bluuebunny/crossref_metadata_2025 huggingface dataset:
An efficient non-binary QC-LDPC coded modulation scheme for long-haul optical systems
Authors: P Sajith Sethu , Solomon Sam
Published: September 2024

Coded modulation (CM), which combines channel codes with high-dimensional modulation schemes, is an attractive technique to improve the spectral efficiency in high-speed optical transmission systems. Non-binary low-density parity check (NB LDPC) codes can provide larger coding gains with smaller codeword lengths compared to their binary counterpart, in addition to reducing the latency of the system. The majority of works based on NB LDPC CM focus on bit-interleaved CM (BICM) and the widely used additive white Gaussian noise (AWGN) channel model. However, the Gaussian channel model is not a realistic model for long-haul intensity-modulated direct-detection (IM/DD) optical systems using erbium-doped fiber amplifiers. In this paper, it is mathematically proved that noise in the received signals after photodetection can be more accurately represented using chi-squared distribution. The efficiency of CM depends on the mapping between coded symbols and the constellation signal points of the modulation scheme. Hence, a symbol interleaved CM with subcarrier modulation for NB LDPC codes based on the proposed channel model is presented in this paper to improve the bit-error rate (BER) performance. The simulation results show that the proposed CM for NB LDPC codes with M-ary quadrature amplitude modulation schemes provides better performance than BICM. The analysis of the error performance of the proposed system gives a coding gain of 1 dB at a BER of 10−7 compared to that of the AWGN channel model. The performance improvement of the system is also evaluated in terms of spectral efficiency and link distance.
Development and validation of a prognostic scoring system for 1-year mortality in older patients with hip fractures
Authors: Katsuyama Yusei , Horie Naoyuki , Yoshii Kengo , Nakamura Shinichiro , Saito Tomoki , Takahashi Kenji
Published: September 2024

Background

Hip fractures in older people result in increased mortality.

Objective

We developed and validated an accurate and simple prognostic scoring system for hip fractures that can be used preoperatively.

Design

Retrospective study.

Setting

Multicenter.

Participants

Patients aged ≥65 years with hip fractures who underwent surgery between 2011 and 2021 were enrolled.

Methods

The significant factors were determined with logistic regression analysis, and a scoring system was developed. The patients were classified into three groups, and a log-rank test was performed to evaluate 1-year survival rates. The model was internally and externally validated using the 5-fold cross-validation and data from another hospital, respectively.

Results

We included 1026 patients. The analysis revealed eight significant prognostic factors: sex, body mass index, history of chronic heart failure and malignancy, activities of daily living (ADLs) before injury, hemoglobin and the prognostic nutritional index (PNI) at injury, and the American Society of Anesthesiologists Physical Status. The area under the receiver operating characteristic curve (AUC) after internal validation was 0.853. The external validation data consisted of 110 patients. The AUC of the model for the validation data was 0.905, showing outstanding discrimination. Sensitivity and specificity were 88.7% vs. 100% and 93.3% vs. 95.2% for the development and validation data, respectively.

Conclusions

We developed and validated an accurate and simple prognostic scoring system for hip fractures using only preoperative factors. Our findings highlight PNI as an important predictor of prognosis in hip fracture patients.
Exposure range matters: considering nonlinear associations in the meta-analysis of environmental pollutant exposure using examples of per- and polyfluoroalkyl substances and birth outcomes
Authors: Guo Pengfei , Warren Joshua L , Deziel Nicole C , Liew Zeyan
Published: September 2024

Meta-analysis is a powerful analytic method for summarizing effect estimates across studies. However, conventional meta-analysis often assumes a linear exposure-outcome relationship and does not account for variability over the exposure ranges. In this work, we first used simulation techniques to illustrate that the linear-based meta-analytical approach may result in oversimplistic effect estimation based on 3 plausible nonlinear exposure-outcome curves (S-shape, inverted U-shape, and M-shape). We showed that subgroup meta-analysis that stratifies on exposure levels can investigate nonlinearity and identify the consistency of effect magnitudes in these simulated examples. Next, we examined the heterogeneity of effect estimates across exposure ranges in 2 published linear-based meta-analyses of prenatal exposure to per- and polyfluoroalkyl substances (PFAS) on changes in mean birth weight or risk of preterm birth. The reanalysis found some varying effect sizes and potential heterogeneity when restricting to different PFAS exposure ranges, but findings were sensitive to the cut-off choices used to rank the exposure levels. Finally, we discussed methodological challenges and recommendations for detecting and interpreting potential nonlinear associations in meta-analysis. Using meta-analysis without accounting for exposure range could contribute to literature inconsistency for exposure-induced health effects and impede evidence-based policymaking. Therefore, investigating result heterogeneity by exposure range is recommended.

