bluuebunny/crossref_metadata_2025 huggingface dataset:
Thermodynamics of the hydrothermal synthesis of xonotlite
Authors: Liu Wei , Liu Chaorong , Huang Liangliang , Liu Chang , Jiang Juan
Published: June 2023

Xonotlite, as a multifunctional inorganic material, has been widely used in the fields of building insulation, friction braking, and bionic composite materials. However, the main method of producing xonotlite, the dynamic hydrothermal method, is regarded as a black box process. Optimization of synthesis conditions can only be achieved through trial-and-error experimentations, and there are inconsistencies in the experimental results reported in the literature. In this work, we established a thermodynamic model of the Ca(OH)2-SiO2-H2O system under hydrothermal conditions, and investigated influencing factors of the xonotlite synthesis. The results show that, the predicted lowest temperature of xonotlite synthesis is approximately 170 °C. Furthermore, an optimum condition to synthesis xonotlite with a purity of 99% is proposed as follows: reaction temperature, 200 °C; Ca/Si ratio, 0.9–1.0; water-solid ratio, no more than 20; pH, 7–8. This new synthesis process has been confirmed by experiments.
Climate change projections from a multi-model ensemble of CORDEX and CMIPs over Angola
Authors: Pinto Izidine , de Perez Erin Coughlan , Jaime Catalina , Wolski Piotr , van Aardenne Lisa , Jjemba Eddie , Suidman Jasmijn , Serrat-Capdevila Aleix , Tall Arame
Published: June 2023

Angola has been characterized as one of the most vulnerable regions to climate change. Climate change compounded by existing poverty, a legacy of conflict and other risk factors, currently impede development and are expected to become worse as climate change impacts increase. In this study we analyze the signal of climate change on temperature and rainfall variables for two time periods, 2020–2040 and 2040–2060. The analysis is based on multi-model ensemble of the Coupled Model Intercomparison Projects (CMIP5 and CMIP6) and the Coordinated Regional Downscaling Experiments (CORDEX). Our findings from the observed dataset indicate that the mean annual temperature over Angola has risen by an average of 1.4 °C since 1951, with a warming rate of approximately 0.2 [0.14–0.25] °C per decade. However, the rainfall pattern appears to be primarily influenced by natural variability. Projections of extreme temperature show an increase with the coldest nights projected to become warmer and the hottest days hotter. Rainfall projections suggest a change in the nature of the rainy season with increases in heavy precipitation events in the future. We investigated how droughts might change in all river basins of Angola, and we found an increased uncertainty about drought in the future. The changes in climate and increased variability demonstrate the need for adaptation measures that focuses on reducing risks in key sectors with a particular focus on adaptation of cities in Angola given a potential increase in mobility towards urban areas.
Subfascial/Intramuscular Dual-Plane Gluteal Implantation and Supplemental Fat Grafting: A Novel Technique for Buttock Augmentation
Authors: Morales Rolando , Mentz James , Hallman Taylor G , Castillo Chase
Published: June 2023

Background

Much debate exists within the current literature as to which plane is safest and most effective for gluteal implant buttock augmentation. A novel subfascial/intramuscular (SF/IM) dual-plane technique appears to combine the benefits of each plane.

Objectives

The aim of this study was to describe our experience with SF/IM plane gluteal implantation, and to discuss its indications, efficacy, and safety, and offer recommendations on its proper use.

Methods

A retrospective chart review was conducted of 175 consecutive cases of gluteal augmentation with solid silicone implants in the SF/IM pocket, with and without supplemental autologous fat transfer. Outcomes from all patients were analyzed to determine the rate of complication and need for surgical revision.

Results

In 175 cases of bilateral buttock augmentation with gluteal implantation using the SF/IM pocket, the most common complication was infection. This complication was seen in 13 cases (7.43%), 7 (4%) of which were superficial and did not require surgical intervention. Other complications included dehiscence, seroma, capsular contracture, and implant migration.

Conclusions

The SF/IM gluteal implantation, in combination with liposculpture and autologous fat transfer into the overlaying subcutaneous space, allows for a durable cosmetic augmentation of the buttocks in patients lacking sufficient volume for augmentation with fat transfer alone. This technique was found to have complication rates similar to those of other established augmentation techniques, as well the cosmetic advantages of a large, stable pocket with thick, soft tissue coverage of the inferior pole.
Athena: Specialty Certificate Examination case for infectious disease
Authors: Hammond Alexander M , Chung Michael , Motaparthi Kiran , Saikaly Sami K
Published: June 2023

A 63-year-old man presented with an extensive pruritic and painful rash on his arm that had gradually progressed over 8 years after pricking his wrist on a bush, despite treatment with antifungals and antibiotics. Physical examination showed numerous erythematous, coalescing verrucous plaques in a sporotrichoid distribution on the arm with crust and scale. We discuss further tests, diagnosis and treatment.
Objects sharpen visual scene representations: evidence from MEG decoding
Authors: Brandman Talia , Peelen Marius V
Published: June 2023

