bluuebunny/crossref_metadata_2025 huggingface dataset:
Enteric methane emissions, growth, and carcass characteristics of feedlot steers fed a garlic- and citrus-based feed additive in diets with three different forage concentrations
Authors: Bitsie Bryce , Osorio Andrea M , Henry Darren D , Silva Breno C , Godoi Leticia A , Supapong Chanadol , Brand Tassilo , Schoonmaker Jon P
Published: April 2022

One hundred and forty-four Angus × Simmental steers were allotted by body weight (BW; 363 kg), breed composition, and farm origin to a 3 × 2 factorial arrangement of six treatments (4 pens per treatment) to determine the effect of Mootral (garlic + citrus extract; 0.25% of the diet dry matter [DM] vs. 0.0%) on methane (CH4) emissions, growth, and carcass characteristics of feedlot cattle. During the first 84 d, cattle were fed three different forage concentrations in the diet (15%, 41.5%, or 68% corn silage) with or without Mootral. From day 85 to slaughter, corn silage was included at 15% of the diet DM with or without Mootral. CH4 emissions were measured on day 42 to 46 and day 203 to 207. Data were analyzed using the GLIMMIX procedure of SAS. Mootral did not affect CH4 emissions on days 42 to 46 (P ≥ 0.47), but there was a forage effect, where steers fed the 68% corn silage emitted more CH4 on a g/d (P = 0.05) and a g/kg of dry matter intake (DMI; P = 0.007) basis and tended (P = 0.07) to produce more CH4 on g/kg BW basis compared to steers fed the 15% corn silage diet. On day 203 to 207, steers fed Mootral emitted less (P ≤ 0.03) CH4 on a g/d, g/kg DMI, and g/kg BW basis compared to steers not fed Mootral. There was an interaction (P = 0.03) between forage concentration and Mootral for DMI from day 0 to 84, where Mootral decreased DMI of steers fed 15% corn silage but did not affect DMI of steers fed 41.5% or 68% corn silage. There were no effects (P ≥ 0.22) of forage concentration or Mootral on BW or average daily gain at any time, or on DMI from day 84 to slaughter and overall. However, overall calculated net energy for maintenance (NEm) and net energy for gain (NEg) tended to be greater for steers fed Mootral (P ≤ 0.10). Intake from day 0 to 84 was lower and gain:feed from day 0 to 84 and overall was greater (P = 0.04) for steers fed 68% compared to steers fed 41.5% corn silage. Calculated NEm and NEg from day 0 to 84 and overall were greater for steers fed 68% corn silage compared to steers fed 41.5% corn silage (P ≤ 0.03). Mootral tended to decrease (P ≤ 0.09) fat thickness and yield grade. In conclusion, increasing forage concentration increased CH4 emissions and Mootral decreased CH4 production in 15% corn silage diets and tended to improve carcass leanness.
Quantification of Fecal Spot Production as a Measure of Environmental Contamination Based on Common Bed Bug (Hemiptera: Cimicidae:Cimex lectulariusL.) Population Size
Authors: Wilson Morgan M , Miller Dini M
Published: April 2022

The presence of fecal spots has often been used to verify the existence of a bed bug (Cimex lectularius) infestation. However, no research has been conducted to determine how much fecal material that a bed bug population produces over time. In this study, the number of fecal spots that each nymphal life stage was capable of producing after a bloodmeal was quantified. Adult fecal spots were also quantified to determine if there was consistent production between feedings. During this study, it was discovered that bed bugs produced visible fecal spots and clear spots that were only visible under ultraviolet light. Therefore, three types of fecal spots were quantified: dark feces, light feces, and clear spots. Clear spots were produced in greater amounts (38.5–55.5%) than either dark spots (27.3–40.7%) or light spots (17.3–21.9%). For example, 5th instar bed bugs were thought to produce an average of 21 spots (dark and light) after a single bloodmeal. However, using the ultraviolet light, it was found that the 5th instars actually produced an average of 44.7 spots. Using the total fecal spot data collected during this study, researchers could project contamination potential for an infestation starting with a single gravid female over 30, 60, and 90 d. In addition, the amount of area covered by these spots was projected to be over 12 m2 in just 3 mo, which could greatly reduce the environmental and aesthetic quality of a home.
Comparative Efficacy of Superheated Dry Steam Application and Insecticide Spray Against Common Bed Bugs Under Simulated Field Conditions
Authors: Ramos Rodrigo Soares , Cooper Richard , Dasgupta Tirthankar , Pashley Nicole E , Wang Changlu
Published: April 2022

The common bed bug, Cimex lectularius L., is a difficult urban pest to control. A simulated field study was conducted to compare the efficacy of steam application and an insecticide mixture spray (0.05% acetamiprid and 0.06% bifenthrin mixture) against C. lectularius. Three types of furniture (desk chair, upholstered armchair, and wooden table) were treated in the laboratory. The efficacy of the treatments was evaluated by visual inspection and placement of interceptor traps under the legs of the furniture. One hundred mixed stages of an insecticide-resistant population of C. lectularius were released onto each furniture item. After a 10-day acclimation period, each furniture item received steam treatment, insecticide spray, or no treatment. The second application of treatment was conducted 14 d later. Bed bug counts from interceptors and visual inspections were recorded at 13 d and 28 d after the initial treatment. At 28 d, the mean (± SE) live bed bug count in the steam, spray, and control group was 1 ± 0, 2 ± 1, and 83 ± 10, respectively. Both treatment methods were highly effective in controlling bed bugs on furniture. The mean bed bug count from interceptors in the steam, spray, and control groups were 0.3 ± 0.2, 11 ± 7, and 47 ± 9, respectively. There was no significant difference in the efficacy between steam and spray treatments based on either visual inspection or bed bug counts from interceptors. However, based on interceptor counts, the steam treatment caused faster bed bug population reduction than insecticide sprays.
Reconsidering Transitional Justice
Authors: Carpenter Christine
Published: April 2022