This article is part of a Special Collection on Environmental Epidemiology.
ST-SCSR: identifying spatial domains in spatial transcriptomics data via structure correlation and self-representation
Authors: Zhang Min , Zhang Wensheng , Ma Xiaoke
Published: September 2024

Recent advances in spatial transcriptomics (ST) enable measurements of transcriptome within intact biological tissues by preserving spatial information, offering biologists unprecedented opportunities to comprehensively understand tissue micro-environment, where spatial domains are basic units of tissues. Although great efforts are devoted to this issue, they still have many shortcomings, such as ignoring local information and relations of spatial domains, requiring alternatives to solve these problems. Here, a novel algorithm for spatial domain identification in Spatial Transcriptomics data with Structure Correlation and Self-Representation (ST-SCSR), which integrates local information, global information, and similarity of spatial domains. Specifically, ST-SCSR utilzes matrix tri-factorization to simultaneously decompose expression profiles and spatial network of spots, where expressional and spatial features of spots are fused via the shared factor matrix that interpreted as similarity of spatial domains. Furthermore, ST-SCSR learns affinity graph of spots by manipulating expressional and spatial features, where local preservation and sparse constraints are employed, thereby enhancing the quality of graph. The experimental results demonstrate that ST-SCSR not only outperforms state-of-the-art algorithms in terms of accuracy, but also identifies many potential interesting patterns.
Potential Implications of Using Locally Validated Risk Factors for Drug-Resistant Pathogens in Patients With Community-Acquired Pneumonia in US Hospitals: A Cross-Sectional Study
Authors: Gasoyan Hamlet , Deshpande Abhishek , Imrey Peter B , Guo Ning , Mittman Benjamin G , Rothberg Michael B
Published: September 2024

Background

The 2019 American Thoracic Society/Infectious Diseases Society of America (ATS/IDSA) community-acquired pneumonia (CAP) guidelines recommend that clinicians prescribe empiric antibiotics for methicillin-resistant Staphylococcus aureus or Pseudomonas aeruginosa only if locally validated risk factors (or 2 generic risk factors if local validation is not feasible) are present.

Methods

In this cross-sectional study that included adults hospitalized for CAP across 50 hospitals in the Premier Healthcare Database from 2010 to 2015, we sought to describe how the use of extended-spectrum antibiotics (ESAs) and the coverage for patients with CAP due to restraint organisms would change under the 2 approaches described in the 2019 ATS/IDSA guidelines. The proportion of ESA use in patients with CAP and the proportion of ESA coverage among patients with infections resistant to recommended CAP therapy were measured.

Results

In the 50 hospitals, 19%–75% of patients received ESAs, and 42%–100% of patients with resistant organisms received ESAs. The median number of risk factors identified per hospital was 9 (interquartile range, 6–12). Overall, treatment according to local risk factors reduced the number of patients receiving ESAs by 38.8 percentage points and by 47.5 percentage points when using generic risk factors. However, the effect varied by hospital. The use of generic risk factors always resulted in less ESA use and less coverage for resistant organisms. Using locally validated risk factors resulted in a similar outcome in all but 1 hospital.

Conclusions

Future guidelines should explicitly define the optimal trade-off between adequate coverage for resistant organisms and ESA use.
Severe aortic valve regurgitation in patient with Takayasu arteritis: a case report
Authors: Tassi Vasiliki , Tzalas Dimitrios , Papadopoulou Elektra , Trikas Athanasios
Published: September 2024

Background

Takayasu arteritis (TAK) is a systemic non-inflammatory vasculitis that primarily affects large- and medium-sized arteries.

Case summary

We report the case of a 57-year-old woman with a history of coronary artery bypass grafting (CABG) 7 years prior, who was referred for a stress echo due to chest pain. Transthoracic echocardiography revealed the left ventricle at the upper limits of normal with preserved contractility, as well as circumferential thickening of the aortic root, causing severe aortic regurgitation (AR). Cardiac computed tomography and angiography demonstrated diffuse thickening of the aortic wall from the aortic root to the descending thoracic aorta, extending to the left carotid artery and significant stenosis of the left subclavian artery. Coronary angiography showed severe narrowing of the left main coronary ostium with ostial stenosis and total occlusion of the right coronary and left internal mammary arteries. Magnetic angiography highlighted thickening of the aortic wall, while no active inflammation was detected on positron emission tomography. These findings suggested Takayasu aortitis with chronic inflammation.

Discussion

In young patients, particularly women, who present with angina and coronary ostial stenosis, Takayasu arteritis should be considered in the differential diagnosis. Aortic regurgitation (AR) is a serious complication, and its surgical management can be challenging.
Idiopathic Granulomatous Mastitis: Imaging Findings and Outcomes with Nonsteroidal Treatment in a Predominantly Hispanic Population
Authors: Rizzo Lucien , Hovanessian-Larsen Linda , Yamashita Mary , Lei Xiaomeng , Cen Steven , Choi Jennifer , Lee Tiffany , Lee Sandy
Published: September 2024

Objective

We describe the demographics, clinical presentation, imaging findings, and treatment response among 235 cases of biopsy-proven idiopathic granulomatous mastitis (IGM) at a single institution.

Methods

An institutional review board–approved retrospective search of the breast imaging database was performed to select patients with biopsy-proven IGM between 2017 and 2022. Retrospective review evaluated clinical presentation, imaging findings with US and mammography, and treatment recommendations (antibiotics, nonsteroidal anti-inflammatory drugs [NSAIDs], warm compresses, or observation only). Response to treatment was evaluated on follow-up US. A favorable treatment response was a decrease in size or resolution of disease on follow-up imaging. Statistical analysis using Poisson regression was performed to evaluate the clinical outcomes associated with each treatment.

Results

A total of 235 patients met the selection criteria with a mean age of 38 years (18 to 68). The majority of patients were Hispanic (95%, 223/235). Of all patients, 75.3% (177/235) received treatment (consisting of 1 or any combination of antibiotics, NSAIDs, warm compresses), 24.7% (58/235) were treated with observation, 78.7% (185/235) returned for follow-up imaging, and 21.3% (50/235) were lost to follow-up. Of those with follow-up imaging, disease improvement was seen in 70.3% (102/145) of patients who received treatment compared with 72.5% (29/40) of patients treated by observation alone. Multivariate analysis further showed no difference in clinical outcomes among the treatment of unifocal, multifocal, or recurrent IGM.

