bluuebunny/crossref_metadata_2025 huggingface dataset:
Access Failure
Authors: Ribot Jesse
Published: January 2023

In the 1950s and 1970s, Josué de Castro and Amartya Sen showed that hunger and famine are not caused by mere food availability decline; indeed, during most modern times of hunger and famine, there was enough food for everyone. Food crises stem from maldistribution and well-functioning markets that allocate food away from the hungry. Sen shows that people cannot obtain enough food when their entitlements (legal means), made up of assets (land, labor, cash, stocks) and social protections (formal and informal networks of support), are inadequate—“entitlement failure.” Climate’s relation to crisis is now similarly misunderstood. Today, we often describe crises—hunger, famine, dislocation, or economic loss—as outcomes of climate change or extreme weather. Yet these crises are not caused by mere weather. The damage is enabled by the human vulnerabilities that weather finds in place. Building on Sen’s entitlements approach, this chapter explores, via a case of dangerous emigration from the Sahel toward Europe, how to identify the deep roots of crisis by starting with and tracing chains of causality from instances of “access failure”—moments in which people fail to access the necessities for security or for fulfilling their aspirations.
Land-Making as State-Making
Authors: Sud Nikita
Published: January 2023

The relationship between land and the state is co-productive. As the state makes the land, it is also shaped by this land-making in turn. In the recent history of the global South, land-making as state-making implicated the colonial state. This state controlled land and made the inhabitants of the land its subjects. Later, the postcolonial modernizing state sought to transform land in keeping with its developmental vision, in tandem with societal elites. The elite appropriation of the development project was furthered under economic liberalization, with global capital being promoted in zoned development on once-sovereign land. Yet, land-making as state-making cannot be read only from the perspective of the formal, high state. Thus, the chapter also highlights land-making as state-making from below. It shows aspirational intermediaries in land inserting themselves in contemporary land-making projects in field sites in western India. In the process, these middlemen who are on the edges of informalized authority broaden the domains of the state, and also of access to land. They assert their subjecthood through the continual making and re-making of the socially embedded state via multi-dimensional land. Amid the climate crisis, this is an argument for appreciating mutuality between humans and nature across space, scales, and time.
Land Alienation, Proletarianization, and Changing Labor Market Regimes in Southern Africa
Authors: Chambati Walter
Published: January 2023

The nature and extent of the rural proletarianization of the peasantry in (Southern) Africa arising from uneven colonial land alienation and structural adjustment programs instigated economic crises, and whether farm and nonfarm activities constitute a continuum in the labor process of the peasantry remains an unresolved question. The labor relations are to a large extent shaped by the degree of access to land, and are thus modified by processes of land alienation or the extension of access through land redistribution. Drawing from secondary literature and primary data marshaled on the recent land reform experiences in Zimbabwe, the chapter demonstrates that peasant forms of production prevail despite the challenges rooted in neoliberal reforms. Taking this stand, the chapter challenges the dominant perspectives that generally perceive a post-peasant society evolving from colonial and postcolonial land alienation and adverse agrarian conditions. Today, as urban-based social reproduction strategies continue to falter, repeasantization and semi-proletarianization, which maintain the significance of land, represent the overarching tendencies in rural areas.
Tax Incentives for Arts and Cultural Organizations
Authors: Hemels Sigrid
Published: January 2023

Many countries use tax legislation as a cultural policy instrument. This includes tax incentives for arts organizations and their benefactors. This chapter analyzes what a tax incentive is, what its positive and negative sides are, and how governments use it to support the arts and cultural organizations. Tax incentives for giving, the possibility of paying tax with art, reduced value added tax rates for art, and exemptions from customs duties are discussed specifically, including cross-border situations. These incentives may have a significant impact on the funding strategy and financial situation of cultural organizations. Not applying the incentives correctly may not only lead to problems with the tax administration but also have negative reputational effects. For those reasons it is important that cultural organizations are aware of these tax incentives and the applicable requirements. Conversely, tax legislators and judges do not always take into account research and doctrine on the arts, leading to a denial of the art status to various forms of contemporary art. This chapter aims to add to mutual understanding and to exchanges of ideas between the arts and lawyers.
SMC5/6 complex-mediated SUMOylation stimulates DNA–protein cross-link repair in Arabidopsis
Authors: Dvořák Tomaštíková Eva , Prochazkova Klara , Yang Fen , Jemelkova Jitka , Finke Andreas , Dorn Annika , Said Mahmoud , Puchta Holger , Pecinka Ales
Published: January 2023

DNA–protein cross-links (DPCs) are highly toxic DNA lesions consisting of proteins covalently attached to chromosomal DNA. Unrepaired DPCs physically block DNA replication and transcription. Three DPC repair pathways have been identified in Arabidopsis (Arabidopsis thaliana) to date: the endonucleolytic cleavage of DNA by the structure-specific endonuclease MUS81; proteolytic degradation of the crosslinked protein by the metalloprotease WSS1A; and cleavage of the cross-link phosphodiester bonds by the tyrosyl phosphodiesterases TDP1 and TDP2. Here we describe the evolutionary conserved STRUCTURAL MAINTENANCE OF CHROMOSOMEs SMC5/6 complex as a crucial component involved in DPC repair. We identified multiple alleles of the SMC5/6 complex core subunit gene SMC6B via a forward-directed genetic screen designed to identify the factors involved in the repair of DPCs induced by the cytidine analog zebularine. We monitored plant growth and cell death in response to DPC-inducing chemicals, which revealed that the SMC5/6 complex is essential for the repair of several types of DPCs. Genetic interaction and sensitivity assays showed that the SMC5/6 complex works in parallel to the endonucleolytic and proteolytic pathways. The repair of zebularine-induced DPCs was associated with SMC5/6-dependent SUMOylation of the damage sites. Thus, we present the SMC5/6 complex as an important factor in plant DPC repair.
STUDIES ON RADIATION SHIELDING PROPERTIES OF NEWLY DEVELOPED HIGH-DENSITY CONCRETE FOR ADVANCED RADIOTHERAPY FACILITIES
Authors: Kaur Amanjot , Sahani G , Mudgal Manish , Chouhan R K , Srivastava Avanish Kumar , Pawaskar Padmaja N
Published: January 2023

