bluuebunny/crossref_metadata_2025 huggingface dataset:
Centre-to-limb variations in coronal hole and quiet sun regions obtained with IRIS spectroscopic observations
Authors: Kayshap Pradeep , Young Peter R
Published: September 2023

The centre-to-limb variations (CLV) of Gaussian fit parameters of the transition region Si iv 1402.77 Å spectral line in quiet Sun (QS) and coronal hole (CH) regions are presented. The results are derived from a full-disc mosaic scan obtained by the Interface Region Imaging Spectrograph on 2017 September 24. The CLV for a CH transition region line has not previously been reported, and the parameters are found to show variations consistent with the QS. The intensity increases towards the limb, consistent with an increasing plasma column depth due to line-of-sight effects. The Doppler velocity is normalized to be zero at the limb for both QS and CH and increases to +4.8 km s−1 (redshift) at disc centre for CH and +5.2 km s−1 for QS. Non-thermal broadening in the CH decreases from a maximum of 24 km s−1 at the limb to 10 km s−1 at disc centre. For QS the broadening decreases from 25 km s−1 at the limb to 14 km s−1 at disc centre. Both Doppler velocities and non-thermal velocities vary linearly with $\cos \, \theta$, where θ is the heliocentric angle. The QS results for both parameters are consistent with earlier work.
Constraining intermediate-mass black holes from the stellar disc of SgrA*
Authors: Fouvry Jean-Baptiste , Bustamante-Rosell María José , Zimmerman Aaron
Published: September 2023

Stars evolving around a supermassive black hole see their orbital orientations diffuse efficiently, a process called ‘vector resonant relaxation’. In particular, stars within the same disc, i.e. neighbours in orientations, will slowly diffuse away from one another through this stochastic process. We use jointly (i) detailed kinetic predictions for the efficiency of this dilution and (ii) the recent observation of a stellar disc around SgrA*, the supermassive black hole at the centre of the Milky Way, to constrain SgrA*’s unobserved stellar cluster. Notably, we investigate quantitatively the impact of a population of intermediate-mass black holes on the survivability of the stellar disc.
When will RNA get its AlphaFold moment?
Authors: Schneider Bohdan , Sweeney Blake Alexander , Bateman Alex , Cerny Jiri , Zok Tomasz , Szachniuk Marta
Published: September 2023

The protein structure prediction problem has been solved for many types of proteins by AlphaFold. Recently, there has been considerable excitement to build off the success of AlphaFold and predict the 3D structures of RNAs. RNA prediction methods use a variety of techniques, from physics-based to machine learning approaches. We believe that there are challenges preventing the successful development of deep learning-based methods like AlphaFold for RNA in the short term. Broadly speaking, the challenges are the limited number of structures and alignments making data-hungry deep learning methods unlikely to succeed. Additionally, there are several issues with the existing structure and sequence data, as they are often of insufficient quality, highly biased and missing key information. Here, we discuss these challenges in detail and suggest some steps to remedy the situation. We believe that it is possible to create an accurate RNA structure prediction method, but it will require solving several data quality and volume issues, usage of data beyond simple sequence alignments, or the development of new less data-hungry machine learning methods.
TGPred: efficient methods for predicting target genes of a transcription factor by integrating statistics, machine learning and optimization
Authors: Cao Xuewei , Zhang Ling , Islam Md Khairul , Zhao Mingxia , He Cheng , Zhang Kui , Liu Sanzhen , Sha Qiuying , Wei Hairong
Published: September 2023

Four statistical selection methods for inferring transcription factor (TF)–target gene (TG) pairs were developed by coupling mean squared error (MSE) or Huber loss function, with elastic net (ENET) or least absolute shrinkage and selection operator (Lasso) penalty. Two methods were also developed for inferring pathway gene regulatory networks (GRNs) by combining Huber or MSE loss function with a network (Net)-based penalty. To solve these regressions, we ameliorated an accelerated proximal gradient descent (APGD) algorithm to optimize parameter selection processes, resulting in an equally effective but much faster algorithm than the commonly used convex optimization solver. The synthetic data generated in a general setting was used to test four TF–TG identification methods, ENET-based methods performed better than Lasso-based methods. Synthetic data generated from two network settings was used to test Huber-Net and MSE-Net, which outperformed all other methods. The TF–TG identification methods were also tested with SND1 and gl3 overexpression transcriptomic data, Huber-ENET and MSE-ENET outperformed all other methods when genome-wide predictions were performed. The TF–TG identification methods fill the gap of lacking a method for genome-wide TG prediction of a TF, and potential for validating ChIP/DAP-seq results, while the two Net-based methods are instrumental for predicting pathway GRNs.
Roles of citrus fruits on energy expenditure, body weight management, and metabolic biomarkers: a comprehensive review
Authors: Aslan Merve Nur , Sukan-Karaçağıl Betül , Acar-Tek Nilüfer
Published: September 2023