Conclusion

Nonsteroidal treatment of IGM showed no significant improvement on follow-up imaging compared to treatment with observation alone in a predominantly Hispanic patient population.
F
ST
between haploids and diploids in species with discrete ploidy phases
Authors: Bessho Kazuhiro , Otto Sarah P
Published: September 2024

Many organisms alternate between distinct haploid and diploid phases, which generates population structure according to ploidy level. In this research, we consider a haploid–diploid population using statistical approaches developed for spatially subdivided populations, where haploids represent one “patch” and diploids another “patch.” In species with alternating generations, sexual reproduction causes movement from diploids to haploids (by meiosis with recombination) and from haploids to diploids (by syngamy). Thus, an allele in one ploidy phase can be said to “migrate” to the other ploidy phase by sexual reproduction and to “remain” in the same ploidy phase by asexual reproduction. By analyzing a coalescent model of the probability of identity by descent and by state for a haploid–diploid system, we define FST-like measures of differentiation between haploids and diploids and show that these measures can be simplified as a function of the extent of sexuality in each ploidy phase. We conduct simulations with an infinite-alleles model and discuss a method for estimating the degree of effective sexuality from genetic data sets that use the observed FST measures of haploid–diploid species.
Decreased in Mitochondrial Complex I Subunit NDUFS2 Is Critical for Oocyte Quality During Postovulatory Aging in Pigs
Authors: Zhou Dongjie , Lee Song-Hee , Li Xiao-Han , Kim Ji-Dam , Lee Gyu-Hyun , Sim Jae-Min , Cui Xiang-Shun
Published: September 2024

The levels of nicotinamide adenine dinucleotide (NADH) dehydrogenase [ubiquinone] iron-sulfur protein 2 (NDUFS2, a subunit of NADH dehydrogenase) decrease in aged tissues, and these reductions may be partly associated with age-related conditions such as Parkinson's disease. Aging leads to many mitochondrial defects, such as biogenesis disruption, dysfunction, defects in the mitochondrial membrane potential, and production of reactive oxygen species, that may be highly related to NDUFS2 expression. The relationship between NDUFS2 and postovulatory oocyte aging in pigs remains unknown. In this study, we investigated changes in NDUFS2 expression during postovulatory aging (POA). Furthermore, NDUFS2 was knocked down via dsRNA microinjection at the MII stage to evaluate the effects on mitochondrial-related processes during POA. The mRNA expression of NDUFS2 decreased significantly after 48-h aging compared with that in fresh oocytes. NDUFS2 knockdown (KD) significantly impaired the maintenance of oocyte morphology and blastocyst development of embryos after POA. The levels of PGC1α (mitochondrial biogenesis-related proteins) decreased significantly after NDUFS2 KD, while the level of GSNOR, a protein denitrosylase, was reduced by NDUFS2 KD after 48 h of aging. These data suggest that NDUFS2 is vital for maintaining the oocyte quality during POA in pigs.
Towards Establishing Best Practice in the Analysis of Hydrogen and Deuterium by Atom Probe Tomography
Authors: Gault Baptiste , Saksena Aparna , Sauvage Xavier , Bagot Paul , Aota Leonardo S , Arlt Jonas , Belkacemi Lisa T , Boll Torben , Chen Yi-Sheng , Daly Luke , Djukic Milos B , Douglas James O , Duarte Maria J , Felfer Peter J , Forbes Richard G , Fu Jing , Gardner Hazel M , Gemma Ryota , Gerstl Stephan S A , Gong Yilun , Hachet Guillaume , Jakob Severin , Jenkins Benjamin M , Jones Megan E , Khanchandani Heena , Kontis Paraskevas , Krämer Mathias , Kühbach Markus , Marceau Ross K W , Mayweg David , Moore Katie L , Nallathambi Varatharaja , Ott Benedict C , Poplawsky Jonathan D , Prosa Ty , Pundt Astrid , Saha Mainak , Schwarz Tim M , Shang Yuanyuan , Shen Xiao , Vrellou Maria , Yu Yuan , Zhao Yujun , Zhao Huan , Zou Bowen
Published: September 2024

As hydrogen is touted as a key player in the decarbonization of modern society, it is critical to enable quantitative hydrogen (H) analysis at high spatial resolution and, if possible, at the atomic scale. H has a known deleterious impact on the mechanical properties (strength, ductility, toughness) of most materials that can hinder their use as part of the infrastructure of a hydrogen-based economy. Enabling H mapping including local hydrogen concentration analyses at specific microstructural features is essential for understanding the multiple ways that H affect the properties of materials including embrittlement mechanisms and their synergies. In addition, spatial mapping and quantification of hydrogen isotopes is essential to accurately predict tritium inventory of future fusion power plants thus ensuring their safe and efficient operation. Atom probe tomography (APT) has the intrinsic capability to detect H and deuterium (D), and in principle the capacity for performing quantitative mapping of H within a material's microstructure. Yet, the accuracy and precision of H analysis by APT remain affected by complex field evaporation behavior and the influence of residual hydrogen from the ultrahigh vacuum chamber that can obscure the signal of H from within the material. The present article reports a summary of discussions at a focused workshop held at the Max-Planck Institute for Sustainable Materials in April 2024. The workshop was organized to pave the way to establishing best practices in reporting APT data for the analysis of H. We first summarize the key aspects of the intricacies of H analysis by APT and then propose a path for better reporting of the relevant data to support interpretation of APT-based H analysis in materials.
Characterization of Carbide Precipitation in Low-Carbon Martensitic Steels Using an Ultrawide Field-of-View 3D Atom Probe
Authors: Minami Hidekazu , Tegg Levi , Sato Takanori , Cairney Julie M
Published: September 2024

