bluuebunny/crossref_metadata_2025 huggingface dataset:
Breamy: An augmented reality mHealth prototype for surgical decision‐making in breast cancer
Authors: Najafi Niki , Addie Miranda , Meterissian Sarkis , Kersten‐Oertel Marta
Published: December 2023

Breast cancer is one of the most prevalent forms of cancer, affecting approximately one in eight women during their lifetime. Deciding on breast cancer treatment, which includes the choice between surgical options, frequently demands prompt decision‐making within an 8‐week timeframe. However, many women lack the necessary knowledge and preparation for making informed decisions. Anxiety and unsatisfactory outcomes can result from inadequate decision‐making processes, leading to decisional regret and revision surgeries. Shared decision‐making and personalized decision aids have shown positive effects on patient satisfaction and treatment outcomes. Here, Breamy, a prototype mobile health application that utilizes augmented reality technology to assist breast cancer patients in making more informed decisions is introduced. Breamy provides 3D visualizations of different surgical procedures, aiming to improve confidence in surgical decision‐making, reduce decisional regret, and enhance patient well‐being after surgery. To determine the perception of the usefulness of Breamy, data was collected from 166 participants through an online survey. The results suggest that Breamy has the potential to reduce patients' anxiety levels and assist them in decision‐making.
Seamless Integration of Computer-Adaptive Patient Reported Outcomes into an Electronic Health Record
Authors: Nolla Kyle , Rasmussen Luke V. , Rothrock Nan E. , Butt Zeeshan , Bass Michael , Davis Kristina , Cella David , Gershon Richard , Barnard Cynthia , Chmiel Ryan , Almaraz Federico , Schachter Michael , Nelson Therese , Langer Michelle , Starren Justin
Published: December 2023

Background Patient-reported outcome (PRO) measures have become an essential component of quality measurement, quality improvement, and capturing the voice of the patient in clinical care. In 2004, the National Institutes of Health endorsed the importance of PROs by initiating the Patient-Reported Outcomes Measurement Information System (PROMIS), which leverages computer-adaptive tests (CATs) to reduce patient burden while maintaining measurement precision. Historically, PROMIS CATs have been used in a large number of research studies outside the electronic health record (EHR), but growing demand for clinical use of PROs requires creative information technology solutions for integration into the EHR.

Objectives This paper describes the introduction of PROMIS CATs into the Epic Systems EHR at a large academic medical center using a tight integration; we describe the process of creating a secure, automatic connection between the application programming interface (API) which scores and selects CAT items and Epic.

Methods The overarching strategy was to make CATs appear indistinguishable from conventional measures to clinical users, patients, and the EHR software itself. We implemented CATs in Epic without compromising patient data security by creating custom middleware software within the organization's existing middleware framework. This software communicated between the Assessment Center API for item selection and scoring and Epic for item presentation and results. The middleware software seamlessly administered CATs alongside fixed-length, conventional PROs while maintaining the display characteristics and functions of other Epic measures, including automatic display of PROMIS scores in the patient's chart. Pilot implementation revealed differing workflows for clinicians using the software.

Results The middleware software was adopted in 27 clinics across the hospital system. In the first 2 years of hospital-wide implementation, 793 providers collected 70,446 PROs from patients using this system.

Conclusion This project demonstrated the importance of regular communication across interdisciplinary teams in the design and development of clinical software. It also demonstrated that implementation relies on buy-in from clinical partners as they integrate new tools into their existing clinical workflow.
The Method of Combining Internal and External Treatment of Ulcerative Colitis in Chinese Medicine
Authors: Dai Qian , Dai Chunyan , Han Jie
Published: December 2023

Traditional Chinese medicine (TCM) believes that the main pathogenesis of ulcerative colitis is spleen deficiency; damp heat in the large intestine as the symptom, the treatment must be warming, clearing, eliminating, tonifying, astringing concurrently. From the concept of combining holism and the local treatment in TCM, idea of combining internal and external treatment is adopted. That is, the external treatment follows the therapeutic principle of using herbs with a bitter and cold nature to eliminate stagnation, and the seven carbon decoction, which can clear heat and dampness, cool the blood, and stop dysentery, is used as a rectal drip to retain the enema. Internal treatment follows the therapeutic principle of warmly tonifying and cultivating vital qi, with oral Chinese herbal medicine named Maodie Tang to strengthen the spleen and tonify the kidney, clearing heat and inducing dampness.
Endo-Hepatology: The Buzz Goes Much beyond Liver Biopsy—A Narrative Review
Authors: Puri Rajesh , Sharma Zubin , Dhampalwar Swapnil , Kathuria Abhishek , Sahu Bimal
Published: December 2023

The word endo-hepatology evokes many perceptions. Some believe it to be the emerging new interventional branch and some believe it to be an extension of endoscopy. Nonetheless, it has continued to evolve into an exciting area of active work. With the advent of endoscopic ultrasound (EUS) based procedures, new vistas have opened up. EUS-guided liver biopsies, portal hypertension management, and multiple new procedures are being described. EUS also plays a large role in the management of patients in the peritransplant period. With this review, we present an overview of the role of EUS in the field of hepatology as well as during the peritransplant period and its applications.
Deriving the cosmological constant from the Euler–Lagrange equation of second-order differentiable gravitational field Lagrangian
Authors: Islam Ashraful
Published: December 2023

