bluuebunny/crossref_metadata_2025 huggingface dataset:
Clinical implications of concentration of alveolar nitric oxide in asthmatic and non-asthmatic subacute cough
Authors: Zeng Guan-Sheng , Chen Hui , Chen Li-Chang , Wu Ling-Ling , Yu Hua-Peng
Published: November 2021

Asthma is an important cause of subacute cough. The concentration of alveolar nitric oxide (CANO) is a sensitive inflammatory indicator in peripheral airways, and it has received much less attention than the fraction of exhaled nitric oxide (FeNO50). The main objective of this study was to explore the correlation between CANO and clinical parameters in asthmatic and non-asthmatic subacute cough, which might promote understanding of the clinical utility of CANO in these special patient populations. 155 patients with subacute cough were included consecutively, of which 25 were diagnosed as asthmatic. Data for demographic characteristics, FeNO50, CANO, baseline spirometry, bronchial provocation test (or bronchodilation test) and response dose ratio (RDR) were collected. Differences between the asthmatic and non-asthmatic groups were analyzed. Spearman’s correlation coefficient (ρ) was used to evaluate the correlation between FeNO50, CANO and other clinical parameters. In patients with subacute cough, baseline CANO values did not differ between asthmatic and non-asthmatic patients (4.4(1.3, 11.4) versus 4.0(2.1, 6.8) ppb, P > 0.05). Besides, CANO exhibited a stronger association with pulmonary function parameters when compared with FeNO50. For asthmatic subacute cough, CANO was inversely correlated with FEV1/FVC (ρ = −0.69, P < 0.01) and small airway parameters including MEF25 (ρ = −0.47, P < 0.05) and MMEF (ρ = −0.45, P < 0.05). For non-asthmatic subacute cough, CANO was inversely correlated with MEF25 (ρ = −0.19, P < 0.05) and RDR (ρ = −0.21, P < 0.05). In subacute cough, asthmatic and non-asthmatic patients had similar values of baseline CANO. In both asthmatic and non-asthmatic subacute cough, CANO exhibited a stronger association with pulmonary function parameters when compared with FeNO50. A low CANO value in non-asthmatic subacute cough corresponded to a higher value of RDR, which implied a stronger tendency towards airway responsiveness.
Noninvasive real-time breath test for controlling hormonal background of the human body: detection of serotonin and melatonin with quantum point-contact sensors
Authors: Kamarchuk Lyudmila , Pospelov Alexander , Harbuz Dmytro , Belan Victor , Volkova Yuliya , Tkachenko Anna , Kamarchuk Gennadii
Published: November 2021

Significant progress in development of noninvasive diagnostic tools based on breath analysis can be expected if one employs a real-time detection method based on finding a spectral breath profile which would contain some energy characteristics of the analyzed gas mixture. Using the fundamental energy parameters of a quantum system, it is possible to determine with a high accuracy its quantitative and qualitative composition. Among the most efficient tools to measure energy characteristics of quantum systems are sensors based on Yanson point contacts. This paper reports the results of serotonin and melatonin detection as an example of testing the human hormonal background with point-contact sensors, which have already demonstrated their high efficiency in detecting carcinogenic strains of Helicobacter pylori and selective detection of complex gas mixtures. When comparing the values of serotonin and melatonin with the characteristic parameters of the spectral profile of the exhaled breath of each patient, high correlation dependences of the concentration of serotonin and melatonin with a number of characteristic parameters of the response curve of the point-contact sensor were found. The performed correlation analysis was complemented with the regression analysis. As a result, empiric regression relations were proposed to realize in practice the new non-invasive breath test for evaluation of the human hormonal background. Registration of the patient’s breath profile using point-contact sensors makes it possible to easily monitor the dynamics of changes in the human hormonal background and perform a quantitative evaluation of serotonin and melatonin levels in the human body in real time without invasive interventions (blood collection) and expensive equipment or reagents.
Introducing matrix sparsity with kernel truncation into dose calculations for fluence optimization
Authors: Stephens Hunter , Wu Q Jackie , Wu Qiuwen
Published: November 2021

Deep learning algorithms for radiation therapy treatment planning automation require large patient datasets and complex architectures that often take hundreds of hours to train. Some of these algorithms require constant dose updating (such as with reinforcement learning) and may take days. When these algorithms rely on commerical treatment planning systems to perform dose calculations, the data pipeline becomes the bottleneck of the entire algorithm’s efficiency. Further, uniformly accurate distributions are not always needed for the training and approximations can be introduced to speed up the process without affecting the outcome. These approximations not only speed up the calculation process, but allow for custom algorithms to be written specifically for the purposes of use in AI/ML applications where the dose and fluence must be calculated a multitude of times for a multitude of different situations. Here we present and investigate the effect of introducing matrix sparsity through kernel truncation on the dose calculation for the purposes of fluence optimzation within these AI/ML algorithms. The basis for this algorithm relies on voxel discrimination in which numerous voxels are pruned from the computationally expensive part of the calculation. This results in a significant reduction in computation time and storage. Comparing our dose calculation against calculations in both a water phantom and patient anatomy in Eclipse without heterogenity corrections produced gamma index passing rates around 99% for individual and composite beams with uniform fluence and around 98% for beams with a modulated fluence. The resulting sparsity introduces a reduction in computational time and space proportional to the square of the sparsity tolerance with a potential decrease in cost greater than 10 times that of a dense calculation allowing not only for faster caluclations but for calculations that a dense algorithm could not perform on the same system.
Response of the low-pressure hot-filament discharge plasma to a positively biased auxiliary disk electrode
Authors: CHOUDHARY Mangilal , SREEJITH Poyyeri Kunnath
Published: November 2021

