bluuebunny/crossref_metadata_2025 huggingface dataset:
Exceptional variability in historical fire regimes across a western Cascades landscape, Oregon, USA
Authors: Johnston James D. , Schmidt Micah R. , Merschel Andrew G. , Downing William M. , Coughlan Michael R. , Lewis David G.
Published: December 2023

Detailed information about the historical range of variability in wildfire activity informs adaptation to future climate and disturbance regimes. Here, we describe one of the first annually resolved reconstructions of historical (1500–1900 ce) fire occurrence in coast Douglas‐fir dominated forests of the west slope of the Cascade Range in western Oregon. Mean fire return intervals (MFRIs) across 16 sites within our study area ranged from 6 to 165 years. Variability in MFRIs was strongly associated with average maximum summer vapor pressure deficit. Fire occurred infrequently in Douglas‐fir forest stands seral to mountain hemlock or silver fir, but fire frequency was much shorter than predicted by theory in other forest types. MFRIs within Douglas‐fir stands seral to western hemlock or grand fir ranged from 19 to 45 years, and MFRIs in stands seral to Douglas‐fir ranged from 6 to 11 years. There was little synchrony in fire occurrence or tree establishment across 16 sites separated by 4 km. The lack of synchrony in fire suggests that large, wind‐driven fire events that are often considered to be characteristic of coast Douglas‐fir forests were not an important driver of succession in our study area during the last ~400–500 years. Climate was more arid than normal during fire years in most forest types, but historical fire in stands seral to Douglas‐fir was strongly associated with antecedent moisture and less strongly associated with drought. We interpret the extraordinary tempo of fire we observed in stands seral to Douglas‐fir and the unique climate pattern associated with fire in these stands to be indicative of Indigenous fire stewardship. This study provides evidence of far more frequent historical fire in coast Douglas‐fir forests than assumed by managers or scientists—including some of the most frequent fire return intervals documented in the Pacific Northwest. We recommend additional research across the western Cascades to create a comprehensive account of historical fire in highly productive forests with significant cultural, economic, and ecological importance.
Safety of sodium‐glucose cotransporter 2 inhibitors drugs among heart failure patients: a systematic review and meta‐analysis
Authors: Soleimani Hamidreza , Saeedian Behrad , Pasebani Yeganeh , Babajani Nastaran , Pashapour Yeganeh Amirreza , Bahirai Pegah , Navid Hossein , Amin Ahmad , Samsky Marc D. , Nanna Micheal G. , Hosseini Kaveh
Published: December 2023

Sodium–glucose cotransporter‐2 inhibitors (SGLT2is) reduce morbidity and mortality for heart failure (HF) patients and are recommended as cornerstones for their medical therapy. Utilization in clinical practice remains low for multiple reasons, one of which may be adverse events. We investigated the incidence of these events to see if they are associated with SGLT2i use. A systematic search was performed in databases, including PubMed, Embase, Cochrane Library, Clinicaltrials.gov, and WHO's International Clinical Trials Registry Platform. Relevant randomized controlled trial studies assessing the safety outcomes of SGLT2i in HF patients were included in this study. We conducted the common‐effect meta‐analysis to estimate the relative risk (RR) and 95% confidence interval (CI) of safety outcomes in SGLT2i compared with placebo. Eighteen studies were included in the meta‐analysis composed of 12 925 HF patients taking an SGLT2i and 12 747 taking a placebo. The meta‐analysis indicated that the all‐cause mortality and serious adverse events (SAEs) were lower in the SGLT2i group (RR, 0.91; 95% CI, 0.85–0.97; P = 0.005, I2 = 0%; and RR, 0.92; 95% CI, 0.90–0.95; P < 0.001, I2 = 43%, respectively). Volume depletion and genitourinary infections were more prevalent in the SGLT2i group (RR, 1.17; 95% CI, 1.06–1.28; P = 0.001, I2 = 0%; and RR, 1.27; 95% CI, 1.13–1.43; P < 0.001, I2 = 17%, respectively). Our meta‐analysis demonstrated that using SGLT2is in HF patients was correlated with reduced mortality and SAEs, with a more prominent effect in HF with reduced ejection fraction patients and those taking dapagliflozin.
Independent prognostic importance of blood urea nitrogen to creatinine ratio in heart failure
Authors: Tolomeo Paolo , Butt Jawad H. , Kondo Toru , Campo Gianluca , Desai Akshay S. , Jhund Pardeep S. , Køber Lars , Lefkowitz Martin P. , Rouleau Jean L. , Solomon Scott D. , Swedberg Karl , Vaduganathan Muthiah , Zile Michael R. , Packer Milton , McMurray John J.V.
Published: December 2023

Aim

Blood urea nitrogen (BUN) to creatinine ratio is associated with worse outcomes in acute heart failure (HF) but little is known about its importance in chronic HF.