The principles underlying the variational approach prove to be invaluable tools in articulating physical phenomena, particularly when dealing with conserved quantities. The derivation of gravitational field equations from the Euler–Lagrange equation, a result of the first-order derivative of Lagrange field density, is a well-established concept. However, within the context of this paper, the field equations stem from the second-order differentiable field Lagrangian in the Euler–Lagrange equation. The Euler–Lagrange equation of the first-order differentiable field Lagrangian yields the gravitational field equations incorporating matter fields and the cosmological constant. On the other hand, the Euler–Lagrange equation of the second-order differentiable field Lagrangian gives rise to the equation governing the cosmological constant. The procedure of determining the cosmological constant through the Euler–Lagrange equation adheres to fundamental mathematical theory encompassing higher-order Euler–Lagrange equations. This theory implies that utilizing higher-order Euler–Lagrange equations may result in instability due to negative energy. The cosmological constant is postulated to be intertwined with negative vacuum energy density. The value assigned to the gravitational constant, as ascertained through the employment of the general relativistic equation, is not only significantly small and nonzero but also demonstrates remarkable compatibility with the value inferred from observational deductions.
Nonlinear bias toward complex contagion in uncertain transmission settings
Authors: St-Onge Guillaume , Hébert-Dufresne Laurent , Allard Antoine
Published: December 2023

Current epidemics in the biological and social domains are challenging the standard assumptions of mathematical contagion models. Chief among them are the complex patterns of transmission caused by heterogeneous group sizes and infection risk varying by orders of magnitude in different settings, like indoor versus outdoor gatherings in the COVID-19 pandemic or different moderation practices in social media communities. However, quantifying these heterogeneous levels of risk is difficult, and most models typically ignore them. Here, we include these features in an epidemic model on weighted hypergraphs to capture group-specific transmission rates. We study analytically the consequences of ignoring the heterogeneous transmissibility and find an induced superlinear infection rate during the emergence of a new outbreak, even though the underlying mechanism is a simple, linear contagion. The dynamics produced at the individual and group levels are therefore more similar to complex, nonlinear contagions, thus blurring the line between simple and complex contagions in realistic settings. We support this claim by introducing a Bayesian inference framework to quantify the nonlinearity of contagion processes. We show that simple contagions on real weighted hypergraphs are systematically biased toward the superlinear regime if the heterogeneity of the weights is ignored, greatly increasing the risk of erroneous classification as complex contagions. Our results provide an important cautionary tale for the challenging task of inferring transmission mechanisms from incidence data. Yet, it also paves the way for effective models that capture complex features of epidemics through nonlinear infection rates.
Ascertaining the influences of auxiliary qubits on the Einstein–Podolsky–Rosen steering and its directions
Authors: Xing 邢 Ling-Ling 玲玲 , Yang 杨 Huan 欢 , Zhang 张 Gang 刚 , Kong 孔 Min 敏
Published: December 2023

Einstein–Podolsky–Rosen (EPR) steering is an example of nontrivial quantum nonlocality and characteristic in the non-classical world. The directivity (or asymmetry) is a fascinating trait of EPR steering, and it is different from other quantum nonlocalities. Here, we consider the strategy in which two atoms compose a two-qubit X state, and the two atoms are owned by Alice and Bob, respectively. The atom of Alice suffers from a reservoir, and the atom of Bob couples with a bit flip channel. The influences of auxiliary qubits on EPR steering and its directions are revealed by means of the entropy uncertainty relation. The results indicate that EPR steering declines with growing time t when adding fewer auxiliary qubits. The EPR steering behaves as damped oscillation when introducing more auxiliary qubits in the strong coupling regime. In the weak coupling regime, the EPR steering monotonously decreases as t increases when coupling auxiliary qubits. The increases in auxiliary qubits are responsible for the fact that the steerability from Alice to Bob (or from Bob to Alice) can be more effectively revealed. Notably, the introductions of more auxiliary qubits can change the situation that steerability from Alice to Bob is certain to a situation in which steerability from Bob to Alice is certain.
Impact of the Brink-Axel hypothesis on unique first-forbidden β-transitions for r-process nuclei*
Authors: Farooq Fakeha , Nabi Jameel-Un , Shehzadi Ramoona
Published: December 2023

Key nuclear inputs for the astrophysical r-process simulations are the weak interaction rates. Consequently, the accuracy of these inputs directly affects the reliability of nucleosynthesis modeling. The majority of the stellar rates, used in simulation studies are calculated by invoking the Brink-Axel (BA) hypothesis. The BA hypothesis assumes that the strength functions of all parent excited states are the same as for the ground state, only shifted in energies. However, the BA hypothesis has to be tested against microscopically calculated state-by-state rates. In this project, we study the impact of the BA hypothesis on calculated stellar

-decay and electron capture rates. Our investigation include both unique first forbidden (U1F) and allowed transitions for 106 neutron-rich trans-iron nuclei ([27, 77] ≤ [Z, A] ≤ [82, 208]). The calculations were performed using the deformed proton-neutron quasiparticle random-phase approximation (pn-QRPA) model with a simple plus quadrupole separable and schematic interaction. Waiting-point and several key r-process nuclei lie within the considered mass region of the nuclear chart. We computed electron capture and

