bluuebunny/crossref_metadata_2025 huggingface dataset:
Osteoporosis Remains Constant in Patients with Hemophilia—Long-Term Course in Consideration of Comorbidities
Authors: Strauss Anna C. , Muellejans Pius , Koob Sebastian , Goldmann Georg , Pennekamp Peter H. , Wallny Thomas A. , Oldenburg Johannes , Strauss Andreas C.
Published: March 2023

Introduction Patients with hemophilia (PWHs) suffer from an increased risk of osteoporosis. Multiple hemophilia and hemophilic arthropathy associated factors correlate with a low bone mineral density (BMD) in PWHs. The aim of this study was to assess the long-term development of BMD in PWH as well as to analyze potentially influencing factors.

Methods A total of 33 adult PWHs were evaluated in a retrospective study. General medical history, specific-hemophilia-associated comorbidities, joint status using the Gilbert score, calcium level, and vitamin D level as well as at least two results of bone density measurements with a minimum range of 10 years per patient were taken into account.

Results The BMD did not change significantly from one point of measurement to the other. A total of 7 (21.2%) cases of osteoporosis and 16 (48.5%) cases of osteopenia were identified. The two following significant correlations could be revealed: the higher the patients' body mass index, the higher their BMD (r = 0.41; p = 0.022). Moreover, a high Gilbert score came along with a low BMD (r = −0.546; p = 0.003).

Conclusion Even if PWHs frequently suffer from a reduced BMD, our data suggest that their BMD remains constant on a low level in the course of time. A risk factor of osteoporosis often found in PWHs is a vitamin D deficiency and joint destruction. Therefore, a standardized screening of PWHs on BMD reduction by collecting vitamin D blood level and assessing joint status seems appropriate.
Bewegungsempfehlungen in der Prävention und Therapie der
Adipositas
Authors: Joisten Christine
Published: March 2023

Die Rolle von körperlicher Aktivität in der Prävention
und Therapie von Übergewicht und Adipositas, aber auch möglicher
Begleit- und Folgeerkrankungen ist heutzutage unbestritten. Die
Weltgesundheitsorganisation fordert in den aktuellen Bewegungsempfehlungen
für Erwachsene 150–300 Minuten pro Woche moderate oder
75–150 Minuten intensive Bewegungszeit sowie die Reduktion vermeidbarer
Sitzzeiten. Für Menschen mit Adipositas gelten nur wenig höhere
Umfänge mit 30 bis 60 Minuten Bewegungszeit pro Tag, um eine relevante
Gewichtsabnahme zu erzielen. Diese beläuft sich aber meist auf nur 2 bis
3 Kg, die im Interventionszeitraum bis maximal 12 Monate erzielt werden.
Wesentlicher sind daher die Effekte von Bewegung auf psychische und physische
Faktoren inkl. der Körperkomposition, die auch unabhängig von
einer Gewichtsreduktion auftreten. Auch beim Gewichtserhalt, ggf. einer weiteren
Gewichtsabnahme über gezielte Maßnahmen hinaus gilt Bewegung als
wichtiger Einflussfaktor. Hier werden 200 bis 300 Minuten pro Woche gefordert.
Nichtsdestotrotz bleibt die Umsetzung in die Praxis erschwert. Bewährt
haben sich eine patientenzentrierte Herangehensweise und eine partizipative
Entscheidungsfindung sowie die Vermittlung, dass letztlich jede Bewegungsform
einen gesundheitlichen Nutzen hat. Zur Minimierung möglicher Risiken
sollte (vorab) eine sportmedizinische Vorsorgeuntersuchung erfolgen.
Multimodaler Ansatz zum Verständnis des Zusammenspiels zwischen dem endokrinen und dem Endocannabinoidsystem, nicht suizidalem selbstverletzendem Verhalten und der Borderline-Persönlichkeitsstörung
Authors: Spohrs Jennifer , Kuehnle Valentin , Ferger Marc D. , Abler Birgit
Published: March 2023

Die Borderline-Persönlichkeitsstörung (BPS) und, unabhängig davon, nicht suizidales selbstverletzendes Verhalten (NSSV) sind äußerst prävalente psychiatrische Störungsbilder, welche häufig mit weiteren psychischen Komorbiditäten einhergehen. Dennoch gibt es wenige wissenschaftliche Untersuchungen zu den zugrunde liegenden Mechanismen, die zudem der Verbesserung derzeitiger Behandlungsmöglichkeiten dienen können. Da Cannabiskonsum häufig zur Selbstmedikation bei Patienten mit BPS und NSSV eingesetzt wird und Cannabismissbrauch vermehrt vorkommt, liegt die Untersuchung des Endocannabinoidsystems (ECS) als potenziellen Modulator der Psychopathologie nahe. Des Weiteren sind die Stressverarbeitung als zugrunde liegender Faktor und die Funktionsfähigkeit des endokrinologischen Systems, welches eine zentrale Rolle in der Entwicklung und Aufrechterhaltung der BPS und NSSV spielt, eng mit dem ECS verbunden, welches unter anderem für die Modulation der Hypothalamus-Hypophysen-Nebennierenrinden (HPA)-Achse bekannt ist. Auch wenn mehr Forschung nötig ist, hat das ECS großes Potenzial die Behandlungsmöglichkeiten zu erweitern.
Expression and Release of Tumor Cell Tissue Factor Triggers Recurrent Thromboembolism in a Patient with Endometrial Cancer
Authors: Beckmann Lennart , Lennartz Maximilian , Poch Annika , Holstein Katharina , Bokemeyer Carsten , Langer Florian
Published: March 2023