In a steady-state plasma, the loss rate of plasma particles to the chamber wall and surfaces in contact with plasma is balanced by the ionization rate of background neutrals in the hot-filament discharges. The balance between the loss rate and ionization rate of plasma particles (electrons and ions) maintains quasi-neutrality of the bulk plasma. In the presence of an external perturbation, it tries to retain its quasi-neutrality condition. In this work, we studied how the properties of bulk plasma are affected by an external DC potential perturbation. An auxiliary biased metal disk electrode was used to introduce a potential perturbation to the plasma medium. A single Langmuir probe and an emissive probe, placed in the line of the discharge axis, were used for the characterization of the bulk plasma. It is observed that only positive bias to the auxiliary metal disk increases the plasma potential, electron temperature, and plasma density but these plasma parameters remain unaltered when the disk is biased with a negative potential with respect to plasma potential. The observed plasma parameters for two different-sized, positively as well as negatively biased, metal disks are compared and found inconsistent with the existing theoretical model at large positive bias voltages. The role of the primary energetic electrons population in determining the plasma parameters is discussed. The experimentally observed results are qualitatively explained on the basis of electrostatic confinement arising due to the loss of electrons to a biased metal disk electrode.
Bandwidth control of loop type frequency selective surfaces using dual elements in various arrangements
Authors: Littman Nickolas , O’Keefe Steven G , Galehdar Amir , Espinosa Hugo G , Thiel David V
Published: November 2021

Frequency selective surfaces (FSSs) have applications across multiple disciplines due to their unique electromagnetic properties. This paper investigates the use of both rounded square loops, and simple loop type dual elements arranged in unique patterns, to control the transmission and reflection bandwidth and resonant frequencies over KU and K frequency bands supported by equivalent circuit models. The FSSs were fabricated using laser engraving to create conductive loop type elements on a thin, flexible and optically transparent Mylar substrate (relative permittivity of 2.7 and thickness of 65 μm). The frequency response of the surfaces are controlled through the element self-inductance and capacitive coupling with neighbouring elements. This work shows that different arrangements result in the formation of multiple distinct resonances. The theoretical and experimental results were in good agreement where rounded squares and dual element arrays were employed to create broadband and multiband band-stop FSSs. A polarization sensitive surface exhibited stop-bands at 12 and 16 GHz in transverse electric polarization and a stop-band at 14.4 GHz in transverse magnetic polarization. This technique can be applied to any periodic array through careful selection of the individual elements in the array, as well as their arrangement.
Path-optimized nonadiabatic geometric quantum computation on superconducting qubits
Authors: Ding Cheng-Yun , Ji Li-Na , Chen Tao , Xue Zheng-Yuan
Published: November 2021

Quantum computation based on nonadiabatic geometric phases has attracted a broad range of interests, due to its fast manipulation and inherent noise resistance. However, it is limited to some special evolution paths, and the gate-times are typically longer than conventional dynamical gates, resulting in weakening of robustness and more infidelities of the implemented geometric gates. Here, we propose a path-optimized scheme for geometric quantum computation (GQC) on superconducting transmon qubits, where high-fidelity and robust universal nonadiabatic geometric gates can be implemented, based on conventional experimental setups. Specifically, we find that, by selecting appropriate evolution paths, the constructed geometric gates can be superior to their corresponding dynamical ones under different local errors. Numerical simulations show that the fidelities for single-qubit geometric phase, π/8 and Hadamard gates can be obtained as 99.93%, 99.95% and 99.95%, respectively. Remarkably, the fidelity for two-qubit control-phase gate can be as high as 99.87%. Therefore, our scheme provides a new perspective for GQC, making it more promising in the application of large-scale fault-tolerant quantum computation.
Attention-based quantum tomography
Authors: Cha Peter , Ginsparg Paul , Wu Felix , Carrasquilla Juan , McMahon Peter L , Kim Eun-Ah
Published: November 2021

With rapid progress across platforms for quantum systems, the problem of many-body quantum state reconstruction for noisy quantum states becomes an important challenge. There has been a growing interest in approaching the problem of quantum state reconstruction using generative neural network models. Here we propose the ‘attention-based quantum tomography’ (AQT), a quantum state reconstruction using an attention mechanism-based generative network that learns the mixed state density matrix of a noisy quantum state. AQT is based on the model proposed in ‘Attention is all you need’ by Vaswani et al (2017 NIPS) that is designed to learn long-range correlations in natural language sentences and thereby outperform previous natural language processing (NLP) models. We demonstrate not only that AQT outperforms earlier neural-network-based quantum state reconstruction on identical tasks but that AQT can accurately reconstruct the density matrix associated with a noisy quantum state experimentally realized in an IBMQ quantum computer. We speculate the success of the AQT stems from its ability to model quantum entanglement across the entire quantum system much as the attention model for NLP captures the correlations among words in a sentence.
Intense Automorphisms of Finite Groups
Authors: Stanojkovski Mima
Published: November 2021

