bluuebunny/crossref_metadata_2025 huggingface dataset:
TOI-332 b: a super dense Neptune found deep within the Neptunian desert
Authors: Osborn Ares , Armstrong David J , Fernández Fernández Jorge , Knierim Henrik , Adibekyan Vardan , Collins Karen A , Delgado-Mena Elisa , Fridlund Malcolm , Gomes da Silva João , Hellier Coel , Jackson David G , King George W , Lillo-Box Jorge , Matson Rachel A , Matthews Elisabeth C , Santos Nuno C , Sousa Sérgio G , Stassun Keivan G , Tan Thiam-Guan , Ricker George R , Vanderspek Roland , Latham David W , Seager Sara , Winn Joshua N , Jenkins Jon M , Bayliss Daniel , Bouma Luke G , Ciardi David R , Collins Kevin I , Colón Knicole D , Crossfield Ian J M , Demangeon Olivier D S , Díaz Rodrigo F , Dorn Caroline , Dumusque Xavier , Keniger Marcelo Aron Fetzner , Figueira Pedro , Gan Tianjun , Goeke Robert F , Hadjigeorghiou Andreas , Hawthorn Faith , Helled Ravit , Howell Steve B , Nielsen Louise D , Osborn Hugh P , Quinn Samuel N , Sefako Ramotholo , Shporer Avi , Strøm Paul A , Twicken Joseph D , Vanderburg Andrew , Wheatley Peter J
Published: September 2023

To date, thousands of planets have been discovered, but there are regions of the orbital parameter space that are still bare. An example is the short period and intermediate mass/radius space known as the ‘Neptunian desert’, where planets should be easy to find but discoveries remain few. This suggests unusual formation and evolution processes are responsible for the planets residing here. We present the discovery of TOI-332 b, a planet with an ultra-short period of 0.78 d that sits firmly within the desert. It orbits a K0 dwarf with an effective temperature of 5251 ± 71 K. TOI-332 b has a radius of $3.20^{+0.16}_{-0.12}$ R⊕, smaller than that of Neptune, but an unusually large mass of 57.2 ± 1.6 M⊕. It has one of the highest densities of any Neptune-sized planet discovered thus far at $9.6^{+1.1}_{-1.3}$ g cm−3. A 4-layer internal structure model indicates it likely has a negligible hydrogen-helium envelope, something only found for a small handful of planets this massive, and so TOI-332 b presents an interesting challenge to planetary formation theories. We find that photoevaporation cannot account for the mass-loss required to strip this planet of the Jupiter-like envelope it would have been expected to accrete. We need to look towards other scenarios, such as high-eccentricity migration, giant impacts, or gap opening in the protoplanetary disc, to try and explain this unusual discovery.
Two-population Bayesian hierarchical model of Type Ia supernovae
Authors: Wojtak Radosław , Hjorth Jens , Hjortlund Jacob Osman
Published: September 2023

The currently used standardization of Type Ia supernovae results in Hubble residuals whose physical origin is unaccounted for. Here, we present a complete physical interpretation of the Hubble residuals based on a novel Bayesian hierarchical model of Type Ia supernovae in which latent variables describing intrinsic and extrinsic (dust related) supernova properties originate from two supernova populations. Fitting the model to SALT2 light-curve parameters of supernovae in the Hubble flow we find strong (4σ) evidence for the presence of two overlapping, but distinct, populations differentiated primarily by their mean SALT2 shape parameter (stretch) x1. Supernovae from the population with predominantly slow decliners (higher average x1) are found to be intrinsically bluer (mean SALT2 colour c ≈ −0.11) and twice as reddened by dust (mean reddening E(B − V) ≈ 0.10) than those from the other population which is dominated by fast decliners (lower average x1) with c ≈ −0.04 and E(B − V) ≈ 0.05. The inferred extinction coefficient RB in both supernova populations follows a broad distribution (scatter 0.9) with a mean of 4.1, which coincides closely with the value associated with mean extinction law in the Milky Way. We also find that the supernova data favour a peaked (two-tailed) distribution of selective extinction E(B − V) over the commonly adopted exponential model. Our approach provides a complete explanation of the distribution of supernova light-curve parameters in terms of extinction properties and the above-mentioned differences between the two populations, without the need for introducing any intrinsic scatter.
New dipole instabilities in spherical stellar systems
Authors: Weinberg Martin D
Published: September 2023

Spherical stellar systems have weakly damped response modes. The dipole modes are seiche modes. The quadrupole are zero pattern-speed prolate modes, the stable precursors to the radial orbit instability (ROI). We demonstrate that small wiggles in the distribution function (DF) can destabilize the dipole modes and describe the newly identified instabilities in NFW-like dark-matter (DM) haloes and other power-law spherical systems. The modes were identified in N-body simulations using multivariate singular spectrum analysis and corroborated using linear-response theory. The new mode peaks inside the half-mass radius but has a pattern speed typical of an outer-halo orbit. As it grows, the radial angle of the eccentric orbits that make up the mode correlates and loses angular momentum by a resonant couple to outer-halo orbits. This leads to an unsteady pattern with a density enhancement that swings from one side of the halo to another along a diameter, like the orbits that comprise the instability. In this way, the dipole mode is similar to the ROI. Since the DF found in Nature is unlikely to be smooth and isotropic with df(E)/dE < 0 necessary for Antonov stability, these modes may be ubiquitous albeit slowly growing. Haloes that are less extended than NFW, such as the Hernquist model, tend to be stable to this dipole instability. We present the critical stability exponents for one- and two-power models. These different critical outer power-law exponents illustrate that the gravitational coupling between the inner and outer DM halo depends on the global shape of density profile.
GRB optical and X-ray plateau properties classifier using unsupervised machine learning
Authors: Bhardwaj Shubham , Dainotti Maria G , Venkatesh Sachin , Narendra Aditya , Kalsi Anish , Rinaldi Enrico , Pollo Agnieszka
Published: September 2023