Although cancer-associated thrombosis (CAT) is a frequent complication in patients with malignancies, its treatment remains a challenge in daily practice. Here, we report the clinical course of a 51-year-old woman presenting with a highly thrombogenic paraneoplastic coagulopathy. Despite therapeutic anticoagulation with various agents, including rivaroxaban, fondaparinux, and low-molecular-weight heparin, the patient suffered from recurrent venous and arterial thromboembolism. Locally advanced endometrial cancer was identified. Tumor cells showed strong expression of tissue factor (TF), and significant concentrations of TF-bearing microvesicles were detected in patient plasma. Coagulopathy was controlled only by continuous intravenous anticoagulation with the direct thrombin inhibitor, argatroban. Multimodal antineoplastic treatment, including neoadjuvant chemotherapy followed by surgery and postoperative radiotherapy, resulted in clinical cancer remission, which was paralleled by normalization of tumor markers, CA125 and CA19–9, D-dimer levels, and TF-bearing microvesicles. In summary, continuous anticoagulation with argatroban and multimodal anticancer treatment may be necessary to control TF-driven coagulation activation with recurrent CAT in endometrial cancer.
Allergie
Authors: Bieger Wilfried
Published: March 2023

Das Auftreten von Autoimmunerkrankungen wird einerseits durch genetische Risikofaktoren begünstigt, andererseits sind ­exogene Einflüsse wie chronische (Virus-)Infektionen, Stress, hormonelle oder Umwelt­faktoren von wesentlicher Bedeutung. Allergien werden als komplexe genetische Krankheiten verstanden, die durch die Interaktion multipler genetischer Faktoren mit Umweltfaktoren entstehen und für die Infektionen ebenfalls eine große Rolle spielen, da sie protektiv, aber auch verstärkend wirken können. Welche Diagnose- und Therapiemöglichkeiten komplementärmedizinische Behandler bei Autoimmunerkrankungen und Allergien nutzen können, ist Gegenstand des Beitrags.
Gestational Trophoblastic Neoplasia—A Retrospective Analysis of Patients Treated at a Tertiary Care Oncology Center in North India
Authors: Gupta Anuj , Kapoor Akhil , Mishra Bal Krishna , Kashyap Lakhan , Choudhary Amit , Singh Arpita , Singh Neha , Sansar Bipinesh
Published: March 2023

Objectives The aim of this study was to do a retrospective analysis of patients of gestational trophoblastic neoplasia (GTN) treated at our center concerning their clinical features and treatment outcomes.

Materials and Methods Patients diagnosed and treated from May 2018 to December 2021 were included. All relevant information pertaining to eligible patients was retrieved from the electronic medical records. Patients were risk-stratified based on the World Health Organization (WHO) risk scoring system with a score of seven and above being classified into the high-risk category. Patients were monitored for response by measuring β-human chorionic gonadotrophin (β-HCG) levels before each consecutive cycle.

Statistical Analysis Appropriate statistical analysis was performed using SPSS version 26.

Results Records of 39 eligible patients were analyzed for clinical features out of which 38 were eligible for response assessment. The median age of presentation was 28 years with the majority of patients (79.4%) diagnosed based on β-HCG levels and clinical history alone. The most common symptom was bleeding per vagina (64%), while the majority of antecedent pregnancies were abortions (59%).

Of the 14 low-risk category patients, 12 received single-agent methotrexate/actinomycin D, while 2 received etoposide, methotrexate actinomycin D (EMACO) regimen. Overall response rates were 85.7% with the others responding to the second-line EMACO regimen. Five patients in this group had a WHO score of 5 or 6 and all of them responded to single-agent treatment. Among the 25 high-risk category patients, all received the EMACO regimen with high-dose methotrexate added to those with brain metastasis. The response rate was 87.5% with all the nonresponders having features of ultra-high risk of liver/brain metastasis and/or a WHO score of more than 12. While one nonresponder had expired despite treatment, the other two responded to the etoposide methotrexate and actinomycin D/ etoposide and cisplatin regimen.

Conclusion Our results are in consonance with other reported studies. The subcategories of low-risk GTN with a WHO score of 5 and 6 and high-risk GTN with ultra-high-risk features deserve further research in the form of multicenter prospective studies.
Bone Marrow Changes and Lesions of Diabetic Foot and Ankle Disease: Conventional and Advanced Magnetic Resonance Imaging
Authors: Bajaj Gitanjali , Chhabra Avneesh
Published: March 2023

Diabetic foot and ankle complications contribute to substantial mortality and morbidity. Early detection and treatment can lead to better patient outcomes. The primary diagnostic challenge for radiologists is distinguishing Charcot's neuroarthropathy from osteomyelitis. Magnetic resonance imaging (MRI) is the preferred imaging modality for assessing diabetic bone marrow alterations and for identifying diabetic foot complications. Several recent technical advances in MRI, such as the Dixon technique, diffusion-weighted imaging, and dynamic contrast-enhanced imaging, have led to improved image quality and increased capability to add more functional and quantitative information.