Let

G
G

be a group. An automorphism of

G
G

is called intense if it sends each subgroup of

G
G

to a conjugate; the collection of such automorphisms is denoted by

Int
⁡
(
G
)

\operatorname {Int}(G)

. In the special case in which

p
p

is a prime number and

G
G

is a finite

p
p

-group, one can show that

Int
⁡
(
G
)

\operatorname {Int}(G)

is the semidirect product of a normal

p
p

-Sylow and a cyclic subgroup of order dividing

p
−
1

p-1

. In this paper we classify the finite

p
p

-groups whose groups of intense automorphisms are not themselves

p
p

-groups. It emerges from our investigation that the structure of such groups is almost completely determined by their nilpotency class: for

p
>
3

p>3

, they share a quotient, growing with their class, with a uniquely determined infinite 2-generated pro-

p
p

group.
Fibroblast to myofibroblast transition is enhanced by increased cell density
Authors: Doolin Mary T. , Smith Ian M. , Stroka Kimberly M.
Published: November 2021

Increased cell density elevates the incidence of the fibroblast-to-myofibroblast transition (FMT) in human lung fibroblasts (HLFs), but mechanical confinement imposed by micropillars has no effect on FMT incidence. HLFs express more α-SMA, a marker of myofibroblasts, and deposit more collagen matrix in response to TGF-β1 when seeded at high density.
preciseTAD: a transfer learning framework for 3D domain boundary prediction at base-pair resolution
Authors: Stilianoudakis Spiro C , Marshall Maggie A , Dozmorov Mikhail G
Published: November 2021

Motivation

Chromosome conformation capture technologies (Hi-C) revealed extensive DNA folding into discrete 3D domains, such as Topologically Associating Domains and chromatin loops. The correct binding of CTCF and cohesin at domain boundaries is integral in maintaining the proper structure and function of these 3D domains. 3D domains have been mapped at the resolutions of 1 kilobase and above. However, it has not been possible to define their boundaries at the resolution of boundary-forming proteins.

Results

To predict domain boundaries at base-pair resolution, we developed preciseTAD, an optimized transfer learning framework trained on high-resolution genome annotation data. In contrast to current TAD/loop callers, preciseTAD-predicted boundaries are strongly supported by experimental evidence. Importantly, this approach can accurately delineate boundaries in cells without Hi-C data. preciseTAD provides a powerful framework to improve our understanding of how genomic regulators are shaping the 3D structure of the genome at base-pair resolution.

Availability and implementation

preciseTAD is an R/Bioconductor package available at https://bioconductor.org/packages/preciseTAD/.

Supplementary information

Supplementary data are available at Bioinformatics online.
Developing a forest inventory approach using airborne single photon lidar data: from ground plot selection to forest attribute prediction
Authors: Queinnec Martin , Coops Nicholas C , White Joanne C , McCartney Grant , Sinclair Ian
Published: November 2021

An increasing number of jurisdictions are integrating airborne laser scanning (ALS) into forest inventory programs to produce spatially explicit and accurate inventories of forest resources. However, wall-to-wall ALS coverage relative to the total area of managed forest remains limited in large forest nations such as Canada, wherein logistics, cost and acquisition capacity can be limiting factors. Technologies such as single photon light detection and ranging (SPL) have emerged commercially, which have the capacity to provide efficient ALS acquisitions over large areas and with a greater point density than conventional linear-mode ALS. However, the large-scale operational application of SPL in a forest inventory still needs to be effectively demonstrated. In this study, we used wall-to-wall SPL data (collected with a Leica SPL100) across a 630 000 ha boreal forest in Ontario, Canada to develop a forest inventory. Specifically, we used a structurally guided sampling approach enabled via a principal component analysis of the SPL100 data to establish a network of 250 ground plots. Random forest models were then used to produce area-based estimates of forest attributes of interest. Results demonstrated that the sampling approach enabled the optimization and enhancement of the existing plot network by extending the range of sampled structural types and reducing the number of plots in oversampled forest types. Moreover, Lorey’s height, basal area, quadratic mean diameter at breast height, stem density, gross and merchantable volume and above-ground biomass were estimated with a relative root mean square error of 8.5, 19.76, 13.97, 30.82, 21.53, 23.79 and 22.87 per cent, respectively, and relative bias <1 per cent. Model accuracies achieved using the SPL100 were comparable with those obtained using linear-mode ALS in a previous forest inventory. This study demonstrates the utility of the SPL100 for the complete development of a forest inventory over large forest areas, from ground plot establishment through to the production of forest attribute estimates.
Impact of optimizing and creating dedicated breast surgical instrument trays using LEAN methodology
Authors: Shetty Spoorthi Sudhakar , Lim Yvonne Lew Fei , Ujagar Gurdip Kaur , Tan Pei Ting , Tan Su-Ming
Published: November 2021

Objectives

For surgery to proceed smoothly and expediently, one often neglected factor is the ready availability of relevant surgical instruments. While breast surgery techniques have evolved over the years, surgical instrument trays (SITs) are rarely revised. Consequently, the type and range of surgical instruments in the standard SITs have become inappropriate for surgeons. This results in an increased number of unused instruments (instrument wastage). This study aimed to assess the impact of a dedicated breast SIT using LEAN methodology on operating theater (OT) efficiency and cost savings.

