bluuebunny/crossref_metadata_2025 huggingface dataset:
Characteristics of the Summating Potential Measured Across a Cochlear Implant Array as an Indicator of Cochlear Function
Authors: Panario Jared , Bester Christofer , O’Leary Stephen John
Published: March 2023

Objectives:

The underlying state of cochlear and neural tissue function is known to affect postoperative speech perception following cochlear implantation. The ability to assess these tissues in patients can be performed using intracochlear electrocochleography (IC ECochG). One component of ECochG is the summating potential (SP) that appears to be generated by multiple cochlear tissues. Its qualities may be able to detect the presence of functional inner hair cells, but evidence for this is limited in human cochleae. This study aimed to examine the IC SP characteristics in cochlear implantation recipients, its relationship to preoperative speech perception and audiometric thresholds, and to other IC ECochG components.

Design:

This is a retrospective analysis of 113 patients’ IC ECochG recordings across the array in response to a 500 Hz tone burst stimulus. Responses to condensation and rarefaction stimuli were then subtracted from one another to emphasize the cochlear microphonic and added to one another to emphasize the SP, auditory nerve neurophonic, and compound action potential. Patients were grouped based on their maximum SP deflection being large and positive (+SP), large and negative (−SP), or minimal (0 SP) to further investigate these relationships.

Results:

Patients in the +SP group had better preoperative speech perception (mean consonant-vowel-consonant phoneme score 46%) compared to the −SP and 0 SP groups (consonant-vowel-consonant phoneme scores 34% and 36%, respectively, difference to +SP: p < 0.05). Audiometric thresholds were lowest for +SP (mean pure-tone average 50 dB HL), then −SP (65 dB HL), and highest for 0 SP patients (70 dB HL), but there was not a statistical significance between +SP and −SP groups (p > 0.1). There were also distinct differences between SP groups in the qualities of their other ECochG components. These included the +SP patients having larger cochlear microphonic maximum amplitude, more apical SP peak electrode locations, and a more spatially specific SP magnitude growth pattern across the array.

Conclusions:

Patients with large positive SP deflection in IC ECochG have preoperatively better speech perception and lower audiometric thresholds than those without. Patterns in other ECochG components suggest its positive deflection may be an indicator of cochlear function.
Erector Spinae Plane Block Reduces Immediate Postoperative Pain and Opioid Demand After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Wetmore Douglas S. , Dalal Sidhant , Shinn Daniel , Shahi Pratyush , Vaishnav Avani , Chandra Akhil , Melissaridou Dimitra , Beckman James , Albert Todd J. , Iyer Sravisht , Qureshi Sheeraz A.
Published: March 2023

Study Design.

Matched cohort comparison.

Objective.

To determine perioperative outcomes of erector spinae plane (ESP) block for minimally invasive transforaminal lumbar interbody fusion (MI-TLIF).

Summary of Background Data.

There is a paucity of data on the impact of lumbar ESP block on perioperative outcomes and its safety in MI-TLIF.

Materials and Methods.

Patients who underwent 1-level MI-TLIF and received the ESP block (group E) were included. An age and sex-matched control group was selected from a historical cohort that received the standard-of-care (group NE). The primary outcome of this study was 24-hour opioid consumption in morphine milligram equivalents. Secondary outcomes were pain severity measured by a numeric rating scale, opioid-related side effects, and hospital length of stay. Outcomes were compared between the two groups.

Results.

Ninety-eight and 55 patients were included in the E and NE groups, respectively. There were no significant differences between the two cohorts in patient demographics. Group E had lower 24-hour postoperative opioid consumption (P = 0.117, not significant), reduced opioid consumption on a postoperative day (POD) 0 (P = 0.016), and lower first pain scores postsurgery (P < 0.001). Group E had lower intraoperative opioid requirements (P < 0.001), and significantly lower average numeric rating scale pain scores on POD 0 (P = 0.034). Group E reported fewer opioid-related side effects as compared with group NE, although this was not statistically significant. The average highest postoperative pain score within 3 hours postprocedurally was 6.9 and 7.7 in the E and NE cohorts, respectively (P = 0.029). The median length of stay was comparable between groups with the majority of patients in both groups being discharged on POD 1.

Conclusions.

In our retrospective matched cohort, ESP blocks resulted in reduced opioid consumption and decreased pain scores on POD 0 in patients undergoing MI-TLIF.

Level of Evidence.

Level 3.
Predictors of Subsidence and its Clinical Impact After Expandable Cage Insertion in Minimally Invasive Transforaminal Interbody Fusion
Authors: Subramanian Tejas , Merrill Robert K. , Shahi Pratyush , Pathania Shane , Araghi Kasra , Maayan Omri , Zhao Eric , Shinn Daniel , Kim Yeo Eun , Kamil Robert , Song Junho , Dalal Sidhant S. , Vaishnav Avani S. , Othman Yahya , Steinhaus Michael E. , Sheha Evan D. , Dowdell James E. , Iyer Sravisht , Qureshi Sheeraz A.
Published: March 2023

Study Design.

Retrospective review of prospectively collected multisurgeon data.

Objective.

