bluuebunny/crossref_metadata_2025 huggingface dataset:
Foraging by larval fish: a full stomach is indicative of high performance but random encounters with prey are also important
Authors: Pepin Pierre
Published: March 2024

This study contrasts diet composition patterns of larval fish categorized as strong and weak foragers, identified from quadratic relationships between larval length and the number of prey eaten, for 11 fish species. Two sets of alternative hypotheses test whether strong foragers (1) exhibit precocious behaviour by eating later developmental stages of copepods, and (2) take advantage of random encounters with zooplankton, based on the contrast between the two categories in each 1 mm length-class. Results indicate that strong foragers shift their feeding toward earlier copepod developmental stages, which was most apparent in four flatfish species, and demonstrate stronger overall prey selectivity than weak foragers. Inverse modeling revealed the latter is achieved through increases in apparent prey perception and/or responsiveness to dominant prey types (i.e. nauplii and copepodites) and declines for less frequent prey (e.g. veliger and Cladocera). Foraging strength increased modestly with larger eye diameter and mouth gape. Two possible explanations for prey selection patterns are that strong foragers have inherently different capacity to perceive and attack prey, or that after initially eating sufficient large prey to meet metabolic requirements fuller stomachs depend on the ability of larval fish to take advantage of random encounters.
From Genome-wide Association Studies to Functional Variants: ARL14 Cis-regulatory Variants Are Associated With Severe Malaria
Authors: Adjemout Mathieu , Gallardo Frederic , Torres Magali , Thiam Alassane , Mbengue Babacar , Dieye Alioune , Marquet Sandrine , Rihet Pascal
Published: March 2024

Background

Genome-wide association studies have identified several nonfunctional tag single-nucleotide polymorphisms (SNPs) associated with severe malaria. We hypothesized that causal SNPs could play a significant role in severe malaria by altering promoter or enhancer activity. Here, we sought to identify such regulatory SNPs.

Methods

SNPs in linkage disequilibrium with tagSNPs associated with severe malaria were identified and were further annotated using FUMA. Then, SNPs were prioritized using the integrative weighted scoring method to identify regulatory ones. Gene reporter assays were performed to assess the regulatory effect of a region containing candidates. The association between SNPs and severe malaria was assessed using logistic regression models in a Senegalese cohort.

Results

Among 418 SNPs, the best candidates were rs116525449 and rs79644959, which were in full disequilibrium between them, and located within the ARL14 promoter. Our gene reporter assay results revealed that the region containing the SNPs exhibited cell-specific promoter or enhancer activity, while the SNPs influenced promoter activity. We detected an association between severe malaria and those 2 SNPs using the overdominance model and we replicated the association of severe malaria with the tagSNP rs116423146.

Conclusions

We suggest that these SNPs regulate ARL14 expression in immune cells and the presentation of antigens to T lymphocytes, thus influencing severe malaria development.
Predictive maintenance of vehicle fleets through hybrid deep learning-based ensemble methods for industrial IoT datasets
Authors: Chaudhuri Arindam , Ghosh Soumya K
Published: March 2024

Connected vehicle fleets have formed significant component of industrial internet of things scenarios as part of Industry 4.0 worldwide. The number of vehicles in these fleets has grown at a steady pace. The vehicles monitoring with machine learning algorithms has significantly improved maintenance activities. Predictive maintenance potential has increased where machines are controlled through networked smart devices. Here, benefits are accrued considering uptimes optimization. This has resulted in reduction of associated time and labor costs. It has also provided significant increase in cost benefit ratios. Considering vehicle fault trends in this research predictive maintenance problem is addressed through hybrid deep learning-based ensemble method (HDLEM). The ensemble framework which acts as predictive analytics engine comprises of three deep learning algorithms viz modified cox proportional hazard deep learning (MCoxPHDL), modified deep learning embedded semi supervised learning (MDLeSSL) and merged LSTM (MLSTM) networks. Both sensor as well as historical maintenance data are collected and prepared using benchmarking methods for HDLEM training and testing. Here, times between failures (TBF) modeling and prediction on multi-source data are successfully achieved. The results obtained are compared with stated deep learning models. This ensemble framework offers great potential towards achieving more profitable, efficient and sustainable vehicle fleet management solutions. This helps better telematics data implementation which ensures preventative management towards desired solution. The ensemble method's superiority is highlighted through several experimental results.
A novel memetic algorithm for solving the generalized traveling salesman problem
Authors: Cosma Ovidiu , Pop Petrică C , Cosma Laura
Published: March 2024

This paper investigates the Generalized Traveling Salesman Problem (GTSP), which is an extension of the well-known Traveling Salesman Problem (TSP), and it searches for an optimal tour in a clustered graph, such that every cluster is visited exactly once. In this paper, we describe a novel Memetic Algorithm (MA) for solving efficiently the GTSP. Our proposed MA has at its core a genetic algorithm (GA), completed by a Chromosome Enhancement Procedure (CEP), which is based on a TSP solver and the Shortest Path (SP) algorithm and for improving the convergence characteristics of the GA, a Local Search (LS) operation is applied for the best chromosomes in each generation. We tested our algorithm on a set of well-known instances from the literature and the achieved results prove that our novel memetic algorithm is highly competitive against the existing solution approaches from the specialized literature.
Recurrent variational autoencoder approach for remaining useful life estimation
Authors: Costa Nahuel , Sánchez Luciano
Published: March 2024