The division of gamma-ray bursts (GRBs) into different classes, other than the ‘short’ and ‘long’, has been an active field of research. We investigate whether GRBs can be classified based on a broader set of parameters, including prompt and plateau emission ones. Observational evidence suggests the existence of more GRB subclasses, but results so far are either conflicting or not statistically significant. The novelty here is producing a machine-learning-based classification of GRBs using their observed X-rays and optical properties. We used two data samples: the first, composed of 203 GRBs, is from the Neil Gehrels Swift Observatory (Swift/XRT), and the latter, composed of 134 GRBs, is from the ground-based Telescopes and Swift/UVOT. Both samples possess the plateau emission (a flat part of the light curve happening after the prompt emission, the main GRB event). We have applied the Gaussian mixture model (GMM) to explore multiple parameter spaces and subclass combinations to reveal if there is a match between the current observational subclasses and the statistical classification. With these samples and the algorithm, we spot a few microtrends in certain cases, but we cannot conclude that any clear trend exists in classifying GRBs. These microtrends could point towards a deeper understanding of the physical meaning of these classes (e.g. a different environment of the same progenitor or different progenitors). However, a larger sample and different algorithms could achieve such goals. Thus, this methodology can lead to deeper insights in the future.
Dust attenuation in galaxies at cosmic dawn from the FirstLight simulations
Authors: Mushtaq Muzammil , Ceverino Daniel , Klessen Ralf S , Reissl Stefan , Puttasiddappa Prajwal Hassan
Published: September 2023

We study the behaviour of dust in galaxies at cosmic dawn, z = 6–8, by coupling the FirstLight simulations with the radiative transfer code polaris. The starburst nature of these galaxies and their complex distribution of dust lead to a large diversity of attenuation curves. These follow the Calzetti model only for relatively massive galaxies, Mstars ≃ 109 M⊙. Galaxies with lower masses have steeper curves, consistent with the model for the Small Magellanic Cloud. The ultraviolet and optical slopes of the attenuation curves are closer to the modified Calzetti model, with a slight preference for the power-law model for galaxies with the highest values of attenuation. We have also examined the relation between the slope in the far-ultraviolet, βUV, and the infrared excess, IRX. At z = 6, it follows the Calzetti model with a shift to slightly lower βUV values due to lower metallicities at lower attenuation. The same relation at z = 8 shows a shift to higher IRX values due to a stronger CMB radiation at high z.
A dual-zone diffusion model for high energy emissions of the Cygnus Cocoon
Authors: Zhan Shihong , Wang Wei
Published: September 2023

As one of the brightest Galactic γ-ray sources, the Cygnus Cocoon superbubble has been observed by many detectors, such as Fermi-LAT, ARGO, HAWC, and LHAASO. However, the origin of γ-ray emission for the Cygnus Cocoon and the possible contribution to PeV cosmic rays are still under debate. The recent ultrahigh-energy γ-ray observations by LHAASO up to 1.4 PeV towards the direction of the Cygnus Cocoon, as well as the neutrino event report of IceCube-201120A coming from the same direction, suggest that the Cygnus Cocoon may be one of the sources of high-energy cosmic rays in the Galaxy. In this work, we propose a dual-zone diffusion model for the Cygnus Cocoon: the cocoon region and surrounding interstellar medium (ISM). This scenario can account for the γ-ray data from GeV to ∼50 TeV and agree with the one sub-PeV neutrino event result from IceCube so far. Moreover, it predicts a non-negligible contribution γ-ray emission at hundreds TeV from the ISM surrounding the Cygnus Cocoon. This possible diffuse TeV–PeV gamma-ray features can be resolved by the future LHAASO observations.
The geometry of the hot corona in MCG-05-23-16 constrained by X-ray polarimetry
Authors: Tagliacozzo D , Marinucci A , Ursini F , Matt G , Bianchi S , Baldini L , Barnouin T , Cavero Rodriguez N , De Rosa A , Di Gesu L , Dovčiak M , Harper D , Ingram A , Karas V , Kim D E , Krawczynski H , Madejski G , Marin F , Middei R , Marshall H L , Muleri F , Panagiotou C , Petrucci P-O , Podgorny J , Poutanen J , Puccetti S , Soffitta P , Tombesi F , Veledina A , Zhang W , Agudo I , Antonelli L A , Bachetti M , Baumgartner W H , Bellazzini R , Bongiorno S D , Bonino R , Brez A , Bucciantini N , Capitanio F , Castellano S , Cavazzuti E , Chen C-T , Ciprini S , Costa E , Del Monte E , Di Lalla N , Di Marco A , Donnarumma I , Doroshenko V , Ehlert S R , Enoto T , Evangelista Y , Fabiani S , Ferrazzoli R , Garcia J A , Gunji S , Heyl J , Iwakiri W , Jorstad S G , Kaaret P , Kislat F , Kitaguchi T , Kolodziejczak J J , La Monaca F , Latronico L , Liodakis I , Maldera S , Manfreda A , Marscher A P , Massaro F , Mitsuishi I , Mizuno T , Negro M , Ng C-Y , O’Dell S L , Omodei N , Oppedisano C , Papitto A , Pavlov G G , Peirson A L , Perri M , Pesce-Rollins M , Pilia M , Possenti A , Ramsey B D , Rankin J , Ratheesh A , Roberts O J , Romani R W , Sgrò C , Slane P , Spandre G , Swartz D A , Tamagawa T , Tavecchio F , Taverna R , Tawara Y , Tennant A F , Thomas N E , Trois A , Tsygankov S S , Turolla R , Vink J , Weisskopf M C , Wu K , Xie F , Zane S
Published: September 2023

