bluuebunny/crossref_metadata_2025 huggingface dataset:
The relative effectiveness of fiscal and monetary policies in promoting Egypt’s output growth: an empirical investigation using an ARDL approach
Authors: El Husseiny Israa A.
Published: May 2023

The relative effectiveness of fiscal and monetary policies in promoting economic growth is not sufficiently examined at the empirical level for developing countries, including Egypt in particular. Hence, this paper is the first attempt to empirically examine the relative effectiveness of fiscal and monetary policies in promoting Egypt’s output growth utilizing a time-series data set over the time-period (1960–2019). The study employs the Autoregressive Distributed Lag (ARDL) Bounds testing approach to cointegration to investigate the long run and short run effects of fiscal and monetary policies on Egypt’s output growth under a modified version of the St. Louis equation model. The study finds that both monetary and fiscal policies have a positive impact on the economic activity in the long run. However, while monetary policy seems to be more effective than fiscal policy in stimulating the growth rate of nominal GDP, fiscal policy tends to have a larger, more predictable and faster impact than monetary policy on the real economic activity. Accordingly, Egypt’s policymakers are advised to follow the Keynesian’s prescription in terms of increasing the reliance on fiscal policy compared to monetary policy to achieve macroeconomic stability in both the short run and long run.
Toxicological response and bioaccumulation of strontium in Festuca rubra L. (red fescue) and Trifolium pratense L. (red clover) in contaminated soil microcosms
Authors: Srikhumsuk Phatchani , Peshkur Tatyana , Renshaw Joanna C. , Knapp Charles W.
Published: May 2023

Potentially toxic elements (PTE) from industrial activities remain a global concern for their environmental hazards. In particular, strontium is found in drinking water and food, primarily from contamination from the nuclear industry, petroleum extractions, fireworks, and electronics. Its carbonate form is bioavailable and closely resembles calcium; thus, it has become a health concern, and phytoremediation has often been considered for Sr2+. We toxicologically determined Sr2+ tolerance in Festuca rubra (red fescue) and Trifolium pratense (red clover), and their ability to bio-accumulate strontium was compared to the sorption capacity of the soils. These plants were chosen for their ubiquity and as primary colonisers in soils. Experimentally uncontaminated farm soils from Lanarkshire, Scotland, were used, along with these two common plants. Further, seed-germination and plant-growth assays demonstrated that strontium chloride exposures impact both species (0–40mM; p < 0.05). Moreover, translocation factors suggest that T. pratense more efficiently accumulated strontium, and F. rubra has the potential to be the excluder species, which restricts strontium to the roots. This knowledge is relevant to how strontium contamination may be phytoremediated, and suggests using clover during the early stages of ecological succession to sequester strontium from soils.
Antitumor effects of erlotinib in combination with berberine in A431 cells
Authors: Cuan Xiangdan , Yang Xingying , Zhu Weiwei , Zhao Yue , Luo Rui , Huang Yanping , Wang Xuanjun , Sheng Jun
Published: May 2023

Background

First-generation epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs), such as erlotinib, have been shown to target tumors with L858R (exon 21) and exon 19 deletions, resulting in significant clinical benefits. However, acquired resistance often occurs due to EGFR mutations. Therefore, novel therapeutic strategies for treatment of patients with EGFR-positive tumors are needed. Berberine (BBR) is an active alkaloid extracted from pharmaceutical plants such as Coptis chinensis. Berberine has been shown to significantly inhibit EGFR activity and mediate anticancer effects in multiple preclinical studies. We investigated whether combining BBR with erlotinib could augment erlotinib-induced cell growth inhibition of EGFR-positive cells in a mouse xenograft model.

Methods

We examined the antitumor activities and potential mechanisms of erlotinib in combination with berberine in vitro and in vivo using the MTT assay, immunoblotting, flow cytometry, and tumor xenograft models.

Results

In vitro studies with A431 cells showed that synergistic cell growth inhibition by the combination of BBR and erlotinib was associated with significantly greater inhibition of pEGFR and pAKT, and inhibition of cyclin D and Bcl-2 expression compared to that observed in response to BBR or erlotinib alone. The efficacy of the combination treatment was also investigated in nude mice. Consistent with the in vitro results, BBR plus erlotinib significantly reduced tumor growth.