Real-world scenes consist of objects, defined by local information, and scene background, defined by global information. Although objects and scenes are processed in separate pathways in visual cortex, their processing interacts. Specifically, previous studies have shown that scene context makes blurry objects look sharper, an effect that can be observed as a sharpening of object representations in visual cortex from around 300 ms after stimulus onset. Here, we use MEG to show that objects can also sharpen scene representations, with the same temporal profile. Photographs of indoor (closed) and outdoor (open) scenes were blurred such that they were difficult to categorize on their own but easily disambiguated by the inclusion of an object. Classifiers were trained to distinguish MEG response patterns to intact indoor and outdoor scenes, presented in an independent run, and tested on degraded scenes in the main experiment. Results revealed better decoding of scenes with objects than scenes alone and objects alone from 300 ms after stimulus onset. This effect was strongest over left posterior sensors. These findings show that the influence of objects on scene representations occurs at similar latencies as the influence of scenes on object representations, in line with a common predictive processing mechanism.
Paediatric aortic valve replacement: a meta-analysis and microsimulation study
Authors: Notenboom Maximiliaan L , Schuermans Art , Etnel Jonathan R G , Veen Kevin M , van de Woestijne Pieter C , Rega Filip R , Helbing Willem A , Bogers Ad J J C , Takkenberg Johanna J M
Published: June 2023

Aims

To support decision-making in children undergoing aortic valve replacement (AVR), by providing a comprehensive overview of published outcomes after paediatric AVR, and microsimulation-based age-specific estimates of outcome with different valve substitutes.

Methods and results

A systematic review of published literature reporting clinical outcome after paediatric AVR (mean age <18 years) published between 1/1/1990 and 11/08/2021 was conducted. Publications reporting outcome after paediatric Ross procedure, mechanical AVR (mAVR), homograft AVR (hAVR), and/or bioprosthetic AVR were considered for inclusion. Early risks (<30d), late event rates (>30d) and time-to-event data were pooled and entered into a microsimulation model. Sixty-eight studies, of which one prospective and 67 retrospective cohort studies, were included, encompassing a total of 5259 patients (37 435 patient-years; median follow-up: 5.9 years; range 1–21 years). Pooled mean age for the Ross procedure, mAVR, and hAVR was 9.2 ± 5.6, 13.0 ± 3.4, and 8.4 ± 5.4 years, respectively. Pooled early mortality for the Ross procedure, mAVR, and hAVR was 3.7% (95% CI, 3.0%–4.7%), 7.0% (5.1%–9.6%), and 10.6% (6.6%–17.0%), respectively, and late mortality rate was 0.5%/year (0.4%–0.7%/year), 1.0%/year (0.6%–1.5%/year), and 1.4%/year (0.8%–2.5%/year), respectively. Microsimulation-based mean life-expectancy in the first 20 years was 18.9 years (18.6–19.1 years) after Ross (relative life-expectancy: 94.8%) and 17.0 years (16.5–17.6 years) after mAVR (relative life-expectancy: 86.3%). Microsimulation-based 20-year risk of aortic valve reintervention was 42.0% (95% CI: 39.6%–44.6%) after Ross and 17.8% (95% CI: 17.0%–19.4%) after mAVR.

Conclusion

Results of paediatric AVR are currently suboptimal with substantial mortality especially in the very young with considerable reintervention hazards for all valve substitutes, but the Ross procedure provides a survival benefit over mAVR. Pros and cons of substitutes should be carefully weighed during paediatric valve selection.
Beneficial effects of chronic mexiletine treatment in a human model of SCN5A overlap syndrome
Authors: Nasilli Giovanna , Yiangou Loukia , Palandri Chiara , Cerbai Elisabetta , Davis Richard P , Verkerk Arie O , Casini Simona , Remme Carol Ann
Published: June 2023

Aims

SCN5A mutations are associated with various cardiac phenotypes, including long QT syndrome type 3 (LQT3), Brugada syndrome (BrS), and cardiac conduction disease (CCD). Certain mutations, such as SCN5A-1795insD, lead to an overlap syndrome, with patients exhibiting both features of BrS/CCD [decreased sodium current (INa)] and LQT3 (increased late INa). The sodium channel blocker mexiletine may acutely decrease LQT3-associated late INa and chronically increase peak INa associated with SCN5A loss-of-function mutations. However, most studies have so far employed heterologous expression systems and high mexiletine concentrations. We here investigated the effects of a therapeutic dose of mexiletine on the mixed phenotype associated with the SCN5A-1795insD mutation in HEK293A cells and human-induced pluripotent stem cell–derived cardiomyocytes (hiPSC-CMs).

Methods and results

To assess only the chronic effects on trafficking, HEK293A cells transfected with wild-type (WT) SCN5A or SCN5A-1795insD were incubated for 48 h with 10 µm mexiletine followed by wash-out, which resulted in an increased peak INa for both SCN5A-WT and SCN5A-1795insD and an increased late INa for SCN5A-1795insD. Acute re-exposure of HEK293A cells to 10 µm mexiletine did not impact on peak INa but significantly decreased SCN5A-1795insD late INa. Chronic incubation of SCN5A-1795insD hiPSC-CMs with mexiletine followed by wash-out increased peak INa, action potential (AP) upstroke velocity, and AP duration. Acute re-exposure did not impact on peak INa or AP upstroke velocity, but significantly decreased AP duration.

Conclusion

These findings demonstrate for the first time the therapeutic benefit of mexiletine in a human cardiomyocyte model of SCN5A overlap syndrome.
Electrocardiographic parameters and the risk of new-onset atrial fibrillation in the general population: the Rotterdam Study
Authors: Geurts Sven , Tilly Martijn J , Kors Jan A , Deckers Jaap W , Stricker Bruno H C , de Groot Natasja M S , Ikram M Arfan , Kavousi Maryam
Published: June 2023

Aims

We aimed to assess the (shape of the) association and sex differences in the link between electrocardiographic parameters and new-onset atrial fibrillation (AF).