The transitional justice literature has, for decades, sought to understand and advocate for mechanisms through which a society may transition from a period of autocracy and mass atrocity into one of democracy, peace and stability. However, this field has left certain geographic regions under-examined — including, for example, events taking place in 20th-century China. Seeking to augment the literature’s consideration of transitional justice, this article employs the case study method to examine two pivotal events in China’s recent history: the 1949 Communist Revolution and the Gang of Four Trials in 1979. It is argued that incorporating these examples into the literature could supplement our understanding of transitional justice and that, by broadening the lens on this concept, events that have long existed on the margins could be internalized to enrich the field’s discussion. In order to accomplish this, the article puts forward a new framework through which transitional justice examples may be analysed — employing a graphical aid to visually designate both the type of justice sought and the degree of transition achieved.
Biological and Molecular Factors Predicting Response to Adoptive Cell Therapies in Cancer
Authors: Ferrer Gerardo , Álvarez-Errico Damiana , Esteller Manel
Published: April 2022

Adoptive cell therapy (ACT) constitutes a major breakthrough in cancer management that has expanded in the past years due to impressive results showing durable and even curative responses for some patients with hematological malignancies. ACT leverages antigen specificity and cytotoxic mechanisms of the immune system, particularly relying on the patient’s T lymphocytes to target and eliminate malignant cells. This personalized therapeutic approach exemplifies the success of the joint effort of basic, translational, and clinical researchers that has turned the patient’s immune system into a great ally in the search for a cancer cure. ACTs are constantly improving to reach a maximum beneficial clinical response. Despite being very promising therapeutic options for certain types of cancers, mainly melanoma and hematological malignancies, these individualized treatments still present several shortcomings, including elevated costs, technical challenges, management of adverse side effects, and a limited population of responder patients. Thus, it is crucial to discover and develop reliable and robust biomarkers to specifically and sensitively pinpoint the patients that will benefit the most from ACT as well as those at higher risk of developing potentially serious toxicities. Although unique readouts of infused cell therapy success have not yet been identified, certain characteristics from the adoptive cells, the tumor, and/or the tumor microenvironment have been recognized to predict patients’ outcome on ACT. Here, we comment on the importance of biomarkers to predict ACT chances of success to maximize efficacy of treatments and increase patients’ survival.
A confounding bronchopulmonary situs abnormality after bilateral lung transplantation
Authors: Ghosh Subha , Fox Steven , Mehta Atul C
Published: April 2022

A 36-year-old female with a past medical history of primary ciliary dyskinesia and bilateral lung transplantation was noted to have a rare and confounding postsurgical anatomy acquired as a result of transplantation. Bronchoscopy and computed tomography showed isomeric main bronchi with a tri-lobed right lung, a bi-lobed left lung and dextrocardia. This rare phenomenon can be observed in lung transplant recipients with situs ambiguous morphology of their native lungs, who receive donor lungs with normal situs solitus morphology. To the best of our knowledge, ours is the first reported case of such a composite bronchopulmonary situs abnormality. Careful review of bronchial anatomy should be done with the help of CT imaging prior to undertaking any bronchial interventions in these subset of patients with bronchial isomerism and bilateral lung transplantation.
Prospective Validation of a Machine Learning Model for Low-Density Lipoprotein Cholesterol Estimation
Authors: Ghayad Jean Pierre , Barakett-Hamadé Vanda , Sleilaty Ghassan
Published: April 2022

Objective

We aim to prospectively validate a previously developed machine learning algorithm for low-density lipoprotein cholesterol (LDL-C) estimation.

Methods

We retrospectively and prospectively evaluated a machine learning algorithm based on k-nearest neighbors (KNN) according to age, sex, health care setting, and triglyceridemia against a direct LDL-C assay. The agreement of low-density lipoprotein-k-nearest neighbors (LDL-KNN) with the direct measurement was assessed using intraclass correlation coefficient (ICC).

Results

The analysis comprised 31,853 retrospective and 6599 prospective observations, with a mean age of 54.2 ± 17.2 years. LDL-KNN exhibited an ICC greater than 0.9 independently of age, sex, and disease status. LDL-KNN was in satisfactory agreement with direct LDL-C in observations with normal triglyceridemia and mild hypertriglyceridemia but displayed an ICC slightly below 0.9 in severely hypertriglyceridemic patients and lower in very low LDL-C observations.