Conclusion

Our data supported use of BBR in combination with erlotinib as a novel strategy for treatment of patients with EGFR positive tumors.
“You are Cursed by the God YHW:” an early Hebrew inscription from Mt. Ebal
Authors: Stripling Scott , Galil Gershon , Kumpova Ivana , Valach Jaroslav , van der Veen Pieter Gert , Vavrik Daniel
Published: May 2023

In December 2019, an expedition on Mt. Ebal to examine the discarded material from Adam Zertal’s 1982–1989 excavation yielded a small, folded lead tablet. The east dump pile, from which the object emerged, contained the discarded matrix from two structures that he interpreted as altars dated to the Late Bronze Age II and Iron Age I. The earlier and smaller round altar lay underneath the geometric center of the later and larger rectangular altar. The tablet could not be opened without damaging it. A team of scientists performed X-ray tomographic measurements with different scanning parameters. The tomographically reconstructed data were subjected to advanced processing to reveal the hidden text. Epigraphic analysis of the tomographic data revealed a formulaic curse written in a proto-alphabetic script likely dating to Late Bronze Age II. The inscription falls within the literary genre of Chiastic Parallelism and predates any previously known Hebrew inscription in Israel by at least 200 years.
Long-term slow slip events with and without tremor activation in the Bungo Channel and Hyuganada, southwest Japan
Authors: Hirose Hitoshi , Matsushima Takeshi , Tabei Takao , Nishimura Takuya
Published: May 2023

Slow slip events (SSEs) lasting for approximately 1 year occur every 6–8 years around the Bungo Channel in the southwest Japan subduction zone. The slip time evolution of the latest Bungo Channel SSE that occurred in 2018–2019 has been studied; however, the detailed spatial and temporal relationship between the slip process and other nearby phenomena, such as tectonic tremors and SSEs, is not well understood. Moreover, the migration of such long-term SSEs from Hyuganada to Shikoku through the Bungo Channel has been suggested, but a slip process connecting the SSEs has not been observed. In this study, we utilized 21 continuous global navigation satellite system (GNSS) stations around the Bungo Channel and Hyuganada that have been installed by us since 2014 in addition to GNSS Earth Observation System (GEONET) stations to improve the spatial resolution of such interplate slip. Based on these data, we estimate the spatial and temporal slip evolutions of the major SSE in 2018–2019, which was accompanied by tremor activity in the deep episodic tremor and slip (ETS) zone, and a smaller SSE in 2015–2016 without tremor activity. We show that the slip area of the major SSE overlaps the ETS zone, whereas that of the smaller SSE does not. This strongly suggests that synchronized tremor activity with an SSE requires a slip close to or overlapping the ETS zone. We also show two distinct slip propagation paths from the Oita area during the 2018–2019 sequence: one is a southward propagation to the Miyazaki area, leading to an SSE around the Miyazaki Plain, and the other is an eastward propagation to an area close to Cape Ashizuri, where “invading slip” is proposed to propagate from the ETS zone to a shallower megathrust source area. These slip propagations may be two of fundamental slip modes that connect slow-slip patch-like areas around the Bungo Channel and Hyuganada.

Graphic Abstract
Sigmoid colon schwannoma difficult to distinguish from peritoneal dissemination 13 years after pancreatic neuroendocrine tumor surgery
Authors: Suzuki Kazunobu , Shiraishi Takuya , Shioi Ikuma , Ozawa Naoya , Okada Takuhisa , Osone Katsuya , Sano Takaaki , Araki Kenichiro , Ogawa Hiroomi , Sano Akihiko , Sakai Makoto , Sohda Makoto , Shirabe Ken , Saeki Hiroshi
Published: May 2023

Background

Schwannoma, which clinicians sometimes struggle to diagnose, is a tumor arising from Schwann cells of peripheral nerves, often in the soft tissues and rarely in the gastrointestinal tract. Pancreatic neuroendocrine tumor (PNET) is rare among pancreatic tumors, and recurrence can occur long after resection. Here, we were presented with a case where a sigmoid colon schwannoma was difficult to distinguish from a postoperative recurrence of PNET and was diagnosed after laparoscopic resection.

