‘balancer’ and ‘independent nation’), thereby causing role conflict and inconsistency in the country's foreign policy behavior. The latter roles push Seoul either toward a more realist, alliance-based form of order or causes it to focus more exclusively on the Korean peninsula order, which emphasizes independence and inter-Korean unity. Based on these insights, the article suggests that it is imperative to minimize domestic dissensus on the interpretation of critical historical events, in order to avoid potential role conflict and to promote consistency in foreign policy.
Strongman politics and China's foreign policy actors: maritime assertiveness under Xi Jinping
Authors: Miura Kacie
Published: July 2023

Since Xi Jinping's ascension to power, China's foreign policy behaviour—including in the maritime domain—has become increasingly assertive. While a number of systemic, domestic and individual-level factors have contributed to China's more muscular approach, adequately understanding the dramatic intensification of its assertiveness under Xi requires a careful examination of the foreign policy implications of his strongman rule. This article contributes to such studies by examining how Xi's efforts to consolidate power, particularly through nationalistic appeals and an anti-corruption campaign, have mobilized China's foreign policy actors. I argue that the political environment that Xi has fostered shapes the career incentives of individual actors, motivating them to demonstrate their loyalty through displays of assertiveness. Drawing on a case-study of China's maritime actors, with a focus on their behaviour in the South China Sea, I show how Xi's consolidation of power has elevated the stakes of zealously showcasing support for his call to ‘resolutely safeguard’ China's sovereignty claims. I find that Xi's emphasis on demonstrations of loyalty often comes at the cost of other interests, such as reassuring potential rivals, suggesting that the current political environment risks pushing foreign policy in an even more assertive direction than perhaps intended.
Mean disease alleviation between surgery and continuous positive airway pressure in matched adults with obstructive sleep apnea
Authors: Every James D , Mackay Stuart G , Sideris Anders W , Do Timothy Q , Jones Andrew , Weaver Edward M
Published: July 2023

Study Objectives

Polysomnography parameters measure treatment efficacy for obstructive sleep apnea (OSA), such as reduction in apnea–hypopnea index (AHI). However, for continuous positive airway pressure (CPAP) therapy, polysomnography measures do not factor in adherence and thus do not measure effectiveness. Mean disease alleviation (MDA) corrects polysomnography measures for CPAP adherence and was used to compare treatment effectiveness between CPAP and multilevel upper airway surgery.

Methods

This retrospective cohort study consisted of a consecutive sample of 331 patients with OSA managed with multilevel airway surgery as second-line treatment (N = 97) or CPAP (N = 234). Therapeutic effectiveness (MDA as % change or as corrected change in AHI) was calculated as the product of therapeutic efficacy (% or absolute change in AHI) and adherence (% time on CPAP of average nightly sleep). Cardinality and propensity score matching was utilized to manage confounding variables.

Results

Surgery patients achieved greater MDA % than CPAP users (67 ± 30% vs. 60 ± 28%, p = 0.04, difference 7 ± 3%, 95% confidence interval 4% to 14%) in an unmatched comparison, despite a lower therapeutic efficacy seen with surgery. Cardinality matching demonstrated comparable MDA % in surgery (64%) and CPAP (57%) groups (p = 0.14, difference 8 ± 5%, 95% confidence interval −18% to 3%). MDA measured as corrected change in AHI showed similar results.

Conclusions

In adult patients with OSA, multilevel upper airway surgery and CPAP provide comparable therapeutic effectiveness on polysomnography. For patients with inadequate CPAP use, surgery should be considered.
Short-Term Clinical Response and Changes in the Fecal Microbiota and Metabolite Levels in Patients with Crohn’s Disease After Stem Cell Infusions
Authors: Yang Fan , Zheng Xiaofang , Liang Weicheng , Ni Beibei , Lu Jianxi , Liu Qiuli , Xu Ruixuan , He Yizhan , Yee Waye Mary Miu , Zhang Qi , Chen Yufeng , Zou Xiaoguang , Chen Wenjie
Published: July 2023

