bluuebunny/crossref_metadata_2025 huggingface dataset:
Elucidation of decomposition pathways of linoleic acid hydroperoxide isomers by GC-MS and LC-MS/MS
Authors: Miyazaki Ruriko , Kato Shunji , Otoki Yurika , Rahmania Halida , Sakaino Masayoshi , Takeuchi Shigeo , Sato Toshiro , Imagi Jun , Nakagawa Kiyotaka
Published: November 2022

Food lipid oxidation provides various volatile compounds involved in food flavor via the decomposition of lipid hydroperoxide (LOOH). This study predicted the pathways which can coherently explain LOOH decomposition focusing on hydroperoxy octadecadienoic acid (HpODE) isomers (9-EZ-HpODE, 9-EE-HpODE, 10-HpODE, 12-HpODE, 13-ZE-HpODE, and 13-EE-HpODE) which are the major LOOH contained in edible oils. Each standard was first prepared and thermally decomposed. Generated volatile and non-volatile compounds were analyzed by GC-MS and LC-MS/MS. The results showed that all HpODE decomposition was based on the factors such as favorable scission, radical delocalization, and cyclization. Interestingly, the formation of 8-HpODE and 14-HpODE were demonstrated during HpODE decomposition. The insights obtained in this study would explain the generation pathways of flavor involved in food quality.
Improving dynamic predictions with ensembles of observable models
Authors: Massonis Gemma , Villaverde Alejandro F , Banga Julio R
Published: November 2022

Motivation

Dynamic mechanistic modelling in systems biology has been hampered by the complexity and variability associated with the underlying interactions, and by uncertain and sparse experimental measurements. Ensemble modelling, a concept initially developed in statistical mechanics, has been introduced in biological applications with the aim of mitigating those issues. Ensemble modelling uses a collection of different models compatible with the observed data to describe the phenomena of interest. However, since systems biology models often suffer from a lack of identifiability and observability, ensembles of models are particularly unreliable when predicting non-observable states.

Results

We present a strategy to assess and improve the reliability of a class of model ensembles. In particular, we consider kinetic models described using ordinary differential equations with a fixed structure. Our approach builds an ensemble with a selection of the parameter vectors found when performing parameter estimation with a global optimization metaheuristic. This technique enforces diversity during the sampling of parameter space and it can quantify the uncertainty in the predictions of state trajectories. We couple this strategy with structural identifiability and observability analysis, and when these tests detect possible prediction issues we obtain model reparameterizations that surmount them. The end result is an ensemble of models with the ability to predict the internal dynamics of a biological process. We demonstrate our approach with models of glucose regulation, cell division, circadian oscillations and the JAK-STAT signalling pathway.

Availability and implementation

The code that implements the methodology and reproduces the results is available at https://doi.org/10.5281/zenodo.6782638.

Supplementary information

Supplementary data are available at Bioinformatics online.
Are female-dominated occupations a secure option? Occupational gender segregation, accompanied occupational characteristics, and the risk of becoming unemployed
Authors: Bächmann Ann-Christin
Published: November 2022

In the German labour market, research hints towards a reversal in gender-specific risk of becoming unemployed: While women previously faced higher risk than men, in recent years, they have consistently lower risk. This paper analyses this reversal by focusing on the role of occupational gender segregation. I discuss theoretical differences in the labour supply and demand structure and thus in the unemployment risk of male- and female-dominated occupations caused by crowding and technological and sectoral change. Using the German National Educational Panel Study combined with occupation level data, I analyse the transition to unemployment over three decades. The results confirm gender-specific trends over time: While women faced higher risk of becoming unemployed in the 1980s, they face significantly lower risk than men in the 21st century. A Karlson-Holm-Breen decomposition shows that the lower risk of women in the newest decade under observation is mediated by the unequal distribution of men and women over the occupational structure. Yet, the higher risk of women in the 1980s cannot be traced back to differences in male- and female-dominated occupations. On the contrary, the results suggest that women were more likely to become unemployed in that decade independent of their occupation.
Improving prescribing: a feasibility study of pharmacogenetic testing with clinical decision support in primary healthcare in Singapore
Authors: Smith Helen , Dawes Martin , Katzov-Eckert Hagit , Burrell Sarah , Xin Hui Sam , Winther Michael D
Published: November 2022

Background

The study of genetic variation as a factor influencing drug safety, efficacy, and effectiveness has brought about significant breakthroughs in understanding the clinical application of gene–drug interactions to better manage drug therapy.

Objective

This study was designed to assess the feasibility of collecting buccal samples by general practitioners (GPs) at private practices in Singapore within a usual consultation, incorporating use of a pharmacogenetics-based medical decision support system to guide subsequent drug dosing.

Methods

We used a prospective cohort study design, with GPs recruiting 189 patients between October 2020 and March 2021. The genotypes of 51 biallelic SNPs were determined using Illumina Infinium Global Screening Array.

Results

Seven GPs from 6 private practices recruited and obtained buccal samples from a total of 189 patients. All patients had at least one actionable variant. The prevalence of patients having 2, 3, or 4 variants was 37.0%, 32.8%, and 12.7%, respectively. Potential alterations to medications were identified using the Clinical Decision Support System. Patients were accepting and the GPs were enthusiastic about the potential of pharmacogenetics to personalize medicine for their patients.

