bluuebunny/crossref_metadata_2025 huggingface dataset:
Adaptive interventions for opioid prescription management and consumption monitoring
Authors: Singh Neetu , Varshney Upkar
Published: December 2022

Objectives

While opioid addiction, treatment, and recovery are receiving attention, not much has been done on adaptive interventions to prevent opioid use disorder (OUD). To address this, we identify opioid prescription and opioid consumption as promising targets for adaptive interventions and present a design framework.

Materials and Methods

Using the framework, we designed Smart Prescription Management (SPM) and Smart Consumption Monitoring (SCM) interventions. The interventions are evaluated using analytical modeling and secondary data on doctor shopping, opioid overdose, prescription quality, and cost components.

Results

SPM was most effective (30–90% improvement, for example, prescriptions reduced from 18 to 1.8 per patient) for extensive doctor shopping and reduced overdose events and mortality. Opioid adherence was improved and the likelihood of addiction declined (10–30%) as the response rate to SCM was increased. There is the potential for significant incentives ($2267–$3237) to be offered for addressing severe OUD.

Discussion

The framework and designed interventions adapt to changing needs and conditions of the patients to become an important part of global efforts in preventing OUD. To the best of our knowledge, this is the first paper on adaptive interventions for preventing OUD by addressing both prescription and consumption.

Conclusion

SPM and SCM improved opioid prescription and consumption while reducing the risk of opioid addiction. These interventions will assist in better prescription decisions and in managing opioid consumption leading to desirable outcomes. The interventions can be extended to other substance use disorders and to study complex scenarios of prescription and nonprescription opioids in clinical studies.
Pediatric Postburn Ear Reconstruction of Significant Cartilage Defects
Authors: DePamphilis Matthew A , Buta Martin R , Bojovic Branko , Driscoll Daniel N
Published: December 2022

The external ear is a vulnerable appendage susceptible to trauma. Repairing and recreating its intricate architecture presents a formidable challenge after burn injury, especially when scar tissue, impaired vasculature, and damage to cartilage all influence reconstructive options. The authors share their institutional experience and provide a guide for reconstruction of significant postburn auricular cartilage defects. A retrospective review was conducted on 54 patients (61 ears) aged 0–21 years old admitted to a specialized pediatric burn hospital between January 2004 and January 2021 for postburn ear cartilage reconstruction. Conchal cartilage grafting was performed in 9 patients (9 ears) with an average age of 14.0 ± 5.1 years, requiring an average of 2.0 ± 1.0 procedures that resulted in one case of infection. A total of 21 patients (24 ears) with an average age of 15.1 ± 4.5 years underwent a conchal transposition flap, requiring an average of 1.8 ± 0.4 procedures that resulted in no major complications. A total of 20 patients (23 ears) with an average age of 12.0 ± 5.3 years underwent porous polyethylene implantation, requiring an average of 3.5 ± 1.5 operations that resulted in 3 complications. Costal cartilage grafting was performed in 4 patients (5 ears) with an average age of 13.2 ± 5.3 years, requiring an average of 3.2 ± 2.2 operations that resulted in one case of infection. Postburn ear cartilage defects necessitate an individualized approach tailored to a patient’s reconstructive goals. In addition to defect size and location, factors such as reconstructive course duration, complication potential, and anticipated aesthetic results should be discussed with the patient.
Energy efficiency optimization of water pump based on heuristic algorithm and computational fluid dynamics
Authors: Wang Wenjie , Han Zhenhua , Pei Ji , Pavesi Giorgio , Gong Xiaobo , Yuan Shouqi
Published: December 2022

To reduce the energy consumption of large centrifugal pumps, modified heuristic intelligent algorithms are used to directly optimize the diffuser of centrifugal pumps. Considering the hydraulic efficiency under the design condition as the optimization target, in this study, 14 geometric parameters such as the inlet diameter, outlet diameter, and leading and trailing vane angles of the diffuser are selected as design variables, and the modified particle swam optimization and gravitational search algorithm are used to directly search for optimization in the design space. The performance and loss of internal entropy production of the different models before and after optimization are compared and analyzed in detail. The results show that the global optimization ability of the modified algorithm is improved. The diffuser model changes from cylindrical to twisted, the vane wrap angle increases, and the thickness of the leading edge decreases. Under the design condition, the efficiency of modified particle swarm optimization algorithm solution is increased by 2.75% and modified gravitational search algorithm solution by 2.21%, while the power remains unchanged. Furthermore, the optimization solution has the largest lift efficiency improvement under part-load conditions. After optimization, the unstable flow in the model is improved and internal entropy production loss is reduced significantly. The interior of the diffuser is dominated by turbulent entropy production and direct entropy production under different operating conditions, and the wall entropy production accounts for the smallest proportion.
Efficacy Evaluation of Medium-Chain Fatty Acids as Skin and Spatial Repellents AgainstAedes aegypti(Diptera:Culicidae) Mosquitoes
Authors: Farooq Muhammad , Qualls Whitney A , Bangonan Lea , Xue Rui-De , Peper Steven T , Aryaprema Vindhya S , Benz Kim , Zhu Junwei J
Published: December 2022

