bluuebunny/crossref_metadata_2025 huggingface dataset:
Online health information-seeking behaviour of patients attending a primary care clinic in Malaysia: a cross-sectional study
Authors: Lim Hooi Min , Wong Swee Shiuan , Yip Kah Chun , Chang Felicia Wen Si , Chin Adrian Jian Zhi , Teo Chin Hai , Abdullah Adina , Ng Chirk Jenn
Published: July 2021

Background

The internet has become a common source of health information; however, little is known about online health information-seeking behaviour (HISB) among patients in low- and middle-income countries (LMICs).

Objectives

This study aimed to determine the prevalence of online health information-seeking and its associated factors among patients in primary care in Malaysia. We also examined the reasons for, and the sources of, online health information-seeking, patients’ level of trust in the information found and what the information was used for.

Methods

A cross-sectional study using a self-administered questionnaire was conducted on patients who attended a primary care clinic. The questionnaire included the use of the internet to seek health information, sources and types of health information, eHealth literacy, patients’ trust in online information, and how patients appraise and use online health information.

Results

Out of 381 patients in this study, 54.7% (n = 208) used the internet to search for health information. Patients mainly sought information via Google (96.2%) and the most common websites that they visited were Wikipedia (45.2%) and MyHEALTH (37.5%). Higher levels of education, longer duration of internet use, and higher eHealth literacy were significantly associated with online HISB. Patients’ trust in websites (45.6%) and social media (20.7%) was low when compared to trust in healthcare professionals (87.9%). Only 12.9% (n = 22) of patients had discussed online health information with their doctors.

Conclusion

Online HISB was common among primary care patients; however, their eHealth literacy was low, with suboptimal appraisal skills to evaluate the accuracy of online health information.
Influence of Diabetes Duration and Glycemic Control on Dementia: A Cohort Study
Authors: Li Fu-Rong , Yang Hai-Lian , Zhou Rui , Zheng Jia-Zhen , Chen Guo-Chong , Wu Xiao-Xiang , Zou Meng-Chen , Wang Jing-Ya , Fu Qiang , Wu Xian-Bo
Published: July 2021

Background

To investigate the influence of diabetes duration and glycemic control, assessed by glycated hemoglobin (HbA1c) levels, on risk of incident dementia.

Methods

The present study is a prospective study of 461 563 participants from the UK Biobank. The age at diabetes diagnosis was determined by self-report. Diabetes duration was calculated as baseline age minus age at diagnosis. Cox proportional hazards regression models were used to estimate hazard ratios (HRs) with 95% confidential intervals (CIs).

Results

During a median follow-up of 8.1 years, 2 233 dementia cases were recorded. As compared with normoglycemic individuals, individuals with diabetes had higher risk of all-cause dementia, and the risk increased with increasing duration of diabetes; compared with participants with diabetes duration of <5 years, the multivariable-adjusted HRs (95% CIs) were 1.49 (1.12–1.97), 1.71 (1.21–2.41), and 2.15 (1.60–2.90) for those with diabetes durations ≥5 to < 10, ≥10 to <15, and ≥ 15 years, respectively (p for trend < .001). Among participants with diabetes, those with both longer diabetes duration (diabetes duration ≥ 10 years) and poor glycemic control (HbA1c ≥ 8%) had the highest risk of all-cause dementia (multivariable-adjusted HR = 2.07, 95% CI 1.45, 2.94), compared with patients with shorter duration of diabetes and better glycemic control (diabetes duration < 10 years and HbA1c < 8%).

Conclusions

Diabetes duration appeared to be associated with the risk of incident dementia due to factors beyond glycemic control. Clinicians should consider not only glycemic control but also diabetes duration in dementia risk assessments for patients with diabetes.
Calcified Leg Ulcers in Older Patients: Clinical Description, Morphology, and Chemical Characterization
Authors: Colboc Hester , Fontaine Juliette , Bazin Dominique , Frochot Vincent , Letavernier Emmanuel , Daudon Michel , Laporte Naomi , Rouzière Stéphan , Reby Michael , Galezowski Agnes , Forasassi Christine , Meaume Sylvie
Published: July 2021

Chronic wounds, including leg ulcers, constitute an important medical problem among older patients. Dystrophic calcifications (DC) are associated with a variety of disorders, including leg ulcers. The aim of this study was to report the clinical and biological characteristics of older patients with DC in leg ulcers and to determine the morphology and chemical composition of these calcifications. We conducted a prospective monocentric study in our Geriatric-Wound and Healing ward, Rothschild Hospital, Paris, from January 2018 to December 2019. Patients with leg ulcers were screened for DC by palpation. Patients’ clinical, biological, and radiological findings were collected. DC morphology was analyzed using field-emission scanning electron microscopy and chemical composition was analyzed using µFourier transform infra-red spectroscopy and X-ray Fluorescence. Ten (7%) of the 143 patients hospitalized for leg ulcers presented DC. Older patients with DC were more likely to have leg ulcers with venous insufficiency (p = .015), colonized by Pseudomonas aeruginosa (p = .026), with a longer healing evolution (p = .0072) and hypercalcemia (p = .041). Five DC were extracted from ulcers: 2 presented 500 nm lacunar spheres and intermingled fibrils of about 10 nm in diameter, consistent with bacterial and biofilm imprints. DC were always composed of calcium–phosphate apatite and associated to the presence of zinc. Our analyses were consistent with the involvement of microorganisms and inflammatory process in DC formation. Early management of venous insufficiency, treatment of chronic bacterial colonization and use of calcium-solubilizing drugs seem to be rational strategies for calcified leg ulcer management in older patients.
Enhancing co-stimulation of CAR T cells to improve treatment outcomes in solid cancers
Authors: Harrison Aaron J , Du Xin , von Scheidt Bianca , Kershaw Michael H , Slaney Clare Y
Published: July 2021