Conclusion

This is the first study in Singapore to demonstrate the feasibility of pharmacogenetic testing in primary care. The high prevalence of genetic variants underscores the potential use of pharmacogenetics in this setting.
Association of Endothelial Protein C Receptor (EPCR) rs867186 Gene Polymorphism With Increased Levels of Soluble EPCR and High Risk of Severe Malaria and Fatality in Beninese Children
Authors: Blankson Samuel Odarkwei , Dikroh Liliane , Tettey Patrick , Tornyigah Bernard , Adamou Rafiou , Moussiliou Azizath , Alao Maroufou J , Amoussou Annick , Padounou Caroline , Milet Jacqueline , Mensah Benedicta Ayiedu , Aniweh Yaw , Ndam Nicaise Tuikue , Roussilhon Christian , Tahar Rachida
Published: November 2022

The endothelial protein C receptor (EPCR)–rs867186 G allele has been linked to high plasma levels of soluble EPCR (sEPCR) and controversially associated with either susceptibility or resistance to severe and cerebral malaria. In this study, quantitative enzyme-linked immunosorbent assay and sequencing were used to assess sEPCR levels and EPCR-rs867186 polymorphism in blood samples from Beninese children with different clinical presentations of malaria. Our findings show that sEPCR levels were higher at hospital admission than during convalescence and that EPCR-rs867186 G allele was associated with increased sEPCR plasma levels, malaria severity, and mortality rate (P < .001, P = .03, and P = .04, respectively), suggesting a role of sEPCR in the pathogenesis of severe malaria.
Behavior Change in Water, Sanitation, and Hygiene: A 100-Year Perspective
Authors: Venis Robbie A
Published: November 2022

The current methodological paradigm for addressing water, sanitation, and hygiene (WaSH) inaccessibility in rural sub-Saharan Africa is achieving insufficient progress. This essay evaluates WaSH-related policy, programming, and discourse from 1918 to 2021 to identify how this paradigm evolved and how it may reform. I argue that political–economic environments have strongly influenced existing sectoral praxis, shaping both programmatic methods and means. Colonial occupations generated rural–urban material inequalities, which were maintained and exacerbated during postwar reconstruction (1950–1970) and the proliferation of neoliberalism (1970–1990s). Meanwhile, modernization theory, a fundamental feature of colonial thought, has persisted discursively and practically. That is, rural resource limitations led WaSH practitioners to promote lower-cost appropriate technologies in the 1980s. Then, with challenges regarding technological disuse and misuse, behavior change–oriented methodologies responsively emerged in the 2000s and continue today. Yet, much like colonial predecessors, this latter turn presupposes that its programmatic benefactors must adapt to access WaSH services. Behavior change programs thus fail to critically consider the role of technological inadequacies and associated risk exposures in perpetuating existing inequities. Investigation of utility-style service models, where WaSH services adapt to the lives of its benefactors and behavioral persuasion is substituted for nonuser technological management, is recommended.
Automated deidentification of radiology reports combining transformer and “hide in plain sight” rule-based methods
Authors: Chambon Pierre J , Wu Christopher , Steinkamp Jackson M , Adleberg Jason , Cook Tessa S , Langlotz Curtis P
Published: November 2022

Objective

To develop an automated deidentification pipeline for radiology reports that detect protected health information (PHI) entities and replaces them with realistic surrogates “hiding in plain sight.”

Materials and Methods

In this retrospective study, 999 chest X-ray and CT reports collected between November 2019 and November 2020 were annotated for PHI at the token level and combined with 3001 X-rays and 2193 medical notes previously labeled, forming a large multi-institutional and cross-domain dataset of 6193 documents. Two radiology test sets, from a known and a new institution, as well as i2b2 2006 and 2014 test sets, served as an evaluation set to estimate model performance and to compare it with previously released deidentification tools. Several PHI detection models were developed based on different training datasets, fine-tuning approaches and data augmentation techniques, and a synthetic PHI generation algorithm. These models were compared using metrics such as precision, recall and F1 score, as well as paired samples Wilcoxon tests.

Results

Our best PHI detection model achieves 97.9 F1 score on radiology reports from a known institution, 99.6 from a new institution, 99.5 on i2b2 2006, and 98.9 on i2b2 2014. On reports from a known institution, it achieves 99.1 recall of detecting the core of each PHI span.

Discussion

Our model outperforms all deidentifiers it was compared to on all test sets as well as human labelers on i2b2 2014 data. It enables accurate and automatic deidentification of radiology reports.

Conclusions

A transformer-based deidentification pipeline can achieve state-of-the-art performance for deidentifying radiology reports and other medical documents.
China-MENA Energy Cooperation under the Belt and Road Initiative: Megaprojects, Economic Planning, and a Pragmatic Approach to the ‘Green’ Transition
Authors: Zoppolato Davide Giacomo , Jiang Shisong
Published: November 2022