A new method for evaluating aircraft engine monitoring data is proposed. Commonly, prognostics and health management systems use knowledge of the degradation processes of certain engine components together with professional expert opinion to predict the Remaining Useful Life (RUL). New data-driven approaches have emerged to provide accurate diagnostics without relying on such costly processes. However, most of them lack an explanatory component to understand model learning and/or the nature of the data. A solution based on a novel recurrent version of a VAE is proposed in this paper to overcome this gap. The latent space learned by the model, trained with data from sensors placed in different parts of these engines, is exploited to build a self-explanatory map that can visually evaluate the rate of deterioration of the engines. Besides, a simple regressor model is built on top of the learned features of the encoder in order to numerically predict the RUL. As a result, remarkable prognostic accuracy is achieved, outperforming most of the novel and state-of-the-art approaches on the available modular aero-propulsion system simulation data (C-MAPSS dataset) from NASA. In addition, a practical real-world application is included for Turbofan engine data. This study shows that the proposed prognostic and explainable framework presents a promising new approach.
Psychopathology and Metaphysics: Can One Be a Realist About Mental Disorder?
Authors: Iliadi Simoni
Published: March 2024

Metaphysical realism about mental disorder is the thesis that mental disorder exists mind-independently. There are two ways to challenge metaphysical realism about mental disorder. The first is by denying that mental disorder exists. The second is by denying that mental disorder exists mind-independently. Or, differently put, by arguing that mental disorder is mind-dependent. The aim of this paper is three-fold: (a) to examine three ways in which mental disorder can be said to be mind-dependent (namely, by being causally dependent on the human mind, by being weakly dependent on human attitudes, and by being strongly dependent on human attitudes), (b) to clarify their differences, and (c) to discuss their implications regarding metaphysical realism about mental disorder. I argue that mental disorder being mind-dependent in the first two senses is compatible with metaphysical realism about mental disorder, whereas mental disorder being mind-dependent in the third sense is not.
(O-05) ESTRADIOL LEVELS IN MEXICAN MEN WITH ERECTILE DYSFUNCTION
Authors: Jiménez J , Rodríguez S , Sandoval C
Published: March 2024

Introduction and Objective

Erectile dysfunction is associated with various psychological and physiological causes, including hormone levels such as testosterone. The role of estradiol in male sexual function is controversial, and studies reporting its impact on erectile function have been inconsistent. The aim of this study was to describe the levels of testosterone and estradiol in Mexican men with erectile dysfunction, based on the severity of dysfunction.

Materials and Methods

Hormonal levels of TSH, T3, T4, LH, FSH, total and free testosterone, and estradiol were measured in men over 18 years of age with erectile dysfunction, attending a clinic in Mexico. Clinical variables were analyzed, estimating measures of central tendency and dispersion for numerical variables, and absolute and relative frequencies for categorical variables. The proportion of men with abnormal levels of estradiol and testosterone was calculated based on the severity of erectile dysfunction.

Results

A total of 70 participants were included. The average age was 53.9 years old (+/- 11.8); 18.5% had severe dysfunction, 65.7% had moderate dysfunction, 14.2% had mild to moderate dysfunction, and 1.4% had mild dysfunction. 35.7% were diabetic, and 34.2% were hypertensive. 62.8% had abnormal levels in at least one of the evaluated hormones: 5.7% had low TSH levels; 2.8% had low T3 levels; 1.4% had low T4 levels; 5.7% had low and 7.1% had high total testosterone levels; 12.8% had low and 2.8% had high free testosterone levels; 17.1% had high prolactin levels; 1.4% had low and 10% had high LH levels; 5.7% had high FSH levels. Estradiol level was high in 6 men (8.5%), 1 had mild-moderate and 5 moderate dysfunction; 8 men had low estradiol levels (11.42%), 1 had mild-moderate, 4 moderate and 3 severe dysfunction.

Conclusions

Alteration on the levels of Estradiol was common in the analyzed group of patients with erectile dysfunction, especially in men with moderate dysfunction, observed in 12.8% of them.

Financing

Boston Medical Group.
(O-13) TESTOSTERONE REPLACEMENT THERAPY AND PROSTATE CANCER PROGRESSION IN HYPOGONADAL MEN ON ACTIVE SURVEILLANCE: A RETROSPECTIVE ANALYSIS
Authors: Moreno J , Khera M
Published: March 2024

Introduction

The use of testosterone replacement therapy (TRT) in hypogonadal men with prostate cancer (PC) on active surveillance (AS) has been controversial. However, recent studies have challenged this notion, warranting further investigation. We aim to assess the impact of TRT on PC progression in hypogonadal men on AS.

Methods

We conducted a retrospective chart review using data from a single hospital system between 2009 and 2022. The database included hypogonadal men with PC on AS who underwent TRT. Patients with prior PC treatment were excluded. PSA and total testosterone (TT) levels were recorded at various time points, including before and after TRT initiation. One-way ANOVA was used to analyze mean PSA and TT levels, and PC treatment progression was documented.

Results

A total of 25 men met the inclusion criteria. Mean PSA and TT levels at each time interval showed no significant difference in PSA (P = 0.283), while TT exhibited significant variation (P = 0.0052) throughout the 2-year study period. Mean TT before TRT initiation was 311.39 ng/dL, and after TRT, it increased to 773.04 ng/dL (P = 0.00011). Only one patient (4%) underwent radiation therapy for PC five years after starting TRT.