-decay rates using two different prescriptions for strength functions. One was based on invoking the BA hypothesis and the other was the state-by-state calculation of strength functions, under stellar density and temperature conditions ([10, 1] ≤ [

(

), T(

)] ≤ [1011, 30]). Our results show that the BA hypothesis invoked U1F

rates are overestimated by 4–5 orders of magnitude as compared to microscopic rates. For capture rates, more than two orders of magnitude differences were noted when applying the BA hypothesis. It was concluded that the BA hypothesis is not a reliable approximation, especially for

-decay forbidden transitions.
The Ponytail Lift: 22 Years of Experience in 600 Cases of Endoscopic Deep Plane Facial Rejuvenation
Authors: Kao Chia Chi , Duscher Dominik
Published: December 2023

Background

During aging, the face loses volume with progressive sagging of the soft tissues, while the neck demonstrates skin laxity and muscle banding. The treatment of facial and neck aging usually involves a traditional facelift, which can cause noticeable scarring and distortion of anatomy.

Objectives

Modern facelift surgery must avoid such shortcomings and still address aging in all layers of the face. To achieve this goal a novel surgical technique was developed and coined the “ponytail lift” (PTL). When global facial rejuvenation is indicated, this procedure is combined with neck skin excision and referred to as the “ponytail facelift” (PTFL).

Methods

A retrospective analysis of 600 consecutive cases over 22 years (2000-2022) of facial rejuvenation employing the endoscopic techniques of PTL and PTFL was performed. Patients were followed for at least 12 months postoperatively. Demographics, surgical data, and complications were recorded and analyzed. Additionally, technical details of the PTL and PTFL are discussed.

Results

There were no instances of postoperative skin flap necrosis, and no permanent nerve injuries were recorded. An additional surgical touch-up procedure to address unsatisfied aesthetic needs was performed in 20 cases.

Conclusions

The ponytail procedures offer a stepwise approach matched to the extent of the problem and are intended to refresh or transform the face with minimal incisions. The procedures represent a deep plane facelift without the scar burden, with incisions that are hidden in the temple, postauricular, and posterior scalp. The described techniques are safe and effective while providing reliable and satisfying results.
Ignoring measurement errors in social networks
Authors: Lewbel Arthur , Qu Xi , Tang Xun
Published: December 2023

We consider peer effect estimation in social network models where some network links are incorrectly measured. We show that if the number or magnitude of mismeasured links does not grow too quickly with the sample size, then standard instrumental variables estimators that ignore these measurement errors remain consistent, and standard asymptotic inference methods remain valid. These results hold even when the link measurement errors are correlated with regressors or with structural errors in the model. Simulations and real data experiments confirm our results in finite samples. These findings imply that researchers can ignore small numbers of mismeasured links in networks.
The Incidence Variety Compactification of Strata ofd-Differentials in Genus0
Authors: Nguyen Duc-Manh
Published: December 2023

Given $d\in \mathbb {Z}_{\geq 2}$, for every $\kappa =(k_{1},\dots ,k_{n}) \in \mathbb {Z}^{n}$ such that $k_{i}\geq 1-d$ and $k_{1}+\dots +k_{n}=-2d$, denote by $\Omega ^{d}\mathcal {M}_{0,n}(\kappa )$ and $\mathbb {P}\Omega ^{d}\mathcal {M}_{0,n}(\kappa )$ the corresponding stratum of $d$-differentials in genus $0$ and its projectivization, respectively. We specify an ideal sheaf of the structure sheaf of $\overline {\mathcal {M}}_{0,n}$ and show that the incidence variety compactification $\mathbb {P}\overline {\Omega }^{d}\mathcal {M}_{0,n}(\kappa )$ of $\mathbb {P}\Omega ^{d}\mathcal {M}_{0,n}(\kappa )$ is isomorphic to the blow-up of $\overline {\mathcal {M}}_{0,n}$ along this sheaf of ideals. We also obtain an explicit divisor representative of the tautological line bundle on the incidence variety. In an accompanying work [22], the construction of $\mathbb {P}\overline {\Omega }^{d}\mathcal {M}_{0,n}(\kappa )$ in this paper will be used to prove a recursive formula computing the volumes of the spaces of flat metric with fixed conical angles on the sphere.
In vitro activity of cefiderocol against a global collection of carbapenem-resistant Pseudomonas aeruginosa with a high level of carbapenemase diversity
Authors: Gill Christian M , Santini Debora , Nicolau David P ,   the ERACE-PA Global Study Group, Aktas Elif , Alfouzan Wadha , Bourassa Lori , Brink Adrian , Burnham Carey-Ann D , Canton Rafael , Carmeli Yehuda , Falcone Marco , Kiffer Carlos , Marchese Anna , Martinez Octavio , Pournaras Spyros , Satlin Michael , Seifert Harald , Thabit Abrar K , Thomson Kenneth S , Villegas Maria Virginia , Wille Julia , Rezende Thais Teles Freitas , Cekin Zuhal , Malkocoglu Gulsah , Gijón Desirèe , Tarakmeh Layla Abdullah , Chu Chun Yat , Opperman Christoffel Johannes , Tootla Hafsah Deepa , Moodley Clinton , Coetzee Jennifer , Vourli Sophia , Dimopoulos George , Attallah Dalya M , Tiseo Giusy , Leonildi Alessandro , Giordano Cesira , Barnini Simona , Menichetti Francesco , Di Pilato Vincenzo , Codda Giulia , Vena Antonio , Giacobbe Daniele Roberto , Westblade Lars , Cardona Armando , Curtis Lauren , Fang Ferric , Thomson Gina
Published: December 2023

Objectives

To determine the in vitro activity of cefiderocol in a global collection of carbapenem-resistant Pseudomonas aeruginosa including >200 carbapenemase-producing isolates.