Methods and results

We combined individual patient data from clinical trials (HF with reduced ejection fraction [HFrEF]: PARADIGM‐HF, ATMOSPHERE and DAPA‐HF, and HF with preserved ejection fraction [HFpEF]: PARAGON‐HF and I‐PRESERVE). The primary outcome examined was a composite time to first HF hospitalization or cardiovascular death; its components and all‐cause death were also examined. Each HF phenotype was categorized according to median BUN/creatinine ratio, generating four groups that is, HFpEF ≤ and >median BUN/creatinine ratio and HFrEF ≤ and >median BUN/creatinine ratio. The association between BUN/creatinine ratio and outcomes was evaluated using the Kaplan–Meier estimator and Cox proportional hazard models. Overall, 28 820 patients were analysed. The median (IQR) BUN/creatinine ratio was 20.1 (Q1–Q3 16.7–24.7) in HFpEF and 18.7 (15.2–22.8) in HFrEF. In both HFpEF and HFrEF, higher BUN/creatinine ratio was associated with older age, female sex, and diabetes, but similar estimated glomerular filtration rate (eGFR). The risk of each outcome examined was significantly higher in patients with BUN/creatinine ratio ≥median, compared to <median, even after adjustment for other prognostic variables, including N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) and eGFR.

Conclusion

Higher BUN/creatinine ratio was associated with worse outcomes in patients with chronic HF across the spectrum of left ventricular ejection fraction, independently of eGFR and NT‐proBNP. BUN/creatinine ratio may reflect neurohumoral activation (especially increased arginine vasopressin), altered renal blood flow or other pathophysiologic mechanisms not incorporated in conventional prognostic variables.
High Inhibition for a CoII Tetrazole Bi‐pyrazole Dinuclear Complex against Fusarium Oxysporum f. sp. Albedinis
Authors: Bahjou Yousra , Radi Smaail , El Massaoudi Mohamed , Draoui Youssef , Adarsh Nayarassery N. , Miras Haralampos N. , Ferbinteanu Marilena , Robeyns Koen , Ouahhoud Sabir , Benabbes Redouan , Hultzsch Kai C. , Wolff Mariusz , Garcia Yann
Published: December 2023

New coordination compounds made of two novel tetrazole and C,N‐bipyrazole ligands, 2‐(3,5,5′‐trimethyl‐1′H‐[1,3′‐bipyrazol]‐1′‐yl)acetonitrile (L1), and 1′‐((1H‐tetrazol‐5‐yl)methyl)‐3,5,5′‐trimethyl‐1′H‐1,3′‐bipyrazole (HL2), were prepared and fully characterized by spectroscopic techniques. Their crystal structures were identified by single‐crystal X‐ray diffraction revealing mononuclear complexes: [Ni(L1)3](ClO4)2 (1), [Cd(L1)2Cl2] (2), [Cu(HL2)(L2)]ClO4 (3), [Cu(L2)2] (4) and a dinuclear complex [Co2(HL2)(L2)Cl3] (5) comprising CoII ions in octahedral and tetrahedral surrounding within the same unit. Noticeably, 3 and 4 show different architectural structures due to ligand deprotonation as well as the effect of the counter anion. All compounds demonstrated antimicrobial activity against Gram (+) bacteria Listeria innocua and Staphylococcus aureus, as well as Gram (−) bacteria such as Escherichia coli and Pseudomonas aeruginosa, and antifungal activity against pathogenic fungi Geotrichum candidum, Aspergillus niger, and Penicillium crustosum. Interestingly, a high inhibition activity of 97 % was reached for 5 with a low concentration of only 81.1 μmol/L against Fusarium oxysporum f. sp. Albedinis, which is commonly damaging palm trees crops.
Advances in Nanohybrid Membranes for Dye Reduction: A Comprehensive Review
Authors: Taheri Mahsa
Published: December 2023

Separating valuable materials such as dyes from wastewater using membranes and returning them to the production line is a desirable environmental and economical procedure. However, sometimes, besides filtration, adsorption, and separation processes, pollutant destruction also can be suitable using photocatalytic membranes. The art of producing nanohybrid materials in contrast with nanocomposites encompasses nanomaterial synthesis as a new product with different properties from raw materials for nanohybrids versus the composition of nanomaterials for nanocomposites. According to the findings of this research, confirming proper synthesis of nanohybrid is one challenge that can be overcome by different analyses, other researchers' reports, and the theoretical assessment of physical or chemical reactions. The application of organic‐inorganic nanomaterials and frameworks is another challenge that is discussed in the present work. According to the findings, Nanohybrid Membranes (NHMs) can achieve 100% decolorization, but cannot eliminate salts and dyes, although the removal efficiency is notable for some salts, especially divalent salts. Hydrophilicity, antifouling properties, flux, pressure, costs, usage frequency, and mechanical, chemical, and thermal stabilities of NHMs should be considered.
ClimShift – A new toolbox for the detection of climate change
Authors: Magyari‐Sáska Zsolt , Croitoru Adina‐Eliza , Horváth Csaba , Dombay Ștefan
Published: December 2023

Climate change no longer involves and affects just a few people or communities. However, most of them need climate change detection studies to adapt to the current and future climate conditions efficiently. The present research aimed to detect climate changes by considering the shift in climate conditions from one region to another over different periods based on a similarity index in the Carpathians basin using the new ClimShift toolbox, specially created for this purpose. Developed in R, based on the cosine similarity index and using a set of 32 climate indices (temperature and precipitation), ClimShift uses NC raster format (NetCDF files) as input data. The application is compatible with Microsoft and Unix/Linux environments. The toolbox allows the detection of forward and backward climate shifts. The results can be employed as a Climate Service and are extremely helpful for an efficient process of adaption to climate changes at a local/regional scale. A user‐friendly interface and a tutorial on how to use the toolbox are also available. The toolbox was tested for four locations in the Carpathians Basin (Vienna, Bekes, Cluj‐Napoca and Kosice) using 1961–1990 as a base period and 1991–2021 as an analysis period for the forward climate shift analysis. For Cluj‐Napoca, the application was also tested for the backward climate shift, using 1991–2021 as the base period and 1961–1990 as the analysis period, identifying the region where present climate conditions were specific during the older period. The scientific results indicated a significant shift towards the east and northeast from the older period to the most recent one and a low percentage (6%–10%) in the overlapping area with highly similar conditions between the two periods.
Decreased long‐range temporal correlations in the resting‐state functional magnetic resonance imaging blood‐oxygen‐level‐dependent signal reflect motor sequence learning up to 2 weeks following training
Authors: Jäger Anna‐Thekla P. , Bailey Alexander , Huntenburg Julia M. , Tardif Christine L. , Villringer Arno , Gauthier Claudine J. , Nikulin Vadim , Bazin Pierre‐Louis , Steele Christopher J.
Published: December 2023