The linear attenuation coefficients and tenth-value layers are determined experimentally for the newly developed Cement-based high-density Concrete and Fly-Ash-based Geopolymer high-density Concrete using Red-Mud-based synthetic aggregate made up from industrial waste. Linear attenuation coefficients were determined in narrow and broad beam conditions for five megavoltage X-ray photon beam energies, i.e. 6, 10, 15 MV, and 6 and 10 MV-FFF generated by Varian TrueBeam medical linear accelerator. These materials are found to be more effective in radiation shielding when compared with ordinary concrete and hematite ore-based high-density concrete making it a useful construction material for radiotherapy accelerator vaults. Similar values of linear attenuation coefficients are observed for all the above-mentioned X-ray beam energies when cement is replaced with fly-ash in ordinary concrete, hematite-based high-density concrete and red-mud-based high-density concrete, making it a good eco-friendly alternative of cement and useful for the construction of radiotherapy vaults.
Inflammation-Mediated Aberrant Glucose Metabolism in Subchondral Bone Induces Osteoarthritis
Authors: Ying Jun , Wang Pinger , Shi Zhenyu , Xu Jianbo , Ge Qinwen , Sun Qi , Wang Weidong , Li Ju , Wu Chengliang , Tong Peijian , Jin Hongting
Published: January 2023

Osteoarthritis (OA) is an entire joint disease with pathological alteration in both articular cartilage and subchondral bone. It has been recognized recently the association between metabolic syndrome and OA, particularly glucose metabolism in regulation of articular cartilage homeostasis and joint integrity. Whereas the role of glucose metabolism in subchondral bone sclerosis remains largely unknown during pathogenesis of OA. Consistent with common OA features, we observed subchondral bone sclerosis and abnormal bone remodeling in human OA joints and murine OA joints as reflected by hyperactive bone resorption and overall bone formation which was measured via dynamic histomorphometry. Osx-CreER;tdTomato mice also displayed the similar overall bone formation under injury-induced OA condition. Immunohistochemistry further revealed increased IL-1β expression in human and murine OA subchondral bone. Given the inflammatory environment in joints under OA condition, we treated MC3T3-E1 cell, a pre-osteoblast cell line, with IL-1β in this study and demonstrated that IL-1β treatment could stimulate the cell osteogenic differentiation and meanwhile upregulate glycolysis and oxidative phosphorylation in cell cultures. More importantly, intraperitoneal injection of 2-deoxy-D-glucose (2-DG) and oligomycin (OGM), respectively, suppressed the subchondral bone glycolysis and oxidative phosphorylation in mice. Consequently, 2-DG and OGM treatment attenuated abnormal osteoblast differentiation and protected against aberrant bone formation in subchondral bone and articular cartilage degradation in wildtype mice following with joint injury. Collectively, these data strongly suggest glycolysis and oxidative may serve as important therapeutic targets for OA treatment.
Acute disseminated encephalomyelitis due to a zoonotic co-infection
Authors: Siddiqui Anam , Randev Shivani , Singla Nidhi , Dhavan Aanandi , Guglani Vishal , Gupta Varsha
Published: January 2023

Acute disseminated encephalomyelitis (ADEM) is a post-infectious, autoimmune, demyelinating neurological illness, usually attributed to infection with viruses. We describe a case of ADEM occurring in a child with Leptospira–Brucella co-infection. The 12-year-old girl developed a biphasic febrile illness with encephalopathy. On evaluation, she was found to have serological evidence of Brucella and Leptospira infections. Persistence of neurological symptoms after initiating treatment for the co-infection led us to do a magnetic resonance imaging scan of the brain which showed typical findings suggestive of ADEM. Patient responded appropriately to treatment of ADEM with glucocorticoids. The high prevalence of these zoonotic infections in developing countries, and the risk that these may lead to ADEM highlights the importance of detailed evaluation of such cases for proper treatment and better outcomes.
Contrasting Nitrogen Fertilization andBrassica napus(Canola) Variety Development Impact Recruitment of the Root-Associated Microbiome
Authors: Li Yunliang , Vail Sally L. , Arcand Melissa M. , Helgason Bobbi L.
Published: January 2023