Citrus fruits are widely consumed for their nutritional and health benefits. They belong to the Rutaceae and have many varieties, such as sweet orange (Citrus sinensis), which is the most popular. Citrus fruits are rich in water (>80%), dietary fiber, and vitamins. They also contain bioactive components, which may modulate energy metabolism and lipid oxidation through various mechanisms. These mechanisms include stimulating β3-adrenergic receptors, increasing mitochondrial biogenesis and thermogenesis, activating AMP kinase and peroxisome proliferator-activated receptor-gamma coactivator-1α pathways, inhibiting lipogenesis and lipid accumulation, and inducing browning of white adipose tissue. This review summarizes the mechanisms and outcomes of citrus fruits and their metabolites on energy metabolism and body weight in different experimental models. The literature was searched for in vitro and in vivo animal and human studies that investigated the effects of citrus consumption on energy expenditure, thermogenesis, adipogenesis, and lipid accumulation. Citrus fruits and their metabolites have shown promising effects on energy metabolism and lipid oxidation in in vitro and in vivo animal studies. However, the evidence from human studies is limited and inconsistent. Possible reasons for the discrepancy are briefly discussed, and knowledge gaps and research needs are identified for future studies. Citrus fruits may have beneficial effects on energy metabolism and body weight, but more rigorous and well-designed human trials are needed to confirm their efficacy and safety.
Root Primordium Defective 1 Encodes an Essential PORR Protein Required for the Splicing of Mitochondria-Encoded Group II Introns and for Respiratory Complex I Biogenesis
Authors: Edris Rana , Sultan Laure D , Best Corinne , Mizrahi Ron , Weinstein Ofir , Chen Stav , Kamennaya Nina A , Keren Nir , Zer Hagit , Zhu Hongliang , Ostersetzer-Biran Oren
Published: September 2023

Cellular respiration involves complex organellar metabolic activities that are pivotal for plant growth and development. Mitochondria contain their own genetic system (mitogenome, mtDNA), which encodes key elements of the respiratory machinery. Plant mtDNAs are notably larger than their counterparts in Animalia, with complex genome organization and gene expression characteristics. The maturation of the plant mitochondrial transcripts involves extensive RNA editing, trimming and splicing events. These essential processing steps rely on the activities of numerous nuclear-encoded cofactors, which may also play key regulatory roles in mitochondrial biogenesis and function and hence in plant physiology. Proteins that harbor the plant organelle RNA recognition (PORR) domain are represented in a small gene family in plants. Several PORR members, including WTF1, WTF9 and LEFKOTHEA, are known to act in the splicing of organellar group II introns in angiosperms. The AT4G33495 gene locus encodes an essential PORR protein in Arabidopsis, termed ROOT PRIMORDIUM DEFECTIVE 1 (RPD1). A null mutation of At.RPD1 causes arrest in early embryogenesis, while the missense mutant lines, rpd1.1 and rpd1.2, exhibit a strong impairment in root development and retarded growth phenotypes, especially under high-temperature conditions. Here, we further show that RPD1 functions in the splicing of introns that reside in the coding regions of various complex I (CI) subunits (i.e. nad2, nad4, nad5 and nad7), as well as in the maturation of the ribosomal rps3 pre-RNA in Arabidopsis mitochondria. The altered growth and developmental phenotypes and modified respiration activities are tightly correlated with respiratory chain CI defects in rpd1 mutants.
Physiological Functions of Phospholipid:Diacylglycerol Acyltransferases
Authors: Sah Saroj Kumar , Fan Jilian , Blanford Jantana , Shanklin John , Xu Changcheng
Published: September 2023

Triacylglycerol (TAG) is among the most energy dense storage forms of reduced carbon in living systems. TAG metabolism plays critical roles in cellular energy balance, lipid homeostasis, cell growth and stress responses. In higher plants, microalgae and fungi, TAG is assembled by acyl-CoA-dependent and acyl-CoA-independent pathways catalyzed by diacylglycerol (DAG) acyltransferase and phospholipid:DAG acyltransferase (PDAT), respectively. This review contains a summary of the current understanding of the physiological functions of PDATs. Emphasis is placed on their role in lipid remodeling and lipid homeostasis in response to abiotic stress or perturbations in lipid metabolism.
The Procedural Politicking Tug of War: Law-Versus-Management Disputes in Contexts of Democratic Backsliding
Authors: Spanghero Lotta Gabriela , Alves de Lima Iana , Costa Silveira Mariana , Fernandez Michelle , Paschoal Pedote João , Landi Corrales Guaranha Olívia
Published: September 2023

The legitimacy of democracy and civil rights is based upon laws and administrative procedures. The presence of a legal framework and its application by bureaucrats in their daily decisions are prerequisites for the democratic rule of law. This explains why, in contexts of democratic backsliding, legal frameworks are under attack. Scholars observed the role of public administration in processes of democratic backsliding, but there is still a gap in understanding the disputes around the legal framework. Here, we analyze the conflicts between politicians and bureaucrats around the legal framework in a context of democratic backsliding. Analyzing the case of Brazil under Bolsonaro’s Government, we draw on 164 interviews with bureaucrats to understand how both bureaucrats and politicians dispute the legitimacy, uses, and interpretations of the legal framework to attack or protect democratic institutions and civil rights. On one side, bureaucrats defend themselves and their legitimacy through existing rules and procedures. On the other side, politicians change or reinterpret the rules to fragilize bureaucrats’ decisions. In this process, both politicians and bureaucrats learn how to improve their strategies around the uses of legal frameworks. These findings contribute to understanding how the dynamics around the legal framework explain processes of democratic backsliding.
Exacerbating inequality over the life-course: examining race differences in the reciprocal effects between incarceration and income
Authors: Silver Ian A , D’Amato Christopher , Wooldredge John
Published: September 2023