Case presentation

A 51-year-old man was diagnosed with PNET (NET G2) after a distal pancreatectomy (DP) 13 years ago. The patient underwent hepatectomy due to liver metastasis 12 years after initial radical surgery. The follow-up magnetic resonance imaging (MRI) after hepatectomy showed pelvic nodules, and laparoscopic surgery was performed for both diagnosis and treatment because peritoneal dissemination of PNET could not be ruled out. Since the tumor was in the sigmoid colon, a partial colon resection was performed. The histopathological diagnosis was a schwannoma, and the patient was discharged on the seventh postoperative day.

Conclusions

We experienced a case of sigmoid colon schwannoma that was difficult to differentiate from peritoneal dissemination of PNET and was later diagnosed after laparoscopic resection. In addition, this case involved a long-term postoperative recurrence of PNET that was amenable to radical resection, further establishing the importance of long-term imaging follow-up.
Multidrug-resistant Escherichia coli and Klebsiella pneumoniae isolated from hospital sewage flowing through community sewage system and discharging into the Indian Ocean
Authors: Seguni Nemganga Z. , Kimera Zuhura I. , Msafiri Frank , Mgaya Fauster X. , Joachim Agricola , Mwingwa Anthony , Matee Mecky I.
Published: May 2023

Background

Hospital sewage is a significant reservoir of antimicrobial-resistant pathogens and genes that pose a huge public health threat. In this study, we determined the occurrence of multidrug-resistant Escherichia coli and Klebsiella pneumoniae in sewage flowing from a referral hospital through the urban sewage system to the point of discharge in the Indian Ocean.

Results

A total of 400 sewage samples were collected, yielding 517 isolates. Of these, 32.3% (167/517) were from hospital sewage, while 67.7% (350/517) were from the community. E. coli was the most common isolate (44.5% (230/517)), followed by K. pneumoniae at 27.3% (141/517), and other gram-negative bacteria constituted 28.2% (146/517) of the isolates. Multidrug resistance (MDR) was seen in 80.9% (186/230) E. coli and 71.6% (101/141) K. pneumoniae. Of the MDR isolates, 27.2% (78/287) were resistant to four different classes of antibiotics, while 6.9% (20/287) exhibited resistance to eight classes. The most frequent MDR pattern was PEN/CEP/TET/QNL/SUL, seen in 14.2% (38/287) of the isolates. The isolation frequency of MDR E. coli and K. pneumoniae at different sampling sites was high, being 47.6% in hospital chambers, 62.0% in hospital ponds, 58.1% in the treated hospital wastewater, and 55.6% in the community stream draining into the Indian Ocean. Extended spectrum beta-lactamase production was observed in 40% (92/230) of E. coli and 36.2% (51/141) of K. pneumoniae isolates. Resistance to quinolones among E. coli was 54.8% (126/230) and was 39.7% in K. pneumoniae (56/141). Carbapenem resistance in E. coli was 39.6% (91/230), while among K. pneumoniae isolates was 32.6% (46/141).

Conclusions

We found high proportions of multidrug-resistant E. coli and K. pneumoniae in the wastewater flowing from the hospital through the community sewage system to the point where it enters the Indian Ocean. Biological treatment did not significantly reduce the proportion of resistant bacteria, posing a very serious public health threat. The release of these highly resistant pathogens into the Indian Ocean is of international concern.
Endophytic fungi related to the ash dieback causal agent encode signatures of pathogenicity on European ash
Authors: Rafiqi Maryam , Kosawang Chatchai , Peers Jessica A. , Jelonek Lukas , Yvanne Hélène , McMullan Mark , Nielsen Lene R.
Published: May 2023

