bluuebunny/crossref_metadata_2025 huggingface dataset:
Optimization of X-mode electron cyclotron current drive in high-electron-temperature plasma in the EAST tokamak
Authors: WANG Hanlin , ZOU Xiaolan , WANG Xiaojie , PEYSSON Yves , LI Miaohui , WU Chenbin , ZHANG Chao , LIU Fukun , DECKER Joan
Published: September 2022

A discharge with electron temperature up to 14 keV has been achieved in EAST. Analysis of the electron cyclotron current drive (ECCD) efficiency at high electron temperature under EAST parameters is presented using C3PO/LUKE code. Simulation results show that the ECCD efficiency of X-mode increases with central electron temperature up to 10 keV and then starts to decrease above 10 keV, at a specific magnetic field and toroidal angle. The efficiency degradation is due to the presence of the third harmonic extraordinary (X3) downshifted absorption at the low field side (LFS); even the cold resonance of X3 mode is located outside the plasma. As the electron temperature increases from 5 to 20 keV, the X3 absorption increases from 0.9% to 96.4%. The trapping electron effect at the LFS produces a reverse Ohkawa current. The competition between the Fisch–Boozer current drive and the Ohkawa current drive results in a decrease in ECCD efficiency. ECCD efficiency optimization is achieved through two methods. One is to increase the toroidal angle, leading to X2 mode predominating again over X3 mode and the electron resonance domain of X2 mode moving far from the trapped/passing boundary. The second one is to increase the magnetic field to move away the X3 resonance layer from the plasma, hence less EC power absorbed by X3 mode.
Methods Employed in the Determining Nectar and Pollen Sources for Bees: A Review of the Global Scenario
Authors: Layek Ujjwal , Das Nandita , Kundu Arijit , Karmakar Prakash
Published: September 2022

Flowering plants and pollinators are in a mutualistic association, where pollinators collect floral resources and plants receive pollination services. Bees and other pollinators are declining in many parts of the world, and their loss affects the functional composition of fauna, flora, and habitats. Different strategies are being deployed to improve pollinator services, including the management of bees. Sustainable management of a bee species strongly depends on floral resource availability. Therefore, beekeepers need to have adequate knowledge about the surrounding vegetation (especially nectar and pollen sources for the bee species). Diverse methodologies are used around the world to determine floral resources for bees. Field surveys and pollen analysis of honey, corbicular/scopal pollen loads, residual pollens in brood cells, forager’s body surface pollen content, and internal organs (gut, intestine, crop, etc.) were used by the researchers. For pollen identification, most researchers carried out microscopy-based methods. However, pollen DNA-based methods were also used by researchers in recent years. Regarding the morphology-based identification, most researchers processed pollen samples according to Erdtman’s acetolysis method to increase the visibility of diagnostic characteristics of the pollen grains. The method specified by the International Commission for Bee Botany was used to conduct qualitative and quantitative pollen analysis on honey samples. For quantitative pollen load analysis, researchers used numerous techniques that may have been the most effective. Our discussion about the different techniques utilized to determine floral resources of a bee species will be helpful for researchers in selecting a suitable protocol and may assist in developing superior methodologies.
Heteromorphic stamens are differentially attractive in Swartzia (Fabaceae)
Authors: Basso-Alves João Paulo , da Silva Rafael Ferreira , Coimbra Gabriel , Leitão Suzana Guimarães , de Rezende Claudia Moraes , Bizzo Humberto Ribeiro , Freitas Leandro , Paulino Juliana Villela , Mansano Vidal de Freitas
Published: September 2022

The division of labour hypothesis between stamens has explained the evolution of divergent functions between dimorphic stamens in the same flower. However, little is known about whether the distinct type of stamens differs in attractiveness to pollinators. Therefore, we investigate whether the two types of stamens commonly found in Swartzia have different visual and olfactory attractants. We performed observations of anthesis dynamics, registration and collection of floral visitors, measurements of reflectance of floral parts and chemical analysis of the volatile organic compounds of the floral parts of two species, S. flaemingii and S. simplex. Both species have two distinct sets of stamens: one with smaller and abundant stamens in the centre of the flower and the other with fewer but larger abaxial stamens. The sets differ in UV reflectance (only S. simplex) and exhibit a distinct chromatic contrast. Concerning olfactory attractiveness, aliphatic compounds make up most of the odour of the two species, both whole flowers and most of their floral organs. On the other hand, only S. simplex presented apocarotenoids (as ionones) and benzenoids. Furthermore, there are differences in the proportion of volatiles emitted by the stamen in both cases, as the high proportion of sesquiterpenes among the smaller stamens compared to the larger ones. In conclusion, the two types of stamens found in S. flaemingii and S. simplex show a distinct attractiveness. In addition, our data have demonstrated diverse ways of differential attractiveness both between distinct stamens set per flower and between the two species from the same pollen flowers genus.
Which Words Matter Most? Operationalizing Lexical Prevalence For Rank-Ordered Word Lists
Authors: Egbert Jesse , Burch Brent
Published: September 2022