We report on the second observation of the radio-quiet active galactic nucleus MCG-05-23-16 performed with the Imaging X-ray Polarimetry Explorer (IXPE). The observation started on 2022 November 6 for a net observing time of 640 ks, and was partly simultaneous with NuSTAR (86 ks). After combining these data with those obtained in the first IXPE pointing on 2022 May (simultaneous with XMM–Newton and NuSTAR) we find a 2–8 keV polarization degree Π = 1.6 ± 0.7 (at 68 per cent confidence level), which corresponds to an upper limit Π = 3.2 per cent (at 99 per cent confidence level). We then compare the polarization results with Monte Carlo simulations obtained with the monk code, with which different coronal geometries have been explored (spherical lamppost, conical, slab, and wedge). Furthermore, the allowed range of inclination angles is found for each geometry. If the best-fitting inclination value from a spectroscopic analysis is considered, a cone-shaped corona along the disc axis is disfavoured.
International comparison and time trends of first kidney transplant recipient characteristics across Europe: an ERA Registry study
Authors: Boenink Rianne , Kramer Anneke , Masoud Sherry , Rodríguez-Benot Alberto , Helve Jaakko , Bistrup Claus , Segelmark Mårten M , Rodríguez Arévalo Olga L , Kerschbaum Julia , de Vries Aiko P J , Lundgren Torbjörn , Bell Samira , Crespo Marta , Sørensen Søren S , Ferraro Pietro Manuel , Arnol Miha , Bakkaloglu Sevcan A , Weekers Laurent , Reisæter Anna Varberg , Rebić Damir , Ortiz Alberto , Jager Kitty J , Stel Vianda S
Published: September 2023

Background

The aim of this study was to provide an overview of age, sex and primary renal disease (PRD) distribution among first kidney transplant recipients across Europe.

Method

The European Renal Association (ERA) Registry database was used to obtain data on patients aged 20 years or older receiving their first kidney transplant between 2010 and 2019 from 12 European countries. The numbers and percentages of recipients in each age, sex and PRD group were calculated by country, donor type and year.

Results

In total, 99 543 adults received a first kidney transplant. Overall, 23% of the recipients were 65 years or older, 36% were female, and 21% had glomerulonephritis and 15% diabetes mellitus as PRD. Compared with deceased donor kidney transplant recipients, living donor kidney transplant recipients were less often 65 years or older (13% versus 26%), more often had glomerulonephritis (25% versus 20%) and less often diabetes mellitus (8% versus 17%) as PRD. We found large international differences, which were most prominent for age and PRD and less prominent for sex. Over time, the largest change in recipient characteristics was observed for the percentage of recipients aged 65 years or older, increasing from 18% in 2010 to 28% in 2019 for all countries combined with a similar trend in most countries.

Conclusion

We observed large differences for age and PRD distribution between recipients of living and deceased donor kidneys and between European countries. Over time, the percentage of older first kidney transplant recipients increased.
Understanding community perception and acceptability of interactive voice response survey method: findings from formative research in Bangladesh.
Authors: Khan Iqbal Ansary , Shano Shahanaj , Islam Khaleda , Shahnaz Sabina , Al Kibria Gulam Muhammed , Pariyo George , Ali Joseph , Gibson Dustin G , Rahman Mahmudur
Published: September 2023

Mobile phone technology’s expansion in Bangladesh has ushered in its use for rapid population-based data collection. This study was conducted to assess community perceptions on the acceptability, usability and challenges of participating in mobile phone surveys (MPS) on non-communicable disease risk factors through interactive voice response (IVR) in Bangladesh. Three user groups and seven focus group discussions with different communities, along with seven key informant interviews with relevant experts, were conducted in Bangla. Interviews were audio-recorded and analysed manually using thematic analysis. Participants indicated their unwillingness to receive calls during their busy hours. They suggested shorter duration calls and two sessions to complete longer duration surveys. They recommended that incentives can increase call completion, and previous notification through voice or text message might improve this further. Previous experience with scam calls and mobile balance depletion resulted in their hesitancy to receive calls from unknown numbers. Respondents showed concerns about sharing sensitive issues like alcohol consumption. Providing responses by key presses, less familiarity with smartphone use, availability and strength of mobile networks were identified as challenges for IVR surveys. The study emphasized careful consideration of survey duration and burden, trustworthiness, general and technical literacy and socio-cultural factors to increase MPS participation.
Monoterpene glucosides in Eustoma grandiflorum roots promote hyphal branching in arbuscular mycorrhizal fungi
Authors: Tominaga Takaya , Ueno Kotomi , Saito Hikaru , Egusa Mayumi , Yamaguchi Katsushi , Shigenobu Shuji , Kaminaka Hironori
Published: September 2023