Recent studies have shown a close relationship between the gut microbiota and Crohn’s disease (CD). This study aimed to determine whether mesenchymal stem cell (MSC) treatment alters the gut microbiota and fecal metabolite pathways and to establish the relationship between the gut microbiota and fecal metabolites. Patients with refractory CD were enrolled and received 8 intravenous infusions of MSCs at a dose of 1.0 × 106 cells/kg. The MSC efficacy and safety were evaluated. Fecal samples were collected, and their microbiomes were analyzed by 16S rDNA sequencing. The fecal metabolites at baseline and after 4 and 8 MSC infusions were identified by liquid chromatography-mass spectrometry (LC--MS). A bioinformatics analysis was conducted using the sequencing data. No serious adverse effects were observed. The clinical symptoms and signs of patients with CD were substantially relieved after 8 MSC infusions, as revealed by changes in weight, the CD activity index (CDAI) score, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR). Endoscopic improvement was observed in 2 patients. A comparison of the gut microbiome after 8 MSC treatments with that at baseline showed that the genus Cetobacterium was significantly enriched. Linoleic acid was depleted after 8 MSC treatments. A possible link between the altered Cetobacterium abundance and linoleic acid metabolite levels was observed in patients with CD who received MSCs. This study enabled an understanding of both the gut microbiota response and bacterial metabolites to obtain more information about host-gut microbiota metabolic interactions in the short-term response to MSC treatment.
Transplantation of hESCs-Derived Neural Progenitor Cells Alleviates Secondary Damage of Thalamus After Focal Cerebral Infarction in Rats
Authors: Li Kongping , Peng Linhui , Xing Qi , Zuo Xialin , Huang Wenhao , Zhan Lixuan , Li Heying , Sun Weiwen , Zhong Xiaofen , Zhu Tieshi , Pan Guangjin , Xu En
Published: July 2023

Human embryonic stem cells-derived neural progenitor cells (hESCs-NPCs) transplantation holds great potential to treat stroke. We previously reported that delayed secondary degeneration occurs in the ventroposterior nucleus (VPN) of ipsilateral thalamus after distal branch of middle cerebral artery occlusion (dMCAO) in adult male Sprague-Dawley (SD) rats. In this study, we investigate whether hESCs-NPCs would benefit the neural recovery of the secondary damage in the VPN after focal cerebral infarction. Permanent dMCAO was performed with electrocoagulation. Rats were randomized into Sham, dMCAO groups with or without hESCs-NPCs treatment. HESCs-NPCs were engrafted into the peri-infarct regions of rats at 48 h after dMCAO. The transplanted hESCs-NPCs survive and partially differentiate into mature neurons after dMCAO. Notably, hESCs-NPCs transplantation attenuated secondary damage of ipsilateral VPN and improved neurological functions of rats after dMCAO. Moreover, hESCs-NPCs transplantation significantly enhanced the expression of BDNF and TrkB and their interaction in ipsilateral VPN after dMCAO, which was reversed by the knockdown of TrkB. Transplantated hESCs-NPCs reconstituted thalamocortical connection and promoted the formation of synapses in ipsilateral VPN post-dMCAO. These results suggest that hESCs-NPCs transplantation attenuates secondary damage of ipsilateral thalamus after cortical infarction, possibly through activating BDNF/TrkB pathway, enhancing thalamocortical projection, and promoting synaptic formation. It provides a promising therapeutic strategy for secondary degeneration in the ipsilateral thalamus post-dMCAO.
Complementary Therapies: Tai Chi in the Prevention and Management of Cardiovascular Disease
Authors: Danilov Alexandrina , Frishman William H.
Published: July 2023