Examine the rate, clinical impact, and predictors of subsidence after expandable minimally invasive transforaminal lumbar interbody fusion (MI-TLIF) cage.

Summary of Background Data.

Expandable cage technology has been adopted in MI-TLIF to reduce the risks and optimize outcomes. Although subsidence is of particular concern when using expandable technology as the force required to expand the cage can weaken the endplates, its rates, predictors, and outcomes lack evidence.

Materials and Methods.

Patients who underwent 1 or 2-level MI-TLIF using expandable cages for degenerative lumbar conditions and had a follow-up of >1 year were included. Preoperative and immediate, early, and late postoperative radiographs were reviewed. Subsidence was determined if the average anterior/posterior disc height decreased by >25% compared with the immediate postoperative value. Patient-reported outcomes were collected and analyzed for differences at the early (<6 mo) and late (>6 mo) time points. Fusion was assessed by 1-year postoperative computed tomography.

Results.

One hundred forty-eight patients were included (mean age, 61 yr, 86% 1-level, 14% 2-level). Twenty-two (14.9%) demonstrated subsidence. Although statistically not significant, patients with subsidence were older, had lower bone mineral density, and had higher body mass index and comorbidity burden. Operative time was significantly higher (P = 0.02) and implant width was lower (P < 0.01) for subsided patients. Visual analog scale-leg was significantly lower for subsided patients compared with nonsubsided patients at a >6 months time point. Long-term (>6 mo) patient-acceptable symptom state achievement rate was lower for subsided patients (53% vs. 77%), although statistically not significant (P = 0.065). No differences existed in complication, reoperation, or fusion rates.

Conclusions.

Of the patients, 14.9% experienced subsidence predicted by narrower implants. Although subsidence did not have a significant impact on most patient-reported outcome measures and complication, reoperation, or fusion rates, patients had lower visual analog scale-leg and patient-acceptable symptom state achievement rates at the >6-month time point.

Level of Evidence.

Level 4.
Precision diagnosis of Hepatocellular Carcinoma
Authors: Wang Zhenxiao , Qin Hanjiao , Liu Shui , Sheng Jiyao , Zhang Xuewen
Published: March 2023

Hepatocellular carcinoma (HCC) is the most common type of primary hepatocellular carcinoma (PHC). Early diagnosis of HCC remains the key to improve the prognosis. In recent years, with the promotion of the concept of precision medicine and more in-depth analysis of the biological mechanism underlying HCC, new diagnostic methods, including emerging serum markers, liquid biopsies, molecular diagnosis, and advances in imaging (novel contrast agents and radiomics), have emerged one after another. Herein, we reviewed and analyzed scientific advances in the early diagnosis of HCC and discussed their application and shortcomings. This review aimed to provide a reference for scientific research and clinical practice.
Herpesvirus Infection Masquerading as a Neoplasm in an HIV-Positive Patient: A Potential Diagnostic Pitfall
Authors: Levett Kaitlyn , Youngs Julie , Hoppenot Claire , Masand Ramya P.
Published: March 2023

Herpesvirus infection classically presents as a clustered, vesicular rash over mild erythema. However, unusual presentations may mimic tumors and be a potential pitfall. We describe the case of a 55-year-old HIV positive woman with this unusual manifestation of a common disease which was initially diagnosed as a benign neoplasm. Review of pathology revealed histologic features characteristic of this form of herpesvirus eruption. Awareness of this rare clinical and microscopic presentation is important to guide appropriate use of immunostains, prevent misdiagnosis, and promptly institute of antiviral therapy.
Radiotherapy-Associated Cutaneous Mastocytosis in a Patient With Breast Carcinoma. Case Report and Review of the Literature
Authors: Murphy Michael , Valentini Rodolfo , Shaughnessy Emily
Published: March 2023

Mast cell skin disease is rarely described after external beam radiation therapy in patients with breast carcinoma, with only 7 previous reports in the literature. Skin changes typically occur within (but are not limited to) the radiation field. We present a 64-year-old woman with postradiotherapy cutaneous mastocytosis on the left breast and adjacent chest wall. The clinical and laboratory findings in all reported patients, including the current case, are reviewed. No clear mechanism has been presented to explain disease pathogenesis; although, mast cell accumulation secondary to local mediators produced in response to radiation damage and/or koebnerization phenomenon have been proposed. Cutaneous/systemic mastocytosis is not widely recognized and may be underdiagnosed in the setting of postradiation for breast cancer. It is important for clinicians and pathologists to be aware of this diagnosis for patients presenting with rashes after radiotherapy.
Beyond “Chilling Effects”
Authors: Young Maria-Elena De Trinidad , Tafolla Sharon , Saadi Altaf , Sudhinaraset May , Chen Lei , Pourat Nadereh
Published: March 2023

Objectives:

Immigration enforcement policies are associated with immigrants’ barriers to health care. Current evidence suggests that enforcement creates a “chilling effect” in which immigrants avoid care due to fear of encountering enforcement. Yet, there has been little examination of the impact of immigrants’ direct encounters with enforcement on health care access. We examined some of the first population-level data on Asian and Latinx immigrants’ encounters with law and immigration enforcement and assessed associations with health care access.

