bluuebunny/crossref_metadata_2025 huggingface dataset:
Detection of the Pin Defects of Power Transmission Lines Based on Improved TPH-MobileNetv3
Authors: Li Mengxuan , Han Jingshan , Yang Zhi , Zhao Bin , Liu Peng
Published: May 2023

Pins are essential connecting components in power transmission lines. Their extensive use yet leads to frequent defects. Given the small size of a pin and many similar components, the detection of such defects is not ideal, which is a technological problem in the identification and diagnosis of power defects. In response to the large size, complex background, and on-site requirements, such as real-time detection, of power transmission lines, this paper proposes a method to detect pin defects based on TPH-MobileNetv3 (Transformer prediction Head Mobilenetv3). This paper modifies and adds a self-attention layer to MobilNetV3-Small to improve the feature extraction capability of small targets after downsampling. A feature fusion structure with layers of self-attention and a convolutional block attention module (CBAM) is added to the neck network, and a transformer prediction head are added to the head network so that different scale characteristics can be fused and focused from space and channels to strengthen the detection of small targets. Compared with the traditional MobileNetV3, the detection accuracy of the algorithm in this paper has been raised by 24%, as shown in the detection results of measured data. Moreover, compared with the mainstream algorithms with the same detection accuracy, this algorithm not only reduces the model size and significantly enhances detection efficiency but also satisfies the requirement of edge image processing of power inspection.
Toward Recognition of Easily Confused TCM Herbs on the Smartphone Using Hierarchical Clustering Convolutional Neural Network
Authors: Lan Kun-Chan , Tsai Tzu-Hao , Hu Min-Chun , Weng Juei-Chun , Zhang Jun-Xiang , Chang Yuan-Shiun
Published: May 2023

Background and Objective. The use of Chinese herbal medicines (CHMs) for treatment plays an important role in traditional Chinese medicine (TCM). However, some herbs are easily confused with the others because their shapes/textures look similar and they could have totally different utilities. Recently, deep learning has attracted great attention for the application of image recognition and could be useful for TCM herb identification. Methods. For recognizing easily‐confused TCM herbs on a smartphone, we propose a CHM recognition system using hierarchical clustering convolutional neural networks (HCNNs) based on the affinity propagation clustering method. Results. We implement our system on the smartphone and show recognition accuracy close to 98%, based on a dataset of 65 kinds of herbs (including 12 easy‐confused herbs pairs). We also investigate the effect of different parameters (e.g., selection of clustering algorithms for HCNNs, types of smartphone, and number of layers in the neural network) on the system performance. Conclusions. In this work, we proposed a hierarchical clustering convolutional neural network (HCNN) method to distinguish similar TCM herbs with a high accuracy. We also showed the usefulness of applying the data augmentation techniques when implementing the proposed system for a variety of smartphones.
FIGURE 6 from p35 is a Crucial Player in NK-cell Cytotoxicity and TGFβ-mediated NK-cell Dysfunction
Authors: Wong Derek P. , Fritz Claire E. , Feinberg Daniel , Huang Alex Y. , Parameswaran Reshmi
Published: May 2023

NK92 cells with p35 knockdown or CDK5-K33T overexpression mitigate TGFβ-induced inhibition of cytotoxicity. A, NK92 cells (shGFP or shp35) were cultured for 48 hours in the presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). They were then cocultured with fluorescently-labeled Jeko-1 cells at 5:1 E:T ratio for 16 hours in the continued presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). Cells were stained with PI and gated on labeled cells to measure cancer cell death. Average cytotoxicity percentage is overlaid on the corresponding bar. ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method. B, Supernatant from NK92 cell culture (shGFP or shp35) with or without Jeko cells was collected after 16 hours. Cytokine concentration was determined using a flow-based, multiplex human cytokine release assay. ns, not significant; *, P < 0.05; **, P < 0.01; ***, P < 0.001. Graphs display mean ± SD, n = 3 biological cocultures, multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method. C, NK92 cells (OE ctrl, OE CDK5, OE CDK5-K33T, or OE p35) were cultured for 48 hours in the presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). They were then cocultured with fluorescently-labeled Jeko-1 cells at 5:1 E:T ratio for 16 hours in the continued presence of 2.5 ng/mL TGFβ or PBS (−TGFβ). Cells were stained with PI and gated on labeled cells to measure cancer cell death. Average cytotoxicity percentage is overlaid on the corresponding bar. **, P < 0.01; ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, two-way ANOVA with Tukey multiple comparisons test. D, Supernatant from NK92 cell culture (OE ctrl, OE CDK5, OE CDK5-K33T, or OE p35) with or without Jeko cells was collected after 16 hours. Cytokine concentration was determined using a flow-based, multiplex human cytokine release assay. *, P < 0.05; **, P < 0.01; ***, P < 0.001; ****, P < 0.0001. Graphs display mean ± SD, n = 3 biological cocultures, two-way ANOVA with Tukey multiple comparisons test.
FIGURE 4 from p35 is a Crucial Player in NK-cell Cytotoxicity and TGFβ-mediated NK-cell Dysfunction
Authors: Wong Derek P. , Fritz Claire E. , Feinberg Daniel , Huang Alex Y. , Parameswaran Reshmi
Published: May 2023