It is important to understand the carbide distribution around high-energy sites such as dislocations and grain boundaries in martensitic steels as they have a major influence on the alloy performance. The aim of this study is to characterize fine ε carbides precipitated in low-carbon lath martensitic steel using the ultrawide field-of-view (FoV) CAMECA Invizo 6000 atom probe. We demonstrate the advantages of the wide FoV and determine the optimum conditions for analysis, by comparing the results such as the background noise and the C++/C+ charge state ratio (CSR) between voltage-pulsed and laser-pulsed modes. Increasing the laser pulse energy decreased the background noise and the CSR, where 70 pJ laser pulse energy produced a comparable mass-to-charge ratio spectrum to that recorded in voltage-pulsed mode, with the bulk compositions of C, Si, and Mn closest to that measured using voltage-pulsed mode. Increasing laser pulse energies to above 300 pJ decreased the bulk carbon content, with a more diffuse distribution of carbon around the carbides. This paper outlines some of the important experimental considerations when performing quantitative study of carbide precipitation in low-carbon martensitic steels using the Invizo 6000, considerations that can also be applied to other ferrous and non-ferrous alloy systems.
Horseshoes and spiral waves: capturing the 3D flow induced by a low-mass planet analytically
Authors: Brown Joshua J , Ogilvie Gordon I
Published: September 2024

The key difficulty faced by 2D models for planet–disc interaction is in appropriately accounting for the impact of the disc’s vertical structure on the dynamics. 3D effects are often mimicked via softening of the planet’s potential; however, the planet-induced flow and torques often depend strongly on the choice of softening length. We show that for a linear adiabatic flow perturbing a vertically isothermal disc, there is a particular vertical average of the 3D equations of motion that exactly reproduces 2D fluid equations for arbitrary adiabatic index. There is a strong connection here with the Lubow–Pringle 2D mode of the disc. Correspondingly, we find a simple, general prescription for the consistent treatment of planetary potentials embedded within ‘2D’ discs. The flow induced by a low-mass planet involves large-scale excited spiral density waves that transport angular momentum radially away from the planet and ‘horseshoe streamlines’ within the coorbital region. We derive simple linear equations governing the flow that locally capture both effects faithfully simultaneously. We present an accurate coorbital flow solution allowing for inexpensive future study of corotation torques, and predict the vertical structure of the coorbital flow and horseshoe region width for different values of adiabatic index, as well as the vertical dependence of the initial shock location. We find strong agreement with the flow computed in 3D numerical simulations, and with 3D one-sided Lindblad torque estimates, which are a factor of 2–3 lower than values from previous 2D simulations.
Mechanism of activation of contact-dependent growth inhibition tRNase toxin by the amino acid biogenesis factor CysK in the bacterial competition system
Authors: Feng Zhaohang , Yashiro Yuka , Tomita Kozo
Published: September 2024

Contact-dependent growth inhibition (CDI) is a bacterial competition mechanism, wherein the C-terminal toxin domain of CdiA protein (CdiA-CT) is transferred from one bacterium to another, impeding the growth of the toxin recipient. In uropathogenic Escherichia coli 536, CdiA-CT (CdiA-CTEC536) is a tRNA anticodon endonuclease that requires a cysteine biogenesis factor, CysK, for its activity. However, the mechanism underlying tRNA recognition and cleavage by CdiA-CTEC536 remains unresolved. Here, we present the cryo-EM structure of the CysK:CdiA-CTEC536:tRNA ternary complex. The interaction between CdiA-CTEC536 and CysK stabilizes the CdiA-CTEC536 structure and facilitates tRNA binding and the formation of the CdiA-CTEC536 catalytic core structure. The bottom-half of the tRNA interacts exclusively with CdiA-CTEC536 and the α-helices of CdiA-CTEC536 engage with the minor and major grooves of the bottom-half of tRNA, positioning the tRNA anticodon loop at the CdiA-CTEC536 catalytic site for tRNA cleavage. Thus, CysK serves as a platform facilitating the recognition and cleavage of substrate tRNAs by CdiA-CTEC536.
Is Kenya’s gender wealth gap narrowing? New insights from probate records
Authors: Simson Rebecca
Published: September 2024

This article introduces a new dataset on individuals leaving inheritances in Kenya, which sheds light on the country’s marked gender disparities in the ownership of wealth. An estimated 9% of decedents in Kenya leave estates that undergo probate or administration. Since the 1980s, men have been four times more likely than women to leave such estates at death. But this gender estate gap has been narrowing. The share of women leaving wealth at death has risen from below 10% in the 1970s to 25% today. The geographic variation in this gender estate gap shows that women are more likely to leave wealth in regions with active land and property markets, suggesting that women are sharing in the ownership of assets purchased in the course of their lifetimes. In contrast, in regions where much of the wealth stock is comprised of ancestral land, women remain a smaller share of inheritance-leavers.
Divine Purpose? Religion, Race, and Attitudes Toward Life Extension Technology
Authors: Frost Jacqui , Schneider Rachel C , Henderson Andrea K , Ecklund Elaine Howard
Published: September 2024