We discuss the bone marrow abnormalities encountered in daily radiologic assessment: osteopenia, reactive bone marrow edema-like signal, insufficiency fractures, Charcot's neuroarthropathy, osteomyelitis, serous marrow atrophy, digital ischemia, and bone infarcts, along with their pathophysiology and the conventional and advanced imaging techniques used for a comprehensive marrow evaluation.
Normal Bone Marrow and Non-neoplastic Systemic Hematopoietic Disorders in the Adult
Authors: Tyler Philippa Anne , Rajakulasingam Ramanan , Saifuddin Asif
Published: March 2023

This article provides an overview of the imaging appearances of normal adult bone marrow with an emphasis on magnetic resonance imaging. We also review the cellular processes and imaging features of normal developmental yellow-to-red marrow conversion and compensatory physiologic or pathologic red marrow reconversion. Key imaging features that differentiate between normal adult marrow, normal variants, non-neoplastic hematopoietic disorders, and malignant marrow disease are discussed, as well as posttreatment changes.
Advances in Bone Marrow Imaging: Strengths and Limitations from a Clinical Perspective
Authors: Mourad Charbel , Cosentino Aurelio , Nicod Lalonde Marie , Omoumi Patrick
Published: March 2023

Conventional magnetic resonance imaging (MRI) remains the modality of choice to image bone marrow. However, the last few decades have witnessed the emergence and development of novel MRI techniques, such as chemical shift imaging, diffusion-weighted imaging, dynamic contrast-enhanced MRI, and whole-body MRI, as well as spectral computed tomography and nuclear medicine techniques. We summarize the technical bases behind these methods, in relation to the common physiologic and pathologic processes involving the bone marrow. We present the strengths and limitations of these imaging methods and consider their added value compared with conventional imaging in assessing non-neoplastic disorders like septic, rheumatologic, traumatic, and metabolic conditions. The potential usefulness of these methods to differentiate between benign and malignant bone marrow lesions is discussed. Finally, we consider the limitations hampering a more widespread use of these techniques in clinical practice.
Observation of Small-amplitude Electromagnetic Cyclotron Waves in the Solar Wind
Authors: Yang Hai-Feng , Zhao Guo-Qing , Feng Heng-Qiang , Pi Gilbert , Liu Qiang , Xiang Liang , Li Qiu-Huan , Ren Dan-Yang
Published: March 2023

Our previous studies on low-frequency electromagnetic cyclotron waves (ECWs) with amplitudes larger than 0.1 nT in the solar wind revealed that the left-handed (LH) polarized ECWs are the dominant waves, and these waves preferentially occur in plasma conditions of high proton speed (V

p
), high proton temperature (T

p
), low proton density (N

p
). In the present study, using magnetic field and plasma data from the Wind mission between 2005 and 2015, we perform a survey of small-amplitude ECWs with amplitudes smaller than 0.1 nT. It is revealed for the first time that the small-amplitude right-handed (RH) polarized ECWs tend to frequently occur in plasmas characterized by low V

p
, low T

p
, low N

p
, although the small-amplitude LH ECWs still preferentially occur in plasma conditions similar to the LH ECWs with amplitudes larger than 0.1 nT. Further investigation shows that the occurrences of small-amplitude RH ECWs and long-lasting radial interplanetary magnetic field (lrIMF) share the similar preferential plasma conditions of low T

p
and low N

p
. During lrIMF events, in particular, the occurrence rates of RH and LH ECWs are comparable, with the occurrence rate of small-amplitude RH ECWs slightly larger than that of small-amplitude LH ECWs. The generation mechanism of the small-amplitude ECWs is discussed.
A perspective on silicon-based polymer-derived ceramics materials for beyond lithium-ion batteries
Authors: Amaral Murilo M , Mujib Shakir Bin , Zanin Hudson , Singh Gurpreet
Published: March 2023

Energy storage devices beyond lithium-ion batteries (LIBs), such as sodium-ion, potassium-ion, lithium-sulfur batteries, and supercapacitors are being considered as alternative systems to meet the fast-growing demand for grid-scale storage and large electric vehicles. This perspective highlights the opportunities that Si-based polymer-derived ceramics (PDCs) present for energy storage devices beyond LIBs, the complexities that exist in determining the structure-performance relationships, and the need for in situ and operando characterizations, which can be employed to overcome the complexities, allowing successful integration of PDC-based electrodes in systems beyond LIBs.
Improved cell performance and sulphur tolerance using A-site substituted Sr2Fe1.4Ni0.1Mo0.5O6–δ anodes for solid-oxide fuel cells
Authors: Li Haixia , Wang Wanhua , Lin Jie , Park Ka-Young , Lee Taehee , Heyden Andreas , Ding Dong , Chen Fanglin
Published: March 2023

Solid-oxide fuel cells (SOFCs) offer great promise for producing electricity using a wide variety of fuels such as natural gas, coal gas and gasified carbonaceous solids; however, conventional nickel-based anodes face great challenges due to contaminants in readily available fuels, especially sulphur-containing compounds. Thus, the development of new anode materials that can suppress sulphur poisoning is crucial to the realization of fuel-flexible and cost-effective SOFCs. In this work, La0.1Sr1.9Fe1.4Ni0.1Mo0.5O6–δ (LSFNM) and Pr0.1Sr1.9Fe1.4Ni0.1Mo0.5O6–δ (PSFNM) materials have been synthesized using a sol-gel method in air and investigated as anode materials for SOFCs. Metallic nanoparticle-decorated ceramic anodes were obtained by the reduction of LSFNM and PSFNM in H2 at 850°C, forming a Ruddlesden–Popper oxide with exsolved FeNi3 bimetallic nanoparticles. The electrochemical performance of the Sr2Fe1.4Ni0.1Mo0.5O6–δ ceramic anode was greatly enhanced by La doping of A-sites, resulting in a 44% decrease in the polarization resistance in reducing atmosphere. The maximum power densities of Sr- and Mg-doped LaGaO3 (LSGM) (300 μm) electrolyte-supported single cells with LSFNM as the anode reached 1.371 W cm −2 in H2 and 1.306 W cm–2 in 50 ppm H2S–H2 at 850°C. Meanwhile, PSFNM showed improved sulphur tolerance, which could be fully recovered after six cycles from H2 to 50 ppm H2S–H2 operation. This study indicates that LSFNM and PSFNM are promising high-performance anodes for SOFCs.
Ethnopharmacological Study of Medicinal Plants Used in the Treatment of Skin Burns in the Arab World
Authors: Al-Samydai Ali , Abu Hajleh Maha N , Mayyas Amal , Al-Mamoori Farah , Al-Tawalbe Deniz M , Alqaraleh Moath , Mousa Mohamad Ak , Aladwan Hala , Alazab Badi’ah , Selwadi Dana , Othman Fatimah Akram , Zaazouee Mohamed Sayed , Ragab Khaled Mohamed , Al-Halaseh Lidia
Published: March 2023