Overexpression of kinase-dead CDK5 increases NK92 cytotoxicity while overexpression of p35 decreases cytotoxicity. A, Western blot analysis of protein from NK92 cells overexpressing CDK5 (OE CDK5), kinase-dead mutant CDK5 (OE CDK5-K33T), p35 (OE p35), or empty vector control (OE Ctrl). B, NK92 cells were plated in complete media with a starting count of 250,000 cells. Live cell count was obtained after 48 hours cell culture via trypan blue staining and manual counting on a hemocytometer. ns, not significant. Graphs display mean ± SD, n = 3 biological cultures, one-way ANOVA with Dunnett multiple comparisons test. C, NK92 cells were stained with Annexin V and PI and analyzed via flow cytometry. Percentage of cells staining positive for Annexin V and/or PI were graphed. Graphs display mean ± SD, n = 3 biological cultures. D, NK92 cells were fixed in 70% ethanol and stained with PI, then analyzed via flow cytometry. G0–G1, S, and G2–M phases of the cell cycle are indicated. E, NK92 cells (OE Ctrl, OE CDK5, OE CDK5-K33T) were cocultured with fluorescently-labeled Jeko-1 cells for 16 hours at different E:T ratios, followed by staining with PI and gating on labeled cancer cells to measure cancer cell death via flow cytometry. ****, P < 0.0001. Graph displays mean ± SD, n = 3 biological cocultures, two-way ANOVA with Dunnett multiple comparisons test. F, NK92 cells (OE Ctrl, OE p35) were cocultured with fluorescently-labeled Jeko-1 cells for 16 hours at 5:1 E:T ratio, followed by staining with PI and gating on labeled cancer cells to measure cancer cell death via flow cytometry. *, P < 0.05. Graph displays mean ± SD, n = 3 biological cocultures, unpaired two-tailed t test.
FIGURE 3 from p35 is a Crucial Player in NK-cell Cytotoxicity and TGFβ-mediated NK-cell Dysfunction
Authors: Wong Derek P. , Fritz Claire E. , Feinberg Daniel , Huang Alex Y. , Parameswaran Reshmi
Published: May 2023

Murine NK cells from p35 k/o mice display heightened cytotoxicity. A, Murine splenocytes or bone marrow cells from WT or p35 k/o mice were stained for CD3 and NK1.1 and mixed with counting beads, then analyzed via flow cytometry. Gating on NK1.1+CD3− cells, as well as the counting beads, allowed determination of mNK concentration and the total mNK cell count in each compartment. ns, not significant. Graphs display mean ± SD, n = 3 mice, unpaired two-tailed t test. B, mNK cells were isolated from WT, p35 k/o, or p35 Het mice and cocultured with calcein AM-labeled B16F10 cells at different E:T ratios for 4 hours. Fluorescence intensity of supernatant corresponding to calcein release from dead cells was measured to calculate NK-mediated cytotoxicity. **, P < 0.01. Graphs display mean ± SD, n = 3 biological cocultures (n = 2 for WT 1:1 ratio, p35 k/o 1:1 ratio, and p35 k/o in WT versus p35 Het versus p35 k/o experiment), and multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method (WT vs. p35 k/o) or one-way ANOVA with Tukey multiple comparisons test (WT vs. p35 Het vs. p35 k/o). C, Murine splenocytes or bone marrow cells were stained for CD11b, CD27, CD3, and NK1.1 and analyzed via flow cytometry after gating on NK1.1+CD3− cells. Representative flow plots are shown. Percentages of mNK cells in each subset (CD11b+CD27−, CD11b−CD27+, and CD11b+CD27+) for each mouse were recorded and graphed. ns, not significant. Graphs display mean ± SD, n = 8 mice, multiple unpaired two-tailed t tests with correction for multiple comparisons using Holm-Šídák method. D, Murine splenocytes were stained for CD3, NK1.1, and NKG2D, NKp46, NKG2A, 2B4, LY6C, or LY49C/F/I/H. Representative histograms of activating/inhibitory receptor expression are shown, gated on live NK1.1+CD3− cells. E, Isolated mNK cells pooled from multiple mice were seeded at a concentration of 2e6 cells/mL and cultured ex vivo in RPMI media supplemented with 1,000 U/mL IL2. An additional 1,000 U/mL IL2 was added 2 days later without changing the media, followed by collection of supernatant after culture for an additional 2 days. Cytokine concentration was determined using a flow-based, multiplex murine cytokine release assay. ns, not significant; *, P < 0.05; **, P < 0.01. Graphs display mean ± SD, n = 3 biological cultures, unpaired two-tailed t tests.
Clinical Outcomes of Anticoagulated Patients With Atrial Fibrillation After Falls or Head Injury: Insights From RE-LY
Authors: Caldeira Daniel , Alves da Silva Pedro , Pinto Fausto J.
Published: May 2023

Background:

Falls are always a concern regarding the balance of risk/benefit in patients with atrial fibrillation treated with anticoagulants. In this analysis, we aimed to evaluate the outcomes of patients that had a fall/head injury reported in the RE-LY clinical trial (Randomized Evaluation of Long-Term Anticoagulation Therapy) and to explore the safety of dabigatran (a nonvitamin K antagonist oral anticoagulant).

Methods:

We performed a post hoc retrospective analysis of intracranial hemorrhage and major bleeding outcomes in the RE-LY trial with 18 113 individuals with atrial fibrillation, according to the status occurrence of falls (or head injury) reported as adverse events. Multivariate Cox regression models were used to provide adjusted hazard ratio (HR) and 95% CI.