The words in a language or language variety are often rank ordered in lists that are meant to reflect the relative importance of those words to language users and learners of a language. This rank ordering is done on the basis of the relative prevalence of words in a corpus. Lexical prevalence is often operationalized as measures of frequency, dispersion, or adjusted frequency. Yet, to date, there is no consensus on best practices for identifying and ranking prevalent words in a corpus, or for evaluating the degree to which a word’s importance is reflected through its prevalence. We begin this paper by introducing and describing a wide range of corpus-based measures for quantifying lexical prevalence. We then carry out two case studies on the Duolingo University Textbook Corpus to evaluate the methods for their ability to identify and appropriately rank words in terms of their importance. We conclude with recommendations for word list creators and researchers and practitioners interested in word importance.
Primary progressive aphasia: in search of brief cognitive assessments
Authors: Matias-Guiu Jordi A , Grasso Stephanie M
Published: September 2022

This scientific commentary refers to ‘Utility of the Addenbrooke’s Cognitive Examination III online calculator to differentiate the primary progressive aphasia variants’ by Foxe et al. (https://doi.org/10.1093/braincomms/fcac161) and ‘A “Mini Linguistic State Examination” to classify primary progressive aphasia’ by Patel et al. (https://doi.org/10.1093/braincomms/fcab299)
Automatic transmission of home blood pressure data can be effective in managing hypertension: a systematic review and meta-analysis
Authors: Kaihara Toshiki , Intan-Goey Valent , Scherrenberg Martijn , Falter Maarten , Kario Kazuomi , Akashi Yoshihiro , Dendale Paul
Published: September 2022

Aims

Home blood pressure telemonitoring (HBPT) is a useful way to manage BP. Recent advances in digital technology to automatically transmit BP data without the patient input may change the approach to long-term BP treatment and follow-up. The purpose of this review is to summarize the latest data on the HBPT with automatic data transmission.

Methods and results

Articles in English from 1980 to 2021 were searched by electronic databases. Randomized controlled trials comparing HBPT with automatic data transmission with usual BP management and including systolic BP (SBP) and/or diastolic BP (DBP) as outcomes in hypertension patients were included in the systematic review. A meta-analysis was conducted. After removing duplicates, 474 papers were included and 23 papers were identified. The HBPT with automatic data transmission had a significant beneficial impact on BP reduction (mean difference for office SBP −6.0 mm Hg; P < 0.001). Subgroup analyses showed that the studies using smartphone applications reduced BP significantly more in the intervention group than in the control group (standardized mean difference for office and home SBP −0.25; P = 0.01) as did the studies using HBPT other than the applications. Longer observation periods showed a sustained effect, and multidisciplinary cooperation was effective.

Conclusion

This review suggests that a care path based on HBPT with automatic data transmission can be more effective than classical management of hypertension. In particular, the studies using smartphone applications have shown beneficial effects. The results support the deployment of digital cardiology in the field of hypertension management.
Cross-fertilisation, not bifurcation, of EMI and EAP
Authors: Galloway Nicola , Rose Heath
Published: September 2022

The article responds to Wingate and Hakim’s paper, where they criticise English Medium Instruction (EMI) research for not drawing on research and practices from EAP. We concur that this cross-fertilisation of knowledge is beneficial for both fields but emphasise the breadth of the current EMI research agenda, which explores several issues beyond English language and academic preparedness. We also counter their claims of a lack of awareness by highlighting several examples of knowledge exchange, much of which has been driven by EMI scholars working within EAP contexts, and vice versa. Finally, we urge caution in recommendations to uncritically adopt EAP practices from Anglophone university settings into EMI settings, due to the complexities associated with EMI growth and provision, where the challenges raised are not necessarily identical. Overall, we agree with the authors that EAP and EMI have much to gain from each other in their shared endeavours and welcome their calls for future research collaboration.
A perspective on the molecular mechanism in the control of organ internal (IN) asymmetry during petal development
Authors: Yu Qianxia , Ge Liangfa , Ahmad Sagheer , Luo Da , Li Xin
Published: September 2022

Floral zygomorphy (monosymmetry) is a key innovation in flowering plants and is related to the coevolution of plants and their animal pollinators. The molecular basis underlying floral zygomorphy has been analysed, and two regulatory pathways have been identified: one determines the dorsoventral (DV) asymmetry along the floral plan, and the other controls organ internal (IN) asymmetry during petal development. While strides have been made to understand the molecular mechanism controlling DV asymmetry, which mainly involves an interplay between TCP and MYB transcription factors, the molecular pathway regulating IN asymmetry remains largely unknown. In this review, we discuss what is known about regulators and the molecular pathway regulating IN asymmetry. Our analysis revealed that the regulation of IN asymmetry occurs at the cellular, tissue, and organ genesis levels during petal development and that the regulatory mechanism is likely integrated into different developmental paths, such as floral and root nodule development. Although the molecular regulation of IN asymmetry is not be a linear path, a key hub for the regulatory network could be vascular patterning during petal organogenesis.
The Isotropy Group of a Foliation: The Local Case
Authors: Cerveau D , Neto A Lins
Published: September 2022