Methods and results

A total of 12 212 participants free of AF at baseline from the population-based Rotterdam Study were included. Up to five repeated measurements of electrocardiographic parameters including PR, QRS, QT, QT corrected for heart rate (QTc), JT, RR interval, and heart rate were assessed at baseline and follow-up examinations. Cox proportional hazards- and joint models, adjusted for cardiovascular risk factors, were used to determine the (shape of the) association between baseline and longitudinal electrocardiographic parameters with new-onset AF. Additionally, we evaluated potential sex differences. During a median follow-up of 9.3 years, 1282 incident AF cases occurred among 12 212 participants (mean age 64.9 years, 58.2% women). Penalized cubic splines revealed that associations between baseline electrocardiographic measures and risk of new-onset AF were generally U- and N-shaped. Sex differences in terms of the shape of the various associations were most apparent for baseline PR, QT, QTc, RR interval, and heart rate in relation to new-onset AF. Longitudinal measures of higher PR interval [fully adjusted hazard ratio (HR), 95% confidence interval (CI), 1.43, 1.02–2.04, P = 0.0393] and higher QTc interval (fully adjusted HR, 95% CI, 5.23, 2.18–12.45, P = 0.0002) were significantly associated with new-onset AF, in particular in men

Conclusion

Associations of baseline electrocardiographic measures and risk of new-onset AF were mostly U- and N-shaped. Longitudinal electrocardiographic measures of PR and QTc interval were significantly associated with new-onset AF, in particular among men.
Classification of missense variants in the N-methyl-d-aspartate receptor GRIN gene family as gain- or loss-of-function
Authors: Myers Scott J , Yuan Hongjie , Perszyk Riley E , Zhang Jing , Kim Sukhan , Nocilla Kelsey A , Allen James P , Bain Jennifer M , Lemke Johannes R , Lal Dennis , Benke Timothy A , Traynelis Stephen F
Published: June 2023

Advances in sequencing technology have generated a large amount of genetic data from patients with neurological conditions. These data have provided diagnosis of many rare diseases, including a number of pathogenic de novo missense variants in GRIN genes encoding N-methyl-d-aspartate receptors (NMDARs). To understand the ramifications for neurons and brain circuits affected by rare patient variants, functional analysis of the variant receptor is necessary in model systems. For NMDARs, this functional analysis needs to assess multiple properties in order to understand how variants could impact receptor function in neurons. One can then use these data to determine whether the overall actions will increase or decrease NMDAR-mediated charge transfer. Here, we describe an analytical and comprehensive framework by which to categorize GRIN variants as either gain-of-function (GoF) or loss-of-function (LoF) and apply this approach to GRIN2B variants identified in patients and the general population. This framework draws on results from six different assays that assess the impact of the variant on NMDAR sensitivity to agonists and endogenous modulators, trafficking to the plasma membrane, response time course and channel open probability. We propose to integrate data from multiple in vitro assays to arrive at a variant classification, and suggest threshold levels that guide confidence. The data supporting GoF and LoF determination are essential to assessing pathogenicity and patient stratification for clinical trials as personalized pharmacological and genetic agents that can enhance or reduce receptor function are advanced. This approach to functional variant classification can generalize to other disorders associated with missense variants.
CRISPR single base-editing: in silico predictions to variant clonal cell lines
Authors: Dickson Kristie-Ann , Field Natisha , Blackman Tiane , Ma Yue , Xie Tao , Kurangil Ecem , Idrees Sobia , Rathnayake Senani N H , Mahbub Rashad M , Faiz Alen , Marsh Deborah J
Published: June 2023

Engineering single base edits using CRISPR technology including specific deaminases and single-guide RNA (sgRNA) is a rapidly evolving field. Different types of base edits can be constructed, with cytidine base editors (CBEs) facilitating transition of C-to-T variants, adenine base editors (ABEs) enabling transition of A-to-G variants, C-to-G transversion base editors (CGBEs) and recently adenine transversion editors (AYBE) that create A-to-C and A-to-T variants. The base-editing machine learning algorithm BE-Hive predicts which sgRNA and base editor combinations have the strongest likelihood of achieving desired base edits. We have used BE-Hive and TP53 mutation data from The Cancer Genome Atlas (TCGA) ovarian cancer cohort to predict which mutations can be engineered, or reverted to wild-type (WT) sequence, using CBEs, ABEs or CGBEs. We have developed and automated a ranking system to assist in selecting optimally designed sgRNA that considers the presence of a suitable protospacer adjacent motif (PAM), the frequency of predicted bystander edits, editing efficiency and target base change. We have generated single constructs containing ABE or CBE editing machinery, an sgRNA cloning backbone and an enhanced green fluorescent protein tag (EGFP), removing the need for co-transfection of multiple plasmids. We have tested our ranking system and new plasmid constructs to engineer the p53 mutants Y220C, R282W and R248Q into WT p53 cells and shown that these mutants cannot activate four p53 target genes, mimicking the behaviour of endogenous p53 mutations. This field will continue to rapidly progress, requiring new strategies such as we propose to ensure desired base-editing outcomes.
Dealing With the Past for a Peaceful Future? Analysing the Effect of Transitional Justice Instruments on Trust in Postconflict Societies
Authors: Fiedler Charlotte , Mross Karina
Published: June 2023