Fatty acids derived from natural oils are considered as perspective products for adoption as repellents. Fatty acids derived from coconut oil have shown promise as repellents. This study consisted of an olfactometer evaluation of new formulations containing medium-chain fatty acids for spatial repellency and an in laboratory arm-in cage study for contact repellency against Aedes aegypti L. mosquitoes. Six formulations each of capric acid and lauric acid were evaluated for spatial repellency. These formulations contained 0.28–10% of either capric acid or lauric acid as the active ingredients in a consumer friendly skin care formulation. Base formula without fatty acids was evaluated as control in spatial repellency evaluation. For the arm-in cage evaluations, six formulations of capric acid, one base formulation, and a 7% N,N-diethyl-m-toluamide (DEET) product were tested for contact repellency. For contact repellency, United States Department of Agriculture (USDA) standard repellent test cages were used to determine the complete protection time (CPT) of the different formulated repellents. Among all capric acid formulations tested, the concentration of 2.25% (wt) indicated the best level of spatial repellency, but not significantly different from other concentrations. None of the lauric acid concentrations showed any level of spatial repellency. In the arm-in-cage evaluations, the highest contact repellency resulted from 4.5% capric acid, which was significantly higher than 7% DEET and base formula.
Assisted Death, Dignity, and Respect for Humanity
Authors: Dige Morten
Published: December 2022

Recent works on the concept of dignity have opened up the otherwise quite deadlocked debate about assisted death (AD). Rather than just reinforcing already fixed positions, it seems to me that these conceptions of dignity make room for a moderate and normatively richer position on the moral permissibility of AD. I do not think that we have seen the full potential of the said conceptions and interpretations. I try in this article to contribute my part. First, I briefly recapitulate some of the paradoxical ways in which dignity is typically invoked in the debate and try to clear up some of the obvious confusions. Then, I go on to explore a particular Kantian line of thought in some recent works on dignity and AD that seems to pave the way for a moderate position with a more principled foundation than the usual compromise positions.
Moral Injury, Moral Identity, and “Dirty Hands” in War Fighting and Police Work
Authors: Miller Seumas
Published: December 2022

In this article, I undertake three main tasks. First, I argue that, contrary to the standard view, moral injury is not a species of PTSD (post-traumatic stress disorder) but rather, on the most coherent conception of moral injury, PTSD is (in effect) a species of moral injury. In doing so, I make use of the notion of caring deeply about something or someone worthy of being cared deeply about. Second, I consider so-called “dirty hands” actions in police work and in war, and distinguish these from the morally legitimate, but harmful, actions of police officers and of war fighters, such as the morally legitimate use of coercive force and lethal force (respectively). While the morally legitimate use of harmful methods is constitutive of these occupational roles, “dirty hands” methods are not. Roughly speaking, a “dirty hands” action is one that is morally wrong and (typically) unlawful but done for the sake of a good outcome. Both categories of action are conducive to moral injury, but “dirty hands” actions much more so, especially given the slippery moral slope from “dirty hands” actions to egregious moral wrongdoing. Third, I offer some recommendations for reducing moral injury among police officers and war fighters.
Being in Relation, Being through Change
Authors: Fitzgerald Martin J
Published: December 2022

Ethics exists among beings that can relate to one another and who can create change in one another. Although this may appear as a simple truism, the implications of relation and change in bioethics are manifold. For instance, one can relate not only to others, but also can enter into self-relation by relating to oneself. Self-relation problematizes autonomy insofar as one does not have immediate access to all of oneself and so therefore also does not immediately fully determine oneself in the way that an uncomplicated understanding of autonomy might imply. This article proceeds as a preliminary exposition of the concepts of relation and change as they apply to bioethics, particularly as they inform autonomy, action theory, and the porous subject.
Plant long non-coding RNAs: biologically relevant and mechanistically intriguing
Authors: Yang Jun , Ariel Federico , Wang Dong
Published: December 2022

Long non-coding RNAs (lncRNAs) are a group of RNAs greater than 200 nucleotides in length exhibiting low or no coding potential that are involved in diverse biological functions through their molecular interaction with proteins, DNA, or other RNAs. With the emergence of advanced high-throughput RNA sequencing technologies, tens of thousands of novel long non-coding RNAs have been identified in plant transcriptomes in the last decade. More importantly, functional studies revealed that several lncRNAs play key regulatory roles in plant development and stress responses. In this review, we focus on summarizing recent progress uncovering regulatory roles and mechanisms of lncRNAs during the plant life cycle, and briefly discuss the possible biotechnological applications of lncRNAs for plant breeding.
Genomic Consequences of and Demographic Response to Pervasive Hybridization Over Time in Climate-Sensitive Pikas
Authors: Ge Deyan , Wen Zhixin , Feijó Anderson , Lissovsky Andrey , Zhang Wei , Cheng Jilong , Yan Chaochao , She Huishang , Zhang Dezhi , Cheng Yalin , Lu Liang , Wu Xinlai , Mu Danping , Zhang Yubo , Xia Lin , Qu Yanhua , Vogler Alfried P , Yang Qisen
Published: December 2022

