bluuebunny/crossref_metadata_2025 huggingface dataset:
Seismic displacement response of SDOF systems with SMA slip friction dampers
Authors: Qiu Canxing , Bai Muyuan , Jiang Tianyuan
Published: December 2023

Owing to superelastic behavior, shape memory alloy (SMA) has been widely utilized to develop self-centering damping devices. Recently, the authors developed a novel SMA damper, i.e. the SMA slip friction (SMASF) damper. The cyclic behavior of the SMASF damper not only depends on the hysteresis shape factors of SMA bars, but also on the coefficient of kinetic friction and the slope of the friction plates. Hence, the basic working mechanism of the SMASF damper is different from that of conventional SMA dampers. In the early work, the features of the SMASF damper have been revealed by static cyclic loading tests. However, the seismic displacement responses of this novel damper remain unknown. To this end, this paper initiates with a brief introduction of the damper, including the configuration, working mechanism, and testing results. And then, extensive seismic analyses based on single-degree-of-freedom systems were conducted. Based on the constant-strength ductility demand spectra, the displacement responses of the SMASF damper were understood through the comparisons with conventional SMA damper and friction damper. A wide range of fundamental periods, strength capacities and seismic intensity levels were considered. Further, parametric analysis was conducted to assess the effect of the hysteresis shape factors of SMA bars and the coefficient of kinetic friction and the slope of the friction plates. This study also sheds light on the force-based seismic design method for this damper.
Evidence for current suppression in superconductor–superconductor bilayers
Authors: Asaduzzaman Md , McFadden Ryan M L , Valente-Feliciano Anne-Marie , Beverstock David R , Suter Andreas , Salman Zaher , Prokscha Thomas , Junginger Tobias
Published: December 2023

Superconducting radio frequency (SRF) cavities, which are critical components in many particle accelerators, need to be operated in the Meissner state to avoid strong dissipation from magnetic vortices. For a defect-free superconductor, the maximum attainable magnetic field for operation is set by the superheating field,

B

s
h

, which directly depends on the surface current. In heterostructures composed of different superconductors, the current in each layer depends not only on the properties of the individual material, but also on the electromagnetic response of the adjacent layers through boundary conditions at the interfaces. Three prototypical bilayers [

N
b

1
−
x

T
i

x

N

 
(

50

n
m

)

/

N
b

,

N

b

1
−
x

T

i

x

N

 
(

80

n
m

)

/

N
b

, and,

N

b

1
−
x

T

i

x

N

 
(

160

n
m

)

/

N
b

] are investigated here by depth-resolved measurements of their Meissner screening profiles using low energy muon spin rotation (LE-µSR). From fits to a model based on London theory (with appropriate boundary and continuity conditions), a magnetic penetration depth for the thin

N

b

1
−
x

T

i

x

N

layers of

λ

N

b

1
−
x

T

i

x

N

=
182.5
(
31
)

n
m

is found, in good agreement with literature values for the bulk alloy. Using the measured

λ

N

b

1
−
x

T

i

x

N

, the maximum vortex-free field,

B

m
a
x

, of the superconductor-superconductor (SS) bilayer structure was estimated to be

610
(
40
)

m
T

. The strong suppression of the surface current in the

N

b

1
−
x

T

i

x

N

layer suggests an optimal thickness of

∼
1.4

λ

N
b

1
−
x

T
i

x

N

=
261
(
14
)

n
m

.
Transport properties of 2H-NbSe2 synthesized by selenization of Nb thin films
Authors: Zaitsev A G , Beck A , Fuchs D , Hott R , Schneider R
Published: December 2023

A novel method for the synthesis of 2H-NbSe2 thin films by selenization of precursor Nb thin films is reported. The polycrystalline films grow predominantly in the hexagonal 2H-NbSe2 phase with bulk lattice constants. Their remarkable microstructure consists of a three-dimensional network of flake-like grains substantially stacked vertically on the substrate. The electronic transport between 1.2 K and 300 K in zero and applied magnetic fields up to 14 T has been extensively studied. The study comprises resistivity, magnetoresistance, Hall coefficient, upper critical field, and critical current density. The results are discussed taking account of the coexisting charge-density-wave and superconducting phases.
Predicting and understanding residential water use with interpretable machine learning
Authors: Rachunok Benjamin , Verma Aniket , Fletcher Sarah
Published: December 2023

Predicting residential water use is critical to efficiently manage urban water resource systems. Simultaneously, understanding the factors driving residential water use is required to plan for future urban change and achieve effective water resource management. Current approaches examining residential water use identify the drivers of household water use through parametric or non-parametric statistical approaches. Parametric approaches have high predictive errors and lack the ability to accurately capture interactions between features but allow for easy interpretation. Non-parametric approaches have lower predictive errors and can capture non-linear feature interactions but do not allow for easy interpretation. We use non-parametric statistical models of household water use and recent advances in interpretable machine learning to understand the drivers of residential water use. Specifically, we use post-hoc interpretability methods to examine how drivers of water use interact, focusing on environmental, demographic, physical housing, and utility policy factors. We find all four categories of factors are important for estimating water use with environmental and utility policy factors playing the largest role. Additionally, we identify non-linear interactions between many variables within and across these classes. We show this approach provides both high predictive accuracy and identification of complex water use factors, offering important insight for urban water management.
Embedding of a non-Hermitian Hamiltonian to emulate the von Neumann measurement scheme
Authors: Singh Gurpahul , Singh Ritesh K , Banerjee Soumitro
Published: December 2023