Canola ( Brassica napus) is an important broadacre crop, produced under high nitrogen (N) fertilizer application. Modern canola varieties are developed under high N rates but the impacts on root-associated microbiomes of different varieties are unknown. We studied eight canola varieties spanning historical Canadian spring canola development at two sites under high and low N fertility and characterized bacterial and fungal microbiomes in the root and rhizosphere using amplicon sequencing. Environmental conditions and the resulting canola varietal responses strongly affected the root-associated bacterial and fungal microbiomes. Microbes regulated by N fertility in each canola variety were mainly Gammaproteobacteria, Bacteroidia, Actinobacteria, Sordariomycetes, Dothideomycetes, and Agaricomycetes classes. Differentially abundant (DA) microbial taxa showed that N more strongly enriched bacteria in the roots and fungi in the rhizosphere. Each variety had its specific pattern of DA amplicon sequence variants (ASVs) responding to soil N availability, and the profile of DA-ASVs in paired canola varieties were also altered by soil N availability, especially bacteria in the rhizosphere. The yield was strongly associated with a subset of microbial taxa, mainly from Proteobacteria, Actinobacteriota, and Ascomycota. These variety-dependent responses to N and links to yield performance make the root-associated microbiome a promising target for improving the agronomic performance of canola by manipulating microorganisms tailored to soil fertility and plant genotype.
Draft Genome Sequence of Seven Pigmented Strains of Xanthomonas citri pv. anacardii, the Causal Agent of Cashew Angular Spot
Authors: Lucena Lucas P. , Benko-Iseppon Ana M. , Brenig Bertram , Azevedo Vasco , Aburjaile Flávia , Souza Elineide B. , Gama Marco A. S.
Published: January 2023

Cashew ( Anacardium occidentale) angular leaf spot is caused by pigmented and non-pigmented strains of Xanthomonas citri pv. anacardii, which have been isolated from infected plants in Brazil. The disease symptoms can be observed in leaves, stems, and fruits. Given that infection in young fruits results in fruits unsuitable for commercialization, angular leaf spot represents a serious threat to the cashew crop in Brazil. Here, we report the genomic sequencing of seven pigmented strains of X. citri pv. anacardii, obtained from the leaves of cashew trees from São Paulo state, Brazil, in 2009. The construction of the libraries was carried out according to the manufacturer, and whole-genome sequencing was performed using the Illumina HiSeq 2500 platform. Genome size, number of coding sequences, largest contig length, and N50 ranged from 4,996,984 to 5,003,485 bp, 4,621 to 4,643 bp, 212,513 to 362,232 bp, and 113,582 to 141,003 bp, respectively. GC content and RNA numbers were 64.68% and 54, respectively, for all strains. ANIm and dDDH analyses showed values above 99.5 and 92.1% among these strains and the non-pigmented pathotype strain of X. citri pv. anacardii (IBSBF2579PT). A maximum likelihood tree built with 2,708 core genes grouped all X. citri pv. anacardii strains in the same clade, with a 100% bootstrap. These resources will contribute in a relevant way to help understand the ecological, taxonomic, evolutionary, pathogenicity, and virulence aspects of X. citri pv. anacardii, which will be useful for the study and development of techniques for managing cashew angular leaf spot.
The Effect of Accuracy and Uncertainty in Test Performance on Optimal Early Detection Survey Budget Allocations
Authors: Rainford James , Macarthur Roy , Agstner Barbara , Jones Glyn , Harrison Catherine , Tomlinson Jenny , McKnight Curtis , van den Berg Femke
Published: January 2023

Early detection of pests at a low population prevalence is a key pillar of surveillance for plant health. A novel pest is expected to undergo exponential growth when it first occurs in a host population. This allows for the use of mathematical rules of thumb for the number of samples required to detect presence before it reaches a target prevalence given the diagnostic performance of the tests used. Previous work assumes that pest presence is diagnosed by applying a single diagnostic test to each sample. However, diagnostic decisions are often made based on outcomes of multiple tests applied to the same sample in a consistent test program; for example, an assessment of symptoms followed by a PCR test applied to samples for which symptoms were observed. Each test can have different testing costs, as well as distinct and independent diagnostic performance and uncertainty values. A framework to optimize early detection surveys by minimizing overall costs for test programs that apply up to three diagnostic tests has been developed. The framework assesses the consequences of the test order and logical rule by which diagnoses are determined on costs across a range of pest prevalence. Explicit definitions of uncertainty in key parameters are incorporated to assess the consequences of uncertainty about their true value. Use of the framework is exemplified with two hypothetical case studies exploring the potential impact of selecting a suboptimal test program (based on Xylella fastidiosa) and investment in test improvements (based on lateral flow devices applied to Phytophthora pluvialis).

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Fostering a Health-Promoting Learning Environment in Medical Education: Adapting the Okanagan Charter for Administrators and Medical Educators
Authors: Do Victor , Lewis Melanie , Goldstein Cheryl , Sonnenberg Lyn K.
Published: January 2023

Medical students enter medical school with similar or even better well-being than their age-matched peers in other educational programs, but there is predictable erosion of their well-being following matriculation. Interventions to counter this erosion predominantly focus on the individual level; however, significant systemic issues persist that thwart meaningful change. Effectively reforming the learning environment and more broadly targeting problematic aspects of the culture of medical education are essential steps to advance efforts to improve medical learner well-being. Although a healthy environment may allow learners to be well in the educational setting, a health-promoting learning environment strives to promote and embed well-being across all aspects of the learner’s experience. Health-promoting learning environments operate by infusing health principles into all aspects of operations, practices, mandates, and businesses. The Okanagan Charter is a widely adopted international framework with principles for best practices of adoption. This charter has the recent endorsement of the Association of Faculties of Medicine of Canada, representing all faculties of medicine in Canada, and serves as a framework for reassessing work on well-being in medical education. In response to this endorsement, the authors have adapted the 5 strategies from the charter for pragmatic integration into the medical education environment and added a sixth strategy: (1) embed health in all policies; (2) develop sustainable, supportive spaces; (3) create thriving medical communities and culture; (4) encourage, support, and sustain meaningful personal development; (5) review, develop, and strengthen faculty-level health services; and (6) collaborate and invest in continuous improvement and evaluation. For each of these 6 strategic directions, actionable steps for implementation in academic medicine are provided to create sustainable and meaningful change.
What Are Parents’ Experiences With Their Child’s Hearing Aid Use in the First 5 Years?
Authors: Nailand Lisa , Munro Natalie , Purcell Alison
Published: January 2023