Given a holomorphic singular foliation ${\mathcal {F}}$ of $({\mathbb {C}}^n,0)$, we define $\textrm {Iso}({\mathcal {F}})$ as the group of germs of biholomorphisms on $({\mathbb {C}}^n,0)$ preserving ${\mathcal {F}}$: $\textrm {Iso}({\mathcal {F}})\!=\!\lbrace \Phi \in \textrm {Diff}({\mathbb {C}}^n,0)\,|\,\Phi ^*({\mathcal {F}})\!=\!{\mathcal {F}}\rbrace $. The normal subgroup of $\textrm {Iso}({\mathcal {F}})$, of biholomorphisms sending each leaf of ${\mathcal {F}}$ into itself, will be denoted as $\textrm {Fix}({\mathcal {F}})$. The corresponding groups of formal biholomorphisms will be denoted as $\widehat {\textrm {Iso}}({\mathcal {F}})$ and $\widehat {\textrm {Fix}}({\mathcal {F}})$, respectively. The purpose of this paper will be to study the quotients $\textrm {Iso}({\mathcal {F}})/\textrm {Fix}({\mathcal {F}})$ and $\widehat {\textrm {Iso}}({\mathcal {F}})/\widehat {\textrm {Fix}}({\mathcal {F}})$, mainly in the case of codimension one foliation.
Method Greenness Profile Assessment to AQbD-Driven Stability Indicating HPTLC Method for Estimation of Aripiprazole Using Screening Design and Response Surface Modeling
Authors: Prajapati Pintu , Gandhi Alina , Shah Shailesh
Published: September 2022

Background

According to the literature review, organic solvents such as methanol, acetonitrile, toluene, and carbon tetrachloride have been used for the chromatographic analysis of aripiprazole (APZ). The green chemistry approach recommends these organic solvents are unsafe for analysts and the environment and should be avoided or minimized in chromatographic analysis.

Objective

Hence, the stability-indicating assay method (SIAM) has been developed for the estimation of aripiprazole using safe organic solvents.

Methods

The quality risk management was started with risk identification, which was followed by risk assessment. By the risk assessment process, seven analytical risk factors (ARFs) were found to be potentially risky for method development. Further risk analysis was done by Taguchi OA design for the study of the main effect of ARF on resolution between the peaks. Design of experiments (DoE)-based response surface modeling (RSM) was performed by central composite design. Method operable design region (MODR) was navigated for resolution between peaks more than 1.0 for risk control. After navigation of the MODR, a risk review was done by validation of the design model for SIAM.

Results

Control strategy was set for ARFs and separation was carried out on the precoated aluminum plate with silica gel 60 F254 using ethyl acetate–ethanol (8.0 + 2.0, v/v) as the mobile phase keeping 15 min saturation time. The developed method was validated as per the International Council for Harmonisation (ICH) Q2 (R1) guideline. The developed SIAM was applied for the assay of aripiprazole in its tablet, and results were found in agreement with the labeled claim.

Conclusions

The organic solvents ethyl acetate and ethanol used in chromatographic analysis of APZ are recommended as safe organic solvents by the ICH Q3C guidelines. The method greenness profiles of developed and published methods were evaluated by national environmental method index (NEMI) and analytical greenness (AGREE) methods. The developed method was found to be safe and green for chromatographic analysis of APZ.

Highlights

Development of a green, robust, accurate, and precise stability-indicating HPTLC method for estimation of APZ. The quality risk management (QRM) and DoE-based analytical quality by design (AQbD) approach was implemented in support of the green analytical chemistry concept. Estimation of greenness profile of method by NEMI and AGREE methods.
Nutrient and Maillard reaction product concentrations of commercially available pet foods and treats
Authors: Oba Patrícia M , Hwisa Nagiat , Huang Xinhe , Cadwallader Keith R , Swanson Kelly S
Published: September 2022

Thermal processing is used to produce most commercial pet foods and treats to improve safety, shelf life, nutritional characteristics, texture, and nutrient digestibility. However, heat treatments can degrade protein quality by damaging essential amino acids, as well as contribute to the Maillard reaction. The Maillard reaction forms melanoidins that favorably improve food qualities (e.g., color, flavor, aroma), but also form Maillard reaction products (MRP) and advanced glycation end-products that may negatively affect health. Because commercial pet diets are frequently fed to domestic cats and dogs throughout their lifetimes, it is critical to quantify MRP concentrations and understand the variables that influence their formation so future diets may be formulated with that in mind. Because few research studies on MRP in pet diets have been conducted, the goals of this study were to measure the MRP in commercial pet foods and treats, estimate pet MRP intake, and correlate MRP with dietary macronutrient concentrations. Fifty-three dry and wet dog foods, dog treats, and cat foods were analyzed for dry matter, organic matter, crude protein, acid-hydrolyzed fat, total dietary fiber, and gross energy using standard techniques. MRP were analyzed using high-performance liquid chromatography and gas chromatography–mass spectrometry. Data were analyzed using the Mixed Models procedure of SAS 9.4. Dry foods had lower reactive lysine concentrations and reactive lysine: total lysine ratios (indicator of damage) than wet foods. Wet foods had more fructoselysine (FRUC) than dry foods; however, dry dog treats contained more FRUC than wet dog treats. The greatest 5-hydroxymethyl-2-furfural (HMF) concentrations were measured in dry and wet dog foods, whereas the lowest HMF concentrations were measured in dry and wet cat foods. Based on dietary concentrations and estimated food intakes, dogs and cats fed wet foods are more likely to consume higher carboxymethyllysine and FRUC concentrations than those fed dry foods. However, dogs fed wet foods are more likely to consume higher HMF concentrations than those fed dry foods. In cats, those fed dry foods would consume higher HMF concentrations than those fed wet foods. We demonstrated that pet foods and treats contain highly variable MRP concentrations and depend on diet/treat type. In general, higher MRP concentrations were measured in wet pet foods and dry treats. While these findings are valuable, in vivo testing is needed to determine if and how MRP consumption affect pet health.
Genome-Wide Identiﬁcation and Expression Proﬁling of theWntGene Family in Three Rice Planthoppers:Sogatella furcifera,Laodelphax striatellus, andNilaparvata lugens
Authors: Peng Lei , Zhao Yan
Published: September 2022