Relative to Whites, Blacks face lower odds of gaining employment with notable wages while also facing longer terms of incarceration when sent to jail or prison for criminal offenses. Although a variety of factors contribute to these patterns, the time a Black individual spends incarcerated could decrease future earnings, whereas lower earnings could increase the time spent incarcerated. Nevertheless, prior research has yet to consider—or evaluate—the reciprocal association between income and incarceration, limiting our ability to discern how involvement in the criminal justice system contributes to the racial gap in income between Black and Whites. Using the National Longitudinal Survey of Youth 1997, the current study evaluated the influence of time spent incarcerated and income on future time spent incarcerated and income of Blacks and Whites. A lagged Latent Curve Model with Structured Residuals was estimated to examine the between- and within-individual reciprocal effects of months incarcerated and income. The findings suggested that a 1 month increase in time spent incarcerated for Blacks resulted in a 300–600 dollar decrease in income during the subsequent measurement period, an effect that was not observed for Whites. It appears that time spent incarcerated reduces future earnings for justice-involved Blacks. Overall, findings suggest that the criminal justice system contributes to the income gap that exists more generally between Blacks and Whites in the United States.
Cluster Zone Leaf Removal Reduces the Rate of Anthracnose (Elsinöe ampelina) Progress and Facilitates Its Control
Authors: Carisse Odile , Provost Caroline
Published: September 2023

Anthracnose caused by Elsinöe ampelina is an economically important disease that affects certain hardy and semihardy grapevine cultivars. The control of this disease requires repeated application of fungicides, which has financial and environmental consequences. In this study, leaf removal in the cluster area was studied with a view to facilitating integrated anthracnose management. First, the effect of leaf removal timing (BBCH stage 53 or 71) and intensity (one or both sides of rows) on the progression of anthracnose and on the microclimate was studied in plots planted with Vidal blanc (Vitis vinifera) at two sites in both 2020 and 2021. Overall, at both sites and in both years, anthracnose on leaves was more severe in plots without cluster zone leaf removal. Regardless of the timing of leaf removal, anthracnose severity on leaves and incidence of infected berries at harvest were significantly lower in plots where leaves had been removed on both sides of the rows compared with plots where leaves were removed on one side only. Second, anthracnose management programs with leaf removal, with or without disease risk estimation, were evaluated. All anthracnose management programs including leaf removal in the cluster zone reduced anthracnose development compared with the standard program without leaf removal. Overall mean leaf anthracnose severity, severity at harvest, and anthracnose incidence on clusters at harvest were lower in plots with leaf removal than in the standard program, but the differences between the two treatments were not significant (P > 0.05). More fungicide applications were made in plots managed using the standard programs, specifically 13 applications, compared with plots managed based on assessing the weather-related risk of anthracnose, with 9 and 10 applications made at sites 1 and 2 for the risk-based program, respectively, and 5 and 7 applications made at sites 1 and 2, respectively, when microclimate within the cluster zone was considered. The results of this study clearly show the important role that leaf removal can play in managing grape anthracnose.
Negative methylene diphosphonate scintigraphy in biopsy-confirmed hereditary transthyretin Ala117Ser cardiac amyloidosis: a case report
Authors: Wu Zejia , Xia Shuang , Ma Dunliang , Li Liwen
Published: September 2023

99mTc-pyrophosphate (99mTc-PYP) scintigraphy is highly sensitive and specific for the diagnosis of transthyretin cardiac amyloidosis (ATTR-CA). Commonly used alternative tracers included 99mTc-3,3-diphosphono-1,2-propanodicarboxylic acid (99mTc-DPD) and 99mTc-hydroxymethylene diphosphonate (99mTc-HMDP). A 61-year-old Chinese man presented with signs indicative of left ventricular hypertrophy. Genetic testing revealed heterozygous transthyretin Ala117Ser mutation. Scintigraphy using 99mTc-methylene diphosphonate failed to show myocardial uptake. Five months later, the patient underwent permanent pacemaker implantation. Tafamidis was used irregularly, and the patient died 2 years later. 99mTc-methylene diphosphonate may not be appropriate for diagnostic use in ATTR-CA patient with transthyretin Ala117Ser mutation.
ROS1 Fusion Angiomatoid Spitz Nevus With Eccrine Duct Fibroadenomatosis and Syringoid Features
Authors: Daruish Maged , Stefanato Catherine M.
Published: September 2023

Eccrine duct fibroadenomatosis is a reactive histological phenomenon observed in a variety of inflammatory and neoplastic pathologies. We report a case of a ROS1 fusion angiomatoid Spitz nevus with associated acrosyringeal hyperplasia and a syringoma-like ductal proliferation in a young female patient.
Intelligent acupuncture: data-driven revolution of traditional Chinese medicine
Authors: Bao Yunfan , Ding Haokang , Zhang Zhihan , Yang Kunhuan , Tran Queena , Sun Qi , Xu Tiancheng
Published: September 2023

Acupuncture, a form of traditional Chinese medicine with a history of 2,000 years in China, has gained wider acceptance worldwide as a complementary therapy. Studies have examined its effectiveness in various health conditions and it is commonly used alongside conventional medical treatments. With the development of artificial intelligence (AI) technology, new possibilities for improving the efficacy and precision of acupuncture have emerged. This study explored the combination of traditional acupuncture and AI technology from three perspectives: acupuncture diagnosis, prescription, and treatment evaluation. The study aimed to provide cutting-edge direction and theoretical assistance for the development of an acupuncture robot.
A Network Pharmacology Approach to Understand the Action Mechanisms of the TangShenKangPing Decoction for Diabetic Nephropathy Treatment
Authors: Chang Jingsheng , Li Xueling , Wang Jue , Zhong Yifei
Published: September 2023

Background:

TangShenKangPing decoction (TSKPD) has been used to treat patients with diabetic nephropathy (DN) for more than 10 years. However, its active ingredients and their pharmacological mechanisms of action remain unclear. In this study, we aimed to identify the key targets, major active ingredients, and pathways of TSKPD using network pharmacology.

