bluuebunny/crossref_metadata_2025 huggingface dataset:
Shaping the nebula around the symbiotic system R Aquarii
Authors: Santamaría E , Toalá J A , Liimets T , Guerrero M A , Botello M K , Sabin L , Ramos-Larios G
Published: July 2024

We present an analysis of high-dispersion spectroscopic observations of the symbiotic system R Aquarii (R Aqr) obtained with the Manchester Echelle Spectrograph at the 2.1-m telescope of the San Pedro Mártir Observatory (Mexico) in conjunction with available narrow-band images. The data are interpreted by means of the shape software to disclose the morpho-kinematics of the nebulosities associated with R Aqr. The model that best reproduces narrow-band images and position–velocity diagrams consists of three structures: an outer (large) hourglass structure surrounding an inner bipolar with a spiral-like filament entwined around the latter. The expansion velocity pattern of each structure is defined by different homologous expansion laws, which correspond to kinematic ages of $\tau _1$ = 450 $\pm$ 25 yr (outer hourglass), $\tau _2$ = 270 $\pm$ 20 yr (inner bipolar), and $\tau _3$ = 285$\pm$ 20 yr (spiral-like filament). We suggest that the spiral-like filament is tracing the regions of the interaction of a precessing jet with the circumstellar material, which simultaneously carves the inner bipolar structure. If a similar process created the large hourglass structure, it means that the action of the jet ceased for about 170 yr. We discuss the implications for other unresolved symbiotic systems detected in X-rays.
MeerKAT observations of starburst galaxies and AGNs within the core of XMMXCS J2215.9−1738 at z = 1.46
Authors: Klutse D Y , Hilton M , Heywood I , Smail I , Swinbank A M , Knowles K , Sikhosana S P
Published: July 2024

We present the first detailed radio study of the galaxy cluster XMMXCS J2215.9−1738 at z  = 1.46 using MeerKAT L-band (1.3 GHz) observations. We combine our radio observation with archival optical and infrared data to investigate the star formation and active galactic nucleus (AGN) population within $R_{200}$ ($R =$ 0.8 Mpc) of the cluster centre. Using three selection criteria; the radio luminosity, the far-infrared radio ratio ($q_{\rm {IR}}$), and the mid-infrared colour, we distinguish galaxies with radio emission predominantly powered by star formation from that powered by AGNs. We selected 24 cluster members within $R_{\rm {200}}$ in the MeerKAT image based on either their photometric or spectroscopic redshift. We classified 12/24 (50 per cent) as galaxies whose radio emission is dominated by star-formation activity, 6/24 (25 per cent) as intermediate star-forming galaxies, and 6/24 (25 per cent) as AGN-dominated galaxies. Using the radio continuum luminosities of the star-forming cluster galaxies, we estimated an integrated star formation rate (SFR) value of 1700 $\pm$ 330 M$_{\odot }$ yr$^{-1}$ within $R_{200}$. We derived a mass-normalized integrated SFR value of $(570 \pm 110) \times 10^{-14}$ yr$^{-1}$. This supports previous observational and theoretical studies that indicated a rapid increase in star formation activity within the core of high-redshift clusters. We also show that the high-AGN fraction within the cluster core is consistent with previous cluster observations at $z \gt $ 1.5.
“I’m standing next to him, I’m supporting him”—Supporting a loved one with brain cancer to donate their brain: A qualitative study
Authors: Griffin Cassandra P , Carlson Melissa A , Walker Marjorie M , Lynam James , Paul Christine L
Published: July 2024

Background

Brain cancer is a devastating and incurable disease that places a high burden of care on next of kin (NOK). NOK can play a core role in supporting end-of-life planning, including the decision to donate one’s brain after death. Postmortem brain donation is crucial to research. As postmortem programs develop it is important to understand the experiences of NOK as they support a loved one in the donation decision.

Methods

Thirteen qualitative interviews were completed with NOK of people who had consented to donate their brains to the Mark Hughes Foundation (MHF) Biobank. A thematic analysis was carried out on the transcribed interviews.

Results

Four central themes were identified: (i) The carer role has additional responsibilities and psychological benefits when brain donation is being considered; (ii) Supporting a loved one to donate requires mutual trust, understanding, and a commitment to honor agency; (iii) Increasing awareness of brain donation is a priority for NOK, and (iv) Brain donation is seen as a natural continuation of the donor’s altruistic values.

Conclusions

When a person with brain cancer decides to donate their brain to research, their NOK can experience additional burdens and benefits as the NOK–patient relationship evolves. Understanding this evolution and recognizing the importance of trust, advocacy, and altruism provides a guide for the integration of brain donation programs into clinical pathways and a basis for normalizing brain donation as an extension of organ donation frameworks.
Rescue of dead MnO2 for stable electrolytic Zn–Mn redox-flow battery: a metric of mediated and catalytic kinetics
Authors: Wang Qi , Zhou Wanhai , Zhang Yanyan , Jin Hongrun , Li Xinran , Zhang Tengsheng , Wang Boya , Zhao Ruizheng , Zhang Junwei , Li Wei , Qiao Yu , Jia Chuankun , Zhao Dongyuan , Chao Dongliang
Published: July 2024