Objectives:

Parents are required to make informed choices for their children regarding the use of hearing amplification after hearing loss has been diagnosed. If parents choose a listening and spoken language approach for their child where the development of age appropriate spoken language is the parents’ goal, then the early fitting and frequent use of hearing aids is crucial. Within the framework of family centered care, parents have the ultimate responsibility for supporting their child’s hearing aid use. However, few studies have focused on parents’ insights regarding the aspects that shape hearing aid use in the early years. Thus the aim of this study was to explore parents’ firsthand experiences with their child’s hearing aid use in the first 5 years. Understanding parents’ insights will help improve service provision to optimize outcomes for children with hearing loss.

Design:

The study utilized a prospective qualitative design to explore parents’ firsthand experiences with their child’s hearing aid use. Purposive sampling was used to recruit 12 parents who participated in semi-structured interviews. Parents’ responses were analyzed using thematic analysis.

Results:

Three overarching themes were conceptualized, namely: (a) towards hearing aids - journey into the wilderness; (b) adjusting to hearing aids - it’s the journey, not the destination; and (c) support for my child’s hearing aid use - it’s not where you are going, it’s who you have beside you. Each theme was further divided into categories and subcategories.

Conclusions:

This study identified that parents have much to contribute to service providers’ understanding regarding the aspects that shape consistent hearing aid use in young children. Parents shared many insights such as the emotionally daunting nature of the first few months post hearing loss confirmation, the influence of family support, and the importance of building connections and understanding about hearing loss and hearing aid use within their social networks. Based on these insights, the authors provide recommendations for clinical best practice that draw upon key principles of family centered care. They consist of practical suggestions including strategic support to overcome less optimal hearing aid use and ways to facilitate parent support within their familial and communal networks.
Effects of Transcendental Meditation on Academic Physician Burnout and Depression: A Mixed Methods Randomized Controlled Trial
Authors: Loiselle Marie , Brown Carla , Travis Frederick , Gruener Gregory , Rainforth Maxwell , Nidich Sanford
Published: January 2023

Introduction:

Burnout is pervasive among physicians and has widespread implications for individuals and institutions. This research study examines, for the first time, the effects of the Transcendental Meditation (TM) technique on academic physician burnout and depression.

Methods:

A mixed methods randomized controlled trial was conducted with 40 academic physicians representing 15 specialties at a medical school and affiliated VA hospital using the TM technique as the active intervention. Physicians were measured at baseline, 1 month, and 4 months using the Maslach Burnout Inventory, Beck Depression Inventory, Insomnia Severity Index, Perceived Stress Scale, and Brief Resilience Scale. Repeated measures analysis of covariance was used to assess adjusted mean change scores for the 1- and 4-months posttests. Qualitative interviews were conducted at baseline and 4 months and compared with the quantitative measurements.

Results:

Significant improvements were found for the TM group compared with controls at 4 months in total burnout (p = .020) including the Maslach Burnout Inventory dimensions of emotional exhaustion (p = .042) and personal accomplishment (p = .018) and depression (p = .016). Qualitative interviews supported quantitative outcomes. Physicians reported classic burnout and depression symptoms in baseline interviews. Those regularly practicing the TM technique reported relief from those symptoms. The control group did not state similar changes.

Discussion:

Mixed methods findings suggest the TM technique is a viable and effective intervention to decrease burnout and depression for academic physicians. Larger longitudinal studies with a wider range of health care providers are needed to validate these findings for extrapolation to the greater medical community.
Gemini Anastomosis for Dual Venous Anastomosis in Head and Neck Reconstruction
Authors: Hamahata Atsumori , Beppu Takeshi , Kirita Miho , Konoeda Hisato , Sakurai Hiroyuki
Published: January 2023

Free tissue transfer has been frequently used in head and neck reconstruction. However, vascular problems still cause serious damage to patients when thromboses occur in microvascular anastomoses. In the Gemini anastomosis procedure, two flap pedicle veins are anastomosed adjacently to the internal jugular vein using the end-to-side anastomosis method. From April 2019 to March 2021, 12 patients whose free flaps had two pedicle veins underwent head and neck surgery in Saitama Cancer Center (Saitama, Japan). In six patients, the veins were anastomosed adjacently to the internal jugular vein using the Gemini procedure (Gemini group). In the other six patients, the veins were anastomosed to the internal jugular vein using the end-to-side anastomosis method at a distance from each other (control group). The anastomosis time was measured retrospectively by reviewing video from the operations and comparing them across groups. There were no reoperations in any patients, and all flaps survived without exhibiting any circulatory problems. The mean total anastomosis time in the Gemini group was 21 minutes 38 seconds ± 75 seconds. The mean total anastomosis time in the control group was 34 minutes 14 seconds ± 121 seconds. The mean flap ischemic time in the Gemini group was 124 minutes ± 3 minutes. The mean flap ischemic time in the control group was 135 minutes ± 6 minutes. The Gemini anastomosis procedure is effective and convenient when the pedicle has two veins and the recipient vein choice is only the internal jugular vein in head and neck reconstruction.
Pancreatic cancer with ovarian metastasis: cases report and literature review
Authors: Li Zeru , Zhou Xingtong , Zhao Bangbo , Zheng Zhibo , Qin Cheng , Liu Xudong , Xue Huadan , Wang Weibin
Published: January 2023