Traditional healers are often practiced in rural areas owing to cultural beliefs and are known to provide various forms of healthcare and home remedies. Patients in the Mediterranean region rely on traditional medicine to cure a variety of health concerns, like skin burns. This study was conducted to identify the various practices used by traditional healers for treating skin burns. The survey was conducted in 18 Arab countries, including Syria, Iraq, Jordan, Saudi Arabia, Egypt, United Arab Emirates, Algeria, Bahrain, Palestine, Kuwait, Oman, Qatar, Lebanon, Yemen, Tunisia, Oman, Morocco, and Sudan. Between September 2020 and July 2021, an online questionnaire was administered to 7530 participants from 12 Asian and 5 African countries. The survey was designed to gather information from common medicinal plant users and herbalists on their practices as specialists in using various herbal and medicinal plant products for diagnosis and treatment. Among the participants, 2260 had a scientific background in plant application, and the study included one phytotherapeutic professional. The crude-extraction technique was favored, by Arabic folk, for plant preparation over the maceration and decoction method. Olive oil was the most commonly used product among participants as an anti-inflammation and for scar reduction. Aloe vera, olive oil, sesame, Ceretonia siliqua, lavender, potato, cucumber, shea butter, and wheat flour are used as crude drugs to reduce pain because of their analgesic and cooling effects. The present study is the first database of medicinal plants with burn-healing properties conducted in Arab countries. These plants can be employed in the search for new bioactive substances through pharmacochemical investigations, as well as in the development of new formulations containing a combination of these plants.
Near-physiologicalin vitroassembly of 50S ribosomes involves parallel pathways
Authors: Dong Xiyu , Doerfel Lili K , Sheng Kai , Rabuck-Gibbons Jessica N , Popova Anna M , Lyumkis Dmitry , Williamson James R
Published: March 2023

Understanding the assembly principles of biological macromolecular complexes remains a significant challenge, due to the complexity of the systems and the difficulties in developing experimental approaches. As a ribonucleoprotein complex, the ribosome serves as a model system for the profiling of macromolecular complex assembly. In this work, we report an ensemble of large ribosomal subunit intermediate structures that accumulate during synthesis in a near-physiological and co-transcriptional in vitro reconstitution system. Thirteen pre-50S intermediate maps covering the entire assembly process were resolved using cryo-EM single-particle analysis and heterogeneous subclassification. Segmentation of the set of density maps reveals that the 50S ribosome intermediates assemble based on fourteen cooperative assembly blocks, including the smallest assembly core reported to date, which is composed of a 600-nucleotide-long folded rRNA and three ribosomal proteins. The cooperative blocks assemble onto the assembly core following defined dependencies, revealing the parallel pathways at both early and late assembly stages of the 50S subunit.
Long-term monitoring of comet 29P/Schwassmann–Wachmann from the Lulin Observatory
Authors: Lin Zhong-Yi
Published: March 2023

Multi-band photometric monitoring of comet 29P/Schwassmann–Wachmann 1 was conducted with the standard Johnson–Cousins filter set. Observations extended from 2018 July to 2021 December. The comet was detected to show at least 12 relatively large outbursts, during which its brightness increased by 1.5 to 5 mag as measured through a 5″ aperture. The outbursts resulted in a clear variation of the cometary brightness profile. The derived slopes of the surface brightness profiles showed a significant variation with time from a shallower slope to a steeper one at the beginning of each outburst and then slowly returning to pre-outburst values. There did not seem to be any obvious change in the color indices as the outbursts occurred. However, for the quadruple outbursts in late September of 2021, we could confidently spot a change in the color of the comet, indicating that the color indices seem to be less than the mean values, especially in the B − V term. Dust production derived by using the dust production rate parameter, Afρ, from the R-band photometry measurements shows the outburst to be accompanied by a large increasing trend. Using a simple model and the derived outflow velocity of 0.11 km s−1 from the expanding shell features, an estimated lower limit of 1.0 × 108 kg up to 2.7 × 109 kg of dust was released during the quadruple outbursts by using a specific dust size of 1 μm.
Regional differences in the assessment of depressive symptoms in the former German Democratic Republic and Federal Republic of Germany
Authors: Schmalbach Bjarne , Tibubos Ana N , Otten Daniëlle , Hinz Andreas , Decker Oliver , Zenger Markus , Beutel Manfred E , Brähler Elmar
Published: March 2023

Aim

The present study investigated regional differences in response behaviour for the Patient Health Quetionnaire-9. We tested for measurement invariance and differential item and test functioning between formerly divided East- and West-Germany: the former German Democratic Republic and Federal Republic of Germany. Diverging socialization experiences in socialist versus capitalist and collectivist versus individualist systems may affect culturally sensitive assessments of mental health.