The problem of how measurement in quantum mechanics takes place has existed since its formulation. Von Neumann proposed a scheme where he treated measurement as a two-part process— a unitary evolution in the full system-ancilla space and then a projection onto one of the pointer states of the ancilla (representing the ‘collapse’ of the wavefunction). The Lindblad master equation, which has been extensively used to explain dissipative quantum phenomena in the presence of an environment, can effectively describe the first part of the von Neumann measurement scheme when the jump operators in the master equation are Hermitian. We have proposed a non-Hermitian Hamiltonian formalism to emulate the first part of the von Neumann measurement scheme. We have used the embedding protocol to dilate a non-Hermitian Hamiltonian that governs the dynamics in the system subspace into a higher-dimensional Hermitian Hamiltonian that evolves the full space unitarily. We have obtained the various constraints and the required dimensionality of the ancilla Hilbert space in order to achieve the required embedding. Using this particular embedding and a specific projection operator, one obtains non-Hermitian dynamics in the system subspace that closely follow the Lindblad master equation. This work lends a new perspective to the measurement problem by employing non-Hermitian Hamiltonians.
Separation and detection of orbital angular momentum states of composite vortex beams in atmospheric turbulence channels
Authors: Hongyan Wei , Han Zhou , Yuejiao Fu , Qianqian Du , Peng Jia , Dongmei Cai
Published: December 2023

The separation and detection of compound orbital angular momentum (OAM) modes are the basis for achieving high-speed and high-capacity communication, but the atmospheric turbulence causes distortion of the phase fronts of vortex beams, which hinders the recognition of OAM modes. To solve this problem, in this work, we propose and investigate a joint scheme of combining the Gerchberg–Saxton (GS) algorithm and the phase of addition and subtraction model that can achieve high recognition accuracy and a wide range of OAM modes of compound perfect optical vortex beam under long-distance turbulence environment. At the receiving end, the GS algorithm and phase addition and subtraction are used to compensate and modulate the incident vortex light field to obtain the pre-processed light field, and then the OAM is detected by the coordinate transformation method. The simulation results show that: The detection range of the OAM of the three optical path detection model for the vortex beam transmitting 1000 m reaches −37 to +37 in the vacuum environment, and the mode purity of −37 to +37 can reach more than 0.3 when the turbulence intensity is Cn

2 = 2 × 10−15 m−2/3. The detection range of the OAM of the vortex can be further expanded by increasing the optical path. This study provides a new method for the separation and detection of OAM of composite vortex beams.
Ethical and legal considerations for the use of artificial intelligence in global health dermatology
Authors: Khan Sidra S , Polo Silveira Luísa , Varma Aakaash , Maurer Toby
Published: December 2023

We outline the ethical and legal considerations for the use of AI in global health dermatology.
Royalist memorials of the civil war in the Vendée during the early Third Republic
Authors: Oakland Gareth
Published: December 2023

In the 1890s, when statuomanie was at its peak, conservatives in the Vendée erected two statues to commemorate figures from the royalist armies in the civil war in order to contest republican education politics and memory culture. The first, aristocrat Henri de La Rochejaquelein (1772–94), was unveiled in 1895. The second, erected a year later, celebrated the first commander-in-chief of the royalist army, Jacques Cathelineau (1759–93). The contested nature of these commemorations illustrates the distinctive character of the Vendée in the early Third Republic; leading conservative politicians and churchmen did not mediate between grandes and petites patries within a republican frame, but rather rejected the notion of the secular democratic republic in its entirety. The memorials sought to assert a distinctive regional history to local Vendéen audiences, but they did so in the service of a vision of France and its history that contradicted the dominant project of republicanism and thus constituted a unique chapter of the wider debate about memory and history in France during the Third Republic.
sTREM-1: A Biomarker of Mortality in Severe Malaria Impacted by Acute Kidney Injury
Authors: Mufumba Ivan , Kazinga Caroline , Namazzi Ruth , Opoka Robert O , Batte Anthony , Bond Caitlin , John Chandy C , Conroy Andrea L
Published: December 2023

Background

Malaria is an important cause of mortality in African children. Identification of biomarkers to identify children at risk of mortality has the potential to improve outcomes.

Methods

We evaluated 11 biomarkers of host response in 592 children with severe malaria. The primary outcome was biomarker performance for predicting mortality. Biomarkers were evaluated using receiver operating characteristic (ROC) curve analysis comparing the area under the ROC curve (AUROC).

Results

Mortality was 7.3% among children in the study with 72% of deaths occurring within 24 hours of admission. Among the candidate biomarkers, soluble triggering receptor expressed on myeloid cells 1 (sTREM-1) had the highest AUROC (0.78 [95% confidence interval, .70–.86]), outperforming several other biomarkers including C-reactive protein and procalcitonin. sTREM-1 was the top-performing biomarker across prespecified subgroups (malaria definition, site, sex, nutritional status, age). Using established cutoffs, we evaluated mortality across sTREM-1 risk zones. Among children with acute kidney injury, 39.9% of children with a critical-risk sTREM-1 result had an indication for dialysis. When evaluated relative to a disease severity score, sTREM-1 improved mortality prediction (difference in AUROC, P = .016).

