bluuebunny/crossref_metadata_2025 huggingface dataset:
How people are exposed to neighborhoods racially different from their own
Authors: de la Prada Àlex G. , Small Mario L.
Published: July 2024

In US cities, neighborhoods have long been racially segregated. However, people do not spend all their time in their neighborhoods, and the consequences of residential segregation may be tempered by the contact people have with other racial groups as they traverse the city daily. We examine the extent to which people’s regular travel throughout the city is to places “beyond their comfort zone” (BCZ), i.e., to neighborhoods of racial composition different from their own—and why. Based on travel patterns observed in more than 7.2 million devices in the 100 largest US cities, we find that the average trip is to a neighborhood less than half as racially different from the home neighborhood as it could have been given the city. Travel to grocery stores is least likely to be BCZ; travel to gyms and parks, most likely; however, differences are greatest across cities. For the first ~10 km people travel from home, neighborhoods become increasingly more BCZ for every km traveled; beyond that point, whether neighborhoods do so depends strongly on the city. Patterns are substantively similar before and after COVID-19. Our findings suggest that policies encouraging more 15-min travel—that is, to amenities closer to the home—may inadvertently discourage BCZ movement. In addition, promoting use of certain “third places” such as restaurants, bars, and gyms, may help temper the effects of residential segregation, though how much it might do so depends on city-specific conditions.
The m
6
A reader SlYTH2 negatively regulates tomato fruit aroma by impeding the translation process
Authors: Bian Hanxiao , Song Peizhe , Gao Ying , Deng Zhiping , Huang Chenyang , Yu Lei , Wang Hanqing , Ye Bingbing , Cai Zhihe , Pan Yu , Wang Fengqin , Liu Jianzhao , Gao Xiangwei , Chen Kunsong , Jia Guifang , Klee Harry J. , Zhang Bo
Published: July 2024

N
6
-methyladenosine (m
6
A) is a fundamentally important RNA modification for gene regulation, whose function is achieved through m
6
A readers. However, whether and how m
6
A readers play regulatory roles during fruit ripening and quality formation remains unclear. Here, we characterized SlYTH2 as a tomato m
6
A reader protein and profiled the binding sites of SlYTH2 at the transcriptome-wide level. SlYTH2 undergoes liquid–liquid phase separation and promotes RNA–protein condensate formation. The target mRNAs of SlYTH2, namely m
6
A-modified
SlHPL
and
SlCCD1B
associated with volatile synthesis, are enriched in SlYTH2-induced condensates. Through polysome profiling assays and proteomic analysis, we demonstrate that knockout of
SlYTH2
expedites the translation process of
SlHPL
and
SlCCD1B
, resulting in augmented production of aroma-associated volatiles. This aroma enrichment significantly increased consumer preferences for CRISPR-edited fruit over wild type. These findings shed light on the underlying mechanisms of m
6
A in plant RNA metabolism and provided a promising strategy to generate fruits that are more attractive to consumers.
Inhibit ammonia volatilization from agriculture and livestock by air plasma-activated water
Authors: Li Mengqi , Xiong Zilan , Song Zhuocheng , Wang Weiyi , Hou Zhenguo , Dai Yi
Published: July 2024

Ammonia volatilization in agriculture and livestock is a considerable cause of air pollution and a significant way of N loss. In this study, we propose a method of using air plasma-activated water (PAW) to inhibit ammonia volatilization from agriculture and livestock and report the inhibitory effect under different discharge times and concentration gradients. PAW was generated through needle–water discharge, while ammonia waters with different concentrations served as simplified models for ammonia release. The compositions of the gas/liquid products of the PAW and those after mixing with ammonia water were detected and analyzed. It was found that the PAW could effectively inhibit the NH3 volatilization from ammonia water over a large range of conditions, however, NH3 volatilization promotion could also happen in some cases. The inhibition rate (IR) generally increased with the longer discharge time of the PAW and decreased with the higher ammonia water concentration. As the discharge time increased, the PAW became more acidic and had more active N components, converting more volatile NH3 to NH4
+ when mixed with ammonia water. Finally, a relationship model was developed between the IR and pH of the mixture. The IR basically decreased with the increase of the mixture pH, and reached ∼100% when a PAW with a discharge time of 7.5 min or 10 min was mixed with ammonia water with a mass fraction of 0.15%, or PAW of 10 min mixed with 0.25% ammonia water in this study, with the mixture pH lower than 8. The basic chemical process and possible reaction mechanisms were discussed. The proposed method not only effectively reduces ammonia volatilization but also adds more N elements in the form of NO3
− and NH4
+, which further improves fertility.
High-performance flexible piezoelectric nanogenerator assisted by a three-phase PVDF/WS2/rGO nanocomposite
Authors: Mondal Arun , Faraz Mohd , Singh Huidrom Hemojit , Khare Neeraj
Published: July 2024