Methods

Isolates (n = 806) from the ERACE-PA Surveillance Program were assessed. Broth microdilution MICs were determined for cefiderocol (iron-depleted CAMHB) and comparators (CAMHB). Susceptibility was interpreted by CLSI and EUCAST breakpoints and reported as percent of isolates. The MIC distribution of cefiderocol in the entire cohort and by carbapenemase status was assessed.

Results

In the entire cohort, cefiderocol was the most active agent (CLSI 98% susceptible; EUCAST 95% susceptible; MIC50/90, 0.25/2 mg/L). Amikacin (urinary only breakpoint) was the second most active, with 70% of isolates testing as susceptible. The percentage of isolates susceptible to all other agents was low (<50%) including meropenem/vaborbactam, imipenem/relebactam, piperacillin/tazobactam and levofloxacin. Cefiderocol maintained significant activity against the most commonly encountered carbapenemases including VIM- (CLSI 97% susceptible; EUCAST 92% susceptible) and GES (CLSI 100% susceptible; EUCAST 97% susceptible)-harbouring isolates. The cefiderocol MIC distribution was similar regardless of carbapenemase status, with MIC50/90 values of 0.5/4 mg/L, 0.5/2 mg/L and 0.25/1 mg/L for MBL, serine carbapenemase and molecular carbapenemase-negative isolates, respectively.

Conclusions

Cefiderocol displayed potent in vitro activity in this global cohort of carbapenem-resistant P. aeruginosa including >200 carbapenemase-harbouring isolates. Cefiderocol was highly active against MBL-producing isolates, where treatment options are limited. These data can help guide empirical therapy guidelines based on local prevalence of carbapenemase-producing P. aeruginosa or in response to rapid molecular diagnostics.
Population pharmacokinetics and dosing simulations of total and unbound temocillin in the plasma and CSF of neurocritically ill patients with external ventricular drain-related cerebral ventriculitis
Authors: Ngougni Pokem Perrin , Liu Xin , Parker Suzanne L , Verroken Alexia , Collienne Christine , Finet Patrice , Wijnant Gert-Jan , Laterre Pierre-François , Roberts Jason A , Van Bambeke Françoise , Wittebole Xavier
Published: December 2023

Background

Cerebral ventriculitis might be caused by Gram-negative bacteria, including ESBL producers. Temocillin may be a useful treatment option in this scenario; however, no consistent data are available regarding its penetration into the CSF.

Objectives

To describe the population pharmacokinetics of temocillin in plasma and CSF and to determine the probability for different simulated dosing regimens to achieve pharmacokinetic/pharmacodynamic (PK/PD) targets in the CSF.

Methods

Ten post-neurosurgical critically ill adult patients requiring continuous drainage of CSF were included in this monocentric, prospective, open-label, non-randomized study. They received 2 g loading dose temocillin over 30 min IV infusion, followed by a 6 g continuous infusion over 24 h. Total and unbound concentrations were measured in plasma (n = 88 and 86) and CSF (n = 88 and 88) samples and used to build a population PK model. Monte Carlo simulations were performed to estimate the PTA at 100% Css>MIC (steady state concentration above the MIC) in CSF.

Results

All patients were infected with Enterobacterales with temocillin MICs ≤8 mg/L. The median (min-max) temocillin penetration in CSF was 12.1% (4.3-25.5) at steady state. Temocillin unbound plasma pharmacokinetics were best described by a one-compartment model. PTA for the applied dosing regimen was >90% for bacteria with MIC ≤ 4 mg/L.

Conclusions

The currently approved dose of 6 g by continuous infusion may be adequate for the treatment of ventriculitis by Enterobacterales with MIC ≤ 4 mg/L if considering 100% Css>MIC as the PK/PD target to reach. Higher maintenance doses could help covering higher MICs, but their safety would need to be assessed.
Evaluating the incidence of acute kidney injury and gentamicin synergy dosing for endocarditis
Authors: Starkel Skyler , Goodberlet Melanie , Schuler Brian , Rock Alex , DeGrado Jeremy R , Pearson Jeffrey C
Published: December 2023

Objectives

Current infective endocarditis guidelines recommend two different gentamicin synergy dosing strategies for selected Gram-positive organisms. The purpose of this analysis was to evaluate the incidence of acute kidney injury (AKI) with gentamicin synergy dosing, comparing divided-daily and once-daily dosing strategies for infective endocarditis (IE).