Methods:

We analyzed the 2018 and 2019 Research on Immigrant Health and State Policy survey in which Asian and Latinx immigrants in California (n=1681) reported on 7 enforcement experiences (eg, racial profiling and deportation). We examined the associations between measures of individual and cumulative enforcement experiences and the usual sources of care and delay in care.

Results:

Latinx, compared with Asian respondents, reported the highest levels of enforcement experiences. Almost all individual enforcement experiences were associated with delaying care for both groups. Each additional cumulative experience was associated with a delay in care for both groups (OR=1.30, 95% CI 1.10–1.50). There were no associations with the usual source of care.

Conclusion:

Findings confirm that Latinx immigrants experience high levels of encounters with the enforcement system and highlight new data on Asian immigrants’ enforcement encounters. Direct experiences with enforcement have a negative relationship with health care access. Findings have implications for health systems to address the needs of immigrants affected by enforcement and for changes to health and immigration policy to ensure immigrants’ access to care.
Machine learning prediction algorithm for in-hospital mortality following body contouring
Authors: Peng Chi , Yang Fan , Jian Yu , Peng Liwei , Zhang Chenxu , Chen Chenxin , Lin Zhen , Li Yuejun , He Jia , Jin Zhichao
Published: March 2023

Background:

Body contouring is a common procedure, but it is worth attention due to concerns for a variety of complications, and even potential for death. As a result, the purpose of this study was to determine the key predictors following body contouring and create models for the risk of mortality using diverse machine learning models.

Methods:

The National Inpatient Sample (NIS) database from 2015 to 2017 was queried to identify patients undergoing body contouring. Candidate predictors such as demographics, comorbidities, personal history, postoperative complications, operative features were included. The outcome was the in-hospital mortality. Models were compared on area under the curve (AUC), accuracy, sensitivity, specificity, positive and negative predictive values, and decision curve analysis (DCA) curve.

Results:

Overall, 8214 patients undergoing body contouring were identified, among whom 141 (1.72%) patients died in the hospital. Variable importance plot demonstrated that sepsis was the variable with greatest importance across all machine learning algorithms, followed by Elixhauser Comorbidity Index (ECI), cardiac arrest (CA), and so forth. Naïve Bayes (NB) had a higher predictive performance (AUC 0.898, 95% CI 0.884 to 0.911) among these eight machine learning models. Similarly, in the DCA curve, the NB also demonstrated a higher net benefit (ie, the correct classification of in-hospital deaths considering a trade-off between false-negatives and false-positives)—over the other seven models across a range of threshold probability values.

Conclusions:

The machine learning models, as indicated by our study, can be used to predict in-hospital deaths for patients at risk who underwent body contouring.
Comparison of multiple 3D scanners to capture foot, ankle, and lower leg morphology
Authors: Farhan Muhannad , Wang Joyce Zhanzi , Lillia Jonathon , Cheng Tegan L. , Burns Joshua
Published: March 2023

Background:

3D scanning of the foot and ankle is gaining popularity as an alternative method to traditional plaster casting to fabricate ankle-foot orthoses (AFOs). However, comparisons between different types of 3D scanners are limited.

Objective(s):

The aim of this study was to evaluate the accuracy and speed of seven 3D scanners to capture foot, ankle, and lower leg morphology to fabricate AFOs.

Study Design:

Repeated-measures design.

Methods:

The lower leg region of 10 healthy participants (mean age 27.8 years, standard deviation [SD] 9.3) was assessed with 7 different 3D scanners: Artec Eva (Eva), Structure Sensor (SS I), Structure Sensor Mark II (SS II), Sense 3D Scanner (Sense), Vorum Spectra (Spectra), Trnio 3D Scanner App on iPhone 11 (Trnio 11), and Trnio 3D Scanner App on iPhone 12 (Trnio 12). The reliability of the measurement protocol was confirmed initially. The accuracy was calculated by comparing the digital scan with clinical measures. A percentage difference of #5% was considered acceptable. Bland and Altman plots were used to show the mean bias and limit of agreement (LoA) for each 3D scanner. Speed was the time needed for 1 complete scan.

Results:

The mean accuracy ranged from 6.4% (SD 10.0) to 230.8% (SD 8.4), with the SS I (21.1%, SD 6.8), SS II (21.7%, SD 7.5), and Eva (2.5%, SD 4.5) within an acceptable range. Similarly, Bland and Altman plots for Eva, SS I, and SS II showed the smallest mean bias and LoA 21.7 mm (LoA 25.8 to 9.3), 21.0 mm (LoA 210.3 to 8.3), and 0.7 mm (LoA 213 to 11.5), respectively. The mean speed of the 3D scanners ranged from 20.8 seconds (SD 8.1, SS I) to 329.6 seconds (SD 200.2, Spectra).

Conclusions:

Eva, SS I, and SS II appear to be the most accurate and fastest 3D scanners for capturing foot, ankle, and lower leg morphology, which could be used for AFO fabrication.
Respiratory syncytial virus infection in the modern era
Authors: Ludlow Martin
Published: March 2023

Purpose of review

Respiratory syncytial virus (RSV) continues to be a major cause of severe lower respiratory tract infection in infants, young children, and older adults. In this review, changes in the epidemiology of RSV during the coronavirus disease 2019 (COVID-19) pandemic are highlighted together with the role which increased molecular surveillance efforts will have in future in assessing the efficacy of vaccines and therapeutics.