Background:

Pancreatic cancer with ovarian metastases is rare and easily misdiagnosed. Patients with ovarian metastases are first diagnosed with ovarian cancer and may miss the opportunity to receive surgical operation. We report 7 rare cases of ovarian metastases secondary to pancreatic adenocarcinoma and review the literature to analyze clinical characteristics, diagnostic methods, and potential therapeutic strategies for the rare malignancy.

Cases Summary:

We retrospectively analyzed the clinical data of 7 female patients with ovarian metastases of primary pancreatic cancer who were admitted to our hospital from January 01, 1985, to April 1, 2020. These 7 patients were diagnosed with ovarian metastasis at an average age of 52.28 (38–69) years. The reason for the patient’s visit was generally a mass in the lower abdomen and/or abdominal pain. Six of them had significantly higher serum Carbohydrate antigen19-9 (CA19-9) levels, 6 patients had pancreatic tumors located in the body or tail, and 1 patient had one in the head of the pancreas. All patients underwent excision of ovarian tumors and resection or biopsy of pancreatic tumors. Five patients had pancreatic ductal adenocarcinoma (PDAC), and 2 had pancreatic cystadenocarcinoma (PCC), all of which were revealed by the pathological results. Ovarian tumors were assessed by pathology and were consistent with pancreatic metastasis. Currently, all 7 patients have died (follow-up to January 2, 2021). The median survival time for all patients was 13.7 months (2.9–27 months).

Conclusions:

For this rare tumor, elevated serum CA19-9 may indicate that the primary lesion is in the pancreas. Enhanced pancreatic Computed Tomography (CT) can facilitate diagnostic localization. In addition, if the pancreatic tumor cannot be removed, the ovarian tumor should still be resected to reduce the tumor load and improve the quality of life.
Hereditary Bilateral Synchronous Pheochromocytomas in a Tibetan Pedigree With a Germline Adenomatous Polyposis Coli (APC) Mutation
Authors: Yang Bin , Yan Ye , Xie Chao , Jiang Jie , Liu Lei , Zhu Xuehua , Liu Zenan , Lu Min , Ma Lulin , Lu Jian
Published: January 2023

Background:

Germline pathogenic mutations associated with pheochromocytoma (PHEO) are present in most patients with hereditary bilateral PHEOs. Adenomatous polyposis coli (APC) gene has previously been identified as a tumor suppressor gene in familial adenomatous polyposis and colorectal cancers, but not PHEO.

Methods:

A father and a son from Tibet were clinically diagnosed with bilateral synchronous PHEOs. The son underwent staged retroperitoneal laparoscopic bilateral total adrenalectomy, and the father underwent retroperitoneal laparoscopic left adrenalectomy. A pedigree investigation was performed with a follow-up of 4 years. Whole-exome sequencing was performed to reveal the susceptibility genes in the pedigree.

Results:

The adrenal masses in the father and son were pathologically diagnosed as hereditary bilateral synchronous PHEOs. A pedigree investigation of 26 family members spanning 3 generations was performed. Multiple endocrine gland–related tumors, including PHEO, pancreatic neuroendocrine tumor, and pituitary adenoma, were diagnosed in the family. DNA sequencing identified a novel heterozygous germline missense mutation (c.896C>G) of the APC gene in the proband. The same heterozygous germline mutation of the APC gene was also present in the pedigree.

Conclusions:

We reported a pedigree from Tibet with hereditary bilateral synchronous PHEOs, which revealed a novel heterozygous germline missense mutation of the APC gene that may predispose to PHEO.
A Clinician's Guide to Targeted Precision Imaging in Patients With Prostate Cancer (RADAR VI)
Authors: Crawford E. David , Albala David M. , Harris Richard G. , Slovin Susan F. , Bryce Alan H. , Carroll Peter R. , Finkelstein Steven E. , Garnick Marc B. , Gomella Leonard G. , Higano Celestia S. , Koo Sonya J. , Petrylak Daniel P. , Sellinger Scott B. , Yu Evan Y. , McKay Rana R. , Crosby Mike “Bing” , Cooperberg Matthew R. , Koo Phillip J.
Published: January 2023

Purpose:

The advent of new imaging agents offers enhanced sensitivity and specificity in the detection and staging of prostate cancer. A growing array of treatment options and ongoing advancements in imaging technologies allow earlier and more extensive detection of metastatic disease and shifting the boundaries between disease states previously defined by conventional imaging. This review seeks to synthesize existing data and expert opinion to better guide patient management in the new era of targeted precision imaging (TPI).

Materials and Methods:

The Radiographic Assessments for Detection of Advanced Recurrence VI Group gathered to develop pathways/recommendations regarding how TPI could best be deployed, given approvals of key radiotracers including 18F-fluciclovine, 68Ga-PSMA, and 18F-DCFPyL positron emission tomography/CT.