Cardiovascular disease has remained the top contributor to global mortality for decades, necessitating research into the most effective methods of its prevention and treatment. Simultaneous with an immense amount of discovery and innovation in the field of cardiology, certain therapies with traditional Chinese origins have become progressively more popular in the West in recent decades. Specifically, ancient meditative mind-body practices such as Qigong and Tai Chi may lower cardiovascular disease risk and severity through a focus on movement and meditation. Such practices are generally low-cost and modifiable, with few adverse effects. Studies have shown higher quality of life in patients with coronary artery disease and heart failure after participation in Tai Chi, as well as a positive impact on cardiovascular risk factors such as hypertension and waist circumference. Most studies in the field have various limitations, such as small sample size, lack of randomization, and inadequate control; however, these practices show potential as an adjunct in the prevention and treatment of cardiovascular disease. Patients unable or unwilling to partake in traditionally aerobic activities may benefit greatly from such mind-body therapies. Nonetheless, more studies are warranted for more definitive answers to the question of Tai Chi and Qigong’s effectiveness. In this narrative review, we discuss the current evidence surrounding the effects of Qigong and Tai Chi on cardiovascular disease, in addition to the limitations and difficulties in conducting such studies.
Triple Therapy Protocol for Primary and Secondary Auricular Keloids: A Prospective Outcome Evaluation
Authors: Datema Frank R. , Saridin Joan , Timmer Ferdinand C.A. , Rothuizen Laura T. , van Zijl Floris V.W.J.
Published: July 2023

BACKGROUND

Ear keloid lesions present a significant challenge to the aesthetic surgeon. Keloids are known to recur and can cause severe cosmetic, functional, and psychological impairments. Several adjuvants to surgical removal have been promoted, with varying recurrence rates.

OBJECTIVE

To evaluate the effectiveness of triple therapy to treat secondary (and large primary) auricular keloids.

MATERIALS AND METHODS

Patients with secondary or large primary auricular keloids undergoing triple therapy were prospectively studied. Keloids were excised intramarginally under magnification and repeated triamcinolone acetonide 40 mg/mL injections were administered, followed by the application of a custom-made acrylate pressure device. Recurrent keloid formation and adverse events were monitored during a minimum of 6 months of follow-up.

RESULTS

Sixteen auricular keloid lesions (3 large primary and 13 secondary) were subjected to the proposed technique with a mean follow-up of 28 months. All cases that adhered to the protocol were free of keloid after triple therapy. Side effects were limited to 1 case of lobular atrophy and slight hypopigmentation. All patients were satisfied with the results.

CONCLUSION

The triple therapy protocol is highly effective in primary and secondary auricular keloid as long as patients remain compliant.
Surgical Tips for Aesthetic Lower Lid Blepharoplasty: Prevention of Round Eye
Authors: Klinger Marco , Vinci Valeriano , Romeo Maria Angela , Battistini Andrea , Klinger Francesco , Bandi Valeria , Maione Luca , Vinciguerra Paolo , Di Maria Alessandra
Published: July 2023

Purpose:

In the present study, we highlight surgical tips based on our experience in lower eyelid blepharoplasty. These have been shown to be crucial in the prevention of several complications, specifically lateral lower-lid displacement.

Methods:

A series of bilateral lower-lid blepharoplasties were performed on 280 patients at Humanitas-Research-Hospital (Milan, Italy) between January 2016 and January 2020. Patients with a history of lower-lid blepharoplasty and patients requiring canthopexy/canthoplasty were excluded. Needing to singularly evaluate and correct several lower-eyelid structures to obtain a harmonic result, we preoperatively assessed the amount of skin excess, the eyelid margin malposition relative to the globe, and the presence/absence of herniated fat-pads. Pre- and postoperative standard photographs were collected. Patients were evaluated by measuring scleral show, snap-back test, and distraction test. Blinded-fashioned photograph analysis was performed by independent plastic and oculoplastic surgeons who did not execute the procedures. A visual analogue scale was administered to all patients to assess satisfaction.

Results:

In total, 280 patients underwent successful lower blepharoplasty, with satisfactory results of scleral show, snap-back test, and distraction test. Of the 280 patients, four presented postoperative complications. At 10-month follow-up visit, we achieved a mean patient visual analogue scale satisfaction score of 8.4. Postoperative surgeon’s photographs mean score was 4.5.