Can dealing with a history of violent conflict through transitional justice help to rebuild social trust? Addressing three gaps in the current literature, we (1) analyse the effect of transitional justice on social trust, thereby going beyond the predominant focus on renewed violence; (2) use novel, handcoded data to take donor support for transitional justice into account, a relevant but mostly overlooked factor; and (3) systematically investigate the combined effect of transitional justice instruments using qualitative comparative analysis. The analysis covers 24 cases in 19 postconflict countries over the period 1990–2010. Our results indicate that transitional justice needs to go beyond a narrow focus on victims or perpetrators to foster trust in postconflict societies. We find that combining victim restitution with amnesties or taking a broader, societal approach by focusing on truth-finding or bridge-building activities can increase trust. Moreover, international transitional justice support can play an important role in fostering trust, even in the absence of major national transitional justice processes.
Toward a Better Understanding of Medieval Temple Food Practices: The View from Srirangam
Authors: Gutiérrez Andrea
Published: June 2023

Vaishnava food offerings provide abundant evidence for material studies on both historical and modern-day ritual practice. The medieval Chola (9th–13th centuries) record of donative inscriptions offers us a wealth of details on the food cooked as naivedya or holy food offerings for temple deities. I present a range of ideas on material temple food and related food practices as gleaned from Tamil epigraphy and other Sanskrit sources, especially utilising evidence from the Srirangam temple dedicated to the reclining Vishnu, a main site of Vaishnava devotion. This article is a scholarly intervention on some key phenomena often misunderstood when considering South Indian food: controversies surrounding eating naivedya and food offerings, historical developments leading to the practice of eating temple prasad, the true ‘sambhar’ offered in Hindu temples, who cooked temple food, and where this happened. All aspects shed light on our understanding of Hindu religious practices involving food.
Beach volleyball and Cutaneous Larva Migrans
Authors: Kuna Anna , Olszański Romuald , Wroczyńska Agnieszka , Biernat Beata , Sikorska Katarzyna
Published: June 2023

Cutaneous larva migrans can affect even athletes who travelled to play beach volleyball in Zanzibar. We describe a cluster of CLM infections in travellers who contracted the disease during their trip to Africa, rather than bringing a volleyball trophy. Despite presenting typical changes, all of them were misdiagnosed.
Research on ontology construction of traditional Chinese handmade paper: Take Kaihua paper as an example
Authors: Cai Mengling
Published: June 2023

Digital technology has broadened the research methods in the field of cultural heritage protection, and promoted the online organization and utilization of different resources. New digital technology is used to further explore the resources related to traditional Chinese handmade paper (TCHP) in order to comprehensively and systematically realize the knowledge association of different types of handmade paper. In this article, the characteristics of TCHP are combined to existing mature and generic ontologies to design a new ontology model of TCHP, and Protégé software is used to construct the visual ontology. The model is verified by analyzing the digital resources of Kaihua paper. Constructing the ontology of TCHP can realize the knowledge organization and visual presentation of related resources, and also promote the further utilization of the resources and wider spread of the culture of TCHP.
Source counts at 7.7–21 μm in CEERS field with JWST
Authors: Wu Cossas K-W , Ling Chih-Teng , Goto Tomotsugu , Kim Seong Jin , Hashimoto Tetsuya , Kilerci Ece , Lin Yu-Wei , Wang Po-Ya , Uno Yuri , Ho Simon C-C , Hsiao Tiger Yu-Yang
Published: June 2023

Source counts – the number density of sources as a function of flux density – represent one of the fundamental metrics in observational cosmology due to their straightforward and simple nature. It is an important tool that provides information on galaxy formation and evolution. Source counting is a direct measurement. Compared to advanced analyses that require more observational input such as luminosity/mass functions, it is less affected by any cosmological parameter assumptions or any errors propagated from luminosities. In this study, we present source counts at the six mid-infrared (MIR) bands, i.e. 7.7, 10, 12.8, 15, 18, and 21 μm from the MIR instrument of the JWST. Contrasted with the infrared source counts achieved by prior generations of infrared space telescopes, our source counts delve up to ∼100 times deeper, showcasing the exceptional sensitivity of the JWST, and aligning with the model predictions based on preceding observations. In a follow-up study, we utilize our source counts to establish a new IR galaxy population evolutionary model that provides a physical interpretation.
Fast and not-so-furious: Case study of the fast and faint Type IIb SN 2021bxu
Authors: Desai Dhvanil D , Ashall Chris , Shappee Benjamin J , Morrell Nidia , Galbany Lluís , Burns Christopher R , DerKacy James M , Hinkle Jason T , Hsiao Eric , Kumar Sahana , Lu Jing , Phillips Mark M , Shahbandeh Melissa , Stritzinger Maximilian D , Baron Eddie , Bersten Melina C , Brown Peter J , de Jaeger Thomas , Elias-Rosa Nancy , Folatelli Gastón , Huber Mark E , Mazzali Paolo , Müller-Bravo Tomás E , Piro Anthony L , Polin Abigail , Suntzeff Nicholas B , Anderson Joseph P , Chambers Kenneth C , Chen Ting-Wan , de Boer Thomas , Fulton Michael D , Gao Hua , Gromadzki Mariusz , Inserra Cosimo , Magnier Eugene A , Nicholl Matt , Ragosta Fabio , Wainscoat Richard , Young David R
Published: June 2023