The emergence of piezoelectric nanogenerators (PENGs) presents a promising alternative to supply energy demands within the realms of portable and miniaturized devices. In this article, the role of 2D transition metal dichalcogenide tungsten sulfide (WS2) and conductive rGO sheets as filler materials inside the polyvinylidene fluoride (PVDF) matrix on piezoelectric performances has been investigated extensively. The strong electrostatic interaction between C–F and C–H monomer bonds of PVDF interacted with the large surface area of the WS2 nanosheets, increasing the electroactive polar phases and resulting in enhanced ferroelectricity in the PVDF/WS2 nanocomposite. Further, the inclusion of rGO sheets in the PVDF/WS2 composite allows mobile charge carriers to move freely through the conductive network provided by the rGO basal planes, which improves the internal polarization of the PVDF/WS2/rGO nanocomposites and increases the electrical performance of the PENGs. The PVDF/WS2/0.3rGO nanocomposite-based PENG exhibits maximum piezoresponses with ∼8.1 times enhancements in the output power density than the bare PVDF-based PENG. The mechanism behind the enhanced piezoresponses in the PVDF/WS2/rGO nanocomposites has been discussed.
Identification of Radio Frequency Interference Using Multi-scale TransUNet
Authors: Zhang Xuan , Liang Bo , Hao Longfei , Feng Song , Wei Shoulin , Dai Wei , Dao Yihang
Published: July 2024

Radio observation is a method for conducting astronomical observations using radio waves. A common challenge in radio observations is Radio Frequency Interference (RFI), which refers to the unintentional or intentional interference of radio signals from other wireless sources within the radio frequency band. Such interference contaminates the astronomical signals received by radio telescopes, significantly affecting time–frequency domain astronomical observations and research. Consequently, identifying RFI is crucial. In this paper, we employ a deep learning approach to detect RFI present in observation data and propose an improved network structure based on TransUNet. This network leverages the principles of a multi-scale convolutional attention mechanism. It introduces an auxiliary branch to extract high-dimensional image information and an enhanced coordinate attention mechanism for feature map extraction, enabling more comprehensive and accurate identification of RFI in time–frequency images. We introduce a novel architecture named the Multi-Scale TransUNet Network, abbreviated as MS-TransUNet. We utilized observation data from the 40 m radio telescope at the Yunnan Observatory as a data set for training, validating, and testing the network. Compared with previous deep learning networks (U-Net, RFI-Net, R-Net, DSC, EMSCA-UNet), the recall rate and f2 score have been significantly improved. Specifically, the recall rate is improved by at least 2.99%, and the f2 score is improved by at least 2.46%. Experiments demonstrate that this network is exceptional in identifying RFI more comprehensively while ensuring high precision.
Simulation Study on Constraining Gravitational Wave Propagation Speed by Gravitational Wave and Gamma-ray Burst Joint Observation on Binary Neutron Star Mergers
Authors: Rao Jin-Hui , Yi Shu-Xu , Tao Lian , Tang Qing-Wen
Published: July 2024

Theories of modified gravity suggest that the propagation speed of gravitational waves (GW) v

g
may deviate from the speed of light c. A constraint can be placed on the difference between c and v

g
with a simple method that uses the arrival time delay between GW and electromagnetic wave simultaneously emitted from a burst event. We simulated the joint observation of GW and short gamma-ray burst signals from binary neutron star merger events in different observation campaigns, involving advanced LIGO (aLIGO) in design sensitivity and Einstein Telescope (ET) joint-detected with Fermi/GBM. As a result, the relative precision of constraint on v

g
can reach ∼10−17 (aLIGO) and ∼10−18 (ET), which are one and two orders of magnitude better than that from GW170817, respectively. We continue to obtain the bound of graviton mass m

g
≤ 7.1(3.2) × 10−20 eV with aLIGO (ET). Applying the Standard-Model Extension test framework, the constraint on v

g
allows us to study the Lorentz violation in the nondispersive, nonbirefringent limit of the gravitational sector. We obtain the constraints of the dimensionless isotropic coefficients

s

¯

00

(
4
)

at mass dimension d = 4, which are

−
1
×

10

−
15

<

s

¯

00

(
4
)

<
9

×

10

−
17

for aLIGO and

−
4
×

10

−
16

<

s

¯

00

(
4
)

<
8

×

10

−
18

for ET.
The structure of simply colored coalgebras
Authors: Mo Yang
Published: July 2024

A simply colored coalgebra is a coassociative counital coalgebra

C
C

over an arbitrary ring

R
R

, which can be decomposed into a direct sum of two

R
R

-modules: one generated by set-like elements and another consisting of conilpotent elements. Our main result is the equivalence between simply colored coalgebras over a field

k
k

and pointed coalgebras with a choice of splitting of its coradical. Additionally, we also prove that the category of simply colored coalgebras is both complete and cocomplete.
On examples and classification of Frobenius objects in Rel
Authors: Contreras Ivan , Long Adele , Marx Sophia , Mehta Rajan
Published: July 2024

We give some new examples of Frobenius objects in the category of sets and relations

R
e
l

\mathbf {Rel}

. One example is a groupoid with a twisted counit. Another example is the set of conjugacy classes of a group. We also classify Frobenius objects in

R
e
l

\mathbf {Rel}

with two or three elements, and we compute the associated surface invariants using the partition functions of the corresponding topological quantum field theories (TQFT).
Stirling decomposition of graph homology in genus 1
Authors: Ward Benjamin
Published: July 2024

We prove that commutative graph homology in genus

g
=
1

g=1

with

n
≥
3

n\geq 3

markings has a direct sum decomposition whose summands have rank given by Stirling numbers of the first kind. These summands are computed as the homology of complexes of certain decorated trees which have an elementary combinatorial description.
The Brill-Noether Theory of the moduli spaces of sheaves on surfaces
Authors: Coskun Izzet , Huizenga Jack , Nuer Howard
Published: July 2024