Host plant–derived strigolactones trigger hyphal branching in arbuscular mycorrhizal (AM) fungi, initiating a symbiotic interaction between land plants and AM fungi. However, our previous studies revealed that gibberellin-treated lisianthus (Eustoma grandiflorum, Gentianaceae) activates rhizospheric hyphal branching in AM fungi using unidentified molecules other than strigolactones. In this study, we analyzed independent transcriptomic data of E. grandiflorum and found that the biosynthesis of gentiopicroside (GPS) and swertiamarin (SWM), characteristic monoterpene glucosides in Gentianaceae, was upregulated in gibberellin-treated E. grandiflorum roots. Moreover, these metabolites considerably promoted hyphal branching in the Glomeraceae AM fungi Rhizophagus irregularis and Rhizophagus clarus. GPS treatment also enhanced R. irregularis colonization of the monocotyledonous crop chive (Allium schoenoprasum). Interestingly, these metabolites did not provoke the germination of the root parasitic plant common broomrape (Orobanche minor). Altogether, our study unveiled the role of GPS and SWM in activating the symbiotic relationship between AM fungi and E. grandiflorum.
Formal degrees of genuine Iwahori-spherical representations
Authors: Dong Ping , Gao Fan , Wang Runze
Published: September 2023

For irreducible genuine Iwahori-spherical discrete series representations of central covers, we verify the Hiraga–Ichino–Ikeda formula for their formal degrees.
Psoriatic arthritis risk in psoriasis patients prescribed acitretin versus disease-modifying antirheumatic drugs: a nationwide cohort study
Authors: Lin Teng-Li , Chang Yi-Ling , Ho Hsiu J , Chen Yi-Ju , Wu Chun-Ying
Published: September 2023

Objectives

To compare the risk of PsA in psoriasis (PsO) patients treated with acitretin vs DMARDs.

Methods

This retrospective study used Taiwan's National Health Insurance Research Database from 1997 to 2013. Adult PsO patients without PsA prescribed acitretin or DMARDs for ≥30 days within a year were assigned to the acitretin cohort or DMARDs cohort, respectively. Patients in the acitretin cohort prescribed DMARDs for >7 days, or in the DMARDs cohort prescribed acitretin for >7 days, were excluded. Cumulative incidence of PsA were determined within both cohorts using the Kaplan–Meier method. The hazard ratio (HR) comparing acitretin to DMARDs was calculated with Cox regression models, adjusting for demographic and clinical covariates including the use of NSAIDs and comorbidities.

Results

The study included 1948 patients in each cohort. The 5-year cumulative incidence of PsA in the acitretin cohort was lower than that in the reference cohort (7.52% vs 9.93%; P = 0.005), with a more pronounced difference in the subpopulation receiving NSAIDs treatment. However, in subpopulations without NSAIDs treatment, the 5-year cumulative incidence of PsA in the acitretin cohort was comparable to the DMARDs cohort (5.26% vs 6.98%; P = 0.106). Acitretin was not associated with PsA development in PsO (HR 0.83, 95% confidence interval 0.65–1.05). This risk remained consistent regardless of adjustments for NSAID treatment and comorbidities. Other independent risk factors for PsA included female and NSAIDs treatment.

Conclusion

Compared with DMARDs, acitretin was not associated with increased PsA risk in PsO patients.
The effect of induced optimism on early pain processing: indication by contact heat evoked potentials (CHEPs) and the sympathetic skin response (SSR)
Authors: Basten-Günther Johanna , Jutz Laura , Peters Madelon L , Priebe Janosch A , Lautenbacher Stefan
Published: September 2023

Situationally induced optimism has been shown to influence several components of experimental pain. The aim of the present study was to enlarge these findings for the first time to the earliest components of the pain response by measuring contact heat evoked potentials (CHEPs) and the sympathetic skin response (SSR). Forty-seven healthy participants underwent two blocks of phasic thermal stimulation. CHEPs, the SSR and self-report pain ratings were recorded. Between the blocks of stimulation, the ‘Best Possible Self’ imagery and writing task was performed to induce situational optimism. The optimism manipulation was successful in increasing state optimism. It did, however, neither affect pain-evoked potentials nor the SSR nor self-report pain ratings. These results suggest that optimism does not alter early responses to pain. The higher-level cognitive processes involved in optimistic thinking might only act on later stages of pain processing. Therefore, more research is needed targeting different time frames of stimulus processing and response measures for early and late pain processing in parallel.
The Management of Pregnant Trauma Patients: A Narrative Review
Authors: Lopez C.E. , Salloum J. , Varon A.J. , Toledo P. , Dudaryk R.
Published: September 2023

(Anesth Analg. 2023;136:830–840)

Within the United States, trauma affects about 1 in 12 pregnancies and is the leading nonobstetric cause of maternal mortality. While in the event of trauma, parturient patients should receive a comprehensive assessment, studies suggest that fetal resuscitation is taking priority over maternal resuscitation.
Pregnancy, Delivery, and Neonatal Outcomes Among Women With Spinal Cord Injury in Sweden 1997-2015: A Population-based Cohort Study
Authors: Khalili M. , Berlin M. , Pettersson K. , Lindgren C. , Hultling C. , Ekéus C.
Published: September 2023

(Acta Obstet Gynecol Scand. 2022;101:1282–1290)