Conclusions

sTREM-1 is a promising biomarker to guide rational allocation of clinical resources and should be integrated into clinical decision support algorithms, particularly when acute kidney injury is suspected.
Occupational asbestos exposure and ovarian cancer: updated systematic review
Authors: Turati F , Rossi M , Spinazzè A , Pira E , Cavallo D M , Patel L , Mensi C , La Vecchia C , Negri E
Published: December 2023

Background

The association between asbestos exposure and ovarian cancer has been questioned given the possible misdiagnosis of peritoneal mesothelioma as ovarian cancer.

Aims

To update a systematic review on ovarian cancer risk in women occupationally exposed to asbestos, exploring the association with the time since first exposure and the duration of exposure.

Methods

We searched PubMed from 2008 onwards, screened previous systematic reviews, combined standardized mortality ratios (SMR) using random effect models and quantified heterogeneity using the I2 statistic. To assess tumour misclassification, we compared the distribution of observed excess ovarian cancers (OEOC) to that expected (EEOC) from the distribution of peritoneal cancers in strata of latency and exposure duration.

Results

Eighteen publications (20 populations), including a pooled analysis of 21 cohorts, were included. The pooled SMR was 1.79 (95% confidence interval 1.38–2.31), with moderate heterogeneity between studies (I2 = 42%), based on 144 ovarian cancer deaths/cases. The risk was increased for women with indirect indicators of higher exposure, longer duration and latency, and lower for chrysotile than for crocidolite exposure. The effect of duration and latency could not be completely disentangled, since no multivariate analysis was available for time-related variables. The dissimilarity index between OEOC and EEOC for the time since first exposure was small suggesting a similar pattern of risk.

Conclusions

While some misclassification between ovarian and peritoneal cancers cannot be excluded, the observed excess risk of ovarian cancer should be added to the overall disease burden of asbestos.
Workplace violence in radiology: results of a systematic review
Authors: Busch I M , Rimondini M , Scott S D , Moretti F , Cecchin D , Wu A W , Giraudo C
Published: December 2023

Background

Workplace violence (WPV) is a growing issue in health care with far-reaching consequences for health workers’ physical and psychological well-being. While some medical specialities like emergency medicine have always been considered at higher risk for WPV, several studies have also reported its occurrence in radiology.

Aims

This systematic review aimed to comprehensively synthesize the types of WPV in radiology, its psychological impact, and the underlying risk and protective factors.

Methods

We searched five electronic databases (PubMed, Web of Science Core Collection, Scopus, PsycINFO and CINAHL) and additional literature, including grey literature, and established weekly search alerts. Two reviewers independently conducted all methodological steps, involving a third reviewer in case of disagreement.

Results

Of the 12 205 retrieved records, 103 full-text articles were evaluated, and 15 studies were included. Across studies, verbal aggression, sexual harassment (mostly against women) and physical violence were experienced by up to 100%, 85% and 46% of health workers, respectively. Perpetrators were patients and patients’ caregivers, followed by co-workers. Victims suffered from various psychological symptoms, such as anxiety (22%–54%), fear (6%–39%), depression (32%) and repeated disturbing memories (21%). Risk factors included female gender, understaffing, worker inexperience, poor communication and lengthy waiting times. Social support and security personnel presence were among the identified protective factors.

Conclusions

Health workers are at high risk of experiencing WPV in the radiological setting, with a strong psychological impact. Radiological departments should create a safe healthcare environment that actively manages the identified risk factors and offers psychological support to affected workers.
AefR, a TetR Family Transcriptional Repressor, Regulates Several Auxin Responses in Pseudomonas syringae Strain PtoDC3000
Authors: Johnson Joshua M. B. , Kunkel Barbara N.
Published: December 2023

The plant hormone indole-3-acetic acid (IAA), also known as auxin, plays important roles in plant growth and development, as well as in several plant–microbe interactions. IAA also acts as a microbial signal and in many bacteria regulates metabolism, stress responses, and virulence. In the bacterial plant pathogen Pseudomonas syringae pv. tomato strain DC3000 ( PtoDC3000), exposure to IAA results in large-scale transcriptional reprogramming, including the differential expression of several known virulence genes. However, how PtoDC3000 senses and responds to IAA and what aspects of its biology are regulated by IAA is not understood. To investigate the mechanisms involved in perceiving and responding to IAA, we carried out a genetic screen for mutants with altered responses to IAA. One group of mutants of particular interest carried disruptions in the aefR gene encoding a TetR family transcriptional regulator. Gene expression analysis confirmed that the aefR mutants have altered responses to IAA. Thus, AefR is the first demonstrated auxin response regulator in PtoDC3000. We also investigated several aspects of PtoDC3000 biology that are regulated by both AefR and IAA, including antibiotic resistance, motility, and virulence. The observation that the aefR mutant has altered virulence on Arabidopsis, suggests that the sector of the IAA response regulated by aefR is important during pathogenesis. Our findings also provide evidence that AefR plays a role in coordinating changes in gene expression during the transition from early to late stages of infection.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Characterization of Ralstonia pseudosolanacearum Diversity and Screening Tomato, Pepper, and Eggplant Resistance to Manage Bacterial Wilt in South Asia
Authors: Subedi Nagendra , Cowell Tabitha , Cope-Arguello Matthew , Paul Pierce , Cellier Gilles , Bkayrat Hashem , Bonagura Nicolas , Cadatal Angela , Chen Rachel , Enriquez Ariana , Parasar Rama , Repetto Lisa , Rivas Aracely Hernandez , Shahbaz Mahnoor , White Kaitlin , Lowe-Power Tiffany M. , Miller Sally A.
Published: December 2023