The virtues of electrolytic MnO2 aqueous batteries are high theoretical energy density, affordability and safety. However, the continuous dead MnO2 and unstable Mn2+/MnO2 electrolysis pose challenges to the practical output energy and lifespan. Herein, we demonstrate bifunctional cationic redox mediation and catalysis kinetics metrics to rescue dead MnO2 and construct a stable and fast electrolytic Zn–Mn redox-flow battery (eZMRFB). Spectroscopic characterizations and electrochemical evaluation reveal the superior mediation kinetics of a cationic Fe2+ redox mediator compared with the anionic ones (e.g. I– and Br–), thus eliminating dead MnO2 effectively. With intensified oxygen vacancies, density functional theory simulations of the reaction pathways further verify the concomitant Fe-catalysed Mn2+/MnO2 electrolysis kinetics via charge delocalization and activated O 2p electron states, boosting its rate capability. As a result, the elaborated eZMRFB achieves a coulombic efficiency of nearly 100%, ultra-high areal capacity of 80 mAh cm–2, rate capability of 20 C and a long lifespan of 2500 cycles. This work may advance high-energy aqueous batteries to next-generation scalable energy storage.
Engagement With Stop Smoking Services After Referral or Signposting: A Mixed-Methods Study
Authors: Pope Ian , Rashid Simrun , Iqbal Hassan , Belderson Pippa , Ward Emma , Clark Lucy , Conway Tom , Stirling Susan , Clark Allan , Agrawal Sanjay , Bauld Linda , Notley Caitlin
Published: July 2024

Introduction

Screening for smoking when people interact with healthcare services and referral of those who smoke to stop smoking services (SSSs) is a key component of efforts to tackle tobacco use. However, little is known about what happens after someone is referred or signposted to SSSs.

Methods

As part of the Cessation of Smoking Trial in the Emergency Department (NCT04854616), those randomized to intervention (n = 505) were referred to local SSSs (along with receiving brief advice and an e-cigarette starter kit) and those randomized to control (n = 502) were given contact details for the same services (signposted). SSS engagement data were collected: (1) directly from participants and (2) from SSS, additional qualitative data came from 33 participant interviews.

Results

Engagement with SSSs was very low. 3.2% (n = 16) of those in the intervention group and 2.4% (n = 12) in the control group reported attending a one-to-one support session. From SSS data, engagement was also low with 8.9% (n = 43) of those referred engaging and 3.1% (n = 15) going on to quit with SSS support. The majority of the 24 intervention participants interviewed did not recall being contacted by an SSS.

Conclusions

Referral or signposting to SSSs within an Emergency Department-based trial resulted in very low levels of engagement. Barriers to engagement identified included participants not being contacted by SSSs and the support offered not meeting their needs.

Implications

Referral or signposting of those who smoke to SSSs from the Emergency Department resulted in low rates of engagement in this large multicenter randomized controlled trial. To better support those who smoke, it may be more effective for smoking cessation advice to be offered “in the moment” within clinical settings, and follow-up to be proactively offered rather than relying on people being motivated to contact the services themselves or engaging when contacted.
Utility of Serial Microbial Cell-free DNA Sequencing for Inpatient and Outpatient Pathogen Surveillance Among Allogeneic Hematopoietic Stem Cell Transplant Recipients
Authors: Fung Monica , Patel Nimish , DeVoe Catherine , Ryan Caitlin N , McAdams Staci , Pamula Meenakshi , Dwivedi Aditya , Teraoka Justin , Smollin Matthew , Sam Srey , Perkins Bradley , Chin-Hong Peter
Published: July 2024

Background

This study characterizes the clinical utility and validity of the Karius test (KT), a plasma microbial cell-free DNA sequencing platform, as an infection surveillance tool among hematopoietic stem cell transplant (HCT) recipients, including monitoring for cytomegalovirus (CMV) and detecting infections relative to standard microbiologic testing (SMT).

Methods

A prospective, observational cohort study was performed among adult HCT recipients as inpatients and outpatients. Serial KTs were performed starting with 1 sample within 14 days before HCT, then weekly from 7–63 days posttransplant then monthly from 3–12 months post-HCT. Diagnostic performance of KT versus CMV polymerase chain reaction was evaluated with positive percent agreement and negative percent agreement. Infectious events (<12 months post-HCT) were extracted from medical records. For infectious events without positive SMT, 2 clinicians adjudicated KT results to determine if any detections were a probable cause. Difference in time from KT pathogen detection and infection onset was calculated.

Results

Of the 70 participants, mean age was 49.9 years. For CMV surveillance, positive percent agreement was 100% and negative percent agreement was 90%. There was strong correlation between CMV DNA and KT molecules per microliter (r2: 0.84, P < .001). Of the 32 SMT+/KT+ infectious events, KT identified 26 earlier than SMT (median: −12 days) and an additional 5 diagnostically difficult pathogens identified by KT but not SMT.

Conclusions

KT detected CMV with high accuracy and correlation with quantitative polymerase chain reaction. Among infectious events, KT demonstrated additive clinical utility by detecting pathogens earlier than SMT and those not detected by SMT.
Low Prevalence of Nirmatrelvir-Ritonavir Resistance-Associated Mutations in SARS-CoV-2 Lineages From Botswana
Authors: Choga Wonderful T , Bareng Ontlametse T , Moraka Natasha O , Maruapula Dorcas , Gobe Irene , Ndlovu Nokuthula S , Zuze Boitumelo J L , Motshosi Patience C , Seru Kedumetse B , Matsuru Teko , Boitswarelo Matshwenyego , Matshaba Mogomotsi , Gaolathe Tendani , Mosepele Mosepele , Makhema Joseph , Tamura Trevor J M , Li Jonathan Z , Shapiro Roger , Lockman Shahin , Gaseitsiwe Simani , Moyo Sikhulile
Published: July 2024

Background

We evaluated naturally occurring nirmatrelvir-ritonavir (NTV/r) resistance-associated mutations (RAMs) among severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) strains from Botswana, a country with no NTV/r use to date, in order to recommend the usage of the agent for high-risk patients with coronavirus disease 2019 (COVID-19).