Methods

A dedicated breast SIT was assembled using LEAN methodology. The utilization of the dedicated breast SIT was audited by looking at the instrument wastage, OT SIT set-up time, SIT processing time, and cost SIT cost charged to the patient. Data were analyzed using an independent T-test and paired T-test.

Results

By using LEAN methodology, three commonly used breast SITs with 119 instruments were combined into a single breast SIT with 61 instruments. The mean instrument wastage was reduced from 57.75% to 17%. The processing cost of each SIT was reduced from $71.75 (U.S. dollars) and $41 (major surgery and minor surgery) to $12.86 (P < 0.001). The SIT processing time data time decreased from 140.5 min to 32 min (P < 0.001). Based on a mean volume of 395 breast surgeries per year, a potential cost saving of $17 040 annually may be achieved.

Conclusion

Optimizing SITs using LEAN methodology can reduce cost and improve efficiency in OT, leading to significant benefits to staff and patients.
Using artificial intelligence to automate meat cut identification from the semimembranosus muscle on beef boning lines
Authors: Prakash Satya , Berry Donagh P , Roantree Mark , Onibonoje Oluwadurotimi , Gualano Leonardo , Scriney Michael , McCarren Andrew
Published: November 2021

The identification of different meat cuts for labeling and quality control on production lines is still largely a manual process. As a result, it is a labor-intensive exercise with the potential for not only error but also bacterial cross-contamination. Artificial intelligence is used in many disciplines to identify objects within images, but these approaches usually require a considerable volume of images for training and validation. The objective of this study was to identify five different meat cuts from images and weights collected by a trained operator within the working environment of a commercial Irish beef plant. Individual cut images and weights from 7,987 meats cuts extracted from semimembranosus muscles (i.e., Topside muscle), post editing, were available. A variety of classical neural networks and a novel Ensemble machine learning approaches were then tasked with identifying each individual meat cut; performance of the approaches was dictated by accuracy (the percentage of correct predictions), precision (the ratio of correctly predicted objects relative to the number of objects identified as positive), and recall (also known as true positive rate or sensitivity). A novel Ensemble approach outperformed a selection of the classical neural networks including convolutional neural network and residual network. The accuracy, precision, and recall for the novel Ensemble method were 99.13%, 99.00%, and 98.00%, respectively, while that of the next best method were 98.00%, 98.00%, and 95.00%, respectively. The Ensemble approach, which requires relatively few gold-standard measures, can readily be deployed under normal abattoir conditions; the strategy could also be evaluated in the cuts from other primals or indeed other species.
Use of a larger surface area tip on bipolar radiofrequency wands in hip arthroscopy is associated with significantly lower traction and total surgery times
Authors: Wininger Austin E , Aflatooni Justin O , Harris Joshua D
Published: November 2021

Clinical outcomes in arthroscopic hip preservation surgery have improved over the past two decades due to many factors, including advancements in technique and instrumentation. Complications following hip arthroscopy are associated with increased traction and overall surgical times. The purpose of this study was to compare traction and surgical times during hip arthroscopy using two different radiofrequency ablation wands produced by the same manufacturer. The authors hypothesized that the wand with a larger surface area would result in significantly less traction and surgical times. This study was a retrospective comparative investigation on patients who underwent arthroscopic surgery of the central, peripheral, peritrochanteric and/or deep gluteal space compartments of the hip. Both wands are 50-degree-angled probes, but the tip and shaft diameters are 3 and 3.75 mm for Wand A (Ambient Super MultiVac 50; tip surface area 7.1 mm2) compared to 4.7 and 4.7 mm for Wand B (Ambient HipVac 50; tip surface area 17.3 mm2), respectively. There was no difference (P = 0.16) in mean age of Wand A patients (30 females, 20 males; 35.2 years) versus Wand B patients (31 females, 19 males; 32.7 years). Traction time was significantly less in the Wand B group (41 ± 6 versus 51 ± 18 min; P < 0.001), as was surgical time (102 ± 13 versus 118 ± 17 min; P < 0.001). There were no significant differences in the number of labral anchors used or Current Procedural Terminology codes performed between groups. In conclusion, it was observed that the use of a larger surface area wand was associated with significantly less traction and surgical times during hip arthroscopy.
The Practitioner's Bookshelf: Review of Lila Abu-Lughod's Do Muslim Women Need Saving?
Authors: Pasha Suraina
Published: November 2021

This review considers Lila Abu-Lughod’s Do Muslim Women Need Saving? and reflects on the book’s key implications for human rights practitioners. Through discussions of topical concerns such as veiling, honour crimes and forced marriages, the book critiques the global project of ‘saving’ the Muslim woman in the name of human rights and gender equality. The author reviews the book from the perspective of a human rights educator and a veiled Muslim woman living in the liberal West.
Desert Locust Episode in Pakistan, 2018–2021, and the Current Status of Integrated Desert Locust Management
Authors: Showler Allan T , Shah Sikandar , Sulaiman  , Khan Sheharyar , Ullah Sami , Degola Francesca
Published: November 2021