There is a growing sociological literature examining how religion shapes attitudes toward science and technology. However, sociologists have done little to explore how attitudes toward religion and science shape support for end-of-life and life extension technologies. Past research suggests that those most likely to be interested in life extension technologies are nonreligious and White. However, we draw on theories in sociology of religion to examine how race and religion might intersect to shape attitudes about life extension. We find that Black Americans are significantly more interested in life extension than White Americans, and while religiosity decreases interest in life extension among White Americans, religiosity increases interest for Black Americans. And we find that Black and Hispanic Americans are more likely than White Americans to cite other-oriented and religious reasons over self-oriented reasons for wanting to extend their lives, such as “divine purpose” and a desire to contribute more to society.
Efficacy and Safety of Low-Fluence 730-nm Picosecond Laser in the Treatment of Melasma in Chinese Patients
Authors: Han Rui , Sun Yifang , Su Mingshan
Published: September 2024

BACKGROUND

The 730-nm picosecond laser has shown promise in treating various benign pigmentary conditions, and it is yet to be determined whether it is effective and safe for melasma.

OBJECTIVE

The aim of this study was to investigate the potential benefits and risks of using the 730-nm picosecond laser to remove melasma.

MATERIALS AND METHODS

This is a retrospective review of all patients who presented to the clinic between April 2021 and April 2022 for the treatment of melasma with 730-nm picosecond laser alone. The efficacy of the laser was assessed based on the Melasma Area and Severity Index (MASI) score using high-resolution photographs evaluated by blinded dermatologists.

RESULTS

A total of 25 Chinese with Fitzpatrick skin Type II to IV were included. Patients were treated for an average of 3.56 ± 0.77 treatment sessions. The mean MASI scores decreased by 33.7% from 11.38 ± 6.60 to 7.55 ± 6.08 at an average of 8.48 ± 2.16 weeks of follow-up (p < .001). Among the patients, 1 experienced a 79% decrease, 6 had a decrease ranging from 51% to 75%, 10 had a decrease ranging from 26% to 50%, 5 had a decrease of less than 25%, and 3 experienced no changes in MASI scores. No hyper/hypopigmentation was observed.

CONCLUSION

Low-fluence 730-nm picosecond laser is an effective and safe modality for the treatment of melasma in Chinese patients.
Role of l-arginine/nitric oxide/cyclic GMP/KATP channel signaling pathway and opioid receptors in the antinociceptive effect of rutin in mice
Authors: Fayazzadeh Sadaf , Fakhri Sajad , Abbaszadeh Fatemeh , Farzaei Mohammad Hosein
Published: September 2024

The l-arginine (l-Arg)/nitric oxide/cyclic GMP/potassium channel (KATP) pathway and opioid receptors are known to play critical roles in pain perception and the antinociceptive effects of various compounds. While there is evidence suggesting that the analgesic effects of rutin may involve nitric oxide modulation, the direct link between rutin and the l-Arg/nitric oxide/cyclic GMP/KATP pathway in the context of pain modulation requires further investigation. The antinociceptive effect of rutin was studied in male NMRI mice using the formalin test. To investigate the role of the l-Arg/nitric oxide/cyclic GMP/KATP pathway and opioid receptors, the mice were pretreated intraperitoneally with different substances. These substances included l-Arg (a precursor of nitric oxide), S-nitroso-N-acetylpenicillamine (SNAP, a nitric oxide donor), N(gamma)-nitro-l-arginine methyl ester (L-NAME, an inhibitor of nitric oxide synthase), sildenafil (an inhibitor of phosphodiesterase enzyme), glibenclamide (a KATP channel blocker), and naloxone (an opioid receptor antagonist). All pretreatments were administered 20 min before the administration of the most effective dose of rutin. Based on our investigation, it was found that rutin exhibited a dose-dependent antinociceptive effect. The administration of SNAP enhanced the analgesic effects of rutin during both the initial and secondary phases. Moreover, L-NAME, naloxone, and glibenclamide reduced the analgesic effects of rutin in both the primary and secondary phases. In conclusion, rutin holds significant value as a flavonoid with analgesic properties, and its analgesic effect is directly mediated through the nitric oxide/cyclic GMP/KATP channel pathway.
Implant-based Breast Reconstruction Salvage with Negative Pressure Wound Therapy with Instillation: An Evaluation of Outcomes
Authors: Ahmed Shahnur , Hulsman Luci , Imeokparia Folasade , Ludwig Kandice , Fisher Carla , Bamba Ravinder , Danforth Rachel , VonDerHaar R. Jason , Lester Mary E. , Hassanein Aladdin H.
Published: September 2024

Background:

Implant infection is problematic in breast reconstruction. Traditionally, infected tissue expanders (TE)/implants are removed for several months before replacement, resulting in breast reconstruction delay. Salvage involving device removal, negative pressure wound therapy with instillation and dwell (NPWTi-d) placement, and early staged TE/implant replacement within a few days has been described. The purpose of this study was to compare outcomes of the NPWTi-d salvage pathway with traditional implant removal.