Recent findings

The introduction of nonpharmaceutical intervention (NPIs) strategies during the COVID-19 pandemic between 2020 and 2022 resulted in worldwide disruption to the epidemiology of RSV infections, especially with respect to the timing and peak case rate of annual epidemics. Increased use of whole genome sequencing along with efforts to better standardize the nomenclature of RSV strains and discrimination of RSV genotypes will support increased monitoring of relevant antigenic sites in the viral glycoproteins. Several RSV vaccine candidates based on subunit, viral vectors, nucleic acid, or live attenuated virus strategies have shown efficacy in Phase 2 or 3 clinical trials with vaccines using RSVpreF protein currently the closest to approval and use in high-risk populations. Finally, the recent approval and future use of the extended half-life human monoclonal antibody Nirsevimab will also help to alleviate the morbidity and mortality burden caused by annual epidemics of RSV infections.

The ongoing expansion and wider coordination of RSV molecular surveillance efforts via whole genome sequencing will be crucial for future monitoring of the efficacy of a new generation of vaccines and therapeutics.
Optimizing Transfer of Postcesarean Patients to Postoperative Ward Through a Quality Improvement (QI) Project: Curtailing Delays, Improving Care
Authors: Nain Shilpi , Puri Manju , Agrawal Swati , Kumari Darshana , Satheesh Lylaja , Chhillar Ekta , Sharma Poornima , Meena Deepika , Singh Meenakshi , Kapur Aishwarya
Published: March 2023

Background and Objectives:

Close monitoring of patients in the first 2 hours after cesarean delivery (CD) is crucial. Delays in shifting of the post-CD patients led to a chaotic environment in the postoperative ward, suboptimal monitoring, and inadequate nursing care. Our aim was to increase the percentage of post-CD patients shifted from transfer trolley to bed within 10 minutes of arrival in the postoperative ward from a baseline of 64% to 100%, and to maintain that rate for more than 3 weeks.

Methods:

A quality improvement team including physicians, nurses, and workers was constituted. Problem analysis revealed lack of communication among the caregivers as the main cause of delay. The percentage of post-CD patients shifted from trolley to bed within 10 minutes of being wheeled into the postoperative ward out of the total number of post-CD patients transferred from the operation theater to the postoperative ward was taken as the outcome indicator for the project. Multiple Plan-Do-Study-Act cycles based on the Point of Care Quality Improvement methodology were undertaken to achieve the target. Main interventions were: 1) written information of patient being transferred to operation theater for CD sent to the postoperative ward; 2) stationing of a duty doctor in the postoperative ward; and 3) keeping a buffer of 1 vacant bed in the postoperative ward. The data were plotted weekly as a dynamic time series chart and signals of change were observed.

Results:

Eighty-three percent (172 out of 206) of women were shifted in time by 3 weeks. After Plan-Do-Study-Act 4, the percentages kept improving leading to a median shift from 85.6% to 100% after 10 weeks post-initiation of the project. Sustainment was confirmed by continuing observations for 6 more weeks to ensure that the changed protocol was assimilated in the system. We found that all women were shifted within 10 minutes of their arrival in postoperative ward from trolley to bed.

Conclusion:

Providing high-quality care to patients must be a priority for all health care providers. High-quality care is timely, efficient, evidence based, and patient-centric. Delays in transfer of postoperative patients to the monitoring area can be detrimental. The point of Care Quality Improvement methodology is useful and effective in solving complex problems by understanding and fixing the various contributory factors one by one. Reorganization of processes and available manpower without any extra investment in terms of infrastructure and resources is pivotal for long term success of a quality improvement project.
Introduction of a New Method to Monitor Patient-Relevant Outcomes and Costs: Using a Quality Improvement Project in Transcatheter Aortic Valve Implantation Care as an Example
Authors: van Steenbergen Gijs J. , Schulz Daniela N. , Slingerland Stacey R. , Tonino Pim A. , Soliman-Hamad Mohamed A. , Dekker Lukas , van Veghel Dennis
Published: March 2023

Background and Objective:

Routine outcome monitoring is becoming standard in care evaluations, but costs are still underrepresented in these efforts. The primary aim of this study was therefore to assess if patient-relevant cost drivers can be used alongside clinical outcomes to evaluate an improvement project and to provide insight into (remaining) areas for improvement.

Methods:

Data from patients who underwent transcatheter aortic valve implantation (TAVI) between 2013 and 2018 at a single center in the Netherlands were used. A quality improvement strategy was implemented in October 2015, and pre- (A) and post-quality improvement cohorts (B) were distinguished. For each cohort, clinical outcomes, quality of life (QoL), and cost drivers were collected from the national cardiac registry and hospital registration data. The most appropriate cost drivers in TAVI care were selected from hospital registration data using a novel stepwise approach with an expert panel of physicians, managers, and patient representatives. A radar chart was used to visualize the clinical outcomes, QoL and the selected costs drivers.