The Wnt gene family plays essential roles in regulating many developmental processes, including the maintenance of stem cells, cell division, and cell migration. The number of Wnt genes varies among species. Due to the diversity and importance of their functions, the Wnt gene family has gained extensive research interest in various animal species from invertebrates to vertebrates. However, knowledge of the Wnt gene family is limited in rice planthoppers. Three planthopper species, the white-backed planthopper (Sogatella furcifera Horvath), the small brown planthopper (Laodelphax striatellus Fallén) and the brown planthopper (Nilaparvata lugens Stål) (Hemiptera: Delphacidae), are devastating specialist pests of rice and cause serious damage to rice plants. To better study the evolution and function of the Wnt gene family in rice planthoppers, we identified 8 Wnt family genes in three rice planthoppers with both genomic and extensive transcriptomic resources available. We conducted a systematic analysis of the three kinds of rice planthoppers and analyzed the dynamic patterns of gene conservation, as well as Wnt gene loss and duplication. The expression profiles in different developmental stages of S. furcifera and different adult organs and tissues of L. striatellus provide preliminary functional implications for the Wnt genes in rice planthopper. This study presents the first genome-wide study of the Wnt gene family in rice planthoppers, and our findings provide insights into Wnt function and evolution in rice planthoppers.
Cloning and Functional Characterization of a Novel β-GRP Gene From Melanotus cribricollis
Authors: Ye Bihuan , Song Qiyan , Li Haibo , Shen Jianjun , Wu Chenyou , Shu Jinping , Zhang Yabo
Published: September 2022

In this study, a novel β-1,3-glucan recognition protein gene (β-GRP) was identified from Melanotus cribricollis, and its potential role in the immune response was investigated. The full length of β-GRP cDNA (Accession Number: MT941530) was 1644 bp, encoding a protein composed of 428 amino acids. The theoretical molecular weight and the isoelectric point were 51.53 kDa and 6.17, respectively. The amino acid sequence of β-GRP from M. cribricollis was closely related to that of. β-GRP-like from Photinus pyralis, and was predicted to contain conserved GH16 domain without glucanase active site. The results of real-time quantitative PCR showed that fungal infection of Metarhizium pingshaense may significantly upregulated the expression level of β-GRP gene. The RNAi suppression of β-GRP gene expression significantly increased the corrected cumulative mortality. Meanwhile, antimicrobial peptide genes defensin and lysozyme were significantly downregulated after interference of β-GRP. Taken together, these results suggest that β-GRP of M. cribricollis probably participates in the host immune system by mediating the expression of antimicrobial peptides. This study provides comprehensive insights into the innate immune system of insect larvae.
Rapid Evaporative Ionization Mass Spectrometry (REIMS): a Potential and Rapid Tool for the Identification of Insecticide Resistance in Mosquito Larvae
Authors: Morgan Jasmine , Salcedo-Sora J Enrique , Wagner Iris , Beynon Robert J , Triana-Chavez Omar , Strode Clare
Published: September 2022

Insecticide resistance is a significant challenge facing the successful control of mosquito vectors globally. Bioassays are currently the only method for phenotyping resistance. They require large numbers of mosquitoes for testing, the availability of a susceptible comparator strain, and often insectary facilities. This study aimed to trial the novel use of rapid evaporative ionization mass spectrometry (REIMS) for the identification of insecticide resistance in mosquitoes. No sample preparation is required for REIMS and analysis can be rapidly conducted within hours. Temephos resistant Aedes aegypti (Linnaeus) larvae from Cúcuta, Colombia and temephos susceptible larvae from two origins (Bello, Colombia, and the lab reference strain New Orleans) were analyzed using REIMS. We tested the ability of REIMS to differentiate three relevant variants: population source, lab versus field origin, and response to insecticide. The classification of these data was undertaken using linear discriminant analysis (LDA) and random forest. Classification models built using REIMS data were able to differentiate between Ae. aegypti larvae from different populations with 82% (±0.01) accuracy, between mosquitoes of field and lab origin with 89% (±0.01) accuracy and between susceptible and resistant larvae with 85% (±0.01) accuracy. LDA classifiers had higher efficiency than random forest with this data set. The high accuracy observed here identifies REIMS as a potential new tool for rapid identification of resistance in mosquitoes. We argue that REIMS and similar modern phenotyping alternatives should complement existing insecticide resistance management tools.
Revealing a trans-Planckian world solves the cosmological constant problem
Authors: Hamada Ken-ji
Published: September 2022