Spinal cord injury (SCI) has been shown to have little effect on fertility after the effects of acute injury have abated, but studies examining the effects of SCI on pregnancy and delivery in detail are lacking. Previous studies have shown that, in general, pregnancy outcomes remain positive, even though SCI increases the risks associated with pregnancy and childbirth because of lack of sensation and movement below the injury level. These previous studies have been limited by small sample sizes, single locations, and retrospective study design. This study aimed to examine the incidence of pregnancy in individuals with SCI, as well as pregnancy, delivery, and neonatal outcomes at a population level.
Tranexamic Acid Administered During Cesarean Delivery in High-risk Patients: Maternal Pharmacokinetics, Pharmacodynamics, and Coagulation Status
Authors: Seifert S.M. , Lumbreras-Marquez M.I. , Goobie S.M. , Carusi D.A. , Fields K.G. , Bateman B.T. , Farber M.K.
Published: September 2023

(Am J Obstet Gynecol. 2022;S0002-9378(22)00441-0)

Tranexamic acid (TXA) is often used to prevent or reduce postpartum hemorrhage (PPH), reducing the risk of maternal mortality and decreasing the blood transfusion rate. TXA is widely used in clinical practice, but dosing and covariates that affect the effectiveness of the drug have yet to be studied in the obstetric population. The purpose of this study was to evaluate the pharmacokinetics and pharmacodynamics of the current recommended 1 g intravenous dosage of TXA typically administered during cesarean delivery, and in conjunction use rotational thromboelastometry to assess clot formation and fibrinolysis in patients with high risk of PPH. The primary aim was to evaluate the central tendency and variability of TXA plasma concentrations in high-risk patients after the standard dose up to 5 hours after delivery. Secondary aims were to estimate the correlation between TXA plasma concentrations and body mass index, assess coagulation measurements using rotational thromboelastometry, and other outcomes related to PPH, such as changes in hemoglobin and the requirement of blood transfusions.
Investigating the Use of Nonloss of Resistance Syringes for Epidural Insertion: Experience on a Mannequin
Authors: Gladwin J. , Maese S. , Ballisat B.
Published: September 2023

(Int J Obstet Anesth. 2022;52:103595)

The Obstetric Anaesthetists’ Association (OAA) announced a supply disruption of the Portex Loss of Resistance (LOR) Syringe, a commonly used tool for epidural catheter insertion. Several studies have shown no difference in epidural insertion success rates when using LOR to saline or air. Other methods for epidural space identification are being considered yet limited research compares specific low-resistance syringes with standard syringes. This study aimed to compare specific LOR syringes with syringes commonly used in epidural insertion.
Crystallization of Ropivacaine and Bupivacaine When Mixed With Different Adjuvants: A Semiquantitative Light Microscopy Analysis
Authors: Hoerner E. , Stundner O. , Putz G. , Steinfeldt T. , Mathis S. , Gasteiger L.
Published: September 2023

(Reg Anesth Pain Med. 2022:rapm-2022-103610)

The use of adjuvants to local anesthetics may prolong their duration or speed the onset of action. Amino-amide local anesthetics have the potential to precipitate when mixed with commonly used adjuvants, which can result in crystal deposition in the perineural or vascular regions. This study aimed to assess the occurrence of crystallization with commonly employed local anesthetic-adjuvant combinations, determine if there is a correlation with the solution’s pH, and assess if there is a change over time in crystallization grade.
Tranexamic Acid for the Prevention of Blood Loss After Cesarean Among Women With Twins: A Secondary Analysis of the TRAnexamic Acid for Preventing Postpartum Hemorrhage Following a Cesarean Delivery Randomized Clinical Trial
Authors: Sentilhes L. , Madar H. , Le Lous M. , Sénat M.V. , Winer N. , Rozenberg P. , Kayem G. , Verspyck E. , Fuchs F. , Azria E. , Gallot D. , Korb D. , Desbrière R. , Le Ray C. , Chauleur C. , de Marcillac F. , Perrotin F. , Parant O. , Salomon L.J. , Gauchotte E. , Bretelle F. , Sananès N. , Bohec C. , Mottet N. , Legendre G. , Letouzey V. , Haddad B. , Vardon D. , Mattuizzi A. , Froeliger A. , Bouchghoul H. , Daniel V. , Regueme S. , Roussillon C. , Georget A. , Darsonval A. , Benard A. , Deneux-Tharaux C. ,   Groupe de Recherche en Obstétrique et Gynécologie
Published: September 2023

(Am J Obstet Gynecol 2022;227:889e1–17)

Tranexamic acid (TXA) has been proposed as a preventive medication in obstetrics to reduce the risk of postpartum hemorrhage (PPH). However, previous research has not shown TXA to be clinically beneficial for vaginal or cesarean delivery among a general obstetric population. Information is lacking on whether TXA might be more effective for women who are at increased risk of PPH. This study aimed to evaluate the effectiveness of prophylactic TXA in one group of women at high risk for PPH—those with multiple gestation. The purpose of this study was to examine the effect of TXA and a uterotonic agent compared with the uterotonic agent alone on the risk of PPH. The primary outcome was the incidence of calculated estimated blood loss of more than 1000 mL or a red blood cell transfusion by day 2 after delivery. Secondary outcomes included clinical and laboratory measurements of postpartum blood loss, adverse effects related to TXA, and maternal satisfaction.
Predicting Postpartum Haemorrhage: A Systematic Review of Prognostic Models
Authors: Carr B.L. , Jahangirifar M. , Nicholson A.E. , Li W. , Mol B.W. , Licqurish S.
Published: September 2023

(Aust N Z J Obstet Gynaecol. 2022;62:813–825)