Conclusions

Initiating TRT in hypogonadal men on AS for PC did not result in a significant change in PSA levels, despite an increase in testosterone. As our database expands, we aim to strengthen the study's statistical power. These findings contribute to the growing evidence supporting the potential viability of TRT in hypogonadal men on AS.

Financing

No conflict.
(O-25) SURGICAL TREATMENT FOR CHRONIC TESTICULAR PAIN: A SYSTEMATIC REVIEW
Authors: de Freitas F C , Sanches M R , Dosatti AdC
Published: March 2024

Introduction and Objetives

Chronic testicular pain (CTP) is defined as 3 months of intermittent or constant testicular pain that is significantly bothersome to the patient. There exist a variety of different surgical treatment options for CTP. They are generally kept as second or even third-line option for persistent cases. This study aims to review and elucidate the literature about surgical treatment for chronic testicular pain.

Methods

We searched Pubmed, Embase and Cochrane for articles evaluating surgical treatments for CTP. Search terms included “orchialgia”, “spermatic cord”, “chronic scrotal pain”, “chronic testicular pain” and “surgery”.

Results

Microsurgical Denervation of the Spermatic Cord (MDSC) is the surgical standard when a procedure is indicated for idiopathic chronic orchialgia unresponsive to conservative therapies. The positive response to spermatic cord block is a predictor of MDSC response. Pain relief after MDSC ranges from 76% to 100%. Ultrasound-guided targeted cryoablation could be used in persistent CTP after MDSC with 75% success rate. Epididymectomy is better indicated for CTP in structural abnormality such as cyst, granuloma or mass, with pain relief reaching 50% to 92%. In case of post-vasectomy pain syndrome, vasectomy reversal and MDSC has an overall success from 50% to 100% and 71% to 81% respectively. Ilioinguinal and genitofemoral peripheral nerve stimulation could be used in persistant CTP, and spinal cord stimulation as well. Orchiectomy can be considered as a last resort in case patients do not respond to other forms of treatment, but do not delivers a 100% relief a pain.

Conclusion

Although it’s variables choices, there is not a gold standard surgical treatment for CTP, representing a challenge for clinicians. Large, controlled trials must be performed to establish strong and reliable evidence for the surgical treatment of CTP.

Financing

No conflict.
(PM-06) A RARE CASE OF SCROTAL URETHROCUTANEOUS FISTULA SECONDARY TO EROSION OF PENILE PROSTHESIS CONNECTOR TUBING
Authors: Garcia S , Santander J , Peña Rodríguez S , Diaz Ritter C , Pomar D , Azuero J , Mogollon M P
Published: March 2024

Objective

The scrotal urethrocutaneous fistula is an uncommon pathology which can lead to serious complications, such as infections, scrotal abscesses, or even Fournier’s gangrene. We present an unusual case of scrotal urethrocutaneous fistula secondary to erosion of a penile prosthesis tubing in a patient with a history of erectile dysfunction.

Case presentation

A 68-year-old patient with no previous comorbidities and a history of prostate adenocarcinoma that was treated with radical prostatectomy + lymphadenectomy, without the need for subsequent adjuvant therapy. He was diagnosed with erectile dysfunction after surgery, refractory to intracavernous therapy therefore required a 3-component penile implant placement procedure performed extra-institutionally. Two years after the surgery, he consulted with our institution for scrotal pain and urine leak from the scrotum during micturition. Physical examination shows extrusion of prosthesis tubes in the scrotal area with no signs of infection or exposure of the cylinders. The patient was hospitalized for management with antibiotics and to replace the penile implant.

A retrograde urethrography with contrast medium was performed during surgery. Fluoroscopy showed a fistulous pathway between the penile urethra and the scrotum. No passage of the contrast to the corpora cavernosa was seen. The urethral lesion and fistula were identified and repaired. A malleable prosthesis was used, considering the amount of scar tissue. The patient had an adequate postoperative period. A urethral catheter and a cystotomy were used for six weeks. After catheter removal, a voiding cystogram was performed, finding no fistulas. The patient was followed for 11 months with no complications.

Conclusion

Although scrotal urethrocutaneous fistulas are an infrequent complication after penile prosthesis implantation, a timely diagnosis is essential for conservative treatment and to avoid life-threatening complications.

Financing

No conflict.
Commercial Tobacco Endgame Goals: Early Experiences From Six Countries
Authors: Nip Janine , Thornley Louise , Schwartz Robert , Cunningham Rob , Hara Mervi , Clancy Luke , Evans David , Howell Fenton , Duffy Sheila , Gilljam Hans , Edwards Richard
Published: March 2024

Introduction

Tobacco use is a major threat to health globally. A number of countries have adopted “endgame goals” to minimize smoking prevalence. The INSPIRED project aims to describe and compare the experiences of the first six countries to adopt an endgame goal.

Aims and Methods

Data were collected on the initial experiences of endgame goals in Canada, Finland, Ireland, New Zealand (Aotearoa), Scotland, and Sweden up to 2018. Information was collated on the nature of the endgame goals, associated interventions and strategies, potential enablers and barriers, and perceived advantages and disadvantages.

Results

The INSPIRED countries had relatively low smoking prevalences and moderate-to-strong smoke-free policies. Their endgame goals aimed for smoking prevalences of 5% or less. Target dates ranged from 2025 to 2035. Except for New Zealand (Aotearoa), all countries had an action plan to support their goal by 2018. However, none of the plans incorporated specific endgame measures. Lack of progress in reducing inequities was a key concern, despite the consideration of equity in all of the country’s goals and/or action plans. Experience with endgame goals was generally positive; however, participants thought additional interventions would be required to equitably meet their endgame goal.