Results:

We included 81 patients in cohort A and 136 patients in cohort B. All-cause mortality at 30 days was borderline significantly lower in cohort B than in cohort A (1.5% vs 7.4%, P = .055). QoL improved after TAVI for both cohorts. The stepwise approach resulted in 21 patient-relevant cost drivers. Costs for pre-procedural outpatient clinic visits (€535, interquartile range [IQR] = 321-675, vs €650, IQR = 512-890, P < .001), costs for the procedure (€1354, IQR = 1236-1686, vs €1474, IQR = 1372-1620, P < .001), and imaging during admission (€318, IQR = 174-441, vs €329, IQR = 267-682, P = .002) were significantly lower in cohort B than in cohort A. Possible improvement potential was seen in 30-day pacemaker implantation and 120-day readmission.

Conclusion:

A selection of patient-relevant cost drivers is a valuable addition to clinical outcomes for use in evaluation of improvement projects and identification of room for further improvement.
Investigation of Flaviviruses Emerging in Brazil as Etiology Factor in Nonsyndromic Orofacial Cleft
Authors: Silva Kaique C.P. , Messias Thiago S. , Soares Simone
Published: March 2023

Brazil has one of the largest forest areas on the planet and the potential for the emergence of new diseases. In turn, orofacial clefts, especially cleft lip and or palate (CL/P), are characterized as congenital malformations and may be associated with genetic and environmental factors. The present study aimed to investigate in silico the flavivirus’s potential to emerge in Brazil as an etiology of CL/P. A scoring method was created based on literature and nucleotide similarity analysis. An integrative analysis of the literature was performed to answer the questions through the databases PubMed/MEDLINE, SciELO, LILACS, and Google Scholar to have a more significant number of results. The software Basic Local Alignment Search Tool—BLAST 2.12.0, through the Genomic + Transcript Databases (Human Genomic plus Transcript Human G+T), was selected to find similarities with human sequences associated with CL/P. The viral sequences used were obtained from the National Center for Biotechnology Information Virus—NCBI Virus, in which only complete and referential genomes were selected. The flavivirus that emerged in Brazil and presented a high potential to cause CL/P was the Iguape virus strain (species Aroa virus), followed by the Cacipacore virus and the Rocio virus strain (species Ilheus virus) with medium potential to cause CL/P. In conclusion, we suggest among the virus evaluated that the Iguape virus presented a high potential of causing CL/P. As prevention, the control of arthropods and the hospital diffusion on viral dynamics, mainly in the CL/P context and other congenital malformations, are indicated.
Fusion of Lateral Calvarial Sutures on Volume-Rendered Computed Tomography Reconstructions in Patients With Known Craniosynostosis
Authors: Wilkinson C Corbett , Belanger Katherine , Elbadry Rasha , Hoffman Jessa , Ryan Megan , Stence Nicholas V. , Graber Sarah J , Ridder Thomas , Batista Ligia , French Brooke M
Published: March 2023

Introduction:

After treating a child with familial sagittal craniosynostosis, clinocephaly, and bilateral parietomastoid/posterior squamosal suture fusion, the authors wondered if major-suture synostosis and clinocephaly were associated with abnormal fusion of minor lateral calvarial sutures.

Methods:

The authors reviewed all preoperative volume-rendered head computed tomography reconstructions performed for craniosynostosis at their institution from 2010 through 2014 and determined whether the sphenoparietal, squamosal, and parietomastoid sutures were open, partially fused, or fused. The authors determined whether any sutures were abnormally fused based upon a previous study from their center, in which abnormal fusion was defined as either 1 of 3 abnormal fusion patterns or abnormally-early fusion. The authors then determined the rate of abnormal fusion of these sutures and whether abnormal fusion was associated with (1) major-suture craniosynostosis, (2) type of craniosynostosis (sutures involved; single-suture versus multisuture; syndromic versus nonsyndromic), and (3) clinocephaly.

Results:

In 97 included children, minor lateral sutures were abnormally fused in 8, or 8.2%, which was significantly higher than in children without craniosynostosis from our earlier study. Abnormal minor lateral suture fusion was not associated with the type of single-suture synostosis or with multisuture synostosis but was associated with syndromic synostosis. Four of 8 children with abnormal minor lateral suture fusion had multisuture synostosis and 6 had syndromic synostosis. Lateral sutures were abnormally fused in 1 of 4 subjects with clinocephaly, which was not significant.

Conclusion:

Abnormal minor lateral calvarial suture fusion is significantly associated with major-suture craniosynostosis, especially syndromic synostosis.
Application and Accuracy of Craniomaxillofacial Plastic Surgery Robot in Congenital Craniosynostosis Surgery
Authors: Lei Bowen , Sun Tiecheng , Ma Hengyuan , Li Binghang , Yang Bin
Published: March 2023

Objective:

The objective of this study was to observe the accuracy and security of the craniomaxillofacial plastic surgery robot in congenital craniosynostosis surgery and to enhance and improve its performance.

Materials and Methods:

We performed model surgical experiments on computed tomography data of 5 children with congenital craniosynostosis who were diagnosed and treated in our hospital, and model surgical experiments and animal experiments on the skulls of 3 Bama minipigs.

Results:

There was no statistically significant difference shown either in model experiments or animal experiments in comparing the actual operation with the surgical simulation and inside the groups (P>0.05).