We present photometric and spectroscopic observations and analysis of SN 2021bxu (ATLAS21dov), a low-luminosity, fast-evolving Type IIb supernova (SN). SN 2021bxu is unique, showing a large initial decline in brightness followed by a short plateau phase. With $M_r = -15.93 \pm 0.16\, \mathrm{mag}$ during the plateau, it is at the lower end of the luminosity distribution of stripped-envelope supernovae (SE-SNe) and shows a distinct ∼10 d plateau not caused by H- or He-recombination. SN 2021bxu shows line velocities which are at least $\sim 1500\, \mathrm{km\, s^{-1}}$ slower than typical SE-SNe. It is photometrically and spectroscopically similar to Type IIb SNe during the photospheric phases of evolution, with similarities to Ca-rich IIb SNe. We find that the bolometric light curve is best described by a composite model of shock interaction between the ejecta and an envelope of extended material, combined with a typical SN IIb powered by the radioactive decay of 56Ni. The best-fitting parameters for SN 2021bxu include a 56Ni mass of $M_{\mathrm{Ni}} = 0.029^{+0.004}_{-0.005}\, \mathrm{{\rm M}_{\odot }}$, an ejecta mass of $M_{\mathrm{ej}} = 0.61^{+0.06}_{-0.05}\, \mathrm{{\rm M}_{\odot }}$, and an ejecta kinetic energy of $K_{\mathrm{ej}} = 8.8^{+1.1}_{-1.0} \times 10^{49}\, \mathrm{erg}$. From the fits to the properties of the extended material of Ca-rich IIb SNe we find a trend of decreasing envelope radius with increasing envelope mass. SN 2021bxu has MNi on the low end compared to SE-SNe and Ca-rich SNe in the literature, demonstrating that SN 2021bxu-like events are rare explosions in extreme areas of parameter space. The progenitor of SN 2021bxu is likely a low-mass He star with an extended envelope.
Nickle-cobalt alloy nanocrystals inhibit activation of inflammasomes
Authors: Lin Jun , Dong Liang , Liu Yi-Ming , Hu Yi , Jiang Chen , Liu Ke , Liu Liu , Song Yong-Hong , Sun Mei , Xiang Xing-Cheng , Qu Kun , Lu Yang , Wen Long-Ping , Yu Shu-Hong
Published: June 2023

Activation of inflammasomes—immune system receptor sensor complexes that selectively activate inflammatory responses—has been associated with diverse human diseases, and many nanomedicine studies have reported that structurally and chemically diverse inorganic nanomaterials cause excessive inflammasome activation. Here, in stark contrast to reports of other inorganic nanomaterials, we find that nickel-cobalt alloy magnetic nanocrystals (NiCo NCs) actually inhibit activation of NLRP3, NLRC4 and AIM2 inflammasomes. We show that NiCo NCs disrupt the canonical inflammasome ASC speck formation process by downregulating the lncRNA Neat1, and experimentally confirm that the entry of NiCo NCs into cells is required for the observed inhibition of inflammasome activation. Furthermore, we find that NiCo NCs inhibit neutrophil recruitment in an acute peritonitis mouse model and relieve symptoms in a colitis mouse model, again by inhibiting inflammasome activation. Beyond demonstrating a highly surprising and apparently therapeutic impact for an inorganic nanomaterial on inflammatory responses, our work suggests that nickel- and cobalt-containing nanomaterials may offer an opportunity to design anti-inflammatory nanomedicines for the therapeutics of macrophage-mediated diseases.
Guideline Concordance of Treatment and Outcomes Among Adult Non-Hodgkin Lymphoma Patients in Sub-Saharan Africa: A Multinational, Population-Based Cohort
Authors: Mezger Nikolaus Christian Simon , Hämmerl Lucia , Griesel Mirko , Seraphin Tobias Paul , Joko-Fru Yvonne Walburga , Feuchtner Jana , Zietsman Annelle , Péko Jean-Félix , Tadesse Fisihatsion , Buziba Nathan Gyabi , Wabinga Henry , Nyanchama Mary , Chokunonga Eric , Kéita Mamadou , N’da Guy , Lorenzoni Cesaltina Ferreira , Akele-Akpo Marie-Thérèse , Mezger Jörg Michael , Binder Mascha , Liu Biying , Bauer Marcus , Henke Oliver , Jemal Ahmedin , Kantelhardt Eva Johanna
Published: June 2023

Background

Although non-Hodgkin lymphoma (NHL) is the 6th most common malignancy in Sub-Saharan Africa (SSA), little is known about its management and outcome. Herein, we examined treatment patterns and survival among NHL patients.

Methods

We obtained a random sample of adult patients diagnosed between 2011 and 2015 from 11 population-based cancer registries in 10 SSA countries. Descriptive statistics for lymphoma-directed therapy (LDT) and degree of concordance with National Comprehensive Cancer Network (NCCN) guidelines were calculated, and survival rates were estimated.

Findings

Of 516 patients included in the study, sub-classification was available for 42.1% (121 high-grade and 64 low-grade B-cell lymphoma, 15 T-cell lymphoma and 17 otherwise sub-classified NHL), whilst the remaining 57.9% were unclassified. Any LDT was identified for 195 of all patients (37.8%). NCCN guideline-recommended treatment was initiated in 21 patients. This corresponds to 4.1% of all 516 patients, and to 11.7% of 180 patients with sub-classified B-cell lymphoma and NCCN guidelines available. Deviations from guideline-recommended treatment were initiated in another 49 (9.5% of 516, 27.2% of 180). By registry, the proportion of all patients receiving guideline-concordant LDT ranged from 30.8% in Namibia to 0% in Maputo and Bamako. Concordance with treatment recommendations was not assessable in 75.1% of patients (records not traced (43.2%), traced but no sub-classification identified (27.8%), traced but no guidelines available (4.1%)). By registry, diagnostic work-up was in part importantly limited, thus impeding guideline evaluation significantly. Overall 1-year survival was 61.2% (95%CI 55.3%-67.1%). Poor ECOG performance status, advanced stage, less than 5 cycles and absence of chemo (immuno-) therapy were associated with unfavorable survival, while HIV status, age, and gender did not impact survival. In diffuse large B-cell lymphoma, initiation of guideline-concordant treatment was associated with favorable survival.