Cooperation between China and the Middle East and North Africa (MENA) in the energy field reached a new impetus with the launch of the Belt and Road Initiative (BRI). Specific cooperation plans and strategies have been implemented both at the regional and bilateral levels to strengthen the cooperation in this area between the two blocks. Despite this progress, crucial questions remain unanswered regarding the approaches, characteristics and rationale behind the green transition in the MENA context. This article focuses on the cooperation between five North African countries—Morocco, Algeria, Tunisia, Libya and Egypt—and China under the BRI. It highlights how the initiative mobilizes funding and expertise urgently needed for developing and deploying clean technologies in North Africa. China’s ‘pragmatic’ approach to energy could speed up the transition in the region, but only if appropriate manufacturing capacities and a solid industrial base are developed in parallel with the deployment of renewables. We argue that an advancement in the cooperation between China and MENA could facilitate the achievement of Sustainable Development Goal 7: ‘Ensure access to affordable, reliable, sustainable and modern energy for all’.
Functions and mechanisms of RNA helicases in plants
Authors: Li Xindi , Li Changhao , Zhu Jiaying , Zhong Songxiao , Zhu Hongliang , Zhang Xiuren
Published: November 2022

RNA helicases (RHs) are a family of ubiquitous enzymes that alter RNA structures and remodel ribonucleoprotein complexes typically using energy from the hydrolysis of ATP. RHs are involved in various aspects of RNA processing and metabolism, exemplified by transcriptional regulation, pre-mRNA splicing, miRNA biogenesis, liquid–liquid phase separation, and rRNA biogenesis, among other molecular processes. Through these mechanisms, RHs contribute to vegetative and reproductive growth, as well as abiotic and biotic stress responses throughout the life cycle in plants. In this review, we systematically characterize RH-featured domains and signature motifs in Arabidopsis. We also summarize the functions and mechanisms of RHs in various biological processes in plants with a focus on DEAD-box and DEAH-box RNA helicases, aiming to present the latest understanding of RHs in plant biology.
MeerKAT follow-up of enigmatic GLEAM 4-Jy (G4Jy) sources
Authors: Sejake Precious K , White Sarah V , Heywood Ian , Thorat Kshitij , Bester Hertzog L , Makhathini Sphesihle , Fanaroff Bernie
Published: November 2022

We present the results from studying 140 radio sources in the GLEAM (GaLactic and Extragalactic All-sky MWA [Murchison Widefield Array]) 4-Jy (G4Jy) Sample. These sources were followed-up with MeerKAT to assess their radio morphology and enable host-galaxy identification, as existing radio images of 25 to 45-arcsec resolution do not provide sufficient information. We refer to these sources as the MeerKAT-2019 subset. The aim is to identify the host galaxy of these sources by visually inspecting the overlays comprising radio data from four surveys (at 150, 200, 843/1400, and 1300 MHz). Our morphological classification and host-galaxy identification relies upon the ∼7-arcsec resolution images from MeerKAT (1300 MHz). Through the visual inspection of the overlays, 14 radio sources in the MeerKAT-2019 subset have wide-angle tail morphology, 10 are head-tail, and 5 have X-, S-/Z-shaped morphology. Most of the remaining sources have the radio morphology of typical symmetric lobes. Of 140 sources, we find host galaxies for 98 sources, leaving 42 with no identified host galaxy. These 42 sources still have ambiguous identification even with higher resolution images from MeerKAT.
Hepatic veno-occlusive disease accompanied by thrombotic microangiopathy developed during treatment of juvenile dermatomyositis and macrophage activation syndrome: A case report
Authors: Mouri Mariko , Kanamori Toru , Tanaka Eriko , Hiratoko Kanako , Okubo Mariko , Inoue Michio , Morio Tomohiro , Shimizu Masaki , Nishino Ichizo , Okiyama Naoko , Mori Masaaki
Published: November 2022

Hepatic veno-occlusive disease (VOD) is a complication of haematopoietic stem cell transplantation. VOD is associated with the occurrence of thrombotic microangiopathy (TMA). In haematopoietic stem cell transplantation, VOD and TMA are endothelial syndromes resulting from endothelial cell activation and dysfunction. In rheumatic disease, while TMA is not rare, there are few reports of VOD. In idiopathic myositis, only one case with VOD and TMA complications has been reported, and there are no published cases in juvenile dermatomyositis (JDM). We report a case of JDM manifesting VOD and TMA complications during the treatment for myositis and macrophage activation syndrome (MAS). A 5-year-old boy diagnosed as anti-nuclear matrix protein 2 antibody–positive JDM was complicated by MAS. He received pulsed methylprednisolone, prednisolone, and tacrolimus, but JDM and MAS progressed. He was then treated with intravenous cyclophosphamide and cyclosporine A, with improvement in myositis symptoms and MAS. After initiation of cyclophosphamide and cyclosporine A, he developed haemolysis, painful hepatomegaly, liver damage, and ascites. He was diagnosed with VOD and TMA. Cyclophosphamide and cyclosporine A were discontinued, with recovery from VOD and TMA. The patient remained well on treatment with methotrexate, without any relapse of JDM and MAS to date. The presence of vasculopathy and hypercytokinaemia because of JDM and MAS exacerbated endothelial cell damage. In the present case, we suggest that the main cause of VOD was medication with CY and CsA, which had been used to treat acute exacerbation of MAS and JDM.
A rare presentation of antisynthetase syndrome requiring intensive care in the midst of a COVID wave
Authors: Arya Akhila , Anand Sanu , Kumar Sandesh , Britto Carl
Published: November 2022