Conclusions:

The craniomaxillofacial plastic surgery robot has achieved good security and accuracy in model surgery and animal experiments. Further studies are needed to be conducted to confirm its security and accuracy and to continuously improve and refine the robot’s performance.
Impact of urbanization on mental health and well being
Authors: Halbreich Uriel
Published: March 2023

Purpose of review

It is predicted that by mid-21st century, over two-thirds of the world population will be urban. The shift from rural to urban living causes a major shift in priorities of public health. The current article aims at illuminating the urbanization process, its challenges and ramifications for mental health and well being of urban dwellers.

Recent findings

Currently, 55% of world population resides in urban areas. By 2050, that percentage will be at least 68%, mostly in developing and emerging economies. Adequate mental health and socioeconomic support services for the new urban migrants are almost nonexistent.

Adequate psychosocial clinics are an absolute urgent necessity in the neighborhoods where new migrants reside. Governments‘ policies and funding should be re-prioritized. For effective advocacy, descriptive comprehensive interdisciplinary epidemiological data should be an initial step of research. This should be followed by investigations of the biopsychosocial–economic causes and processes, which would point to adequate culturally sensitive practical solutions.
Benefits of video games for people with schizophrenia: a literature review
Authors: Quiles Clélia , Verdoux Hélène
Published: March 2023

Purpose of review

In spite of the overwhelming concerns about the deleterious impact of exposure to video games, a growing body of evidence suggests that it may be of potential interest for therapeutic purposes, particularly in schizophrenia. As literature is rapidly evolving, we carried out a systematic review of recent articles on this issue.

Recent findings

We identified seven studies published from 2017 to 2022 exploring the benefits of commercial video games in people with schizophrenia and related disorders regarding symptoms, cognition and functional outcome. Six studies used an RCT design. Associations between gaming and better outcomes were found in three main areas: physical condition (walking speed, aerobic fitness), neurocognition (processing speed, memory and executive functions), and social functioning, self-efficacy in daily life activities and quality of life.

Active use of video games is associated with better aerobic fitness and cognitive performances. Video gaming may contribute to better functional outcome and quality of life in patients suffering from cognitive impairments and difficulties in social functioning. Persons with schizophrenia may benefit from using commercial video games because of their potential therapeutic impact on functioning and cognition.
Evolutionarily stable strategy analysis and its links to demography and genetics through invasion fitness
Authors: Van Cleve Jeremy
Published: March 2023

Evolutionarily stable strategy (ESS) analysis pioneered by Maynard Smith and Price took off in part because it often does not require explicit assumptions about the genetics and demography of a population in contrast to population genetic models. Though this simplicity is useful, it obscures the degree to which ESS analysis applies to populations with more realistic genetics and demography: for example, how does ESS analysis handle complexities such as kin selection, group selection and variable environments when phenotypes are affected by multiple genes? In this paper, I review the history of the ESS concept and show how early uncertainty about the method lead to important mathematical theory linking ESS analysis to general population genetic models. I use this theory to emphasize the link between ESS analysis and the concept of
invasion fitness
. I give examples of how invasion fitness can measure kin selection, group selection and the evolution of linked modifier genes in response to variable environments. The ESSs in these examples depend crucially on demographic and genetic parameters, which highlights how ESS analysis will continue to be an important tool in understanding evolutionary patterns as new models address the increasing abundance of genetic and long-term demographic data in natural populations.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
Fertility signalling games: should males obey the signal?
Authors: Kovalov Viktor , Kokko Hanna
Published: March 2023

Game theory is frequently used to study conflicting interests between the two sexes. Males often benefit from a higher mating rate than females do. A temporal component of this conflict has rarely been modelled: females' interest in mating may depend on when females become fertile. This sets conditions for male–female coevolution, where females may develop fertility signals, and males may obey the signal, such that they only target signalling females. Modelling this temporal aspect to sexual conflict yields two equilibria: (i) a trivial equilibrium without signals and with males targeting all females, and (ii) a signalling equilibrium where all females signal before ovulation, and where either some, or all, males obey the signal. The ‘all males obey the signal’ equilibrium is more likely if we assume that discriminating males have an advantage in postcopulatory sperm competition, while in the absence of this benefit, we find the ‘some males obey the signal’ equilibrium. The history of game-theoretic models of sex differences often portrays one sex as the 'winner' and the opposite sex as the ‘loser’. From early models emphasizing ‘battle of the sexes’-style terminology, we recommend moving on to describe the situation as non-signalling equilibria having stronger unresolved sexual conflict than signalling equilibria.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
A marine cleaning mutualism provides new insights in biological market dynamics
Authors: Bshary Redouan , Noë Ronald
Published: March 2023