Decreased long‐range temporal correlations (LRTC) in brain signals can be used to measure cognitive effort during task execution. Here, we examined how learning a motor sequence affects long‐range temporal memory within resting‐state functional magnetic resonance imaging signal. Using the Hurst exponent (HE), we estimated voxel‐wise LRTC and assessed changes over 5 consecutive days of training, followed by a retention scan 12 days later. The experimental group learned a complex visuomotor sequence while a complementary control group performed tightly matched movements. An interaction analysis revealed that HE decreases were specific to the complex sequence and occurred in well‐known motor sequence learning associated regions including left supplementary motor area, left premotor cortex, left M1, left pars opercularis, bilateral thalamus, and right striatum. Five regions exhibited moderate to strong negative correlations with overall behavioral performance improvements. Following learning, HE values returned to pretraining levels in some regions, whereas in others, they remained decreased even 2 weeks after training. Our study presents new evidence of HE's possible relevance for functional plasticity during the resting‐state and suggests that a cortical subset of sequence‐specific regions may continue to represent a functional signature of learning reflected in decreased long‐range temporal dependence after a period of inactivity.
The tumor immune microenvironment remodeling and response to HER2‐targeted therapy in HER2‐positive advanced gastric cancer
Authors: Jiang Lei , Zhao Xingwang , Li Yilin , Hu Yajie , Sun Yu , Liu Shengde , Zhang Zizhen , Li Yanyan , Feng Xujiao , Yuan Jiajia , Li Jian , Zhang Xiaotian , Chen Yang , Shen Lin
Published: December 2023

Combination therapy with anti‐HER2 agents and immunotherapy has demonstrated significant clinical benefits in gastric cancer (GC), but the underlying mechanism remains unclear. In this study, we used multiplex immunohistochemistry to assess the changes of the tumor microenvironment in 47 advanced GC patients receiving anti‐HER2 therapy. Additionally, we performed single‐cell transcriptional sequencing to investigate potential cell‐to‐cell communication and molecular mechanisms in four HER2‐positive GC baseline samples. We observed that post‐treated the infiltration of NK cells, CD8+ T cells, and B lymphocytes were significantly higher in patients who benefited from anti‐HER2 treatment than baseline. Further spatial distribution analysis demonstrated that the interaction scores between NK cells and CD8+ T cells, B lymphocytes and M2 macrophages, B lymphocytes and Tregs were also significantly higher in benefited patients. Cell–cell communication analysis from scRNA sequencing showed that NK cells utilized CCL3/CCL4‐CCR5 to recruit CD8+ T cell infiltration. B lymphocytes employed CD74‐APP/COPA/MIF to interact with M2 macrophages, and utilized TNF‐FAS/ICOS/TNFRSR1B to interact with Tregs. These cell–cell interactions contribute to inhibit the immune resistance of M2 macrophages and Tregs. Our research provides potential guidance for the use of anti‐HER2 therapy in combination with immune therapy.
Revisiting the analysis of matched‐pair and stratified experiments in the presence of attrition
Authors: Bai Yuehao , Hsieh Meng Hsuan , Liu Jizhou , Tabord‐Meehan Max
Published: December 2023

In this paper, we revisit some common recommendations regarding the analysis of matched‐pair and stratified experimental designs in the presence of attrition. Our main objective is to clarify a number of well‐known claims about the practice of dropping pairs with an attrited unit when analyzing matched‐pair designs. Contradictory advice appears in the literature about whether or not dropping pairs is beneficial or harmful, and stratifying into larger groups has been recommended as a resolution to the issue. To address these claims, we derive the estimands obtained from the difference‐in‐means estimator in a matched‐pair design both when the observations from pairs with an attrited unit are retained and when they are dropped. We find limited evidence to support the claims that dropping pairs helps recover the average treatment effect, but we find that it may potentially help in recovering a convex‐weighted average of conditional average treatment effects. We report similar findings for stratified designs when studying the estimands obtained from a regression of outcomes on treatment with and without strata fixed effects.
Heterogeneity of weight loss and transcriptomic signatures in pancreatic ductal adenocarcinoma
Authors: Riner Andrea N. , Herremans Kelly M. , Vudatha Vignesh , Han Song , Qu Xufeng , Liu Jinze , Mukhopadhyay Nitai , Freudenberger Devon C. , George Thomas J. , Judge Sarah M. , Judge Andrew R. , Hughes Steven J. , Trevino Jose G.
Published: December 2023

Background

Pancreatic ductal adenocarcinoma (PDAC) is highly associated with cachexia and weight loss, which is driven by the tumour's effect on the body. Data are lacking on differences in these metrics based on PDAC anatomic location. We hypothesize that the primary tumour's anatomic region influences the prevalence and severity of unintentional weight loss.