Co-stimulation is a fundamental component of T cell biology and plays a key role in determining the quality of T cell proliferation, differentiation, and memory formation. T cell-based immunotherapies, such as chimeric antigen receptor (CAR) T cell immunotherapy, are no exception. Solid tumours have largely been refractory to CAR T cell therapy owing to an immunosuppressive microenvironment which limits CAR T cell persistence and effector function. In order to eradicate solid cancers, increasingly sophisticated strategies are being developed to deliver these vital co-stimulatory signals to CAR T cells, often specifically within the tumour microenvironment. These include designing novel co-stimulatory domains within the CAR or other synthetic receptors, arming CAR T cells with cytokines or using CAR T cells in combination with agonist antibodies. This review discusses the evolving role of co-stimulation in CAR T cell therapies and the strategies employed to target co-stimulatory pathways in CAR T cells, with a view to improve responses in solid tumours.
Time Fractional Parabolic Equations with Measurable Coefficients and Embeddings for Fractional Parabolic Sobolev Spaces
Authors: Dong Hongjie , Kim Doyoon
Published: July 2021

We consider time fractional parabolic equations in divergence and non-divergence form when the leading coefficients $a^{ij}$ are measurable functions of $(t,x_1)$ except for $a^{11}$, which is a measurable function of either $t$ or $x_1$. We obtain the solvability in Sobolev spaces of the equations in the whole space, on a half space, and on a partially bounded domain. The proofs use a level set argument, a scaling argument, and embeddings in fractional parabolic Sobolev spaces for which we give a direct and elementary proof.
A simple electronic medical record system designed for research
Authors: King Andrew J , Calzoni Luca , Tajgardoon Mohammadamin , Cooper Gregory F , Clermont Gilles , Hochheiser Harry , Visweswaran Shyam
Published: July 2021

With the extensive deployment of electronic medical record (EMR) systems, EMR usability remains a significant source of frustration to clinicians. There is a significant research need for software that emulates EMR systems and enables investigators to conduct laboratory-based human–computer interaction studies. We developed an open-source software package that implements the display functions of an EMR system. The user interface emphasizes the temporal display of vital signs, medication administrations, and laboratory test results. It is well suited to support research about clinician information-seeking behaviors and adaptive user interfaces in terms of measures that include task accuracy, time to completion, and cognitive load. The Simple EMR System is freely available to the research community and is on GitHub.
A mobile application to support bedside nurse documentation and care: a time and motion study
Authors: Ehrler Frederic , Wu Danny T Y , Ducloux Pascal , Blondon Katherine
Published: July 2021

Documentation at the bedside is still often initiated on paper before being entered in electronic charts, even after implementing electronic health records (EHRs). This 2-step process is time-consuming, a potential source of error, and hinders the use of real-time information. We developed the “Bedside mobility” smartphone application to facilitate bedside documentation in the EHR.

Objective

This study aims to evaluate the impact of our app in 2 wards of a teaching hospital with a pre-post design.

Materials and methods

The duration and location of all documentation activities were recorded using a time motion study.

Results

Using the app significantly decreased the duration of EHR documentation per hour of observation by 4.10 min (P = 0.003), while the time spent interacting with patient increased by 1.45 min although not significantly. Also, in the intervention period, the average duration of uninterrupted documentation episodes increased by 0.27 min (P = 0.16) and the uninterrupted interaction with patient increased by 8.50 min (P = 0.027).

Discussion

By reducing the fragmentation of documentation workflow, decreasing the overall EHR documentation time and allowing nurses to spend more time with their patients, app use led to potential higher quality of care and higher patient satisfaction and may help maintain a smoother workflow.

Conclusion

Our mobile app has the potential to positively impact bedside nurses’ clinical workflow and documentation, as well as patient–provider communication and relationship.
Smart About Meds (SAM): a pilot randomized controlled trial of a mobile application to improve medication adherence following hospital discharge
Authors: Habib Bettina , Buckeridge David , Bustillo Melissa , Marquez Santiago Nicolas , Thakur Manish , Tran Thai , Weir Daniala L , Tamblyn Robyn
Published: July 2021

Objective

The objectives of this pilot study were (1) to assess the feasibility of a larger evaluation of Smart About Meds (SAM), a patient-centered medication management mobile application, and (2) to evaluate SAM’s potential to improve outcomes of interest, including adherence to medication changes made at hospital discharge and the occurrence of adverse events.