Methods:

A retrospective review was performed on patients who underwent implant-based reconstruction and developed TE/implant infection/exposure requiring removal. Patients were divided into two groups. Group 1 had TE/implant removal, NPWTi-d placement, and TE/implant replacement 1–4 days later. Group 2 (control) underwent standard TE/implant removal and no NPWTi-d. Reinfection after TE/implant salvage, TE/implant-free days, and time to final reconstruction were assessed.

Results:

The study included 47 patients (76 TE/implants) in group 1 (13 patients, 16 TE/implants) and group 2 (34 patients, 60 TE/implants). The success rate (no surgical-site infection within 90 days) of implant salvage was 81.3% in group 1. No group 1 patients abandoned completing reconstruction after TE/implant loss versus 38.2% (13 of 34) in group 2 (P = 0.0094). Mean implant-free days was 2.5 ± 1.2 in group 1 versus 134.6 ± 78.5 in group 2 (P = 0.0001). The interval to final implant-based reconstruction was 69.0 ± 69.7 days in group 1 versus 225.6 ± 93.6 days in group 2 (P = 0.0001).

Conclusions:

A breast implant salvage pathway with infected device removal, NPWTi-d placement, and early TE/implant replacement was successful in 81.3%. Patients experienced 132 less implant-free days and faster time to final reconstruction.
The Influence of Treatment With Sofosbuvir/Velpatasvir on Children’s Growth—Results of the PANDAA-PED Study
Authors: Pokorska-Śpiewak Maria , Talarek Ewa , Aniszewska Małgorzata , Pluta Magdalena , Dobrzeniecka Anna , Marczyńska Magdalena , Indolfi Giuseppe
Published: September 2024

Background:

The aim of this study was to evaluate the influence of treatment of hepatitis C with sofosbuvir and velpatasvir (SOF/VEL) on children’s growth.

Methods:

Fifty children 6-18 years of age were successfully treated for hepatitis C with a 12-week course of SOF/VEL fixed dose adjusted to the body weight in the PANDAA-PED (Treatment of chronic hepatitis C in children 6–18 years of age using a pangenotypic direct-acting antiviral sofosbuvir/velpatasvir) project. Growth parameters were compared at 1 year after treatment with baseline (at the start of treatment) and 12-week-posttreatment values. Body mass index (BMI), weight and height Z scores adjusted to sex and age were calculated according to the World Health Organization reference data.

Results:

Forty-nine participants (23 boys and 26 girls) completed all the visits. The mean age at 1 year after treatment was 10.9 ± 2.5 years, and all children had undetectable hepatitis C virus RNA at this point. Significant weight and height gains were observed after treatment irrespective of the patients’ age and sex. Height Z scores did not vary significantly both at 12 weeks and 1 year after treatment, confirming a normal increase in participants’ height. Weight Z scores for 16 children below 10 years of age decreased at 1 year after treatment. BMI Z score values decreased at 12 weeks after treatment compared to the baseline in boys, but no difference was found between 1-year posttreatment and baseline BMI Z scores in both girls and boys.

Conclusions:

Results of the PANDAA-PED study showed normal growth up to 1 year after successful treatment with SOF/VEL in children 6-18 years of age. Despite the decrease in BMI Z score in boys observed at 12 weeks after treatment, no differences were found between baseline and 1-year posttreatment values. Our observations confirm the long-term safety of the SOF/VEL treatment in children 6-18 years of age.
Stenotrophomonas maltophilia Associated Factors and Outcomes in a Neonatal Intensive Care Unit: A Retrospective Matched Case-control Study
Authors: Franco Susannah , Abdelhemid Ashraf , Fordjour Lawrence , Kohlhoff Stephan , Hammerschlag Margaret R.
Published: September 2024

Background:

Stenotrophomonas maltophilia is a multi-drug-resistant, hospital-acquired Gram-negative bacillus associated with significant morbidity and mortality. The objective of this study is to identify risk factors and outcomes associated with S. maltophilia isolation in a high-risk neonatal population.

Methods:

This was a retrospective matched case-control study. Cases were matched 1:2 for years of neonatal intensive care unit admission, completed weeks’ gestational age and birth weight in 250-gram incremental categories.

Results:

A total of 15 cases and 35 controls were included in the analyses. Risk factors for S. maltophilia isolation included days of antibiotics (24 vs. 18, P = 0.036), days of broad-spectrum antibiotics (19 vs. 12 days, P = 0.027), days of meropenem (9 vs. 6 days, P = 0.018) and any meropenem exposure (100% vs. 22%, P = 0.005). Other risk factors were any corticosteroid exposure (66.7% vs. 20%, P = 0.001), days of total parenteral nutrition (55 vs. 31 days, P = 0.017) and days of invasive mechanical ventilation (28 vs. 7, P = 0.015). S. maltophilia isolation was associated with increased length of neonatal intensive care unit stay (134 vs. 69 days, P < 0.001) and mortality (33.3% vs. 0%, P = 0.001).

Conclusions:

Antibiotic stewardship efforts should be made to decrease the risk of S. maltophilia isolation and associated mortality. Carbapenem over-use should be specifically addressed with institutional policies and unit-based guidelines. Additional neonatal studies are needed to confirm these findings and explore other possible risk factors.
Pediatric Clinical Outcomes of Nasal Methicillin-resistant Staphylococcus aureus Polymerase Chain Reaction Utilization
Authors: Demirhan Salih , Burgos Kevin , Escobar Lee Kiriam , Lee Philip , Sy Sharlene , Herold Betsy C. , Anosike Brenda I.
Published: September 2024

Background:

Methicillin-resistant Staphylococcus aureus (MRSA) is a clinical challenge in selecting empiric antimicrobials for pediatric infections. We implemented nasal MRSA polymerase chain reaction (nMRSA PCR) screening as a diagnostic tool and evaluated its impact on empiric antibiotic use and clinical outcomes.