Interpretation

This study shows that a majority of NHL patients in SSA are untreated or undertreated, resulting in unfavorable survival. Investments in enhanced diagnostic services, provision of chemo(immuno-)therapy and supportive care will likely improve outcomes in the region.
The latest breakthrough on genetic characteristics of inflammatory bowel disease in Chinese and other East Asian ancestries
Authors: Gao Han , Liu Zhanju
Published: June 2023

Inflammatory bowel diseases (IBDs) are complex chronic disorders of the gastrointestinal tract with the following two subtypes: Crohn's disease and ulcerative colitis. Disease presentation and progression within and across IBDs, especially Crohn's disease, are highly heterogeneous in the location, severity of inflammation, intestinal stenosis and obstruction, and extraintestinal manifestations. Clinical classifications fail to accurately predict the disease course and response to therapies. To date, most IBD genetic associations are derived from individuals of European ancestries, leading to a limitation of the discovery and application of IBD genetics in the rest of the world populations. In this mini-review, we summarize the latest progress of genome-wide association studies of IBD across global ancestries especially the Chinese population, the similarities and differences in genetic architecture between European and East Asian ancestries, as well as, the clinical significances relevant to IBD genetic study.
Heterologous expression of genes from a cyanobacterial endosymbiont highlights substrate exchanges with its diatom host
Authors: Nieves-Morión Mercedes , Camargo Sergio , Bardi Sepehr , Ruiz María Teresa , Flores Enrique , Foster Rachel A
Published: June 2023

A few genera of diatoms are widespread and thrive in low-nutrient waters of the open ocean due to their close association with N2-fixing, filamentous heterocyst-forming cyanobacteria. In one of these symbioses, the symbiont, Richelia euintracellularis, has penetrated the cell envelope of the host, Hemiaulus hauckii, and lives inside the host cytoplasm. How the partners interact, including how the symbiont sustains high rates of N2 fixation, is unstudied. Since R. euintracellularis has evaded isolation, heterologous expression of genes in model laboratory organisms was performed to identify the function of proteins from the endosymbiont. Gene complementation of a cyanobacterial invertase mutant and expression of the protein in Escherichia coli showed that R. euintracellularis HH01 possesses a neutral invertase that splits sucrose producing glucose and fructose. Several solute-binding proteins (SBPs) of ABC transporters encoded in the genome of R. euintracellularis HH01 were expressed in E. coli, and their substrates were characterized. The selected SBPs directly linked the host as the source of several substrates, e.g. sugars (sucrose and galactose), amino acids (glutamate and phenylalanine), and a polyamine (spermidine), to support the cyanobacterial symbiont. Finally, transcripts of genes encoding the invertase and SBPs were consistently detected in wild populations of H. hauckii collected from multiple stations and depths in the western tropical North Atlantic. Our results support the idea that the diatom host provides the endosymbiotic cyanobacterium with organic carbon to fuel N2 fixation. This knowledge is key to understanding the physiology of the globally significant H. hauckii–R. euintracellularis symbiosis.
PRISM—Pain Recovery and Integrative Systems Model: A Process-Based Cognitive-Behavioral Approach for Physical Therapy
Authors: Tatta Joe , Pignataro Rose M , Bezner Janet R , George Steven Z , Rothschild Carey E
Published: June 2023

The Academy of Orthopedic Physical Therapy Pain Education Manual supports the advancement of modern pain content, and the National Institutes of Health Federal Pain Research Strategy has called for new models for pain management. This Perspective proposes the Pain Recovery and Integrative Systems Model (PRISM) as a new model that addresses the multidimensional nature of pain. PRISM is a salutogenic, integrative, process-based cognitive-behavioral model designed for physical therapist education and practice. PRISM aligns with national and international initiatives to better understand and manage pain, thereby mitigating the global opioid crisis. PRISM aims to address the multidimensional nature of pain while building resilience, nurturing growth, and facilitating pain recovery.

Impact

PRISM is a salutogenic, integrative, process-based cognitive-behavioral model to guide physical therapists in managing the multidimensional nature of pain.
Dosimetric impact of bladder volume on organs at risk during external beam radiotherapy of cervical cancer
Authors: Mohamadian Niloofar , Nasseri Shahrokh , Hosseini Sare , Molaie Fatemeh , Zarifi Shiva , Eskandari Azam , Momennezhad Mehdi
Published: June 2023