In South Asia, bacterial wilt pathogens in the Ralstonia solanacearum species complex (RSSC) impose major constraints on eggplant, tomato, and pepper production. To improve the efficacy of bacterial wilt management, the goals of this study were to (i) conduct a survey of RSSC pathogens in Bangladesh and Nepal, (ii) characterize the genetic diversity of these isolates, and (iii) screen 37 tomato, eggplant, and pepper accessions for resistance to six representative isolates from South Asia. We isolated 99 isolates from Bangladesh and 20 isolates from Nepal and determined that all are phylotype I isolates of the Ralstonia pseudosolanacearum species. We sequenced and assembled draft genomes for 25 isolates. Phylogenomic analyses suggest that there is a wide diversity of endemic phylotype I isolates in South Asia and possible introductions of two clonal phylotype I lineages into Bangladesh and Nepal. We contextualize our newly described isolates based on prior reports of RSSC diversity in South Asia and global reports of RSSC pathogens on eggplant and pepper. Greenhouse trials revealed multiple tomato, eggplant, and pepper accessions that exhibit promising levels of resistance to six phylotype I isolates from South Asia.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Differences in Hearing Devices and Speech Therapy Utilization Between Children With Permanent Unilateral Versus Bilateral Hearing Loss
Authors: Brodie Kara D. , Florentine Michelle M. , Taketa Emily , Ho Melissa , Chan Dylan K.
Published: December 2023

Objectives:

In this study, we aimed to describe differences in diagnosis and both auditory and speech/language intervention utilization between children with permanent unilateral hearing loss as compared with bilateral hearing loss.

Design:

A retrospective cohort study was performed of children evaluated in a multidisciplinary hearing loss clinic at a tertiary care pediatric hospital. Children aged 0 to 18 years with either permanent unilateral or bilateral hearing loss were included.

Results:

One hundred fourteen children with unilateral hearing loss and 268 children with bilateral hearing loss were studied for a total of 382 children. There were no demographic differences between children with permanent unilateral versus bilateral hearing loss. Rates of newborn hearing screening and referred screening results were similar between those with unilateral and bilateral hearing loss. Despite similar rates of referred newborn hearing screening, those with bilateral hearing loss were diagnosed at a younger age (mean 3.6 years, SD 3.8 years) as compared with those with unilateral hearing loss (mean 5.0 years, SD 4.2 years). Children with unilateral hearing loss had similar severity of hearing loss in their poorer hearing ear as compared with children with bilateral hearing loss, yet they were significantly less likely to be fitted with hearing devices (53% versus 78%) or receive speech/language therapy (36% versus 54%) as compared with children with bilateral hearing loss. Multivariate analysis found that bilateral hearing loss and earlier age of hearing loss diagnosis were associated with hearing device use.

Conclusions:

Early diagnosis and intervention for childhood hearing loss have a significant impact on a child’s educational success and social relationships. However, little is known about differences in diagnosis and resource utilization between children with permanent unilateral hearing loss versus bilateral hearing loss. Children with unilateral hearing loss were diagnosed at a later age and were less likely to utilize hearing devices or speech/language therapy compared with those with bilateral hearing loss, despite having similar severity of hearing loss in the poorer hearing ear. There is a strong body of evidence that children with unilateral hearing loss have improved hearing outcomes with hearing devices, which suggests there is room for improvement in identifying unilateral hearing loss and providing adequate services to optimize educational success. However, speech therapy is generally implemented in response to language delays. Therefore, children with unilateral loss may have lower rates of language delays as compared with those with bilateral hearing loss, thereby explaining differences in speech therapy utilization.
Practical Methods of Assessing Coronal Alignment and Outcomes in Adult Spinal Deformity Surgery
Authors: Shen Yong , Sardar Zeeshan M. , Greisberg Gabriella , Katiyar Prerana , Malka Matan , Hassan Fthimnir , Reyes Justin , Zuckerman Scott L. , Marciano Gerard , Lombardi Joseph M. , Lehman Ronald A. , Lenke Lawrence G. ,   Multi-Ethnic Normative Alignment Study (MEANS) Group
Published: December 2023

Study Design.

Asymptomatic cohort: prospective, cross-sectional, multicenter. Symptomatic: retrospective, multisurgeon, single-center.

Objective.

To assess the association between cranial coronal alignment and adult spinal deformity (ASD) surgical risk and outcomes.

Summary of Background Data.

ASD leads to decreased quality of life. Studies have shown that coronal malignment (CM) is associated with worse surgical outcomes.

Materials and Methods.

A total of 468 adult participants were prospectively enrolled in the asymptomatic cohort. Totally, 172 symptomatic ASD patients with 2-year follow-ups were retrospectively enrolled in the symptomatic cohort. Three cranial plumb line parameters: the positions of the plumb lines from the midpoint between the medial orbital rims (ORB-L5), the odontoid (OD-L5), and the C7 centroid (C7-L5) relative to the L5 pedicle, were measured. Each subject had plumb line medial (M), touching (T), or lateral (L) to either pedicle. The association between each group of patients and radiographic parameters, intraoperative variables, patient-reported outcomes, and clinical outcomes were analyzed.

Results.