Conclusions:

Without the use of muscle flaps, our technique averts tarsal ligament misposition, preserves orbicularis-muscle innervation, and limits thermal spread, assuring excellent stability of results and high patient and surgeon satisfaction. Cosmetic outcome in terms of symmetry, appearance, and lower lid line definition revealed high satisfaction with the result over time, with a remarkably low complication rate.
Biventricular Assist Devices as a Bridge to Heart Transplantation Under the New Donor Heart Allocation System in the United States
Authors: Prasad Mark , Mishaev Raffael , Bhamidipati Castigliano , Aldweib Nael , Colaco Nalini , Masha Luke
Published: July 2023

Biventricular assist devices (BiVADs) for pre-heart transplant care is rare. The outcomes of pretransplant BiVAD support after the 2018 heart transplant allocation policy change are entirely unknown at this time. The United Network of Organ Sharing database was retrospectively queried from October 2018 to June 2022 to identify patients supported to transplant with BiVADs. They were compared to patients listed as Status 2 for heart transplantation with an isolated VAD (uni-VAD). The primary outcome of interest was 1 year survival. Secondary outcomes included length of stay, posttransplant stroke, dialysis, and pacemaker implantation. The frequency of BiVAD use for heart transplantation has remained unchanged after the 2018 allocation policy change, making up approximately 2% of transplant recipients annually. Patients supported with BiVADs appeared to be similar to patients supported with uni-VADs. One year survival was similar between the groups (88.57% vs. 87.90%). Length of stay was longer and there was a trend toward higher frequencies of posttransplant dialysis use. Patients supported to transplant with BiVADs appear to have posttransplant outcomes comparable to patients commonly listed as Status 2 with an isolated VAD. Compared to past analyses, there is a suggestion of improved survival with the 2018 allocation policy change.
Importance of circulating monocyte subpopulations and Fcγ receptors in immune thrombocytopenia
Authors: Abou-Elalla Amany A. , Yacoub Maha F. , Abdelfattah Walaa , Abdelhameed Asmaa M. , Khereba Basma Samir , Hanna Mariam Onsy F.
Published: July 2023

Monocytes have been linked to the pathogenesis of immune thrombocytopenia (ITP) because of their role in autoantibody-mediated platelet phagocytosis. However, monocytes constitute unique populations with major differences in expression for surface Fcγ receptors (FcγRs). Thus, we evaluated monocytes in whole blood samples from patients with newly diagnosed and chronic ITP. Monocyte subpopulations were identified phenotypically by flow cytometry and defined according to the surface expression of CD14 (lipopolysaccharide receptor) and of CD16 (low-affinity Fcγ receptor III) into classical (CLM), intermediate (INTM) and nonclassical (non-CLM) monocytes. We also examined the expression of FcγRI/CD64 and FcγRIII/CD16 by monocyte subpopulations.

Newly diagnosed patients showed a decrease in non-CLM, expressed as a relative percentage of total monocytes compared with controls and chronic ITP patients. Both non-CLM and INTM of newly diagnosed patients closely correlated with platelet count. These monocyte subpopulations showed significantly enhanced CD64 expression in newly diagnosed patients. On the contrary, patients with chronic ITP presented higher non-CLM in percentage than controls and concomitant lower CLM and total monocytes, in percentage and number. The expression of CD64 was increased by all monocyte subpopulations, CLM, INTM, and non-CLM in chronic patients. In conclusion, differences in monocyte subpopulations, together with enhanced expression of FcγRI/CD64 are evident in patients with ITP.
Measuring coagulopathy in pediatric craniofacial surgery
Authors: Borst Alexandra J. , Bonfield Christopher M. , Deenadayalan Poornachanda S. , Le Chi H. , Xu Meng , Reddy Srijaya K.
Published: July 2023