Desert locust, Schistocerca gregaria (Forskål) (Orthoptera: Acrididae), swarms during outbreaks, and plagues can invade many countries across vast regions of Africa and Asia, consuming substantial quantities of crops and rangeland vegetation. In the most recent desert locust episode, which originated in Saudi Arabia’s remote interior in June 2018, and swarms entered Pakistan in March 2019, devastating important crops, such as cotton, Gossypium hirsutum L.; wheat, Triticum aestivum L.; and maize, Zea mays L., in >60 districts of Baluchistan, Punjab, Khyber Pakhtunkhwa, and Sindh provinces. A national emergency was declared on 1 February 2020. A national emergency was declared on 1 February 2020 and the Department of Plant Protection responded by conducting surveillance and control operations with the assistance of other Pakistani organizations, and multilateral and bilateral international aid agencies. Surveillance and control operations were performed by ground and by air, applying mostly oil-based ultra-low volume insecticide formulations combined with some nonconventional control tactics. The Pakistan government also established a detailed multi-phased locust control policy and a National Locust Control Center with rapid response units deployed to vulnerable districts. To prevent or mitigate desert locust-associated agricultural damage, additional improvements to surveillance and control approaches are needed. The desert locust’s unique behaviors, and the magnitude and intermittency of swarming episodes, pose challenges to the development and implementation of coherent integrated pest management strategies. The status of a possible integrated approach to desert locust management, including proactive and preventive intervention strategies, is discussed.
Citrullination Was Introduced into Animals by Horizontal Gene Transfer from Cyanobacteria
Authors: Cummings Thomas F M , Gori Kevin , Sanchez-Pulido Luis , Gavriilidis Gavriil , Moi David , Wilson Abigail R , Murchison Elizabeth , Dessimoz Christophe , Ponting Chris P , Christophorou Maria A
Published: November 2021

Protein posttranslational modifications add great sophistication to biological systems. Citrullination, a key regulatory mechanism in human physiology and pathophysiology, is enigmatic from an evolutionary perspective. Although the citrullinating enzymes peptidylarginine deiminases (PADIs) are ubiquitous across vertebrates, they are absent from yeast, worms, and flies. Based on this distribution PADIs were proposed to have been horizontally transferred, but this has been contested. Here, we map the evolutionary trajectory of PADIs into the animal lineage. We present strong phylogenetic support for a clade encompassing animal and cyanobacterial PADIs that excludes fungal and other bacterial homologs. The animal and cyanobacterial PADI proteins share functionally relevant primary and tertiary synapomorphic sequences that are distinct from a second PADI type present in fungi and actinobacteria. Molecular clock calculations and sequence divergence analyses using the fossil record estimate the last common ancestor of the cyanobacterial and animal PADIs to be less than 1 billion years old. Additionally, under an assumption of vertical descent, PADI sequence change during this evolutionary time frame is anachronistically low, even when compared with products of likely endosymbiont gene transfer, mitochondrial proteins, and some of the most highly conserved sequences in life. The consilience of evidence indicates that PADIs were introduced from cyanobacteria into animals by horizontal gene transfer (HGT). The ancestral cyanobacterial PADI is enzymatically active and can citrullinate eukaryotic proteins, suggesting that the PADI HGT event introduced a new catalytic capability into the regulatory repertoire of animals. This study reveals the unusual evolution of a pleiotropic protein modification.
Sex Differences in Non-AIDS Comorbidities Among People With Human Immunodeficiency Virus
Authors: Pond Renee A , Collins Lauren F , Lahiri Cecile D
Published: November 2021

Women are grossly underrepresented in human immunodeficiency virus (HIV) clinical and translational research. This is concerning given that people with HIV (PWH) are living longer, and thus accumulating aging-related non-AIDS comorbidities (NACMs); emerging evidence suggests that women are at higher risk of NACM development and progression compared with men. It is widely recognized that women vs men have greater immune activation in response to many viruses, including HIV-1; this likely influences sex-differential NACM development related to differences in HIV-associated chronic inflammation. Furthermore, many sociobehavioral factors that contribute to aging-related NACMs are known to differ by sex. The objectives of this review were to (1) synthesize sex-stratified data on 4 NACMs among PWH: bone disease, cardiovascular disease, metabolic dysfunction, and neurocognitive impairment; (2) evaluate the characteristics of key studies assessing sex differences in NACMs; and (3) introduce potential biological and psychosocial mechanisms contributing to emerging trends in sex-differential NACM risk and outcomes among PWH.
Arterial and Mixed Venous Kinetics of Desflurane and Sevoflurane, Administered Simultaneously, at Three Different Global Ventilation to Perfusion Ratios in Piglets with Normal Lungs
Authors: Kretzschmar Moritz , Baumgardner James E. , Kozian Alf , Hachenberg Thomas , Schilling Thomas , Hedenstierna Göran , Larsson Anders
Published: November 2021

Background

Previous studies have established the role of various tissue compartments in the kinetics of inhaled anesthetic uptake and elimination. The role of normal lungs in inhaled anesthetic kinetics is less understood. In juvenile pigs with normal lungs, the authors measured desflurane and sevoflurane washin and washout kinetics at three different ratios of alveolar minute ventilation to cardiac output value. The main hypothesis was that the ventilation/perfusion ratio (VA/Q) of normal lungs influences the kinetics of inhaled anesthetics.

Methods

Seven healthy pigs were anesthetized with intravenous anesthetics and mechanically ventilated. Each animal was studied under three different VA/Q conditions: normal, low, and high. For each VA/Q condition, desflurane and sevoflurane were administered at a constant, subanesthetic inspired partial pressure (0.15 volume% for sevoflurane and 0.5 volume% for desflurane) for 45 min. Pulmonary arterial and systemic arterial blood samples were collected at eight time points during uptake, and then at these same times during elimination, for measurement of desflurane and sevoflurane partial pressures. The authors also assessed the effect of VA/Q on paired differences in arterial and mixed venous partial pressures.