The impact of postpartum hemorrhage (PPH, loss of ≥500 mL blood within 24 h of birth) on women, families, and communities is significant. PPH has been reported with increasing incidence and severity in well-resourced countries and is a major contributor to global maternal morbidity and mortality. Diagnosis can be challenging due to variability of risk factors and underestimation of blood loss leading to delayed response and treatment. Prognostic models to identify patients at risk and to provide resources and facilitate early intervention are not commonly integrated into clinical practice. Few, if any, are considered validated for use in the general obstetric population. This systematic review provides a comprehensive evaluation of current PPH prognostic models to identify best practices for prediction, describe model characteristics, and compare performance.
General or Regional Anaesthesia for Postpartum Hemorrhage: A National Population-based Cohort Study
Authors: Wikkelsø A.J. , Secher E.L. , Edwards H.
Published: September 2023

(Acta Anaesthesiol Scand. 2022;66:103–113)

Postpartum hemorrhage (PPH) continues to be a life-threatening complication following delivery. Anesthesia is required for the treatment of PPH when emptying the uterine cavity or manual placenta removal, and the choice between using general or regional anesthesia is impacted by factors such as airway, existing epidural, hypovolemia, and tradition. This study aimed to describe the variation in anesthesia for PPH treatment procedures as well as the occurrence of aspiration and difficult or failed intubation for Danish nationals between 2010 and 2015.
Prevention of Pre-eclampsia With Aspirin: A Systematic Review of Guidelines and Evaluation of the Quality of Recommendation Evidence
Authors: Ninan K. , Ali R. , Morfaw F. , McDonald S.D.
Published: September 2023

(Int J Gynecol Obstet. 2022;00:1–14)

Aspirin, or acetylsalicylic acid (ASA) has been shown repeatedly to reduce the risk of pre-eclampsia. Literature has shown that ASA can additionally reduce other pregnancy complications such as gestational hypertension, intrauterine growth restriction, and perinatal death, as well as reducing direct healthcare costs by a significant margin in the United States and Canada. Despite these findings, there is also research that indicates that many women at risk of pre-eclampsia do not receive ASA as a preventative treatment. This study aimed to review clinical guidelines on ASA and pre-eclampsia and determine if the current guidelines are evidence-based and of good quality.
Percreta Score to Differentiate Between Placenta Accreta and Placenta Percreta With Ultrasound and MR Imaging
Authors: Pain F.A. , Dohan A. , Grange G. , Marcellin L. , Uzan-Augui J. , Goffinet F. , Soyer P. , Tsatsaris V.
Published: September 2023

(Acta Obstet Gynecol Scand. 2022;101:1135–1145)

In approximately 1.7 to 4.6 per 10,000 deliveries, the placenta remains attached to the uterine wall after birth, indicating that it is embedded in the myometrium; this is called placenta accrete spectrum (PAS) disorder. Cesarean delivery is associated with a significantly increased risk of PAS, and diagnosis of PAS is associated with severe delivery complications such as postpartum hemorrhage and peripartum hysterectomy. Placenta percreta is a severe form of PAS, where the placenta grows through the wall of the uterus and potentially into nearby organs, severely threatening the mother’s life: placenta percreta is associated with significant maternal morbidity. Being able to diagnose and correctly treat this condition is of paramount importance in reducing maternal morbidity due to these conditions. This study was designed to assess the ability of ultrasound and magnetic resonance imaging (MRI) features in classifying PAS (accreta/increta vs. percreta) predictively.
Changes in Sensory Block Level During a Programmed Intermittent Epidural Bolus Regimen for Labor Analgesia: A Prospective Observational Cohort Study
Authors: Casellato J.F. , Ye X.Y. , Downey K. , Carvalho J.C.A.
Published: September 2023

(Can J Anesth/J Can Anesth. 2022;69:1471–1476)

Currently, one of the most widely used methods of pain management is epidural analgesia, with drug delivery in a programmed intermittent epidural bolus (PIEB) in conjunction with patient-controlled epidural analgesia. Previously the investigators reported 2 sensory block levels associated with epidural analgesia: (1) upper sensory block level (USBL), the highest dermatome with any altered sensation to cold, and (2) lower sensory block level (LSBL), the highest dermatome with complete sensory block to cold. The purpose of this study was to further explore these sensory block levels and how they change over time with PIEB and patient-controlled epidural analgesia as a pain management method.
Effect of Continuous Infusion of a Subhypnotic Dose of Propofol on Nausea and Vomiting after Carboprost Administration at Cesarean Delivery: A Randomized, Double-blind, Placebo-controlled Trial
Authors: Yanmei B. , Ruihan Z. , Jinxiang H. , Huang H.
Published: September 2023

(Int J Gynecol Obstet. 2022;157:283–288)

Postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. Carboprost is a 15-methyl F2a prostaglandin that induces uterine contractions and is recommended for PPH treatment. Carboprost has adverse side effects, the most prominent being nausea and vomiting. Propofol, when used at its subhypnotic dose, is known for reducing nausea and vomiting after chemotherapy treatment. This study aimed to show whether a steady administration of a subhypnotic dose of propofol prevents nausea and vomiting after carboprost is administered during cesarean delivery (CD).
Respiratory Depression After Administration of Single-dose Neuraxial Morphine for Postcesarean Delivery Analgesia: A Retrospective Cohort Study
Authors: Palleschi G.T. , Gerasimov M. , Blitz M.J. , Aronsohn J.L. , Shore-Lesserson L. , Ruggiero A. , Lim G. , Habib A.S.
Published: September 2023

(Int J Obstet Anesth. 2022;52:103592)