Methods

Treatment naïve patients with PDAC who underwent pancreatectomy at a single institution between 2012 and 2020 were identified retrospectively. Patients with pancreatic head or distal tumours were matched by sex, age, N and T stage. Serologic and anthropometric variables were obtained at the time of diagnosis. Skeletal muscle index (SMI), muscle radiation attenuation (MRA) and adiposity were measured. The primary outcome was presence of significant weight loss [>5% body weight (BW) loss in past 6 months]. Signed rank tests, Cochran Mantel Haenszel tests and Kaplan–Meier survival analysis are presented. RNA‐seq of tumours was performed to explore enriched pathways related to cachexia and weight loss.

Results

Pancreatic head tumours (n = 24) were associated with higher prevalence (70.8% vs. 41.7%, P = 0.081) and degree of weight loss (7.9% vs. 2.5%, P = 0.014) compared to distal tumours (n = 24). BMI (P = 0.642), SMI (P = 0.738) and MRA (P = 0.478) were similar between groups. Combining BW loss, SMI and MRA into a composite score, patients with pancreatic head cancers met more criteria associated with poor prognosis (P = 0.142). Serum albumin (3.9 vs. 4.4 g/dL, P = 0.002) was lower and bilirubin (4.5 vs. 0.4 mg/dL, P < 0.001) were higher with pancreatic head tumours. Survival differed by tumour location (P = 0.014) with numerically higher median overall survival with distal tumours (11.1 vs. 21.8 months; P = 0.066). Transcriptomic analysis revealed inactivation of appetite stimulation, weight regulation and nutrient digestion/metabolism pathways in pancreatic head tumours.

Conclusions

Resectable pancreatic head PDAC is associated with higher prevalence of significant weight loss and more poor prognosis features. Pancreaticobiliary obstruction and hypoalbuminemia in patients with head tumours suggests compounding effects of nutrient malabsorption and systemic inflammation on molecular drivers of cachexia, possibly contributing to shorter survival. Therefore, PDAC‐associated cachexia is a heterogenous syndrome, which may be influenced by the primary tumour location. Select patients with resectable pancreatic head tumours may benefit from nutritional rehabilitation to improve outcomes.
Marked irregular myofiber shape is a hallmark of human skeletal muscle ageing and is reversed by heavy resistance training
Authors: Soendenbroe Casper , Karlsen Anders , Svensson Rene B. , Kjaer Michael , Andersen Jesper L. , Mackey Abigail L.
Published: December 2023

Background

Age‐related loss of strength is disproportionally greater than the loss of mass, suggesting maladaptations in the neuro‐myo‐tendinous system. Myofibers are often misshaped in aged and diseased muscle, but systematic analyses of large sample sets are lacking. Our aim was to investigate myofiber shape in relation to age, exercise, myofiber type, species and sex.

Methods

Vastus lateralis muscle biopsies (n = 265) from 197 males and females, covering an age span of 20–97 years, were examined. The gastrocnemius and soleus muscles of 11 + 22‐month‐old male C57BL/6 mice were also examined. Immunofluorescence and ATPase stainings of muscle cross‐sections were used to measure myofiber cross‐sectional area (CSA) and perimeter. From these, a shape factor index (SFI) was calculated in a fibre‐type‐specific manner (type I/II in humans; type I/IIa/IIx/IIb in mice), with higher values indicating increased deformity. Heavy resistance training (RT) was performed three times per week for 3–4 months by a subgroup (n = 59). Correlation analyses were performed comparing SFI and CSA with age, muscle mass, maximal voluntary contraction (MVC), rate of force development and specific force (MVC/muscle mass).

Results

In human muscle, SFI was positively correlated with age for both type I (R2 = 0.20) and II (R2 = 0.38) myofibers. When subjects were separated into age cohorts, SFI was lower for type I (4%, P < 0.001) and II (6%, P < 0.001) myofibers in young (20–36) compared with old (60–80) and higher for type I (5%, P < 0.05) and II (14%, P < 0.001) myofibers in the oldest old (>80) compared with old. The increased SFI in old muscle was observed in myofibers of all sizes. Within all three age cohorts, type II myofiber SFI was higher than that for type I myofiber (4–13%, P < 0.001), which was also the case in mice muscles (8–9%, P < 0.001). Across age cohorts, there was no difference between males and females in SFI for either type I (P = 0.496/0.734) or II (P = 0.176/0.585) myofibers. Multiple linear regression revealed that SFI, after adjusting for age and myofiber CSA, has independent explanatory power for 8/10 indices of muscle mass and function. RT reduced SFI of type II myofibers in both young and old (3–4%, P < 0.001).