Results

For desflurane washin, the scaled arterial partial pressure differences between 5 and 0 min were 0.70 ± 0.10, 0.93 ± 0.08, and 0.82 ± 0.07 for the low, normal, and high VA/Q conditions (means, 95% CI). Equivalent measurements for sevoflurane were 0.55 ± 0.06, 0.77 ± 0.04, and 0.75 ± 0.08. For desflurane washout, the scaled arterial partial pressure differences between 0 and 5 min were 0.76 ± 0.04, 0.88 ± 0.02, and 0.92 ± 0.01 for the low, normal, and high VA/Q conditions. Equivalent measurements for sevoflurane were 0.79 ± 0.05, 0.85 ± 0.03, and 0.90 ± 0.03.

Conclusions

Kinetics of inhaled anesthetic washin and washout are substantially altered by changes in the global VA/Q ratio for normal lungs.

Editor’s Perspective

What We Already Know about This Topic

What This Article Tells Us That Is New
Formal Patient Complaints and Malpractice Events Involving Orthopedic Spine Surgeons
Authors: Rae Matthew , Barreto Rocha Daniela F. , Hayes Daniel S. , Haak Michael , Maniar Hemil , Grandizio Louis C.
Published: November 2021

Study Design.

Case-control study.

Objective.

To analyze patient complaints, potential risk, and malpractice events involving orthopedic spine surgeons over a 10-year period.

Summary of Background Data.

Unsolicited patient complaints may be associated with risk management and malpractice events.

Methods.

We analyzed patient complaint, potential risk event, and malpractice event data for six orthopedic spine surgeons over a 10-year period. Patient complaints were analyzed and classified according to the Patient Complaint Analysis System. Baseline demographics were recorded for patients with complaints as well as the surgeons. A control group consisting of all patients seen by the six surgeons during the study period was created to identify patient and physician risk factors for formal patient complaints. Event rates (for complaints, risk, and malpractice events) were calculated by dividing the number of events by the total number of unique patients seen.

Results.

There were 214 complaint designations among 202 patients with formal complaints, resulting in a complaint rate of 0.79%. Patients were most likely to complain about access and availability (35%) followed by care and treatment (32%). Of the 68 complaints regarding care and treatment, 34 were related to dissatisfaction with surgical outcome. Complications were identified in 26/34 cases. The malpractice event rate ranged from 0.06% to 0.65%. Patients who had surgery (P< 0.0001) or a mental, behavioral, or neurodevelopmental disorder (P = 0.0004) were more likely to file complaints compared with the control group.

Conclusion.

While infrequent, patient complaints against orthopedic spine surgeons are most related to access and availability. The rate of malpractice events varies widely between surgeons.
SILICONE OIL–FILLED FOLDABLE CAPSULAR VITREOUS BODY VERSUS SILICONE OIL ENDOTAMPONADE FOR TREATMENT OF NO LIGHT PERCEPTION AFTER SEVERE OCULAR TRAUMA
Authors: Zhang Chun , Xiao Ruihan , Wang Anan , Zhao Zhenquan
Published: November 2021

Purpose:

To compare the anatomical and functional outcomes of silicone oil (SO)–filled foldable capsular vitreous body (FCVB) and SO endotamponade in vitrectomy for patients with no light perception after ocular trauma.

Methods:

A total of 64 patients (64 eyes) with no light perception caused by severe ocular trauma were divided into FCVB and SO groups based on the surgical treatment. The main outcome measurements were retinal reattachment rate, intraocular pressure, best-corrected visual acuity, and number of operations.

Results:

Both the FCVB group (29 eyes) and the SO group (35 eyes) showed significant improvement in postoperative best-corrected visual acuity and intraocular pressure. The two groups showed no significant differences in final intraocular pressure and the retinal reattachment rate. The postoperative vision (≥LP) in the FCVB group was significantly worse than in the SO group (FCVB [4/29] vs. SO [18/35], P = 0.003). However, the number of surgeries in the FCVB group was significantly lower than in the SO group (FCVB [1.10] vs. SO [2.23], P < 0.001).

Conclusion:

Vitrectomy combined with SO endotamponade shows better short-term improvement in the treatment of no light perception caused by severe ocular trauma. However, SO-filled FCVB can effectively prevent many complications caused by direct SO endotamponade, such as secondary surgeries or SO dependence.
Modified Carlevale Intraocular Lens Fixation Technique: Two Vitrectomy Ports As Lens Plug Fixation Sites
Authors: Caporossi Tomaso , Governatori Lorenzo , Baldascino Antonio , Mosca Luigi , Scampoli Alessandra , D'Amico Guglielmo , De Vico Umberto , Rizzo Stanislao
Published: November 2021

Purpose:

To describe and evaluate the effectiveness of the modified Carlevale intraocular lens (IOL) fixation technique, using two vitrectomy ports as lens plug fixation sites.

Materials and Methods:

This prospective, consecutive, interventional study examined 60 eyes in 60 patients, who underwent 25- or 23-gauge vitrectomy for an IOL subluxation/luxation, lens dislocation, or aphakia, with Carlevale IOL implantation.