Conclusion

LDL-KNN performs robustly across ages, genders, health care settings, and triglyceridemia. Further algorithm development is needed for very low LDL-C observations.
BusyBee Web: towards comprehensive and differential composition-based metagenomic binning
Authors: Schmartz Georges P , Hirsch Pascal , Amand Jérémy , Dastbaz Jan , Fehlmann Tobias , Kern Fabian , Müller Rolf , Keller Andreas
Published: April 2022

Despite recent methodology and reference database improvements for taxonomic profiling tools, metagenomic assembly and genomic binning remain important pillars of metagenomic analysis workflows. In case reference information is lacking, genomic binning is considered to be a state-of-the-art method in mixed culture metagenomic data analysis. In this light, our previously published tool BusyBee Web implements a composition-based binning method efficient enough to function as a rapid online utility. Handling assembled contigs and long nanopore generated reads alike, the webserver provides a wide range of supplementary annotations and visualizations. Half a decade after the initial publication, we revisited existing functionality, added comprehensive visualizations, and increased the number of data analysis customization options for further experimentation. The webserver now allows for visualization-supported differential analysis of samples, which is computationally expensive and typically only performed in coverage-based binning methods. Further, users may now optionally check their uploaded samples for plasmid sequences using PLSDB as a reference database. Lastly, a new application programming interface with a supporting python package was implemented, to allow power users fully automated access to the resource and integration into existing workflows. The webserver is freely available under: https://www.ccb.uni-saarland.de/busybee.
Multi-CSAR: a web server for scaffolding contigs using multiple reference genomes
Authors: Liu Shu-Cheng , Ju Yan-Ru , Lu Chin Lung
Published: April 2022

Multi-CSAR is a web server that can efficiently and more accurately order and orient the contigs in the assembly of a target genome into larger scaffolds based on multiple reference genomes. Given a target genome and multiple reference genomes, Multi-CSAR first identifies sequence markers shared between the target genome and each reference genome, then utilizes these sequence markers to compute a scaffold for the target genome based on each single reference genome, and finally combines all the single reference-derived scaffolds into a multiple reference-derived scaffold. To run Multi-CSAR, the users need to upload a target genome to be scaffolded and one or more reference genomes in multi-FASTA format. The users can also choose to use the ‘weighting scheme of reference genomes’ for Multi-CSAR to automatically calculate different weights for the reference genomes and choose either ‘NUCmer on nucleotides’ or ‘PROmer on translated amino acids’ for Multi-CSAR to identify sequence markers. In the output page, Multi-CSAR displays its multiple reference-derived scaffold in two graphical representations (i.e. Circos plot and dotplot) for the users to visually validate the correctness of scaffolded contigs and in a tabular representation to further validate the scaffold in detail. Multi-CSAR is available online at http://genome.cs.nthu.edu.tw/Multi-CSAR/.
Impact of kidney transplantation in obese candidates: a time-dependent propensity score matching study
Authors: Castelli Christel , Foucher Yohann , Boucquemont Julie , Prezelin-Reydit Mathilde , Giral Magali , Savoye Emilie , Hazzan Marc , Lenain Rémi
Published: April 2022

Background

Although kidney transplantation (KT) is considered the best treatment for end-stage renal disease (ESRD), there are concerns about its benefit in the obese population because of the increased incidence of post-transplant adverse events. We compared patients who underwent KT versus patients awaiting KT on dialysis.

Methods

We estimated the life expectancy [restricted mean survival time (RMST)] for a 10-year follow-up by matching on time-dependent propensity scores. The primary outcome was time to death.

Results

In patients with a body mass index (BMI) ≥30 kg/m2 (n = 2155 patients per arm), the RMST was 8.23 years [95% confidence interval (CI) 8.05–8.40] in the KT group versus 8.00 years (95% CI 7.82–8.18) in the awaiting KT group, a difference of 2.71 months (95% CI −0.19–5.63). In patients with a BMI ≥35 kg/m2 (n = 212 patients per arm), we reported no significant difference [8.56 years (95% CI 7.96–9.08) versus 8.66 (95% CI 8.10–9.17)]. Hence we deduced that KT in patients with a BMI between 30 and 35 kg/m2 was beneficial in terms of life expectancy.

Conclusion

Regarding the organ shortage, KT may be questionable for those with a BMI ≥35 kg/m2. These results do not mean that a BMI ≥35 kg/m2 should be a barrier to KT, but it should be accounted for in allocation systems to better assign grafts and maximize the overall life expectancy of ESRD patients.
Electronic alerts and a care bundle for acute kidney injury—an Australian cohort study
Authors: Kotwal Sradha , Herath Sanjeeva , Erlich Jonathan , Boardman Sally , Qian Jennifer , Lawton Paul , Campbell Craig , Whatnall Andrew , Teo Su , Horvath A Rita , Endre Zoltán H
Published: April 2022

Background

Early recognition of hospital-acquired acute kidney injury (AKI) may improve patient management and outcomes.

Methods

This multicentre study was conducted at three hospitals (H1—intervention; H2 and H3—controls) served by a single laboratory. The intervention bundle [an interruptive automated alerts (aAlerts) showing AKI stage and baseline creatinine in the eMR, a management guide and junior medical staff education] was implemented only at H1. Outcome variables included length-of-stay (LOS), all-cause in-hospital mortality and management quality.