Results:

In the study, 974 falls or head injury events were reported among 716 patients (4%). These patients were older and had more frequently comorbidities such as diabetes, previous stroke, or coronary artery disease. Patients with fall had a higher risk of major bleeding (HR, 2.41 [95% CI, 1.90–3.05]), intracranial hemorrhage (HR, 1.69 [95% CI, 1.35–2.13]), and mortality (HR, 3.91 [95% CI, 2.51–6.10]) compared to those who did not have reported falls or head injury. Among patients who had falls, those allocated to dabigatran showed a lower intracranial hemorrhage risk (HR, 0.42 [95% CI, 0.18–0.98]) compared with warfarin.

Conclusions:

In this population, the risk of falls is important and confers a worse prognosis, increasing intracranial hemorrhage, and major bleeding. Patients who fell and were under dabigatran was associated with lower intracranial hemorrhage risk than those anticoagulated with warfarin, but the analysis was merely exploratory.
The Territorial Principle as a Basis for State Criminal Jurisdiction: Particularly with Regard to Cross-Border Offences and Attempts, and to Multiple Parties to an Offence Acting in Different Countries
Authors: Payer Andrés
Published: May 2023

The purpose of this article is to explore the scope of the territorial principle under (customary) international law, with a particular focus on cases of cross-border offences and attempts, and multiple parties to an offence acting in different countries. Our analysis will begin with an examination of the foundations and limits of state criminal jurisdiction and the territorial principle in general. In this context, we will also discuss the justification of this principle vis-à-vis other states and its relationship to other jurisdictional principles. In order to determine the pertinent contours of customary international law, we will use an approach that is both inductive and deductive, and, as such, involves the reporting on and analysis of relevant state practice.
Whose ‘Intangible Cultural Heritage’?
Authors: Musapir
Published: May 2023

This article explores the alienating effects of ‘Intangible Cultural Heritage’ (ICH) (Ch.: fei wuzhi wenhua yichan 非物质文化遗产; Uy.: gheyri maddi medeniyet mirasliri) discourse on Uyghur villagers, particularly Uyghur knowledge-holders. Since China became a signatory to UNESCO’s ICH convention in 2004, the ICH framework has provided opportunities for people in China to protect and profit from their heritage. But it has also been used to further Chinese state nation-building in ways that do not meaningfully include the grassroots knowledge and holistic practices of Indigenous communities. In the Xinjiang Uyghur Autonomous Region (XUAR), top-down ICH policies have been implemented in tandem with increasingly repressive security policies and anti-extremism discourse. In this environment, authorised ICH discourse, which defines the nature, value and management of ICH, has marginalised and distanced Uyghur knowledge-holders from the heritage that they embody, contributing to the profound transformation of the Uyghur way of life.
Russia’s Ethnic Minority Casualties of the 2022 Invasion of Ukraine
Authors: Vyushkova Mariya , Sherkhonov Evgeny
Published: May 2023

The Free Buryatia Foundation is Russia’s first ethnic anti-war advocacy group founded in the wake of Russia’s invasion of Ukraine. One of the major parts of our work is analysis of open-source data on the participation of Russia’s ethnic minorites (including Buryats) in the war in Ukraine. In this paper, we discuss ethnic disproportions in the confirmed Russian-side casualties of the war in Ukraine where such ethnicities as Buryats, Kazakhs, and Tuvans are clearly over-represented.
Russia’s Invasions
Authors: Yangulbaev Abubakar
Published: May 2023

The paper provides a discussion of various aspects of Chechen relation to the war in Ukraine, including oppositional voices as well as discourses and actions of those supporting the Russian position. The article compares and contrasts the war in Ukraine with the two wars Russia waged against Chechnya in 1994 and 1999. Commenting on the war in Ukraine, the author focuses on the phenomenon of the ‘Kadyrovites’ (Chechen auxiliary troops fighting on the Russian side) on the one hand and Chechen units fighting on the Ukrainian side on the other. It is argued that the silence of the international community in the Chechen war afforded Russia a sense of impunity, thus reinforcing its reckless military strategies.
Continental Constitutionalism, Systemic Legitimacy, and Judicial Review
Authors: Iglesias Vila Marisa
Published: May 2023

This article elaborates on the justification and legitimacy of judicial review in continental constitutionalism. After the Second World War, continental constitutionalism shifted from a Kelsenian conception of constitutional courts to a strong model of judicial review whose legitimacy requires maintaining distance both from the U.S. model built around checks and balances and from the model embodied by the New Commonwealth constitutionalism. I suggest that the legitimacy of continental judicial review should not depend on the degree to which it resists the countermajoritarian objection, but rather that it should follow a logic of protective efficacy that takes a systemic perspective. On this basis, I propose coordinating judicial review in terms of a weak form of constitutionalism that I call “cooperative constitutionalism”, whose three main axes are: a democratic culture of justification, a conception of fundamental rights as qualified mandatory goals and a systemic approach to the proportionality test.
Assisted Suicide in Italy: Navigating the Frontiers of “Legitimate Medicine”
Authors: Madera Adelaide
Published: May 2023

The unrestrainable evolution of medical science and technology is drastically changing healthcare, enabling new medical procedures and remedies, which are increasingly intertwined with moral principles. Although a uniform European approach to assisted suicide is lacking, a common trend is developing: the boundary between euthanasia, assisted suicide, and end-of-life care on one hand, and the frontiers of “legitimate medicine”, on the other are becoming increasingly blurred, emphasizing the polarization between secular and religious narratives.

In Italy, ruling no. 242/2019 of the Constitutional Court declared the partial unconstitutionality of Article 580 of the Italian Criminal Code, which prohibits assistance in suicide.