In this paper, we survey recent developments in the Brill-Noether Theory of higher rank vector bundles on complex projective surfaces. We focus on weak Brill-Noether Theorems on rational and

K
K

-trivial surfaces and their applications.
Moduli spaces and geometric invariant theory: old and new perspectives
Authors: Hoskins Victoria
Published: July 2024

Many moduli spaces are constructed as quotients of group actions; this paper surveys the classical theory, as well as recent progress and applications. We review geometric invariant theory for reductive groups and how it is used to construct moduli spaces, and explain two new developments extending this theory to non-reductive groups and to stacks, which enable the construction of new moduli spaces.
Co-Evolution and Spatial Diffusion
Authors: Antony Alexander K , Thompson William R
Published: July 2024

This chapter covers the key concepts of co-evolution and spatial diffusion. It looks into how the industrialization transition affects other peace factors shown to affect conflict levels among states. The chapter considers whether the neighborhood in which a state is located influences and conditions state values on peace variables or spatial interdependence. The potential for industrialization to diffuse to other local actors at high rates enables a stronger explanation and prediction of the neighborhoods most prone to adopt peaceful relations. Since the peace factor is fostered by industrialization, the effects of industrialization on peace are likely conditional on neighborhood levels of industrialization.
Atypical melanocytes of an atypical Spitz tumour observed with optical super-high magnification dermoscopy
Authors: Daviti Maria , Papadimitriou Ilias , Cinotti Elisa , Lallas Aimilios
Published: July 2024

A 64-year-old woman presented with a 6-mm pigmented lesion on her thigh. Dermatoscopy revealed the ‘starburst’ dermatoscopic pattern of a Spitzoid tumour. Before excision, the lesion was examined under ×400 magnification dermoscopy using the videoscope Fotofinder Medicam 1000 (Fotofinder System, Bad Birnbach, Germany) and in vivo Reflectance Confocal Microscopy (RCM) (Vivascope 1500®, MAVIG GmbH, Munich, Germany).
A chromosome-level genome assembly provides insights into the local adaptation of Tamarix austromongolica in the Yellow River Basin, China
Authors: Gong Shuai , Gan Honghao , Chu Jianmin , Wang Zhaoshan , Sun Jia
Published: July 2024

Tamarix austromongolica is endemic to the Yellow River Basin and has adapted to diverse ecological settings in the region, including the arid areas of northwestern China and the saline soil regions of the Yellow River Delta. However, the genetic basis of its local adaptation remains unclear. We report a chromosome-level assembly of the T. austromongolica genome based on PacBio high-fidelity sequencing and Hi-C technology. The 12 pseudochromosomes cover 98.44% of the 1.32 Gb assembly, with a contig N50 of 52.57 Mb and a BUSCO score of 98.2%. The genome comprises 913.6 Mb (68.83%) of repetitive sequences and 22,374 protein-coding genes. Genome evolution analyses suggest that genes under positive selection and significantly expanded gene families have facilitated T. austromongolica’s adaptability to diverse environmental factors and high resistance to diseases. Using genotyping-by-sequencing, we conducted population structure and selection analyses of 114 samples from 15 sites. Two genetic groups were identified, and 114 and 289 candidate genes were assigned to the populations of the northwestern and eastern parts of the Yellow River, respectively. Furthermore, we discovered numerous candidate genes associated with high-altitude adaptability and salt tolerance. This research provides valuable genomic resources for the evolutionary study and genetic breeding of tamarisk.
Addressing the effectiveness of health literacy programs within the Gulf Corporation Council: an integrative review
Authors: Johnson J , Mohamed H , Lowe T , Khraim F , Wolsey C , Haque S , Al-Farsi A , Schnurman D , Chowdhury N , Raihan M M H , Turin T C
Published: July 2024

Health literacy is an increasingly required need to help individuals, families and communities manage their health and health conditions. It is linked with better self-adherence to treatments, use of resources, access to care and overall reduced costs in healthcare. In the Gulf Cooperation Council (GCC), which comprises Bahrain, Kuwait, Oman, Qatar, Saudi Arabia and the United Arab Emirates, various health literacy programs are implemented across states to address people’s unique and complex healthcare needs. This article aims to examine the current literature and assess the factors that influence the outcomes of health literacy programs within the GCC. An integrative review methodology has been conducted to pursue a comprehensive understanding of health literacy interventions in the GCC. This investigative approach was shaped by Whittemore and Knafl’s framework (2005), which includes problem identification, literature search, data evaluation, data analysis and presentation. The literature on the effectiveness of health literacy interventions and the factors that shape them are notably limited worldwide and within the GCC region. This integrative review addresses this knowledge gap and highlights the significance of key themes such as sessions, evaluation and improvement in shaping health literacy outcomes within the GCC region. Through this integrative review, the three main themes of sessions, evaluation and improvement were identified as influencing the outcomes of health literacy programs within the GCC.
Set Players to Stun: Inducing Basic Psychological Need Frustration in a Casual Video Game
Authors: Phillips Cody , Neufeld Parker , Klarkowski Madison
Published: July 2024