Methods:

Human phenotypic disease, Gene Ontology, and Kyoto Encyclopedia of Genes and Genomes pathway enrichment analyses were performed and 37 candidates targets of 40 active TSKPD ingredients were identified. Enrichment analyses revealed that TSKPD reduced podocyte apoptosis via vitamin metabolic processes, regulated the inflammatory response via the advanced glycation end product–receptor for AGE (AGE-RAGE) signaling, and reduced abnormal angiogenesis via vascular endothelial growth factor (VEGF) signaling in patients with DN. Furthermore, we verified the therapeutic roles and action mechanism of TSKPD in db/db mice with DN. The medicine was administered via gavage for 12 weeks. Fasting blood glucose, blood lipid, pro-inflammatory cytokine, and 24 h urinary albumin levels and pathological alterations in the renal tissues were evaluated. KHDRBS1, NLRP3 and VEGF relative mRNA and protein expression levels in renal tissues were determined using reverse transcription-quantitative olymerase chain reaction (RT-qPCR) and western blotting, respectively.

Results:

Treatment with TSKPD decreased proteinuria and lipid levels in the serum, significantly decreased the kidney weight, ameliorated renal histopathological alterations, and reduced pro-inflammatory cytokine expression and oxidative stress in db/db mice.

Conclusion:

TSKPD exerts therapeutic effects by regulating multiple factors, reducing oxidative stress and inflammation, and protecting the podocytes.
Influence of Nd:YAG laser capsulotomy on toric intraocular lens rotation and change in cylinder power
Authors: Cinar Esat , Yuce Berna , Aslan Fatih , Erbakan Gökhan
Published: September 2023

Purpose:

To investigate toric monofocal intraocular lens (TIOL) rotation and associated changes in cylinder power caused by Nd:YAG laser capsulotomy performed due to posterior capsule opacification (PCO).

Setting:

Ekol Eye Hospital, Izmir, Turkey.

Design:

Prospective case series.

Methods:

41 eyes of 20 women and 21 men were included in the study. Before and 1 month after Nd:YAG laser capsulotomy, TIOL tilt and decentration were determined with Scheimpflug camera, and TIOL axial rotation and the change in cylinder power induced by this rotation were measured by ray tracing aberrometry. The time interval between cataract surgery and Nd:YAG laser capsulotomy was noted.

Results:

Rotational misalignment of the TIOL was measured as 4.65 ± 2.75 degrees (range 0 to 11 degrees) before vs 6.97 ± 2.92 degrees (range 0 to 13 degrees) after capsulotomy, and absolute rotation was 2.75 ± 1.94 degrees (range 0 to 7 degrees, P = .028). Before and after Nd:YAG laser capsulotomy, cylinder power was 0.24 ± 0.70 diopter (D) (range 0.00 to 0.63 D) vs 0.56 ± 0.77 D (range 0.02 to 0.91 D), respectively, with an absolute change in cylinder power of 0.34 ± 0.22 D (range 0.01 to 0.90 D, P = .001). After capsulotomy, there was a significant decrease in IOL tilt in the horizontal and vertical planes and an increase in decentration (P < .05). Time interval (33.02 ± 12.9 months) and IOL horizontal decentration were independent factors affecting IOL rotation after capsulotomy (P < .05).

Conclusions:

Nd:YAG laser capsulotomy may cause TIOL rotation as well as tilt and decentration, resulting in a change in the TIOL's corrective effect on corneal astigmatism. Although this change was clinically insignificant, it may be beneficial to consider that TIOL rotational misalignment may occur in patients undergoing early capsulotomy.
Bradykinin receptor expression and bradykinin-mediated sensitization of human sensory neurons
Authors: Yi Jiwon , Bertels Zachariah , Del Rosario John Smith , Widman Allie J. , Slivicki Richard A. , Payne Maria , Susser Henry M. , Copits Bryan A. , Gereau Robert W.
Published: September 2023