Results

Over 6 months, 639 patients developed AKI (265 at H1 and 374 at controls), with 94.7% in general wards; 537 (84%) patients developed Stage 1, 58 (9%) Stage 2 and 43 (7%) Stage 3 AKI. Median LOS was 9 days (IQR 4–17) and was not different between intervention and controls. However, patients with AKI stage 1 had shorter LOS at H1 [median 8 versus 10 days (P = 0.021)]. Serum creatinine had risen prior to admission in most patients. Documentation of AKI was better in H1 (94.8% versus 83.4%; P = 0.001), with higher rates of nephrology consultation (25% versus 19%; P = 0.04) and cessation of nephrotoxins (25.3 versus 18.8%; P = 0.045). There was no difference in mortality between H1 versus controls (11.7% versus 13.0%; P = 0.71).

Conclusions

Most hospitalized patients developed Stage 1 AKI and developed AKI in the community and remained outside the intensive care unit (ICU). The AKI eAlert bundle reduced LOS in most patients with AKI and increased AKI documentation, nephrology consultation rate and cessation of nephrotoxic medications.
Improving Management Through Worker Evaluations: Evidence from Auto Manufacturing
Authors: Cai Jing , Wang Shing-Yi
Published: April 2022

Using a randomized experiment with an automobile manufacturing firm in China, we measure the effects of letting workers evaluate their managers on worker and firm outcomes. In the treatment teams, workers evaluate their managers monthly. We find that providing feedback leads to significant reductions in worker turnover and increases in team-level productivity. In addition, workers report higher levels of happiness and well-being. The evidence suggests that these results are driven by learning by managers, leading to changes in their behavior and an overall better relationship between managers and workers.
Enriching research quality: A proposition for stakeholder heterogeneity
Authors: Franssen Thomas
Published: April 2022

Dominant approaches to research quality rest on the assumption that academic peers are the only relevant stakeholders in its assessment. In contrast, impact assessment frameworks recognize a large and heterogeneous set of actors as stakeholders. In transdisciplinary research non-academic stakeholders are actively involved in all phases of the research process and actor-network theorists recognize a broad and heterogeneous set of actors as stakeholders in all types of research as they are assigned roles in the socio-material networks, also termed ‘problematizations’, that researchers reconfigure. Actor-network theorists consider research as a performative act that changes the reality of the stakeholders it, knowingly or unknowingly, involves. Established approaches to, and notions of, research quality do not recognize the heterogeneity of relevant stakeholders nor allow for reflection on the performative effects of research. To enrich the assessment of research quality this article explores the problematization as a potential new object of evaluation. Problematizations are proposals for how the future might look. Hence, their acceptance does not only concern fellow academics but also all other human and other-than-human actors that figure in them. To enrich evaluative approaches, this article argues for the inclusion of stakeholder involvement and stakeholder representation as dimensions of research quality. It considers a number of challenges to doing so including the identification of stakeholders, developing quality criteria for stakeholder involvement and stakeholder representation, and the possibility of participatory research evaluation. It can alternatively be summarized as raising the question: for whose benefit do we conduct evaluations of research quality?
Letters of wishes and their ongoing importance in a trustee’s decision-making
Authors: Sanders Nigel , Yates Charlotte
Published: April 2022

With the rise in judicial commentary on the significance of letters of wishes—in part led by beneficiaries disputing the construction, validity or weight that a trustee has given to them—their status as important relevant considerations for a trustee to take into account when engaging in a decision-making process has been established. However, the Courts are continuing to have to grapple with myriad circumstances and different scenarios in which expressions of wishes are made and fall to be considered. This article considers the importance of a settlor's letters of wishes, a trustee's duty to take a settlor's wishes into consideration, the position where there are multiple letters of wishes, which letter of wishes applies where a trust to trust appointment is concerned and the approach the courts are likely to follow when considering letters of wishes.
Heavy metals in road-deposited sediment and runoff in urban and intercity expressways
Authors: Gao Shuohan , Wang Xinjun , Li Hua , Kong Yaping , Chen Jiding , Chen Zheng
Published: April 2022

Road-deposited sediments (RDS) accumulated on road surfaces are an important environmental medium that often provides transport for heavy metals. In order to understand the characteristics of heavy metals in RDS, we investigated the size distribution and heavy metal (i.e. Cd, Cr, Cu, Ni, Pb and Zn) concentrations in RDS and road runoff in typical expressways of suburban and rural area in China. The results demonstrated that RDS particles from all impervious expressway surfaces were predominantly coarse particles (>250 $\mu$m, 58.4% ± 3.8%) and the RDS on all expressways contained more heavy metals than background soils. Furthermore, the concentrations of Cd, Cr, Cu, Ni, Pb and Zn increased with traffic volume, suggesting that these heavy metals are mainly derived from traffic activities. Moreover, it is found that although heavy metals were concentrated in fine grain fractions, the total loading is highest for the coarsest particles due to their large mass percentage. Additionally, it reveals that the heavy metal concentrations in road runoff of suburban expressway are higher than that in urban expressway. Our findings enhance the understanding of expressway pollution, and imply that for controlling runoff pollution from RDS, transportation agencies should be concerned with both fine and coarse particles and take cleaning methods into account.
The Rapid Screening for Somatosensory Tinnitus Tool: a Data-Driven Decision Tree Based on Specific Diagnostic Criteria
Authors: Michiels Sarah , Cardon Emilie , Gilles Annick , Goedhart Hazel , Vesala Markku , Van Rompaey Vincent , Van de Heyning Paul , Schlee Winfried
Published: April 2022

Background:

Somatosensory or somatic tinnitus (ST) is a type of tinnitus where changes in somatosensory afference from the cervical spine or temporomandibular area alter the tinnitus perception. Very recently, the diagnostic value of a set of 16 diagnostic criteria for ST was determined. The next step in the development of easily applicable diagnostic criteria is to provide an uncomplicated model, based on the existing criteria, which can easily be used in clinical practice.