The Planck scale is usually believed to be an unpassable wall. Putting a cutoff there and thinking of it as a quantized spacetime entity shows that. However, this is exactly the cause of many problems in quantum gravity. The cosmological constant problem also comes down to the problem of how to describe a trans-Planckian world by a continuum theory that shall be renormalizable and background free. Here, we show that when quantizing gravity in a diffeomorphism-invariant method, in which background freedom arises asymptotically as an exact conformal symmetry, the zero-point energy vanishes identically. Thus, there is no problem with the cosmological constant, which is a physical constant, namely a renormalization group invariant. We also argue that new quanta based on the background freedom emerge and spacetime is discretized dynamically. Primordial fluctuations will originate from such quanta.
Product Innovation and Credit Market Disruptions
Authors: Granja João , Moreira Sara
Published: September 2022

We provide new evidence that disruptions in firms’ access to credit during the Global Financial Crisis significantly affected product innovation in the consumer goods sector. We combine highly granular retail scan data with lending data and find that credit-constrained firms introduced fewer new products, those products were less novel, and new products sold less well. Overall, these findings suggest that disruptions to credit markets impair firms’ ability to compete for profits through new product offerings.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Role of Plasma Membrane Dicarboxylate Transporters in the Uptake and Toxicity of Diglycolic Acid, a Metabolite of Diethylene Glycol, in Human Proximal Tubule Cells
Authors: Tobin Julie D , Robinson Corie N , Luttrell-Williams Elliot S , Landry Greg M , Dwyer Donard , McMartin Kenneth E
Published: September 2022

Diethylene glycol (DEG) mass poisonings have resulted from ingestion of pharmaceuticals mistakenly adulterated with DEG, typically leading to proximal tubular necrosis and acute kidney injury. The metabolite, diglycolic acid (DGA) accumulates greatly in kidney tissue and its direct administration results in toxicity identical to that in DEG-treated rats. DGA is a dicarboxylic acid, similar in structure to metabolites like succinate. These studies have assessed the mechanism for cellular accumulation of DGA, specifically whether DGA is taken into primary cultures of human proximal tubule (HPT) cells via sodium dicarboxylate transporters (NaDC-1 or NaDC-3) like those responsible for succinate uptake. When HPT cells were cultured on membrane inserts, sodium-dependent succinate uptake was observed from both apical and basolateral directions. Pretreatment with the NaDC-1 inhibitor N-(p-amylcinnamoyl)anthranilic acid (ACA) markedly reduced apical uptakes of both succinate and DGA. Basolateral uptake of both succinate and DGA were decreased similarly following combined treatment with ACA and the NaDC-3 inhibitor 2,3-dimethylsuccinate. When the cells were pretreated with siRNA to knockdown NaDC-1 function, apical uptake of succinate and toxicity of apically applied DGA were reduced, while the reduction in basolateral succinate uptake and basolateral DGA toxicity was marginal with NaDC-3 knockdown. DGA reduced apical uptake of succinate but not basolateral uptake. This study confirmed that primary HPT cells retain sodium dicarboxylate transport functionality and that DGA was taken up by these transporters. This study identified NaDC-1 as a likely and NaDC-3 as a possible molecular target to reduce uptake of this toxic metabolite by the kidney.
Will This Treatment Help My Child?
Authors: Nelson Sarah , Smith Allison M. , Jervis Kelsey , Silvia Megan N. , Randall Edin
Published: September 2022

Objective:

An extensive body of research has highlighted the impact that parent/caregiver factors have on functioning and treatment outcomes among youth with chronic pain. However, parent/caregiver expectations in pain treatment have been largely understudied, despite strong evidence that treatment expectations are associated with treatment engagement and overall outcomes in nonpain populations. Accordingly, the primary aim of this investigation was to preliminarily examine the manifestation and measurement of parent/caregiver treatment expectations in an intensive interdisciplinary pediatric pain treatment (IIPT) setting.

Methods:

Participants in this study (N=328) included children and adolescents who attended an IIPT program for chronic pain between August 2013 and March 2020 and their parent/caregiver(s). Outcomes examined include parent/caregiver self-report of treatment expectations for their child upon admission to the IIPT in addition to pain-related and psychosocial factors at admission and discharge.

Results:

Findings revealed a high level of expectations (ie, belief that the treatment will be helpful) on average, with higher parent/caregiver expectations associated with poorer functioning at admission to and discharge from the IIPT program.

Conclusion:

Extremely high treatment expectations among parents of more disabled youth may be indicative of unrealistic hopes or the “need” for IIPT to help their child; tempering parental expectations with psychoeducation about IIPT goals and realistic outcomes may indirectly improve treatment outcomes for their children. Future research should examine the potentially unique and important role that treatment expectations, of both parent/caregivers and their children, may have in overall IIPT outcomes.
Urine Drug Screening for Isolated Marijuana Use in Labor and Delivery Units
Authors: Rubin Alexandra , Zhong Lydia , Nacke Lauren , Woolfolk Candice , Raghuraman Nandini , Carter Ebony , Kelly Jeannie
Published: September 2022