Bradykinin is a peptide implicated in inflammatory pain in both humans and rodents. In rodent sensory neurons, activation of B1 and B2 bradykinin receptors induces neuronal hyperexcitability. Recent evidence suggests that human and rodent dorsal root ganglia (DRG), which contain the cell bodies of sensory neurons, differ in the expression and function of key GPCRs and ion channels; whether bradykinin receptor expression and function are conserved across species has not been studied in depth. In this study, we used human DRG tissue from organ donors to provide a detailed characterization of bradykinin receptor expression and bradykinin-induced changes in the excitability of human sensory neurons. We found that B2 and, to a lesser extent, B1 receptors are expressed by human DRG neurons and satellite glial cells. B2 receptors were enriched in the nociceptor subpopulation. Using patch-clamp electrophysiology, we found that acute bradykinin increases the excitability of human sensory neurons, whereas prolonged exposure to bradykinin decreases neuronal excitability in a subpopulation of human DRG neurons. Finally, our analyses suggest that donor's history of chronic pain and age may be predictors of higher B1 receptor expression in human DRG neurons. Together, these results indicate that acute bradykinin-induced hyperexcitability, first identified in rodents, is conserved in humans and provide further evidence supporting bradykinin signaling as a potential therapeutic target for treating pain in humans.
Expectations underlie the effects of unpredictable pain: a behavioral and electroencephalogram study
Authors: Pavy Fabien , Zaman Jonas , Von Leupoldt Andreas , Torta Diana M.
Published: September 2023

Previous studies on the potential effects of unpredictability on pain perception and its neural correlates yielded divergent results. This study examined whether this may be explained by differences in acquired expectations. We presented 41 healthy volunteers with laser heat stimuli of different intensities. The stimuli were preceded either by predictable low, medium, or high cues or by unpredictable low–medium, medium–high, or low–high cues. We recorded self-reports of pain intensity and unpleasantness and laser-evoked potentials (LEPs). Furthermore, we investigated whether dynamic expectations that evolved throughout the experiment based on past trials were better predictors of pain ratings than fixed (nonevolving) expectations. Our results replicate previous findings that unpredictable pain is higher than predictable pain for low-intensity stimuli but lower for high-intensity stimuli. Moreover, we observed higher ratings for the medium–high unpredictable condition than the medium–low unpredictable condition, in line with an effect of expectation. We found significant interactions (N1, N2) for the LEP components between intensity and unpredictability. However, the few significant differences in LEP peak amplitudes between cue conditions did not survive correction for multiple testing. In line with predictive coding perspectives, pain ratings were best predicted by dynamic expectations. Surprisingly, expectations of reduced precision (increased variance) were associated with lower pain ratings. Our findings provide strong evidence that (dynamic) expectations contribute to the opposing effects of unpredictability on pain perception; therefore, we highlight the importance of controlling for them in pain unpredictability manipulations. We also suggest to conceptualize pain expectations more often as dynamic constructs incorporating previous experiences.
Suicide Data in Trauma Centers: Implications of Imprecision
Authors: Cronn Susan E. , Kant Jacey M. , Brandolino Amber , Kohlbeck Sara , deRoon-Cassini Terri , Emerson Nathan , Schramm Andrew
Published: September 2023

BACKGROUND:

Trauma registries exist to provide data for evaluating the quality of care of trauma patients. These data facilitate research and can be used for outreach, planning, and improvement in trauma patient outcomes. However, the accuracy of registry data related to suicide has not been well studied.

OBJECTIVE:

This study sought to evaluate the accuracy of current trauma registry coding practices related to labeling injury as a suicide attempt among patients presenting to a Level I trauma center after self-inflicted injury.

METHODS:

We conducted a single-center, retrospective cohort analysis of a Level I trauma center trauma registry on all patients with self-inflicted injuries from 2011 to 2021. Manual chart review was used to identify cases wherein patients' injuries were categorized as suicidal despite the absence of suicidal intent.

RESULTS:

During this 11-year period, 537 patients were identified as having presented to the trauma center for traumatic self-inflicted injuries. Manual chart review revealed that 16% of these patients were incorrectly categorized as having attempted suicide despite their self-inflicted injury lacking suicidal intent (e.g., accidents, nonsuicidal self-harm).

CONCLUSION:

We found that 16% of trauma registry patients were overcategorized as having attempted suicide. Trauma registry data are an important source of information for activities related to injury prevention in trauma centers. Imprecise coding of self-inflicted injury may lead to poorly targeted programs and interventions due to incorrectly represented injury causes and patterns in trauma patient populations, including suicide prevention.
Standardized Calcium Replacement in Massive Transfusion: A Quality Improvement Project
Authors: Laing Marisa L. , Burtch Kimberly , Storrer Angie , McCoy Cameron
Published: September 2023

BACKGROUND:

Hypocalcemia is common in trauma patients receiving massive transfusion protocol and often leads to worsening coagulopathies. Despite the identified problem and recommendations for replacement, few institutions have implemented a standardized calcium replacement protocol.

OBJECTIVE:

This study aims to assess whether a revised massive transfusion protocol, including standardized calcium replacement, increases the incidence of calcium administration in trauma patients receiving massive transfusion protocol.

METHODS:

This quality improvement project used a retrospective pre-/postdesign to study the revision of the current facility's massive transfusion protocol to include calcium replacement and ionized calcium monitoring at an urban Level I academic trauma center. Pre- and postintervention data were collected from January 2022 through October 2022 to determine the number of times massive transfusion protocol was ordered, ionized calcium monitoring, and calcium administration rates. Feedback regarding the protocol was collected throughout the monitoring period and was utilized in the final analysis.

RESULTS:

A total of 40 patients received massive transfusion protocol, preintervention, 18 of 23 (78%) received calcium supplementation, postintervention, 15 of 16 (98%) were treated. The majority of protocol activations occurred in the trauma bay (79%) and postintervention; ionized calcium monitoring dropped by 14%.