The goal of this study was to describe hematologic and coagulation laboratory parameters and identify if these laboratory studies could predict blood loss in a cohort of pediatric patients undergoing complex cranial vault reconstruction (CCVR) for repair of craniosynostosis. We reviewed records from 95 pediatric CCVR patients between 2015 and 2019. Primary outcome measures were hematologic and coagulation laboratory parameters. Secondary outcome measures were intraoperative and postoperative calculated blood loss (CBL). Preoperative laboratory values were within normal limits and did not predict outcomes. Intraoperative platelet count and fibrinogen predicted CBL but without clinically relevant thrombocytopenia or hypofibrinogenemia. Intraoperative prothrombin time (PT) and partial thromboplastin time (PTT) predicted perioperative CBL, possibly reflecting surgically induced coagulopathy. Postoperative laboratory values did not predict postoperative blood loss. We found that standard hematologic and coagulation laboratory parameters predicted intraoperative and postoperative blood loss but provided limited mechanistic information to improve our understanding of coagulopathy in craniofacial surgery.
Efficacy, Safety, and Cost-effectiveness of Bezlotoxumab in Preventing Recurrent Clostridioides difficile Infection
Authors: Mohamed Mouhand F.H. , Ward Christopher , Beran Azizullah , Abdallah Mohamed A. , Asemota Joseph , Kelly Colleen R.
Published: July 2023

Introduction:

Clostridioides difficile infection (CDI) remains a global health challenge. Bezlotoxumab (BEZ) is a monoclonal antibody against C. difficile toxin B. Two randomized controlled trials (RCTs), MODIFY I and II, confirmed BEZ efficacy in preventing recurrent Clostridioides difficile infection (rCDI). However, there are safety concerns about its use in patients with a history of congestive heart failure. Observational studies have since been conducted, and it is important to explore the consistency of BEZ efficacy, cost-effectiveness, and its safety utilizing these real-world data.

Methods:

We performed a systematic review and meta-analysis to pool the rate of rCDI in patients receiving BEZ and explore its efficacy and safety in preventing rCDI compared with control. We searched PubMed, EMBASE, Cochrane Library, and Google Scholar from inception through April 2023 for relevant RCTs or observational studies assessing BEZ in preventing rCDI. Single-arm studies describing experience with BEZ in preventing rCDI were also included for proportion meta-analysis. A proportion meta-analysis with a random-effects model was used to pool the rCDI rate with its corresponding 95% CI. In a meta-analysis of efficacy, we generated the relative risk (RR) to compare BEZ versus control in preventing rCDI.

Results:

Thirteen studies including 2 RCTs and 11 observational studies totaling 2337 patients, of which 1472 received BEZ, were included in the analysis. Of the constituent studies, 5 (1734 patients) compared BEZ versus standard-of-care (SOC). Pooled rate of rCDI in patients receiving BEZ was 15.8% (95% CI: 14%-17.8%), and was 28.9% (95% CI: 24%-34.4%) in the SOC. BEZ significantly reduced rCDI risk compared with SOC [RR=0.57 (95% CI: 0.45-0.72, I
2=16%)]. There was no difference in the overall mortality or heart failure risk. Of the 9 included cost-effectiveness analyses, 8 demonstrated BEZ+SOC cost-effectiveness compared with SOC alone.

Discussion:

Our meta-analysis comprising real-world data revealed lower rCDI in patients receiving BEZ and supported its efficacy and safety when added to SOC therapy. The results were consistent across various subgroups. Available cost-effectiveness analyses mostly support BEZ+SOC cost-effectiveness compared with SOC alone.
Impact of body composition for patients with hepatocellular carcinoma who received atezolizumab plus bevacizumab therapy
Authors: Uojima Haruki , Chuma Makoto , Hidaka Hisashi , Tsuda Takashi , Kobayashi Satoshi , Hattori Nobuhiro , Ogushi Katsuaki , Arase Yoshitaka , Take Akira , Sakaguchi Yoshihiko , Tomoko Ando , Nishigori Shuhei , Wanatanbe Tsunamasa , Numata Kazushi , Morimoto Manabu , Kagawa Tatehiro , Kako Makoto , Kusano Chika
Published: July 2023

Objective

To investigate the association between body composition and prognosis in patients with advanced hepatocellular carcinoma treated with atezolizumab plus bevacizumab.