Materials and Methods

We conducted a pilot randomized controlled trial among patients discharged from internal medicine units of an academic health center between June 2019 and March 2020. Block randomization was used to randomize patients to intervention (received access to SAM at discharge) or control (received usual care). Patients were followed for 30 days post-discharge, during which app use was recorded. Pharmacy claims data were used to measure adherence to medication changes made at discharge, and physician billing data were used to identify emergency department visits and hospital readmissions during follow-up.

Results

Forty-nine patients were eligible for inclusion in the study at hospital discharge (23 intervention, 26 control). In the 30 days of post-discharge, 15 (65.2%) intervention patients used the SAM app. During this period, intervention patients adhered to a larger proportion of medication changes (83.7%) than control patients (77.8%), including newly prescribed medications (72.7% vs 61.7%) and dose changes (90.9% vs 81.8%). A smaller proportion of intervention patients (8.7%) were readmitted to hospital during follow-up than control patients (15.4%).

Conclusion

The high uptake of SAM among intervention patients supports the feasibility of a larger trial. Results also suggest that SAM has the potential to enhance adherence to medication changes and reduce the risk of downstream adverse events. This hypothesis needs to be tested in a larger trial.

Trial registration

Clinicaltrials.gov, registration number NCT04676165.
Evolutionary history and climate conditions constrain the flower colours of woody plants in China
Authors: Wang Qinggang , Guo Qiang , Chi Xiulian , Zhu Shaoqi , Tang Zhiyao
Published: July 2021

In this study, we investigated (i) the differences in flower colour composition among growth forms of woody plants in China and (ii) the influences of biogeographic regions, evolutionary age and climatic conditions on geographic variation in the proportions of different flower colours. Using distribution maps and flower colour information (white, red, yellow, yellow-green, green and blue-purple) of 7673 Chinese woody plant species and a dated genus-level phylogenetic tree, we compared flower colour composition among different growth forms (shrubs, trees and lianas). We further estimated the relationships of geographical patterns in the proportions of different flower colours with seven different biogeographic regions, evolutionary age and different contemporary climatic variables. Compared with trees or lianas, shrubs showed a higher proportion of species with anthocyanin-based red and blue-purple flowers. The geographic patterns of flower colour composition of woody plants in China were strongly influenced by regional effects and contemporary climate, especially precipitation and ultraviolet B irradiance. The proportion of species with presumably bee-pollinated yellow and blue-purple flowers and stress tolerant anthocyanin-based red and blue-purple flower colours tended to be high in the northwestern part of China. Green flowers tended to evolve earlier than others, but evolutionary age had quite weak influences on the geographic pattern of flower colours. Our results reflect both evolutionary and environmental constraints on the distribution of flower colours of woody plants in China.
Rhus coriaria L., a new candidate for controlling metabolic syndrome: a systematic review
Authors: Hashem-Dabaghian Fataneh , Ghods Roshanak , Shojaii Asie , Abdi Leila , Campos-Toimil Manuel , Yousefsani Bahareh Sadat
Published: July 2021

Objectives

Rhus coriaria L. (RC) is a deciduous shrub with several pharmacological activities. Evidence of the effects of RC on weight, hyperlipidaemia, hypertension and diabetes mellitus have been presented in this study. Books, thesis and internet-based resources such as PubMed, Web of Science, Scopus, EMBASE, Cochrane, Ovid and Google Scholar were searched for the English, Arabic and Persian literature from 1966 to 2020 (December). The keywords were Rhus coriaria L., Sumac, metabolic syndrome and all its medical conditions (hyperlipidaemia, hypertension, obesity and diabetes mellitus). The inclusion criteria were full-text animal and human studies conducted on RC to evaluate its efficacy on any components of metabolic syndrome (MetS). Jadad scale was used to assess the quality of evidence.

Key findings

Reviewing 23 relevant studies demonstrated that RC is able to decrease the level of blood glucose, glycated haemoglobin, serum insulin and insulin resistance. Studies on hyperlipidaemia and obesity have very contradicting results, and there is no definite conclusion on the effect of RC on lipid profile. However, the hypotensive and effect of RC was confirmed in the existing studies.

According to the literature, RC can be considered as a promising curative candidate for MetS. However, further studies with larger sample size and higher methodological quality are needed.
Masculinity, Madness and Empire in Kipling’s ‘Thrown Away’ and ‘The Madness of Private Ortheris’
Authors: Griffiths Andrew
Published: July 2021

Institutional records suggest that the grounds for anxiety about insanity in late-nineteenth-century India were many and varied. Amongst other causes, one might have been rendered insane by sunstroke, fever, head injury, strong drink, and inherited tendency, the loss of money, grief, jealousy, anger, sexual excess, excessive joy, or (perhaps disturbingly) excessive study.1 With such a panoply of anxieties to explore, it is scarcely surprising that Rudyard Kipling’s Indian fiction abounds with characters who experience madness of various kinds and degrees. This paper focuses on two short stories collected in Kipling’s 1888 volume Plain Tales from the Hills: ‘Thrown Away’ and ‘The Madness of Private Ortheris’. These two stories offer particular insight into madness, its relationship to masculinity, and its consequences for the social order of British India. As Jonathan Saha has pointed out, madness in a colonial context was doubly significant. Since insanity ‘could strike anyone, rulers and the ruled, men and women . . . madness threatened to undermine the colonial racial boundary and disrupt the established norms of masculinity and femininity’.2 Both ‘Thrown Away’ and ‘The Madness of Private Ortheris’ explore or expose a psychological crisis that takes the form of a deviation from gender norms and is resolved by an enforced return to those norms. Reading the stories alongside asylum records, this paper contextualizes their representation of gender and madness and argues that the fiction offers a glimpse of what might fill important gaps in the archival record.
QUiC Clinics in the Central Texas Market: Value-Based Primary Care in Military Medicine
Authors: Malish Richard , Flannery Brian J , Meyers Garrett , Hall Brian T
Published: July 2021