The present paper analyzes the legal regime of assisted dying in Italy, the role of the rule of law, the religious influence on political decision making, and investigates current legal challenges and potential future legal tracks.
A new species and a new record for Cedrela (Meliaceae, Sapindales) in Ecuador: morphological, molecular, and distribution evidence
Authors: PALACIOS WALTER A. , TORRES MARIA DE LOURDES , ALBUJA QUINTANA MARTINA , ASADOBAY PACARINA , IGLESIAS JUAN , QUILLUPANGUI RICHARD , ROJAS ESTEFANIA , SANTIANA JANETH , SOLA AUGUSTO , RIVAS-TORRES GONZALO
Published: May 2023

A new Cedrela (Meliaceae) species, Cedrela angusticarpa, is described through a combination of taxonomic, morphological, and molecular analyses. Cedrela kuelapensis, originally described as an endemic species of northern Peru, is also reported here as a new record for Ecuador. Cedrela angusticarpa has oblong or oblong-lanceolate glabrous leaflets, rounded at the base. Inflorescences are up to 70 cm long, and flowers present a cupuliform calyx with five regular teeth. Fruits are narrowly obovoid capsules. Through molecular analyses using nine microsatellite loci, it is evident that samples from C. angusticarpa form their own genetic cluster when compared to the most morphologically similar species, C. odorata, suggesting that they belong to a new separate species. Additionally, here we report that C. angusticarpa has a very narrow geographic range, recorded between 550 and 1300 m in elevation, and restricted to the relatively small areas of northwestern Ecuador. Climatic niche modelling techniques were used as a proxy for assessing potential distributions and habitat loss percentages for both C. angusticarpa and C. kuelapensis. Finally, IUCN Red List categories and criteria were applied to assess the conservation status of both Cedrela species analyzed here.
Two new species of the pseudoscorpion genus Stenohya (Pseudoscorpiones: Neobisiidae) from Guangxi Zhuang Autonomous Region, China
Authors: LI YUN-CHUN , SHI AI-MIN
Published: May 2023

Two new pseudoscorpion species, Stenohya dongtianensis sp. nov. and S. jiahensis sp. nov., from Guangxi Zhuang Autonomous Region, are described and illustrated. An identification key is provided for all known representatives of the genus Stenohya from China.
Taxonomic studies on Harnischia complex from India (Diptera: Chironomidae)
Authors: MUKHERJEE BINDARIKA , HAZRA NILADRI
Published: May 2023

Beckidia Sæther, 1979, Kloosia Kruseman, 1933, Parachironomus Lenz, 1921 and Saetheria Jackson, 1977 of the Harnischia complex are four newly recorded genera in India. Beckidia inflata sp. n., Kloosia incurva sp.n., Parachironomus salsus sp.n., Saetheria circinata sp.n., and Harnischia bulbosa sp.n. are described and illustrated. Microchironomus ishii Sasa, 1987, as a new record, is re-described and illustrated based on males. Three species, Paracladopelma nigrotibia (Bhattacharya, Dutta & Chaudhuri, 1985), Cryptotendipes acutus (Goetghebuer, 1936), and Saetheria sacculifera (Chaudhuri & Chattopadhyay, 1990) are proposed here as new combinations. Other Indian species of little known genera within the Harnischia complex are also re-examined and synonymisation is made. Molecular barcodes of five new species Beckidia inflata sp.n., Kloosia incurva sp.n., Parachironomus salsus sp.n., Saetheria circinata sp.n., and Harnischia bulbosa sp.n. and three known species of the Harnischia complex are also provided. Separate world keys of adult males of five genera are also designed here.
Longwave Radiative Effects beyond the Initial Intensification Phase of Tropical Cyclones
Authors: Dai Yi , Torn Margaret S. , Williams Ian N. , Collins William D.
Published: May 2023

The effects of longwave radiation on tropical cyclone intensification, with an emphasis on the mature stage, are explored in an idealized modeling framework. Results show that although the cloud-radiative effect aids in early intensification of the vortex, it does not promote increase in the maximum tangential wind (Vmax) and could even reduce Vmax at the mature stage. At later stages, maximum radiative heating is located outside the eyewall and promotes convection there, and the secondary circulation encourages convergence of absolute angular momentum outside the eyewall instead of near the eyewall region, based on a budget analysis. Clear-sky radiative cooling helps invigorate domainwide convection, also limiting the Vmax increase at later stages. The area-averaged frozen moist static energy (FMSE) variance increases even though Vmax decreases. In this sense, the FMSE variance is similar to the monotonically growing integrated kinetic energy, and is more indicative of the system-scale strength than of Vmax. Sensitivity experiments are performed with random initial perturbations and varied initial soundings. An axisymmetric model with a 10-member ensemble not only confirms the results from three-dimensional simulations, but also demonstrates that the weak radiative heating outside the eyewall is indeed able to slow down Vmax within 1 day.
Impacts of Oceanic Mesoscale Structures on Sea Surface Temperature in the Arabian Sea and Indian Summer Monsoon Revealed by Climate Model Simulations
Authors: Yamagami Yoko , Tatebe Hiroaki , Kataoka Takahito , Suzuki Tatsuo , Watanabe Masahiro
Published: May 2023