A 24-year-old female with pneumonia two months prior presented with fever, cough, and worsening dyspnoea in the midst of a COVID-19 spike. Her initial episode was treated as COVID-19 pneumonia. On presentation, her chest computed tomography was suggestive of bilateral lower zone organising pneumonia with mild fibrosis and was attributed to post-COVID sequelae with an infective exacerbation. Oral steroids and antibiotics were administered, following which she had initial improvement and then subsequent deterioration requiring intensive care unit (ICU) care. A detailed clinical examination (in-person and virtually) at this point revealed the presence of pigmented rashes over the knuckles and weakness of hip muscles. Laboratory work showed elevated creatine kinase levels and positive anti-Ro and anti-Jo1 antibodies, which pointed to a diagnosis of antisynthetase syndrome. Unique attributes of this case include younger age of presentation in an atypical ethnic group, which are possibly incited by COVID-19 infection in the peak of a COVID-19 wave. The work-up, diagnosis, and initial management of this patient were carried out through a hybrid ICU model, which functioned as a traditional ICU in the day and a tele-ICU at night with an appropriate network of subspecialists including rheumatologists consulting, thus highlighting a collaborative model in a low-resource setting capable of managing rare cases even in the midst of increasing critical care needs during the pandemic.
GPSAdb: a comprehensive web resource for interactive exploration of genetic perturbation RNA-seq datasets
Authors: Guo Shipeng , Xu Zhougeng , Dong Xiangjun , Hu Dongjie , Jiang Yanshuang , Wang Qunxian , Zhang Jie , Zhou Qian , Liu Shengchun , Song Weihong
Published: November 2022

Gene knock-out/down methods are commonly used to explore the functions of genes of interest, but a database that systematically collects perturbed data is not available currently. Manual curation of all the available human cell line perturbed RNA-seq datasets enabled us to develop a comprehensive human perturbation database (GPSAdb, https://www.gpsadb.com/). The current version of GPSAdb collected 3048 RNA-seq datasets associated with 1458 genes, which were knocked out/down by siRNA, shRNA, CRISPR/Cas9, or CRISPRi. The database provides full exploration of these datasets and generated 6096 new perturbed gene sets (up and down separately). GPSAdb integrated the gene sets and developed an online tool, genetic perturbation similarity analysis (GPSA), to identify candidate causal perturbations from differential gene expression data. In summary, GPSAdb is a powerful platform that aims to assist life science researchers to easily access and analyze public perturbed data and explore differential gene expression data in depth.
ClusterCAD 2.0: an updated computational platform for chimeric type I polyketide synthase and nonribosomal peptide synthetase design
Authors: Tao Xavier B , LaFrance Sarah , Xing Yifei , Nava Alberto A , Martin Hector Garcia , Keasling Jay D , Backman Tyler W H
Published: November 2022

Megasynthase enzymes such as type I modular polyketide synthases (PKSs) and nonribosomal peptide synthetases (NRPSs) play a central role in microbial chemical warfare because they can evolve rapidly by shuffling parts (catalytic domains) to produce novel chemicals. If we can understand the design rules to reshuffle these parts, PKSs and NRPSs will provide a systematic and modular way to synthesize millions of molecules including pharmaceuticals, biomaterials, and biofuels. However, PKS and NRPS engineering remains difficult due to a limited understanding of the determinants of PKS and NRPS fold and function. We developed ClusterCAD to streamline and simplify the process of designing and testing engineered PKS variants. Here, we present the highly improved ClusterCAD 2.0 release, available at https://clustercad.jbei.org. ClusterCAD 2.0 boasts support for PKS-NRPS hybrid and NRPS clusters in addition to PKS clusters; a vastly enlarged database of curated PKS, PKS-NRPS hybrid, and NRPS clusters; a diverse set of chemical ‘starters’ and loading modules; the new Domain Architecture Cluster Search Tool; and an offline Jupyter Notebook workspace, among other improvements. Together these features massively expand the chemical space that can be accessed by enzymes engineered with ClusterCAD.
Stem Cell Basis of Shoot Branching
Authors: Yang Tingting , Jiao Yuling , Wang Ying
Published: November 2022

During their postembryonic development, plants continuously form branches to conquer more space and adapt to changing environments. In seed plants, this is achieved by lateral branching, in which axillary meristems (AMs) initiate at the leaf axils to form axillary buds. The developmental potential of AMs to form shoot branches is the same as that of embryonic shoot apical meristems (SAMs). Recent studies in Arabidopsis thaliana have revealed the cellular origin of AMs and have identified transcription factors and phytohormones that regulate sequential steps leading to AM initiation. In particular, a group of meristematic cells detached from the SAM are key to AM initiation, which constitutes an excellent system for understanding stem cell fate and de novo meristem formation.
Expression inheritance and constraints on cis- and trans-regulatory mutations underlying lotus color variation
Authors: Gao Zhiyan , Yang Xingyu , Chen Jinming , Rausher Mark D , Shi Tao
Published: November 2022