Rare and geographically restricted species may be vulnerable to genetic effects from inbreeding depression in small populations or from genetic swamping through hybridization with common species, but a third possibility is that selective gene flow can restore fitness (genetic rescue). Climate-sensitive pikas (Ochotona spp.) of the Qinghai–Tibetan Plateau (QHTP) and its vicinity have been reduced to residual populations through the movement of climatic zones during the Pleistocene and recent anthropogenic disturbance, whereas the plateau pika (O. curzoniae) remains common. Population-level whole-genome sequencing (n = 142) of six closely related species in the subgenus Ochotona revealed several phases of ancient introgression, lineage replacement, and bidirectional introgression. The strength of gene flow was the greatest from the dominant O. curzoniae to ecologically distinct species in areas peripheral to the QHTP. Genetic analyses were consistent with environmental reconstructions of past population movements. Recurrent periods of introgression throughout the Pleistocene revealed an increase in genetic variation at first but subsequent loss of genetic variation in later phases. Enhanced dispersion of introgressed genomic regions apparently contributed to demographic recovery in three peripheral species that underwent range shifts following climate oscillations on the QHTP, although it failed to drive recovery of northeastern O. dauurica and geographically isolated O. sikimaria. Our findings highlight differences in timescale and environmental background to determine the consequence of hybridization and the unique role of the QHTP in conserving key evolutionary processes of sky island species.
Sodium-based batteries: development, commercialization journey and new emerging chemistries
Authors: Yadav Poonam , Shelke Vilas , Patrike Apurva , Shelke Manjusha
Published: December 2022

Development, commercialization and use of Li-ion batteries (LIBs) will reach their peak soon. At present, this is posing the future risk of supply of raw materials for LIBs due to their restricted distribution and lack of effective Li-recycling technology. Sodium-based batteries (SBBs) are considered the best alternative to LIBs due to their similarity in chemistries and fabrication techniques. However, SBB technology does not have high energy density and is not mature enough yet to meet the energy requirement of wide application sectors. Scientists are optimizing different anode, cathode and electrolyte materials, and fabrication techniques to boost the electrochemical performance of SBB. Several companies have been founded to commercialize the SBB technology. This review summarizes the development of different SBB chemistries and their commercialization by companies. It also discusses chemistries that seem promising in the future development and commercialization of SBBs.
Mitochondrial H2S donor AP39 induces stomatal closure by modulating guard cell mitochondrial activity
Authors: Pantaleno Rosario , Scuffi Denise , Costa Alex , Welchen Elina , Torregrossa Roberta , Whiteman Matthew , García-Mata Carlos
Published: December 2022

Hydrogen sulfide (H2S) is a gaseous signaling molecule involved in numerous physiological processes in plants, including gas exchange with the environment through the regulation of stomatal pore width. Guard cells (GCs) are pairs of specialized epidermal cells that delimit stomatal pores and have a higher mitochondrial density and metabolic activity than their neighboring cells. However, there is no clear evidence on the role of mitochondrial activity in stomatal closure induction. In this work, we showed that the mitochondrial-targeted H2S donor AP39 induces stomatal closure in a dose-dependent manner. Experiments using inhibitors of the mitochondrial electron transport chain (mETC) or insertional mutants in cytochrome c (CYTc) indicated that the activity of mitochondrial CYTc and/or complex IV are required for AP39-dependent stomatal closure. By using fluorescent probes and genetically encoded biosensors we reported that AP39 hyperpolarized the mitochondrial inner potential (Δψm) and increased cytosolic ATP, cytosolic hydrogen peroxide levels, and oxidation of the glutathione pool in GCs. These findings showed that mitochondrial-targeted H2S donors induce stomatal closure, modulate guard cell mETC activity, the cytosolic energetic and oxidative status, pointing to an interplay between mitochondrial H2S, mitochondrial activity, and stomatal closure.
EVALUATION OF ELECTROMAGNETIC FIELDS IN HUMAN BODY EXPOSED TO INVERTER OF PURE ELECTRIC VEHICLE
Authors: Dong XuWei , Sun WenXue , Lu Mai
Published: December 2022

On the basis of the basic principle of electromagnetic dosimetry, the paper studies the electromagnetic exposure of a passenger’s body to a compound electromagnetic field caused by the combined action of DC and AC bus currents of a pure electric vehicle inverter. By building an electromagnetic model of a pure electric vehicle body, adult human body and inverter, the finite element method is used to calculate the magnetic induction intensity(|B|), induced electric field intensity(|E|) and induced current density(|J|) of the compound electromagnetic field to the human trunk and central nervous system in the driver and front seat passenger. The numerical results are compared with the exposure limits defined by the International Commission on Non-Ionizing Radiation Protection (ICNIRP). The fields are well below the safe exposure limits defined by ICNIRP.
Online panel work through a gender lens: implications of digital peer review meetings
Authors: Peterson Helen , Husu Liisa
Published: December 2022