Objectives:

This study aims to construct an accurate decision tree, combining several diagnostic criteria, to optimize both sensitivity and specificity of ST diagnosis.

Design:

An online survey was launched on the online forum Tinnitus Talk, managed by Tinnitus Hub in a convenience sample of participants with tinnitus. The survey included 42 questions, both on the presence of diagnostic criteria for ST and on other potentially influencing factors. A decision tree was constructed to classify participants with and without ST using the rpart package in R. Tree depth was optimized during a five-fold cross-validation. Finally, model performance was evaluated on a subset containing 20% of the original dataset.

Results:

Data of 7981 participants were used to construct a decision tree for ST diagnosis. Four criteria were included in the final decision tree: ‘Tinnitus and neck/jaw pain increase/decrease simultaneously’, ‘Tension in suboccipital muscles’, ‘Somatic modulation’, and ‘Bruxism’. The presented model has an accuracy of 82.2%, a sensitivity of 82.5%, and a specificity of 79%. Receiver operator characteristic curves demonstrated an area under the curve of 0.88.

Conclusions:

Based on a 42-item survey, a decision tree was created that was able to detect ST patients with high accuracy (82.2%) using only 4 questions. The RaSST is therefore expected to be easily implementable in clinical practice.
Identifying exposure pathways mediating adverse birth outcomes near active surface mines in Central Appalachia
Authors: Ruktanonchai Corrine W. , McKnight Molly X. , Buttling Lauren , Kolivras Korine , Krometis Leigh-Anne , Gohlke Julia
Published: April 2022

Background:

Previous work has determined an association between proximity to active surface mining within Central Appalachia and an increased risk of preterm birth (PTB) and low birthweight (LBW). Multiple potential exposure pathways may exist; however, including inhalation of particulate matter (airshed exposure), or exposure to impacted surface waters (watershed exposure). We hypothesize that this relationship is mediated by exposure to contaminants along one or both of these pathways.

Methods:

We geolocated 194,084 birth records through health departments in WV, KY, VA, and TN between 1990 and 2015. We performed a mediation analysis, iteratively including within our models: (a) the percent of active surface mining within 5 km of maternal residence during gestation; (b) the cumulative surface mining airshed trajectories experienced during gestation; and (c) the percent of active surface mining occurring within the watershed of residency during gestation.

Results:

Our baseline models found that active surface mining was associated with an increased odds of PTB (1.09, 1.05–1.13) and LBW (1.06, 1.02–1.11), controlling for individual-level predictors. When mediators were added to the baseline model, the association between active mining and birth outcomes became nonsignificant (PTB: 0.48, 0.14–1.58; LBW 0.78, 0.19–3.00), whereas the association between PTB and LBW remained significant by airshed exposure (PTB: 1.14, 1.11–1.18; LBW: 1.06, 1.03–1.10).

Conclusions:

Our results found that surface mining airsheds at least partially explained the association between active mining and adverse birth outcomes, consistent with a hypothesis of mediation, while mediation via the watershed pathway was less evident.
Publish or Perish: A Cross-Sectional, Bibliometric Analysis of Physician Assistant Faculty Publications
Authors: Garino Alexandria , Wang Lei , Min Elana A.
Published: April 2022

Purpose:

Little is known about physician assistant (PA) educators' publishing practices and the collective impact of their published works. The goal of this study was to describe the scholarly output of the PA professoriate in a way that is useful to both promotion committees and individual educators who are planning careers.

Methods:

A cross-sectional study was performed to demonstrate publishing patterns. The name of each PA-credentialed educator in academic health centers was searched in Scopus. Citations of peer-reviewed articles published through 2019 were retrieved and de-duplicated. The number of publications, h-indices, journal names, and keywords were collected between May 2019 and January 2020. Differences among academic ranks were explored, and keywords were analyzed. Frequently used journals were determined and their impact factors retrieved.

Results:

A total of 364 faculty met inclusion criteria. Between 1972 and 2019, 895 peer-reviewed articles were published; 603 were published in the last 10 years. Approximately half the study cohort (n = 172) published at least one peer-reviewed article that met inclusion criteria (range 1-89; median = 2). Overall, productivity remained steady over the last 10 years (range 0-59; median = 2). Faculty at the professor and associate level had a median h-index of 2.00 and assistants had a median h-index of 1.00. PhD-prepared faculty published more articles and had higher h-indices than faculty with other types of degrees.