Conclusions

Here, we identify type I and II myofiber shape in humans as a hallmark of muscle ageing that independently predicts volumetric and functional assessments of muscle health. RT reverts the shape of type II myofibers, suggesting that a lack of myofiber recruitment might lead to myofiber deformity.
Untangling the nexus between marketization, crop diversity, farmers' wealth and nutrition: The case of Uzbekistan
Authors: Lombardozzi Lorena
Published: December 2023

The effects of marketization on crop diversity and dietary diversity is very contested. Therefore, more empirical work is needed to unpack the multidimensional factors that underpin these processes. This article expands the analytical understanding of the linkages between these dimensions by looking at the case of Uzbekistan. First, it uses quantitative methods to assess the hypotheses that (a) wealth leads to higher dietary diversity; (b) agricultural marketization leads to lower dietary diversity; and (c) crop diversity leads to higher dietary diversity. Regression analysis shows that only wealth is an independent determinant of dietary diversity. Second, the article uses qualitative data to argue that state policies and social norms, by influencing food availability, knowledge and nutritional values, are key to unpacking the relationships between marketization, crop diversity and dietary diversity.
Embracing ethical research: Implementing the 3R principles into fracture healing research for sustainable scientific progress
Authors: Anup Amritha , Dieterich Sandra , Oreffo Richard O. C. , Dailey Hannah L. , Lang Annemarie , Haffner‐Luntzer Melanie , Hixon Katherine R.
Published: December 2023

As scientific advancements continue to reshape the world, it becomes increasingly crucial to uphold ethical standards and minimize the potentially adverse impact of research activities. In this context, the implementation of the 3R principles—Replacement, Reduction, and Refinement—has emerged as a prominent framework for promoting ethical research practices in the use of animals. This article aims to explore recent advances in integrating the 3R principles into fracture healing research, highlighting their potential to enhance animal welfare, scientific validity, and societal trust. The review focuses on in vitro, in silico, ex vivo, and refined in vivo methods, which have the potential to replace, reduce, and refine animal experiments in musculoskeletal, bone, and fracture healing research. Here, we review material that was presented at the workshop “Implementing 3R Principles into Fracture Healing Research” at the 2023 Orthopedic Research Society (ORS) Annual Meeting in Dallas, Texas.
Nitrogen fixation of lablab and finger millet in South‐India
Authors: Mock Andrea , Ingold Mariko , Vazhacharickal Prem Jose , Sourav Suman Kumar , Dittert Klaus , Buerkert Andreas
Published: December 2023

Background

In a long‐term rotation experiment (2016–2022) with different nitrogen (N) fertilizer levels in subtropical South‐India, crop yields of low N plots were unexpectedly high. We therefore hypothesized that in the absence of mineral N application, these yields are largely due to N inputs by N2 fixation in the component crops. To assess the diazotrophic N2‐fixation of lablab (Lablab purpureus L. Sweet) and possible associative N2‐fixation of finger millet (Eleusine coracana L. Gaertn), a controlled experiment was conducted during the 2021 monsoon season within the above‐mentioned long‐term field study. Two approaches were used to estimate the quantity of N derived from the atmosphere (Ndfa): the dilution method using a 15N‐labeled fertilizer and the natural abundance method.

Method

For the 15N dilution method irrigated maize (Zea maize L.), finger millet and lablab were labeled with two split applications of 10% 15N fertilizer (50:50 15N‐urea and 15N‐ammonium sulfate) amounting to a total of 15 kg N ha−1. Maize was selected as the non‐fixing reference plant to estimate diazotrophic N2‐fixation. The entire aboveground biomass of the labeled plants was harvested at maturity and analyzed for total DM, N concentration, and the 15N isotope ratio.

Results

N2 fixation efficiency for lablab was 52%–69% depending on the calculation method, corresponding to 40–53 kg N ha−1. For finger millet, the natural abundance method resulted in an estimated N2‐fixation of 5 kg N ha−1, which was suggested by the results of the dilution method whereby the reference plant maize was only poorly labeled.

Conclusion

Labeling of maize might have been diluted due to unexpected associative N2‐fixation or N‐uptake from unlabeled deep soil N pools. The data underline the importance of symbiotic N2‐fixation in crop rotation systems of South‐India.
Hepatic extravasation of total parenteral nutrition following umbilical venous catheter insertion: A rare complication
Authors: Berger Tal David , Gavri Ayelet , Jesin Stuart , Strauss Tzipi , Weiss Batia
Published: December 2023

Umbilical venous catheters are commonly inserted in critically ill newborns and can lead to severe complications when misplaced. We report a preterm female with a prenatal diagnosis of duodenal atresia who presented 2 days after the surgical repair with abdominal distension, hemodynamic instability, elevated liver enzymes with severe cholestatic jaundice, and a hepatic collection on abdominal sonography. An urgent explorative laparotomy demonstrated a large amount of white, milky‐appearing fluid in the abdominal cavity. Together with the sonographic findings, this led to the diagnosis of hepatic total parenteral nutrition extravasation. Upon removal of the umbilical venous catheter line, the infant's clinical state rapidly improved; however, cholestasis continued for months, with a very slow resolution. During follow‐up, the liver enzymes normalized, and a complete resolution of the liver collection was observed, without drainage.
Exploring the Role of Artificial Intelligence Chatbots in Preoperative Counseling for Head and Neck Cancer Surgery
Authors: Lee Jason C. , Hamill Chelsea S. , Shnayder Yelizaveta , Buczek Erin , Kakarala Kiran , Bur Andrés M.
Published: December 2023

Objective

To evaluate the potential use of artificial intelligence (AI) chatbots, such as ChatGPT, in preoperative counseling for patients undergoing head and neck cancer surgery.

Study Design

Cross‐Sectional Survey Study.

Setting

Single institution tertiary care center.

Methods

ChatGPT was used to generate presurgical educational information including indications, risks, and recovery time for five common head and neck surgeries. Chatbot‐generated information was compared with information gathered from a simple browser search (first publicly available website excluding scholarly articles). The accuracy of the information, readability, thoroughness, and number of errors were compared by five experienced head and neck surgeons in a blinded fashion. Each surgeon then chose a preference between the two information sources for each surgery.