Previous studies have highlighted how the academic peer review system has been marked by gender bias and nepotism. Panel meetings arranged by research funding organisations (RFOs), where reviewers must explain and account for their assessment and scoring of grant applications, can potentially mitigate and disrupt patterns of inequality. They can however also constitute arenas where biases are reproduced. This article explores, through a gender lens, the shift from face-to-face to digital peer review meetings in a Swedish RFO, focusing on the implications for an unbiased and fair grant allocation process. Drawing on twenty-two interviews with panellists and staff in the RFO, the analysis identifies both benefits and challenges of this shift, regarding use of resources, meeting dynamics, micropolitics, social glue, and possibilities for group reflections. RFOs deliberating digitalisation of their peer review processes need to consider these implications to develop policies promoting unbiased and fair grant allocation processes and procedures.
Navigating uncertainty in networks of social exchange: a relational event study of a community currency system
Authors: Hoffmann Jakob , Glückler Johannes
Published: December 2022

This article analyzes the structure of socially embedded exchange under uncertainty in the context of a community currency system in Germany. We discuss three relational and path-dependent mechanisms—experience-based trust, networked reputation and public reputation—which serve as navigation practices to mitigate uncertainty. We furthermore associate these mechanisms with observable structures of exchange, namely repeated transactions and reciprocity, transitivity and provider activity, and discuss differences in product-inherent uncertainty as a source of variation in network structure. Based on original observations of more than 4000 transactions over a period of 8 years, we use relational event models to demonstrate that the history of transactions exhibits structure consistent with the three hypothesized mechanisms, with some variation across different types of transactions. This variation is partly in line with differences in product-inherent uncertainty, but we also discuss alternative sources of variation related to organizational and institutional conditions of the exchange system.
Increased muscle activity during sleep and more RBD symptoms in H1N1-(Pandemrix)-vaccinated narcolepsy type 1 patients compared with their non-narcoleptic siblings
Authors: Viste Rannveig , Follin Louise F , Kornum Birgitte R , Lie Benedicte A , Viken Marte K , Thorsby Per M , Rootwelt Terje , Christensen Julie A E , Knudsen-Heier Stine
Published: December 2022

Study Objectives

Narcolepsy type 1 (NT1) is characterized by unstable sleep-wake and muscle tonus regulation during sleep. We characterized dream enactment and muscle activity during sleep in a cohort of post-H1N1 NT1 patients and their siblings, and analyzed whether clinical phenotypic characteristics and major risk factors are associated with increased muscle activity.

Methods

RBD symptoms and polysomnography m. tibialis anterior electromyographical signals [long (0.5–15 s); short (0.1–0.49 s)] were compared between 114 post-H1N1 NT1 patients and 89 non-narcoleptic siblings. Association sub-analyses with RBD symptoms, narcoleptic symptoms, CSF hypocretin-1 levels, and major risk factors [H1N1-(Pandemrix)-vaccination, HLA-DQB1*06:02-positivity] were performed.

Results

RBD symptoms, REM and NREM long muscle activity indices and REM short muscle activity index were significantly higher in NT1 patients than siblings (all p < 0.001). Patients with undetectable CSF hypocretin-1 levels (<40 pg/ml) had significantly more NREM periodic long muscle activity than patients with low but detectable levels (40–150 pg/ml) (p = 0.047). In siblings, REM and NREM sleep muscle activity indices were not associated with RBD symptoms, other narcolepsy symptoms, or HLA-DQB1*06:02-positivity. H1N1-(Pandemrix)-vaccination status did not predict muscle activity indices in patients or siblings.

Conclusion

Increased REM and NREM muscle activity and more RBD symptoms is characteristic of NT1, and muscle activity severity is predicted by hypocretin deficiency severity but not by H1N1-(Pandemrix)-vaccination status. In the patients’ non-narcoleptic siblings, neither RBD symptoms, core narcoleptic symptoms, nor the major NT1 risk factors is associated with muscle activity during sleep, hence not indicative of a phenotypic continuum.
Overnight emotional inertia in relation to depressive symptomatology and subjective sleep quality
Authors: Frérart Liesse , Bilsen Lauren , Dejonckheere Egon , Kuppens Peter
Published: December 2022

Emotions show a certain degree of continuity during the day, a quality referred to as emotional inertia, and that is typically elevated in depression. Little is known however about the extent to which our emotional experiences may or may not also persist overnight. Do our feelings continue from evening to morning or not? And how is this related to depressive symptoms and sleep quality? In an experience sampling studies in healthy subjects (ns = 123) we investigated (1) to what extent people’s mood, in terms of positive and negative affect, in the morning, after a night of sleep, can be predicted from their mood of the evening before, and whether this is moderated by (2) depressive symptom severity or (3) subjective sleep quality. Results showed that morning negative affect could be strongly predicted based on previous evening negative affect, whilst this carry-over effect was not observed for positive affect, indicating that negative affect shows a general tendency to persist overnight, while positive affect did not show such continuity. The overnight prediction of both negative and positive affect was not moderated by level of depressive symptoms, nor by subjective sleep quality.
Trustees cannot ask Argentine Courts for guidance (Macri, Mauricio c/Inspección General de Justicia)
Authors: Malumián Nicolás
Published: December 2022

One of the questions most commonly asked to practitioners by trustees is if it is possible to request advice, or a binding order from a Judge, on the right course of action. Obviously, such possibility would preclude any further discussion of the responsibility of the trustee (that followed the judicial advice or instruction). This request is possible in most jurisdictions on tax issues, but is not possible on business or other issues. Argentina is no exception, and this case explains the applicable law.
Knowledge and participation in mass drug administration against lymphatic filariasis and soil-transmitted helminth infections among the community members in Dar es Salaam, Tanzania
Authors: Ngunyali Diana A , Mpomele Stella S , Kilonzi Manase , Mutagonda Ritah F , Mikomangwa Wigilya P , Mlyuka Hamu J , Kibanga Wema , Marealle Alphonce Ignace
Published: December 2022

Background

Although the WHO has made an effort to ensure optimal participation of the community in mass drug administration (MDA) against lymphatic filariasis (LF) and soil-transmitted helminth infections (STHIs), studies are still reporting suboptimal coverage. This study assessed the knowledge and participation of the community in MDA against LF and SHTIs in Tanzania to provide updates on its acceptability.