Results:

Postoperatively, transient ocular hypotension was observed in four eyes. The mean refractive prediction error was −0.27 ± 0.78 diopters. No postoperative complications, such as retinal detachment, endophthalmitis, or IOL dislocation, were observed in the 4-month follow-up.

Conclusion:

This new technique may be simple, fast, and effective because of fewer scleral wounds and fewer postoperative complications.
Comparison of Efficacy and Safety of XEN45 Implant Versus Trabeculectomy in Asian Eyes
Authors: Kee Ae Ra , Vivien Yip Cherng Hui , Chua Chun Hau , Bryan Ang Chin Hou , Jeremy Hu Youwei , Guo Xiner , Leonard Yip Wei Leon
Published: November 2021

Précis:

Combined phacoemulsification and trabeculectomy is able to achieve greater reduction in intraocular pressure (IOP), higher rates of complete surgical success and fewer postoperative manipulations and visits compared with combined phacoemulsification and Xen implantation in glaucomatous eyes.

Purpose:

Our study aims to compare and understand the differences between the efficacy and safety of XEN45 implantation and trabeculectomy in Asian eyes with glaucoma.

Materials and Methods:

This was a retrospective, single-center, comparative study of consecutive patients who underwent combined phacoemulsification and trabeculectomy (Phaco-Trab) from January 2013 to June 2014 and combined phacoemulsification and XEN45 implantation (Phaco-Xen) from May 2017 to September 2018 in a tertiary Ophthalmology center in Singapore. Outcome measures included IOP, number of anti-glaucoma eyedrops, success rate, factors leading to success/failure, number of postoperative interventions and visits required, and surgical complications.

Results:

A total of 137 eyes (91 Phaco-Trab, 46 Phaco-Xen) were included. Phaco-Trab group had greater mean IOP reduction at all time points beyond postoperative month (POM) 1 (mean difference 2.9 to 3.8 mm Hg; P<0.05), and greater reduction in mean number of antiglaucoma eyedrops beyond POM3, thought this was not statistically significant. At POM12, complete success was achieved in 83.5% in Phaco-Trab and 52.2% of Phaco-Xen group, respectively (P<0.001). There was no significant factor associated with surgical failure, other than the difference in surgical procedure. Phaco-Trab group required fewer number of postoperative interventions (P=0.009), with only a mean of 0.1 bleb interventions required per patient, versus 1.5 in Phaco-Xen group (P<0.001). Safety profiles in both groups were comparable, with no statistically significant difference in intraoperative/postoperative complications.

Conclusion:

Phaco-Trab has significantly higher reduction in both IOP and number of antiglaucoma medications compared with Phaco-Xen group, with greater surgical success and fewer postoperative manipulations and visits. Safety profiles were comparable.
CYP2D6 Genotyping and Antipsychotic-Associated Extrapyramidal Adverse Effects in a Randomized Trial of Aripiprazole Versus Quetiapine Extended Release in Children and Adolescents, Aged 12–17 Years, With First Episode Psychosis
Authors: Rudå Ditte , Jensen Karsten Gjessing , Decara Marie Stentebjerg , Klauber Dea Gowers , Fagerlund Birgitte , Møllegaard Jens Richardt , Linnet Kristian , Werge Thomas , Correll Christoph U. , Fink-Jensen Anders , Jürgens Gesche , Pagsberg Anne Katrine
Published: November 2021

Purpose/Background

The aim of this study was to examine the association between genetically predicted CYP2D6 phenotypes and extrapyramidal symptoms (EPSs).

Methods/Procedures

Data from the Tolerability and Efficacy of Antipsychotics trial of adolescents with first-episode psychosis randomized to aripiprazole versus quetiapine extended release were studied. Extrapyramidal symptom assessments included the Simpson-Angus Scale and the Barnes Akathisia Rating Scale. Patients were CYP2D6 genotyped. Plasma concentrations of antipsychotics and antidepressants were analyzed.

Findings/Results

One hundred thirteen youths (age, 12–17 years; males, 30%; antipsychotic naive, 51%) were enrolled. Poor metabolizers had a significantly higher dose-adjusted aripiprazole plasma concentration (±SD) compared with normal metabolizers at week 4 (24.30 ± 6.40 ng/mL per milligram vs 14.85 ± 6.15 ng/mL per milligram; P = 0.019), but not at week 12 (22.15 ± 11.04 ng/mL per milligram vs 14.32 ± 4.52 ng/mL per milligram; P = 0.067). This association was not found in the quetiapine extended release group. No association between CYP2D6 genotype groups and global Barnes Akathisia Rating Scale score or Simpson-Angus Scale score was found in any of the treatment arms.

Implications/Conclusions

Our results do not support routine use of CYP2D6 testing as a predictor of drug-induced parkinsonism or akathisia risk in clinical settings. Further studies with larger samples of CYP2D6 poor metabolizers are needed.
Lifetime Cannabis Use Disorder Is Not Associated With Lifetime Impulsive Behavior and Severe Violence in Patients With Schizophrenia Spectrum Disorders From a High-Security Hospital
Authors: Comai Stefano , Fuamba Yves , Rivolta Maria Chiara , Gobbi Gabriella
Published: November 2021

Purpose/Background

The link between substances of abuse, impulsivity, and violence in psychotic patients remains unclear. This study aims at unraveling whether cannabis use disorder is associated with violent and/or psychotic behavior in patients who are hospitalized in a high-security hospital.