Methods

Groups were split into patients who received gentamicin divided-daily dosing and once-daily (3 mg/kg) dosing for Gram-positive IE. The primary outcome was the incidence of AKI defined by RIFLE (risk, injury, failure, loss, end-stage renal disease) criteria after starting gentamicin. A multivariable logistic regression analysis was performed to identify possible independent predictors of developing AKI. Notable secondary outcomes included hospital length of stay, need for gentamicin dose adjustments based on therapeutic drug monitoring, and assessment of each case of AKI using the Naranjo algorithm.

Results

The incidence of AKI was significantly higher in the divided-daily group compared with the once-daily group (52.5% versus 13%, P < 0.01). The divided-dosing group had significantly longer median [IQR] hospital length of stay (19 days [12:29] versus 13.5 days [9:22], P < 0.01) and a greater number of patients who required dose adjustments (76.2% versus 21.7%, P < 0.01). The multivariable regression analysis showed that the divided-dosing strategy, duration and institution were independently associated with incidence of AKI.

Conclusions

This analysis suggests a lower incidence of AKI in the treatment of endocarditis with gentamicin synergy dosed once-daily compared with a divided-daily dosing. Further studies are warranted to assess if there is a difference in efficacy between gentamicin synergy dosing strategies and in gentamicin compared with no gentamicin regimens for IE.
Long-term carriage and evolution of vancomycin-resistant Enterococcus faecium: a genomic study on consecutive isolates
Authors: Knudsen Maja Johanne Søndergaard , Samaniego Castruita Jose Alfredo , Mollerup Sarah , Holzknecht Barbara Juliane , Hoppe Morten , Westh Henrik , Pinholt Mette , Rubin Ingrid Maria Cecilia
Published: December 2023

Objectives

To determine if vancomycin-resistant Enterococcus faecium (VREfm) carriers carry the same VREfm clone after a minimum follow-up of 365 days. For those carrying the same clone, we investigated the genomic evolution per year per genome.

Methods

We used WGS results to assign VREfm clones to each isolate and determine clone shifts. Finally, we calculated distance in core-genome MLST alleles, and the number of SNPs between consecutive VREfm isolates from patients carrying the same VREfm clone.

Results

In total, 44.2% of patients carried the same VREfm clone, and the genomic evolution was 1.8 alleles and 2.6 SNPs per genome per year.

Conclusions

In our population of long-term carriers, we calculated a molecular clock of 2.6 SNPs.
DF-Phos: Prediction of Protein Phosphorylation Sites by Deep Forest
Authors: Zahiri Zeynab , Mehrshad Nasser , Mehrshad Maliheh
Published: December 2023

Phosphorylation is the most important and studied post-translational modification (PTM), which plays a crucial role in protein function studies and experimental design. Many significant studies have been performed to predict phosphorylation sites using various machine-learning methods. Recently, several studies have claimed that deep learning-based methods are the best way to predict the phosphorylation sites because deep learning as an advanced machine learning method can automatically detect complex representations of phosphorylation patterns from raw sequences and thus offers a powerful tool to improve phosphorylation site prediction. In this study, we report DF-Phos, a new phosphosite predictor based on the Deep Forest to predict phosphorylation sites. In DF-Phos, the feature vector taken from the CkSAApair method is as input for a Deep Forest framework for predicting phosphorylation sites. The results of 10-fold cross-validation show that the Deep Forest method has the highest performance among other available methods. We implemented a Python program of DF-Phos, which is freely available for non-commercial use at https://github.com/zahiriz/DF-Phos Moreover, users can use it for various PTM predictions.
Ultraviolet and infrared luminescence of near-Earth objects
Authors: Simonia Irakli
Published: December 2023

This work deals with a possible ultraviolet and infrared luminescence of the solid substance of the near-Earth objects. In particular, features of the phenomena of photoluminescence and cathodoluminescence of substance of these objects are considered. It is shown that ultraviolet and infrared luminescence of these objects can be revealed by orbital-based instruments. It is demonstrated that detectability of luminescence of near-Earth objects opens up the possibilities for determination of the physical–chemical properties of their solid substance and finding of the dark small low-albedo bodies, which could approach dangerously closer to the Earth. Equations for calculation of luminescence intensity of these objects are proposed. Data on the luminescence of the corresponding minerals and the numerical values of the yields of luminescence and albedo, as the conditions for the detectability of the luminescence of near-Earth objects are presented as well.
De Ritis ratio in elderly glioblastoma patients treated with chemoradiation: A comprehensive analysis of serum biomarkers
Authors: Kim Jina , Lee Hye In , Kim In Ah , Lee Joo Ho , Cho Jaeho , Wee Chan Woo , Yoon Hong In
Published: December 2023

Background

We aimed to comprehensively investigate the prognostic value of pretreatment laboratory parameters in elderly patients with glioblastoma treated with temozolomide (TMZ)-based chemoradiation.

Methods

Patients aged ≥ 65 years from 4 institutions with newly diagnosed IDH-wild-type glioblastoma who received radiotherapy (RT) with concurrent TMZ between 2006 and 2021 were included. Patient factors (age, Karnofsky performance status (KPS), temporalis muscle thickness), molecular factors (MGMT promoter methylation, EGFR amplification, TERT promoter mutation, and TP53 mutation status), treatment factors (extent of resection, and RT dose), and pretreatment laboratory parameters (serum De Ritis ratio, glucose level, neutrophil-to-lymphocyte ratio, platelet count, and systemic immune-inflammation index) were included in the analysis. The primary endpoint was overall survival (OS).