Conclusions

There was variation in the nature and approach to endgame goals. This suggests that countries should consider adopting endgame goals and strategies to suit their social, cultural, and political contexts. The experiences of the INSPIRED countries suggest that further and more significant interventions will be required for the timely and equitable achievement of endgame goals.

Implications

By 2018, six countries (Canada, Finland, Ireland, New Zealand (Aotearoa), Scotland, and Sweden) had introduced government-endorsed “endgame goals,” to rapidly reduce smoking prevalence to very low levels by a specified date. The nature and implementation of endgame goals were variable. Early experiences with the goals were generally positive, but progress in reducing smoking prevalence was insufficient, particularly for priority groups. This finding suggests more significant interventions (“endgame interventions”) and measures to reduce inequities need to be implemented to achieve endgame goals. Variation in the nature and experience of endgame goals demonstrates the importance of designing endgame strategies that suit distinct social, cultural, and political contexts.
Ecology and Colonialism in Late Chosŏn Korea: Ullŭngdo, 1882–1905
Authors: Sack Will
Published: March 2024

In the late nineteenth century, the Chosŏn state, which ruled the Korean peninsula from 1392 to 1910, moved settlers, animals and crops to the isolated oceanic island (do) of Ullŭng, displacing or killing the indigenous people, animals and possibly plant species living there. Having first sent observers to investigate Japanese settler colonialism in Hokkaido, the Chosŏn court accurately replicated its institutions and their impact during its settlement of Ullŭngdo. Documents from the settlement also mention non-Korean islanders uprooted by the state. Their presence shaped these events and the Chosŏn court’s policies, but the nature of their lives is now beyond reconstruction. Although the settlement of Ullŭngdo employed institutions and policies characteristic of settler colonialism, the lack of a self-identifying indigenous people, either at the time or surviving today, complicates the application to this case of the term ‘settler colonialism’. This offers an opportunity to discuss nationalizing settler colonialisms because, unlike the iconic settler colonies of North America and Oceania, settler colonialism in late Chosŏn Korea violently integrated outsiders into the emerging nation.
Dynamic relationships among pathways producing hydrocarbons and fatty acids of maize silk cuticular waxes
Authors: Chen Keting , Alexander Liza E , Mahgoub Umnia , Okazaki Yozo , Higashi Yasuhiro , Perera Ann M , Showman Lucas J , Loneman Derek , Dennison Tesia S , Lopez Miriam , Claussen Reid , Peddicord Layton , Saito Kazuki , Lauter Nick , Dorman Karin S , Nikolau Basil J , Yandeau-Nelson Marna D
Published: March 2024

The hydrophobic cuticle is the first line of defense between aerial portions of plants and the external environment. On maize (Zea mays L.) silks, the cuticular cutin matrix is infused with cuticular waxes, consisting of a homologous series of very long-chain fatty acids (VLCFAs), aldehydes, and hydrocarbons. Together with VLC fatty-acyl-CoAs (VLCFA-CoAs), these metabolites serve as precursors, intermediates, and end-products of the cuticular wax biosynthetic pathway. To deconvolute the potentially confounding impacts of the change in silk microenvironment and silk development on this pathway, we profiled cuticular waxes on the silks of the inbreds B73 and Mo17, and their reciprocal hybrids. Multivariate interrogation of these metabolite abundance data demonstrates that VLCFA-CoAs and total free VLCFAs are positively correlated with the cuticular wax metabolome, and this metabolome is primarily affected by changes in the silk microenvironment and plant genotype. Moreover, the genotype effect on the pathway explains the increased accumulation of cuticular hydrocarbons with a concomitant reduction in cuticular VLCFA accumulation on B73 silks, suggesting that the conversion of VLCFA-CoAs to hydrocarbons is more effective in B73 than Mo17. Statistical modeling of the ratios between cuticular hydrocarbons and cuticular VLCFAs reveals a significant role of precursor chain length in determining this ratio. This study establishes the complexity of the product–precursor relationships within the silk cuticular wax-producing network by dissecting both the impact of genotype and the allocation of VLCFA-CoA precursors to different biological processes and demonstrates that longer chain VLCFA-CoAs are preferentially utilized for hydrocarbon biosynthesis.
A wave of specific transcript and protein accumulation accompanies pollen dehydration
Authors: Sze Heven , Klodová Božena , Ward John M , Harper Jeffrey F , Palanivelu Ravishankar , Johnson Mark A , Honys David
Published: March 2024

In flowering plants, male gametes are immotile and carried by dry pollen grains to the female organ. Dehydrated pollen is thought to withstand abiotic stress when grains are dispersed from the anther to the pistil, after which sperm cells are delivered via pollen tube growth for fertilization and seed set. Yet, the underlying molecular changes accompanying dehydration and the impact on pollen development are poorly understood. To gain a systems perspective, we analyzed published transcriptomes and proteomes of developing Arabidopsis thaliana pollen. Waves of transcripts are evident as microspores develop to bicellular, tricellular, and mature pollen. Between the “early”- and “late”-pollen-expressed genes, an unrecognized cluster of transcripts accumulated, including those encoding late-embryogenesis abundant (LEA), desiccation-related protein, transporters, lipid-droplet associated proteins, pectin modifiers, cysteine-rich proteins, and mRNA-binding proteins. Results suggest dehydration onset initiates after bicellular pollen is formed. Proteins accumulating in mature pollen like ribosomal proteins, initiation factors, and chaperones are likely components of mRNA-protein condensates resembling “stress” granules. Our analysis has revealed many new transcripts and proteins that accompany dehydration in developing pollen. Together with published functional studies, our results point to multiple processes, including (1) protect developing pollen from hyperosmotic stress, (2) remodel the endomembrane system and walls, (3) maintain energy metabolism, (4) stabilize presynthesized mRNA and proteins in condensates of dry pollen, and (5) equip pollen for compatibility determination at the stigma and for recovery at rehydration. These findings offer novel models and molecular candidates to further determine the mechanistic basis of dehydration and desiccation tolerance in plants.
Ideational robustness of economic ideas in action: the case of European Union economic governance through a decade of crisis
Authors: Carstensen Martin B , Schmidt Vivien A
Published: March 2024