Methods

We conducted a retrospective analysis using 5254 complete SARS-CoV-2 sequences from Botswana (September 2020–September 2023). We evaluated the mutational landscape of SARS-CoV-2 3-Chymotrypsin-like protease (3CLpro) relative to the highlighted list of RAMs granted Food and Drug Administration Emergency Use Authorization in 2023.

Results

The sequenced 5254 samples included Beta variants of concerns (VOCs; n = 323), Delta VOCs (n = 1314), and Omicron VOCs (n = 3354). Overall, 77.8% of the sequences exhibited at least 1 polymorphism within 76/306 amino acid positions in the nsp5 gene. NTV/rRAMs were identified in 34/5254 (0.65%; 95% CI, 0.43%–0.87%) and occurred at 5 distinct positions. Among the NTV/r RAMS detected, A191V was the most prevalent (24/34; 70.6%). Notably, T21I mutation had a prevalence of 20.6% (7/34) and coexisted with either K90R (n = 3) polymorphism in Beta sequences with RAMs or P132H (n = 3) polymorphism for Omicron sequences with RAMs. Other NTV/r RAMs detected included P108S, with a prevalence of 5.88% (2/34), and L50F, with a prevalence of 2.94% (1/34). NTV/r RAMs were significantly higher (P < .001) in Delta (24/35) compared with Beta (4/34) and Omicron (6/34) sequences.

Conclusions

The frequency of NTV/r RAMs in Botswana was low. Higher rates were observed in Delta VOCs compared to Omicron and Beta VOCs. As NTV/r use expands globally, continuous surveillance for drug-resistant variants is essential, given the RAMs identified in our study.
Ceftriaxone Versus Cefazolin Susceptibility as a Surrogate Marker for Cefpodoxime Susceptibility in Enterobacterales
Authors: Lambert Kaitlyn V , Demkowicz Ryan , Murray Amanda , Howard Catessa , Slain Douglas
Published: July 2024

The Clinical and Laboratory Standards Institute stated that cefpodoxime susceptibility among Enterobacterales can be inferred from cefazolin, but this may overcall cefpodoxime resistance. We report a categorical agreement rate of 64% for cefazolin and 97% for ceftriaxone with cefpodoxime (P = .0001). Ceftriaxone appears to be a more useful cefpodoxime surrogate.
ATBS1-INTERACTING FACTOR 2 Positively Regulates Freezing Tolerance via INDUCER OF CBF EXPRESSION 1/C-REPEAT BINDING FACTOR-Induced Cold Acclimation Pathway
Authors: Kim Yoon , Kim Sun-Ho , Lim Jun , Kim Soo-Hwan
Published: July 2024

The INDUCER OF CBF EXPRESSION 1/C-REPEAT BINDING FACTOR (ICE1/CBF) pathway plays a crucial role in plant responses to cold stress, impacting growth and development. Here, we demonstrated that ATBS1-INTERACTING FACTOR 2 (AIF2), a non-DNA-binding basic helix-loop-helix transcription factor, positively regulates freezing tolerance through the ICE1/CBF-induced cold tolerance pathway in Arabidopsis. Cold stress transcriptionally upregulated AIF2 expression and induced AIF2 phosphorylation, thereby stabilizing the AIF2 protein during early stages of cold acclimation. The AIF2 loss-of-function mutant, aif2-1, exhibited heightened sensitivity to freezing before and after cold acclimation. In contrast, ectopic expression of AIF2, but not the C-terminal-deleted AIF2 variant, restored freezing tolerance. AIF2 enhanced ICE1 stability during cold acclimation and promoted the transcriptional expression of CBFs and downstream cold-responsive genes, ultimately enhancing plant tolerance to freezing stress. MITOGEN-ACTIVATED PROTEIN KINASES 3 and 6 (MPK3/6), known negative regulators of freezing tolerance, interacted with and phosphorylated AIF2, subjecting it to protein degradation. Furthermore, transient co-expression of MPK3/6 with AIF2 and ICE1 downregulated AIF2/ICE1-induced transactivation of CBF2 expression. AIF2 interacted preferentially with BRASSINOSTEROID-INSENSITIVE 2 (BIN2) and MPK3/6 during the early and later stages of cold acclimation, respectively, thereby differentially regulating AIF2 activity in a cold acclimation time-dependent manner. Moreover, AIF2 acted additively in a gain-of-function mutant of BRASSINAZOLE-RESISTANT 1 (BZR1; bzr1-1D) and a triple knockout mutant of BIN2 and its homologs (bin2bil1bil2) to induce CBFs-mediated freezing tolerance. This suggests that cold-induced AIF2 coordinates freezing tolerance along with BZR1 and BIN2, key positive and negative components, respectively, of brassinosteroid signaling pathways.
The Savings of Corporate Giants
Authors: Darmouni Olivier , Mota Lira
Published: July 2024

We construct a novel panel data set to provide new evidence on how the largest nonfinancial firms manage their financial assets. Our granular data show that, over the past decade, bond portfolios have grown to be at least as large as cash-like instruments, driven by the meteoric rise of corporate bond holdings. To shed light on the drivers of this growth, we conduct a pair of event studies around the 2017 tax reform and the 2020 liquidity crisis. We find that large holdings of marketable securities are primarily driven by cross-border tax incentives, while cash-like instruments are driven by liquidity motives. (JEL G32, G35, G11, E440)
Estimating Discount Functions with Consumption Choices over the Lifecycle
Authors: Laibson David , Lee Sean Chanwook , Maxted Peter , Repetto Andrea , Tobacman Jeremy
Published: July 2024