Conclusions:

The results provide benchmarking data that can be used for promotion and professional development. More faculty must publish and increase the citation rate of their publications if we are to improve the reputation of the PA educator literature.
Histopathologic and Molecular Characterization of Uterine Leiomyoma–like Inflammatory Myofibroblastic Tumor
Authors: Kuisma Heli , Jokinen Vilja , Pasanen Annukka , Heikinheimo Oskari , Karhu Auli , Välimäki Niko , Aaltonen Lauri , Bützow Ralf
Published: April 2022

Uterine leiomyoma (UL) is a common benign neoplasm which can sometimes be difficult to differentiate from the uterine inflammatory myofibroblastic tumor (IMT) based on morphology alone. IMT is a myofibroblastic/fibroblastic neoplasm which has typically been considered to be rare in the uterus. Its clinical behavior is usually indolent although aggressive variants exist. The majority of IMTs harbor genomic rearrangement of anaplastic lymphoma kinase (ALK), while ALK fusion has not been thus far detected in ULs. We analyzed 2263 ULs of which 9 (0.4%) had tyrosine-kinase activation. Seven of the samples were ALK immunopositive: 6 had an ALK fusion gene and 1 overexpressed an ALK transcript skipping exons 2 to 3, Moreover, 1 sample had a RET, and 1 a PDGFRB fusion gene. While no recurrent somatic mutations were found, 1 patient had an ALK germline mutation. Seven tumors showed leiomyoma-like morphology, 1 tumor had slightly loose, and 1 fibrous growth pattern. Six tumors had mild to moderate lymphocyte infiltration, while no immune cell infiltration was detected in 3 cases. None of the tumors showed aggressive behavior. Except for strong ALK positivity (7/9 tumors) the protein expression profile of the tumors was identical to ULs and distinct from other mesenchymal uterine tumors. In gene expression level, these tumors and the known UL subclasses did not separate perfectly. However, vitamin C metabolism and epithelial-mesenchymal transition pathways were uniquely enriched in these lesions. The overall similarity of the analyzed tumors to UL raises the question whether an UL diagnosis would be more proper for a subset of uterine IMTs.
A Retrospective Case Series on Free Flap Reconstruction for Ischemic Diabetic Foot: The Nutrient Flap Further Explained
Authors: Kwon Jin Geun , Cho Min-Jeong , Pak Changsik John , Suh Hyunsuk Peter , Hong Joon Pio
Published: April 2022

Background:

This retrospective case series compares the outcomes and postoperative oxygen levels in patients who underwent free flap versus primary closure/local flap reconstruction for ischemic diabetic foot wounds to determine the influence of free flap on the surrounding ischemic tissues. The authors hypothesized that the free flap would benefit the surrounding ischemic tissue as a nutrient flap by increasing the tissue oxygen content.

Methods:

The patients were divided into two groups: group 1 underwent free flap reconstruction, and group 2 underwent partial foot amputation with primary closure/local flap. Patient demographics, endovascular intervention, surgical outcome, postreconstruction intervention, and prereconstruction and postreconstruction transcutaneous oximetry were analyzed.

Results:

Among 54 patients, 36 were in group 1 and 18 were in group 2. There were no differences in patient demographics between the two groups. All patients had successful angioplasty. Statistical significance was noted in postreconstruction intervention in which group 2 required 2.8 ± 2.9 débridements (versus 1.2 ± 2.5 for group 1) and seven of 18 below-knee amputations (versus three of 36 for group 1) (p < 0.05). Transcutaneous partial pressure of oxygen levels were significantly higher in group 1 at 6 months after reconstruction (61.6 ± 7.5 versus 32.6 ± 5.8 mmHg) (p < 0.01).

Conclusion:

This study shows that the role of the free flap in ischemic diabetic limb may expand beyond that of providing coverage over the vital structures, and it supports the use of the free flap as a nutrient to increase oxygen content in the ischemic diabetic foot.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Comparing forefoot and heel stiffnesses across commercial prosthetic feet manufactured for individuals with varying body weights and foot sizes
Authors: Ruxin Talia R. , Halsne Elizabeth G. , Turner Anne T. , Curran Carl S. , Caputo Joshua M. , Hansen Andrew H. , Hafner Brian J. , Morgenroth David C.
Published: April 2022

Background:

Despite the effects of prosthetic foot mechanical properties on gait of people with lower limb amputation, scant forefoot and heel stiffness data exist to help guide prosthetic foot prescription.

Objective:

To measure forefoot and heel linear stiffness properties across commonly prescribed commercial prosthetic foot models and to describe variations in stiffness across feet targeted for users with different body weights and foot sizes.

Study design:

Mechanical testing of five types of commercial prosthetic feet across nine user body weight and foot size combinations.

Methods:

Linear forefoot and heel stiffness (force vs. displacement) data were collected for 41 prosthetic feet. Quasistatic testing was conducted at −15 and +20 degrees to isolate loading of the heel and forefoot, respectively.

Results:

Overall, there was a significant relationship between user body weight and both forefoot and heel stiffness, when adjusted for foot size and type (P < 0.001). However, there were a substantial number of inconsistencies across foot type within example user body weight and foot sizes combination. Furthermore, the relative order of forefoot stiffness across foot type differed from the relative order of heel stiffness across foot type.

Conclusions:

The inconsistencies and differences in relative order of forefoot and heel stiffness across commercial foot type suggest the importance of publishing objective stiffness and other mechanical properties of prosthetic feet. These data can aid clinicians in better matching mechanical properties of prosthetic feet with the functional goals and abilities of prosthesis users.
Feasibility of reconstructing the glenohumeral center of rotation with a single camera setup
Authors: Haarman Claudia J.W. , Hekman Edsko E.G. , Rietman Johan S. , van der Kooij Herman
Published: April 2022

Background:

An accurate estimation of the glenohumeral joint center of rotation (CoR) is important during alignment of braces and exoskeletons, as a misalignment will introduce undesired forces on the human body. The aim of this research was to develop a new method to estimate the glenohumeral CoR and register the location to the body using a single camera and two printed markers.