Is it possible to develop a robust crisis management response in a system where governance is characterized by coercive power and adversarial bargaining rather than the diversity, inclusion, and openness highlighted by extant scholarship as conducive factors for robustness? Using two instances of crisis in the European Union—the Eurozone crisis (2010‒2015) and COVID-19 pandemic (2020‒2022)—the paper argues that how actors reinterpret existing rules and institutions offers an important source of robustness in crisis management. Based on the employment of a disaggregation of robustness into degrees of robustness, as well as the concepts of ideational and institutional power, we show how actors can counter the coercive power of dominant coalitions and open up for rule adaptation through reinterpretations of existing rules that, at least in the short term, can solidify the functioning of existing institutions faced by turbulence. In the context of the Eurozone crisis, ideational and institutional power thus enabled a moderately robust response without treaty reform. In the case of the pandemic, it was possible to convince (particularly German) policymakers of the need to employ new ideas about common debt. This meant less need to employ ideational and institutional power by other actors, leading to significantly more effective crisis management than in the Eurozone crisis, what the paper terms maximal robustness.
Dynamic Demand Estimation in Auction Markets
Authors: Backus Matthew , Lewis Greg
Published: March 2024

We study demand estimation in a large auction market. In our model, a dynamically evolving population of buyers with unit demand and heterogeneous and privately known preferences for a finite set of differentiated products compete in a sequence of auctions that occur in discrete time. We define an empirically tractable equilibrium concept in which bidders behave as though they are competing with the stationary distribution of opposing bids, characterize bidding strategies, and prove existence of equilibrium. Having developed this demand system, we prove that it is non-parametrically identified from panel data. We extend the model to consider a random coefficients demand system akin to workhorse demand models in industrial organization, and show that this too is non-parametrically identified. We apply the model to estimate demand and show how large sellers can exercise market power by using persistent reserve price policies, which induce higher bids and, therefore, revenues. Our analysis highlights the importance of both dynamic bidding strategies and panel data sample selection issues when analysing these markets.
The concept and necessity of ‘control’ in the use of emerging technologies in commercial transactions
Authors: Gabriel Henry Deeb
Published: March 2024

An understanding of the concept of ‘control’ is essential to understand recent developments in commercial law. This article charts the history of ‘control’, the need for this concept in contemporary commercial law, why ‘control’ is not the electronic equivalent of ‘possession’, and the necessary recent and future developments of this concept.
Association of Personality Traits With the Efficacy of Stress Management Interventions for Medical Students Taking Objective Structured Clinical Examinations
Authors: Le Saux Olivia , Canada Brice , Debarnot Ursula , Haouhache Nour El Houda , Lehot Jean Jacques , Binay Marion , Cortet Marion , Rimmelé Thomas , Duclos Antoine , Rode Gilles , Lilot Marc , Schlatter Sophie
Published: March 2024

Purpose

Personality traits are associated with psychophysiological stress, but few studies focus on medical students. This study aimed to better understand the association of personality traits with the efficacy of stress management interventions for medical students.

Method

A randomized controlled trial was conducted with fourth-year students who took the objective structured clinical examination at Bernard University Lyon 1 in December 2021. Students were randomized in cardiac biofeedback, mindfulness, and control groups. Each intervention was implemented for 6 minutes before the examination. Physiological stress levels were collected during the intervention. Psychological stress levels were rated by students at baseline and after the intervention. Personality traits were assessed via the Big-Five Inventory. Interactions between personality traits and the efficacy of the interventions were analyzed using multivariable linear regression models.

Results

Four hundred eighty-one students participated. Higher baseline psychological stress levels were associated with higher neuroticism and agreeableness (β = 10.27 [95% confidence interval {CI}, 7.40–13.13; P < .001] and β = 3.42 [95% CI, 0.98–5.85; P = .006], respectively) and lower openness (β = −4.95; 95% CI, −7.40 to −2.49; P < .001). As compared with the control intervention, both stress management interventions led to lower levels of psychological (P < .001 for both) and physiological stress levels (biofeedback: P < .001 and mindfulness: P = .009). Biofeedback efficacy varied by extraversion score for psychological (β = −5.66; 95% CI, −10.83 to −0.50; P = .03) and physiological stress reduction (β = −0.002; 95% CI, −0.003 to −0.00004; P = .045). Mindfulness efficacy varied by agreeableness score for psychological stress reduction (β = −7.87; 95% CI, −13.05 to −2.68; P = .003).