Results:

Radiographic Assessments for Detection of Advanced Recurrence VI Group members developed consensus pathways/suggestions based on the best available evidence for use of TPI in prostate cancer.

Conclusions:

Patients with prostate cancer have the potential to benefit from judicious use of TPI. However, additional research is needed to ensure that TPI is used appropriately and provides actionable findings that inform treatment decisions for these patients.
Single-Port (SP) Robotic Nephroureterectomy in a Pediatric Patient
Authors: Smith Jordan M. , Hernandez Alexandra D. , Miyagi Hiroko , Batra Nikhil V. , Demarco Romano T. , Bayne Christopher E.
Published: January 2023

The da Vinci SP (single port) robotic surgical platform has expanded surgical options for single-incision, minimally invasive surgery in the pediatric population. Challenges to SP use include mastering an expected learning curve, less fine instrument movement compared with multiport da Vinci surgery, and ensuring optimal camera length from target anatomy. If these challenges can be overcome, single-port robotic surgery offers the advantage of a single incision for minimally invasive pediatric surgery, both extirpative and reconstructive. We present our experience with an SP robotic nephroureterectomy in a 9-year-old patient.
No Increased Risk of Taking Additional Intestinal Mucosal Research Biopsies From the Duodenum During Pediatric Endoscopy
Authors: DaFonte Tracey M. , Gleeson Elizabeth , Morson Taylor , Olshan Katherine L. , Moran Christopher J. , Leonard Maureen M.
Published: January 2023

Studies involving human intestinal tissue are essential for advancing the field of celiac disease (CeD), as diagnosis requires duodenal biopsies. Performing studies in children helps to better understand CeD in this important subpopulation. This study aims to determine the risk in obtaining duodenal research biopsies during pediatric endoscopy. In this retrospective chart review from 2016 to 2022 of 1180 research subjects and controls, there were 18 procedure-related adverse events within 48 hours. Most adverse events were for symptoms of pain and fever. There was no increased risk of adverse events if additional duodenal research biopsies were taken during pediatric endoscopy.
Utility of Whole Exome Sequencing in the Early Diagnosis of Atypical Diamond-Blackfan Anemia
Authors: Al-Mulla Abdulla , Austin Frances , Helou Marieka
Published: January 2023

Diamond-Blackfan anemia (DBA) is a rare congenital bone marrow failure syndrome, with a hallmark of erythroblastopenia and congenital anomalies. DBA demonstrates genetic heterogeneity and variable phenotypic expression. We present two cases of atypical DBA harboring de novo mutations in the RPS-19 gene with c.49 G>C and c.357-1G>T allelic variants. The two cases presented confounding critical illness demonstrated by multiorgan failure, aplastic crisis, with case 2 meeting the criteria for hemophagocytic lymphohistiocytosis. We highlight the utility of genetic testing in the early diagnosis of DBA and the associated complexities and burden of disease in caring for DBA patients.
Changing Osteoporosis Knowledge and Behaviors Through Structured Education
Authors: McWilliam Ross Kindra , Gilder Richard E.
Published: January 2023

Osteoporosis is a silent disease that is associated with enormous cost and can lead to disability and death. We identified that individuals who have sustained a fracture from a fall are often unaware of osteoporosis risk factors and have a knowledge deficit regarding osteoporosis. Therefore, they do not receive the proper treatment. An evidence-based practice project was completed using “pre-post” intervention tools with an educational intervention to measure osteoporosis knowledge and self-efficacy in individuals hospitalized with a fragility fracture. A convenience sample of 25 participants 50 years and older, who were admitted with a fragility fracture, received targeted education. Descriptive and comparative statistics were used for comparison of pre- and postintervention data. Hospitalized osteoporotic individuals have a gap in knowledge regarding the existence of osteoporosis. Healthcare workers can improve knowledge and self-efficacy by offering osteoporosis education for these individuals.
Association between balance confidence and basic walking abilities in people with unilateral transtibial lower-limb amputations: A cross-sectional study
Authors: Omaña Humberto , Frengopoulos Courtney , Montero-Odasso Manuel , Payne Michael W. , Viana Ricardo , Hunter Susan W.
Published: January 2023

Introduction:

Falls are common for people with lower-limb amputations (PLLA). Low balance confidence is also prevalent, is worse in PLLA not reporting walking automaticity, and is known to negatively affect prosthesis use, social engagement, and quality of life. Moreover, walking with a prosthesis requires continuous attention. Low balance confidence may act as a distractor imposing an additional cognitive load on the already cognitively demanding task of walking with a prosthesis.

Methods:

Adults with unilateral, transtibial amputations were recruited. The Activities-specific Balance Confidence (ABC) scale quantified balance confidence. The L Test assessed basic walking abilities under single-task (ST) (usual) and dual-task (DT) (walking while counting backwards) conditions. The relative change in gait and secondary task performance between conditions (ie, DT cost) was calculated. Separate multivariable linear regressions examined the association of balance confidence on the L Test.

Results:

Forty-four PLLA (56.6 ± 12.6 years) participated. An independent association of the ABC to ST (P < 0.001, R2 = 0.56) and DT (P = 0.008, R2 = 0.43) L Test performance was observed. A 1% ABC increase was related with a 0.24 (95% confidence interval, 0.35–0.14) and 0.23 (95% confidence interval, 0.39–0.06) second reduction with the ST and DT L Test, respectively. No association to DT cost was observed.