Tree diseases constitute a significant threat to biodiversity worldwide. Pathogen discovery in natural habitats is of vital importance to understanding current and future threats and prioritising efforts towards developing disease management strategies. Ash dieback is a fungal disease of major conservational concern that is infecting common ash trees, Fraxinus excelsior, in Europe. The disease is caused by a non-native fungal pathogen, Hymenoscyphus fraxineus. Other dieback causing-species have not previously been identified in the genus Hymenoscyphus. Here, we discover the pathogenicity potential of two newly identified related species of Asian origin, H. koreanus and H. occultus, and one Europe-native related species, H. albidus. We sequence the genomes of all three Hymenoscyphus species and compare them to that of H. fraxineus. Phylogenetic analysis of core eukaryotic genes identified H. albidus and H. koreanus as sister species, whilst H. occultus diverged prior to these and H. fraxineus. All four Hymenoscyphus genomes are of comparable size (55–62 Mbp) and GC contents (42–44%) and encode for polymorphic secretomes. Surprisingly, 1133 predicted secreted proteins are shared between the ash dieback pathogen H. fraxineus and the three related Hymenoscyphus endophytes. Amongst shared secreted proteins are cell death-inducing effector candidates, such as necrosis, and ethylene-inducing peptide 1-like proteins, Nep1-like proteins, that are upregulated during in planta growth of all Hymenoscyphus species. Indeed, pathogenicity tests showed that all four related Hymenoscyphus species develop pathogenic growth on European ash stems, with native H. albidus being the least virulent. Our results identify the threat Hymenoscypohus species pose to the survival of European ash trees, and highlight the importance of promoting pathogen surveillance in environmental landscapes. Identifying new pathogens and including them in the screening for durable immunity of common ash trees is key to the long-term survival of ash in Europe.
Association between glycated hemoglobin (HbA1c) level and cardiac perfusion and function on gated myocardial perfusion SPECT
Authors: Nasr Hatem , Alsomali Hoda , Saad Ibrahim , AbdElaal Asmaa , Mohamadien Nsreen
Published: May 2023

Background

Glycated hemoglobin (HbA1c) is a recognized biomarker that keeps track of long-term blood sugar levels. Some studies revealed that even a modest elevation of blood glucose levels was linked to a higher chance of developing CAD. In this study we aim to test the impact of HbA1c level on perfusion and function metrics derived from myocardial perfusion gated SPECT (MPGS) imaging.

Results

Two hundred patients were recruited in this study (mean age 58.21 ± 11.53 years; 51% males), of whom 132 patients (66%) were diabetic. Diabetic patients had a higher mean HbA1c of 7.92 ± 1.99 versus 6.05 ± 0.99 in non-diabetics (p < 0.001). HbA1c% was negatively correlated to LVEF% (r = − 0.262; p < 0.001) and HDL (r = − 0.316; p < 0.001), though, it was positively correlated to ESV (r = 0.221; p = 0.002) and EDV (r = 0.291; p < 0.001). Patients with HbA1c% > 6.5 compared to ≤ 6.5%, had lower LVEF% of 53.17 ± 14.55 vs. 57.8 ± 12.61 (p = 0.017), lower HDL of 1.046 ± 0.262 vs. 1.196 ± 0.295 (p < 0.001), more LVEF < 50% (30% vs. 15.6%; p = 0.017), ESV > 44 ml (38.2% vs. 20%; p = 0.005), and WMA (24.5% vs. 12.2%; p = 0.027), hypertension (77.3% vs. 54.4%; p = 0.001) and dyspnea (27.3% vs. 15.6%; p = 0.047), however, with less chest pain (70.9% vs. 83.3%; p = 0.039). Diabetic patients with HbA1c% > 7.5 had lower LVEF% (52.0 ± 14.59 vs. 57.6 ± 11.55; p = 0.018) and HDL (1.005 ± 0.239 vs 1.148 ± 0.273; p < 0.002), more LVEF < 50% (33.3% vs. 14.5%; p = 0.011), ESV > 44 ml (41.3% vs. 20.3%; p = 0.009), WMA (30.2% vs. 11.6%; p = 0.008), and EDV > 100 ml (34.9% vs. 18.8%; p = 0.037). No significant relation was found between HbA1c% and perfusion variables.

Conclusions

Elevated HbA1c% was associated with multiple abnormal MPGS function parameters including lower LVEF, greater ESV, and more WMA. The same was observed in the diabetic group, together with greater EDV. No significant relation was detected between HbA1c% and perfusion parameters. The effect of impaired glycemic control on cardiac function parameters, even in absence of significant effect on perfusion, could be an alarming sign, while interpreting MPGS studies, both in known diabetic patients and in those with probably insulin resistance but not known to be diabetic. Such findings may be calling for further investigations, to uncover the true mechanisms behind cardiac dysfunction and the possibility of associated microvascular disease.
An RBD bispecific antibody effectively neutralizes a SARS-CoV-2 Omicron variant
Authors: Yuan Mengqi , Zhu Yanzhi , Liu Guanlan , Wang Yujie , Wang Guanxi , Zhang Guozhong , Ye Lilin , Qian Zhaohui , Liu Pinghuang
Published: May 2023