This study investigates the concept of psychological need frustration within the context of video games. We explore the potential of discrete in-game events, specifically the usage of widely popular ‘stun’ mechanics, to induce feelings of need frustration in players. We designed, developed and experimentally tested a bespoke video game with four conditions: No Stuns, Avoidable Stuns, Unavoidable Stuns and Layered Stuns (a combination of avoidable and unavoidable stuns). Our findings show that Unavoidable Stuns lead to statistically significantly greater autonomy need frustration. This finding has important implications for games research, as psychological need frustration is linked to negative effects on player engagement and wellbeing. Our results also highlight that a variety of stun mechanics can undermine psychological need satisfaction. Taken together, this work makes a meaningful contribution to HCI and games literature, showcasing that game mechanics can be designed in a way that undermines psychological needs.
Flow State Requires Effortful Attentional Control but Is Experienced Effortlessly by Video Game Players
Authors: Pujol Morgane , Caroux Loïc , Lemercier Céline
Published: July 2024

Flow is a mental state of intense concentration that occurs when a person is completely absorbed in a task. The amount of mental effort required by this mental state is currently subject to debate. The present experimental study explored the link between flow and both objective and subjective measures of mental effort. Subjective measures of flow and mental effort, and objective measures of mental effort (pupil diameter and heart rate variability), were collected during a puzzle video game played at one of three levels of difficulty: too easy, optimal and too difficult. Participants in the optimal condition reported more flow than those in both the too-easy condition (which generated less mental effort and less subjective mental effort) and too-difficult condition (which generated an equal amount of mental effort and more subjective mental effort). Flow is a state that may require mental effort, even if it feels effortless for video game players.
Population pharmacokinetics of flucloxacillin as intermittent bolus infusion in patients with Staphylococcus aureus bloodstream infection
Authors: Hermann Laura , Schöning Verena , Dräger Sarah , Rentsch Katharina , Moser Stephan , Gürtler Nicolas , Sendi Parham , Osthoff Michael , Hammann Felix
Published: July 2024

Background

Optimal antibiotic dosing for Staphylococcus aureus bloodstream infections (BSI) is still controversial. One reason is inter-individual variation in pharmacokinetics, which may be influenced by various patient-related factors, particularly in critically ill patients.

Objectives

To describe the population pharmacokinetics (PopPK) of the antibiotic flucloxacillin in patients with S. aureus BSI. Subsequently, we sought to translate the model into a user-friendly app for generating a priori and a posteriori time–concentration curves and dose recommendations to optimize dosing regimens.

Methods

Total and unbound flucloxacillin concentrations were included from 49 patients from a prospective cohort study conducted during clinical routine, including non-critically ill and critically ill individuals who received intermittent bolus applications. These data were analysed using non-linear mixed-effects modelling.

Results

Most patients (98%) were treated with 2 g of flucloxacillin every 4 h. We developed a joint model that simultaneously described total and unbound concentrations. The model included an allometric effect of glomerular filtration rate on clearance and albumin on the albumin dissociation constant. The latter was especially important, as in our population the unbound fraction was higher at 11.5% (16.7% for critically ill patients) compared with reported values of approximately 5%. Based on our joint model, we developed a web-based app for optimizing dosing regimens of flucloxacillin.

Conclusions

By utilizing data from clinical routine, we were able to create a predictive PopPK model of flucloxacillin and identify influential covariates. The web-based app is currently being validated in a clinical trial.
Contabilizar el comercio imperial: analysis of early double-entry accounting books with TEI/DEPCHA
Authors: Kokaze Naoki , Fushimi Takeshi , Nakamura Yusuke
Published: July 2024

This article discusses the encoding of double-entry accounting books from the 16th-century Spanish Empire and presents initial stage results from analyzing the encoded text, based on our case study. We selected the accounting books containing transactional data from 1558 to 1560. The encoding process followed the Text Encoding Initiative proposed by the Digital Edition Publishing Cooperatives for Historical Accounts (DEPCHA), with some additional attributes specific to the ontology of the double-entry books. The article explains the method of encoding and describes the unique characteristics of the ledger, such as the format of bookkeeping and the spatial arrangement of information. We adopted DEPCHA’s markup methodology to represent the accounting vocabulary and used the @ana attributes to invoke a domain ontology for bookkeeping structure of transactions. The results from the data analysis focus on three aspects: identification of person names, accounting terms, and checking the balance of payments. The study concludes by highlighting our contribution to expanding new semantic vocabularies within the DEPCHA’s Bookkeeping Ontology, namely “bk: Total” and “bk: SubTotal.” It illuminates the flexibility in name spelling and the preference for mundane vocabularies in the left column of the ledger, while emphasizing accuracy in numerical values and calculations in the right column. We propose further encoding and analysis of transactional records to enhance the understanding of historical double-entry commercial records.
Phylodynamic Insights into Global Emergence and Diversification of the Tomato Pathogen Xanthomonas hortorum pv. gardneri
Authors: Jibrin Mustafa O. , Sharma Anuj , Mavian Carla N. , Timilsina Sujan , Kaur Amandeep , Iruegas-Bocardo Fernanda , Potnis Neha , Minsavage Gerald V. , Coutinho Teresa A. , Creswell Tom C. , Egel Daniel S. , Francis David M. , Kebede Misrak , Miller Sally A. , Montelongo María J. , Nikolaeva Ekaterina , Pianzzola María J. , Pruvost Olivier , Quezado-Duval Alice M. , Ruhl Gail E. , Shutt Vou M. , Maynard Elizabeth , Maeso Diego C. , Siri María I. , Trueman Cheryl L. , Salemi Marco , Vallad Gary E. , Roberts Pamela D. , Jones Jeffrey B. , Goss Erica M.
Published: July 2024