Methods:

A retrospective single-center study of patients hospitalized with infections who were empirically prescribed anti-MRSA antibiotics was conducted prior to and following the initiation of nMRSA PCR screening. Electronic medical records, pharmacy data and bacterial cultures results were reviewed. Predictive values of nMRSA PCR testing were calculated and the duration of anti-MRSA empiric therapy and clinical outcomes preimplementation and postimplementation were compared.

Results:

During the preimplementation period, there were 382 distinct episodes (294 unique patients) that met the inclusion criteria and during post-nMRSA PCR implementation, 394 episodes (360 unique patients) were identified. The median time to discontinuation of anti-MRSA antibiotics and proportion of patients prescribed anti-MRSA antibiotics at discharge were significantly lower in postimplementation compared with preimplementation period; 48 versus 56 hours, P < 0.001 and 20.1% versus 40.3%, P < 0.001, respectively. The negative and positive predictive values of nMRSA PCR compared to clinical culture results were 95.6% and 51.2%, respectively. Predefined adverse outcomes were documented in 11 patients who had early anti-MRSA discontinuation with negative nMRSA PCR results but only 3 were restarted on anti-MRSA treatment and none grew MRSA in clinical cultures.

Conclusions:

Shortened anti-MRSA antibiotic duration, high negative predictive value and low adverse events provide promising evidence that nMRSA PCR is an effective, rapid antimicrobial stewardship tool for hospitalized children.
Kiteboarding Injuries: Epidemiology, Common Treatment Strategies, and Time to Return to Kiteboarding Following Injury
Authors: Beer Yiftah , Yona Tzadok , Arama Yuval , Lindner Dror , Garrigues Grant , Feletti Francesco , Blond Lars , Gilat Ron
Published: September 2024

Objective:

To evaluate the prevalence and types of injuries incurred during kiteboarding (1), along with treatment approaches (2). In addition, the time to return to kiteboarding following injury (3) and factors associated with the rate and type of injury were analyzed (4).

Setting:

Recreational kiteboarding.

Design:

Retrospective cohort.

Participants:

Three hundred twelve kiteboarders (280 men, 32 women, mean age 42.91 ± 13) were included in the study.

Independent Variables:

Age, sex, experience, and the use of protective gear.

Main Outcome Measures:

Kiteboarding experience, injury location, type, incidence, nonsurgical and surgical treatment modalities, and return-to-kiteboarding data.

Results:

The number of injuries calculated per 1000 sessions was a mean of 7.82 (4.83-10.81). Patients with less than 2 years of kiteboarding experience were at a greater risk of injury than more experienced kiters (P < 0.001). The knee (24.1%), ankle and foot (18.9%), ribs (12.7%), and shoulder (10.2%) were the body parts most frequently injured. Overall, 14.4% of kiters underwent surgical intervention, with knee surgery being the most common site of operation (41.9%) and the most frequently performed procedure being anterior cruciate ligament reconstruction.

Conclusions:

The pattern of reported injury was found to be different from that previously reported in the scientific literature among freeriding kiters, with knees, ribs, and shoulders being most frequently involved. Participants with <2 years of experience had a significantly greater risk of injury; therefore, proper technical and physical training is advisable.
Doctor of Nursing Practice–prepared academics: Promotion and tenure-eligible?
Authors: Berg Judith A. , Hicks Rodney W.
Published: September 2024

Since the Doctor of Nursing Practice (DNP) was implemented, there has been ongoing discussion about whether or not DNP-prepared faculty are eligible for promotion and tenure. This column updates that discussion through input from two DNP-prepared faculty key informants.
TASER 7 and TASER 10 Probe Penetration Into Human Skull Simulants
Authors: Khmara Natalia , Gort Silvan , Kaelin Beat , Thali Michael J. , Bolliger Stephan A.
Published: September 2024

The older generation TASER probes X26 and X2 have been shown to be capable of piercing the skull with their tips. With the introduction of the new TASER 7 and the far more powerful TASER 10, concerns have arisen as to whether these weapons might penetrate the skull more deeply and thus prove to be potentially lethal. For this reason, we tested the penetration capacity of these weapons on polyurethane-gelatine-buckskin head simulants at different firing distances. The striking speeds and striking angles were documented with a high-speed camera, and the piercing depths were recorded by computed tomography. None of the probes penetrated the skull, but their tips did; TASER 7 probe tips pierced up to 5.6 mm, whereas TASER 10 probe tips pierced up to 10.4 mm. The TASER 7 probes fared better with regard to penetration depth at shorter firing distances; on the other hand, the TASER 10 probes pierced more deeply at distances of 3 to 4 m, with their flight stability improving after the first 2 m. Our results imply that TASER 7 and TASER 10 probes are not to be expected to cause great harm or even death when striking the head.
Reconstructing Failure: Assessing Surgical and Patient Reported Outcomes Following Loss of Initial Breast Reconstruction
Authors: Kim Minji , Khavanin Nima , Jiang Charles Z. , Barnett Joshua M. , Boe Lillian A. , Allen Robert J. , Stern Carrie S. , Mehrara Babak J. , Nelson Jonas A.
Published: September 2024

Background:

Breast reconstruction failure, defined as the removal of a prosthetic device or flap without immediate replacement, can be traumatic for patients. We aim to describe the progression of patients who experience tissue expander (TE), implant, or autologous breast reconstructive failure and assess the patient reported outcomes (PROs) among patients who undergo additional reconstruction.