Introduction

For the past 16 years, Military Health System primary care providers have been incentivized to pursue work in a fee-for-service (FFS) model. The system values documentation of productivity to earn as many relative value units as possible. The result is densely packed clinic schedules that often lack the space or flexibility to accommodate patients when sick. Leakage ensues. Furthermore, prevention and patient experience are not directly incentivized.

Methods

The Central Texas Market’s Accountable Care Organization reformed incentives in its #5 FFS-designed community-based medical homes to value outcomes over productivity. The resulting quality, urgent, internet, and phone care (QUiC) clinics are value-based and, therefore, better structured to achieve the Quad aim (better care, better health/readiness, and low cost). Forsaking deeply ingrained FFS practices, QUiC clinics funnel all routine (information-sharing) appointments into efficient internet or phone appointments. With the time freed by managing common needs in short bursts, QUiC clinics see sick patients with no notice (urgent care). They also focus on prevention and patient experience. We measured the effectiveness of the QUiC clinics in the value-based metrics of (1) patient experience, (2) Healthcare Effectiveness Data and Information Set measures of quality and prevention. (3) access-to-care, (4) leakage, and (5) enrollment.

Results

Over a 19 month period, the five community-based medical homes improved significantly in all areas. Specifically, measures of patient satisfaction improved from the mid-80s percent satisfied to the mid-90s percent satisfied. Healthcare Effectiveness Data and Information Set measures increased from average compared to national benchmarks (<50th percentile to 75th percentile) to the 90th percentile in four of five measures of quality and the 75th percentile in the remaining measure. Access to care for routine appointments decreased from 15.4 days to the third next available appointment to 2.8 days. Leakage decreased from 12.2% to 9.6%. These successes were attained without cost or significant reductions in patient enrollments. In changing workflows, the market became the #1 user of virtual video visits in the DOD.

Conclusions

This performance improvement project proved the concept that a military market can vastly improve value-based primary care outcomes at no cost and within multiple community-based clinics.
What Would it Take to Put a Chiropractor in Khakis? Effecting Chiropractors as Commissioned Officers in the U.S. Military—A Historical Brief
Authors: Barassi James P
Published: July 2021

The purpose of this article is to provide a historical perspective on the commissioning of chiropractors within the U.S. Military and to propose a pathway by which this can be accomplished. A comprehensive review of Congressional actions proposed and enacted, and historical documents to create a chronology of actions that influence and support a proposed pathway for commissioning. The authority to commission chiropractors within the U.S. Military has long been provided to the Secretary of Defense, but it has never been acted upon despite decades of legislation. Chiropractors currently serve within the DoD as contractors or government employees; however, the direct association with the military in terms of commissioning has remained elusive. Musculoskeletal injuries are statistically one of the most prevalent combat-related injury classifications within the active duty military and subsequent veteran population. Chiropractic physicians serving within military medicine and veteran health care facilities routinely manage common and complex neurological and musculoskeletal injuries sustained by combat and non-combat servicemen and women. Patient satisfaction with chiropractic services within both the active duty and veteran population is high and routinely sought after. Chiropractic inclusion in the medical corps or medical service corps within the DoD is long overdue.
Constraining cosmological parameters from strong lensing with DECIGO and B-DECIGO sources
Authors: Hou Shaoqi , Fan Xi-Long , Zhu Zong-Hong
Published: July 2021

Gravitational lensing has long been used to measure or constrain cosmology models. Although the lensing effect of gravitational waves has not been observed by LIGO/Virgo, it is expected that there can be a few to a few hundred lensed events to be detected by the future Japanese space-borne interferometers DECIGO and B-DECIGO, if they are running for 4 years. Given the predicted lensed gravitational wave events, one can estimate the constraints on the cosmological parameters via the lensing statistics and the time delay methods. With the lensing statistics method, the knowledge of the lens redshifts, even with the moderate uncertainties, will set the tight bound on the energy density parameter ΩM for matter, that is, 0.288 ≲ ΩM ≲ 0.314 at best. The constraint on the Hubble constant H0 can be determined using the time delay method. It is found out that at 5σ, |δH0|/H0 ranges from $3{{\ \rm per\ cent}}$ to $11{{\ \rm per\ cent}}$ for DECIGO, and B-DECIGO will give less constrained results, $8{{\ \rm per\ cent}}\ \mathrm{ to}\ 15{{\ \rm per\ cent}}$. In this work, the uncertainties on the luminosity distance and the time delay distance are set to be $10{{\ \rm per\ cent}}$ and $20{{\ \rm per\ cent}}$, respectively. The improvement on measuring these distances will tighten the bounds.
Stability of superthermal strahl electrons in the solar wind
Authors: Schroeder J M , Boldyrev S , Astfalk P
Published: July 2021