CONCLUSION:

This study found that the addition of standardized calcium replacement improved administration rates of calcium in this patient population. Ongoing research will ensure the recommended changes improve the identified shortcomings and that patients maintain adequate ionized calcium levels with the current dosing parameters.
Genetic therapies in cystic fibrosis
Authors: Taylor-Cousar Jennifer L. , Boyd A. Christopher , Alton Eric W.F.W. , Polineni Deepika
Published: September 2023

Purpose of review

Advances in cystic fibrosis (CF) therapies over the past decade pivotally changed the morbidity and mortality of CF with the advent of cystic fibrosis transmembrane conductance regulator (CFTR) modulators that rescue dysfunctional CFTR protein in individuals with eligible genotypes. However, a significant proportion of the CF population is in need of alternative treatment strategies to address CFTR variants that are ineligible for therapeutic protein correction and/or potentiation. Current drug development efforts of nucleic-acid based therapies (i.e., DNA and RNA based therapies) in CF are informed by historic challenges of CF gene therapy trials, recent FDA guidance informed by non-CF gene therapy trials, and advances in therapeutic applications related to severe acute respiratory syndrome coronavirus 2 vaccine development. These historic and timely developments are of significant relevance for advancing genetic therapies in CF.

Recent findings

This article reviews the main themes of semi-permanent genetic therapy strategies covering recent literature focused on: adenovirus and adeno-associated virus vector delivery, advances in lentivirus vector use and safety considerations, mRNA delivery and antisense oligonucleotide drug development.

Currently, drug development and clinical trials for genetic therapies in CF are rapidly progressing. This review aims to increase the foundational knowledge of CF genetic therapies.
Outcomes of Children Discharged Prior to Absolute Neutrophil Count Recovery After Admission for Febrile Neutropenia
Authors: Peters Sarah , Adler Mark , Rossoff Jenna
Published: September 2023

Febrile neutropenia (FN) management in pediatric oncology patients traditionally necessitates inpatient admission until evidence of bone marrow recovery. Discharge before count recovery may be a way to safely reduce the length of hospitalizations for select patients. A chart review was conducted of patients admitted for FN at one tertiary care children’s hospital, where the standard is to discharge well-appearing patients after 48 hours of negative cultures if afebrile for at least 24 hours, irrespective of absolute neutrophil count (ANC). Patients with ANC <500 at discharge were identified as early discharges, and data were collected with respect to rates of readmission and infectious complications in this cohort. Among 1230 FN encounters, 765 (62%) were early discharges. 122 patients (15.9%) were readmitted within 7 days. Patients with acute myeloid leukemia and ANC <100 at discharge were more likely to be readmitted. Of the early discharges, only 10 (1.31%) were readmitted with positive blood cultures and 5 (0.7%) were admitted to the pediatric intensive care unit within 24 hours of readmission. Routine discharge before ANC recovery allows for short hospital stays with low rates of readmission, infectious complications, and critical illness for pediatric oncology patients. This safe and beneficial policy should be considered at other institutions.
Brain 18F-FET in a Case of Acute Myeloid Leukemia
Authors: Castello Angelo , Crosta Giacomo , Pacella Sara , Florimonte Luigia , Castellani Massimo
Published: September 2023

A 58-year-old woman, with a history of acute myeloid leukemia in complete response, was referred to the emergency department of our hospital for loss of consciousness. A brain MRI showed an intracranial mass suggestive for either primary brain tumor or brain metastasis. 18F-FET PET/CT revealed increased uptake of the lesion. Metastasis from acute myeloid leukemia was diagnosed after brain biopsy. Whole-body 18F-FDG PET/CT did not demonstrate other abnormal foci of 18F-FDG accumulation, whereas brain lesion had an uptake slightly below the adjacent brain.
Superior Identification of Metastatic Lesions by 68Ga-FAPI-46 to 18F-FDG PET/CT in a Case of SMARCA4-Deficient Undifferentiated Carcinoma of Stomach
Authors: Pang Yizhen , Cai Jiayu , Zhao Liang , Xu Weizhi , Chen Haojun
Published: September 2023

SMARCA4-deficient undifferentiated carcinoma is a new clinical entity characterized by SMARCA4 inactivation and has a dismal prognosis because of rapid growth. In this case, we reported 18F-FDG and 68Ga-FAPI-46 PET/CT imaging findings in a patient with SMARCA4-deficient undifferentiated carcinoma of stomach. 68Ga-FAPI-46 PET/CT showed much higher tumor-to-background contrast of primary tumor and revealed more metastatic lesions than 18F-FDG PET/CT. This case demonstrated the superiority of 68Ga-FAPI PET/CT over 18F-FDG for identifying both primary and metastatic lesions in SMARCA4-deficient undifferentiated carcinoma. This observation may add the information on the benefit of FAPI PET in oncology imaging.
Application of Modified V-Y Advancement Flap in Alar Base Reduction
Authors: Xu Yihao , Fan Fei , You Jianjun , Zheng Ruobing , Wu Lehao , Zhang Xulong , Tian Le , Guo Junsheng , Wang Huan
Published: September 2023

Background:

A variety of techniques for alar base modification have been described in the literature. Limitations of these techniques include scars, recurrence, asymmetry, etc. An incorrect excision of the lateral alar wall can result in a tear-drop or Q-shaped deformity.