Climate models typically have a cold sea surface temperature (SST) bias for the Arabian Sea, which regulates the Indian monsoon system as a water vapor source. Since the SST for the Arabian Sea is critical for the Indian monsoon, a better understanding of the processes that affect the SST is required. In this study, the effects of mesoscale oceanic variability on simulations of the Arabian Sea SST and Indian summer monsoon precipitation were investigated based on a comparison of climate model experiments in which non-eddying and eddy-permitting ocean components are coupled. In the eddy-permitting model, warm water advection driven by mesoscale variability near the Gulf of Aden and the Gulf of Oman increases the SST in the western Arabian Sea. Lateral eddy heat transport enhances warm water outflows to the Arabian Sea and suppresses surface water cooling by coastal upwelling during the southwestern monsoon season. Furthermore, a sensitivity experiment shows the primary importance of resolving oceanic mesoscale eddies and the secondary importance of resolving the Persian Gulf and Red Sea for the Arabian Sea SST. Also, the summer monsoonal precipitation decreases (increases) over the southeastern Arabian Sea (western and northern India) in the eddy-permitting model due to enhancement of wind convergence in the lower troposphere. Atmospheric general circulation model experiments indicate that the precipitation difference is partly caused by SST changes over the western Arabian Sea. The findings imply that the ocean resolution of climate models is a key factor in efficiently simulating the Indian monsoon.
Two-Way Nesting in a Split-Implicit Ocean Model: NCOM
Authors: Yu Jie , Blain Cheryl Ann , Martin Paul J. , Campbell Tim J.
Published: May 2023

Presented is the approach, implementation, and evaluation of two-way nesting in a split-implicit ocean model, the Navy Coastal Ocean Model (NCOM). Emphasis is on the strategies applied to feed back fields from the fine-mesh nest (child grid) to the coarse mesh (parent grid). On an appropriate separation of dynamic and feedback interfaces, attention is especially needed for the feedback interface of surface elevation. One particular issue addressed is the inconsistency between the 3D baroclinic velocities and 2D barotropic transports in the feedback. The discrepancy is inherently associated with bathymetry, depth integration, and the need to average over spatial grid points. A simple remedy is proposed and proven to be effective and necessary in realistic coastal applications. In addition to the full two-way nesting, a simplified two-way nesting approach is provided in which only the temperature and salinity are fed back from the nest, and the velocity fields are assumed to self-adjust according to the geostrophic balance. The performance of both approaches is evaluated using the idealized benchmark, propagation of a baroclinic vortex, and an application to the Mississippi River outflow in the northeast Gulf of Mexico, including a comparison with available observations. Discussions are also made on the computational efficiency of the two-way nesting and its sensitivity to the open boundary conditions in regard to noise suppression.

Significance Statement

The two-way nesting approach reported here can be adapted to other structured-grid ocean models, in particular those using the split-implicit technique. The treatment of the feedback interface for surface elevation is especially important for suppressing the noise production and improving the feedback consistency. An effective procedure is given to amend the inconsistency in the velocity field feedback that is inherently due to bathymetry.
Abdominal Pseudoaneurysms in Patients With High-Grade Traumatic Injuries
Authors: Scheuermann Alexis , Berard Meredyth , Jain Shivani , Travis Harrison , Duke Marquinn , Fairchild Alexandra , Ferral Hector , Ustunsoz Bahri , Rhodes Jennifer , Smith Alison
Published: May 2023

Utilization of CT scans in the work-up of trauma patients has led to increasing diagnosis of traumatic pseudoaneurysms (PSAs). While rare, PSAs have devastating consequences if ruptured. Evidence for the benefit of early detection of PSAs is lacking. The objective of this case series was to determine the incidence of solid organ PSAs after trauma. A retrospective chart review of patients with AAST grade 3-5 traumatic solid organ injuries was performed. 47 patients were identified with PSAs. PSAs were most common in the spleen. A CT finding of contrast blush or extravasation was found in 33 patients. 36 patients underwent embolization. 12 patients had an abdominal CTA prior to discharge. Re-admission was required for 3 patients. 1 patient presented with PSA rupture. During the study, there was no consistency in surveillance for PSAs. Future studies are needed to develop evidence-based practice guidelines for PSA surveillance in high risk populations.
Staged Repair of Primary Aortoesophageal Fistula
Authors: Seal Kimberly S. , Abu-Halimah Shadi J. , Dyer Benjamin W. , Tobin Edward C. , Jadue-Tobar Andre
Published: May 2023

Primary aortoenteric fistulas are rare with an incidence reported up to .07% at autopsy. Literature review yields few reported cases, and rarer still is a fistula between a normal thoracic aorta and the esophagus. Rather, 83% of cases are associated with an aneurysmal aorta and 54% involve the duodenum. Patients with aortoesophageal fistula (AEF) usually present with a triad of chest pain, dysphasia, and a herald bleed. Without treatment, AEFs will result in exsanguination and are universally fatal; even with traditional open surgical treatment, mortality is reported over 55%. The complex pathology of AEFs makes repair more challenging, given an infected field, friable tissue, and patients who are often hemodynamically unstable. Staged repair using endografts as initial treatment with the primary goal of controlling bleeding and preventing fatal exsanguination has been reported. We present a case where a descending thoracic aorta to esophageal fistula was repaired, and this strategy was utilized.
Lateral Compartment Syndrome From Inversion Injury
Authors: Petrochko Jameson M. , Ullrich Lauryn A.
Published: May 2023