Conclusions

Students with a high score in extraversion may benefit more from biofeedback interventions, while students with high scores in agreeableness may benefit more from mindfulness interventions.
Long-Term Outcomes of Robotic Versus Laparoscopic Total Mesorectal Excisions: A Propensity-Score Matched Cohort study of 5-year survival outcomes
Authors: Duhoky Rauand , Rutgers Marieke L. W. , Burghgraef Thijs A. , Stefan Samuel , Masum Shamsul , Piozzi Guglielmo N. , Sagias Filippos , Khan Jim S.
Published: March 2024

Objective:

To compare long-term outcomes between laparoscopic and robotic total mesorectal excisions (TMEs) for rectal cancer in a tertiary center.

Background:

Laparoscopic rectal cancer surgery has comparable long-term outcomes to the open approach, with several advantages in short-term outcomes. However, it has significant technical limitations, which the robotic approach aims to overcome.

Methods:

We included patients undergoing laparoscopic and robotic TME surgery between 2013 and 2021. The groups were compared after propensity-score matching. The primary outcome was 5-year overall survival (OS). Secondary outcomes were local recurrence (LR), distant recurrence (DR), disease-free survival (DFS), and short-term surgical and patient-related outcomes.

Results:

A total of 594 patients were included, and after propensity-score matching 215 patients remained in each group. There was a significant difference in 5-year OS (72.4% for laparoscopy vs 81.7% for robotic, P = 0.029), but no difference in 5-year LR (4.7% vs 5.2%, P = 0.850), DR (16.9% vs 13.5%, P = 0.390), or DFS (63.9% vs 74.4%, P = 0.086). The robotic group had significantly less conversion (3.7% vs 0.5%, P = 0.046), shorter length of stay [7.0 (6.0–13.0) vs 6.0 (4.0–8.0), P < 0.001), and less postoperative complications (63.5% vs 50.7%, P = 0.010).

Conclusions:

This study shows a correlation between higher 5-year OS and comparable long-term oncological outcomes for robotic TME surgery compared to the laparoscopic approach. Furthermore, lower conversion rates, a shorter length of stay, and a less minor postoperative complications were observed. Robotic rectal cancer surgery is a safe and favorable alternative to the traditional approaches.
Prediction of the Labrum Shape in Patients With Developmental Dysplasia of the Hip Based on Pelvic Radiography
Authors: Huang Xinyan , Cheng Xiang , Gao Sijie , Liu Yinxin , Su Yuxi , Feng Chuan
Published: March 2024

Background:

The shape of the labrum is strongly correlated with outcomes of developmental dysplasia of the hip (DDH). Magnetic resonance imaging (MRI) is the generally preferred imaging technique for observing the labrum.

Purpose:

We aimed to find a correlation between the labrum shape and anterior–posterior (AP) pelvic measurements in children with DDH.

Methods:

Preoperative AP pelvic x-ray radiographs and MRI of patients with DDH from January 2019 to December 2021 were retrospectively collected and divided into three groups by labrum shape on MRI: everted, partly inverted, and inverted. The acetabular length ratio (RAL) in patients with unilateral DDH and the ratio of acetabular length to interpedicular distance (RALI) in all patients were calculated. T-tests were used to analyze differences between the groups. Receiver operating characteristic curve (ROC) analysis was performed between the everted group and the partly inverted and inverted groups.

Results:

We found significant differences in RAL between the everted and partly inverted groups, everted and inverted groups, and everted and combined groups. The ROC analysis showed that the best cutoff value for RAL was 0.945 between the everted and combined groups, with an area under the curve (AUC) of 88.4%. The sensitivity at the best RAL value was 0.783, and the specificity was 0.887. Moreover, we observed a significant difference in RALI between the everted, partly inverted, and inverted groups, as well as between the everted and combined groups. The optimal cutoff value for RALI between the everted and combined groups was 0.575, with an AUC of 74.5%. The sensitivity at the best RALI value was 0.765, and the specificity was 0.674.

Conclusion:

The RAL or RALI values on pelvic AP radiographs can be used to predict the shape of the labrum.

Level of Evidence:

III.
Fulminant Myocarditis Complicated by Stiff-person Syndrome: A Case Report
Authors: Chen Peng , Tang Nana , Zhang Huilan , Wang Dao Wen
Published: March 2024

This case report described a 61-year-old woman who presented with dizziness, headache, muscle ache, diplopia, and vomiting who lost consciousness. Upon hospital admission, the levels of high-sensitivity cardiac troponin I and partial pressure of carbon dioxide were increased markedly. Loss of consciousness occurred twice after removal of invasive ventilator support. Coronary angiography demonstrated no stenosis in coronary arteries. Ultrasonography revealed inactivity of respiratory muscles. Oculomotor disturbance and autonomic-nerve dysfunctions were observed. Serum antibody against glutamic acid decarboxylase was positive. The rare phenotypes of persistent stiffness of muscles in the neck, face, bilateral upper and lower limbs were observed. The patient was diagnosed with fulminant myocarditis complicated by Stiff-person syndrome. Immunomodulatory treatment (glucocorticoids and immunoglobulins) elicited satisfactory therapeutic effects. In this case report, it was found that fulminant myocarditis and Stiff-person syndrome shared a common pathogenesis: “cytokine storm”. Such patients may benefit from early treatment with immunomodulatory agents.
Novel proteomic signatures may indicate MRI-assessed intrahepatic fat state and changes: The DIRECT PLUS clinical trial
Authors: Goldberg Dana T. , Yaskolka Meir Anat , Tsaban Gal , Rinott Ehud , Kaplan Alon , Zelicha Hila , Klöting Nora , Ceglarek Uta , Iserman Berend , Shelef Ilan , Rosen Philip , Blüher Matthias , Stumvoll Michael , Etzion Ohad , Stampfer Meir J. , Hu Frank B. , Shai Iris
Published: March 2024

Background and Aims:

We demonstrated in the randomized 18-month DIRECT PLUS trial (n = 294) that a Mediterranean (MED) diet, supplemented with polyphenol-rich Mankai duckweed, green tea, and walnuts and restricted in red/processed meat, caused substantial intrahepatic fat (IHF%) loss compared with 2 other healthy diets, reducing NAFLD by half, regardless of similar weight loss. Here, we investigated the baseline proteomic profile associated with IHF% and the changes in proteomics associated with IHF% changes induced by lifestyle intervention.