Results

In total, 490 patients were included in the analysis. The median follow-up period was 12.3 months (range, 1.6–149.9 months). Median OS was significantly prolonged in patients with De Ritis ratio < 1.2 (18.2 vs 15.3 months, P = .022) and in patients with glucose level < 150 mg/dL (18.7 vs 16.5 months, P = .034) per univariate analysis. In multivariate analysis, KPS ≥ 70, MGMT promoter methylation, extent of resection greater than partial resection, De Ritis ratio < 1.2, and glucose level < 150 mg/dL were significant prognostic factors for improved OS.

Conclusions

Along with well-known prognostic factors, pre-RT serum biomarkers, including the De Ritis ratio and glucose level, also had prognostic value in elderly patients with glioblastoma treated with TMZ-based chemoradiation.
Investigating and Summarizing Information Resources Related to the Clinical Presentation and Diagnosis of Cutaneous Manifestations of Infectious Diseases in Patients With Skin of Color
Authors: McGowan Dorothea , Kermani Anosh , Sheagren John
Published: December 2023

Patients with skin of color (SOC) present diseases differently in many circumstances, yet there is a lack of information regarding the presentation and diagnosis of cutaneous manifestations in such patients experiencing infectious diseases. Therefore, we conducted a scoping review to investigate and summarize information pertaining to the clinical presentation and diagnosis of cutaneous manifestations of infectious diseases in patients with SOC focusing on the following viral, bacterial, toxin-mediated, and infestation diseases and fungal infections: human immunodeficiency virus, shingles, impetigo, scarlet fever, Lyme disease, toxic shock syndrome, scabies, rickettsioses, and cutaneous fungal infections. This scoping review identified literature gaps regarding cutaneous manifestations of infectious diseases in patients with SOC such as a lack of visual examples and more precise descriptions of common infectious diseases. The lack of better-quality literature and educational resources describing cutaneous manifestations of infectious diseases in patients with SOC may contribute to care barriers; therefore, more research and collaboration are needed in the specialties of both infectious diseases and dermatology.
Prevention of methylmercury-triggered ROS-mediated impairment of embryo development by co-culture with adult adipose-derived mesenchymal stem cells
Authors: Lee Cheng-Kai , Wang Fu-Ting , Huang Chien-Hsun , Chan Wen-Hsiung
Published: December 2023

Methylmercury (MeHg) is a potent toxin that exerts deleterious effects on human health via environmental contamination. Significant effects of MeHg on neuronal development in embryogenesis have been reported. Recently, our group demonstrated that MeHg exerts toxic effects on pre- and post-implantation embryonic development processes from zygote to blastocyst stage. Our results showed that MeHg impairs embryo development by induction of apoptosis through reactive oxygen species (ROS) generation that triggers caspase-3 cleavage and activation, which, in turn, stimulates p21-activated kinase 2 (PAK2) activity. Importantly, ROS were identified as a key upstream regulator of apoptotic events in MeHg-treated blastocysts. Data from the current study further confirmed that MeHg exerts hazardous effects on cell proliferation, apoptosis, implantation, and pre- and post-implantation embryo development. Notably, MeHg-induced injury was markedly prevented by co-culture with adipose-derived mesenchymal stem cells (ADMSCs) in vitro. Furthermore, ADMSC injection significantly reduced MeHg-mediated deleterious effects on embryo, placenta, and fetal development in vivo. Further investigation of the regulatory mechanisms by which co-cultured ADMSCs could prevent MeHg-induced impairment of embryo development revealed that ADMSCs effectively reduced ROS generation and its subsequent downstream apoptotic events, including loss of mitochondrial membrane potential and activation of caspase-3 and PAK2. The collective findings indicate that co-culture with mesenchymal stem cells (MSCs) or utilization of MSC-derived cell-conditioned medium offers an effective potential therapeutic strategy to prevent impairment of embryo development by MeHg.
Is There a Role for Isolated Closed Reduction in the Emergency Department Without Fixation for Displaced Proximal Humerus Fractures in Adolescents?
Authors: Torres-Izquierdo Beltran , Tippabhatla Abhishek , Baldwin Keith , Upasani Vidyadhar , Sanders Julia , Goldstein Rachel , Denning Jaime Rice , Hosseinzadeh Pooya
Published: December 2023

Objective:

Pediatric proximal humerus fractures (PHFx) are uncommon and makeup ~2% of all pediatric fractures. Traditionally, most cases are treated nonoperatively with closed reduction (CR) or immobilization with no reduction (INR) with excellent outcomes. Indications for CR without fixation remain unclear as immobilization in the position of reduction (shoulder abduction and external rotation) is not practical. We aim to determine the need for CR among adolescents with displaced PHFx treated nonoperatively.

Methods:

We conducted an IRB-approved prospective multicenter study involving 42 adolescents aged 10 to 16 years, treated for displaced PHFx across 6 institutions between 2018 and 2022. CR was performed under conscious sedation in the emergency department, with data collected during follow-up visits at 6 weeks and 3 months. Radiographic measurements, range of motion, and patient-reported outcomes, including the Patient-Reported Outcomes Measurement Information System Upper Extremity and Physical Function, Shoulder Pain and Disability Index, and QuickDash scores, were compared between the INR and CR groups.