We estimate β-δ time preferences and relative risk aversion (RRA) using a lifecycle model including stochastic income, liquid and illiquid assets, credit cards, dependents, Social Security, mortality, and bequests. Preference parameters are identified by cross-tabulating four lifecycle age intervals and four balance sheet moments: the share of households carrying (ie, revolving) credit card debt, average carried credit card debt, average net wealth among households carrying credit card debt, and average net wealth among households not carrying credit card debt. The 16 moments are approximately matched by (MSM) parameter estimates β=0.53, δ=0.99, and RRA = 1.9.
‘An amazing gang of women crooks and blackmailers’: women, organized crime, and the ‘Forty Elephants’ gang in inter-war Britain
Authors: Di Méo Grace
Published: July 2024

Women’s participation in organized crime has been overlooked within historical research, with studies typically relegating their roles to that of auxiliaries to male gangsters. This article explores the activities and portrayals of women involved in organized crime during the British inter-war period, focusing specifically on one of Britain’s only known all-female criminal organizations (the ‘Forty Elephants’). Examining coverage from local, regional, and national newspapers, it argues that the Forty Elephants captivated the inter-war press, with depictions of gang members reflecting the stereotypical ‘devil in disguise’; according to the media, the female gangster was a dangerous and ‘professional’ criminal who hid behind a façade of good looks, fashionable clothing, and high social status. Furthermore, the article demonstrates how portrayals of the gang resonated with contemporary discussions around the emerging ‘modern woman’, reflecting concerns over women’s growing participation in social, political, and economic life.
Safety and Efficacy of Trastuzumab Deruxtecan for Metastatic HER2+ and HER2-low Breast Cancer
Authors: Qureshi Zaheer , Altaf Faryal , Jamil Abdur , Siddique Rimsha , Fatima Eeshal
Published: July 2024

Objectives:

Trastuzumab deruxtecan (T-DXd) is a novel antibody-drug conjugate (ADC) promising in treating metastatic HER2+ and HER2-low breast cancer. This updated systematic review and meta-analysis, integrating data from the latest clinical trials, aimed to evaluate the safety and efficacy of T-DXd in this patient population.

Methods:

We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. A comprehensive search was conducted across PubMed, Scopus, and Web of Science up to January 2024, focusing on clinical trials that assessed T-DXd’s efficacy and safety. Eligibility criteria were based on the PICOS framework, and selected studies underwent rigorous quality assessment and data extraction. The primary outcomes were progression-free survival (PFS), overall survival (OS), and the incidence of adverse events. A random-effects meta-analysis was performed to synthesize the data.

Results:

Seven studies involving 2,201 patients met the inclusion criteria. The pooled analysis revealed that T-DXd significantly improved PFS (OR=0.37, 95% CI: 0.27-0.52), indicating a robust efficacy in slowing disease progression. However, treatment was associated with an increased risk of anemia (OR=2.10, 95% CI: 1.36-3.25), fatigue (OR=1.56, 95% CI: 1.21-2.02), nausea (OR=6.42, 95% CI: 4.37-9.42), vomiting (OR=6.21, 95% CI: 3.14-12.25), constipation (OR=2.26, 95% CI: 1.53-3.34), and notably, drug-related interstitial lung disease (OR=10.89, 95% CI: 3.81-31.12). The efficacy outcomes demonstrated significant heterogeneity, which was addressed through sensitivity analysis.

Conclusions:

T-DXd shows significant efficacy in treating metastatic HER2+ and HER2-low breast cancer, offering a valuable therapeutic option for patients with advanced disease. However, the treatment is associated with notable adverse events, including a heightened risk of ILD. These findings underscore the need for careful patient selection, monitoring, and management strategies to mitigate risks. Future research should focus on optimizing treatment protocols and exploring methods to enhance safety profiles.
A 12-Month Analysis of the Dermatologic Effects and Durability of Midface Volume Correction With DEFCL Volumizing Filler in a Prospective, Single-Center Study
Authors: Siquier-Dameto Gabriel , Salti Giovanni , Rharbaoui Siham , Malgapo Dennis Malvin Hernandez , Innocenti Silvia , Manni Martina
Published: July 2024

BACKGROUND

Certain manufacturing processes confer distinctive rheologic features to hyaluronic acid (HA), ensuring long-lasting effects. Skin quality improvement and the volumizing effects of the DEFCL volumizer filler, a sterile, biodegradable, viscoelastic, transparent, isotonic, and homogenized injectable cross-linked high G′ filler for the treatment of moderate-to-severe age-related midface changes, were initially documented at 6 months after the first injection.

OBJECTIVE

The authors aimed to objectively evaluate the effects of the DEFCL volumizer filler in improving skin density, thickness, and biomechanical properties and on tissue volume augmentation in women with midface volume loss after 12 months.

MATERIALS AND METHODS

Fifty women with midface volume loss were recruited in this prospective, noncomparative, single-center, postmarket study. The authors report changes in skin density, thickness, and quality and subjective and objective evaluation of facial and/or cheek volume augmentation using the Global Aesthetic Improvement Scale, as well as injection site reactions and adverse events.

RESULTS

Improvements in skin quality and thickness and volumization were maintained 12 months after the first injection. Injector and patient satisfaction were highly rated with only mild adverse reactions observed.

CONCLUSION

Skin improvement and volumizing effects persisted in patients treated with the DEFCL volumizer after 12 months.
Premature ovarian insufficiency: knowledge, attitudes, and quality of care offered by gynecologists
Authors: Rosa e Silva Pedro Henrique , Ferreira Silvia Regina , Pravatta Rezende Gabriela , Angerame Yela Daniela , Benetti-Pinto Cristina Laguna
Published: July 2024

Objective

Premature ovarian insufficiency (POI) affects up to 3% of the global female population, influencing metabolic, cardiovascular, and reproductive health. Medical expertise in diagnosis, effects, and treatment strategies, particularly for gynecologists, is crucial for ensuring improved healthcare for women. The objective of this study is to assess the state of medical knowledge regarding the diagnosis, treatment, and follow-up of POI among Brazilian gynecologists.