Subject and Methods

To test this empirically, we used factor analytic and item-response-theoretic frameworks, differentiating between East- and West-Germans by birthplace and current residence based on several representative samples of the German general population (n = 3 802).

Results

Across all survey, we discovered slightly higher depression sum scores for East- versus West-Germans. The majority of items did not display differential item functioning—with a crucial exception in the assessment of self-harm tendencies. The scale scores were largely invariant exhibiting only small amounts of differential test functioning. Nonetheless, they made up on average about a quarter of the observed group differences in terms of effect magnitude.

Conclusion

We explore possible causes and discuss explanations for the item-level differences. Overall, analyses of East- and West-German depressive symptom developments in the wake of reunification are feasible and statistically grounded.
Moral distress and injury in the public health professional workforce during the COVID-19 pandemic
Authors: Bow Steven M A , Schröder-Bäck Peter , Norcliffe-Brown Dominic , Wilson James , Tahzib Farhang
Published: March 2023

Background

There is growing concern about moral distress and injury associated with the COVID-19 pandemic in healthcare professions. This study aimed to quantify the nature, frequency, severity and duration of the problem in the public health professional workforce.

Methods

Between 14 December 2021 and 23 February 2022, Faculty of Public Health (FPH) members were surveyed about their experiences of moral distress before and during the pandemic.

Results

In total, 629 FPH members responded, of which, 405 (64%; 95% confidence interval [95%CI] = 61–68%) reported one or more experience of moral distress associated with their own action (or inaction), and 163 (26%; 95%CI = 23–29%) reported experiencing moral distress associated with a colleague’s or organization’s action (or inaction) since the start of the pandemic. The majority reported moral distress being more frequent during the pandemic and that the effects endured for over a week. In total, 56 respondents (9% of total sample, 14% of those with moral distress), reported moral injury severe enough to require time off work and/or therapeutic help.

Conclusions

Moral distress and injury are significant problems in the UK public health professional workforce, exacerbated by the COVID-19 pandemic. There is urgent need to understand the causes and potential options for its prevention, amelioration and care.
Credit Access, Selection, and Incentives in a Market for Asset-Collateralized Loans: Evidence From Kenya
Authors: Jack William , Kremer Michael , de Laat Joost , Suri Tavneet
Published: March 2023

We study the potential for asset collateralization to expand access to credit in rural Kenya. Increasing the share of a loan for a durable agricultural asset that is collateralized by the physical asset itself (from 0 to 96%) while reducing the share backed by financial assets increases loan take-up considerably, with only a very limited impact on repayment behavior and the lender's profitability. A Karlan–Zinman test finds evidence of small and marginally significant selection effects in some specifications but no evidence of moral hazard. We find no evidence that joint versus individual liability affects take-up or repayment. Loans had real impacts on investment, milk sales, and girls’ school enrollment. The lender, a savings and credit cooperative, responded to the study results by offering 80% asset-collateralized loans.
Salience and Taxation with Imperfect Competition
Authors: Kroft Kory , Laliberté Jean-William , Leal-Vizcaíno René , Notowidigdo Matthew J
Published: March 2023

This paper studies commodity taxation in a model featuring heterogeneous consumers, imperfect competition, and tax salience. We derive new formulas for the incidence and marginal excess burden of commodity taxation highlighting interactions between tax salience and market structure. We estimate the necessary inputs to the formulas by using Nielsen Retail Scanner and Consumer Panel data covering grocery stores and households in the U.S. and detailed sales tax data. We estimate a large amount of pass-through of taxes onto consumer prices and find that households respond more to changes in prices than taxes. We also estimate significant heterogeneity in tax salience across households. We calibrate our new formulas using these results and conclude that essentially all of the incidence of sales taxes falls on consumers, and the marginal excess burden of taxation is larger than estimates based on standard formulas that ignore imperfect competition and tax salience.
Displaced Trust: Disrupting Legal Estrangement during Disaster Recovery
Authors: Simington Jasmine
Published: March 2023

Recent research on federal disaster aid distribution reveals stark racial and economic inequalities. Importantly, the very individuals and groups disadvantaged by FEMA funding—non-White, low-income households—are also the populations most likely to exhibit distrust toward the state. How does distrust shape the disaster recovery process in a low-income, rural, predominantly Black context? Using semi-structured interviews coupled with ethnographic observations in Marion County, SC, I find that the disaster recovery process is hindered by legal estrangement. To combat distrust and exclusion, emergent groups use the tactic of displacing trust away from disaster recovery officials back onto emergent groups in order to initiate and sustain residents’ engagement with the formal disaster recovery process. While existing theories argue that distrust leads to withdrawal from services, I show that emergent groups during disaster recovery intervene such that applicants persist in applying for aid despite their distrust. These strategies point to an important paradox about mitigating legal estrangement. Emergent disaster recovery groups assist applicants without improving trust toward disaster recovery officials, and sometimes in solidarity with applicant distrust. Broadly, the efforts of emergent groups reveal that institutional intermediaries can play a key brokering role in helping structurally excluded populations pursue state assistance amidst distrust.
Metabolic Bone Disorders Are Predictors for 2-year Adverse Outcomes in Patients Undergoing 2–3 Level Anterior Cervical Discectomy and Fusion for Cervical Radiculopathy or Myelopathy
Authors: Diebo Bassel G. , Kovoor Matthew , Alsoof Daniel , Beyer George A. , Rompala Alexander , Balmaceno-Criss Mariah , Mai David H. , Segreto Frank A. , Shah Neil V. , Lafage Renaud , Passias Peter G. , Aaron Roy K. , Daniels Alan H. , Paulino Carl B. , Schwab Frank J. , Lafage Virginie
Published: March 2023

Study Design:

Retrospective cohort study utilizing the New York statewide planning and research cooperative system.