Isolated marijuana use is frequently used as an indication for urine drug screening in labor and delivery units. We aimed to identify the results of urine drug screening in a labor and delivery unit for isolated marijuana use. This retrospective cohort study reviewed data from patients admitted for delivery at an urban academic center from January 1, 2020, to December 31, 2020. Patients undergoing urine drug screening for isolated marijuana use were more likely to be younger (median age 25 vs 29 years, P<.001), more often Black (adjusted odds ratio [aOR] 2.58, 95% CI 1.94–3.41), and more likely to have public insurance (aOR 1.54, 95% CI 1.21–1.95). A few (5/338, 1.5%) urine drug screening tests performed for isolated marijuana use were positive for substances besides marijuana. Most patients (177/197, 89.8%) with a urine drug screening test result that was positive for marijuana were reported to the state child abuse hotline. The utility of isolated marijuana use as a criterion for urine drug screening thus appears limited in benefit but rife with inequitable potential to harm.
Outpatient Compared With Inpatient Preinduction Cervical Ripening Using a Synthetic Osmotic Dilator
Authors: Saad Antonio F. , Gavara Rachana , Senguttuvan Rosemary Noel , Goncharov Arena D. , Berry Marissa , Eid Joe , Goldman Brett , Nutter Ana , Moutos Christopher P. , Wang Amanda M. , Saade George R.
Published: September 2022

OBJECTIVE:

To assess whether outpatient cervical ripening with a synthetic osmotic dilator shortens the length of hospital stay in term pregnancies undergoing labor induction.

METHODS:

Pregnant participants scheduled for labor induction at term with unfavorable cervix (less than 3-cm dilated and less than 60% effaced) and not requiring inpatient maternal or fetal monitoring were consented, and synthetic osmotic dilator rods were inserted on the day of scheduled induction. After reassuring fetal heart tracing, patients randomized to the outpatient group were asked to return 12 hours after insertion or sooner if needed. Those randomized to the inpatient group remained in the hospital. After the first round of ripening, additional ripening, oxytocin, and labor management were left up to the clinical health care professionals. The primary outcome was the proportion of participants with hospital stays longer than 48 hours. We estimated that a sample size of 338 would provide 85% power to detect a 30% difference between groups.

RESULTS:

From November 2018 to November 2021, 339 participants were randomized (171 inpatient, 167 outpatient, one withdrawal). Four patients in the outpatient group were admitted before12 hours for suspected labor and rupture of membranes, and 19 in the inpatient group had the device removed before 12 hours. The proportion of participants with hospital stays longer than 48 hours was lower in the outpatient group compared with the inpatient group (89 [53%] vs 152 [89%], relative risk [RR] 0.60, 95% CI 0.52–0.70). Patients in the outpatient group had a shorter total length of stay and time from admission to active labor. They were more likely to have a vaginal delivery within 24 hours of admission and were less likely to receive analgesics during ripening. Route of delivery and other maternal and neonatal outcomes were not significantly different between groups.

CONCLUSION:

Outpatient cervical ripening with a cervical osmotic dilator decreased hospital stay compared with inpatient ripening, without significant adverse outcomes.

FUNDING SOURCE:

Medicem Technology s.r.o., Czech Republic.

CLINICAL TRIAL REGISTRATION:

ClinicalTrials.gov, NCT03665688.
Insights into molecular and clinical characteristics of very early systemic sclerosis
Authors: Bellando-Randone Silvia , Del Galdo Francesco , Matucci-Cerinic Marco
Published: September 2022

Purpose of review

The early heterogenous presentation of systemic sclerosis (SSc), in particular without skin involvement, has been a confounding factor delaying early diagnosis. In fact, early signs of SSc as Raynaud's phenomenon and puffy fingers, are also typical of other connective tissue diseases (CTDs) such as mixed CTD and undifferentiated CTD. In the last decade, a significant effort has been dedicated in defining molecular characteristics that could be used as early SSc biomarkers. In this narrative review, we address the present situation where several clinical scenarios are in search of a correct positioning into the prescleroderma (pre-SSc) phase as well as in the very early phase of SSc.

Recent findings

Literature data showed that a part of patients classified as sine scleroderma SSc (ssSSc), mixed CTD and undifferentiated CTD may already belong to the very early phase of SSc, thus having a different pattern of progression to SSc. Recently, the very early diagnosis of systemic sclerosis (VEDOSS) criteria has been validated.

while the area of pre-SSc still remains fuzzy, the VEDOSS study has shown that a ‘window of opportunity’ does exist also for SSc. In the very next future, this may allow to start the treatment to prevent the disease progression to a more advanced fibrotic stage.
Biomarkers of disease activity in dermatomyositis
Authors: Lu Xin , Peng Qinglin , Wang Guochun
Published: September 2022

Purpose of review

This review provides updates regarding biomarker studies that address key clinical unmet needs, which relate to the evaluation of the disease activity in patients with dermatomyositis.

Recent findings

Increasing evidence supports that the serum levels of dermatomyositis-specific antibodies (DM-MSAs), which include anti-Mi-2, anti-NXP2, anti-MDA5, anti-TNF1-γ, and anti-SAE, are correlated with the disease activity. Moreover, serial measurements of DM-MSA levels may help to predict the disease status. Beyond the MSA, macrophage activation-related biomarker-soluble CD163, CD206, neopterin, and galectin-3/9 are the most currently talked biomarkers for disease activity in dermatomyositis; new circulating T-cell subsets CD4+CXCR5+CCR7loPD-1hi and TIGIT+CD226+ CD4 T cells can potentially harbor biomarkers of disease activity in dermatomyositis. In addition, LDGs and NETs were also shown to be correlated with the disease activities of dermatomyositis.