Methods

A cross-sectional study was conducted using online questionnaires administered to 16,000 members of the Brazilian Federation of Gynecology and Obstetrics.

Results

In total, 460 questionnaires were received from gynecologists who had an average age of 44.49 ± 12.57 years and 19.37 ± 12.95 years of professional experience. Fifty-three percent of gynecologists diagnosed POI correctly, and 49% requested karyotype analysis, while fewer than 10% identified all POI etiologies. Over 90% of gynecologists understood the long-term consequences of POI for bone and cardiovascular health. Despite being a consequence of hypoestrogenism, hormone therapy was recommended only by 20% of doctors, with no more than 50% of them prescribing appropriate doses for young women. Regarding self-perception, 60% of gynecologists declared deficient knowledge regarding how to offer care and guidance to women, with hormone therapy being reported as the most important reason (47%).

Conclusions

Current concepts and guidelines for POI are not adequately understood or applied in Brazilian clinical practice, leading to suboptimal care.
Budgets: How They Are Planned, Prepared, and Managed
Authors: Chandawarkar Rajiv , Nadkarni Prakash , Barmash Elizabeth , Krasniak Peter , Capek Allison , Casey Kathleen
Published: July 2024

Background:

Budget planning and execution is as difficult as it is vital to any practice, whether academic, private, or group. Well-planned and executed budgets are a source of revenue and growth that fuels the practice for the next cycle. Conversely, poorly planned budget is disastrous, and a badly executed one invariably leads to unrecoverable losses. Many clinicians, especially those in academic centers, are not involved in budget-planning preparation and yet are held accountable for their yearly performance in relation to the budget.

Methods:

Key processes for budget planning and their significance are identified. Integrating these steps with the needs of a clinical practice, a stepwise method is described for both clinicians and administrators to work together to plan, prepare, and manage budgets.

Results:

Relevant examples of how budgets affect clinical workflow and common pitfalls of budget planning and mitigation methods are identified. A simplified systematic approach allows for a streamlined, smooth budget-planning process that involves faculty and staff, which holds them accountable for the year-long performance of the entire clinical team.

Conclusions:

A systematic proactive approach to budget-planning, preparation, and management provides a financial direction to the department; tracks performance; allows growth; and provides the flexibility to stay on track, change course, or reassign resources.
Liposuction as a Treatment for Lipedema: A Scoping Review
Authors: Bejar-Chapa Maria , Rossi Nicoló , King Nicholas , Hussey Madison R. , Winograd Jonathan M. , Guastaldi Fernando P.S.
Published: July 2024

Background:

Lipedema is the progressive symmetrical deposition of subcutaneous fat and fluid in the lower body, ordinarily sparing the trunk, upper limbs, face, and neck. It may follow an autosomal dominant inheritance pattern. The gold standard treatment for lipedema is complete decongestive therapy, consisting of manual lymphatic drainage and compression garments. This scoping review assessed the existing literature on the effectiveness of liposuction as an alternative treatment for lipedema.

Methods:

A scoping review of electronically available literature within PubMed, Scopus, and Cochrane focused on liposuction as a treatment for lipedema considering the following inclusion criteria: human studies, case series of 10 or more, controlled trials, randomized controlled trials, patient-reported outcome measurement studies, survey analyses, descriptive studies, retrospective analyses, recurrence included, follow-up of 6 months or more, age 18 years or older, and treatment modality being liposuction.

Results:

Thirteen studies were selected. Nine studies reported decreased compression therapy use among patients following liposuction. No studies reported a long-term increase in compression therapy following liposuction. Studies found self-reported improvements in pain, mobility, bruising, and overall quality of life for patients following liposuction, many of whom had previously been on compressive therapy. Studies reported low rates of serious adverse events following liposuction, including deep vein thrombosis, pulmonary embolism, and infection.

Conclusions:

These results suggest that liposuction can be a viable treatment alternative to compression therapy for lipedema in patients whose compression therapy has not been helpful. However, there is not enough evidence to say whether liposuction is as effective as compression for patients first presenting with lipedema.
“Retinal Displacement Following Retinectomy in Complex Macula-Involving Recurrent Rhegmatogenous Retinal Detachment”
Authors: Ghalibafan Seyyedehfatemeh , Leal Sebastian , Rohowetz Landon J. , Cai Louis Z , Shaheen Abdulla , Grau Maria Magraner , Sridhar Jayanth , Yannuzzi Nicolas A
Published: July 2024

Purpose:

To assess the incidence and degree of retinal displacement following nonprimary retinectomy in macula-involving rhegmatogenous retinal detachment (RRD) complicated by proliferative vitreoretinopathy (PVR).

Methods:

A retrospective interventional case series was conducted on eyes that underwent a second surgery involving retinectomy for complex macula-involving RRD between December 2011 and September 2023 at the Bascom Palmer Eye Institute. Clinical records and imaging were analyzed to assess the incidence and degree of retinal displacement using postoperative fundus autofluorescence (FAF).

Results:

Ten eyes of 10 patients (mean age 63.67 years) with complex RRD were followed over an average period of 18.4 months. Postoperative FAF imaging, performed on average 6.32 ± 8.7 months after retinectomy, revealed retinal displacement in 70% of eyes (n=7) with an average displacement measuring 0.52 ± 0.75 mm. Metamorphopsia was noted in 2 patients (20%) with retinal displacement. The best-corrected visual acuity improved from 1.62 logMAR before the second surgery to 1.20 logMAR by last follow-up visit.