The emergence of plant pathogens is often associated with waves of unique evolutionary and epidemiological events. Xanthomonas hortorum pv. gardneri is one of the major pathogens causing bacterial spot disease of tomatoes. After its first report in the 1950s, there were no formal reports on this pathogen until the 1990s, despite active global research on the pathogens that cause tomato and pepper bacterial spot disease. Given the recently documented global distribution of X. hortorum pv. gardneri, our objective was to examine genomic diversification associated with its emergence. We sequenced the genomes of X. hortorum pv. gardneri strains collected in eight countries to examine global population structure and pathways of emergence using phylodynamic analysis. We found that strains isolated post-1990 group by region of collection and show minimal impact of recombination on genetic variation. A period of rapid geographic expansion in X. hortorum pv. gardneri is associated with acquisition of a large plasmid conferring copper tolerance by horizontal transfer and coincides with the burgeoning hybrid tomato seed industry through the 1980s. The ancestry of X. hortorum pv. gardneri is consistent with introduction to hybrid tomato seed production and dissemination during the rapid increase in trade of hybrid seeds.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Efficacy of nimotuzumab in combination with immunotherapy for a young recurrent cervical cancer patient: a case report and literature review
Authors: Shi Mingtao , Zhang Yongchun
Published: July 2024

Cervical cancer is one of the most common malignant tumors in women, and more than one-third of the patients have already developed to a locally advanced stage at initial diagnosis. After standard concurrent chemoradiotherapy, recurrence still occurs in 29–38% of patients with locally advanced cervical cancer (LACC), and the 5-year survival rate of patients with recurrence is only 3.8–13.0%, resulting in a poor prognosis and limited therapeutic choices. Currently, the recommended first-line systemic treatment for recurrent metastatic cervical cancer involves cisplatin or carboplatin in combination with paclitaxel-based chemotherapy, supplemented with the antivascular agent bevacizumab and the immune checkpoint inhibitor pembrolizumab. The use of these drugs, however, is limited due to side effects such as myelosuppression, gastrointestinal perforation, and bleeding, so new treatment modalities need to be explored. Anti-EGFR (epithelial growth factor receptor, anti-surface growth factor receptor antibody) targeted drugs have been demonstrated to have a significant radiosensitizing effect on synchronous chemoradiotherapy in LACC and are now considered to have potential for the treatment of recurrent cervical cancer. We represented a LACC patient who relapsed 6 months after concurrent chemoradiotherapy. The patient received six cycles of nimotuzumab combined with camrelizumab, and the efficacy was evaluated to be partial remission after two or four cycles of treatment, with progression-free survival up to 9 months, without significant side effects. Until March 2024, the patient was still undergoing treatment. Promising efficacy and tolerable side effects of nimotuzumab in combination with camrelizumab were observed in this case.
An Imperative Role of Fetal Autopsy in Previable Fetuses - Amniotic Deformity Adhesions, Mutilations Complex
Authors: JKA Harini Devi , Ganesan Nidhya , Gurusamy Umamaheswari
Published: July 2024

Objective

To identify the occurrence of the amniotic deformity adhesions, mutilation (ADAM) complex and imperative role of fetal autopsy in diagnosing this condition.

Methods

A retrospective descriptive study spanning nine years, from January 2014 to January 2022, was conducted at the Department of Pathology within a tertiary care hospital in South India. The study focused on analyzing the clinical presentation, prenatal ultrasonogram, and morphological features of fetuses with the ADAM complex, limb body wall complex, or amniotic bands.

Results

Among the 438 fetuses assessed during the study period, five fetuses showed features of the ADAM complex (0.01%). The most frequent gestational age observed was 12–18 weeks and most fetuses were female. The common anomaly encountered was limb defects, followed by abdominal and cranial anomalies.

Conclusion

The diagnosis of the ADAM complex relies primarily on fetal autopsy to differentiate it from similar conditions like anencephaly or body-stalk anomalies. The pathologist plays a crucial role in understanding the complexities of the ADAM complex. Advanced antenatal imaging and therapies offer potential for prevention through improved counseling.
Use of Muscle Relaxants for Acute Postoperative Pain: A Practical Review
Authors: Farishta Akil , Iancau Alex , Janis Jeffrey E. , Joshi Girish P.
Published: July 2024

Background:

Skeletal muscle relaxants have emerged as a broad category of analgesic adjuncts, aiming to improve pain relief and reduce opioid reliance. These drugs induce muscle relaxation and reduce muscle spasms, and therefore, they are commonly used in surgical procedures involving muscle manipulation, such as abdominal surgery, breast surgery, and spine surgery. However, their analgesic efficacy and opioid-sparing effects are poorly explored.

Methods:

A scoping review of literature was performed with several electronic databases. We used a search string with a sequence of text words and word variants related to central muscle relaxants, pain management, postoperative pain, and specific muscle relaxants.

Results:

Review of literature shows significant heterogeneity among the studies in terms of surgical procedures, patient populations, choice of muscle relaxant, and timing and duration of administration, potentially limiting the generalizability of the findings and the ability for pooled analysis.