A 17-year-old male presented for the evaluation of right calf pain after an inversion ankle sprain sustained while playing soccer 24 hours prior. On exam, he exhibited swelling and tenderness to palpation over his right calf, mild first web space numbness, and compartment pressures <30 mmHg. Magnetic resonance imaging was significant for findings of lateral compartment syndrome (CS). Upon admission, his exam worsened, prompting an anterior and lateral compartment fasciotomy. Intraoperative findings were significant for lateral CS, with findings of avulsed, nonviable muscle with associated hematoma. Postoperatively the patient had mild foot drop, which improved with physical therapy. Lateral CS rarely develops from an inversion ankle sprain. This presentation of CS is unique due to its mechanism, delayed clinical presentation, and limited signs of CS. Providers should maintain a high index of suspicion for CS in patients with this injury complex and continued pain beyond 24 hours without signs of ligamentous injury.
Colorectal Malignancy Complicated by Arterioenteric Fistula
Authors: Woodruff Grant C. , Yap Chelsea A. , Kazaleh Matthew S. , Crandall Marie L. , Zhang Jeanette
Published: May 2023

Arterioenteric fistulas (AEF) are rare and devastating complications of colorectal/pelvic malignancies. These fistulas can be seen following neoadjuvant or adjuvant therapy but are exceptionally rare de novo. The reported incidence of AEF is less than 1% and iliac artery-enteric fistulas make up less than .1% of all AEF. Here we present a patient in hemorrhagic shock secondary to an advanced colorectal malignancy without adjuvant therapies with local invasion of the right external iliac artery. Following initial resuscitation and hemorrhage control with coil embolization, definitive control with ligation and excision of the involved artery, end colostomy, and ureteral stent placement was achieved. It is important to consider malignancy as the source of lower gastrointestinal bleeds, especially in elderly patients without current colonoscopy studies. The management of this unfortunate diagnosis often involves a multidisciplinary approach with early and frequent goals of care discussions.
An Analysis of the Timing for Closure of a Diverting Loop Ileostomy
Authors: Hussein Nadia L. , Stevenson Autumn P. , Lawton Catherine F. , Elmayan Ardem , Hillis Emma E. , Burton Jeffrey H. , Fuhrman George
Published: May 2023

A diverting loop ileostomy (DLI) is used to protect a distal gastrointestinal anastomosis at risk of leakage. While patients typically prefer early DLI closure, surgeons vary in opinion regarding optimal timing. This study evaluated whether the timing of DLI closure impacts outcomes.

A retrospective review was performed on patients who underwent DLI creation within one health care system between 2012 and 2020. Patient characteristics and postoperative outcomes were compared across ileostomies closed in ≤2 months, 2-4 months, and >4 months. Outcomes examined included anastomotic leak, other complications, reintervention, and death within 30 days.

A total of 500 DLIs were analyzed for the study, 455 of which were closed. The three closure groups were similar in patient characteristics and comorbidities. None of the outcome variables analyzed in this study demonstrated a statistically significant difference between groups, suggesting that in patients otherwise fit for surgery, DLI closure can be safely performed within 2 months of creation.
Quilting Suture Technique After Mastectomy: A Meta-Analysis
Authors: Drivas Eleni , Gachabayov Mahir , Kajmolli Agon , Stadlan Zehavya , Felsenreich Daniel Moritz , Castaldi Maria
Published: May 2023

Background

There is no level 1a evidence testing quilting suture (QS) technique after mastectomy on wound outcomes. The aim of this systematic review and meta-analysis evaluates QS and association with surgical site occurrences as compared to conventional closure (CC) for mastectomy.

Methods

MEDLINE, PubMed, and Cochrane Library were systematically searched to include adult women with breast cancer undergoing mastectomy. The primary endpoint was postoperative seroma rate. Secondary endpoints included rates of hematoma, surgical site infection (SSI), and flap necrosis. The Mantel-Haenszel method with random-effects model was used for meta-analysis. Number needed to treat was calculated to assess clinical relevance of statistical findings.

Results

Thirteen studies totaling 1748 patients (870 QS and 878 CC) were included. Seroma rates were statistically significantly lower in patients with QS (OR [95%CI] = .32 [.18, .57]; P < .0001) than CC. Hematoma rates (OR [95%CI] = 1.07 [.52, 2.20]; P = .85), SSI rates (OR [95%CI] = .93 [.61, 1.41]; P = .73), and flap necrosis rates (OR [95%CI] = .61 [.30, 1.23]; P = .17) did not significantly vary between QS and CC.

Conclusion

This meta-analysis found that QS was associated with significantly decreased seroma rates when compared to CC in patients undergoing mastectomy for cancer. However, improvement in seroma rates did not translate into a difference in hematoma, SSI, or flap necrosis rates.
Liver Transplantation in Elderly Recipients: Is Age Just a Number?
Authors: Kurian Joshua , Matevish Lauren E. , Feizpour Cyrus , Shah Jigesh A. , Hwang Christine , Hanish Steven I. , Mufti Arjmand R. , Neill-Fogus Susan , Vagefi Parsia A. , Patel Madhukar S.
Published: May 2023

Background

The proportion of older patients on the liver transplant waitlist continues to increase. With limited existing data to guide liver transplant evaluation of elderly patients, we aimed to study selection practices and outcomes of patients ≥70 years old. We hypothesized that 1-year patient and graft survival would not differ between appropriately selected elderly patients and those who are younger.

Methods

All patients referred for liver transplantation between 2018 and 2020 were stratified into elderly (age ≥70) and young (age <70) cohorts. Evaluation data pertaining to medical, surgical, and psychosocial risk assessment were reviewed. Recipient characteristics and post-operative outcomes, primarily 1-year graft and patient survival, were compared, with a median follow-up of 16.4 months.