In the asymptomatic cohort, OD-L5 was medial to or touching the L5 pedicle in 98.3% of volunteers. In the symptomatic patients, preoperative OD-L5-L exhibited higher mean age (56.2±14.0), odontoid-coronal vertical axis (OD-CVA) (5.5±3.3 cm), Oswestry disability index (ODI) score (40.6±18.4), pelvic fixation rate (56/62, 90.3%), OR time (528.4±144.6 min), median estimated blood loss (1300 ml), and durotomy rate (24/62, 38.7%). A similar pattern of higher CVA, preoperative ODI, intraoperative pelvic fixation rate, OR time, estimated blood loss, and durotomy rate was observed in ORB-L5-L and C7-L5-L patients. Final follow-up postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis (13.0%) and pseudarthrosis (17.4%).

Conclusion.

Preoperative OD-L5, ORB-L5, and C7-L5 lateral to pedicles were associated with worse preoperative ODI and higher intraoperative complexity. Postoperative OD-L5-L was associated with higher rates of proximal junctional kyphosis and pseudarthrosis. Postoperative CM, approximated by the cranial plumb line lateral to the L5 pedicles, was associated with sagittal plane complications.
Inborn errors of type I interferon immunity in patients with symptomatic acute hepatitis E
Authors: Saadat Ali , Gouttenoire Jérôme , Ripellino Paolo , Semela David , Amar Soraya , Frey Beat M. , Fontana Stefano ,   HEV Human Genetics Collaborators, Mdawar-Bailly Elise , Moradpour Darius , Fellay Jacques , Fraga Montserrat
Published: December 2023

Background and Aims:

The clinical spectrum of human infection by HEV ranges from asymptomatic to severe acute hepatitis. Furthermore, HEV can cause diverse neurological manifestations, especially Parsonage-Turner syndrome. Here, we used a large-scale human genomic approach to search for genetic determinants of severe clinical presentations of HEV infection.

Approach and Results:

We performed whole genome sequencing in 3 groups of study participants with PCR-proven acute HEV infection: (1) 24 patients with symptomatic acute hepatitis E; (2) 12 patients with HEV-associated Parsonage-Turner syndrome; and (3) 16 asymptomatic blood donors (controls). For variant calling and annotation, we used GATK4 best practices followed by Variant Effect Predictor (VEP) and Annovar. For variant classification, we implemented the American College of Medical Genetics and Genomics/Association for Molecular Pathology Bayesian classification framework in R. Variants with a probability of pathogenicity >0.9 were considered damaging. We used all genes with at least 1 damaging variant as input for pathway enrichment analyses.

We observed a significant enrichment of type I interferon response pathways in the symptomatic hepatitis group: 10 out of 24 patients carried a damaging variant in one of 9 genes encoding either intracellular viral sensors (IFIH1, DDX58, TLR3, POLR3B, POLR3C) or other molecules involved in type I interferon response [interferon regulatory factor 7 (IRF7), MYD88, OAS3, GAPDH]. We did not find any enriched pathway in the Parsonage-Turner syndrome group or in the controls.

Conclusions:

Our results highlight the essential role of type I interferon in preventing symptomatic acute hepatitis E.
Insufficiency of plasmatic arginine/homoarginine during the initial postoperative phase among patients with tumors affecting the medulla oblongata heightens the likelihood of neurogenic pulmonary oedema following surgery
Authors: Wang Liang , Zhang Qing , Zhang Yuan , Zheng Guanghui , Wang Ke , Wu Zhen , Zhang Junting , Jia Wang , Zhang Guojun
Published: December 2023

Background:

This prospective clinical study aims to investigate the fluctuations of neurotransmitters in peripheral venous blood during the perioperative period and to identify independent predictors for postoperative neurogenic pulmonary oedema (NPE) in patients with medulla oblongata-involved tumours.

Materials and methods:

Peripheral venous blood samples of the enroled patients at seven perioperative time points, as well as their medical records and radiologic data were collected. High-performance liquid chromatography-tandem mass spectrometry was utilized to detect the concentrations of 39 neurotransmitters in these samples. The study applied univariate and multivariate generalized estimating equation (GEE) logistic regression analyses to explore independent predictors of postoperative NPE, and one-way repeated-measures ANOVA to compare the concentrations of the same neurotransmitter at different perioperative time points.

Results:

The study included 36 patients with medulla oblongata-involved tumours from January to December 2019, and found that 13.9% of them experienced postoperative NPE. The absence of intraoperative use of sevoflurane (P=0.008), decreased concentrations of arginine (P=0.026) and homoarginine (P=0.030), and prolonged postoperative tracheal extubation (P<0.001) were identified as independent risk factors for postoperative NPE in medulla oblongata-involved tumour patients. Pairwise comparison analysis revealed that the perioperative decreases in arginine and homoarginine concentrations mainly occurred within the postoperative 8 h.

Conclusion:

This study demonstrates that NPE is not uncommon in patients with medulla oblongata-involved tumours. The absence of intraoperative use of sevoflurane, decreased concentrations of plasmatic arginine and homoarginine, and prolonged postoperative tracheal extubation are independent predictors of postoperative NPE. These two neurotransmitters’ concentrations dropped mainly within the early postoperative hours and could serve as potential early warning indicators of postoperative NPE in clinical practice.
Decoding surgical skill: an objective and efficient algorithm for surgical skill classification based on surgical gesture features –experimental studies
Authors: Chen Zixin , Yang Dewei , Li Ang , Sun Louzong , Zhao Jifan , Liu Jie , Liu Linxun , Zhou Xiaobo , Chen Yonghua , Cai Yunqiang , Wu Zhong , Cheng Ke , Cai He , Tang Ming , Peng Bing , Wang Xin
Published: December 2023

Background:

Various surgical skills lead to differences in patient outcomes and identifying poorly skilled surgeons with constructive feedback contributes to surgical quality improvement. The aim of the study was to develop an algorithm for evaluating surgical skills in laparoscopic cholecystectomy based on the features of elementary functional surgical gestures (Surgestures).