Both cis- and trans-regulatory mutations drive changes in gene expression that underpin plant phenotypic evolution. However, how and why these two major types of regulatory mutations arise in different genes and how gene expression is inherited and associated with these regulatory changes are unclear. Here, by studying allele-specific expression in F1 hybrids of pink-flowered sacred lotus (Nelumbo nucifera) and yellow-flowered American lotus (N. lutea), we reveal the relative contributions of cis- and trans-regulatory changes to interspecific expression rewiring underlying petal color change and how the expression is inherited in hybrids. Although cis-only variants influenced slightly more genes, trans-only variants had a stronger impact on expression differences between species. In F1 hybrids, genes under cis-only and trans-only regulatory effects showed a propensity toward additive and dominant inheritance, respectively, whereas transgressive inheritance was observed in genes carrying both cis- and trans-variants acting in opposite directions. By investigating anthocyanin and carotenoid coexpression networks in petals, we found that the same category of regulatory mutations, particularly trans-variants, tend to rewire hub genes in coexpression modules underpinning flower color differentiation between species; we identified 45 known genes with cis- and trans-regulatory variants significantly correlated with flower coloration, such as ANTHOCYANIN 5-AROMATIC ACYLTRANSFERASE (ACT), GLUTATHIONE S-TRANSFERASE F11 (GSTF11), and LYCOPENE Ε-CYCLASE (LCYE). Notably, the relative abundance of genes in different categories of regulatory divergence was associated with the inferred magnitude of constraints like expression level and breadth. Overall, our study suggests distinct selective constraints and modes of gene expression inheritance among different regulatory mutations underlying lotus petal color divergence.
Immunophilin CYN28 is required for accumulation of photosystem II and thylakoid FtsH protease in Chlamydomonas
Authors: Fu Weihan , Cui Zheng , Guo Jia , Cui Xiayu , Han Guomao , Zhu Yunpeng , Hu Jinju , Gao Xiaoling , Li Yeqing , Xu Min , Fu Aigen , Wang Fei
Published: November 2022

Excess light causes severe photodamage to photosystem II (PSII) where the primary charge separation for electron transfer takes place. Dissection of mechanisms underlying the PSII maintenance and repair cycle in green algae promotes the usage of genetic engineering and synthetic biology to improve photosynthesis and biomass production. In this study, we systematically analyzed the high light (HL) responsive immunophilin genes in Chlamydomonas (Chlamydomonas reinhardtii) and identified one chloroplast lumen-localized immunophilin, CYN28, as an essential player in HL tolerance. Lack of CYN28 caused HL hypersensitivity, severely reduced accumulation of PSII supercomplexes and compromised PSII repair in cyn28. The thylakoid FtsH (filamentation temperature-sensitive H) is an essential AAA family metalloprotease involved in the degradation of photodamaged D1 during the PSII repair cycle and was identified as one potential target of CYN28. In the cyn28 mutant, the thylakoid FtsH undergoes inefficient turnover under HL conditions. The CYN28-FtsH1/2 interaction relies on the FtsH N-terminal proline residues and is strengthened particularly under HL. Further analyses demonstrated CYN28 displays peptidyl–prolyl isomerase (PPIase) activity, which is necessary for its physiological function. Taken together, we propose that immunophilin CYN28 participates in PSII maintenance and regulates the homeostasis of FtsH under HL stress via its PPIase activity.
Real Effects of Search Frictions in Consumer Credit Markets
Authors: Argyle Bronson , Nadauld Taylor , Palmer Christopher
Published: November 2022

We show that search frictions in credit markets affect accepted interest rates and loan sizes and distort consumption. Using data on car loan applications and originations not intermediated by car dealers, we isolate quasi-exogenous variation in both the costs and benefits to searching for credit. After identifying lender-specific policies that price risk discontinuously, we study the differential response to offered interest rates by borrowers who face high and low search costs. High-search-cost borrowers are 10$\%$ more likely to accept loan offers with higher markups, consequently originating smaller loans and purchasing older and less expensive cars than lower-search-cost borrowers.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Practical MRI of Endometrial Neoplasms, Part 3: Staging Pitfalls and Mimics
Authors: Piccolo Luciana Maksoud , Uski Ana Claudia Vincenzi Raduan , de Ávila Fernandes Jose , Abud Carolina Pereira , Leite Marcela Cavichioli , de Andrade Larre Ailma Fabiane , Naves Inácio Pedroso Maria Helena
Published: November 2022

Endometrial carcinomas (ECs) exhibit well-recognized characteristics on MRI sequences. In T2-weighted imaging (T2WI), the tumor presents as a diffuse or well-delineated soft tissue mass with an epicenter in the endometrial cavity and a heterogeneous intermediate signal relative to the hyperintense normal endometrium and hypointense myometrium. In diffusion-weighted imaging (DWI), tumors are hyperintense at a high b value in correspondence with the hypointense signal in the apparent diffusion coefficient (ADC) map. In dynamic contrast-enhanced MRI (DCE-MRI), endometrial tumors can show slower enhancement than the myometrium in the early phases and a hypointense signal in the later phases. In summary, dynamic sequences assist in the evaluation of continuous enhancement of the subendometrial zone (best evaluated approximately 35–40 seconds after the injection of gadolinium) and the estimated degree of myometrial invasion (best evaluated during the equilibrium phase—2.5 minutes after the injection of the contrast) and permit an adequate evaluation of the presence of infiltration of the cervical stroma (CSI), ideally evaluated 4 to 5 minutes after the injection of the contrast.1
Surgical Emergencies in the ICU
Authors: Saini Vikram , Ashraf Obaid , Babowice James , Hamilton Holly A. , Khan Uzer , Bhanot Nitin
Published: November 2022