We present a kinetic stability analysis of the solar wind electron distribution function consisting of the Maxwellian core and the magnetic-field aligned strahl, a superthermal electron beam propagating away from the sun. We use an electron strahl distribution function obtained as a solution of a weakly collisional drift-kinetic equation, representative of a strahl affected by Coulomb collisions but unadulterated by possible broadening from turbulence. This distribution function is essentially non-Maxwellian and varies with the heliospheric distance. The stability analysis is performed with the Vlasov–Maxwell linear solver leopard. We find that depending on the heliospheric distance, the core-strahl electron distribution becomes unstable with respect to sunward-propagating kinetic-Alfvén, magnetosonic, and whistler modes, in a broad range of propagation angles. The wavenumbers of the unstable modes are close to the ion inertial scales, and the radial distances at which the instabilities first appear are on the order of 1 au. However, we have not detected any instabilities driven by resonant wave interactions with the superthermal strahl electrons. Instead, the observed instabilities are triggered by a relative drift between the electron and ion cores necessary to maintain zero electric current in the solar wind frame (ion frame). Contrary to strahl distributions modelled by shifted Maxwellians, the electron strahl obtained as a solution of the kinetic equation is stable. Our results are consistent with the previous studies based on a more restricted solution for the electron strahl.
An approximation for the capture radius of gaseous protoplanets
Authors: Valletta Claudio , Helled Ravit
Published: July 2021

Determining the heavy-element accretion rate of growing giant planets is crucial for understanding their formation and bulk composition. The solid (heavy-element) accretion rate should be carefully modelled during the various stages of giant planet formation and therefore the planetary capture radius must be determined. In some simulations that model the heavy-element accretion rate, such as in N-body simulations, the presence of the gaseous envelope is either neglected or treated in an oversimplified manner. In this paper, we present an approximation for the capture radius that does not require the numerical solution of the stellar structure equations. Our approximation for the capture radius works extremely well for various planetesimal sizes and compositions. We show that the commonly assumed constant density assumption for inferring the capture radius leads to a large error in the calculated capture radius and we therefore suggest that our approximation should be implemented in future simulations.
Microsurgical Management of Blister-Type Basilar Artery Apex Region Aneurysms: Companion Cases Demonstrate Technical Nuances of the Subtemporal Approach: 2-Dimensional Operative Video
Authors: Howard Brian M , Barrow Daniel L
Published: July 2021

The proportion of intracranial aneurysms treated by microsurgical clip ligation has drastically decreased in the endovascular era. However, some aneurysms cannot be treated by current endovascular techniques. Therefore, trainees and young vascular neurosurgeons must develop and maintain microsurgical skills to safely treat aneurysms that require surgery. Ruptured, basilar artery apex, blister-type aneurysms are particularly treacherous and require a high degree of skill to safely manage them surgically. In this video, 2 companion cases are exhibited to demonstrate the nuances of the subtemporal, skull base, approach to the basilar apex region. In each case, the patient consented to surgery and anonymized recording. The subtemporal approach is favored over the trans-sylvian for posteriorly directed basilar apex region aneurysms as the former affords a complete view of the relevant anatomy. Points for consideration include variations on the standard subtemporal approach, use of retractors vs lumbar drainage to mobilize the temporal lobe, and splitting the tentorium vs a suture-retraction technique for visualization of the basilar artery apex region. Techniques for successful navigation of intraoperative rupture are demonstrated. As the number of intracranial aneurysms treated by microsurgery continues to ebb, high-quality educational videos that supplement surgeon experience will become increasingly critical to ensure that a cohort of capable microvascular neurosurgeons is prepared to tackle challenging, but manageable aneurysms, such as the blister-type basilar apex variety. Video (c) Emory University School of Medicine, 2021. Used with permission.
Microsurgical Resection of Dorsal Pontine Cavernous Malformation: The Telovelar Approach Augmented by the Tonsillouvular Fissure Exposure: 2-Dimensional Operative Video
Authors: Patra Devi P , Turcotte Evelyn L , Bendok Bernard R
Published: July 2021

Surgical approaches to lesions of the fourth ventricle (FV) have been modified over the years to reduce the complications associated with splitting the inferior cerebellar vermis (ICV) and disrupting the brainstem and critical surrounding structures.
1-4
Two common approaches to lesions of this region include the transvermian approach (TVA) and telovelar approach (TeVA).
2
The TVA was initially considered the conventional route of access to lesions of the FV
1
but has been associated with significant risks, including possible gait ataxia and dysarthria.
3
The TeVA is advantageous, as it involves dissection along natural clefts and division of non-neural tissue and provides good exposure of the superolateral recess with modest exposure of the rostral FV. The TeVA approach can be augmented by opening the tonsilouvular fissures (TUFs). This added dissection allows greater lateral and superior exposure with less need for retraction.

In this operative video, we demonstrate a case in which we augmented the TeVA with a TUF dissection to access a dorsal pontine cavernous malformation. We performed a midline suboccipital craniotomy with a C1 posterior laminectomy. TUF dissection was followed by division of the tela choroidea (TC), which allowed for more lateral exposure of the FV and excellent visualization of the cavernous malformation without the need to traverse neural tissue. TeVA augmented by TUF dissection provided adequate access to the dorsal pons for complete resection of the cavernous malformation.