Conclusions:

Given the lack of evidence, we recommend that the use of skeletal muscle relaxants be reserved for patients in whom an optimal multimodal analgesic technique is not adequate. Also, there may be a limited role for these drugs in patients at high risk of postoperative pain undergoing surgical procedures with expected high opioid requirements. Due to the concerns of potential adverse effects, the decision to use muscle relaxants in vulnerable populations should be made carefully, weighing the benefits against the risks.
Current Applications of Artificial Intelligence in Billing Practices and Clinical Plastic Surgery
Authors: Zhu Christina , Attaluri Pradeep K. , Wirth Peter J. , Shaffrey Ellen C. , Friedrich Jeffrey B. , Rao Venkat K.
Published: July 2024

Integration of artificial intelligence (AI), specifically with natural language processing and machine learning, holds tremendous potential to enhance both clinical practices and administrative workflows within plastic surgery. AI has been applied to various aspects of patient care in plastic surgery, including postoperative free flap monitoring, evaluating preoperative risk assessments, and analyzing clinical documentation. Previous studies have demonstrated the ability to interpret current procedural terminology codes from clinical documentation using natural language processing. Various automated medical billing companies have used AI to improve the revenue management cycle at hospitals nationwide. Additionally, AI has been piloted by insurance companies to streamline the prior authorization process. AI implementation holds potential to enhance billing practices and maximize healthcare revenue for practicing physicians.
Leveraging the Apple Ecosystem: Easy Viewing and Sharing of Three-dimensional Perforator Visualizations via iPad/iPhone-based Augmented Reality
Authors: Necker Fabian N. , Cholok David J. , Shaheen Mohammed S. , Fischer Marc J. , Gifford Kyle , El Chemaly Trishia , Leuze Christoph W. , Scholz Michael , Daniel Bruce L. , Momeni Arash
Published: July 2024

We introduce a novel technique using augmented reality (AR) on smartphones and tablets, making it possible for surgeons to review perforator anatomy in three dimensions on the go. Autologous breast reconstruction with abdominal flaps remains challenging due to the highly variable anatomy of the deep inferior epigastric artery. Computed tomography angiography has mitigated some but not all challenges. Previously, volume rendering and different headsets were used to enable better three-dimensional (3D) review for surgeons. However, surgeons have been dependent on others to provide 3D imaging data. Leveraging the ubiquity of Apple devices, our approach permits surgeons to review 3D models of deep inferior epigastric artery anatomy segmented from abdominal computed tomography angiography directly on their iPhone/iPad. Segmentation can be performed in common radiology software. The models are converted to the universal scene description zipped format, which allows immediate use on Apple devices without third-party software. They can be easily shared using secure, Health Insurance Portability and Accountability Act–compliant sharing services already provided by most hospitals. Surgeons can simply open the file on their mobile device to explore the images in 3D using “object mode” natively without additional applications or can switch to AR mode to pin the model in their real-world surroundings for intuitive exploration. We believe patient-specific 3D anatomy models are a powerful tool for intuitive understanding and communication of complex perforator anatomy and would be a valuable addition in routine clinical practice and education. Using this one-click solution on existing devices that is simple to implement, we hope to streamline the adoption of AR models by plastic surgeons.
Rhinoplasty Exclusively Utilizing Autologous Costal Cartilage for Patients with Prior Unilateral Cleft Lip Repair
Authors: Le Vinh Hoang , Do Hung Quang , Tran Luan Viet
Published: July 2024

Background:

Rhinoplasty in patients with previous unilateral cleft lip repair is a surgical challenge due to complex nasal deformities, including a horizontally positioned nasal wing, wide cleft side nostrils, nasal base defects, and a short and deviated nasal columella. To comprehensively address these complexities, we exclusively utilized autologous costal cartilage in rhinoplasty procedures, using various surgical techniques.

Methods:

This study presents a comprehensive case series of 39 patients who had previously undergone unilateral cleft lip surgery but still had nasal deformities. Rhinoplasty using autologous costal cartilage was performed at Cho Ray Hospital, Vietnam. Costal cartilage was partially crushed and then finely cut to shape the dorsal area and raise the nasal base on the cleft side. Partially crushed cartilage was also used to shape shield grafts, cap grafts, and alar batten grafts, whereas sliced cartilage was utilized for septal extension grafts. Evaluation was based on improvements in anthropometric indicators, patient satisfaction using Rhinoplasty Outcome Evaluation (ROE) scale and FACE-Q scores.

Results:

The average age of patients was 25.13 years. All postoperative anthropometric indicators showed significant improvements. Postsurgery, the total ROE score was three times higher than before surgery (P < 0.001), and the total FACE-Q score was 2.26 times higher (P < 0.001). No significant intraoperative or postoperative complications were observed.

Conclusions:

This procedure effectively addresses complex nasal deformities in patients with prior unilateral cleft lip repair, emphasizing the value of autologous costal cartilage in rhinoplasty for such individuals.
Absolute Method for Measuring Environmental Radioactive Materials Using Imaging Plates
Authors: Yutaro Mori , Tomonori Isobe , Hideyuki Takei , Yosuke Yoshimura , Yasuwo Ide , Keito Sugaya , Gudetyjum Sajyrau , Takeji Sakae
Published: July 2024