Approach and Results:

We calculated IHF% by proton magnetic resonance spectroscopy (normal IHF% <5% and abnormal IHF% ≥5%). We assayed baseline and 18-month samples for 95 proteomic biomarkers.Participants (age = 51.3 ± 10.8 y; 89% men; and body mass index = 31.3 ± 3.9 kg/m2) had an 89.8% 18-month retention rate; 83% had eligible follow-up proteomics measurements, and 78% had follow-up proton magnetic resonance spectroscopy. At baseline, 39 candidate proteins were significantly associated with IHF% (false discovery rate <0.05), mostly related to immune function pathways (eg, hydroxyacid oxidase 1). An IHF% prediction based on the DIRECT PLUS by combined model (R
2 = 0.47, root mean square error = 1.05) successfully predicted IHF% (R
2 = 0.53) during testing and was stronger than separately inputting proteins/traditional markers (R
2 = 0.43/0.44). The 18-month lifestyle intervention induced changes in 18 of the 39 candidate proteins, which were significantly associated with IHF% change, with proteins related to metabolism, extracellular matrix remodeling, and immune function pathways. Thrombospondin-2 protein change was higher in the green-MED compared to the MED group, beyond weight and IHF% loss (p = 0.01). Protein principal component analysis revealed differences in the third principal component time distinct interactions across abnormal/normal IHF% trajectory combinations; p < 0.05 for all).

Conclusions:

Our findings suggest novel proteomic signatures that may indicate MRI-assessed IHF state and changes during lifestyle intervention. Specifically, carbonic anhydrase 5A, hydroxyacid oxidase 1, and thrombospondin-2 protein changes are independently associated with IHF% change, and thrombospondin-2 protein change is greater in the green-MED/high polyphenols diet.
Comprehensive molecular classification predicted microenvironment profiles and therapy response for HCC
Authors: Chen Yihong , Deng Xiangying , Li Yin , Han Ying , Peng Yinghui , Wu Wantao , Wang Xinwen , Ma Jiayao , Hu Erya , Zhou Xin , Shen Edward , Zeng Shan , Cai Changjing , Qin Yiming , Shen Hong
Published: March 2024

Background and Aims:

Tumor microenvironment (TME) heterogeneity leads to a discrepancy in survival prognosis and clinical treatment response for patients with HCC. The clinical applications of documented molecular subtypes are constrained by several issues.

Approach and Results:

We integrated 3 single-cell data sets to describe the TME landscape and identified 6 prognosis-related cell subclusters. Unsupervised clustering of subcluster-specific markers was performed to generate transcriptomic subtypes. The predictive value of these molecular subtypes for prognosis and treatment response was explored in multiple external HCC cohorts and the Xiangya HCC cohort. TME features were estimated using single-cell immune repertoire sequencing, mass cytometry, and multiplex immunofluorescence. The prognosis-related score was constructed based on a machine-learning algorithm. Comprehensive single-cell analysis described TME heterogeneity in HCC. The 5 transcriptomic subtypes possessed different clinical prognoses, stemness characteristics, immune landscapes, and therapeutic responses. Class 1 exhibited an inflamed phenotype with better clinical outcomes, while classes 2 and 4 were characterized by a lack of T-cell infiltration. Classes 5 and 3 indicated an inhibitory tumor immune microenvironment. Analysis of multiple therapeutic cohorts suggested that classes 5 and 3 were sensitive to immune checkpoint blockade and targeted therapy, whereas classes 1 and 2 were more responsive to transcatheter arterial chemoembolization treatment. Class 4 displayed resistance to all conventional HCC therapies. Four potential therapeutic agents and 4 targets were further identified for high prognosis-related score patients with HCC.

Conclusions:

Our study generated a clinically valid molecular classification to guide precision medicine in patients with HCC.
Quality measures in pre-liver transplant care by the Practice Metrics Committee of the American Association for the Study of Liver Diseases
Authors: Brahmania Mayur , Kuo Alexander , Tapper Elliot B. , Volk Michael L. , Vittorio Jennifer M. , Ghabril Marwan , Morgan Timothy R. , Kanwal Fasiha , Parikh Neehar D. , Martin Paul , Mehta Shivang , Winder Gerald Scott , Im Gene Y. , Goldberg David , Lai Jennifer C. , Duarte-Rojo Andres , Paredes Angelo H. , Patel Arpan A. , Sahota Amandeep , McElroy Lisa M. , Thomas Charlie , Wall Anji E. , Malinis Maricar , Aslam Saima , Simonetto Douglas A. , Ufere Nneka N. , Ramakrishnan Sudha , Flynn Mary Margaret , Ibrahim Yasmin , Asrani Sumeet K. , Serper Marina
Published: March 2024