Results

322 patients underwent transplant out of 2331 referred. Elderly patients represented 230 of these referrals and 20 underwent transplant. The most common reasons for denial of elderly patients were multiple medical comorbidities (49%), cardiac risk (15%) and psychosocial barriers (13%). The median MELD of elderly recipients was lower (19 vs 24, P = .02), and proportion of hepatocellular carcinoma was higher (60% vs 23%, P < .001). There was no difference in 1-year graft (elderly 90.9% vs young 93.3%, P = .72) or patient survival (elderly 90.9% vs young 94.7%, P = .88).

Discussion

Liver transplant outcomes and survival are not affected by advanced age in carefully evaluated and selected recipients. Age should not be considered an absolute contraindication for liver transplant referral. Efforts should be made to develop guidelines for risk stratification and donor–recipient matching that optimize outcomes in elderly patients.
Relationship of Obesity and Severe Penetrating Thoracic and Abdominal Injuries in Adolescent Patients
Authors: Alvarez Claudia A. , Grigorian Areg , Swentek Lourdes , Chin Theresa , Guner Yigit , Goodman Laura , Kuza Catherine , Nahmias Jeffry
Published: May 2023

Background

Over 20% of United States adolescents are obese. A thicker layer of subcutaneous adiposity might provide a protective “armor” layer against penetrating wounds. We hypothesized that adolescents with obesity presenting after isolated thoracic and abdominal penetrating trauma have lower rates of severe injury and mortality than adolescents without obesity.

Methods

The 2017-2019 Trauma Quality Improvement Program database was queried for patients between 12 and 17 years old presenting with knife or gunshot wounds. Patients with body mass index (BMI) ≥30 (obese) were compared to patients with BMI <30. Sub-analyses were performed for adolescents with isolated abdominal trauma and isolated thoracic trauma. Severe injury was defined as an abbreviated injury scale grade >3. Bivariate analyses were performed.

Results

12,181 patients were identified; 1603 (13.2%) had obesity. In isolated abdominal gunshot or knife wounds, rates of severe intra-abdominal injuries and mortality were similar (all P > .05) between groups. In isolated thoracic gunshot wounds, adolescents with obesity had a lower rate of severe thoracic injury (5.1% vs 13.4%, P = .005) but statistically similar mortality (2.2% vs 6.3%, P = .053) compared to adolescents without obesity. In isolated thoracic knife wounds, rates of severe thoracic injuries and mortality were similar (all P > .05) between groups.

Discussion

Adolescent trauma patients with and without obesity presenting after isolated abdominal or thoracic knife wounds had similar rates of severe injury, operative intervention, and mortality. However, adolescents with obesity presenting after an isolated thoracic gunshot wound had a lower rate of severe injury. This may impact the future work-up and management of adolescents sustaining isolated thoracic gunshot wounds.
Is eGFR ≥60 mL/min/1.73 m2 in Patients Undergoing Coronary Angiography Really Safe for Contrast Nephropathy?
Authors: Comoglu Mustafa , Acehan Fatih , Katipoglu Bilal , Demir Burak F. , Guven Cetin Zehra , Ates Ihsan
Published: May 2023

The aim of the present study was to define the risk factors associated with contrast-induced acute kidney injury (CI-AKI) in patients who underwent coronary artery angiography (CAG). In this retrospective cohort study, patients who underwent CAG between March 2014 and January 2022 were evaluated. A total of 2923 eligible patients were included in the study. Univariate and multivariate logistic regression analysis was used to identify the predictive factors. CI-AKI developed in 77 (2.6%) of 2923 patients. In multivariate analysis, diabetes mellitus (DM), chronic kidney disease (CKD), and estimated glomerular filtration rate (eGFR) were found to be independent factors associated with CI-AKI. In the subgroup analysis of patients with eGFR ≥60 mL/min/1.73 m2, eGFR remained a predictor of CI-AKI (Odds ratio (OR): .89, 95% CI: .84-.93; that is, a lower eGFR remains a risk factor for CI-AKI). In the receiving operating characteristic (ROC) analysis of patients with eGFR ≥60 mL/min/1.73 m2, the area under the curve of the eGFR was .826. Using the ROC curve based on Youden’s index, the eGFR cut-off was found to be 70 mL/min/1.73 m2 for patients with eGFR ≥60 mL/min/1.73 m2. eGFR is also an important risk factor in patients with eGFR 60-70 mL/min/1.73 m2.
Do Proxies Provide Plausible Deniability? Evidence From Experiments on Three Surveys
Authors: Williamson Scott
Published: May 2023

A purported advantage of secrecy in international politics is its ability to reduce pressures for conflict escalation by obscuring responsibility for hostile actions. Delegating these actions to proxies is one strategy states use to retain plausible deniability and limit escalation risks. Yet, proxies often have strong ties to sponsoring states, raising questions about their ability to influence blame and demands for retaliation. This paper tests these effects by analyzing American responses to hypothetical attacks by Chinese, Russian, and Iranian actors through experiments administered on three surveys. The results show that using proxies for these attacks modestly reduced how much Americans blamed the respective foreign governments, while also limiting demands that their senior leadership be sanctioned. However, the use of proxies did not affect Americans’ attitudes toward more forceful responses by the US government. These findings contribute to understanding of how proxies shape plausible deniability and escalation risks in international conflicts.
Loneliness during the Pregnancy-Seeking Process: Exploring the Role of Medically Assisted Reproduction
Authors: Köksal Selin , Goisis Alice
Published: May 2023