We had previously developed a measurement method using an imaging plate (IP) to evaluate and address surface contamination caused by the release of radioactive materials during the Fukushima nuclear accident. The measurement units for the surface contamination density were in relative values [described as relative luminescence levels measured in luminescence arbitrary units (LAU)], but the evaluation was required in absolute values, such as Bq cm−2, to enable appropriate control of exposure doses. This study establishes a method for converting the IP measurements of surface contamination density due to environmental radioactivity into absolute values. Soil contaminated with radioactive materials from the Fukushima nuclear accident was collected to create a working reference material (WRM). The conversion coefficient for surface contamination density was calculated using the WRM values measured with an IP and high-purity germanium detectors. The IP measurement values were converted into the surface contamination density using the conversion coefficient. The WRM values measured with the IP and high-purity germanium detectors were 324.1 LAU and 32.22 ± 2.27 Bq cm−2, respectively. The surface contamination density conversion factor was calculated as 0.0994. The surface contamination density on the roof of the Tsukuba City facility was re-evaluated using the conversion factor. The average value of 29,972 Bq m−2 matched the amount of radioactive material fallen in Tsukuba City. By standardizing the measurement conditions for surface contamination when using IPs, we successfully quantified the surface contamination density with an accuracy comparable to that of conventional methods. This method is expected to make a significant contribution to efficient radiation safety management.
Dynamics of Corneal Swelling With Hypoosmolar Riboflavin After Induction During Corneal Collagen Crosslinking in Patients With Progressive Keratoconus
Authors: Syed Zeba A. , Yu Julia , Crespo Marcos A. , Daher Nathalie D. , Chang Clark Y.
Published: July 2024

Purpose:

To evaluate the rate of corneal swelling induced by hypoosmolar riboflavin in patients with progressive keratoconus (KCN) with corneal thickness <400 µm after the induction phase using riboflavin with 20% dextran during epithelium-off corneal crosslinking (CXL).

Methods:

Prospective, nonrandomized, single-center consecutive case series. Preoperative assessments included tomography, specular microscopy, and hysteresis. After epithelial debridement, riboflavin with 20% dextran (Photrexa Viscous; Glaukos, Burlington, MA) was applied at 2-min intervals during a 30-min induction phase. Eyes that dehydrated to a minimum corneal thickness (MCT) of <400 µm after induction (postinduction pachymetry) were recruited. Hypoosmolar riboflavin 0.146% (Photrexa; Glaukos) was used every 10 s to induce stromal swelling, with pachymetry performed every 30 s until the MCT was ≥400 µm (postswelling pachymetry). Corneal swelling rate was compared with variables using regression analysis.

Results:

In 31 eyes of 31 patients, mean postinduction pachymetry was 338.4 ± 28.7 μm. Hypoosmolar riboflavin induced a postswelling pachymetry of 413.4 ± 15.0 μm over a mean of 5.2 ± 3.2 min, and the average stromal swelling rate was 10.3 ± 8.7 μm/30 s. All eyes reached a postswelling pachymetry MCT ≥400 µm and no cases were aborted. Eyes with highly severe KCN (Kmax >70 and Belin/Ambrosio enhanced ectasia display final D score >17) experienced quicker swelling (14.4 ± 12.8 μm/30 s and 14.9 ± 12.4 μm/30 s, respectively; P < 0.05 for both). A thicker postinduction pachymetry was moderately associated with a faster rate of swelling (rs = 0.389; P = 0.030).

Conclusions:

Hypoosmolar riboflavin 0.146% can be safely employed in thinner corneas, allowing for swelling to ≥400 µm for epithelium-off CXL. Associations between swelling rate, KCN severity, and postinduction pachymetry were determined, allowing for a more accurate prediction of procedure time during CXL.
Intrathoracic Lymph Node Microcalcifications are Associated With a High Prevalence of Malignancy and Anaplastic Lymphoma Kinase Rearrangement
Authors: Leoncini Fausto , Sotgiu Giovanni , Cancellieri Alessandra , Puci Mariangela , Cortese Stefania , Livi Vanina , Simonetti Jacopo , Paioli Daniela , Magnini Daniele , Cappuzzo Federico , Bria Emilio , Trisolini Rocco
Published: July 2024

Background:

Microcalcifications are acknowledged as a malignancy risk factor in multiple cancers. However, the prevalence and association of intrathoracic lymph node (ILN) calcifications with malignancy remain unexplored.

Methods:

In this cross-sectional study, we enrolled patients with known/suspected malignancy and an indication for endosonography for diagnosis or ILN staging. We assessed the prevalence and pattern of calcified ILNs and the prevalence of malignancy in ILNs with and without calcifications. In addition, we evaluated the genomic profile and PD-L1 expression in lung cancer patients, stratifying them based on the presence or absence of ILN calcifications.

Results:

A total of 571 ILNs were sampled in 352 patients. Calcifications were detected in 85 (24.1%) patients and in 94 (16.5%) ILNs, with microcalcifications (78/94, 83%) being the predominant type. Compared with ILNs without calcifications (214/477, 44.9%), the prevalence of malignancy was higher in ILNs with microcalcifications (73/78, 93.6%; P<0.0001) but not in those with macrocalcifications (7/16, 43.7%; P=0.93). In patients with lung cancer, the high prevalence of metastatic involvement in ILNs displaying microcalcifications was independent of lymph node size (< or >1 cm) and the clinical stage (advanced disease; cN2/N3 disease; cN0/N1 disease). The anaplastic lymphoma kinase (ALK) rearrangement was significantly more prevalent in patients with than in those without calcified ILNs (17.4% vs. 1.7%, P<0.001), and all of them exhibited microcalcifications.