Promising candidate biomarkers are now available for evaluating disease activity in dermatomyositis. These biomarkers need external validation in other large cohort studies.
Motorized Plate Lengthening of the Femur in Children: A Preliminary Report
Authors: Georgiadis Andrew G. , Gannon Nicholas P. , Dahl Mark T.
Published: September 2022

Background:

Limb lengthening by distraction osteogenesis can be performed with motorized internal devices, but intramedullary implants risk avascular necrosis of the femoral head in young children. A method of internal limb lengthening using a motorized expandable plate has been developed and preliminary results are presented.

Methods:

Seven skeletally immature patients (ages 2.7 to 9.7 y) with congenital femoral deficiencies underwent femoral lengthening with the use of a magnetic expandable plate. Surgical details, lengthening parameters, Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion index, and complications were reviewed and classified according to the modified Clavien-Dindo system.

Results:

An average lengthening was 4.1 cm (range, 3.3 to 4.4 cm) comprising 18% of initial femoral segment length (range, 14% to 21%). The average lengthening phase was 50.2 days (range, 40 to 57 d) and weight-bearing was initiated at an average of 13 weeks from surgery (range, 8 to 18 wk). Limb deformities and length discrepancies were of moderate complexity, with an Limb Lengthening and Reconstruction Society-Angular deformity, Infection, Motion score of 6.57 (range, 6 to 7). Complication rates were comparable to previously reported methods of femoral lengthening. One patient underwent reoperation for patellar instability and 1 patient experienced radiographic hip subluxation which was observed. Small magnitude varus was observed in regenerate in 3 of 7 cases, none requiring treatment. Preoperative planning consisted of careful localization of the corticotomy site, acute deformity correction at the lengthening site in 3 cases, and implant orientation.

Conclusions:

Limb lengthening with motorized internal plates is feasible for young children with congenital femoral deficiency for whom intramedullary lengthening is unsafe or if external fixation is to be avoided. However, the fundamental principles of distraction osteogenesis and risks of lengthening for congenital discrepancies remain unchanged. Specific considerations herein include: careful planning of implant length and positioning, adjacent joint protection with adjunctive means, and mitigating deformity of the regenerate during distraction.

Level of Evidence:

Level IV, retrospective case series.
Operative Versus Nonoperative Management of Unstable Spine Fractures in the Elderly: Outcomes and Mortality
Authors: Malacon Karen , Rangwalla Taiyeb , Wadhwa Harsh , Zygourakis Corinna
Published: September 2022

Study Design.

Retrospective cohort study

Objective.

To assess outcomes and mortality in elderly patients following unstable spine fractures depending on treatment modality.

Summary of Background Data.

Operative management of unstable spine fractures in the elderly remains controversial due to increased risk of perioperative complications. Mortality rates after operative versus nonoperative treatment of these injuries have not been well-characterized.

Methods.

Patients age >65 with unstable spine fractures without neurologic injury from 2015-2021 were identified from the Clinformatics® Data Mart (CDM) Database. Demographics, complications, and mortality were collected. Multivariable logistic regression was used to adjust for the effect of baseline characteristics on mortality following unstable fracture diagnosis.

Results.

Of 3,688 patients included, 1,330 (36.1%) underwent operative management and 2,358 (63.9%) nonoperative. At baseline, nonoperative patients were older, female, had higher Elixhauser comorbidity scores, and were more likely to have a cervical fracture. Operative patients had a longer length of stay in the hospital compared to nonoperative patients (9.7 vs. 7.7 d; P<0.001). Although patients in the operative group had higher rates of readmission at 30-, 60-, 90-, and 120-days after diagnosis (P<0.01), they had lower mortality rates up to 5 years after injury. After adjusting for covariates, nonoperative patients had a 60% greater risk of mortality compared to operative patients (HR: 1.60 [1.40-1.78], P<0.001). After propensity score matching, operative patients age 65-85 had greater survivorship compared to their nonoperative counterparts.

Conclusion.

Elderly patients with an unstable spine fracture who undergo surgery experience lower mortality rates up to five years post diagnosis compared to patients who received nonoperative management, despite higher hospital readmission rates and an overall perioperative complication rate of 37.3%. Operating on elderly patients with unstable spine fractures may outweigh the risks and should be considered as a viable treatment option in appropriately selected patients.
Biomechanics of Transforaminal Endoscopic Approaches
Authors: Farshad Mazda , Hagel Vincent , Spirig José Miguel , Fasser Marie-Rosa , Burkhard Marco Dimitri , Widmer Jonas , Calek Anna-Katharina
Published: September 2022

Study Design.

Biomechanical cadaveric study.

Objective.

The aim of this study was to compare the effect of transforaminal endoscopic approaches with open decompression procedures.

Summary.of Background Data.

Clinical studies have repeatedly highlighted the benefits of endoscopic decompression, however, the biomechanical effects of endoscopic approaches (with and without injury to the disc) have not been studied up to now.

Methods.

Twelve spinal segments originating from four fresh frozen cadavers were biomechanically tested in a load-controlled endoscopic transforaminal approach study. Segmental range of motion (ROM) after endoscopic approach was compared with segmental ROM after (1) microsurgical decompression with unilateral laminotomy and (2) midline decompression with bilateral laminotomy. In the intact state and after decompression, the segments were loaded in flexion-extension (FE), lateral shear (LS), lateral bending (LB), anterior shear (AS) and axial rotation (AR).