Methods

This cohort study analysed 119 patients who received atezolizumab plus bevacizumab for unresectable hepatocellular carcinoma. We investigated the association between body composition and progression-free survival and overall survival. Body composition was quantified by the visceral fat index, subcutaneous fat index, and skeletal muscle index. A high or low index score was defined as that above or below the median of these indices.

Results

Poor prognosis was observed in the low visceral fat index and low subcutaneous fat index groups. The mean progression-free survival in the low visceral fat index and low subcutaneous fat index groups vs. the other groups were 194 and 270 days, respectively [95% confidence interval (CI), 153–236 and 230–311 days, respectively; P = 0.015], while the mean overall survival was 349 vs. 422 days, respectively (95% CI, 302–396 and 387–458 days, respectively; P = 0.027). In the multivariate analysis, both a low subcutaneous fat index and low visceral fat index were statistically associated with lower progression-free and overall survival rates [hazard ratio (HR) 1.721; 95% CI, 1.101–2.688; P = 0.017; and HR 2.214; 95% CI, 1.207–4.184; P = 0.011, respectively].

Conclusion

Low visceral fat index and subcutaneous fat index scores were independent predictors of poor prognosis in patients with unresectable hepatocellular carcinoma treated with atezolizumab plus bevacizumab.
Bladder-sparing strategies in patients with clinically localized muscle-invasive bladder cancer
Authors: de Angelis Mario , Basile Giuseppe , Scornajenghi Carlo Maria , Asero Vincenzo , Del Giudice Francesco , Moschini Marco
Published: July 2023

Purpose of review

Radical cystectomy is the standard of care for patients with localized muscle-invasive bladder cancer (MIBC). In this context, bladder-sparing strategies (BSS) have been investigated as viable alternatives for patients who are unfit for radical cystectomy or aim to preserve their bladder without compromising oncological outcomes. This review aims to provide the most up-to-date evidence on BSSs as an alternative treatment for patients with MIBC.

Recent findings

Different studies have highlighted the long-term efficacy of trimodal therapy or chemoradiation protocols. However, due to the lack of randomized controlled trials, there is still a lack of high-level evidence on BSS efficacy as compared to radical cystectomy. Consequently, the adoption of these approaches is still limited. A possible turning point could be represented by the introduction of immunotherapy, as several studies are investigating the potential combination with chemoradiotherapy or radiotherapy alone. Patient selection, together with the implementation of new predictive biomarkers and imaging tools, may improve the efficacy of BSS in the near future.

Radical cystectomy with perioperative chemotherapy remains the gold standard treatment for MIBC patients. Nevertheless, BSS can be considered a viable option in selected patients who desire to preserve their bladder. Further evidence is needed to clearly state the role of BSS in MIBC.
Self-Reported Effects of Diet on Gastrointestinal Symptoms in Healthy Children
Authors: Telborn Lovisa , Axelsson Irene , Granéli Christina , Stenström Pernilla
Published: July 2023

Objectives:

Evidence on dietary effects on gastrointestinal (GI) symptoms in healthy children is lacking. Despite this, dietary advice is still common practice in the treatment of children’s GI symptoms. The aim was to investigate self-reported dietary effects on GI symptoms in healthy children.

Methods:

In this observational cross-sectional study on children, a validated self-reporting questionnaire including 90 specified food items was used. Healthy children aged 1–18 years old and their parents were invited to participate. Descriptive data were presented as median (range) and n (%).

Results:

In total, 265 of 300 children (9 years [1–18]; 52% boys) answered the questionnaire. Overall, 21 of 265 (8%) reported that diet induced GI symptoms regularly. In total, 2 (0–34) food items were reported per child as inducing GI symptoms. The most frequently reported items were beans (24%), plums (21%), and cream (14%). More children with GI symptoms (constipation, abdominal pain, troublesome gases) than with No/Seldom GI symptoms reported that diet could potentially induce GI symptoms (17/77 [22%] vs 4/188 [2%], P ≤ 0.001). Furthermore, they adjusted their diet to regulate GI symptoms (16/77 [21%] vs 8/188 [4%], P ≤ 0.001).