Conclusions:

Balance confidence influences basic walking abilities yet does not modulate the added cognitive load associated with DT. Interventions that address balance confidence may be beneficial throughout rehabilitation. This research is novel and offers the possibility for alternative avenues for focus in rehabilitation and falls prevention in a population at high risk for falls.
THE INITIAL ION SHIFT INDEX AS A PROGNOSTIC INDICATOR TO PREDICT PATIENT SURVIVAL IN TRAUMATIC DAMAGE CONTROL LAPAROTOMY PATIENTS
Authors: Jang Hyunseok , Jeung Kyung Woon , Kang Ji-Hyoun , Jo Younggoun , Jeong Euisung , Lee Naa , Kim Jungchul , Park Yunchul
Published: January 2023

Objective: The ion shift index (ISI), which considers extracellular fluid ions such as phosphate, calcium, and magnesium, represents the ion shift following ischemia; concentrations of these ions are maintained within narrow normal ranges by adenosine triphosphate-dependent homeostasis. The ISI is defined as follows: {potassium (mmol/L-1) + phosphate (mmol/L-1) + Mg (mmol/L-1)}/calcium (mmol/L-1). This study investigated the possibility of predicting the 30-day survival rate of patients who underwent traumatic damage control laparotomy by comparing ISI and other laboratory findings, as well as the initial Trauma and Injury Severity Score (TRISS) and shock indices. Methods: Among the 134 patients who underwent damage control surgery between November 2012 and December 2021, 115 patients were enrolled in this study. Data regarding injury mechanism, age, sex, laboratory findings, vital signs, Glasgow Coma Scale score, Injury Severity Score, Abbreviated Injury Scale score, blood component transfusion, type of surgery, postoperative laboratory outcomes, morbidity, mortality rates, fluids administered, and volume of transfusions were collected and analyzed. Results: In univariate analysis, the odds ratio of the initial ISI was 2.875 (95% confidence interval, 1.52–5.43; P = 0.04), which showed a higher correlation with mortality compared with other indices. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were derived from different multivariable logistic regression models. The initial ISI had high sensitivity and specificity in predicting patient mortality (AUC, 0.7378). In addition, in the model combining the initial ISI, crystalloids, and TRISS, the AUC showed a high value (AUC, 0.8227). Conclusion: The ISI evaluated using electrolytes immediately after admission in patients undergoing traumatic damage control surgery may be a predictor of patient mortality.
NEUROLOGIC IMPAIRMENT IN PATIENTS WITH EXTRACORPOREAL CARDIOPULMONARY RESUSCITATION SUPPORT: CLINICAL FEATURES AND LONG-TERM OUTCOMES
Authors: Shi Xiaobei , Zhang Lili , Zeng Xiaokang , Li Yiwei , Hu Wei , Xi Shaosong
Published: January 2023

Introduction: The present study aimed to explore the clinical features and long-term outcomes associated with neurologic impairment in patients with cardiac arrest (CA) who received extracorporeal cardiopulmonary resuscitation (ECPR). Methods: A total of 37 adult CA patients who underwent venoarterial extracorporeal membrane oxygenation and were admitted to our department between January 2015 and February 2022 were divided according to neurologic impairment. Baseline and CPR- and ECMO-related characteristics were compared between the two groups. Long-term neurologic outcomes were collected via telephone follow-ups. Results: Twenty-four (64.9%) ECPR-supported patients developed neurologic impairments. The two groups differed significantly in median age (P = 0.026), proportion of intra-aortic balloon pump (IABP) support (P = 0.011), proportion of continuous renal replacement therapy (P = 0.025), and median serum creatinine (Cr) level (P = 0.012) pre-ECMO. The 28-day mortality (P = 0.001), hospital mortality (P = 0.003), median duration from CA to restoration of spontaneous circulation (P = 0.029), proportion of patients with nonpulsatile perfusion (NP) >12 hours (P = 0.040), and median ECMO duration (P = 0.047) were higher in the neurologic impairment group. In contrast, the group without neurologic impairment exhibited a longer median intensive care unit length of stay (P = 0.047), longer median hospital LOS (P = 0.031), and more successful ECMO weaning (P = 0.049). Moreover, NP >12 hours combined with IABP support (odds ratio [OR], 14.769; 95% confidence interval [CI], 1.417~153.889; P = 0.024) and serum Cr level (OR, 1.028; 95% CI, 1.001~1.056; P = 0.043) were independent risk factors for neurologic impairment. Furthermore, neurologic impairment was associated with significantly worse 90-day survival (hazards ratio, 4.218; 95% CI, 1.745~10.2; P = 0.0014). Conclusions: The incidence of neurologic impairment was higher in patients who received ECPR and was closely related to 28-day mortality and discharge survival. NP >12 hours combined with IABP support and serum Cr levels were independent risk factors for neurologic impairments in ECPR-supported patients. Neurologic impairment significantly adversely affected the long-term outcomes of ECPR-supported patients after discharge.
Maximize Donor Cornea Use in a Hepatitis B Endemic Area via Serology Matching
Authors: Chu Hsiao-Sang , Killeen Olivia J. , Hsieh Yi-Ting , Su Tung-Hung , Soong H. Kaz , Shih Chung-Liang , Hu Fung-Rong
Published: January 2023

Background.