Materials and methods:

Seventy-five laparoscopic cholecystectomy videos were collected from 33 surgeons in five hospitals. The phase of mobilization hepatocystic triangle and gallbladder dissection from the liver bed of each video were annotated with 14 Surgestures. The videos were grouped into competent and incompetent based on the quantiles of modified global operative assessment of laparoscopic skills (mGOALS). Surgeon-related information, clinical data, and intraoperative events were analyzed. Sixty-three Surgesture features were extracted to develop the surgical skill classification algorithm. The area under the receiver operating characteristic curve of the classification and the top features were evaluated.

Results:

Correlation analysis revealed that most perioperative factors had no significant correlation with mGOALS scores. The incompetent group has a higher probability of cholecystic vascular injury compared to the competent group (30.8 vs 6.1%, P=0.004). The competent group demonstrated fewer inefficient Surgestures, lower shift frequency, and a larger dissection-exposure ratio of Surgestures during the procedure. The area under the receiver operating characteristic curve of the classification algorithm achieved 0.866. Different Surgesture features contributed variably to overall performance and specific skill items.

Conclusion:

The computer algorithm accurately classified surgeons with different skill levels using objective Surgesture features, adding insight into designing automatic laparoscopic surgical skill assessment tools with technical feedback.
Intraoperative strategies in identification and functional protection of parathyroid glands for patients with thyroidectomy: a systematic review and network meta-analysis
Authors: Lu Dengwei , Pan Bin , Tang Enjie , Yin Supeng , Sun Yiceng , Yuan Yuquan , Yin Tingjie , Yang Zeyu , Zhang Fan
Published: December 2023

Background:

This study aimed to assess the benefits and limitations of four intraoperative visualization of parathyroid gland (IVPG) strategies in the identification and functional protection of parathyroid glands (PGs).

Methods:

We searched PubMed, the Cochrane Central Register of Controlled Trials, CNKI, EMBASE, Web of Science and Google Scholar databases until 30 June 2023. Four IVPG strategies were composed of the naked eyes (NE) and three imaging strategies: autofluorescence (AF), indocyanine green fluorescence (ICGF), and carbon nanoparticles (CN). We performed a pairwise meta-analysis (PMA) for direct comparisons and a Bayesian network meta-analysis (NMA) for indirect comparisons.

Results:

A total of 29 eligible studies were included. According to NMA and PMA, AF had significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, PG inadvertent resection, and PG auto-transplantation compared to NE, while had significantly higher rate of PG identification. CN showed significantly lower rates of postoperative hypocalcemia and hypoparathyroidism, and PG inadvertent resection compared to NE in PMA and NMA. ICGF showed a significantly higher rate of PG auto-transplantation compared to NE in PMA and AF in NMA. According to SUCRA values, AF showed the best advantage in reducing the rate of postoperative hypocalcemia (0.85) and PG inadvertent resection (0.89), and increasing the rate of PG identification (0.80). CN had the greatest advantage in reducing the rate of postoperative hypoparathyroidism (0.95). ICGF ranked the highest in the rate of PG auto-transplantation (0.98).

Conclusions:

Three imaging strategies demonstrate significant superiority over NE in the intraoperative PG identification and functional protection. AF is the best strategy in reducing the incidence of postoperative hypocalcemia, increasing the rate of PG identification, and reducing the rate of PG inadvertent resection and auto-transplantation. ICGF has great value in assessing PG viability, leading to the trend towards PG auto-transplantation. CN is the best strategy in reducing the incidence of postoperative hypoparathyroidism.
Mechanical Characterization of Anchoring Devices for the Prevention of Driveline Infection in Left Ventricular Assist Device Patients
Authors: Schachl Johanna , Stoiber Martin , Socha Martina , Zimpfer Daniel , Wiedemann Dominik , Schima Heinrich , Schlöglhofer Thomas
Published: December 2023

Driveline infection (DLI) is associated with increased mortality and morbidity in left ventricular assist device (LVAD) patients. Because trauma to the driveline exit-site (DLES) is a risk factor for DLI, adhesive anchoring devices are used to immobilize the DL. In this study, commonly used products (identified through literature review and contact with nine international VAD implantation centers) were mechanically characterized to evaluate their effectiveness in preventing DLES trauma. Eight devices were tested in an in vitro abdominal model of the DLES, where a tensile force (10 N) was applied to a HeartMate 3 DL, whereas the resulting force (F
Total) on the DLES was recorded using a three-axis load cell. Four devices (CathGrip: F
Total = 2.1 ± 0.4 N, Secutape: F
Total = 2.6 ± 0.3 N, Hollister: F
Total = 2.7 ± 0.5 N, Tubimed: F
Total = 2.9 ± 0.2 N) were significantly (p < 0.05) better at preventing tensile forces at the DLES compared to the other four devices (Main-Lock: F
Total = 3.7 [0.7] N, Secutape sensitive: F
Total = 3.9 ± 0.4 N, Foley Anchor: F
Total = 4.3 ± 0.5 N, Grip-Lok: F
Total = 5.4 ± 0.8 N). Immobilization of the DL with each anchoring device resulted in lower tensile force on the DLES than without an anchor (F
Total = 8.2 ± 0.3 N). In conclusion, the appropriate selection of anchoring devices plays a critical role in reducing the risk of DLI, whereas the CathGrip, Secutape, Hollister, or Tubimed were superior in preventing trauma to the DLES in this study.
Combining the Hospital Frailty Risk Score With the Charlson and Elixhauser Multimorbidity Indices to Identify Older Patients at Risk of Poor Outcomes in Acute Care
Authors: Gilbert Thomas , Cordier Quentin , Polazzi Stéphanie , Street Andrew , Conroy Simon , Duclos Antoine
Published: December 2023

Objective:

The Hospital Frailty Risk Score (HFRS) can be applied to medico-administrative datasets to determine the risks of 30-day mortality and long length of stay (LOS) in hospitalized older patients. The objective of this study was to compare the HFRS with Charlson and Elixhauser comorbidity indices, used separately or combined.