Results

With the exception of total word count, ChatGPT‐generated pre‐surgical information has similar readability, content of knowledge, accuracy, thoroughness, and numbers of medical errors when compared to publicly available websites. Additionally, ChatGPT was preferred 48% of the time by experienced head and neck surgeons.

Conclusion

Head and neck surgeons rated ChatGPT‐generated and readily available online educational materials similarly. Further refinement in AI technology may soon open more avenues for patient counseling. Future investigations into the medical safety of AI counseling and exploring patients' perspectives would be of strong interest.

Level of evidence

N/A. Laryngoscope, 134:2757–2761, 2024
Determination of internal target volume with Cine‐MRI sequence for prostate MRI‐Guided radiotherapy
Authors: Wei Ran , Liang Bin , Men Kuo , Qin Shirui , Gao Linrui , Lu Ningning , Dai Jianrong
Published: December 2023

Background

In prostate radiotherapy, the intrafractional target motion negatively affects treatment accuracy. Generating internal target volume (ITV) using four‐dimensional (4D) images may resolve the issue of intrafractional target motion induced by bladder filling and bowel movement. However, no 4D imaging techniques suitable for the prostate are currently available in clinical practice.

Purpose

This study aimed to determine the ITV based on cine magnetic resonance imaging (MRI) sequence for intrafractional target motion management in prostate MRI‐guided radiotherapy.

Materials and Methods

A reference ITV was generated in simulation process. Then, the reference ITV was adapted with cine MRI sequence before online planning in each fraction. Finally, the reference ITV was updated with the cine MRI sequence acquired during beam delivery after each fraction. Cine MRI sequences and positioning three‐dimensional (3D) MRI from 35 patients were retrospectively collected. Clinical target volume (CTV) coverage was computed according to the two‐dimensional contour of CTV and ITV on cine MRI images. Relative target size was calculated as the ratio of the volume of ITV and CTV. Isotropic planning target volume (PTV; 5 mm margin) and anisotropic PTV (3 mm margin in the posterior direction and 5 mm margin in other directions) were generated for comparison.

Results

The CTV coverage rate of the proposed ITV had a mean value of 98.61% ± 0.51%, whereas the CTV coverage rates of the isotropic and anisotropic PTVs were 97.43% ± 0.41% and 96.58% ± 0.73%, respectively. The proposed ITV had a relative target size of 1.79 ± 0.17, whereas the anisotropic and isotropic PTVs had relative target sizes of 1.92 ± 0.12 and 2.21 ± 0.19, respectively. For both the CTV coverage rate and target relative size, significant differences were observed between the proposed ITV and the other two PTVs (p < 0.05).

Conclusion

The ITV achieved higher CTV coverage with smaller size than conventional isotropic and anisotropic PTVs, indicating that it can effectively deal with the intrafractional movement of the prostate.
Technical note: hydrogel‐based mimics of prostate cancer with matched relaxation, diffusion and kurtosis for validating multi‐parametric MRI
Authors: Malyarenko Dariya , Ono Shigeto , Lynch Ted J. E. , Swanson Scott D.
Published: December 2023

Background

Protocol standardization and optimization for clinical translation of emerging quantitative multiparametric (mp)MRI biomarkers of high‐risk prostate cancer requires imaging references that mimic realistic tissue value combinations for bias assessment in derived relaxation and diffusion parameters.

Purpose

This work aimed to develop a novel class of hydrogel‐based synthetic materials with simultaneously controlled quantitative relaxation, diffusion, and kurtosis parameters that mimic in vivo prostate value combinations in the same spatial compartment and allow stable assemblies of adjacent structures.

Methods

A set of materials with tunable T2, diffusion, and kurtosis were assembled to create quantitative biomimetic (mp)MRI references. T2 was controlled with variable agarose concentration, monoexponential diffusion by polyvinylpyrrolidone (PVP), and kurtosis by addition of lamellar vesicles. The materials were mechanically stabilized by UV cross‐linked polyacrylamide gels (PAG) to allow biomimetic morphologies. The reference T2 were measured on a 3T scanner using multi‐echo CPMG, and diffusion kurtosis—with multi‐b DWI.

Results

Agarose concentration controls T2 values which are nominally independent of PVP or vesicle concentration. For agarose PVP hydrogels, monoexponential diffusion values are a function of PVP concentration and independent of agarose concentration. Compared to free vesicles, for agarose‐PAG combined with vesicles, diffusion was predominantly controlled by vesicles and PAG, while kurtosis was affected by agarose and vesicle concentration. Both hydrogel classes achieved image voxel parameter values (T2, Da, Ka) for relaxation (T2: 65–255 ms), apparent diffusion (Da: 0.8−1.7 μm2/ms), and kurtosis (Ka: 0.5–1.25) within the target literature ranges for normal prostate zones and cancer lesions. Relaxation and diffusion parameters remained stable for over 6 months for layered material assemblies.

Conclusion

A stable biomimetic mpMR reference based on hydrogels has been developed with a range of multi‐compartment diffusion and relaxation parameter combinations observed in cancerous and healthy prostate tissue.
Diaphragmatic ultrasonography as a predictor of respiratory muscle fatigue in myasthenia gravis
Authors: Ma Jing , Zhang Huiqiu , Pang Xiaomin , Zhang Jing , Zhao Rongjuan , Wang Juan , Chang Xueli , Guo Junhong , Zhang Wei
Published: December 2023

Introduction/Aims

Easy fatigability, the clinical hallmark of generalized myasthenia gravis (GMG), cannot be detected in a dynamic way. The aim of this study was to assess respiratory function dynamically through diaphragmatic ultrasonography (DUS) in GMG patients.