Surgical emergencies are common in the critical care setting and require prompt diagnosis and management. Here, we discuss some of the surgical emergencies involving the gastrointestinal, hepatobiliary, and genitourinary sites. In addition, foreign body aspiration and necrotizing soft-tissue infections have been elaborated. Clinicians should be aware of the risk factors, keys examination findings, diagnostic modalities, and medical as well as surgical treatment options for these potentially fatal illnesses.
Family-Centered Practices and Caregiver Mental Health in a Developmental Intervention for Young Children With Congenital Zika Syndrome
Authors: Williams Natalie A. , Villachan-Lyra Pompéia , Hatton-Bowers Holly , Marvin Christine , Chaves Emmanuelle , Hollist Cody , Gomes Renata Trefiglio Mendes , Barbosa Leopoldo Nelson F.
Published: November 2022

The goal of this study was to describe the provision of intervention services to children with congenital Zika syndrome (CZS) in a large health care institution located in Recife, Brazil, and family factors related to intervention involvement, through the lens of family-centered developmental–behavioral pediatric care principles. Caregivers (N = 50) of children with CZS who were receiving services at a public rehabilitation hospital participated a cross-sectional survey study. Among caregivers, 22% reported a low number of both child and caregiver intervention contacts, 26% reported a high number of child contacts but low caregiver contacts, and 52% reported both high child and caregiver contacts with intervention staff in the past 3 months. Caregiver stress scores were higher and coping strategies were lower in the low child and caregiver intervention contact group. Most caregivers reported high levels of family-centered practices. In regression models, low family resources was associated with higher depression and stress and low coping strategy use, whereas higher support was associated with higher coping. This study adds to the small literature exploring intervention services provided to children with CZS with a particular emphasis on family-centered care principles. It is recommended that intervention programs in Brazil evaluate the availability and accessibility of family resources and develop strategies to help connect families to resources that promote caregiver mental health and child outcomes.
Recent Alcohol Use Is Associated With Increased Pre-exposure Prophylaxis (PrEP) Continuation and Adherence Among Pregnant and Postpartum Women in South Africa
Authors: Miller Amanda P. , Shoptaw Steven , Moucheraud Corrina , Mvududu Rufaro , Essack Zaynab , Gorbach Pamina M. , Myer Landon , Davey Dvora L. Joseph
Published: November 2022

Background:

South African women experience high levels of alcohol use and HIV infection during the perinatal period. Oral pre-exposure prophylaxis (PrEP) is highly effective at reducing HIV risk. We examined associations between alcohol use and PrEP use during pregnancy and postpartum.

Methods:

The PrEP in Pregnant and Postpartum women study is a prospective observational cohort of 1200 HIV-negative pregnant women enrolled at first antenatal care visit and followed through 12 months' postpartum in Cape Town, South Africa. The analytic sample comprised pregnant women who initiated PrEP at baseline and were not censored from study follow-up before 3-month follow-up. We examined associations between any or hazardous alcohol use (Alcohol Use Disorders Identification Test—Consumption score ≥3) in the year before pregnancy and PrEP continuation and adherence during pregnancy (self-report of missing <2 doses in past 7 days and biomarker-confirmed with tenofovir diphosphate in dried blood spots).

Results:

Of 943 women on PrEP (median age of 26 years), 50% reported alcohol use before pregnancy, and 33% reported hazardous use. At 3-month follow-up, 58% of women were still using PrEP; 41% reported recent adherence, and 23% were biomarker-confirmed adherent. In multivariable models, hazardous alcohol use was associated with increased odds of continuing PrEP [adjusted odds ratio (aOR) = 1.54, 95% confidence interval (CI): 1.16–2.06], self-reported PrEP adherence (aOR = 1.41, 95% CI: 1.07–1.87), and biomarker-confirmed PrEP adherence (aOR = 1.35 95% CI: 0.98, 1.87). Associations were similar in models of any alcohol use and PrEP continuation/adherence.

Conclusions:

Pregnant and postpartum women who reported recent alcohol use had increased odds of continuing to take PrEP, indicating that higher risk women may continue on oral PrEP.
Pulmonary Embolism Risk After Cosmetic Abdominoplasty and Functional Panniculectomy
Authors: Kalmar Christopher L. , Thayer Wesley P. , Kassis Salam , Higdon Kent K. , Perdikis Galen
Published: November 2022

Background

Tighter abdominal wall reconstruction may increase intra-abdominal pressure, which can decrease lower extremity venous return. Decreased venous return through the inferior vena cava has been demonstrated to increase risk of deep vein thrombosis.

Objectives

Tighter abdominal wall plication during cosmetic abdominoplasty compared with functional panniculectomy may increase these risks. The purpose of this study was to determine whether cosmetic abdominoplasty increases risk for thromboembolic events compared with functional panniculectomy.

Methods

Retrospective cohort study was conducted using the National Surgical Quality Improvement Program database for excision of excessive subcutaneous infraumbilical skin and soft tissue at participating hospitals between 2015 and 2019. Procedures performed for cosmetic abdominoplasty versus functional panniculectomy were compared for occurrences of postoperative pulmonary embolism (PE).

Results

During the study interval, 11,137 patients underwent excision of excessive infraumbilical abdominal skin, including 57.4% (n = 6397) patients undergoing functional panniculectomy and 42.6% (n = 4740) patients undergoing cosmetic abdominoplasty. Patients undergoing functional panniculectomy were significantly more likely to have comorbidities than those undergoing cosmetic abdominoplasty (P < 0.001). The risk for postoperative PE was independently associated with cosmetic abdominoplasty (P < 0.001), elevated body mass index (P = 0.001), preoperative recent weight loss (P = 0.006), and concurrent hernia repair (P = 0.049). Most PE events occurred outpatient after discharge (87.2%), and the average postoperative time from surgery until PE was 10.5 ± 6.7 days.