Objectives:

In this study, a modified V-Y advancement flap will be introduced that will avoid the complications discussed above as well as adjust the positional relationship between the nasal alar and the columella using this technique. In addition, this method is reversible; once the nostril is narrow due to excessive advancement of the flap, the reverse V-Y advancement method can be used to enlarge the nostril.

Methods:

In this study, a retrospective review of wide nasal bases in the past 3 years was conducted. A blind analysis of anthropometric points was conducted. There were 3 outcome variables: the width of the alar base, the width of the flare, and the distance between the alar base and columellar base.

Results:

The alar base was reduced with a modified V-Y advancement flap on 65 female patients ranging from 18 to 45 years of age. In 10 cases, an “Inclined Y-arm flap” was used to narrow alar bases and adjust columella-alar positions. In the remaining cases, a “Horizontal Y-arm flap” was performed to narrow the simple nasal alar width. In all cases, the nasal base was reduced without distortion. In the postoperative period, all the effects were seen to persist for a long time, and patients were generally satisfied with the results of the procedure.

Conclusion:

By using this modified V-Y advancement flap technique, the incision can be concealed as thoroughly as possible, thereby avoiding “tear-drop” or “Q” deformities as well as narrowing the nasal alar effectively. Furthermore, this method, in combination with rhinoplasty surgery, will greatly enhance the nasal appearance.
An Experimental Design to Compare the Compatibility of Absorbable and Nonabsorbable Suture Materials in the Lateral Canthus Area
Authors: Vu Que Anh , Choi Kwang-Eon , Nguyen Cong Trung , Baek Sehyun
Published: September 2023

Polyglactin 910 (Vicryl) and polypropylene (Prolene) are common suture materials used in ophthalmic surgical procedures. However, there are limited studies assessing tissue reactions to different sutures in eyelid areas. In this study, these suture materials were used subcutaneously in 10 lateral canthi of 5 pigs. Clinical reactive score (CRS) was assessed 14 days and 60 days after surgery. On histology, subcutaneous tissue reactions were assessed by the presence of different inflammatory cells, and the aggregate tissue irritation score was calculated. CRS and the histology score did not differ between these sutures. None of the suture materials used were superior for use in the lateral canthi of pig eyes. Therefore, we recommend both of these sutures for use in the subcutaneous tissue of the eyelid area in animal experiments or clinical practice.
Association of fibrinolysis phenotype with patient outcomes following traumatic brain injury
Authors: Durbin Samantha , Brito Alexandra , Johnson Alicia , Cotton Bryan , Rowell Susan , Schreiber Martin A.
Published: September 2023

BACKGROUND

Impaired coagulation is associated with elevated risk of mortality in trauma patients. Prior studies have demonstrated increased mortality in patients with hyperfibrinolysis (HF) and fibrinolysis shutdown (SD). In addition, prior studies have demonstrated no effect of tranexamic acid (TXA) on fibrinolysis phenotypes. We examined the association of admission fibrinolysis phenotype with traumatic brain injury (TBI) patient outcomes.

METHODS

Data were extracted from a placebo-controlled multicenter clinical trial. Patients ≥15 years with TBI (Glasgow Coma Scale score, 3–12) and systolic blood pressure ≥90 mm Hg were randomized in the out-of-hospital setting to receive placebo bolus/placebo infusion (Placebo), 1 gram (g) TXA bolus/1 g TXA infusion (bolus maintenance [BM]); or 2 g TXA bolus/placebo infusion (bolus only [BO]). Fibrinolysis phenotypes on admission were determined by clot lysis at 30 minutes (LY30): SD, ≤0.8%; physiologic, 0.9% to 2.9%; HF, ≥3%. Logistic regression was used to control for age, sex, penetrating injury, Injury Severity Score, maximum head AIS, and TXA treatment group.

RESULTS

Seven hundred forty-seven patients met inclusion criteria. Fibrinolysis shutdown was the most common phenotype in all treatment groups and was associated with increased age, Injury Severity Score, and presence of intracranial hemorrhage (ICH). Inpatient mortality was 15.2% for SD and HF, and 10.6% for physiologic (p = 0.49). No differences in mortality, disability rating scale at 6 months, acute kidney injury, acute respiratory distress syndrome, or multi-organ failure were noted between fibrinolysis phenotypes.

CONCLUSION

SD is the most common phenotype expressed in moderate to severe TBI. In TBI, there is no association between fibrinolysis phenotype and mortality or other major complications.

LEVEL OF EVIDENCE

Prognostic and Epidemiological; Level IV.
Self-expanding foam versus preperitoneal packing for exsanguinating pelvic hemorrhage
Authors: King David Richard , Hwabejire John O. , Pham Quynh P. , Elsharkawy Ahmed E. , Eid Ahmed I. , Duggan Michael J. , Gelsinger Shawn , Fornaciari Michael , Sharma Upma
Published: September 2023

BACKGROUND

Mortality for pelvic fracture patients presenting with hemorrhagic shock ranges from 21% to 57%. The objective of this study was to develop a lethal and clinically relevant pelvic hemorrhage animal model with and without bony fracture for evaluating therapeutic interventions. ResQFoam is a self-expanding foam that has previously been described to significantly decrease mortality in large-animal models of abdominal exsanguination. We hypothesized that administration of ResQFoam into the preperitoneal space could decrease mortality in exsanguinating pelvic hemorrhage.