Method:

Patients undergoing TE, implant, or autologous breast reconstruction between 2017 and 2022 were included, and patients with reconstructive failures were identified. Outcomes of interests included (1) receipt of additional reconstruction and (2) BREAST-Q scores 1-year after reconstructive failure. We also performed a propensity-matched analysis between patients who undergo secondary reconstruction and patients who had an uncomplicated reconstruction.

Results:

4,258 TE, 4,420 implant, and 1,545 autologous breast reconstruction patients were included. Of patients who experienced reconstructive failures, 49.5% of TE, 4.8% of implant, and 53.8% of autologous patients underwent secondary reconstruction. Age, psychiatric diagnosis, chemotherapy, radiation, and mastectomy type were associated with increased likelihood of secondary reconstruction. Between patients with and without additional reconstruction, higher Psychosocial Well-being trended towards the former cohort (61 [Interquartile Range: 56, 80] vs 50 [46, 65], p=0.085). Propensity-matched analysis demonstrated comparable PROs at 1-year after definite reconstruction.

Conclusion:

Less than half of reconstructive failure patients undergo an additional reconstruction. Patients with secondary reconstruction may have improved Psychosocial Well-being than those who do not and comparable PROs to those who had uncomplicated initial reconstruction. Surgeons should counsel patients with reconstructive failures that although traumatizing, secondary reconstruction may be beneficial.
Low food security is associated with frailty status and frailty components among people with HIV
Authors: Ruderman Stephanie A. , Willig Amanda L. , Cleveland John D. , Burkholder Greer , Davey Christine Horvat , Fleming Julia , Gripshover Barbara , Katundu Mari , Buford Thomas W. , Jones Raymond , Saag Michael S. , Delaney Joseph A.C. , Crane Heidi M. , Webel Allison R.
Published: September 2024

Background:

Low food security is common among people with HIV (PWH) and is associated with poorer health outcomes. Frailty, an aging-related outcome that is increasingly prevalent among PWH, may be stimulated by low food security. We assessed associations between food security and frailty among PWH.

Methods:

The Impact of Physical Activity Routines and Dietary Intake on the Longitudinal Symptom Experience of People Living with HIV (PROSPER-HIV) study follows PWH to evaluate how diet and physical activity impact symptoms. We utilized food security and frailty data from PROSPER-HIV Year 1 visits (January 2019 to July 2022) to estimate associations. Food security was measured via the validated two-item Food Security Questionnaire and categorized as Food Secure, Low Food Security, or Very Low Food Security. Frailty was measured with the Fried frailty phenotype, and categorized as robust, prefrail, and frail. We used relative risk regression to estimate associations between food security and frailty status, adjusted for demographic characteristics.

Results:

Among 574 PWH, nearly one-quarter were women (22%), mean age was 52 years old, 8% were frail, and 46% prefrail. Low food security was reported among nearly one-third of PWH: 13% Low Food Security and 18% Very Low Food Security. Compared with being Food Secure, we found Low Food Security was associated with frailty [prevalence ratio: 4.06 (95% confidence interval (CI) 2.16–7.62] and Very Low Food Security was associated with both prefrailty [1.48 (1.23–1.78)] and frailty [5.61 (3.14–10.0)], as compared with robust status.

Conclusion:

Low food security was associated with increased frailty among PWH in this study, suggesting a potential intervention point to promote healthy aging.
Trends in Racial and Ethnic Differences in Declined Surgery for Resectable Malignancies in the United States
Authors: Patel Vishal R. , Liu Michael , Snyder Rebecca A. , Loehrer Andrew P. , Haynes Alex B.
Published: September 2024

Objective:

To assess trends in patients’ decisions to decline cancer surgery in the United States by race and ethnicity.

Background:

Racial and ethnic differences in declining potentially curative cancer surgery are suggested to be due to systemic inequities in healthcare access and mistrust of healthcare systems, among other factors. Despite ongoing national efforts to address these inequities, it is unknown whether differences in rates of declined cancer surgery have improved.

Methods:

Using population-based data from the US Surveillance, Epidemiology, and End Results Program from 2000 to 2019, we studied individuals with non-metastatic cancer who were recommended surgery. Racial and ethnic differences in risk-adjusted rates of declined surgery were evaluated by year and cancer site using mixed-effects logistic regression.

Results:

Of 2,740,129 patients with resectable, non-metastatic cancer, Black patients had the highest rates of declined surgery (2.10% [95% CI, 1.91-2.31%]) while White patients had the lowest (1.04% [95% CI, 0.95-1.14%]). From 2000 to 2019, racial and ethnic differences in declined surgery did not change significantly, except for a decrease in the difference between Hispanic and White patients (difference-in-difference, −0.4% [95% CI, −0.71% to −0.09%]). When stratified by cancer site, Black-White differences in rates of declined surgery decreased significantly (but were not eliminated) for four of fifteen sites (esophageal, pancreatic, lung, and kidney) (P<0.001).

Conclusions:

Patients from racial and ethnic minority groups were more likely to decline surgical intervention for potentially curable malignancies and these differences have persisted over time. Further work is needed to understand the causes of these differences and identify opportunities for improvement.