Conclusions

Cosmetic abdominoplasty has greater than 4 times the risk of postoperative PE than functional panniculectomy. Risk of PE is further increased by concurrent hernia repair, elevated body mass index, and rapid weight loss in the immediate preoperative period. It may be advisable to caution patients to delay abdominal excisional body contouring procedures until their weight has plateaued.
A Cohort Study on Neuropathic Pain of the Sural Nerve—Can Neurectomy Be Considered a Valid Treatment Option?
Authors: Besmens Inga S. , Brackertz Sophie , Schiller Andreas , Knipper Sophie , Giovanoli Pietro , Calcagni Maurizio
Published: November 2022

Background

Sural nerve neuroma is often caused by an injury during prior surgery, for example, osteosynthesis or ligament refixations at ankle level. Different surgical techniques to treat neuroma have been described. Neurectomy of an injured symptomatic sural nerve has been described as a treatment option for neuropathic pain. The aim of this study was to evaluate the outcomes of this technique to operatively treat sural nerve neuroma in our department.

Methods

From 2010 to 2020, a total of 30 consecutive patients with neuropathic pain and suspected neuroma of the sural nerve underwent sural nerve neurectomy. A medical chart review was performed to collect patient-, pain-, and treatment-specific factors. Outcomes were registered.

Results

After neurectomy, 22 patients (73.3%) had persisting pain. In logistic regression models evaluating the risk of persisting pain after sural nerve neurectomy, no independent predictor of higher risk of persisting pain could be identified.

Conclusion

For sural nerve neuromas, neurectomy remains an option as the surgical morbidity is minor, but patients need to be counseled that only a fourth of those undergoing surgery will be pain-free afterward.
Secondary Surgery in Facial Feminization
Authors: Rochlin Danielle H. , Chaya Bachar F. , Rodriguez Colon Ricardo , Onuh Ogechukwu , Rojas Allison , Rodriguez Eduardo D.
Published: November 2022

Background

As facial feminization surgery (FFS) continues to grow in access and popularity, the need for secondary FFS can be expected to increase. The purpose of this study was to identify reasons for FFS reoperation and offer recommendations to minimize secondary surgery.

Methods

A retrospective cohort study of patients who underwent FFS from October 2017 to 2021 was performed. Patients who underwent nonstaged secondary surgery were identified and sorted in 2 non–mutually exclusive surgical cohorts: additional surgery, defined as unplanned additional feminization surgery on previously unoperated facial units, and revision surgery, defined as redo surgery on previously operated facial units. Reasons for secondary surgery were examined in the context of the senior author's experience.

Results

Of 161 patients who underwent FFS, 41 (25.5%) underwent secondary surgery consisting of additional surgery (n = 32) and/or revision surgery (n = 30). There were no significant differences in clinical or demographic data between the secondary surgery and total FFS cohorts. Among additional surgery patients, facial units that had been previously operated on were as follows: nose (46.3%), trachea (31.7%), forehead/brow (22.0%), chin (12.2%), lips (9.8%), and cheeks (7.3%). Among revision patients, facial units revised were as follows: nose (36.6%), forehead/brow (26.8%), cheeks (17.1%), chin (17.1%), lips (12.5%), and trachea (2.4%). The main indication for revision for all facial units was undercorrection to feminine ideals.

Conclusions

One-quarter of patients who underwent FFS had prior FFS and/or sought revision. Keeping in mind that the dominant indication for revision was undercorrection, FFS surgeons can minimize the need for secondary surgery in the future.
Literature Review
Authors: Khan Mustafa T.A. , Won Brian Wong , Baumgardner Kyle , Lue Melinda , Montorfano Lisandro , Hosein Rayaad C. , Wang Howard T. , Martinez Roberto A.
Published: November 2022

Introduction

Robotic-assisted surgery is gaining popularity because of reported improvement in aesthetic outcomes while reducing the occurrence of complications compared with conventional surgical methods. Deep inferior epigastric perforator (DIEP) flap harvesting has a long track record as a viable procedure for autologous reconstruction of the breast. In this literature review, we describe the feasibility of using the robotic platform in DIEP flap harvest.

Methods

The Preferred Reporting Items for Systemic Reviews and Meta-Analysis methodology was to guide the literature review. PubMed and Scopus databases were searched from inception to June 6, 2022. The Medical Subject Heading terms and keywords used to conduct this search are as described: “Robotic AND deep inferior epigastric perforator AND Breast reconstruction.”

Results

Seven publications, detailing a total of 56 robotic-assisted DIEP flap harvest procedures, were selected for review. Four publications used the transabdominal preperitoneal approach, whereas 2 exclusively used a totally extraperitoneal approach, and 1 compared the 2 approaches. The measured outcomes included technical feasibility of flap harvest in cadavers, viable flap harvest in live patients, harvest time and pedicle dissection time, pedicle length, fascial incision length, donor site pain, need for postoperative narcotic, donor site morbidity, and hernia formation. Overall, the reviewed articles demonstrated successful DIEP flap harvesting without the need for conversion to the conventional open procedure. Postoperative complications were minimal. Robotic DIEP flap harvest was shown to be safe and there were no reports of donor-site morbidity in the studies reviewed. The main advantages of the robotic approach include decreased postoperative pain and length of hospital stay, along with improved aesthetic outcomes. The main disadvantages are increased operative time and cost.