Results:

Among 42 fractures, 23 (55%) were treated with INR and 19 (45%) with CR, followed by placement in a hanging arm cast or sling. Of the cases, 62% were high-energy injuries. Radiographic alignment and range of motion were similar between groups at preoperative, 6 weeks, and 3 months with no significant differences noted.

Patient-Reported Outcomes Measurement Information System Upper Extremity, Physical Function, QuickDash, and Shoulder Pain and Disability Index scores at 6 weeks and 3 months showed no significant differences between cohorts. Significant improvement was observed between 6 weeks and 3 months for every patient-reported outcome in both cohorts.

Conclusions:

For displaced PHFx treated nonoperatively, our data suggests INR has a similar radiographic and clinical outcome when compared with CR. Our results question the necessity of performing CR in this group of patients.

Level of Evidence:

Level II—therapeutic studies: prospective cohort study.
Quantitative methods for optimizing patient outcomes in liver transplantation
Authors: Al-Bahou Raja , Bruner Julia , Moore Helen , Zarrinpar Ali
Published: December 2023

Liver transplantation (LT) is a lifesaving yet complex intervention with considerable challenges impacting graft and patient outcomes. Despite best practices, 5-year graft survival is only 70%. Sophisticated quantitative techniques offer potential solutions by assimilating multifaceted data into insights exceeding human cognition. Optimizing donor-recipient matching and graft allocation presents additional intricacies, involving the integration of clinical and laboratory data to select the ideal donor and recipient pair. Allocation must balance physiological variables with geographical and logistical constraints and timing. Quantitative methods can integrate these complex factors to optimize graft utilization. Such methods can also aid in personalizing treatment regimens, drawing on both pretransplant and posttransplant data, possibly using continuous immunological monitoring to enable early detection of graft injury or infected states. Advanced analytics is thus poised to transform management in LT, maximizing graft and patient survival. In this review, we describe quantitative methods applied to organ transplantation, with a focus on LT. These include quantitative methods for (1) utilizing and allocating donor organs equitably and optimally, (2) improving surgical planning through preoperative imaging, (3) monitoring graft and immune status, (4) determining immunosuppressant doses, and (5) establishing and maintaining the health of graft and patient after LT.
Cochlear Implant Electrode Array Design and Speech Understanding
Authors: Vohra Varun , Andresen Nicholas S. , Carver Courtney , Dunham Rachel , Marsiglia Dawn , Yeagle Jenifer , Della Santina Charles C. , Creighton Francis X. , Bowditch Stephen P. , Sun Daniel Q.
Published: December 2023

Objective

Cochlear implant electrode arrays are categorized based on their design as lateral wall (LW) and perimodiolar (PM) electrode arrays. The objective of this study was to investigate the effect of LW versus PM designs on postoperative speech perception across multiple manufacturers and over long follow-up durations.

Design

Retrospective cohort study.

Setting

Single academic medical center.

Participants

A total of 478 adult cochlear implant recipients, implanted between the years 1992 and 2017.

Interventions(s)

PM versus LW cochlear implants

Main Outcome(s) and Measure(s)

Postoperative Consonant-Nucleus-Consonant Word (CNC-w) and Hearing in Noise Test (HINT) scores between 6 months and 5 years.

Results

Across 478 patients, approximately one-third received LW (n = 176, 36.8%), whereas 302 patients received a PM array (63.2%). The PM group had higher CNC-w scores from 6 months to 2 years (52 [interquartile range, 38–68] versus 48 [31–62],p= 0.036) and from 2 to 5 years (58 [43–72] versus 48 [33–66],p< 0.001). Multivariable analysis of patient-averaged scores indicated that the PM group had greater improvement from preoperative scores at all time points after the initial 6 months for both CNC-w (β= 4.4 [95% confidence interval, 0.6–8.3],p= 0.023) and HINT testing (β= 4.5 [95% confidence interval, 0.3–8.7],p= 0.038).

Conclusions

This study indicates that PM electrode arrays are associated with small increases in postoperative speech perception scores, relative to LW arrays, when assessed across manufacturers, over long time durations, and using multiple outcome instruments. These findings may help guide surgeon selection and patient counseling of cochlear implant arrays.
Differences in Substance Use and Harm Reduction Practices by Race and Ethnicity: Rhode Island Harm Reduction Surveillance System, 2021-2022
Authors: Rodriguez McClaren , McKenzie Michelle , McKee Haley , Ledingham Emily M. , John Kristen , Koziol Jennifer , Hallowell Benjamin D.
Published: December 2023

Context:

In the United States, minority populations are disproportionately affected by the overdose epidemic, have higher mortality rates, and unequal access to harm reduction and treatment services.

Objective:

This analysis aims to better understand harm reduction utilization and substance use patterns among minority populations to improve overdose outreach and prevention initiatives in Rhode Island.

Design:

The present analysis used data from the Harm Reduction Surveillance System from January 2021 to December 2022 (N = 393). Chi-square tests and multivariable regression models were used to investigate differences in substance use behaviors by race and ethnicity.