Conclusion:

ILN microcalcifications are common in patients undergoing endosonography for suspected malignancy, and they are associated with a high prevalence of metastatic involvement and ALK rearrangement.
Feasibility of a Recumbent Stepper for Short-Interval, Low-Volume High-Intensity Interval Exercise in Stroke
Authors: Bartsch Bria L. , Whitaker Alicen A. , Oloyede Shem , Waghmare Saniya , Billinger Sandra A.
Published: July 2024

Background and Purpose:

Studies investigating high-intensity interval exercise (HIIE) in stroke typically emphasize treadmill training. However, a literature review suggested that seated devices such as a recumbent stepper or cycle offer a promising alternative for HIIE since exercise can be prescribed using peak power output (PPO). Therefore, this would give health care professionals the ability to monitor and adapt power output for the target heart rate range. The purpose of this secondary analysis was to examine the feasibility of prescribing short-interval, low-volume HIIE using PPO in chronic stroke.

Methods:

We used several methods to test feasibility: (1)Acceptability: Measured by the percentage of participants who completed the entire HIIE protocol; (2) Implementation was assessed by the number of reported cardiac or serious adverse events during submaximal exercise testing and HIIE and the average percentage of participants reaching vigorous intensity, defined by the American College of Sports Medicine as at least 77% of age-predicted maximal heart rate (HRmax).

Results:

Data were available for 28 participants who were 32.2 (17.2) months post-stroke and 61.4 (11.9) years of age. Twenty-eight participants completed HIIE per protocol. No cardiac or serious adverse events occurred during the submaximal exercise test or during HIIE. The rapid switching between HIIE and recovery showed no evidence of blood pressure reaching unsafe thresholds. Average intensity during HIIE reached 76.8% HRmax, which is slightly below the target of 77.0%.

Discussion and Conclusions:

A single bout of short-interval, low-volume HIIE, prescribed using PPO, was feasible in chronic stroke.

Video Abstract: Available for more insights from the authors (Supplemental Digital Content, Video, available at: http://links.lww.com/JNPT/A474).
Tubulocystic Carcinoma of Bile Ducts
Authors: Masetto Francesca , Mafficini Andrea , Saka Burcu , Armutlu Ayse , Chatterjee Deyali , Jang Kee-Taek , Zen Yoh , Navale Pooja , Fassan Matteo , Bacchi Carlos E. , Mattiolo Paola , Simbolo Michele , Ruzzenente Andrea , Lawlor Rita T. , Reid Michelle , Basturk Olca , Adsay Volkan , Scarpa Aldo , Luchini Claudio
Published: July 2024

A type of cholangiocarcinoma (CCA) characterized by peculiar histologic patterns and underlying adenofibromatous lesions has been reported in the literature mostly as individual case reports. This study aims to further clarify the defining characteristics of this spectrum of lesions. Clinicopathologic analysis of 8 biliary tumors with tubulocystic architecture arising in the background of adenofibroma-type lesions was performed. Three of these were also investigated with next-generation sequencing with a 174 genes panel. The patients were 5 males and 3 females, with a mean age of 64.6. All tumors were intrahepatic except for one perihilar that protruded into soft tissues. The mean size was 4.4 cm. At histology, all cases showed a peculiar and cytologically bland tubulocystic pattern that closely resembled tubulocystic-type kidney cancers, including back-to-back microcystic units that formed relatively demarcated nodules, and occurring in the background of adenofibromatous lesions. One case showed perineural invasion by otherwise deceptively benign-appearing microcystic structures, one had areas transitioning to intraductal tubulopapillary neoplasm, and 3 cases harbored more conventional small-duct CCA foci. In those 3 cases, both the tubulocystic and conventional CCA components were investigated by next-generation sequencing separately, and they shared the molecular alterations, including recurrent mutations in chromatin remodeling genes, such as ARID1A, BAP1, and PBRM1, and the actionable FGFR2-MCU fusion gene. In the limited follow-up, all but one were alive and free of disease after surgical resection. In conclusion, we described a distinct entity of CCA with specific histo-molecular features, for which we propose the designation of tubulocystic carcinoma of bile ducts.
Evidence of Lactobacillus strains shared between the female urinary and vaginal microbiota
Authors: Atkins Haley , Sabharwal Baani , Boger Leah , Stegman Natalie , Kula Alexander , Wolfe Alan J. , Banerjee Swarnali , Putonti Catherine
Published: July 2024

Lactobacillus species are common inhabitants of the ‘healthy’ female urinary and vaginal communities, often associated with a lack of symptoms in both anatomical sites. Given identification by prior studies of similar bacterial species in both communities, it has been hypothesized that the two microbiotas are in fact connected. Here, we carried out whole-genome sequencing of 49 Lactobacillus strains, including 16 paired urogenital samples from the same participant. These strains represent five different Lactobacillus species: L. crispatus, L. gasseri, L. iners, L. jensenii, and L. paragasseri. Average nucleotide identity (ANI), alignment, single-nucleotide polymorphism (SNP), and CRISPR comparisons between strains from the same participant were performed. We conducted simulations of genome assemblies and ANI comparisons and present a statistical method to distinguish between unrelated, related, and identical strains. We found that 50 % of the paired samples have identical strains, evidence that the urinary and vaginal communities are connected. Additionally, we found evidence of strains sharing a common ancestor. These results establish that microbial sharing between the urinary tract and vagina is not limited to uropathogens. Knowledge that these two anatomical sites can share lactobacilli in females can inform future clinical approaches.