Conclusions

Although at its current iteration, the robotic-assisted DIEP flap is feasible, it may not be practical in all settings. Furthermore, the true benefit of the robotic platform is yet to be determined, as more long-term studies are necessary.
An Updated Definition of Plastic Surgery
Authors: Li Qingfeng , Wang Wenjin , Zan Tao , Xiang MengPing , Pu Lee L. Q. , Schaefer Dirk J. , Ohjimi Hiroyuki
Published: November 2022

Modern medicine tends to provide comprehensive medical services based on disease or pathological features. As a result, the overlap between plastic surgery and other surgical departments greatly deepened. What was exclusively done by plastic surgeons are nowadays frequently practiced by other surgeons as well. Thus, generating confusion as to whether plastic surgery is an independent subject or a tool. Therefore, in this new era of modern medicine, it is necessary to reconsider the definition of plastic surgery.
Obstructive Sleep Apnea in Men With Idiopathic Intracranial Hypertension: A Prospective Case–Control Study
Authors: Kabanovski Anna , Chan Aaron , Shapiro Colin , Margolin Edward
Published: November 2022

Background:

Idiopathic intracranial hypertension (IIH) is uncommon in men. Previous studies reported on high frequency of obstructive sleep apnea (OSA) in men with IIH, but the pathophysiology of this association remains unclear. One possible culprit for increased intracranial pressure in patients with OSA is hypercapnia. The purpose of this study was to compare the rate of hypercapnia during polysomnography (PSG) study in men with and without IIH and to report on the rate and severity of OSA in men with IIH compared with control subjects of similar age and body mass index (BMI).

Methods:

Prospective case–control study of male patients diagnosed with IIH underwent PSG with continuous oxygen and carbon dioxide monitoring overnight. Healthy control subjects with similar age and BMI also underwent PSG. The incidence of OSA diagnosis, rate of hypercapnia and hypoxia, and apnea hypopnea index (AHI) were compared between 2 groups.

Results:

Eleven subjects with IIH and 10 controls underwent PSG. Both groups were similar regarding age and BMI on the Mann–Whitney U test (P = 0.072 for age, P = 0.251 for BMI). Subjects for whom carbon dioxide data were not available for more than 50% of total sleep time were excluded from hypercapnia analysis. The mean age was 41.9 years, and the mean BMI was 33.8 kg/m2 in subjects and controls. OSA was diagnosed in 9 of 11 men with IIH and 4 of 10 controls. There was no statistically significant difference in the rate of hypercapnia and hypoxia between 2 groups for whom the data were available. All patients with BMI over 30 kg/m2 (7 of 7) and 50% (2 of 4) controls with BMI over 30 kg/m2 were diagnosed with OSA compared with 50% (2 of 4) of cases and 33% (2 of 6) of controls with BMI less than 30 kg/m2. BMI was a significant predictor of total AHI (P = 0.042) and OSA severity (P = 0.023), but IIH diagnosis was not (P > 0.05).

Conclusions:

There was no difference in hypercapnia rate between men with IIH and controls; thus, hypercapnia is an unlikely causative factor in pathophysiology of IIH. OSA on PSG was almost 2 times as prevalent in patients with IIH compared with controls; however, BMI was the strongest predictor of OSA diagnosis, and most patients (9 of 11) with BMI over 30 kg/m2 had OSA on PSG. In men with BMI less than 30, the rate of OSA on PSG study was higher in men with IIH. Based on these data, we recommend that all men with the diagnosis of IIH should undergo PSG study.
It Has Become a Part of Me: Living With Low Anterior Resection Syndrome After Ostomy Reversal
Authors: Buergi Catherine
Published: November 2022

PURPOSE:

The purpose of this study was to explore challenges of individuals living with low anterior resection syndrome (LARS) 1 year or more after ostomy reversal and formulate a greater understanding of their needs.

DESIGN:

Qualitative study with a phenomenological approach.

SUBJECTS AND SETTING:

The sample comprised 2 women and 5 men. All participants had undergone low anterior resection in the Comprehensive Cancer Center of a Swiss university hospital. The mean age of participants was 66 years (range, 61-71 years).

METHODS:

Interviews were conducted 12 to 42 months after ostomy reversal. Data were collected from one-on-one in-depth interviews using a standardized interview guide with open-ended questions. An interpretative phenomenological analysis was used to interpret data.

RESULTS:

Analysis revealed 3 central categories addressing the burden of living with LARS: “Internalizing new living conditions”; “Actively planning a new everyday life”; and “Knowing the body and controlling symptoms.” “Unpredictability” emerged as the key challenge. Being informed in advance about the problems expected to arise, having the possibility to talk about problems, as well as receiving peer support and structured aftercare were identified as means to ease patients' challenges when living with LARS.

CONCLUSIONS:

Twelve to 42 months after stoma reversal, participants had internalized their new living conditions. Their level of acceptance of their situation was substantial. There are indications that a culture of open information before ostomy reversal contributed to being mentally prepared for the situation after surgery. Talking openly about their problems helped participants organize their everyday life.