The liver transplantation (LT) evaluation and waitlisting process is subject to variations in care that can impede quality. The American Association for the Study of Liver Diseases (AASLD) Practice Metrics Committee (PMC) developed quality measures and patient-reported experience measures along the continuum of pre-LT care to reduce care variation and guide patient-centered care. Following a systematic literature review, candidate pre-LT measures were grouped into 4 phases of care: referral, evaluation and waitlisting, waitlist management, and organ acceptance. A modified Delphi panel with content expertise in hepatology, transplant surgery, psychiatry, transplant infectious disease, palliative care, and social work selected the final set. Candidate patient-reported experience measures spanned domains of cognitive health, emotional health, social well-being, and understanding the LT process. Of the 71 candidate measures, 41 were selected: 9 for referral; 20 for evaluation and waitlisting; 7 for waitlist management; and 5 for organ acceptance. A total of 14 were related to structure, 17 were process measures, and 10 were outcome measures that focused on elements not typically measured in routine care. Among the patient-reported experience measures, candidates of LT rated items from understanding the LT process domain as the most important. The proposed pre-LT measures provide a framework for quality improvement and care standardization among candidates of LT. Select measures apply to various stakeholders such as referring practitioners in the community and LT centers. Clinically meaningful measures that are distinct from those used for regulatory transplant reporting may facilitate local quality improvement initiatives to improve access and quality of care.
Determinants of Type-Specific Human Papillomavirus Concordance Across Anatomic Sites in Young Men Who Have Sex With Men and Transgender Women, 3 U.S. Cities, 2016–2018
Authors: Shah Adeel , Meites Elissa , Lin John , Hughes James P. , Gorbach Pamina M. , Mustanski Brian , Crosby Richard A. , Unger Elizabeth R. , Querec Troy , Golden Matthew , Markowitz Lauri E. , Winer Rachel L.
Published: March 2024

Background

Among men who have sex with men (MSM) and transgender women (TGW), the dynamics of human papillomavirus (HPV) infections at different anatomical sites are not well understood. Information on HPV concordance between anatomic sites can inform the extent of autoinoculation, and susceptibility of different anatomic areas to HPV infection. We described and assessed correlates of HPV concordance across anal, oral, and genital samples.

Methods

We enrolled 1876 MSM and TGW aged 18 to 26 years in 3 US cities. Oral, genital, and anal samples were self-collected for type-specific HPV DNA testing (37 types). Demographics, sexual behaviors, and health history were self-reported. Kappa statistics based on percent positive agreement (kappa+) and generalized estimating equations were used to describe and identify correlates of HPV type-specific concordance between anatomic sample pairs.

Results

Any HPV was detected in 69.9%, 48.6%, and 7.4% of anal, genital, and oral samples, respectively. Detection of any HPV (concurrence) was most common in anal-genital pairs (40.9%) and uncommon in oral-genital and oral-anal pairs (3.4% and 6.5% respectively). Type-specific concordance was poor across all sample pairs (kappa+ <0.20). Younger age and older age at first sex were positively associated with type-concordant anal-genital infections. Sexual behaviors were unassociated with concordance.

Conclusions

Poor oral/anogenital concordance suggests the oral mucosa has different susceptibility to HPV infection, differential clearance and/or autoinoculation between oral and anogenital sites is unlikely. There was some observed concurrence and concordance between anal and genital sites, unassociated with sexual behavior, suggesting autoinoculation. Longitudinal studies are necessary to further elucidate mechanisms of multisite infections.
Behavioral economic incentives to support HIV care: Results from a randomized controlled trial in Uganda
Authors: Linnemayr Sebastian , Wagner Zachary , Saya Uzaib Y. , Stecher Chad , Lunkuse Lillian , Wabukala Peter , Odiit Mary , Mukasa Barbara
Published: March 2024

Background:

This study tests behavioral economics incentives to improve adherence to antiretroviral treatment (ART), with one approach being low-cost.

Setting:

329 adults at Mildmay Hospital in Kampala, Uganda on ART for at least two years and showing adherence problems received the intervention for about 15 months until the study was interrupted by a nation-wide COVID-19 lockdown.

Methods:

We randomized participants into one of three (1:1:1) groups: usual care (‘control’ group; n=109) or one of two intervention groups where eligibility for non-monetary prizes was based on: showing at least 90% electronically measured ART adherence (‘adherence-linked’ group, n=111); or keeping clinic appointments as scheduled (‘clinic-linked’; n=109). After 12 months, participants could win a larger prize for consistently high adherence or viral suppression. Primary outcomes were mean adherence and viral suppression. Analysis was by intention-to-treat using linear regression. This trial is registered with ClinicalTrials.gov, NCT03494777.

Results:

Neither incentive arm increased adherence compared to the control; we estimate a 3.9 percentage point increase in ‘adherence-linked’ arm [95% CI -0.70 to 8.60 (p=0.10)], and 0.024 in the ‘clinic-linked’ arm [95% CI -0.02 to 0.07 (p=0.28)]. For the prespecified subgroup of those with initial low adherence, incentives increased adherence by 7.60 percentage points (95% CI 0.01, 0.15; p=0.04, ‘adherence-linked’) and 5.60 percentage points (95% CI -0.01, 0.12; p=0.10, ‘clinic-linked’). We find no effects on clinic attendance or viral suppression.

Conclusions:

Incentives did not improve viral suppression or ART adherence overall but worked for the pre-specified subgroup of those with initial low adherence. More effectively identifying those in need of adherence support will allow better targeting of this and other incentive interventions.