Methods/Procedures

We conducted a cross-sectional retrospective study in 124 patients with schizophrenia spectrum disorders admitted to a high-security hospital. Lifetime violent behavior was assessed using the History of Aggressive Behavior Form-Subject of the MacArthur Violence Risk Assessment Study and impulsivity using the Psychopathy Checklist–Revised (considering items: “proneness to boredom,” “lack of self-control,” and “impulsive thoughtless gestures”). Substance use disorder was diagnosed according to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition criteria. Positive and Negative Syndrome Scale was also administered.

Findings/Results

Violent and nonviolent psychotic patients showed similar prevalence of cannabis use disorder. Alcohol and cocaine use disorders were more prevalent among violent psychotic patients. Cannabis use disorder was not associated with any dimension of impulsivity, whereas alcohol use disorder was positively correlated to impulsive thoughtless gestures (standardized β = 0.213, P = 0.027) and cocaine use disorder with proneness to boredom (standardized β = 0.290, P = 0.002). Finally, logistic regression analysis revealed that, unlike cannabis and cocaine use disorders, alcohol use disorder (odds ratio, 3.964; 95% confidence interval, 1.729–9.087; P = 0.001) was a factor associated with violence.

Implications/Conclusions

These findings show that cannabis and alcohol are largely abused and coabused by psychotic patients with a propsensity for violence, but only alcohol is associated with impulsive and violent behavior. Therefore, especially alcohol abuse should be seriously considered by practitioners when evaluating the dangerousness of patients with schizophrenia spectrum disorders.
The Team Physician: Return to Play Considerations and Outcomes
Authors: Zhou MAJ Liang , Haley COL Chad
Published: November 2021

Successful rehabilitation of sports-related orthopedic injuries remains a challenge for both orthopedic surgeons and their patients. Team physicians are tasked with the complex problem of minimizing time away from competition, while simultaneously mitigating the risk of reinjury. Varying levels of expectation and demand between recreational and competitive athletes coupled with the already complex nature of sports-related injuries present a multifactorial challenge for the even the most experienced physicians. In the realm of sports medicine, timing of return to sport has become a controversial yet ubiquitous criterion by which treatment outcomes are measured. While accelerated rehabilitation may be desired in many cases, surgeons must also recognize the identifiable risk factors for potential reinjury. With these principles in mind, we present a summary of the available literature on data pertaining to return to sport, with coverage of injuries commonly seen within an orthopedic sports medicine practice.
Cognitive Patterns and Conversion in a Representative Sample of Individuals at Risk for Psychosis
Authors: Haddad Natalia Mansur , Hortêncio Lucas , Andrade Julio Cesar , Serpa Mauricio Henriques , Alves Tania Maria , van de Bilt Martinus Theodorus , Rössler Wulf , Gattaz Wagner Farid , Loch Alexandre Andrade
Published: November 2021

Clinical high-risk (CHR) individuals belong to a heterogeneous group, of which only a few will cross the threshold for a clinical diagnosis. Cognitive disturbances are present in CHR subjects and may be indicative of transition. Our study aims to identify such deficits in a representative CHR for psychosis sample. Our sample comprised 92 CHR individuals and 54 controls from a representative cohort of the general population. They were followed up for a mean of 2.5 years, with 15 individuals converting to schizophrenia or other Diagnostic and Statistical Manual of Mental Disorders, 5th Edition diagnoses. Neurocognitive assessment was performed with the University of Pennsylvania Computerized Neuropsychological Testing, and CHR status was assessed with the Structured Interview for Prodromal Syndromes (SIPS). Baseline scores were entered in a latent profile analysis model. Our study brought forward a four-class model on cognitive performance. One class displayed better performance, whereas the other three performed worse, all compared with controls. The class with lower executive function also had the highest score on disorganized communication (SIPS P5 = 1.36, p < 0.05), although unrelated to conversion. Among the low performers, the class significantly related to conversion (p = 0.023) had the highest score in decreased expression of emotion (SIPS N3 = 0.85, p < 0.05). Our study brings new and relevant data on non–help-seeking CHR individuals and the relationship between cognitive patterns and conversion. We have highlighted a specific cognitive signature, associated with negative symptoms, which represents a stable trait with presumed lower conversion to a psychiatric illness.
Graphical details: the secret life of Christopher Wren's drawing of the weather clock
Authors: Mihailescu Ion
Published: November 2021

Historians have unanimously credited Christopher Wren with having constructed a weather clock (a self-registering instrument) in the early 1660s. This conclusion was based on the account of the French diplomat Balthasar de Monconys, which included a sketch uncannily similar to an undated drawing by Wren of the weather clock. By critically re-examining the available sources, I argue that one can infer that Wren never actually constructed a weather clock. What Monconys saw and sketched was, in fact, a drawing produced by Wren for a meeting of the Royal Society that took place on 8 January 1662. I further show that there is strong evidence to assume that Wren's drawing for the Royal Society is the undated drawing preserved at the Royal Institute of British Architects. The new context in which I place Wren's drawing provides an incentive to look at it with fresh eyes. Though the drawing does not represent a device actually constructed by Wren, it still bears (unexpected) connections to the material world that surrounded him. The analysis of the drawing developed in this article will be relevant for historians interested in the role that images can play as historical evidence.