Conclusion:

Retinectomy in the setting of treatment for complex PVR-associated RRD carries a high risk of retinal displacement as measured by fundus autofluorescence. It is unclear how much retinal displacement impacts visual outcomes, but it may contribute to post-operative visual acuity and metamorphopsia.
Treatment Outcomes of Conjunctival Cyst Ablation by Pattern Scan Laser
Authors: Kang Hyunkyoo , Lee Shin-Hyo , Shin Hyun Jin
Published: July 2024

Purpose:

To evaluate the effectiveness of conjunctival cyst ablation using pattern scan laser photoablation.

Methods:

Ninety-four cases of symptomatic conjunctival cysts were included. After staining the surface of a conjunctival cyst with a dark-purple marker pen, an incision was made into the conjunctival cyst using a 26-gauge needle. Low-energy photoablation using 3 × 3 grids of spots was then applied around the incision site for a mean of 50 times. The laser spots were 400 μm in size, the power delivered ranged from 400 to 450 mW, and the duration of each laser pulse was 80 ms.

Results:

During a mean follow-up period of 6.5 months (range 6–16 months), 84 cases of conjunctival cysts (89.4%) were successfully corrected by conducting either 1 or 2 laser sessions. The cyst was completely resolved after a single laser session in 74 cases (78.7%). There were 20 cases of recurrence, which involved fixed, thick, and large cysts. The conjunctival cyst recurred again after the second laser session in 2 of the 12 eyes in which the procedure was repeated. The remaining 8 cases were observed without additional treatment. No postoperative complications such as conjunctival scarring or persistent ocular irritation were observed.

Conclusions:

Pattern scan laser photoablation of a conjunctival cyst with the adjunctive use of cyst surface staining to increase the amount of thermal laser energy absorption is a simple and effective method for treating conjunctival cysts in an outpatient clinic.
Effect of carbon nanoparticle suspension injection versus indocyanine green tracer in guiding lymph node dissection during radical gastrectomy (FUTURE-01): a randomized clinical trial
Authors: Tian Yuan , Pang Yue , Yang Peigang , Guo Shuo , Ma Wenqian , Guo Honghai , Liu Yang , Zhang Ze , Ding Pingan , Zheng Tao , Li Yong , Fan Liqiao , Zhang Zhidong , Wang Dong , Zhao Xuefeng , Tan Bibo , Liu Yu , Zhao Qun
Published: July 2024

Background:

Carbon nanoparticle suspension injection (CNSI) and indocyanine green (ICG) have both been applied intraoperatively to facilitate lymphatic mapping and postoperatively to sort lymph nodes (LNs) in gastric cancer patients. However, no study has compared the two tracers in gastric cancer patients.

Materials and methods:

This prospective randomized controlled trial was conducted from January 2022 to March 2023. Patients with potentially resectable gastric cancer (cT1-4a N0/+ M0) were randomized to the CNSI or ICG group.

Results:

This study enrolled 96 patients. Ninety patients were in the modified intention-to-treat population, including 46 patients [32 males and 14 females; mean (SD) age, 57.4 (9.4) years] in the CNSI group and 44 patients [31 males and 13 females; mean (SD) age, 60.8 (8.8) years] in the ICG group. The mean (SD) number of retrieved LNs was 69.8 (21.9) and 53.6 (17.2) in the CNSI and ICG groups, respectively (P<0.001). The mean (SD) number of retrieved micro-LNs was 19.9 (13.3) and 11.6 (9.9) in the CNSI and ICG groups, respectively (P=0.001). The mean (SD) number of metastatic LNs was 8.1 (11.9) and 5.2 (9.2) in the CNSI and ICG groups, respectively (P=0.19).

Conclusions:

Compared with ICG, CNSI can increase the number of LNs detected, especially micro-LNs. Both tracers have high diagnostic value for detecting metastatic LNs. CNSI-guided lymphography may be a superior method for improving the accuracy of LN dissection.
Added Value of a Robotic-assisted Bronchoscopy Platform in Cone Beam Computed Tomography-guided Bronchoscopy for the Diagnosis of Pulmonary Parenchymal Lesions
Authors: Shaller Brian D. , Duong Duy K. , Swenson Kai E. , Free Dwayne , Bedi Harmeet
Published: July 2024

Background:

Cone beam computed tomography (CBCT)-guided bronchoscopic sampling of peripheral pulmonary lesions (PPLs) is associated with superior diagnostic outcomes. However, the added value of a robotic-assisted bronchoscopy platform in CBCT-guided diagnostic procedures is unknown.

Methods:

We performed a retrospective review of 100 consecutive PPLs sampled using conventional flexible bronchoscopy under CBCT guidance (FB-CBCT) and 100 consecutive PPLs sampled using an electromagnetic navigation-guided robotic-assisted bronchoscopy platform under CBCT guidance (RB-CBCT). Patient demographics, PPL features, procedural characteristics, and procedural outcomes were compared between the 2 cohorts.

Results:

Patient and PPL characteristics were similar between the FB-CBCT and RB-CBCT cohorts, and there were no significant differences in diagnostic yield (88% vs. 90% for RB-CBCT,P=0.822) or incidence of complications between the 2 groups. As compared with FB-CBCT cases, RB-CBCT cases were significantly shorter (median 58 min vs. 92 min,P<0.0001) and used significantly less diagnostic radiation (median dose area product 5114 µGy•m2vs. 8755 µGy•m2,P<0.0001).