Setting:

Rhode Island.

Participants:

Participants include individuals who self-reported the use of illicit drugs, currently reside in Rhode Island, and were older than 18 years.

Main Outcome Measures:

Methods of drug use and uptake of harm reduction practices.

Results:

Among survey participants, 41% were non-Hispanic White, 57% were aged 25 to 44 years, 62% identified as male, and 95% had health insurance coverage. Most participants reported smoking as their method of drug use (90%) and harm reduction practices were underutilized by all race and ethnicity groups. Fewer non-Hispanic Black participants reported carrying naloxone compared to the other race and ethnicity groups. Non-Hispanic Black and Hispanic participants were significantly less likely to inject drugs compared with non-Hispanic White participants (adjusted odds ratio [AOR] = 0.14; 95% confidence interval [CI], 0.04-0.45) (AOR = 0.40; 95% CI, 0.18-0.90).

Conclusions:

Smoking was the most common self-reported method of substance administration for all participants, whereas injection was more prevalent among non-Hispanic White participants. There is a continued need for minority-led and culturally informed harm reduction and treatment services for minority populations.
Physical activity, sitting time, and thermal quantitative sensory testing responses in African Americans
Authors: Huber Felicitas A. , Carpenter Rachel , Goodin Burel R. , Bruehl Stephen , Karlson Cynthia , Rao Uma , Kinney Kerry , Nag Subodh , Morris Matthew C.
Published: December 2023

Introduction:

Prior research suggests that African Americans (AAs) have more frequent, intense, and debilitating pain and functional disability compared with non-Hispanic Whites (NHWs). Potential contributing factors to this disparity are physical activity and sedentary behavior, given that AAs are less physically active, and physical activity is associated with antinociception (whereas sedentary behavior is linked to pronociception). However, impact of these factors on pain processing has largely been unexplored in AAs, especially before chronic pain onset.

Objective:

This study examined relationships between physical activity, sedentary behavior (sitting time), and laboratory measures of pain and pain modulation in adult AAs. These included heat pain threshold and tolerance, temporal summation of pain (TSP, a marker of central sensitization), and conditioned pain modulation (CPM, a marker of descending pain inhibition).

Methods:

Multiple regressions were conducted to examine the effects of physical activity and sitting time on heat threshold and tolerance. Multilevel models were conducted to assess the relationship between physical activity, sitting time, and temporal summation of pain. Additional multilevel models were conducted to assess the relationship between physical activity, sitting time, and conditioned pain modulation.

Results:

Higher level of physical activity, but not sitting time, was associated with reduced TSP slopes. Neither physical activity nor sitting time was associated with CPM slopes. No significant relationships between physical activity or sitting time and heat pain threshold or tolerance were detected.

Conclusions:

These findings suggest that physical activity is associated with reduced TSP, an effect which may be driven by reduced spinal hyperexcitability in more active individuals. Thus, structural and individual interventions designed to increase physical activity in healthy, young AAs may be able to promote antinociceptive processes (ie, reduced TSP/reduced pain facilitation) potentially protective against chronic pain.
Different time scales used for sexual partner surveys pose a challenge in modelling dynamics of sexually transmitted infections
Authors: Murayama Hiroaki , Nishi Akihiro , Endo Akira
Published: December 2023

Mathematical models for sexually transmitted infections (STIs) are parameterised by empirical data on sexual behaviour (e.g. the number of partners over a given period) obtained from surveys. However, the time window for reporting sexual partnerships may vary between surveys and how data for different windows can be translated from one to another remains an open question. To highlight this issue, we compared the distributions of the number of sexual partners over one year and four weeks from the British National Surveys of Sexual Attitudes and Lifestyles. The results show that simple linear rescaling did not render the one-year and four-week partner distributions aligned. Parameterising STI models using survey-based sexual encounter rates without considering the implication of the reporting window used can lead to misleading results.
From solitary to colonial with zooid miniaturization: ancestral-state reconstruction based on NGS data of stolidobranch ascidians
Authors: Hasegawa Naohiro , Matsubara Shin , Shiraishi Akira , Satake Honoo , Shenkar Noa , Kajihara Hiroshi
Published: December 2023

The size of organisms has consistently intrigued researchers across various disciplines in biology. However, the evolutionary process of zooid miniaturization in colonial animals remained an enigmatic topic. The family Styelidae, within the ascidian order Stolidobranchia, showcases a diverse spectrum of coloniality, positioning it as an ideal candidate for delving into the intricacies of colonial evolution. In this research, we inferred a phylogenomic relationship mainly within Styelidae using transcriptomes of a total of 42 ascidians; from 17 species sampled in Israel and Japan and transcriptome data from 25 species sourced from a previous study and a database. Through ancestral-state reconstruction, our analysis indicated a clear directional change: following the acquisition of coloniality, zooids tended to become progressively smaller. This miniaturization is likely an adaptive response, enabling organisms to swiftly colonize limited marine substrate. We formulated a mathematical model suggesting that zooid miniaturization, due to living space constraints, would result in a faster asexual cycle and accelerated expansion in a colony. Our data also suggested that coloniality evolved independently three times within Styelidae. Moreover, once colonial traits are established, they appear to be consistently preserved, underscoring their biological importance in the colonial lineage.