Methods

A cross-sectional study was conducted in Dar es Salaam from December 2021 to February 2022 among market vendors. The information regarding demographic characteristics, knowledge and participation in MDA was collected using a questionnaire. Statistical Package for Social science version 26 was used for data analysis.

Results

More than half of the participants demonstrated an adequate level of knowledge of LF and STHI, 212 (50.8%) and 267 (64%), respectively. Only 286 (68.5%) reported having heard about MDA against LF and STHIs, out of which 119 (42%) had taken the medication. Of those who disagreed to participate in MDA, 20 (50%) claimed to fear the side effects of the medication.

Conclusions

This study found that the community has average knowledge and poor participation in MDA against LF and STHIs. Community sensitization is recommended to increase the participation of the community.
Impact of healthcare strain on access to mechanical ventilation and mortality of hospitalized COVID-19 patients: a retrospective cohort study
Authors: Núñez Isaac , Soto-Mota Adrian
Published: December 2022

Objective

Healthcare saturation has been a prominent worry during the COVID-19 pandemic. Increase of hospital beds with mechanical ventilators has been central in Mexico's approach, but it is not known whether this actually improves access to care and the resulting quality of it. This study aimed to determine the impact of healthcare strain and other pre-specified variables on dying from coronavirus disease 2019 (COVID-19) without receiving invasive mechanical ventilation (IMV).

Methods

A retrospective cohort study was conducted using open data from Mexico City between 8 May 2020 and 5 January 2021. We performed Cox proportional hazards models to identify the strength of the association between proposed variables and the outcomes.

Results

Of 33 797 hospitalized patients with suspected or confirmed COVID-19, 19 820 (58.6%) did not require IMV and survived, 5414 (16.1%) required IMV and were intubated and 8563 (25.3%) required IMV but died without receiving it. A greater occupation of IMV-capable beds increased the hazard of death without receiving IMV (hazard ratio [HR] 1.56, comparing 90% with 50% occupation). Private healthcare was the most protective factor for death without IMV (HR 0.14).

Conclusions

Higher hospital bed saturation increased the hazard of dying without being intubated and worsened the outcomes among mechanically ventilated patients. Older age also increased the hazard of the outcomes, while private healthcare dramatically decreased them.
Reekeekee- and roodoodooviruses, two different Microviridae clades constituted by the smallest DNA phages
Authors: Olo Ndela Eric , Roux Simon , Henke Christian , Sczyrba Alexander , Sime Ngando Télesphore , Varsani Arvind , Enault François
Published: December 2022

Small circular single-stranded DNA viruses of the Microviridae family are both prevalent and diverse in all ecosystems. They usually harbor a genome between 4.3 and 6.3 kb, with a microvirus recently isolated from a marine Alphaproteobacteria being the smallest known genome of a DNA phage (4.248 kb). A subfamily, Amoyvirinae, has been proposed to classify this virus and other related small Alphaproteobacteria-infecting phages. Here, we report the discovery, in meta-omics data sets from various aquatic ecosystems, of sixteen complete microvirus genomes significantly smaller (2.991–3.692 kb) than known ones. Phylogenetic analysis reveals that these sixteen genomes represent two related, yet distinct and diverse, novel groups of microviruses—amoyviruses being their closest known relatives. We propose that these small microviruses are members of two tentatively named subfamilies Reekeekeevirinae and Roodoodoovirinae. As known microvirus genomes encode many overlapping and overprinted genes that are not identified by gene prediction software, we developed a new methodology to identify all genes based on protein conservation, amino acid composition, and selection pressure estimations. Surprisingly, only four to five genes could be identified per genome, with the number of overprinted genes lower than that in phiX174. These small genomes thus tend to have both a lower number of genes and a shorter length for each gene, leaving no place for variable gene regions that could harbor overprinted genes. Even more surprisingly, these two Microviridae groups had specific and different gene content, and major differences in their conserved protein sequences, highlighting that these two related groups of small genome microviruses use very different strategies to fulfill their lifecycle with such a small number of genes. The discovery of these genomes and the detailed prediction and annotation of their genome content expand our understanding of ssDNA phages in nature and are further evidence that these viruses have explored a wide range of possibilities during their long evolution.
Implementing change in the care of the complex cardiac patient
Authors: Rus Ioana A. , Kudela Molly , Suffredini Giancarlo , Ariyo Promise T. , Hensley Nadia B. , Abernathy James H.
Published: December 2022

Purpose of review

Development of advanced and minimally invasive surgical procedures is providing treatment opportunities to older and higher risk patients. This has also led to highly specialized physicians and a need for better communication and planning with the patients and within the care team.