Conclusion:

CBCT-guided bronchoscopy with or without a robotic-assisted bronchoscopy platform is a safe and effective method for sampling PPLs, although the integration of a robotic-assisted platform was associated with significantly shorter procedure times and significantly less radiation exposure.
Effectiveness of Zhuang medicine medicated thread moxibustion on human xanthelasma – a case series
Authors: Jiang Yuan , Suriyonplengsaeng Chinnawut , Wu Mengyi , Lin Jinran , Liu Qingmei , Zhou Yinghui , Lin Jui-Ming , Meesin Saowaluck , Suwanchinda Atchima , Wu Wenyu , Thianthanyakij Traidit
Published: July 2024

Rationale:

Xanthelasma, characterized by yellowish plaques around the eyelids due to lipid deposits, is typically treated through invasive methods like laser therapy or surgery, which often leads to scarring and dyspigmentation. This case series investigates the potential of Zhuang medicine medicated thread moxibustion as a less invasive alternative.

Patient Concerns:

Three female patients, aged 34, 45, and 55, presented with non-tender, soft yellow plaques near the medial canthi of both upper eyelids. The lesions varied in size and had been present for durations ranging from 6 months to 2 years. These patients expressed concerns about the pain and potential adverse reactions associated with conventional treatments, opting instead for an alternative approach.

Diagnoses:

Each patient was diagnosed with xanthelasma based on clinical evaluation. Standard diagnostic tests returned normal results, confirming the absence of underlying systemic issues.

Interventions:

The treatment regimen involved Zhuang medicine medicated thread moxibustion applied at 10-day intervals for a total of three sessions. This traditional method was selected due to its minimally invasive nature.

Outcomes:

After the first session, patients experienced mild edema, which resolved within 24 h. A significant reduction in the size of the plaques was observed after the second session, and by the third session, there was complete resolution of the plaques. Throughout the treatment and follow-up period of 3 months, no adverse reactions or recurrence of the xanthelasma was noted.

Lessons:

This case series suggests that Zhuang medicine medicated thread moxibustion could be a safe and effective alternative for the treatment of xanthelasma, avoiding the complications associated with more invasive conventional methods. Further research involving larger sample sizes is recommended to validate these preliminary findings and possibly integrate this method into broader clinical practice.
Lymph Node Yield is Associated with Improved Overall Survival and Increased Time to Recurrence in Node-Negative Pancreatic Ductal Adenocarcinoma Following Neoadjuvant Therapy
Authors: Servin-Rojas Maximiliano , Fong Zhi Ven , Fernandez-Del Castillo Carlos , Lionetto Gabriella , Bolm Louisa , Fagenholz Peter J. , Ferrone Cristina R. , Rocha-Castellanos Dario M. , Lillemoe Keith D. , Qadan Motaz
Published: July 2024

Objective:

To determine if lymph node yield (LNY) is associated with improved overall survival (OS) and time to recurrence (TTR) in patients with node-negative pancreatic ductal adenocarcinoma (PDAC) treated with neoadjuvant therapy (NAT).

Background:

Lymph node yield has been associated with survival in solid gastrointestinal cancers, including PDAC.

Methods:

Patients with pathological T stage I-III, node-negative (N0), PDAC treated with NAT followed by pancreatoduodenectomy were identified in the Massachusetts General Hospital (MGH) pancreatectomy database and the National Cancer Database (NCDB). A cutoff point of 22 nodes was identified in the NCDB using the point with the optimal (log-rank test) split. Overall survival and TTR were evaluated using univariate and multivariable analyses.

Results:

In the MGH cohort, 233 node-negative patients following NAT were included. A LNY ≥ 22 was associated with prolonged median OS (59 months vs. 25 months, P<0.001) and prolonged TTR (32 months vs. 14 months, P=0.019). On multivariable analysis, LNY was an independent predictor of survival (HR 0.97, 95% CI 0.95-0.99, P=0.034) per sampled node. In the NCDB, 2,029 node-negative patients following NAT were included. A LNY ≥ 22 was associated with prolonged median OS (49 months vs. 33 months, P<0.001). On multivariable analysis, LNY was an independent predictor of survival (HR 0.99, 95% CI 0.98-0.99, P<0.001) per sampled node.

Conclusion:

Lymph node yield was associated with improved oncologic outcomes in patients treated with NAT followed by pancreatoduodenectomy in two independent datasets. Responsible mechanisms by which LNY impacts the outcomes of node-negative patients following NAT warrant further exploration.
Comparative Analysis of Performance of Large Language Models in Urogynecology
Authors: Yadav Ghanshyam S. , Pandit Kshitij , Connell Phillip T. , Erfani Hadi , Nager Charles W.
Published: July 2024

Importance

Despite growing popularity in medicine, data on large language models in urogynecology are lacking.

Objective

The aim of this study was to compare the performance of ChatGPT-3.5, GPT-4, and Bard on the American Urogynecologic Society self-assessment examination.

Study Design

The examination features 185 questions with a passing score of 80. We tested 3 models—ChatGPT-3.5, GPT-4, and Bard on every question. Dedicated accounts enabled controlled comparisons. Questions with prompts were inputted into each model’s interface, and responses were evaluated for correctness, logical reasoning behind answer choice, and sourcing. Data on subcategory, question type, correctness rate, question difficulty, and reference quality were noted. The Fisher exact or χ2 test was used for statistical analysis.

Results

Out of 185 questions, GPT-4 answered 61.6% questions correctly compared with 54.6% for GPT-3.5 and 42.7% for Bard. GPT-4 answered all questions, whereas GPT-3.5 and Bard declined to answer 4 and 25 questions, respectively. All models demonstrated logical reasoning in their correct responses. Performance of all large language models was inversely proportional to the difficulty level of the questions. Bard referenced sources 97.5% of the time, more often than GPT-4 (83.3%) and GPT-3.5 (39%). GPT-3.5 cited books and websites, whereas GPT-4 and Bard additionally cited journal articles and society guidelines. Median journal impact factor and number of citations were 3.6 with 20 citations for GPT-4 and 2.6 with 25 citations for Bard.