Design:

A retrospective analysis of the French medical information database. The HFRS, Charlson index, and Elixhauser index were calculated for each patient based on the index stay and hospitalizations over the preceding 2 years. Different constructions of the HFRS were considered based on overlapping diagnostic codes with either Charlson or Elixhauser indices. We used mixed logistic regression models to investigate the association between outcomes, different constructions of HFRS, and associations with comorbidity indices.

Setting:

743 hospitals in France.

Participants:

All patients aged 75 years or older hospitalized as an emergency in 2017 (n=1,042,234).

Main outcome measures: 30-day inpatient mortality and LOS >10 days.

Results:

The HFRS, Charlson, and Elixhauser indices were comparably associated with an increased risk of 30-day inpatient mortality and long LOS. The combined model with the highest c-statistic was obtained when associating the HFRS with standard adjustment and Charlson for 30-day inpatient mortality (adjusted c-statistics: HFRS=0.654; HFRS + Charlson = 0.676) and with Elixhauser for long LOS (adjusted c-statistics: HFRS= 0.672; HFRS + Elixhauser =0.698).

Conclusions:

Combining comorbidity indices and HFRS may improve discrimination for predicting long LOS in hospitalized older people, but adds little to Charlson’s 30-day inpatient mortality risk.
Factors associated with postoperative quality of life in patients with intertrochanteric fracture
Authors: Ramezani Akam , Babagoli Mazyar , Ghaseminejad-Raeini Amirhossein , Golbakhsh Mohammadreza , Shafiei Seyyed Hossein
Published: December 2023

Introduction:

Intertrochanteric fractures, which make up the majority of hip fractures, are a common and serious injury that can greatly impact quality of life. Treatment of such fractures comprises nearly half of the costs contributed to hip fractures. Identifying the factors affecting the functional outcomes of patients after intertrochanteric fracture can help to reduce burden of disease for the patient and healthcare system. The present study investigated the factors underlying the worsening of short form-36 score (SF-36) scores for intertrochanteric fracture patients.

Materials and methods:

This retrospective cohort study was designed based on data from our clinic. All consecutive patients with intertrochanteric fractures from November 2016 to September 2020 were reviewed. The exclusion criteria included patients having a second injury or having had previous surgery related to the hip and those with incomplete data. Baseline characteristics of patients were extracted from annotated records. The lab data were acquired from the electronic hospital system. The outcomes were SF-36 scores obtained by phone contact with patients or their families. Statistical analysis was conducted in SPSS.

Results:

A total of 310 patients were included in the current study. The female gender, advanced age, history of diabetes, thyroid malfunction, cancer, osteoporosis, anticoagulant use and blood transfusion were identified as risk factors for lower SF-36 scores. Low levels of haemoglobin before surgery, blood urea nitrogen (BUN), BUN/Creatinine, and white blood count values correlated with lower SF-36 scores.

Conclusion:

Numerous contextual variables affected the functional outcomes of the patients. Consideration of these factors could be helpful in reducing costs and improving the quality of life for intertrochanteric fracture patients.
Tranexamic acid is not associated with a higher rate of thrombotic-related reintervention after major vascular injury repair
Authors: Asaadi Sina , Mukherjee Kaushik , Abou-Zamzam Ahmed M. , Ji Liang , Luo-Owen Xian , Tabrizi Maryam B. , Catalano Richard D. , Dubose Joseph J. , Rosenthal Martin G. ,   AAST PROOVIT Study Group
Published: December 2023

BACKGROUND

Tranexamic acid (TXA) is associated with lower mortality and transfusion requirements in trauma patients, but its role in thrombotic complications associated with vascular repairs remains unclear. We investigated whether TXA increases the risk of thrombosis-related technical failure (TRTF) in major vascular injuries (MVI).

METHODS

The PROspective Observational Vascular Injury Treatment (PROOVIT) registry was queried from 2013 to 2022 for MVI repaired with an open or endovascular intervention. The relationship between TXA administration and TRTF was examined.