Recent findings

In the field of cardiac surgery, the heart team model has been advocated and implemented as a vehicle to optimize decision making prior to procedure, care during the procedure and in the recovery process. The goal is to provide a treatment path that prioritizes the patient's goals and to anticipate and minimize complications.

In this review, we discuss the concepts of shared decision making (SDM) and implementation science in the context of the complex cardiac patient. We also review the most recent evidence for their use in cardiac surgery. We argue that a team model not only bridges knowledge gaps but provides a multidisciplinary environment for the practice of SDM and implementation of evidence-based practices. Be believe this will provide patients with a better experience as they navigate their care and improve their medical outcomes as well.
How, when and why to establish preoperative surgical risk in thoracic surgery
Authors: Coleman John R. , Hanson Neil A.
Published: December 2022

Purpose of review

Emphasizing a systems-based approach, we discuss the timing for referral for perioperative surgical consultation. This review then highlights several types of comorbidities that may complicate thoracic procedures, and references recent best practices for their management.

Recent findings

Patients requiring thoracic surgeries present some of the most challenging cases for both intraoperative and postoperative management. The recent SARS-CoV-2 pandemic has only exacerbated these concerns. Effective preoperative optimization, however, provides for identification of patient comorbidities, allowing for mitigation of surgical risks. This kind of planning is multidisciplinary by nature. We believe patients benefit from early engagement of a dedicated preoperative clinic experienced for caring for complex surgical patients.

Optimizing patients for thoracic surgery can be challenging for small and large health systems alike. Implementation of evidence-based guidelines can improve care and mitigate risk. As surgical techniques evolve, future research is needed to ensure that perioperative care continues to progress.
Presurgical radiation and chemotherapy in preparation for thoracic tumor resection
Authors: Tavakoli Iran , Turner Simon R. , Diaz-Gutierrez Ilitch
Published: December 2022

Purpose of review

This article aims at describing the role of neoadjuvant chemotherapy, radiation therapy as well the novel immunotherapy and targeted therapy in thoracic oncology with focus on anesthetic considerations of such treatments for the surgical patient.

Recent findings

In recent years, immune check point inhibitors have changed the landscape of thoracic oncology treatment. In this review, we summarize the key studies that have been fundamental in this change.

Rather than a comprehensive review, the purpose of this work is to provide the reader with an overview of the most common neoadjuvant regimens used in current practice, with the corresponding most prevalent adverse effects as it pertains for patients with esophageal and lung cancer, malignant pleural mesothelioma and mediastinal tumors. Considerations relevant to the anesthesiologist, including specific toxicities related to each treatment type, and the impact of each treatment type on perioperative outcomes and complications will be discussed.
Low-dose interleukin-2 therapy: a promising targeted therapeutic approach for systemic lupus erythematosus
Authors: Akbarzadeh Reza , Riemekasten Gabriela , Humrich Jens Y.
Published: December 2022

Purpose of review

Low-dose interleukin-2 (IL-2) therapy is increasingly recognized as a promising novel therapeutic concept in inflammatory and autoimmune diseases, in particular in systemic lupus erythematosus (SLE). As IL-2 is indispensable for the growth and survival of regulatory T cells (Treg), deficiency of this regulatory cytokine plays a significant role in immune dysregulation and breach of tolerance in SLE. Recovery of Treg activity by low-dose IL-2 therapy directly interferes with the immune pathology in SLE and thus can be considered a targeted treatment approach with a unique and physiological mode of action.

Recent findings

In this review, the pathophysiological rationales behind the concept of low-dose IL-2 therapy in SLE will be explained and major advances in translational research and the clinical development of low-dose IL-2 therapy focusing on the results from two recent, randomized and placebo-controlled phase 2 trials will be highlighted.

Several clinical studies including two recent randomized trials have proven the very good safety profile of low-dose IL-2 therapy and its capability to selectively recover and expand the Treg population in patients with active SLE. Given the emerging evidence for the clinical potential of low-dose IL-2 therapy in SLE, these studies strongly confirm the pathophysiological concept behind this targeted therapeutic approach in SLE and provide a robust basis for establishing further in-depth and confirmatory clinical trials testing the application of low-dose IL-2 in SLE and other autoimmune diseases.
CD3high and FoxP3− tumor-infiltrating lymphocytes in the invasive margin as a favorable prognostic marker in patients with invasive urothelial carcinoma of the bladder
Authors: Sun Zi-Jun , Zhao Jing-Wen , Zhao Ming , Chen Yuan , Zhang Xin , Li Hai-Chang , Wu Guo-Qing , Zhang Da-Hong
Published: December 2022