The patient consented to the procedure as shown in this operative video and gave informed written consent for use of her images in publication.

Anatomic images provided by courtesy of © The Rhoton Collection. http://rhoton.ineurodb.org/.

Video © Mayo Foundation for Medical Education and Research, 2021. Used with permission.
Mechanical Thrombectomy of Carotid Terminus Occlusion Using Direct Aspiration Technique—Video Illustration: 2-Dimensional Operative Video
Authors: Al Kasab Sami , Sattur Mithun , Porto Guilherme , Spiotta Alejandro M ,   ENRG Group, Arthur Adam , Bain Mark , Bendock Bernard , Jo Binning Mandy , Boulos Alan S , Crowley Webster , Fessler Richard , Grande Andrew , Guterman Lee , Hanel Ricardo , Hoit Daniel , Hopkins L Nelson , Howington Jay , James Robert , Jankowitz Brian , Kan Peter , Khalessi Alex A , Kim Louis , Langer David , Lanzino Giuseppe , Levitt Michael , Levy Elad I , Lopes Demetrius , Mack William , Mericle Robert , Mocco J , Ogilvy Chris , Pandey Aditya , Replogle Robert , Riina Howard , Ringer Andrew , Rodriguez Rafael , Saugaveau Eric , Schirmer Clemens , Siddiqui Adnan H , Spiotta Alex , Sultan Ali , Tawk Rabih , Thomas Ajith , Turner Raymond , Veznedaroglu Erol , Welch Babu , White Jonathan
Published: July 2021

Acute carotid terminus occlusion (CTO) is responsible for up to 5% of acute ischemic strokes secondary to emergent large vessel occlusion (ELVO) and up to 20% of acute internal carotid artery (ICA) occlusions.
1
The term “CTO” has also been used to describe occlusions in the supra-clinoid segment or at the bifurcation of the ICA. Compared to other ELVOs, patients with CTO present with higher stroke severity and larger infarct volume, likely to be a result of disruption of direct Circle of Willis collaterals across the anterior communicating artery (AComA) and posterior communicating artery (PComA).
2,3

 Similary, CTO is usually associated with worse prognosis compared to other ELVOs in general. With regard to response to treatment, previous studies have reported significantly lower recanalization rates with intravenous alteplase with CTO compared to M1 segment occlusion. With regard to the safety and efficacy of mechanical thrombectomy, prior reports provide conflicting results with some reporting lower successful recanalization rates with CTO compared to M1 occlusion, and others reporting similar results. In our experience, we have found that successful recanalization of CTO can be achieved with a similar approach to M1 occlusions utilizing a direct aspiration first pass technique (ADAPT).
3,4
Herein, we present a case of CTO for which we performed mechanical thrombectomy using ADAPT. This procedure was an emergent standard of care procedure for which a consent was not required and so not obtained.
Intraoperative Cochlear Nerve Monitoring for Vestibular Schwannoma Resection and Simultaneous Cochlear Implantation in Neurofibromatosis Type 2: A Case Series
Authors: Butler Margaret J , Wick Cameron C , Shew Matthew A , Chicoine Michael R , Ortmann Amanda J , Vance Janet , Buchman Craig A
Published: July 2021

BACKGROUND

Neurofibromatosis type 2 (NF2) often results in profound hearing loss and cochlear implantation is an emerging hearing rehabilitation option. However, cochlear implant (CI) outcomes in this population vary, and intraoperative monitoring to predict cochlear nerve viability and subsequent outcomes is not well-established.

OBJECTIVE

To review the use of intraoperative electrically evoked cochlear nerve monitoring in patients with NF2 simultaneous translabyrinthine (TL) vestibular schwannoma (VS) resection and cochlear implantation.

METHODS

A retrospective review was performed of 3 patients with NF2 that underwent simultaneous TL VS resection and cochlear implantation with electrical auditory brainstem response (eABR) measured throughout tumor resection. Patient demographics, preoperative assessments, surgical procedures, and outcomes were reviewed.

RESULTS

Patients 1 and 3 had a reliable eABR throughout tumor removal. Patient 2 had eABR pretumor removal, but post-tumor removal eABR presence could not be reliably determined because of electrical artifact interference. All patients achieved auditory percepts upon CI activation. Patients 1 and 2 experienced a decline in CI performance after 1 yr and after 3 mo, respectively. Patient 3 continues to perform well at 9 mo. Patients 2 and 3 are daily users of their CI.