This study aimed to investigate the effect of bladder volume on the dosimetry of pelvic organs at risk (OARs) in patients treated with external beam radiation therapy. Twenty patients with locally advanced cervical cancer were selected. Two computed tomography-simulation scans were obtained, one with an empty bladder followed by one with a full bladder. The acquired images were transferred to the treatment planning system. Target and OARs were contoured in both images, and treatment plans were performed for each computed tomography image. The delivered doses to target and OARs were determined using dose–volume histograms. The mean dose of the bowel bag in the empty and full bladder were 35.06 ± 4.13 (Gy) and 31.59 ± 3.86 (Gy), respectively. Furthermore, the V45 of the bowel bag in the empty bladder was 364.27 ± 154.39 (cc) and in the full bladder, it was 240.84 ± 129.66 (cc). The mean dose of the rectum in the empty and full bladder were 49.50 ± 1.95 (Gy) and 49.18 ± 1.03 (Gy), respectively. The rectal V50 (%) was 52.82 ± 21.84 (%) in the empty bladder and 45.49 ± 29.55 (%) in the full bladder. The mean dose and V45 of the bowel bag, also V50 of the rectum, had significantly decreased in the full bladder status (p-value < 0.05). The results showed that the bladder volume significantly affected the delivered dose to the bowel bag and rectum. The average bowel bag V45 and rectum V50 in the full bladder were significantly decreased. Bladder distention is an effective method to improve the dosimetric parameters of pelvic OARs.
Effect of grain inclusion rates in diets provided to early-weaned calves and steroidal implants utilization on growth performance and carcass characteristics of beef steers
Authors: Pittaluga Alejandro M , Kieffer Justin , Relling Alejandro E
Published: June 2023

One hundred and twenty-one Angus × SimAngus-crossbred steers (body weight (BW) = 159 ± 22 kg) were used to evaluate the effects of different grain inclusion (GI) rates in diets provided to early-weaned calves and steroidal implants (SI) utilization on growth performance and carcass characteristics, particularly intramuscular fat deposition, of beef steers. The experiment was conducted as a randomized complete block design with a 2 × 2 factorial arrangement of treatments, consisting of two GI rates (35% vs. 58%, dry matter (DM) basis), each one associated or not to steroidal implant utilization (no implants vs. 80 mg trenbolone acetate (TA) + 16 mg estradiol followed by 120 mg TA + 24 mg of estradiol). After being early-weaned (124 ± 14 d of age), steers were offered an average of 4.5 kg/d (DM basis) of a concentrate-based diet with a greater or lesser GI rate for 60 d. After being fed a concentrate-based diet with different GI rates for 60 d, steers were fed a common backgrounding diet for 56 d and subsequently fed a common high-grain diet until harvested at a constant final BW (620 kg). Steers were not implanted until the beginning of the backgrounding phase and then re-implanted when initiating the finishing phase. Data were analyzed using PROC MIXED in SAS. There were no GI × SI interactions (P ≥ 0.62) for any of the growth performance parameters throughout the experimental period. Implanted steers tended to have a greater average daily gain (P = 0.10) during the finishing phase than nonimplanted steers. For the 12th rib fat thickness and yield grade (YG), a GI × SI interaction (P = 0.03) and a tendency for a GI × SI interaction (P = 0.10) was detected, respectively. Nonimplanted steers fed diets with greater GI rates presented the greatest 12th rib fat thickness and tended to have the greatest YG among treatments. No other interactions (P ≥ 0.33) were observed for the hot carcass weight, Longissimus muscle (LM) area, quality grade, marbling score, and kidney-pelvic-heart fat content. Steers fed diets with lesser GI rates tended to have a greater LM area than steers fed diets with greater GI rates (P = 0.10). Results from this experiment indicate that varying GI rates in diets provided to early-weaned calves and subsequent implantation with steroidal hormones did not affect marbling deposition.
Moving Beyond the Dichotomous Assessment of Professionalism in the Internal Medicine Clerkship: Results of a National Survey of Clerkship Directors
Authors: Montgomery Mary W. , Petersen Elizabeth M. , Weinstein Amy R. , Curren Camilla , Hufmeyer Kathryn , Kisielewski Michael , Krupat Edward , Osman Nora Y.
Published: June 2023

Purpose

This study examines how internal medicine clerkship faculty and leadership conceptualize professionalism and professional behaviors and attitudes, identifies whether and how faculty use metrics to assess professionalism and factor it into clerkship grades, and describes barriers that prevent faculty from feeling prepared to support the development of professional behaviors in students.

Method

The Clerkship Directors in Internal Medicine opened a call for thematic survey section proposals to its physician-faculty members, blind-reviewed all submissions, and selected 4 based on internal medicine clinical clerkship training experience relevance. The survey launched on October 5 and closed on December 7, 2021. Data were analyzed using descriptive statistics.

Results

Of 137 core clerkship directors (CDs) at Liaison Committee on Medical Education–accredited medical schools, 103 (75.2%) responded to the survey. Of 102 respondents (1 nonrespondent), 84 (82.4%) identified professional behavior lapses in involvement and 60 (58.8%) identified introspection lapses. Of 103 respondents, 97 (94.2%) reported that their clerkships ask clinical faculty and residents to formally evaluate professionalism, and 64 (62.1%) reported that they factor professionalism assessments into final clerkship grades. CDs reported multiple barriers to addressing professionalism directly with students, including logistical barriers, professionalism assessment subjectivity concerns, and the possible adverse effect of an unprofessional label for students.

Conclusions

Professionalism assessment and remediation in medical education currently center on a deficit model that seeks to identify and remediate professionalism lapses, rather than a developmental model that seeks to nurture growth. This dichotomous characterization of behaviors as professional or unprofessional limits assessment and can adversely affect the learning environment. The authors propose a shift to a developmental model that considers professionalism as a continuous process parallel to the acquisition of clinical skills and medical knowledge.
Scholarly Curriculum at a Psychiatry Residency Program in Canada: 10-Year Outcomes
Authors: Iskhakova S. , Vasudev K.
Published: June 2023

Problem

For research in medicine to address needed interventions and produce outcomes relevant to patient care, it is important for physicians to gain hands-on experience in scientific methods during their training. However, the results of recent studies in the United States and Canada indicate low interest in research among residents.