Methods:

During shoulder anteflexion, the arm roughly describes an arc in the sagittal plane, with the glenohumeral joint in the center. Two binary square-fiducial ArUco markers were secured to the upper arm and the scapula, their position and orientation were obtained, and a sphere was fitted to the coordinates of the arm marker. The sphere center position was then registered on the skin. The accuracy was assessed with a test bench with a known rotational center. The repeatability was assessed in vivo with five healthy participants.

Results:

The mean absolute offset between the true CoR of the test bench and the fitted sphere centers across multiple trials was 2.7 mm at a velocity of 30 degrees/s, and 2.5 mm at 60 degrees/s. The root mean squared distance from the estimated sphere centers after each trial to the mean sphere center across all trials per participant was 5.1 mm on average for the novice examiner and 5.2 mm for the expert examiner.

Conclusions:

The proposed method is able to accurately and precisely estimate the glenohumeral CoR.
FDG PET/CT and Bone Scintigraphy in Desmoplastic Fibroma of the Bone
Authors: Zhang Jun , Nian Shensheng , Bai Yushu , Dong Aisheng
Published: April 2022

Desmoplastic fibroma is a very rare benign bone tumor with local aggressiveness. We describe imaging findings in 2 cases with desmoplastic fibroma of the bone. One case had a desmoplastic fibroma in the right distal femur, showing bone destruction with sclerotic margins and inhomogeneous FDG uptake. The other case had a desmoplastic fibroma in the left ninth rib, showing progressive peripheral enhancement and increased 99mTc-MDP uptake.
Contrast-Enhanced Ultrasound as a Problem-Solving Modality
Authors: Kim Solomon , Chughtai Komal , Brahmbhatt Akshaar , Rubens Deborah , Dogra Vikram
Published: April 2022

Contrast-enhanced ultrasound (CEUS) continues to be an ever-growing tool in radiation-free imaging. While it has been widely used in cardiac imaging, CEUS has only recently become an Food and Drug Administration–approved and viable modality for evaluation of abdominal structures. Ultrasound contrast agents are nontoxic, microbubble-based vascular agents and can be used to reliably assess enhancement patterns of various lesions in real time. In particular, it's non nephrotoxic nature makes CEUS a particularly important tool in renal failure patients requiring serial follow-up. This review provides a comprehensive discussion on the utility of CEUS agents, imaging techniques, comparison with traditional cross-sectional imaging modalities, and its application in diagnosing kidney and liver lesions. This pictorial review is illustrated with cases of renal and hepatic lesions that the practicing radiologist should become familiar with as CEUS becomes increasingly popular.
Long-Term Visual Prognosis in Patients With Aquaporin-4-Immunoglobulin G–Positive Neuromyelitis Optica Spectrum Disorder
Authors: Moon Yeji , Jang Yeonji , Lee Haeng-Jin , Kim Sung-Min , Kim Seong-Joon , Jung Jae Ho
Published: April 2022

Background:

To identify the factors associated with visual prognosis for functional and structural outcomes of optic neuritis (ON) in patients with aquaporin-4-immunoglobulin (AQP4-IgG)–positive neuromyelitis optica spectrum disorder (NMOSD).

Methods:

We included the eyes that experienced at least 1 episode of ON and were followed for at least 2 years after the first attack of ON in patients with AQP4-IgG–positive NMOSD. We performed a retrospective review of clinical data, including ophthalmological examination and orbital MRI, of 34 eyes of 22 patients. Functional outcomes were measured as final visual acuity, visual field index, and mean deviation and structural outcomes as final retinal nerve fiber layer (RNFL) and ganglion cell–inner plexiform layer (GCIPL) thickness.

Results:

The mean age at onset of the first ON was 42.7 ± 13.7, and all patients were female. The poor visual acuity was significantly associated with the worse final visual acuity and thinner RNFL and GCIPL. Older age also showed a negative correlation with RNFL thickness. The number of attacks was not statistically significant for functional and structural outcomes. The lesion involving the intracanalicular optic nerve to the chiasm on orbital MRI showed worse visual acuity and a thinner GCIPL. Rapid high-dose intravenous methylprednisolone pulse therapy within 3 days was statistically significant, with better visual acuity and more preserved GCIPL thickness.

Conclusions:

Our results indicate that the severity of ON rather than the number of recurrences might be critical for the visual prognosis of patients with AQP4-IgG–positive NMOSD. Rapid treatment within 3 days may improve visual outcomes, and a younger age at onset may have better visual outcomes.
Laparoscopic Ultrasound for Bile Duct Imaging during Cholecystectomy: Clinical Impact in 785 Consecutive Cases
Authors: Deziel Daniel J
Published: April 2022

BACKGROUND:

The influence of laparoscopic ultrasonography (LUS) on the operative management of patients during laparoscopic cholecystectomy (LC) has not been examined in a large unselected series.

STUDY DESIGN:

Seven hundred eight-five consecutive LC operations were reviewed to determine whether the findings of LUS for bile duct imaging altered operative management. Patients were analyzed according to the primary indication for imaging: anatomic identification (group I), possible common bile duct stones (group II), and routine use absent other indications (group III).