This study aims to investigate the rationality of the allocation guidelines in a hepatitis B endemic area that uses corneas from hepatitis B donors.

Methods.

Under Taiwan’s current guidelines, corneas donated from hepatitis B surface antigen (HBsAg)(+) donors can be allocated to HBsAg(+) or hepatitis B surface antibody recipients. From January 1, 2015, to December 31, 2019, corneas donated to National Taiwan University Hospital were divided into HBsAg(+), HBsAg(–)/hepatitis B core antibody (anti-HBc)(+), and HBsAg(–)/anti-HBc(–) groups. Hepatitis B virus (HBV) DNA extracted from corneoscleral rims was quantified by polymerase chain reaction and correlated with donor serum HBsAg, anti-HBc, and HBV DNA. Recipients of HBV DNA(+) grafts were called back for serology and serum HBV DNA tests.

Results.

The corneoscleral HBV DNA of 170 corneas (113 donors) was quantified, of which 45 corneas were from 28 HBsAg(+) donors, 87 were from 57 HBsAg(–)/anti-HBc(+) donors, and 38 were from 28 HBsAg(–)/anti-HBc(–) donors, and HBV DNA was detected in 80.0%, 9.2%, and 0% of the corneoscleral rims in each group. Donor anti-HBc(+) provided the highest sensitivity (1.00) and negative predictive value (1.00) for corneoscleral HBV DNA. Twenty-eight of 40 recipients (70%) using HBV DNA(+) grafts were called back, and none developed hepatitis in follow-up periods ranging from 6 to 55.5 mo.

Conclusions.

Donor anti-HBc should be tested routinely with HBsAg. Allocating corneas from HBsAg(+) or anti-HBc(+) donors to HBsAg(+) or hepatitis B surface antibody recipients maximizes cornea usage from hepatitis B donors without compromising transplant safety in a hepatitis B endemic setting.
Outcomes of Declined Deceased Donor Kidney Offers That Are Subsequently Implanted: A UK Registry Study
Authors: Ibrahim Maria , Mehew Jennifer , Martin Kate , Forsythe John , Johnson Rachel J. , Callaghan Chris
Published: January 2023

Background.

Deceased donor kidneys are often declined for ≥1 patients but then implanted into another. Studies are needed to guide transplant clinicians and patients, especially given the increasing age and comorbidity of donors. This study compares outcomes of recipients of transplanted kidneys that were initially declined with outcomes of patients who remained on the waiting list.

Methods.

This UK Transplant Registry study examined named-patient, adult donation after brain death donor single kidney-only offers that were declined for donor- or organ-related reasons (DORRs), in which the kidney was subsequently transplanted from January 1, 2010, to December 31, 2018. Outcomes included graft function and survival of kidneys transplanted following DORR decline, survival and transplant status of patients who had a kidney declined, and intercenter decline rates.

Results.

A total of 4722 kidneys declined for DORRs, which eventually resulted in single kidney-only transplants, were examined. One year after the offer decline, 35% of patients for whom the organ was declined remained on the list, 55% received a deceased donor transplant at a median of 174 d after the initial offer decline, and 4% had been removed or died. For patients transplanted following offer decline, there was no significant difference in 5-y graft survival when comparing the outcomes to those recipients who received the declined kidney. There was significant variation in DORR decline rates between UK transplant units (17%–54%).

Conclusions.

This study shows reasonable outcomes of kidneys previously declined for DORRs and supports the utilization of those considered to be of higher risk for carefully selected recipients.
A Standardized Approach to Orthotopic (Life-supporting) Porcine Cardiac Xenotransplantation in a Nonhuman Primate Model
Authors: Goerlich Corbin E. , Griffith Bartley P. , Shah Aakash , Treffalls John A. , Zhang Tianshu , Lewis Billeta , Tatarov Ivan , Hershfeld Alena , Sentz Faith , Braileanu Gheorghe , Ayares David , Singh Avneesh K. , Mohiuddin Muhammad M.
Published: January 2023

Cardiac xenotransplantation from swine has been proposed to “bridge the gap” in supply for heart failure patients requiring transplantation. Recent preclinical success using genetically modified pig donors in baboon recipients has demonstrated survival greater than 6 mo, with a modern understanding of xenotransplantation immunobiology and continued experience with large animal models of cardiac xenotransplantation. As a direct result of this expertise, the Food and Drug Administration approved the first in-human transplantation of a genetically engineered cardiac xenograft through an expanded access application for a single patient. This clinical case demonstrated the feasibility of xenotransplantation. Although this human study demonstrated proof-of-principle application of cardiac xenotransplantation, further regulatory oversight by the Food and Drug Administration may be required with preclinical trials in large animal models of xenotransplantation with long-term survival before approval of a more formalized clinical trial. Here we detail our surgical approach to pig-to-primate large animal models of orthotopic cardiac xenotransplantation, and the postoperative care of the primate recipient, both in the immediate postoperative period and in the months thereafter. We also detail xenograft surveillance methods and common issues that arise in the postoperative period specific to this model and ways to overcome them. These studies require multidisciplinary teams and expertise in orthotopic transplantation (cardiac surgery, anesthesia, and cardiopulmonary bypass), immunology, genetic engineering, and experience in handling large animal donors and recipients, which are described here. This article serves to reduce the barriers to entry into a field with ever-growing enthusiasm, but demands expertise knowledge and experience to be successful.