Methods

GMG patients and controls were recruited in a 1:1 ratio. DUS was performed during one quiet breath and 15 consecutive deep breaths. The diaphragm thicknesses were measured at different positions. Diaphragm thickening fraction (TFdi) and the maximal change in diaphragm thickness (Tmax) during 15 consecutive deep breaths were calculated and transformed to normality, named N‐TFdi and N‐Tmax, respectively. The percentages of changes in TFdi and Tmax compared with baseline were named ΔTFdi and ΔTmax, respectively. The diagnostic parameter for respiratory muscle fatigue was chosen from ΔTFdi and ΔTmax at different deep breath times according to their ability to distinguish GMG patients from controls and the interrater reliability of TFdi and Tmax.

Results

Thirty‐four GMG patients and 30 healthy controls were enrolled. N‐TFdi and N‐Tmax significantly changed as the number of deep breaths increased (p < .001) in GMG patients, but not in controls. ΔTmax of the 15th deep breath (ΔTmax15) was selected as the diagnostic parameter for respiratory muscle fatigue. There were no significant differences in percentage of predicted values of forced vital capacity and arterial partial pressure of carbon dioxide between patients with normal and abnormal ΔTmax15.

Discussion

DUS could identify diaphragm fatiguability in GMG patients, which may be more reliable and sensitive in assessment of diaphragm fatigue than conventional methods.
A novel eviction policy based on shortest remaining time for software defined networking flow tables
Authors: Dhandapani Kavi Priya , Thanganadar Thangathai Mirnalinee , Hamead Haja Moinudeen Shahul
Published: December 2023

Software defined networking is a modern paradigm that divides the control plane from the data plane for improved network manageability. A flow table in the data plane has limited and expensive memory called TCAM. The presence of unwanted flow rules would lead to flow bloat conditions and make the lookup operation inefficient. Eviction schemes based on LRU policy have been widely studied in the literature which preempts the life of the least recently used flow rule and reduces the occupancy of the flow table. LRU considers the past behavior for the eviction of a flow rule. This paper proposes a novel policy that preempts a flow rule by considering its future characteristic, the shortest remaining time (SRT). A rule with a higher probability of being used is avoided from eviction to mitigate the degradation of performance. The modeling of the SRT technique exhibits better utilization of a flow rule that has higher probability of being used. On the other hand, LRU does not guarantee that the evicted flow rule will not be used frequently in the future and it has been shown that an incorrectly evicted flow rule incurs controller delay. The experimental results show that for different traffic rates, SRT has reduced the delay by 15%, reinstallation count by 25%, and jitter by 40%. SRT has increased utilization by 22% compared to LRU.
Close relatives' perspective of critical illness due to COVID‐19: Keeping in touch at a distance
Authors: Nordin Anna , Engström Åsa , Strömbäck Ulrica , Juuso Päivi , Andersson Maria
Published: December 2023

Aim

To elucidate the meaning of being a close relative of a critically ill person cared for in intensive care during the initial phase of the COVID‐19 pandemic.

Design

A narrative inquiry design following the COREQ guidelines.

Methods

Individual interviews with fifteen close relatives of patients critically ill with COVID‐19 were analysed using phenomenological hermeneutics.

Results

The surreal existence of not being allowed to be near was emotionally difficult. While distancing due to restrictions was challenging, physicians' phone calls served as a connection to their relatives and brought a sense of security. Keeping notes helped them remember what happened and brought order to a chaotic situation.

Conclusion

Close relatives feel secure when they receive regular information about their critically ill relative, not just when their condition worsens. They wish to be physically near to their critically ill person; when this is impossible, digital technology can provide support, but further accessibility developments are needed.
Knowledge about the best practice guidelines in the nursing degree: A non‐randomized post‐test design
Authors: García‐Sierra Rosa , Fernández‐Cano María Isabel , Jiménez‐Pera Miguel , Feijoo‐Cid Maria , Arreciado Marañón Antonia
Published: December 2023

Aim

To compare knowledge of Nursing Degree students about Best Practice Guidelines when there are included as teaching content in a subject vs knowledge through having the usual internship experience without teaching specific guidelines contents.

Design

Non‐randomized post‐test‐only design with a comparison group.

Methods

143 students of the nursing degree at the Autonomous University of Barcelona were recruited. The intervention group received a classroom training in three Best Practice Guidelines with Problem‐Based Learning methodology. The comparison group only attended internship, without specific guidelines contents. Knowledge was evaluated with an ad hoc post intervention questionnaire. The information was collected between 2016 and 2018.

Results

The average score of knowledge was low, 5.1 out of 10, and differs between guides. The best results were obtained by the students with internships and that had consulted the guides on some occasions. Synchronized effort and leadership in Academia and Healthcare are needed to favour evidence‐based practice. The combination of the consultation of the Best Practice Guidelines in theoretical learning combined with the practice, increases the knowledge of the Best Practice Guidelines and will favour the implementation of evidence‐based practice. Some students were involved in questionnaire design.
Factors Associated with Iatrogenic Laryngeal Injury in Recurrent Respiratory Papillomatosis
Authors: So Raymond J. , Hillel Alexander T. , Motz Kevin M. , Akst Lee M. , Best Simon R.
Published: December 2023

Objective

To describe iatrogenic laryngeal injury and identify its risk factors in recurrent respiratory papillomatosis (RRP) patients receiving surgical care.