Neuraxial anesthesia is the analgesia of choice during cesarean delivery which frequently includes long‐acting morphine. While the standard practice, neuraxial morphine poses an increased risk of delayed respiratory depression. While the risk is low at 1.08 to 1.63 per 10,000 cases, patient comorbidities can increase occurrence. In 2019, the Society for Obstetric Anesthesia and Perinatology (SOAP) gave guidelines for patient surveillance following cesarean delivery (CD) with morphine though evidence-based research is lacking and is rather a result of expert opinion. The aim of this retrospective study was to determine the occurrence of respiratory depression in CD patients who received neuraxial morphine for pain management.
Update on muscle imaging in myositis
Authors: Tan Ai Lyn , Di Matteo Andrea , Wakefield Richard J. , Biglands John
Published: September 2023

Purpose of review

Imaging techniques such as MRI, ultrasound and PET/computed tomography (CT) have roles in the detection, diagnosis and management of myositis or idiopathic inflammatory myopathy (IIM). Imaging research has also provided valuable knowledge in the understanding of the pathology of IIM. This review explores the latest advancements of these imaging modalities in IIM.

Recent findings

Recent advancements in imaging of IIM have seen a shift away from manual and qualitative analysis of the images. Quantitative MRI provides more objective, and potentially more sensitive characterization of fat infiltration and inflammation in muscles. In addition to B-mode ultrasound changes, shearwave elastography offers a new dimension to investigating IIM. PET/CT has the added advantage of including IIM-associated findings such as malignancies.

It is evident that MRI, ultrasound and PET/CT have important roles in myositis. Continued technological advancement and a quest for more sophisticated applications help drive innovation; this has especially been so of machine learning/deep learning using artificial intelligence and the developing promise of texture analysis.
Work Productivity Loss After Minimally Displaced Complete Lateral Compression Pelvis Fractures
Authors: McKibben Natasha S. , O’Hara Nathan N. , Slobogean Gerard P. , Gaski Greg E. , Nascone Jason W. , Sciadini Marcus F. , Natoli Roman M. , McKinley Todd , Virkus Walter W. , Sorkin Anthony T. , Howe Andrea , O’Toole Robert V. , Levy Joseph F.
Published: September 2023

Objective:

To quantify work impairment and economic losses due to lost employment, lost work time (absenteeism), and lost productivity while working (presenteeism) after a lateral compression pelvic ring fracture. Secondarily, we compared productivity loss of patients treated with surgical fixation versus nonoperative management.

Design:

A secondary analysis of a prospective, multicenter trial.

Setting:

Two level 1 academic trauma centers.

Patients/Participants: Sixty-four adult patients with a minimally displaced lateral compression pelvic fracture who were working before their injury. Forty-seven percent (30/64) of patients were treated with surgical fixation, and 53% (30/64) with nonoperative management.

Main Outcome Measurements:

Work impairment, including hours lost to unemployment, absenteeism, and presenteeism, measured by Work Productivity and Activity Impairment (WPAI) assessments in the year after injury.

Results:

Of the 64 included patients, 63% returned to work within 1 year of injury. Workers lost an average of 67% of a 2,080-hour average work year, corresponding with $56,276 in lost economic productivity. Of the 1,395 total hours lost, 87% was due to unemployment, 3% to absenteeism, and 10% to presenteeism. Surgical fixation was associated with 27% fewer lost hours (1,155 versus 1,583, P = 0.005) and prevented $17,266 in average lost economic productivity per patient compared to nonoperative management.

Conclusions:

Lateral compression pelvic fractures are associated with a substantial economic impact on patients and society. Our findings suggest surgical fixation might reduce work impairment and the corresponding economic burden.

Level of Evidence:

Economic Level II. See Instructions for Authors for a complete description of levels of evidence.
The Impact of Postoperative Patient Aromatherapy on Nurse Self-Efficacy
Authors: Manning Mollie H. , Nix Elizabeth S.
Published: September 2023

A nurse-driven aromatherapy program investigated the effect on nurses' self-efficacy when using an essential oil inhalation protocol to reduce patients' postoperative pain and associated symptoms. After viewing an investigator-developed training module, staff nurses implemented aromatherapy. Results of changes in nurses' report of self-efficacy were evaluated using the Self-Efficacy in Providing Non-Drug therapies (SEND) survey tool. Results support that an integrated approach of adding nonpharmacologic pain management to postoperative pain and nausea care may increase nurse self-efficacy.
Fostering Nursing Students' Growth in Patient Teaching and Empathy Toward Homeless People
Authors: DeBrew Jacqueline Kayler
Published: September 2023

Helping nursing students explore personal perceptions toward the poor can support students' ability to care for impoverished people in their later nursing practice. A community-based mental health clinical site at a transitional housing complex for the homeless provided a meaningful experience for accelerated baccalaureate nursing students. Students offered basic health screening to the low-income residents and participated in a virtual health education question-and-answer meeting with former transitional housing residents. Through reflective journaling, students described how they gained empathy and new understanding of the needs of people living in poverty or unhoused, and developed confidence in patient teaching.
Remission Strategies with Fat Grafting to Prevent Recurrence of Pedal Ulcerations and Pain: A Case Series
Authors: Kress Gavin Thomas , Swerdlow Mark , Mohan Natasha , Patel Ketan , Shin Laura
Published: September 2023

Background:

Foot deformities and gait abnormalities can result in locally elevated peak pedal pressures or atypical pedal biomechanics. Combined with underlying comorbidities such as neuropathy, stroke, atrophic fat padding and history of ulcerations, this can lead to recurrent ulcerations and pain. Pedal fat grafting (PFG) is a treatment modality that has been shown to reduce peak pressures and accelerate wound healing. This study aimed to investigate the utility of PFG to treat and prevent ulcerations.