Approach

In 2011, involvement in a scholarly activity was made mandatory for all residents joining the Western University psychiatry residency program (WUPRP). A faculty member was appointed as a research coordinator who collaborated with research-intensive faculty members and prepared a list of potential projects suitable for resident involvement; organized monthly research meetings to support residents in initiating scholarly activities, monitor their progress, and address challenges; and developed competency-based research objectives, guidelines, and assessment tool.

Outcomes

Data on all residents enrolled at WUPRP from 2011 to 2017 (the latter graduated in 2022 with completed scholarly requirements) were analyzed with respect to residents’ participation in a scholarly project. A total of 54 residents were enrolled during this period. Fifty-two (96%) residents were involved in a scholarly project; of these 52, 38 (73%) completed their project. Of these 38, 32 (84%) had academic achievements, which include poster and oral presentations at a conference, publications, and prizes and awards. Of the 52 residents involved in a scholarly project, 14 (27%) residents could not complete their projects, though they still met scholarly activity requirements and 1 (2%) enrolled in the Western University Clinician Investigator Program with the goal of pursuing research as a career.

Next Steps

There is a lack of data on how many WUPRP graduates from 2011 to 2017 are currently pursuing careers in research. The authors plan to perform longer and closer follow-up of residents to evaluate whether a scholarly curriculum makes an impact on residents’ career choices.
The Evaluation and Treatment of an Infant Exposed to Nongenital HSV-2
Authors: Staggs Jenna
Published: June 2023

Background:

Pregnant persons with a primary genital herpes simplex virus (HSV) infection can transfer HSV to the fetus or infant through the placenta or birth canal, which can cause significant infant morbidity or mortality. Primary nongenital infections with HSV-1 or HSV-2 in pregnant persons and the risk of infant infection are not well documented, leaving the clinician to make non-evidence-based decisions on evaluation and treatment in such presentations.

Clinical Findings:

A term newborn was delivered vaginally by a pregnant person with a nongenital HSV-2 infection. The pregnant person's rash first appeared around 32 weeks' gestation, started on their lower back, and terminated on the outer left hip. The rash improved but was still present at time of delivery, and this rash was their first known HSV outbreak.

Primary Diagnosis:

Prenatal exposure to HSV-2.

Interventions:

Diagnostics included the pregnant person's rash surface culture, immunoglobulin G and immunoglobulin M for HSV-1 and -2; infant surface, cerebral spinal fluid (CSF), and serum HSV-1 and HSV-2 polymerase chain reactions (PCRs), infant CSF studies, blood culture, liver function tests, and treatment with intravenous acyclovir.

Outcomes:

This infant remained clinically well during hospitalization and was discharged home at 5 days of life when CSF, surface, and serum PCRs resulted negative.

Practice Recommendations:

Risk for infant HSV infection versus parent/infant separation and exposure to invasive procedures and medications should be considered when pregnant persons present with primary versus recurrent nongenital HSV infections. Research is needed for the evaluation and treatment of infants born to pregnant persons with primary nongenital HSV infections in pregnancy.
Readability of Patient-Reported Outcomes in Spine Surgery and Implications for Health Literacy
Authors: Issa Tariq Z. , Lee Yunsoo , Mazmudar Aditya S. , Lambrechts Mark J. , Sellig Mason , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: June 2023

Study Design:

Observational study.

Objective:

To evaluate the readability of commonly utilized patient-reported outcome measures (PROMs) in spine surgery.

Summary of Background Data:

Although studies have evaluated patient education materials, discharge instructions, and informed consent forms in spine surgery, there is a dearth of literature on the readability of PROMs despite widespread health illiteracy. Without knowledge of PROM readability, it is unclear whether these measures are able to be understood by the average spine patient.

Materials and Methods:

We analyzed all commonly utilized nonvisual PROMs within the spinal literature and uploaded PROMs into an online readability calculator. The Flesch Reading Ease Score (FRES) and Simple Measure of Gobbledygook (SMOG) Index were collected. A FRES>79 or SMOG<7 was considered readable by the general population per American Medical Association and Centers for Disease Control guidelines. A stricter threshold recommended in health care (SMOG <6 or FRES>89) was then used to further review readability.

Results:

Seventy-seven PROMs were included. Based on FRES, the mean readability of all PROMs was 69.2 ± 17.2 (range, 10–96.4), indicating an average eighth to ninth-grade reading level. The mean readability score categorized by the SMOG Index was 8.12 ± 2.65 (range, 3.1–25.6), representing an eighth-grade reading level. Compared with the reading level of the general population, 49 (63.6%) PROMs are written above the United States literacy level, according to FRES. Using stricter definitions of readability, 8 PROMs were considered readable, including PROM Information System pain behavior (FRES: 96.4 and SMOG: 5.2), PROM Information System sleep disturbance (SMOG: 5.6), Neck Pain and Disability Scale (SMOG: 4.3), and Zung Depression Scale (SMOG: 3.1).

Conclusions:

Most PROMs utilized in spine surgery require an average reading competency far above the average patient’s comprehension. This may have a meaningful impact on understanding PROM instruments and may affect the accuracy of complete surveys and the rates of incompletion.