Tumor-infiltrating lymphocytes (TILs) have been extensively explored as prognostic biomarkers and cellular immunotherapy methods in cancer patients. However, the prognostic significance of TILs in bladder cancer remains unresolved. We evaluated the prognostic effect of TILs in bladder cancer patients. Sixty-four bladder cancer patients who underwent surgical resection between 2018 and 2020 in Zhejiang Provincial People’s Hospital were analyzed in this study. Immunohistochemistry was used to evaluate CD3, CD4, CD8, and FoxP3 expression on TILs in the invasive margin of tumor tissue, and the presence of TIL subsets was correlated with the disease-free survival (DFS) of bladder cancer patients. The relationship between clinical-pathological features and DFS were analyzed. A high level of CD3+TILs (CD3highTILs) (P = 0.027) or negative expression of FoxP3 TILs (FoxP3− TILs) (P = 0.016) was significantly related to better DFS in bladder cancer patients. Those with CD3highFoxP3− TILs had the best prognosis compared to those with CD3highFoxP3+ TILs or CD3lowFoxP3− TILs (P = 0.0035). Advanced age [HR 4.57, (1.86–11.25); P = 0.001], CD3low TILs [HR 0.21, (0.06–0.71); P = 0.012], CD8low TILs [HR 0.34, (0.12–0.94); P = 0.039], and FoxP3+ TILs [HR 10.11 (1.96–52.27); P = 0.006] in the invasive margin were associated with a worse prognosis (DFS) by multivariate analysis. In conclusion, we demonstrated that CD3high, FoxP3−, and CD3highFoxP3− TILs in the invasive margin were significantly associated with better DFS. CD8high and CD4high TILs in the invasive margin tended to predict better DFS in bladder cancer. Patients with CD4highCD8high TILs in the invasive margin were likely to have a better prognosis.
Airway management in a patient with Stevens-Johnson syndrome/toxic epidermal necrolysis: a case report
Authors: Morrison-Nozik Alexander , Schechtman Samuel , Wixson Matthew , Khatibi Nabi
Published: December 2022

Stevens-Johnson syndrome (SJS), of which toxic epidermal necrolysis (TEN) is a more severe variant, is a cutaneous hypersensitivity reaction, usually triggered by certain prescribed medications. Airway management in SJS/TEN poses significant challenges, particularly when there is facial skin and oropharyngeal mucosal and/or laryngeal involvement. There is limited literature guiding definitive airway management in patients with severe SJS/TEN. We describe a case utilizing transnasal humidified rapid insufflation ventilatory exchange (THRIVE) to preoxygenate and maintain apneic oxygenation as a means of avoiding facemask ventilation and excessive airway instrumentation in a patient with SJS/TEN involving the face and oral mucosa. This case report demonstrates the use of THRIVE as a tool to optimize oxygenation and safe airway management in situations where conventional approaches may be challenging.
Theory of Pivoting Uncertainties
Authors: Dzou Tiffany , Eastwood Jo-Ann , Doering Lynn , Pavlish Carol , Pieters Huibrie
Published: December 2022

Background

Individuals living with mechanical circulatory support (MCS) devices are confronted with risks for catastrophic outcomes such as stroke and systemic infection. Considering these complexities, ongoing advance care planning (ACP) is important for shared decision making.

Objective

The purpose of this study was to describe how experiences of the MCS trajectory informed decision making about ACP.

Methods

All aspects of the research were guided by constructivist grounded theory. Focused conversations were conducted with a semistructured interview guide.

Results

A total of 24 community-dwelling patients living with MCS were interviewed (33% female; mean age, 60.6 years; 50% White). Participants were implanted with MCS (average duration, 29.8 months; bridge to transplant, 58%). Reflected in the narratives were tensions between initial expectations of living with the device in contrast with the realities that emerged over time. A crucial finding was that ACP decision making pivoted around the growing awareness of uncertainties in the MCS trajectory. Yet, clinicians were perceived to be silent in initiating ACP, and their reticence was understood as a sign of encouragement to hold on to hope for a heart transplant. The complex and dynamic decision-making processes around ACP were organized into the theory of pivoting uncertainties.

Conclusions

In this sample, patients were ready to share their concerns about the uncertainties of living with MCS and waited for MCS clinicians to initiate ACP. The theory of pivoting uncertainties is useful for elucidating the ebb and flow of ACP and lending clinicians' guidance for opportunities to initiate these sensitive conversations.
“The Superficial Fascia System: Anatomical Guideline for Zoning in Liposuction-Assisted Back Contouring.”
Authors: Si Loubin , Li Hairui , Li Zhijin , Zhang Mingzi , Chen Xi , Yu Lu , Wang Hayson Chenyu , Wang Yang
Published: December 2022

Background:

Dorsal contour deformity presents with different manifestations in each part of the back, such as back rolls, iliac crest deposit, and buffalo hump. However, scant current literature exists on the anatomical basis of dorsal contour deformity. The aim of this study is to better understand the anatomical characteristics of the back, in order to propose evidence-based zoning principles for liposuction-assisted back contouring.

Method:

A total of 12 fresh cadavers were dissected for observation of each hierarchy in the vertical order (skin-to-deep fascia) and transverse comparison of the superficial fascial system (SFS) in the scapular-infrascapular-lumbar triangle region. Full-dorsum vectorial sections were used for the study of suprascapular fat deposits.

Results:

The SFS acts as a bridge connecting all levels of the dorsal subcutaneous tissue. Macroscopically, it is denser in the scapular and lumbar triangle regions and looser in the infrascapular region, and microscopically, the ultrastructure of the retinaculum cutis consists of loose interlobular fascia and stiff functional fascia.