RESULTS

The TXA group (n = 297) had higher rates of hypotension at admission (33.6% vs. 11.5%, p < 0.001), need for continuous vasopressors (41.4% vs. 18.4%, p < 0.001), and packed red blood cell transfusion (3.2 vs. 2.0 units, p < 0.001) during the first 24 hours compared with the non-TXA group (n = 1941), although demographics, injury pattern, and interventions were similar. Cryoprecipitate (9.1% vs. 2%, p < 0.001), and anticoagulant administration during the intervention (32.7% vs. 43.8%, p < 0.001) were higher in the TXA group; there was no difference in the rate of factor VII use between groups (1% vs. 0.7%, p = 0.485). Thrombosis-related technical failure was not different between the groups (6.3% vs. 3.8 p = 0.141) while the rate of immediate need for reoperation (10.1% vs. 5.7%, p = 0.006) and overall reoperation (11.4% vs. 7%, p = 0.009) was significantly higher in the TXA group on univariate analysis. There was no significant association between TXA and a higher rate of immediate need for reintervention (odds ratio [OR], 1.19; 95% confidence interval [CI], 0.75–1.88; p = 0.465), overall reoperation rate (OR, 1.33; 95% CI, 0.82–2.17; p = 0.249) and thrombotic events in a repaired vessel (OR, 1.07; 95% CI, 0.60–1.92; p = 0.806) after adjusting for type of injury, vasopressor infusions, blood product and anticoagulant administration, and hemodynamics.

CONCLUSION

Tranexamic acid is not associated with a higher risk of thrombosis-related technical failure in traumatic injuries requiring major vascular repairs. Further prospective studies to examine dose-dependent or time-dependent associations between TXA and thrombotic events in MVIs are needed.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level IV.
Analysis of lipid metabolites derived from gut microbiota in ischemia-reperfusion model
Authors: Nakatsutsumi Keita , Morishita Koji , Costantini Todd W. , Adachi Tomohiro , Suekane Akira , Suzuki Keisuke , Kojima Mitsuaki , Arita Makoto , Otomo Yasuhiro
Published: December 2023

BACKGROUND

Disruption of intestinal barrier caused by intestinal ischemia due to hemorrhagic shock is associated with the pathogenesis of multiple organ dysfunction (MOD) after severe trauma. Mesenteric lymph (ML) plays an important role as a route for transporting inflammatory mediators, including lipids. Postbiotics, such as 10-hydroxy-cis-12-octadecenoic acid (HYA), have received much attention as a treatment option. However, the relationship between postbiotics and MOD has yet to be clarified. The aim of the present study was to analyze lipid metabolites derived from gut microbiota in the intestinal ischemia-reperfusion (IR) rat model.

METHODS

Male Sprague-Dawley rats underwent laparotomy, and their ML duct and superior mesenteric artery were exposed. The superior mesenteric artery was clamped for 60 minutes, followed by 120 minutes of reperfusion. The ML and the plasma were collected before and after intestinal IR. Lipids were extracted from plasma and ML, and liquid chromatography–tandem mass spectrometry was performed.

RESULTS

The concentration of linoleic acid in plasma samples was not different before and after IR; however, the linoleic acid concentration in the ML samples increased after intestinal IR. Eicosapentaenoic acids and docosahexaenoic related to linoleic acids showed similar changes with IR-induced increase in the ML. The concentration of HYA, a linoleic acid–derived bioactive metabolite produced by gut bacteria, was high in ML samples, while that in plasma samples was low. The relative increase rate of HYA in ML samples after IR was higher than that of the plasma samples (the ML samples: relative increase, 3.23 ± 1.36; the plasma samples: relative increase, 0.95 ± 0.35; n = 3, p = 0.048).

CONCLUSION

The present study demonstrated increased linoleic acids and high concentrations of HYA, lipid metabolites derived from gut bacteria in the ML after intestinal IR. These findings may contribute to clarifying the relation between gut microbiota and MOD after severe trauma.
Long wavelength light exposure reduces systemic inflammation coagulopathy and acute organ injury following multiple injuries in mice
Authors: Zarisfi Mohammadreza , Younes Reem , Alsaadi Nijmeh , Liu Zeyu , Loughran Patricia , Williamson Kelly , Spinella Philip C. , Shea Susan M. , Rosengart Matthew R. , Andraska Elizabeth A. , Neal Matthew D.
Published: December 2023

BACKGROUND

Evidence suggests that variation in light exposure strongly influences the dynamic of inflammation, coagulation, and the immune system. Multiple injuries induce systemic inflammation that can lead to end-organ injury. Here, we hypothesize that alterations in light exposure influence posttrauma inflammation, coagulopathy, and end-organ injury.

METHODS

C57BL/6 mice underwent a validated multiple-injury and hemorrhage model performed following 72 hours of exposure to red (617 nm, 1,700 lux), blue (321 nm, 1,700 lux), and fluorescent white light (300 lux) (n = 6–8/group). The animals were sacrificed at 6 hours posttrauma. Plasma samples were evaluated and compared for proinflammatory cytokine expression levels, coagulation parameters, markers of liver and renal injury, and histological changes (Carstairs staining). One-way analysis of variance statistical tests were applied to compare study groups.

RESULTS

Preexposure to long-wavelength red light significantly reduced the inflammatory response at 6 hours after multiple injuries compared with blue and ambient light, as evidenced by decreased levels of interleukin 6, monocyte chemoattractant protein-1 (bothp< 0.001), liver injury markers (alanine transaminase,p< 0.05), and kidney injury markers (cystatin C,p< 0.01). In addition, Carstairs staining of organ tissues revealed milder histological changes in the red light–exposed group, indicating reduced end-organ damage. Furthermore, prothrombin time was significantly lower (p< 0.001), and fibrinogen levels were better maintained (p< 0.01) in the red light–exposed mice compared with those exposed to blue and ambient light.

CONCLUSION

Prophylactic light exposure can be optimized to reduce systemic inflammation and coagulopathy and minimize acute organ injury following multiple injuries. Understanding the mechanisms by which light exposure attenuates inflammation may provide a novel strategy to reducing trauma-related morbidity.