METHODS

Two pelvic hemorrhage models were developed using noncoagulopathic swine. Pelvic hemorrhage model 1: bilateral, closed-cavity, major vascular retroperitoneal hemorrhage without bony pelvic fracture. After injury, animals received no treatment (control, n = 10), underwent preperitoneal packing using laparotomy pads (n = 11), or received ResQFoam (n = 10) injected into the preperitoneal space. Pelvic hemorrhage model 2: unilateral, closed-cavity, retroperitoneal hemorrhage injury (with intraperitoneal communication) combined with complex pelvic fracture. After injury, animals received resuscitation (control, n = 12), resuscitation with preperitoneal packing (n = 10) or with ResQFoam injection (n = 10) into the preperitoneal space.

RESULTS

For model 1, only ResQFoam provided a significant survival benefit. The median survival times were 50 minutes and 67 minutes for preperitoneal packing and ResQFoam, compared with 6 minutes with controls (p = 0.002 and 0.057, respectively). Foam treatment facilitated hemodynamic stabilization and resulted in significantly less hemorrhage (21.5 ± 5.3 g/kg) relative to controls (31.6 ± 5.0 g/kg, p < 0.001) and preperitoneal packing (32.7 ± 5.4 g/kg, p < 0.001). For model 2, both ResQFoam and preperitoneal packing resulted in significant survival benefit compared with controls. The median survival times were 119 minutes and 124 minutes for the preperitoneal packing and ResQFoam groups, compared with 4 minutes with controls (p = 0.004 and 0.013, respectively).

CONCLUSION

Percutaneous injection of ResQFoam into the preperitoneal space improved survival relative to controls, and similar survival benefit was achieved compared with standard preperitoneal pelvic packing. The technology has potential to augment the armamentarium of tools to treat pelvic hemorrhage.
The most predictable component of a linear stochastic model
Authors: DelSole Timothy , Tippett Michael K.
Published: September 2023

It is known that special combinations of variables can have more predictability than any variable in the combination. While such combinations can be obtained numerically in specific cases, this leaves broader questions unanswered. For example, given the dynamics of a linear stochastic model, what is the maximum predictability? What is its structure? What stochastic forcing maximizes predictability? This paper answers these questions. Specifically, this paper derives an upper bound on the predictability of linear combinations of variables. This bound is achieved when stochastic forcing correlates perfectly between eigenmodes. In a certain limit, the structure of the most predictable combination can be derived analytically. This structure is called the Pascal Mode due to its relation to Pascal’s Triangle in a special case. These results provide a new perspective on observation-based climate predictability estimates. For instance, the most predictable component of monthly North Atlantic sea surface temperature is only modestly more predictable than the least-damped eigenmode. This aligns with the theoretical findings, as neither the stochastic forcing nor the dynamical eigenvalues are tailored to enhance predictability. The Pacific shows more predictability relative to the least-damped mode, but this increase is an order of magnitude smaller than the theoretical limit given the dynamics.
Strain, disfigurement and flexure tensors in continuum kinematics
Authors: Emami Mohamad , Eskandari-Ghadi Morteza
Published: September 2023

In the differential geometric formulation of nonlinear elasticity, the strain tensor can intrinsically be regarded as a measure of change of the metric of the Riemannian manifold that embodies the continuum undergoing a deformation. Here, this classical concept is revisited and complemented with two newly defined higher order deformation measures, namely the disfigurement and flexure tensors, which respectively measure the change of the Levi-Civita connexion and the Riemann curvature of the continuum. The strain, disfigurement and flexure tensors can, thereby, roughly indicate the alteration of the geometry of a deforming body in the zeroth, first and second orders, respectively. In this light, one may predict that the disfigurement and flexure tensors should be related to the first and second covariant derivatives of the strain tensor. While this is true, the exact strain-disfigurement-flexure relations, as derived in this paper, are found to be involved and non-trivial, offering a deeper understanding of the deformation. In our discussions, distance-preserving, geodesic-preserving and curvature-preserving deformations are studied as three special cases to help better interpret the above-mentioned deformation measures. Some related results have also been found as by-products that might be of current interest or prove useful in future investigations.
Computational synthesis of wheeled vehicles via multi-layer topology optimization
Authors: James Kai A. , Kelley Patrick L. , Kang Ziliang , Bhattacharyya Anurag , Alacoque Lee R.
Published: September 2023

In current engineering practice, computer-aided design (CAD) tools play a key role in the design and fabrication of most mechanical systems, including the design of most vehicles. This software tends to rely heavily on human designers to provide the basic design concept, with the software being used to computationally render an existing design, or to perform modifications to a design to achieve incremental improvements in performance. However, an emerging class of computational methods, known astopology optimizationmethods, offers the potential for trueblack boxcomputational design. Under this general framework, practitioners provide the algorithm with the constitutive properties of the design materials, and the mechanical function being designed for (e.g. maximum stiffness under a given loading condition), and the algorithm autonomously generates a description of the corresponding structure. With some exceptions, existing topology optimization methods are limited to generating static, single-body designs. In this study, we present a novel method that builds upon the current state of the art by combining multiple collocated planar design domains to achieve automated computational synthesis of multi-body wheeled vehicles. This capability represents an important step on the path toward automated computational design of increasingly complex, innovative and impactful mechanical systems.