Most mutually beneficial social interactions (cooperation within species, mutualism between species) involve some degree of partner choice. In an analogy to economic theory as applied to human trading practices, biological market theory (BMT) focuses on how partner choice affects payoff distributions among non-human traders. BMT has inspired a great diversity of research, including research on the mutualism between cleaner fishLabroides dimidiatusand other marine fish, their ‘clients’. In this mutualism, clients have ectoparasites removed and cleaners obtain food in return. We use the available data onL. dimidiatuscleaner–client interactions to identify avenues for future expansion of BMT. We focus on three main topics, namely how partner quality interacts with supply-to-demand ratios to affect service quality, the role of threats and forms of forceful intervention, and the potential role of cognition. We consider it essential to identify the specifics of each biological market as a basis for the development of more sophisticated BMT models.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
Evolutionary game theory of continuous traits from a causal perspective
Authors: Lehtonen Jussi , Otsuka Jun
Published: March 2023

Modern evolutionary game theory typically deals with the evolution of continuous, quantitative traits under weak selection, allowing the incorporation of rich biological detail and complicated nonlinear interactions. While these models are commonly used to find candidates for evolutionary endpoints and to approximate evolutionary trajectories, a less appreciated property is their potential to expose and clarify the causal structure of evolutionary processes. The mathematical step of differentiation breaks a nonlinear model into additive components which are more intuitive to interpret, and when combined with a proper causal hypothesis, partial derivatives in such models have a causal meaning. Such an approach has been used in the causal analysis of game-theoretical models in an informal manner. Here we formalize this approach by linking evolutionary game theory to concepts developed in causal modelling over the past century, from path coefficients to the recently proposed causal derivative. There is a direct correspondence between the causal derivative and the derivative used in evolutionary game theory. Some game theoretical models (e.g. kin selection) consist of multiple causal derivatives. Components of these derivatives correspond to components of the causal derivative, to path coefficients, and to edges on a causal graph, formally linking evolutionary game theory to causal modelling.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
Multivariate brain-based dimensions of child psychiatric problems: degrees of generalizability
Authors: Xu Bing , Dall’Aglio Lorenza , Flournoy John , Bortsova Gerda , Tervo-Clemmens Brenden , Collins Paul , de Bruijne Marleen , Luciana Monica , Marquand Andre , Wang Hao , Tiemeier Henning , Muetzel Ryan L.
Published: March 2023

Multivariate machine learning techniques are a promising set of tools for identifying complex brain-behavior associations. However, failure to replicate results from these methods across samples has hampered their clinical relevance. This study aimed to delineate dimensions of brain functional connectivity that are associated with child psychiatric symptoms in two large and independent cohorts: the Adolescent Brain Cognitive Development (ABCD) Study and the Generation R Study (totaln=8,605). Using sparse canonical correlations analysis, we identified three brain-behavior dimensions in ABCD: attention problems, aggression and rule-breaking behaviors, and withdrawn behaviors. Importantly,out-of-samplegeneralizability of these dimensions was consistently observed in ABCD, suggesting robust multivariate brain-behavior associations. Despite this,out-of-studygeneralizability in Generation R was limited. These results highlight that thedegreeof generalizability can vary depending on the external validation methods employed as well as the datasets used, emphasizing that biomarkers will remain elusive until models generalize better in true external settings.
Poisoned in Their Homes- Red Blood Cell Abnormalities in Lead-Exposed Residents of a Pakistani Industrial Zone
Authors: Shah Farhad Ali , Shoaib Naila , Iqbal Asim , Jamil Nazia , Batool Rida , Munir Rimsha , Lutfi Ameem , Zaidi Nousheen
Published: March 2023

The present study investigated the clinical and hematological effects of chronic lead exposure in the population residing inShadi Pura, a small industrial zone in Lahore, Pakistan. A cross-sectional analysis of 149 participants recruited through health camps was conducted to explore the hematological manifestations of environmental lead exposure, focusing on various red blood cell (RBC) indices and morphology. Moreover, the study examined the differences in the impact of lead exposure on RBC indices and morphology between men, women, and children. Participants exhibited symptoms of lead poisoning, including fatigue, muscle pain, and headache, with a significant percentage of women (44%) reporting miscarriages. Iron deficiency anemia was highly prevalent among all sub-groups of the study population, with adult females showing a significantly higher prevalence than adult males. Male children were the most affected subgroup, with 93% displaying anemia. The RBC count in children remained unchanged, while 31% of male and 7% of female participants displayed elevated RBC counts. RBC indices, mainly mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH), were below normal levels, with children being more affected than adults and adult males being the least affected group. Furthermore, RBC morphology was severely affected, with a considerable proportion of females and children displaying hypochromic microcytic morphology. Our results highlight variations in the hematological impacts of lead exposure in different gender and age cohorts. Overall our findings underscore the urgency of addressing the issue of environmental lead exposure in similar industrial zones. It is critical to implement appropriate measures to reduce lead exposure and enhance the infrastructure for safe drinking water and waste disposal to protect the health of populations in such areas.
Stabilizing the return to normal behavior in an epidemic
Authors: Berry Tyrus , Ferrari Matthew , Sauer Timothy , Greybush Steven J. , Ebeigbe Donald , Whalen Andrew J. , Schiff Steven J.
Published: March 2023

Predicting the interplay between infectious disease and behavior has been an intractable problem because behavioral response is so varied. We introduce a general framework for feedback between incidence and behavior for an infectious disease. By identifying stable equilibria, we provide policy end-states that are self-managing and self-maintaining. We prove mathematically the existence of two new endemic equilibria depending on the vaccination rate: one in the presence of low vaccination but with reduced societal activity (the “new normal”), and one with return to normal activity but with vaccination rate below that required for disease elimination. This framework allows us to anticipate the long-term consequence of an emerging disease and design a vaccination response that optimizes public health and limits societal consequences.