Conclusions

Although GPT-4 outperformed GPT-3.5 and Bard, none of the models achieved a passing score. Clinicians should use language models cautiously in patient care scenarios until more evidence emerges.
Nicholas Avrion Mitchison. 5 May 1928—28 December 2022
Authors: Mitchison FRS Timothy J. , Beverley Peter C. L.
Published: July 2024

Avrion Mitchison, universally known as Av, made enormous contributions to the field of cellular immunity. Working under Peter Medawar FRS during his PhD in Oxford, Av made the crucial discovery that viable lymphocytes were responsible for rejection of grafts of foreign tissue, initiating the field of cellular immunology, which was to preoccupy him throughout his career. In 1962 he was appointed head of the Division of Experimental Biology at the National Institute for Medical Research and began using proteins decorated with small synthetic molecules termed haptens, enabling him to make his second major discovery. He showed that optimal antibody responses to a hapten required the cooperation of two cell populations: bone-marrow-derived ‘B’ lymphocytes, which synthesized the antibody, and thymus-derived ‘T’ lymphocytes, which recognized moieties in the carrier protein molecule and provided help to the B cells. In 1971 Av became the Jodrell Professor of Zoology at University College London and head of the Imperial Cancer Research Fund Tumour Immunology Unit (TIU), where he continued to investigate how antibody and cytotoxic T cell responses are regulated and the role of major histocompatibility genes in this process. The TIU was a mecca for immunologists from around the world, and Av inspired those who passed through to make major contributions to cellular immunity, neuroimmunology, leukaemogenesis, tumour immunology and autoimmune disease. In 1991 he became the first director of the Rheumatism Research Centre in Berlin, and in a few short years after the fall of the Berlin wall established a flourishing institute. The annual award of the Mitchison Prize for Young Researchers honours his legacy.
Exploring the midgut physiology of the non-haematophagous mosquito
Toxorhynchites theobaldi
Authors: Barbosa Renata C. , Godoy Raquel S. M. , Ferreira Priscila G. , Mendes Tiago A. O. , Ramalho-Ortigão Marcelo , Ribeiro José M. C. , Martins Gustavo F.
Published: July 2024

Toxorhynchites
mosquitoes have an exclusively phytophagous feeding habit as adults, which leads to significant differences in their morphophysiology compared with haematophagous mosquitoes. However, the molecular mechanisms of digestion in this mosquito are not well understood. In this study, RNA sequencing of the posterior midgut (PMG) of the mosquito
Toxorhynchites theobaldi
was undertaken, highlighting its significance in mosquito digestion. Subsequently, a comparison was made between the differential gene expression of the PMG and that of the anterior midgut. It was found that the most abundant proteases in the PMG were trypsin and chymotrypsin, and the level of gene expression for enzymes essential for digestion (such as serine protease, α-amylase and pancreatic triacylglycerol lipase) and innate immune response (including catalase, cecropin-A2 and superoxide dismutase) was like that of haematophagous mosquitoes. Peritrophin-1 was detected in the entire midgut, with an elevated expression level in the PMG. Based on our findings, it is hypothesized that a non-haematophagic habit might have been exhibited by the ancestor of
Tx. theobaldi
, and this trait may have been retained. This study represents a pioneering investigation at the molecular level of midgut contents in a non-haematophagous mosquito. The findings offer valuable insights into the evolutionary aspects of feeding habits in culicids.
Deviation from the recommended schedule: optimal dosing interval for a two-dose vaccination programme
Authors: Wang Zhen , Röst Gergely , Moghadas Seyed M.
Published: July 2024

Optimizing vaccination impact during an emerging disease becomes crucial when vaccine supply is limited, and robust protection requires multiple doses. Facing this challenge during the early stages of the COVID-19 vaccine deployment, a pivotal policy question arose: whether to administer a single dose to a larger proportion of the population by deferring the second dose, or to prioritize stronger protection for a smaller subset of the population with the established dosing interval from clinical trials. Using a delay-differential model and considering waning immunity and distribution capacity, we compared these strategies. We found that the efficacy of the first dose significantly influences the impact of delaying the second dose. Even for a relatively low efficacy of the first dose, a delayed strategy may outperform vaccination with the recommended dosing interval in reducing short-term hospitalizations and deaths despite increase in infections. The optimal delay, however, depends on the specific outcome measured and timelines within which the vaccination strategy is evaluated. We found transition lines for the relative reduction of infection, hospitalization and death below which vaccination with the recommended schedule is the preferred strategy. In a realistic parameter space, our results highlight scenarios in which the conclusions of previous studies are invalid.
The role of male quality in sequential mate choice: pregnancy replacement in small mammals?
Authors: Vodjerek Lea , Erixon Filippa , Mendes Ferreira Clara , Fickel Jörns , Eccard Jana A.
Published: July 2024

Females mainly increase their reproductive success by improving the quality of their mates and need to be discriminative in their mate choices. Here, we investigate whether female mammals can trade up sire quality in sequential mate choice during already progressed pregnancies. A male-induced pregnancy termination (functional ‘Bruce effect’) could thus have an adaptive function in mate choice as a functional part of a pregnancy replacement. We used bank voles (
Myodes glareolus
) as a model system and exchanged the breeding male in the early second trimester of a potential pregnancy. Male quality was determined using urine marking values. Females were offered a sequence of either high- then low-quality male (HL) or a low- then high-quality male (LH). The majority of females bred with high-quality males independent of their position in the sequence, which may indicate a pregnancy replacement in LH but not in HL. The body size of the second male, which could have been related to the coercion of females by males into remating, did not explain late pregnancies. Thus, pregnancy replacement, often discussed as a counterstrategy to infanticide, may constitute adaptive mate choice in female mammals, and female choice may induce pregnancy replacement in mammals.