Study Objective:

To investigate postoperative complications of patients with metabolic bone disorders (MBDs) who undergo 2–3 levels of anterior cervical discectomy and fusion (ACDF).

Summary of Background Data:

MBDs and cervical degenerative pathologies, including cervical radiculopathy (CR) and cervical myelopathy (CM), are prevalent in the aging population. Complications with ACDF procedures can lead to increased hospitalization times, more expensive overhead, and worse patient outcomes.

Method:

Patients with CM/CR who underwent an ACDF of 2–3 vertebrae from 2009 to 2011 with a minimum 2-year follow-up were identified. Patients diagnosed with 1 or more MBD at baseline were compared with a control cohort without any MBD diagnosis. Cohorts were compared for demographics, hospital-related parameters, and 2-year medical, surgical, and overall complications. Binary multivariate logistic regression was used to identify independent predictors.

Results:

A total of 22,276 patients were identified (MBD: 214; no-MBD: 22,062). Among MBD patients, the majority had vitamin D deficiency (n = 194, 90.7%). MBD patients were older (53.0 vs 49.7 y, P < 0.001), and with higher Deyo index (1.0 vs 0.5, P < 0.001). MBD patients had higher rates of medical complications, including anemia (6.1% vs 2.3%), pneumonia (4.7% vs 2.1%), hematoma (3.3% vs 0.7%), infection (2.8% vs 0.9%), and sepsis (3.7% vs 0.9%), as well as overall medical complications (23.8% vs 9.6%) (all, P ≤0.033). MBD patients also experienced higher surgical complications, including implant-related (5.7% vs 1.9%), wound infection (4.2% vs 1.2%), and wound disruption (0.9% vs 0.2%), and overall surgical complications (9.8% vs 3.2%) (all, P ≤0.039). Regression analysis revealed that a baseline diagnosis of MBD was independently associated with an increased risk of 2-year surgical complications (odds ratio = 2.10, P < 0.001) and medical complications (odds ratio = 1.84, P = 0.001).

Conclusions:

MBD as a comorbidity was associated with an increased risk of 2-year postoperative complications after 2–3 level ACDF for CR or CM.
Anterior temporal lobectomy improved mood status and quality of life in Chinese patients with mesial temporal lobe epilepsy: a single-arm cohort study
Authors: Lu Song , Chu Min , Wang Xian , Wu Yating , Hou Yue , Liu Aihua
Published: March 2023

Background:

Many studies have emphasized that selective resection of epileptic lesions in temoral lobe is associated with better preservation of cognition function, whether this applies to patients with refractory mesial temporal lobe epilepsy (MTLE) has remained unknown. The objective of this study was to evaluate changes in cognitive functions, mood status, and quality of life after anterior temporal lobectomy in patients with refractory MTLE.

Methods:

This single-arm cohort study assessed cognitive function, mood status, and quality of life, as well as electroencephalography findings, in patients with refractory MTLE who underwent anterior temporal lobectomy at Xuanwu Hospital from January 2018 to March 2019. Pre- and post-operative characteristics were compared to evaluate the effects of surgery.

Results:

Anterior temporal lobectomy significantly reduced the frequencies of epileptiform discharges. The overall success rate of surgery was acceptable. Anterior temporal lobectomy did not result in significant changes in overall cognitive functions (P 
> 0.05), although changes in certain domains, including visuospatial ability, executive ability, and abstract thinking, were detected. Anterior temporal lobectomy resulted in improvements in anxiety and depression symptoms and quality of life.

Conclusions:

Anterior temporal lobectomy reduced epileptiform discharges and incidence of post-operative seizures as well as resulted in improved mood status and quality of life without causing significant changes in cognitive function.
Current Concepts in the Management of Neurogenic Thoracic Outlet Syndrome: A Review
Authors: Khabyeh-Hasbani Nathan , Connors Katherine , Buksbaum Joshua R. , Koehler Steven K.
Published: March 2023

Background:

Thoracic outlet syndrome is a constellation of signs and symptoms due to compression of the neurovascular bundle of the upper limb. In particular, neurogenic thoracic outlet syndrome can present with a wide constellation of clinical manifestations ranging from pain to paresthesia of the upper extremity, resulting in a challenge to correctly diagnose this syndrome. Treatment options range from nonoperative treatment, such as rehabilitation and physical therapy, to surgical correction, such as decompression of the neurovascular bundle.

Methods:

Following a systematic review of the literature, we describe the need for a thorough patient history, physical examination, and radiologic images which have been reported to correctly diagnose neurogenic thoracic outlet syndrome. Additionally, we review the various surgical techniques recommended to treat this syndrome.

Results:

Postoperative functional outcomes have been shown to be more favorable in arterial and venous thoracic outlet syndrome (TOS) patients when compared with neurogenic TOS patients, likely due to the ability to completely remove the site of compression in cases of vascular TOS as compared with incomplete decompression in neurogenic TOS.