RESULTS:

LUS demonstrated the cystic duct–common bile duct junction, the common hepatic duct, the common bile duct to the ampulla, and the right hepatic artery in 95.8% of cases. Among 56 of 111 (50%) patients in group I for whom initial dissection failed to result in adequate anatomic identification, subsequent LUS provided sufficient anatomic identification to allow completion of a laparoscopic operation in 87.5%. Group I patients were more likely to have acute cholecystitis (p < 0.0001) and Tokyo Guidelines 2018 grade II or III acute cholecystitis (p < 0.001). LUS changed operative management for 19 of 256 (7.5%) group II patients and 10 of 361 (2.8%) group III patients by demonstrating common bile duct stones that resulted in common bile duct exploration with stone clearance. Five patients had common bile duct stones that were not detected by LUS. There were no major bile duct or vascular injuries.

CONCLUSIONS:

The primary value of LUS during LC is for anatomic identification when there are severe local inflammatory conditions. In this setting, LUS imaging can facilitate safe completion of LC or an early decision for an alternate operative strategy. When performed primarily for common bile duct stones or as routine practice, LUS results in CBDE for a limited proportion of patients.
Longitudinal Durability of Patient-Reported Pain Outcomes after Targeted Muscle Reinnervation at the Time of Major Limb Amputation
Authors: O’Brien Andrew L , West Julie M , Gokun Yevgeniya , Janse Sarah , Schulz Steven A , Valerio Ian L , Moore Amy M
Published: April 2022

BACKGROUND:

Phantom limb pain (PLP) and residual limb pain (RLP) are debilitating sequelae of major limb amputation. Targeted muscle reinnervation (TMR), when performed at the time of amputation, has been shown to be effective for management of this pain; however, its long-term effects and the longitudinal trend of patient-reported outcomes is unknown. The purpose of this study was to characterize the longitudinal patient-reported outcomes of pain and quality of life following TMR at the time of initial amputation.

STUDY DESIGN:

A prospective case series of patients undergoing major limb amputation with TMR performed at the time of amputation were followed from October 2015 to December 2020 with outcomes measured 3, 6, 12, and 18 months or longer after amputation and TMR. Outcomes included patient-reported severity of PLP and RLP as measured by the numeric rating scale (NRS). Secondary outcomes included the Patient-Reported Outcomes Measurement Information System (PROMIS) Pain Interference and Pain Behavior Questionnaires.

RESULTS:

Eighty-one patients with 83 treated limbs were included in the study, and 23 patients completed surveys at 18 months or later, with an average follow-up time of 2.4 years. By 3 months after operation, all patient-reported outcomes for PLP and RLP were consistent with previously reported data that demonstrated superiority to non-TMR amputees. Mixed-model linear regression analysis showed that PLP NRS severity scores continued to improve over the study period (p = 0.022). The remaining outcomes for RLP severity and PROMIS quality-of-life measures demonstrated that these scores remained stable over the study period (p > 0.05).

CONCLUSION:

TMR is an effective surgical procedure that improves the chances of having reduced RLP and PLP when performed at the time of amputation, and our study demonstrates the long-term durability of its efficacy.
Analysis of Intraoperative Frozen Pancreatic Resection Margin and Prediction of Postoperative Pancreatic Fistula Risk During Pancreatoduodenectomy
Authors: Brunner Maximilian , Kovacevic Jasna , Krautz Christian , Merkel Susanne , Hartmann Arndt , Grützmann Robert , Haller Florian , Weber Georg F
Published: April 2022

BACKGROUND:

Pancreatic duct diameter and pancreatic texture are important predictive factors for a postoperative pancreatic fistula (POPF) and are assessed intraoperatively by the surgeon. However, surgical evaluation is arbitrary and difficult to objectify, especially in minimally invasive approaches in pancreatic surgery.

STUDY DESIGN:

We conducted a retrospective analysis of 275 patients that underwent pancreatoduodenectomy from 2012 to 2019 at our institution. Pancreatic duct diameter and pancreatic fibrosis were assessed by histopathologic examination of the pancreatic resection margin using intraoperative frozen sections and correlated with the occurrence of POPF and clinically relevant POPF (CR-POPF).

RESULTS:

The POPF and CR-POPF rates were 27% and 19%, respectively. Univariate analysis indicated that the indication for surgery, the surgically determined pancreatic duct diameter, and pancreatic texture, as well as the histopathologically determined pancreatic duct diameter and pancreatic fibrosis were significant predictive factors for POPF and CR-POPF. A multivariate analysis revealed histopathologically determined pancreatic duct diameter and pancreatic fibrosis as independent risk factors for POPF (OR [odds ratio] 2.3 [1.1 to 4.5], p = 0.022 and OR 2.4 [1.1 to 5.1], p = 0.023, respectively) and CR-POPF (OR 2.2 [1.1 to 4.8], p = 0.037 and OR 2.6 [1.1 to 6.1], p = 0.036).

CONCLUSIONS:

Histopathologically determined pancreatic duct diameter and pancreatic fibrosis are quantitatively measurable independent risk factors for POPF and CR-POPF. An intraoperative objective histopathologic evaluation of these parameters using frozen sections could support the surgical assessment of the pancreatic duct diameter and the pancreatic texture.