Results.

Vertebral segment ROM was comparable between the two endoscopic transforaminal approaches. However, there was a – statistically non-significant – trend for a larger ROM after accessing via the inside-out technique: FE:+3% versus+7%, P=0.484; LS:+1% versus+12%, P=0.18; LB:+0.6% versus+9%, P=0.18; AS:+2% versus+11%, P=0.31; AR: −4% versus+5%, P=0.18. No significant difference in vertebral segment ROM was seen between the transforaminal endoscopic approaches and open unilateral decompression. Vertebral segment ROM was significantly smaller with the transforaminal endoscopic approaches compared to midline decompression for almost all loading scenarios: FE:+4% versus+17%, P=0.005; AS:+6% versus 21%, P=0.007; AR: 0% versus+24%, P=0.002.

Conclusion.

Biomechanically, the transforaminal endoscopic intracanal technique preserves the native range of motion of lumbar vertebral segments and shows a trend towards biomechanically superiority to the inside-out technique and open decompression procedures.
Effectiveness of Lumbosacral Orthosis after Discectomy for Lumbar Disc Herniation: A Prospective Comparative Study
Authors: Sakaki Kyohei , Yoshii Toshitaka , Arai Yoshiyasu , Torigoe Ichiro , Tomori Masaki , Onuma Hiroaki , Ogawa Takahisa , Hirakawa Akihiro , Sakai Kenichiro , Okawa Atsushi
Published: September 2022

Study Design.

Prospective comparative study.

Objective.

To investigate the benefits of postoperative application of lumbosacral orthosis after single-level discectomy for lumbar disc herniation (LDH).

Summary of Background Data.

Although many surgeons use postoperative lumbosacral orthosis for patients with LDH, there is no clear evidence to support or deny its effectiveness.

Methods.

Ninety-nine consecutive patients who underwent the microscopic discectomy were included. They were divided into two groups: Orthosis group and Non-orthosis group, before surgery. The recurrence rate and reoperation rate were compared between the two groups at 4-week, 6-month and 1-year follow-up. Japanese Orthopaedic Association Score for lumbar spine (L-JOA score) at 2-week and 1-year follow-up, lower extremities and low back pain’s visual analog scale (VAS) and Oswestry Disability Index (ODI) at 6-month and 1-year follow-up were compared.

Results.

Forty-two patients in the Orthosis group and 39patients in the Non-orthosis group were followed up for at least 1-year after surgery. Recurrence occurred in 3 patients (7.1%) in the Orthosis group and 6 (15.4%) in the Non-orthosis group within 1-year. Two patients (4.8%) in the Orthosis group and 2 patients (5.1%) in the Non-orthosis group underwent reoperation. There were no significant intergroup differences in the recurrence rate and in the reoperation rate. No significant difference was also observed between the two groups in L-JOA score, ODI, VAS of low back pain, and leg pain at 1-year after surgery. Furthermore, at any other follow-up period, no significant differences were observed between the two groups in recurrence rate, reoperation rate, L-JOA score, VAS of low back/leg pain, or ODI.

Conclusions.

Postoperative orthosis did not reduce the recurrence/ reoperation rates, nor improve postoperative clinical symptoms. Routine use of orthosis may not be necessary after single-level lumbar discectomy.
Risk of Bleeding Among Individuals on Direct-Acting Oral Anticoagulants: An Academic Medical Center Cohort Study
Authors: Gomez Lumbreras Ainhoa , Tan Malinda S. , Moorman-Bishir Krystal , Ilham Sabrina , Malone Daniel C.
Published: September 2022

Previous research has identified risk factors that may affect the risk of bleeding when individuals are exposed to oral anticoagulants. It is unclear if the risk continues to exist with the direct oral anticoagulants (DOACs). The purpose of this study was to assess the risk of bleeding in patients on DOACs (apixaban, rivaroxaban, dabigatran, edoxaban, and betrixaban) based on known risk factors including demographics, medical conditions, and concomitant medications. This study was a retrospective analysis using electronic health record data from the University of Utah Hospital (Division of Cardiovascular Medicine) of individuals receiving a DOAC from 2015 to 2020. The primary outcome of interest was bleeding events [gastrointestinal (GI) bleeding, other anatomical site bleeding (excluding GI), and any bleeding] recorded in the electronic health record that codes using International Classification of Diseases 9th and 10th codes. Known risk factors were used to predict bleeding using multivariate logistic regression. A total of 5492 patients received a DOAC during the study period. Less than half the study population were female (2287, 41.6%). During the follow-up, there were 988 patients (18.0%) experiencing a bleeding event. Of them, 351 patients (35.5%) had a GI bleeding event. Significant risk factors of GI bleeding included clopidogrel [odds ratio (OR) 1.71; 95% confidence interval (95% CI), 1.16–2.52] and previous GI bleeding episodes (OR 7.73; 95% CI, 5.36–11.16). Exposure to corticosteroids (OR 1.50; 95% CI, 1.20–1.87) and previous GI bleeding (OR 1.61; 95% CI, 1.10–2.35) were associated with an increase in bleeding at other anatomical sites (not GI included).