Conclusion:

The regional variation pattern of the SFS in the back was consistent with observed back contour deformities in Asian females. A better understanding of the topographic anatomy of the back applied to evidenced zoning is the basis for improving surgical precision and avoiding dorsal contour deformity.
18F-FDG PET/CT Findings of Leptomeningeal Metastasis in Nasopharyngeal Carcinoma
Authors: Montanarella Matthew , Boldig Kimberly , Natter Patrick , Ozdemir Savas
Published: December 2022

Nasopharyngeal carcinoma (NC) is an epithelial tumor with distinctive prevalence in East and Southeast Asia. Most patients with NC only experience regional metastasis. In cases of distant metastasis, prognosis is grim. Leptomeningeal spread of the disease is a rare occurrence, which is sparsely described in the literature. We present a case of a 33-year-old man with a history of high-grade NC with leptomeningeal metastasis. Initial MRI lumbar spine demonstrated subtle findings consistent with leptomeningeal disease. These findings are easily discernible on 18F-FDG PET/CT.
HYPOTENSION AT THE TIME OF SEPSIS RECOGNITION IS NOT ASSOCIATED WITH INCREASED MORTALITY IN SEPSIS PATIENTS WITH NORMAL LACTATE LEVELS
Authors: Kim Ji Hwan , Kim Yong Kyun , Oh Dong Kyu , Jeon Kyeongman , Ko Ryoung-Eun , Suh Gee Young , Lim Sung Yun , Lee Yeon Joo , Cho Young-Jae , Park Mi-Hyeon , Hong Sang-Bum , Lim Chae-Man , Park Sunghoon ,   On behalf of the Korean Sepsis Alliance (KSA) investigators
Published: December 2022

Background and Objective: Although sepsis is heterogeneous, data on sepsis patients with normal lactate levels are very limited. We explored whether hypotension at the time of sepsis recognition (i.e., time zero) was significant in terms of survival when lactate levels were normal in sepsis patients. Patients and Design: This was a prospective multicenter observational study conducted in 19 hospitals (20 intensive care units [ICUs]). Adult sepsis patients with normal lactate levels (≤2 mmol/L) admitted to ICUs were divided by the mean arterial pressure at time zero into hypotensive (<65 mm Hg) and nonhypotensive groups (≥65 mm Hg). Measurements and Results: Of 2,032 patients with sepsis (not septic shock), 617 with normal lactate levels were included in the analysis. The hypotensive group (n = 237) was characterized by higher rates of abdominal or urinary infections, and bacteremia, whereas the nonhypotensive group (n = 380) was characterized by higher rates of pulmonary infections and systemic inflammatory response. However, the Simplified Acute Physiology Score 3 and Sequential Organ Failure Assessment score (excluding the cardiovascular score) were not different between the groups. During sepsis resuscitation, the rates of antibiotic administration within 1, 3, and 6 h of time zero were higher in the hypotensive than nonhypotensive group (P < 0.05 for all time points), and the amounts of pre-ICU fluids given were also higher in the hypotensive group. However, despite a higher rate of vasopressor use in the hypotensive group, ICU and in-hospital mortality rates were not different between the groups (12.7% vs. 13.9% [P = 0.648] and 19.4% vs. 22.4% [P = 0.382], respectively). In multivariable analysis, the use of appropriate antibiotics and early lactate measurement were significant risk factors for in-hospital mortality. Conclusions: In sepsis patients with normal lactate levels, neither hypotension nor vasopressor use adversely impacted the hospital outcome. Our results emphasize the importance of early interventions and appropriate use of antibiotics regardless of whether a patient is or is not hypotensive.
Tau PET visual reads find sources of tau not explained by typical Alzheimer disease pathophysiology
Authors: Chen Charles D. , Ponisio Maria Rosana , Lang Jordan A. , Flores Shaney , Schindler Suzanne E. , Fagan Anne M. , Morris John C. , Benzinger Tammie L.S.
Published: December 2022

18F-flortaucipir-PET received FDA approval to visualize tauopathy in the brains of adult patients with cognitive impairment being evaluated for Alzheimer disease (AD). However, manufacturer’s guidelines for the visual interpretation of18F-flortaucipir-PET differs greatly from how18F-flortaucipir-PET has been measured in research settings using standardized uptake value ratios (SUVRs). How visual interpretation relates to18F-flortaucipir-PET SUVR, CSF biomarkers, or longitudinal clinical assessment is not well understood. Here we compare these various diagnostic methods in participants enrolled in studies of aging and memory (n=189, of whom 23 were cognitively impaired). Visual interpretation had high agreement with SUVR (98.4%); discordant participants had hemorrhagic infarcts or atypical AD tauopathies. Visual interpretation had moderate agreement with CSF p-tau181 (86.1%). Two participants demonstrated18F-flortaucipir uptake from meningiomas. Visual interpretation could not predict follow-up clinical assessment in 9.52% of cases. We conclude that close association between AD tauopathy and clinical onset in group-level studies does not always hold at the individual level, with discrepancies arising from atypical AD, vascular dementia, or frontotemporal dementia. A better understanding of relationships across imaging, CSF biomarkers, and clinical assessment is needed to provide appropriate diagnoses for these individuals.