CONCLUSION

Cochlear implantation is attainable in cases of NF2-associated VS resection. Intraoperative eABR may facilitate cochlear nerve preservation during tumor removal, though more data and long-term outcomes are needed to refine eABR methodology and predictive value for this population.
An ABHD17-like hydrolase screening system to identify de-S-acylation enzymes of protein substrates in plant cells
Authors: Liu Xiaoshi , Li Min , Li Yang , Chen Zian , Zhuge Chun , Ouyang Youwei , Zhao Yawen , Lin Yuxin , Xie Qi , Yang Chengwei , Lai Jianbin
Published: July 2021

Protein S-acylation is an important post-translational modification in eukaryotes, regulating the subcellular localization, trafficking, stability, and activity of substrate proteins. The dynamic regulation of this reversible modification is mediated inversely by protein S-acyltransferases and de-S-acylation enzymes, but the de-S-acylation mechanism remains unclear in plant cells. Here, we characterized a group of putative protein de-S-acylation enzymes in Arabidopsis thaliana, including 11 members of Alpha/Beta Hydrolase Domain-containing Protein 17-like acyl protein thioesterases (ABAPTs). A robust system was then established for the screening of de-S-acylation enzymes of protein substrates in plant cells, based on the effects of substrate localization and confirmed via the protein S-acylation levels. Using this system, the ABAPTs, which specifically reduced the S-acylation levels and disrupted the plasma membrane localization of five immunity-related proteins, were identified respectively in Arabidopsis. Further results indicated that the de-S-acylation of RPM1-Interacting Protein 4, which was mediated by ABAPT8, resulted in an increase of cell death in Arabidopsis and Nicotiana benthamiana, supporting the physiological role of the ABAPTs in plants. Collectively, our current work provides a powerful and reliable system to identify the pairs of plant protein substrates and de-S-acylation enzymes for further studies on the dynamic regulation of plant protein S-acylation.
A mutation in a C2H2-type zinc finger transcription factor contributed to the transition toward self-pollination in cultivated tomato
Authors: Shang Lele , Song Jianwen , Yu Huiyang , Wang Xin , Yu Chuying , Wang Ying , Li Fangman , Lu Yongen , Wang Taotao , Ouyang Bo , Zhang Junhong , Larkin Robert M , Ye Zhibiao , Zhang Yuyang
Published: July 2021

The degree of stigma exsertion has a major influence on self-pollination efficiency in tomato, and its improvement is essential for raising productivity and for fixing advantageous traits in cultivated tomato. To study the evolution of stigma exsertion degree in tomato, we searched for genes associated with this trait and other aspects of flower morphology, including the lengths of anthers, styles, and ovaries. We performed a genome-wide association on 277 tomato accessions and discovered a novel stigma exsertion gene (SE3.1). We reannotated the structure of the gene, which encodes a C2H2-type zinc finger transcription factor. A mutation of the lead single nucleotide polymorphism creates a premature termination codon in SE3.1 and an inserted stigma in cultivated tomatoes. SE3.1 is essential for the conversion of flush stigmas to inserted stigmas. This conversion has a major impact on the rate of self-fertilization. Intriguingly, we found that both SE3.1 and Style2.1 contribute to the transition from stigma exsertion to insertion during the domestication and improvement of tomato. Style2.1 controls the first step of exserted stigmas to flush stigmas, and SE3.1 controls the second step of flush stigmas to inserted stigmas. We provide molecular details for the two-step process that controls the transition from stigma exsertion to insertion, which is of great agronomic importance in tomato.
Identifying the Most Important Confounders When Assessing the Association Between Low-Grade Systemic Inflammation and Musculoskeletal Pain: A Modified Delphi Study
Authors: Koop Meghan A , Lutke Schipholt Ivo J , Scholten-Peeters Gwendolyne G M , Coppieters Michel W
Published: July 2021

Objective

The association between low-grade systemic inflammation and musculoskeletal pain may be influenced by multiple factors. However, little is known about the relative importance of these factors, and few studies account for them. This Delphi study aimed to reach consensus on the most important confounders which influence the association between low-grade systemic inflammation and musculoskeletal pain.

Methods

The panel consisted of 48 experts. In Round 1, the experts proposed what they believed were important confounders. In Round 2, the experts indicated for each confounder whether they believed it was important (yes/no). At least 50% of experts had to indicate the confounder was important to be considered in the final round. In Round 3, the experts rated the importance of each confounder on a 7-point Likert scale. Consensus was reached if ≥75% of the experts considered the factor either extremely or moderately important.

Results

In Round 1, 120 confounders were proposed, which were synthesized into 38 distinct factors. In Round 2, 33 confounders met the criterion to be considered important. In Round 3, consensus was reached for 14 confounders: acute illness/trauma, immune disease, medication use, endocrine, nutritional, or metabolic disease, other musculoskeletal conditions, age, handling of blood samples, sex, cancer, body composition, pregnancy, cardiovascular disease, physical activity, and pain characteristics.

Conclusions

These findings provide insight in the complexity of the association between low-grade systemic inflammation and musculoskeletal pain. Some factors currently listed as confounders may be re-classified as moderators or mediators as insights progress.
Dynamic alterations of amplitude of low-frequency fluctuations in patients with chronic neck pain
Authors: Zhang Jiabao , Xu Tao , Wang Linjia , Chen Dan , Gong Lisha , Chen Huafu , Yu Jiali , Zhao Ling , Gao Qing
Published: July 2021

Background

The pathogenesis of neck pain in the brain, which is the fourth most common cause of disability, remains unclear. Furthermore, little is known about the characteristics of dynamic local functional brain activity in cervical pain.

Objective

The present study aimed to investigate the changes of local brain activity caused by chronic neck pain and the factors leading to neck pain.