Conclusions:

In this review article, we provide an overview of the anatomy, etiology, diagnostic modalities, and current treatment options of correcting neurogenic TOS. Additionally, we offer a detailed step-by-step technique of the supraclavicular approach to the brachial plexus, a preferred approach for decompressing neurogenic TOS.
Combined Volume Reduction Surgery and Lymphaticovenular Anastomosis for Treatment of Lower Leg Lymphedema
Authors: Onoda Satoshi , Tsukura Kahori , Tachibana Gaku , Kobayashi Kohta , Katsuragi Ryohei , Satake Toshihiko , Hamada Erika
Published: March 2023

Much has been reported in the past regarding obesity as a risk factor for the origin of lymphedema. There are also reports of surgical treatments for obesity-related lymphedema. We have previously reported on the effectiveness of lymphaticovenular anastomosis in reducing chronic inflammation, and we believe that lymphaticovenular anastomosis is a very useful surgical approach in patients with recurrent cellulitis. In this report, we describe a case of a severely obese patient with a body mass index over 50 who developed lymphedema in both lower extremities due to pressure from sagging abdominal fat accompanied by frequent episodes of cellulitis.
Oocytes collected from small follicles after a dual trigger with gonadotropin-releasing hormone agonist (Gn-RHa) and human chorionic gonadotropin (hCG) for final oocyte maturation, in poor responder patient do not impact negatively ICSI cycles outcomes
Authors: Barbara Samira , Oumeziane Amina , Nanouche Fatima , Djerroudib Karima , Boucekine Nadjia , Chabane N. , Tazairt Nawal , Lacheheb Ahlem , Chemoul Samia , Bourihane Rachida , Mouhoub Samia , Devroey Paul
Published: March 2023

Introduction:

Follicles (FOs) of 16–22 mm produce more mature oocytes compared with small FOs as reported. In patients with poor ovarian response, late trigger results in premature luteinization, and an early trigger increases the number of immature oocytes. The purpose of this study was to demonstrate that metaphase II oocytes collected from FO of 11–15 mm results in similar pregnancy outcomes as metaphase II of oocytes collected from FO >16 mm when a dual trigger is used in patients with poor ovarian response.

Materials and method:

This was a prospective cohort study. A total of 122 patients were included according to the Bologna criteria for “poor ovarian responders”. From 2018 to 2020, controlled ovarian stimulation using antagonist protocols was used for ovarian stimulation. Two-dimensional ultrasound combined with hormonal assessment were used to monitor ovarian stimulation. Ovulation was induced with 0.2 mg gonadotropin-releasing hormone agonist and 5000 IU human chorionic gonadotropin when at least 1 FO ≥16 mm; 36 hours later, oocyte retrieval was performed. FO were collected separately. For all laboratory steps, oocytes were treated according to size FO. A single cleavage stage embryo was transferred. The luteal phase was supported with micronized progesterone. Excess embryos were cryopreserved according to FO size. If pregnancy did not occur, a single frozen embryo was replaced. Two groups of punctate FOs were analyzed: group 1 (G1) =246 FO size 11–15 mm, group 2 (G2) =238 FO size ≥16 mm.

Results:

In all, 122 cycles were started, 27 were cancelled. Forty-six fresh embryo transfers in G1 and 49 in G2 were performed, 31 frozen embryo transfers for G1 and 10 for G2. There were no significant differences in fertilization rate, clinical pregnancy rate (CPR), and live birth rate. Logistic regression adjusting the CPR to FO size and other influencing factors revealed no predictors for CPR and live birth rate.

Conclusion:

Study showed similar pregnancy outcomes regardless of FO size.
Primary Retinal Detachment Outcomes Study: summary of reports number 1 to number 18
Authors: Starr Matthew R. , Ryan Edwin H. , Yonekawa Yoshihiro
Published: March 2023

Purpose of review

To highlight the recent work published from the Primary Retinal Detachment Outcomes (PRO) Study Group.

Recent findings

The PRO database was a large dataset made up of patients with primary rhegmatogenous retinal detachments (RRD) who had surgical repair during 2015. The database was constituted of nearly 3000 eyes from 6 centers across the United States and included 61 vitreoretinal surgeons. Nearly 250 metrics were collected for each patient, creating one of the richest datasets of patients with primary rhegmatogenous detachments and their outcomes. The importance of scleral buckling was demonstrated, particularly for phakic eyes, elderly patients, and those with inferior breaks. 360° laser may result in poorer outcomes. Cystoid macular edema was common, and risk factors were identified. We also found risk factors for vision loss in eyes presenting with good vision. A PRO Score was devised, to predict outcomes based on presenting clinical characteristics. We also identified characteristics of surgeons with the highest single surgery success rates. Overall, there were no major outcome differences between viewing systems, gauges, buckles sutured vs. scleral tunnels, drainage method, and techniques to address proliferative vitreoretinopathy. All incisional techniques were found to be very cost-effective treatment modalities.

Numerous studies resulted from the PRO database that significantly added to the literature regarding the repair of primary RRDs in the current era of vitreoretinal surgery.
Recent advances in the management of proliferative diabetic retinopathy
Authors: Pandit Saagar , Ho Allen C. , Yonekawa Yoshihiro
Published: March 2023

Purpose of review

The prevalence of diabetic retinopathy continues to rise. This review highlights advances in imaging, medical, and surgical management of proliferative diabetic retinopathy (PDR) in recent years.

Recent findings

Ultra-widefield fluorescein angiography has been shown to better characterize which patients have predominantly peripheral lesions and who may advance to more advanced forms of diabetic retinopathy. This was well demonstrated in DRCR Retina Network's Protocol AA. Protocol S demonstrated that antivascular endothelial growth factor (VEGF) treatment alone can be useful in the management of select PDR patients – particularly those without high-risk features. However, a growing body of literature highlights how lapse in care is a significant concern in PDR patients, and tailoring one's approach to treatment based on patient needs is recommended. In patients with high-risk features or where there is concern for lost-to-follow-up, incorporation of panretinal photocoagulation in the treatment paradigm is recommended. Protocol AB highlighted how patients with more advanced disease may benefit from earlier surgical intervention for earlier visual recovery but that continued anti-VEGF treatment may result in similar visual outcomes over a longer period. Finally, earlier surgical intervention for PDR without vitreous hemorrhage (VH) or retinal detachment is being considered a potential option to minimize treatment burden.