Significance Statement

The experience of the COVID-19 pandemic has revealed that behavior can change dramatically in response to the spread of a disease. This behavioral response impacts disease transmission. Predicting future outcomes requires accounting for the feedback between behavior and transmission. We show that accounting for these feedbacks generates long-term predictions about disease burden and behavior that can guide policy.
RNA-seq analysis of skeletal muscle in motor neurone disease cases and controls
Authors: Freydenzon Anna , Wani Shivangi , Bharti Vanda , Wallace Leanne M. , Henders Anjali K. , McCombe Pamela A. , Henderson Robert D. , Steyn Frederik J. , Wray Naomi R. , Ngo Shyuan T. , McRae Allan F.
Published: March 2023

Background

Amyotrophic lateral sclerosis (ALS), the most predominant form of Motor Neuron Disease (MND), is a progressive and fatal neurodegenerative condition that spreads throughout the neuromotor system by afflicting upper and lower motor neurons. Lower motor neurons project from the central nervous system and innervate muscle fibres at motor endplates, which degrade over the course of the disease leading to muscle weakness. The direction of neurodegeration from or to the point of neuromuscular junctions and the role of muscle itself in pathogenesis has continued to be a topic of debate in ALS research.

Methods

To assess the variation in gene expression between affected and nonaffected muscle tissue that might lead to this local degeneration of motor units, we generated RNA-seq skeletal muscle transcriptomes from 28 MND cases and 18 healthy controls and conducted differential expression analyses on gene-level counts, as well as an isoform switching analysis on isoform-level counts.

Results

We identified 52 differentially-expressed genes (Benjamini-Hochberg-adjustedp< 0.05) within this comparison, including 38 protein coding, 9 long non-coding RNA, and 5 pseudogenes. Of protein-coding genes, 31 were upregulated in cases including with notable genes including the collagenicCOL25A1(p= 3.1 × 10−10),SAA1which is released in response to tissue injury (p= 3.6 × 10−5) as well as others of the SAA family, and the actin-encodingACTC1(p= 2.3 × 10−5). Additionally, we identified 17 genes which exhibited a functional isoform switch with likely functional consequences between cases and controls.

Conclusions

Our analyses provide evidence of increased tissue generation in MND cases, which likely serve to compensate for the degeneration of motor units and skeletal muscle.
Aberrant brain-heart coupling is associated with the severity and prognosis of hypoxic-ischemic brain injury after cardiac arrest
Authors: Hermann Bertrand , Candia-Rivera Diego , Sharshar Tarek , Gavaret Martine , Diehl Jean-Luc , Cariou Alain , Benghanem Sarah
Published: March 2023

Background and Objectives

Approximately 50% of post-cardiac arrest survivors remain comatose after 72h, a substantial proportion of which will have a poor neurological outcome, predominantly due to irreversible hypoxic-ischemic brain injury. Recent findings in healthy subjects and patients suggested that autonomic nervous system activity measured by brain-heart interactions could be reliable markers of consciousness and cognitive processing. Thus, we hypothesized that brain-heart interactions are associated with the severity of hypoxic-ischemic brain injury and the prognosis of these patients.

Methods

In post-cardiac arrest patients still comatose 48h after sedation weaning, brain-heart interaction markers were computed on 5 minutes of continuous EEG/ECG recording using a synthetic data generation model, gathering bidirectional interactions between EEG frequency bands (delta, theta and alpha) and heart-rate variability frequency bands (low and high frequency). The strength and complexity of the interactions were quantified using medians and refined composite multiscale entropy. Primary outcome was the severity of brain injury, assessed by: (i) standardized qualitative EEG classification, (ii) somatosensory evoked potentials (N20), and (iii) neuron-specific enolase levels. Secondary outcome was the 3-month neurological status, assessed by the Cerebral Performance Category score [good (1-2) vs. poor outcome (3-4-5)].

Results

Between January 2007 and July 2021, 181 patients [116 males (64%), median age 61 years, age range 49-72 years] were admitted to ICU for a resuscitated cardiac arrest (76% out-of-hospital, 69% non-shockable rhythm). Poor neurological outcome was observed in 134 patients (74%). Qualitative EEG patterns suggesting high severity were associated with a decreased sympatho-vagal balance. Severity of EEG changes were proportional to higher absolute values of brain-to-heart coupling strength (p<2×10−3for all brain-to-heart frequencies) and lower values of complexity (all p-values<0.05 except for alpha-to-low frequency). Brain-to-heart coupling strength was significantly higher in patients with bilateral absent N20 and correlated with neuron-specific enolase levels at day 3. This aberrant brain-to-heart coupling (increased strength, decreased complexity) was also associated with 3-month poor neurological outcome.

Discussion

Our results suggest that autonomic dysfunctions may well represent hypoxic-ischemic brain injury post-cardiac arrest pathophysiology. These results open avenues for integrative monitoring of autonomic functioning in critical care patients with potential prognostic applications.