Conclusions:

Few healthy children reported that diet induced GI symptoms, and only a minority of food items were reported to induce GI symptoms. Children who had already experienced GI symptoms reported that diet impacted on GI symptoms to a greater, but still very limited, extent. Results can be used to determine accurate expectations and goals of dietary treatment of GI symptoms in children.
Assessment of Elastic Laminal Invasion Contributes to an Objective pT3 Subclassification in Colon Cancer
Authors: Kojima Motohiro , Yokota Mitsuru , Yanagisawa Naotake , Kitamura Sakiko , Amemiya Kota , Kawano Shingo , Tsukada Yuichiro , Sakuyama Naoki , Nagayasu Kiichi , Hashimoto Taiki , Nakashima Kota , Jiang Kun , Kanemitsu Yukihide , Fujita Fumihiro , Akiba Jun , Notohara Kenji , Itakura Junya , Sekine Shigeki , Sakashita Shingo , Sakamoto Naoya , Ishikawa Shumpei , Nakanishi Yukihiro , Yao Takashi , Liang Wen-Yih , Lauwers Gregory Y. , Ito Masaaki , Sakamoto Kazuhiro , Ishii Genichiro , Ochiai Atsushi
Published: July 2023

The extent of tumor spread influences on the clinical outcome, and which determine T stage of colorectal cancer. However, pathologic discrimination between pT3 and pT4a in the eighth edition of the American Joint Committee on Cancer (AJCC)-TNM stage is subjective, and more objective discrimination method for deeply invasive advanced colon cancer is mandatory for standardized patient management. Peritoneal elastic laminal invasion (ELI) detected using elastic staining may increase the objective discrimination of deeply invasive advanced colon cancer. In this study, we constructed ELI study group to investigate feasibility, objectivity, and prognostic utility of ELI. Furthermore, pT classification using ELI was investigated based on these data. At first, concordance study investigated objectivity using 60 pT3 and pT4a colon cancers. Simultaneously, a multi-institutional retrospective study was performed to assess ELI’s prognostic utility in 1202 colon cancer cases from 6 institutions. In the concordance study, objectivity, represented by κ, was higher in the ELI assessment than in pT classification. In the multi-institutional retrospective study, elastic staining revealed that ELI was a strong prognostic factor. The clinical outcome of pT3 cases with ELI was significantly and consistently worse than that of those without ELI. pT classification into pT3 without ELI, pT3 with ELI, and pT4a was an independent prognostic factor. In this study, we revealed that ELI is an objective method for discriminating deeply invasive advanced colon cancer. Based on its feasibility, objectivity, and prognostic utility, ELI can subdivide pT3 lesions into pT3a (without ELI) and pT3b (with ELI).
177Lu-DOTA-IBA Therapy in Prostate Cancer With Bone Metastases
Authors: Li Hongmei , Xu Tingting , Hua Qingchu , Wang Li , Chen Yue
Published: July 2023

Bone is the most common metastatic site in patients with prostate cancer. 177Lu-DOTA-ibandronic acid (177Lu-DOTA-IBA) is a new therapeutic radiopharmaceutical targeting bone metastasis. We report a case of refractory bone pain due to bone metastasis, who demonstrated an excellent therapy response after 3 cycles of 177Lu-DOTA-IBA therapy. In addition, the patient did not have any observable adverse reactions. 177Lu-DOTA-IBA may be a promising radiopharmaceutical for the treatment of bone metastasis.
The Northeastern Society of Plastic Surgeons
Authors: Davis Thomas S. , Potochny John D.
Published: July 2023

The concept for creating the Northeastern Society of Plastic Surgeons originated in May 1982, at the American Association of Plastic Surgeons in Colorado Springs Colorado. The new society would supplement, not supplant, existing state and small regional societies. Two hundred fifty-seven northeastern plastic surgeons joined the charter membership. The inaugural meeting of the Northeastern Society of Plastic Surgeons was held in Philadelphia, September 1984. The following historical account highlights our society's founding principles and leadership throughout the first 40 years.