This study explores whether undergoing medically assisted reproduction (MAR) is associated with experiencing loneliness and whether this association varies by gender and having a live birth. Using two waves of the Generations and Gender Survey (n = 2,725) from countries in Central and Eastern Europe, we estimate the changes in levels of emotional and social loneliness among pregnancy seekers in heterosexual relationships and test if they vary by the mode of conception while controlling for individual sociodemographic characteristics. Individuals who underwent MAR experienced increased levels of social loneliness compared to individuals who were trying to conceive spontaneously. This association is entirely driven by respondents who did not have a live birth between the two observation periods, while the results did not differ by gender. No differences emerged in emotional loneliness. Our findings suggest that increased social loneliness during the MAR process might be attributable to infertility-related stress and stigma.
Mouse isoflurane anesthesia using the drop method
Authors: Bodnar Maya J , Ratuski Anna S , Weary Daniel M
Published: May 2023

Anesthesia with isoflurane prior to carbon dioxide euthanasia is recommended as a refinement, but vaporizer access can be limited. An alternative to vaporizers is the ‘drop’ method, introducing a fixed volume of isoflurane into the induction chamber. Previous work suggests that isoflurane administered at a concentration of 5% via the drop method is effective but aversive to mice; lower concentrations have not been tested. We assessed mouse behavior and insensibility with induction using the drop method for isoflurane concentrations below 5%. Male Crl:CD-1 (ICR) mice ( n = 27) were randomly allocated to one of three isoflurane concentrations: 1.7%, 2.7%, and 3.7%. During induction, measures of insensibility and stress-related behaviors were recorded. All mice reached a surgical plane of anesthesia, and mice exposed to higher concentrations did so more quickly; as concentrations increased from 1.7 to 2.7 and 3.7%, the time to recumbency (Least squares means ± SE: 120.5 s ± 8.1, 97.9 s ± 8.1, and 82.8 s ± 8.1, respectively), loss of righting reflex (149.1 s ± 8.5, 127.7 s ± 8.5, and 100.7 s ± 8.5, respectively), and loss of pedal withdrawal reflex (214.5 s ± 8.3, 172.2 s ± 8.3, and 146.4 s ± 8.3, respectively) all declined. Rearing was the most frequently performed stress-related behavior, and was most pronounced immediately following isoflurane administration for all treatments. Our results indicate that the drop method can be used to effectively anesthetize mice with isoflurane concentrations as low as 1.7%; future work should assess mouse aversion.
Catholic Teaching: A Middle Ground and Guide for End-of-Life Care and Decision-Making and an Antidote for Dying Badly in America
Authors: Kozakowski Jennifer L.
Published: May 2023

Dying in the United States is characterized as: medicalized, depersonalized, high technology, fragmented with frequent transitions among care settings, burdensome to patients and families, driven by efficiency and effectiveness, and lacking in key areas, for example, access to palliative care and adequate pain and symptom treatment. Patients and families are often left with a choice of two extremes: vitalism or utilitarian pessimism (utilitarianism). The Catholic Church, however, rejects both of these extremes, and Catholic social teaching (CST) at end of life focuses on ordinary-extraordinary treatments/means, a culture of life and human dignity, accompaniment and community, and caring for whole persons through the end of life. The Catholic tradition of ordinary-extraordinary means is helpful to guide complex end-of-life decisions, regardless of one's religious beliefs, and offers a middle ground between vitalism and utilitarianism that can inform end-of-life care and decision-making for all patients in Catholic health care. While it does not provide answers, it offers guidance and enables conversations that are crucial for the dying and their families to make autonomous, informed decisions about end-of-life care. It provides an opportunity for the dying to let the care team, loved ones, and decision-makers know what a life with meaning, purpose, and passion is for them—and how they want to live and die. This article will summarize the problem, describe end-of-life Catholic teaching, and discuss how it offers a middle-ground. Arguments for and against vitalism and utilitarianism will be explored, including a discussion of CST's response to those receiving care in Catholic health care facilities who are outside the Catholic tradition and do not believe in the teaching. The last section describes a model of collaborative partnership where local parishes and Catholic health care come together to tackle the challenges of caring for and ministering to the seriously ill and those facing death.
DOES SUB‐SAHARAN AFRICA'S RAPID POPULATION GROWTH HAVE POSITIVE OR NEGATIVE EFFECTS ON AGGREGATE DOMESTIC INVESTMENT?
Authors: Byaro Mwoya , Kinyondo Abel , Lemnge Deusdedit A.
Published: May 2023

This study examines the effect of population growth on aggregate domestic investments in 45 Sub‐Saharan African (SSA) countries over the period 2000–2020. It applies the Quantile Method of Moments with fixed effects (i.e., MM‐QR), which has the ability to identify both negative and positive effects while controlling for trade, HIV/AIDS prevalence, and economic growth. The findings show that SSA's rapid population growth has a positive and statistically significant effect on aggregate domestic investments. Findings from this study show that an increase in population growth in the 10th to 60th quantiles is associated with an increase of domestic investment in SSA. This suggests that, as the population grows in SSA, it generates demand for domestic investments such as healthcare services, education, and other social services. Our findings also show that trade is positive and significant across all quantiles (10th to 90th). We find evidence that disease risks, such as the prevalence of HIV/AIDS, slowed the increase in domestic investment in the region across all quantiles (10th to 90th). We conclude by arguing that, since SSA's population growth will double in the near future, the region is bound to become world's next investment hub. In order to enable long‐term domestic investments in the region, future policy options should take the challenges of population growth into account.