Study Design

Case‐control.

Setting

Tertiary care academic hospital in a metropolitan area.

Methods

Charts of patients with RRP seen at our institution from January 2002 to December 2022 were reviewed. Patients were separated into 2 cohorts based upon whether they experienced any form of iatrogenic laryngeal injury—including anterior commissure synechiae, vocal cord scar, reduced vocal fold pliability, vocal fold motion impairment, and glottic and/or subglottic stenosis. Adjusted logistic regressions were performed to identify factors associated with iatrogenic laryngeal injury.

Results

Of 199 RRP patients, 133 (66.8%) had identifiable iatrogenic laryngeal injury. The most common injuries were anterior commissure synechiae (n = 67; 50.4%) and reduced vocal fold pliability (n = 54; 40.6%). On a multivariate logistic regression, patients with diabetes mellitus (adjusted odds ratio [aOR] [95% confidence interval [CI]]: 2.99 [1.02, 8.79]; P = .04) and who received at least 10 surgeries lifetime (aOR [95% CI]: 14.47 [1.70, 123.19]; P = .01) were at increased risk for iatrogenic laryngeal injury, whereas receiving less than 5 surgeries (aOR [95% CI]: 0.21 [0.09, 0.51]; P < .001) was found to be protective. When treating the lifetime number of surgeries as a continuous variable, a greater number of surgeries was a significant risk factor for iatrogenic laryngeal injury (aOR [95% CI]: 1.32 [1.14, 1.53]; P < .001).

Conclusion

These results suggest the importance of strict glucose control for diabetic patients receiving RRP surgical care, and emphasize the clinical need to identify medical therapies to decrease RRP surgical frequency for patients.
Where wilderness is found: Evidence from 70,000 trip reports
Authors: Derrien Monika M. , Winder Samantha G. , Wood Spencer A. , Miller Lesley , Lia Emilia H. , Cerveny Lee K. , Lange Sarah , Kolstoe Sonja H. , McGrady Grace , Roth Anna
Published: December 2023

Outdoor recreation is an essential way many people engage with nature. The provision of public spaces for recreation intersects with conservation practices motivated by intertwined social and ecological values, such as strict practices associated with the concept of ‘wilderness’. Debates persist about how such concepts and management practices influence people's recreation experiences.

Many US public land management agencies facilitate opportunities for outdoor recreation, relying on management frameworks and tools intended to foster specific experiential qualities. But these frameworks and tools assume simplistic relationships between settings and people's experiences, and managers rarely assess these relationships.

This study uses a data set of nearly 70,000 crowdsourced trip reports from a hiking website to understand the qualities of visitors' experiences on trails. We study the geographic distribution of experiential qualities commonly associated with US wilderness areas: aesthetics, awe, challenge, pristineness, quietness, solitude and timelessness. Using analytical methods that rely on machine learning and natural language processing, we identify these experiential qualities in trip reports from hundreds of routes, and use generalized linear models to analyse relationships between the frequency of each experiential quality and the route's administrative, built, biophysical, geographic and social settings.

We find that four of the seven experiential qualities (aesthetics, awe, challenge and solitude) are commonly described in trip reports, each appearing in 15%–55% of manually coded reports. The extent to which setting characteristics explained variability in experiences differed, ranging from 34% of the variability in the proportion of trip reports describing aesthetics to 55% for awe. The setting characteristics associated with each experiential quality also differed, with characteristics such as trail mileage and summit destinations having stronger influences on experiential qualities than characteristics such as wilderness designation.

Synthesis and applications. Our findings suggest the need to consider more diverse variables in experience–setting relationships, develop more robust models to characterize those relationships and create new data sources to represent understudied variables. These advances would help empirically inform and improve frameworks and tools used for recreation and wilderness planning and monitoring, and potentially promote more responsive management to evolving social–ecological values.

Read the freePlain Language Summaryfor this article on the Journal blog.
Efficient removal of aqueous Pb(II) ions by magnetic alginate composite microcapsules containing canola straw‐derived biochar as the reinforcing fillers
Authors: Luo Mina , Che Tianfu , Huang Chao , Zhu Chunmei , Yang Hanchao , Zhong Cheng
Published: December 2023

With the rapid development of industry, water pollution caused by lead has caused great harm to human health. In this study, alginate is used as a base and blended with biochar to form calcium alginate hydrogel beads with high mechanical properties through ionic cross‐linking. Besides, the material (BC/MCAC) is prepared by the material (C‐γ‐Fe2O3) as a magnetizing agent and to remove lead. Then, a series of batch experiments and material characterizations are performed to evaluate the adsorption process of the material. The results show that the maximum adsorption capacity of BC/MCAC to Pb(II) is 211.6 mg g−1 at pH = 7. The adsorption process is well described by the Langmuir adsorption isotherm and pseudo‐second‐order kinetic model. This indicates that the lead adsorbed by BC/MCAC is a monolayer chemisorption that occurs on a uniform surface. After three regeneration cycles, BC/MCAC is found to retain 82.37% of the lead adsorption capacity and has good regeneration ability. Lead is removed by BC/MCAC mainly through the complexation of oxygen‐containing functional groups, electrostatic interaction, and ion exchange. BC/MCAC allows for more sustainable use of the wastes and is expected to be a new type of lead adsorbent for industrial wastewater.