Recent advances in imaging, as well as medical and surgical treatment options for PDR, have provided a deeper understanding of PDR management, which can be optimized for the individual patient.
Pneumatization of the Greater Wing of Sphenoid Utilization for Lateral Wall Decompression
Authors: Okafor Linda , Malhotra Raman
Published: March 2023

The goal of orbital decompression for thyroid orbitopathy is to expand the orbital space for the contents with various techniques described. Deep lateral wall decompression is a procedure that expands the orbit by removing bone from the greater wing of sphenoid however its effectiveness is dependent on the volume of bone removed. Pneumatization of the greater wing of sphenoid is defined as an extension of the sinus beyond the VR line (a straight line crossing the medial edges of the vidian canal and the foramen rotundum) which is a demarcation between the sphenoid body and the lateral parts of the sphenoid bone, including the greater wings and pterygoid process. We present a case of complete pneumatization of the greater wing of sphenoid affording a greater volume of bony decompression in a patient with significant proptosis and globe subluxation as a result of thyroid eye disease.
HeartMate-3 Ventricular Assist Devices Versus the Total Artificial Heart for Biventricular Support: A Single-Center Series.
Authors: Satish Mohan , Anyanwu Anelechi , Moss Noah , Lala Anuradha , Itagaki Shinobu , Roldan Julie , Mancini Donna
Published: March 2023

Introduction:

The SynCardia total artificial heart (TAH) is the only device approved for biventricular support. Continuous flow ventricular assist devices (VAD) in a biventricular configuration (BiVAD) have been used with variable results. The purpose of this report was to examine differences in patient characteristics and outcomes between two HeartMate-3 (HM-3) VADs in comparison with TAH support.

Methods:

All patients who received durable biventricular mechanical support from November 2018 to May 2022 at The Mount Sinai Hospital (New York) were considered. Baseline clinical, echocardiographic, hemodynamic, and outcome data were extracted. Primary outcomes were postoperative survival and successful bridge-to-transplant (BTT).

Results:

A total of 16 patients received durable biventricular mechanical support during the study period, of which 6 (38%) patients received two HM-3 VAD pumps as BiVAD support and 10 (62%) patients received a TAH. Overall, TAH patients had a lower median lactate (p < 0.05) at baseline compared to those on HM-3 BiVAD support yet had higher operative morbidity, lower 6-month survival (p < 0.05), and a higher rate of renal failure (80 vs. 17%; p = 0.03). However, survival declined to the same rate at 1 year (50%) and was largely because of extracardiac adverse events related to underlying comorbidities (particularly, renal failure and diabetes, p < 0.05). Successful BTT was achieved in 3 out of 6 HM-3 BiVAD patients and in 5 out of 10 TAH patients.

Conclusion:

In our single center experience, similar outcomes were observed among patients BTT with HM-3 BiVAD compared to those BTT on TAH support despite lower Interagency Registry for Mechanically Assisted Circulatory Support level.
Alterations in Coronary Blood Flow and the Risk of Left Ventricular Distension in Venoarterial Extracorporeal Membrane Oxygenation
Authors: Myneni Manoj , Cheema Faisal H. , Rajagopal Keshava
Published: March 2023

Previous theoretical studies have suggested that veno-arterial extracorporeal membrane oxygenation (VA-ECMO) ought to consistently result in markedly increased left ventricular (LV) intracavitary pressures and volumes because of increased LV afterload. However, this phenomenon of LV distension does not universally occur and occurs only in a minority of cases. We sought to explain this discrepancy by considering the potential implications of VA-ECMO support on coronary blood flow and consequently improved LV contractility (the “Gregg” effect), in addition to the effects of VA-ECMO support upon LV loading conditions, in a lumped parameter-based theoretical circulatory model. We found that LV systolic dysfunction resulted in reduced coronary blood flow; VA-ECMO support augmented coronary blood flow proportionally to the circuit flow rate. On VA-ECMO support, a weak or absent Gregg effect resulted in increased LV end-diastolic pressures and volumes and increased end-systolic volume with decreased LV ejection fraction (LVEF), consistent with LV distension. In contrast, a more robust Gregg effect resulted in unaffected and/or even reduced LV end-diastolic pressure and volume, end-systolic volume, and unaffected or even increased LVEF. Left ventricular contractility augmentation proportional to coronary blood flow increased by VA-ECMO support may be an important contributory mechanism underlying why LV distension is observed only in a minority of cases.
First-in-Man Use of a Modified Controller to Resolve HVAD Failure-to-Restart
Authors: Li Song , Beckman Jennifer A. , Wiederspan Lisa , Guertin Lisa , Pal Jay , Mahr Claudius
Published: March 2023

We report a case of Medtronic HeartWare ventricular assist device (HVAD) pump failure-to-restart. Despite HVAD withdrawal from the market in June 2021, up to 4,000 patients remain on HVAD support worldwide, and many are at high risk for this serious complication. This report describes the first-in-man use of a new HVAD controller that restarted a defective HVAD pump and avoided a fatal outcome. This new controller has the potential of preventing unnecessary VAD exchanges and saving lives.