Methods:

We retrospectively analyzed medical history, demographics, wound volume at time of procedure, volume of fat injected, surgical outcomes, and presence of new wounds in 15 patients who underwent PFG at Keck Hospital between 2018 and 2023.

Results:

Seventeen feet from 15 patients (63 ± 12 years old, body mass index 30.9 ± 3.1) received PFG with an average volume of fat injected of 10.7 mL and procedure time of 84.6 minutes. At the time of PFG, nine wounds were present on nine feet with an average wound volume of 1.6 ± 2.7 cm3. Average follow-up was 6.9 months (range 1–36 months), with no complications or recurrent ulcerations since the procedure.

Conclusions:

PFG is a promising treatment option for reducing peak pedal pressure and preventing ulcer recurrence in patients with various conditions. Further study is warranted for long-term follow-up.
The Use of Nerve Caps after Nerve Transection in Headache Surgery: Cadaver and Case Reports
Authors: Hwang Charles D. , Chegireddy Vishwanath , Remy Katya , Irwin Timothy J. , Valerio Ian L. , Gfrerer Lisa , Austen William G.
Published: September 2023

Background:

Nerve transection with nerve reconstruction is part of the treatment algorithm for patients with refractory pain after greater occipital nerve (GON) and lesser occipital nerve (LON) decompression or during primary decompression when severe nerve injury or neuroma formation is present. Importantly, the residual nerve stump is often best addressed via contemporary nerve reconstruction techniques to avoid recurrent pain. As a primary aim of this study, nerve capping is explored as a potential viable alternative that can be utilized in certain headache cases to mitigate pain.

Methods:

The technical feasibility of nerve capping after GON/LON transection was evaluated in cadaver dissections and intraoperatively. Patient-reported outcomes in the 3- to 4-month period were compiled from clinic visits. At 1-year follow-up, subjective outcomes and Migraine Headache Index scores were tabulated.

Results:

Two patients underwent nerve capping as a treatment for headaches refractory to medical therapy and surgical decompressions with significant improvement to total resolution of pain without postoperative complications. These improvements on pain frequency, intensity, and duration remained stable at a 1-year time point (Migraine Headache Index score reductions of –180 to –205).

Conclusions:

Surgeons should be equipped to address the proximal nerve stump to prevent neuroma and neuropathic pain recurrence. Next to known contemporary nerve reconstruction techniques such as targeted muscle reinnervation/regenerative peripheral nerve interface and relocation nerve grafting, nerve capping is another viable method for surgeons to address the proximal nerve stump in settings of GON and LON pain. This option exhibits short operative time, requires only limited dissection, and yields significant clinical improvement in pain symptoms.
Primary Regenerative Peripheral Nerve Interfaces Using Devascularized Vastus Lateralis Muscle in Sensate Anterolateral Thigh Flap Donor Sites
Authors: Isbester Kelsey A. , Ferrin Peter , Krakauer Kelsi N. , Peters Blair R.
Published: September 2023

Sensate flaps are increasingly used in diverse areas of plastic surgery. Concurrently, modern techniques in neuroma prevention have emerged, such as regenerative peripheral nerve interface (RPNI). Despite increasing use of sensate flaps, the combined use of donor-site neuroma prevention techniques has yet to be described. We report on the use of primary donor-site RPNI at the time of sensate anterolateral thigh (ALT) reconstructions. In ALT flaps, the vastus lateralis muscle can be segmentally devascularized from perforator dissection. These segments of devascularized vastus lateralis muscle can easily be used and repurposed as the free muscle grafts needed for RPNI, providing a physiologic target for the regenerating neurons. Donor-site neuroma has not been shown to be a significant issue at standard ALT flap donor sites. Sensate ALT flaps involve harvest of the lateral femoral cutaneous nerve and/or additional femoral sensory branches at a more proximal location close to the level of the anterior superior iliac spine, where injury to the lateral femoral cutaneous nerve may be associated with pain. In this series, eight patients underwent senate ALT flaps with the use of primary RPNI at the sensate ALT donor site. At a mean follow-up of 16.3 months (range 5–25 months), there was minimal to no nerve pain and no clinical evidence of donor-site neuroma. As sensate flap reconstructions are increasingly performed in plastic surgery and data on neuroma prevention techniques continue to grow, we propose consideration of their combined use.
Dissecting the tumor ecosystem of liver cancers in the single-cell era
Authors: Wang Yue , Wang Pengxiang , Zhang Zefan , Zhou Jian , Fan Jia , Sun Yunfan
Published: September 2023

Primary liver cancers (PLCs) are a broad class of malignancies that include HCC, intrahepatic cholangiocarcinoma, and combined hepatocellular and intrahepatic cholangiocarcinoma. PLCs are often associated with a poor prognosis due to their high relapse and low therapeutic response rates. Importantly, PLCs exist within a dynamic and complex tumor ecosystem, which includes malignant, immune, and stromal cells. It is critical to dissect the PLC tumor ecosystem to uncover the underlying mechanisms associated with tumorigenesis, relapse, and treatment resistance to facilitate the discovery of novel therapeutic targets. Single-cell and spatial multi-omics sequencing techniques offer an unprecedented opportunity to elucidate spatiotemporal interactions among heterogeneous cell types within the complex tumor ecosystem. In this review, we describe the latest advances in single-cell and spatial technologies and review their applications with respect to dissecting liver cancer tumor ecosystems.