Methods

Using the amplitude of low-frequency fluctuations (ALFF) method combined with sliding window approach, we compared local brain activity that was measured by the functional magnetic resonance imaging (fMRI) of 107 patients with chronic neck pain (CNP) with that of 57 healthy control participants. Five pathogenic factors were selected for correlation analysis.

Results

The group comparison results of dynamic amplitude of low-frequency fluctuation (dALFF) variability showed that patients with CNP exhibited decreased dALFF variability in the left inferior temporal gyrus, the middle temporal gyrus, the angular gyrus, the inferior parietal marginal angular gyrus, and the middle occipital gyrus. The abnormal dALFF variability of the left inferior temporal gyrus was negatively correlated with the average daily working hours of patients with neck pain.

Conclusions

The findings indicated that the brain regions of patients with CNP responsible for audition, vision, memory, and emotion were subjected to temporal variability of abnormal regional brain activity. Moreover, the dALFF variability in the left inferior temporal gyrus might be a risk factor for neck pain.

This study revealed the brain dysfunction of patients with CNP from the perspective of dynamic local brain activity, and highlighted the important role of dALFF variability in understanding the neural mechanism of CNP.
Recent progress in treatments of rheumatoid arthritis: an overview of developments in biologics and small molecules, and remaining unmet needs
Authors: Tanaka Yoshiya
Published: July 2021

Through treatment with biological DMARDs (bDMARDs) or targeted synthetic (tsDMARDs) such as Janus kinase (JAK) inhibitors in addition to MTX, clinical remission has become a realistic therapeutic goal for the majority of patients with RA, and sustained remission facilitates prevention of joint damage and physical dysfunction. Long-term safety and sustained inhibition of structural changes and physical dysfunction by bDMARDs have been reported. The development of next-generation bDMARDs and expansion of their indications to various autoimmune diseases are expected. Five JAK inhibitors show comparable efficacy to bDMARDs, and the latest ones are effective for overcoming difficult-to-treat RA regardless of prior medications. Patients treated with JAK inhibitors should be adequately screened and monitored for infection, cardiovascular disorders, thrombosis, malignancies and so on. Advances in therapeutic strategies, including the differential use of therapeutic drugs and de-escalation of treatment after remission induction, are prioritized.
Stress and sleep across the onset of the novel coronavirus disease 2019 pandemic: impact of distance learning on US college students’ health trajectories
Authors: Gusman Michaela S , Grimm Kevin J , Cohen Adam B , Doane Leah D
Published: July 2021

Study Objectives

This study examined associations between average and intraindividual trajectories of stress, sleep duration, and sleep quality in college students before, during, and after transitioning to online learning due to the COVID-19 pandemic.

Methods

One hundred and sixty-four first-year college students answered twice-weekly questionnaires assessing stress exposure and perception, sleep duration, and sleep quality from January until May, 2020 (N = 4269 unique observations).

Results

Multilevel growth modeling revealed that prior to distance learning, student stress was increasing and sleep duration and quality were decreasing. After transitioning online, students’ stress exposure and perception trajectories immediately and continuously decreased; sleep quality initially increased but decreased over time; and sleep duration increased but then plateaued for the remainder of the semester. Days with higher stress exposure than typical for that student were associated with lower sleep quality, and both higher stress exposure and perception at the transition were linked with simultaneous lower sleep quality. Specific groups (eg, females) were identified as at-risk for stress and sleep problems.

Conclusions

Although transitioning to remote learning initially alleviated college students’ stress and improved sleep, these effects plateaued, and greater exposure to academic, financial, and interpersonal stressors predicted worse sleep quality on both daily and average levels. Environmental stressors may particularly dictate sleep quality during times of transition, but adaptations in learning modalities may help mitigate short-term detrimental health outcomes during global emergencies, even during a developmental period with considerable stress vulnerability. Future studies should examine longer-term implications of these trajectories on mental and physical health.
Multiple convergences in the evolutionary history of the testate amoeba family Arcellidae (Amoebozoa: Arcellinida: Sphaerothecina): when the ecology rules the morphology
Authors: González-Miguéns Rubén , Soler-Zamora Carmen , Villar-Depablo Mar , Todorov Milcho , Lara Enrique
Published: July 2021

Protists are probably the most species-rich eukaryotes, yet their systematics are inaccurate, leading to an underestimation of their actual diversity. Arcellinida (= lobose testate amoebae) are amoebozoans that build a test (a hard shell) whose shape and composition are taxonomically informative. One of the most successful groups is Arcellidae, a family found worldwide in many freshwater and terrestrial environments where they are indicators of environmental quality. However, the systematics of the family is based on works published nearly a century ago. We re-evaluated the systematics based on single-cell barcoding, morphological and ecological data. Overall, test shape appears to be more related to environmental characteristics than to the species’ phylogenetic position. We show several convergences in organisms with similar ecology, some traditionally described species being paraphyletic. Based on conservative traits, we review the synapomorphies of the infraorder Sphaerothecina, compile a list of synonyms and describe a new genus Galeripora, with five new combinations. Seven new species: Arcella guadarramensis sp. nov., Galeripora balari sp. nov., Galeripora bufonipellita sp. nov., Galeripora galeriformis sp. nov., Galeripora naiadis sp. nov., Galeripora sitiens sp. nov. andGaleripora succelli sp. nov. are also described here.