Potent neutralizing antibodies (nAbs) against SARS-CoV-2 are a promising therapeutic against the ongoing COVID-19 pandemic. However, the continuous emergence of neutralizing antibody escape variants makes it challenging for antibody therapeutics based on monospecific nAbs. Here, we generated an IgG-like bispecific antibody (bsAb), Bi-Nab, based on a pair of human neutralizing antibodies targeting multiple and invariant sites of the spike receptor binding domain (RBD): 35B5 and 32C7. We demonstrated that Bi-Nab exhibited higher binding affinity to the Delta spike protein than its parental antibodies and presented an extended inhibition breadth of preventing RBD binding to angiotensin-converting enzyme 2 (ACE2), the cellular receptor of SARS-CoV-2. In addition, pseudovirus neutralization results showed that Bi-Nab improved the neutralization potency and breadth with a lower half maximum inhibitory concentration (IC50) against wild-type SARS-CoV-2, variants being monitored (VBMs) and variants of concern (VOCs). Notably, the IgG-like Bi-Nab enhanced the neutralizing activity against Omicron variants with potent capabilities for transmission and immune evasion in comparison with its parental monoclonal antibody (mAb) 32C7 and a cocktail (with the lowest IC50 values of 31.6 ng/mL against the Omicron BA.1 and 399.2 ng/mL against the Omicron BA.2), showing evidence of synergistic neutralization potency of Bi-Nab against the Omicron variants. Thus, Bi-Nab represents a feasible and effective strategy against SARS-CoV-2 variants of concern.
How to Improve Cancer Patients ENrollment in Clinical Trials From rEal-Life Databases Using the Observational Medical Outcomes Partnership Oncology Extension: Results of the PENELOPE Initiative in Urologic Cancers
Authors: Kempf Emmanuelle , Vaterkowski Morgan , Leprovost Damien , Griffon Nicolas , Ouagne David , Breant Stéphane , Serre Patricia , Mouchet Alexandre , Rance Bastien , Chatellier Gilles , Bellamine Ali , Frank Marie , Guerin Julien , Tannier Xavier , Livartowski Alain , Hilka Martin , Daniel Christel
Published: May 2023

PURPOSE

To compare the computability of Observational Medical Outcomes Partnership (OMOP)–based queries related to prescreening of patients using two versions of the OMOP common data model (CDM; v5.3 and v5.4) and to assess the performance of the Greater Paris University Hospital (APHP) prescreening tool.

MATERIALS AND METHODS

We identified the prescreening information items being relevant for prescreening of patients with cancer. We randomly selected 15 academic and industry-sponsored urology phase I-IV clinical trials (CTs) launched at APHP between 2016 and 2021. The computability of the related prescreening criteria (PC) was defined by their translation rate in OMOP-compliant queries and by their execution rate on the APHP clinical data warehouse (CDW) containing data of 205,977 patients with cancer. The overall performance of the prescreening tool was assessed by the rate of true- and false-positive cases of three randomly selected CTs.

RESULTS

We defined a list of 15 minimal information items being relevant for patients' prescreening. We identified 83 PC of the 534 eligibility criteria from the 15 CTs. We translated 33 and 62 PC in queries on the basis of OMOP CDM v5.3 and v5.4, respectively (translation rates of 40% and 75%, respectively). Of the 33 PC translated in the v5.3 of the OMOP CDM, 19 could be executed on the APHP CDW (execution rate of 58%). Of 83 PC, the computability rate on the APHP CDW reached 23%. On the basis of three CTs, we identified 17, 32, and 63 patients as being potentially eligible for inclusion in those CTs, resulting in positive predictive values of 53%, 41%, and 21%, respectively.

CONCLUSION

We showed that PC could be formalized according to the OMOP CDM and that the oncology extension increased their translation rate through better representation of cancer natural history.
Tracheal Narrowing and Its Impact on Anesthesia Care in Patients With Morquio A (Mucopolysaccharidosis Type IVA): An Observational Study
Authors: Theroux Mary C. , DiCindio Sabina , Averill Lauren W. , Pizarro Christian , Oommen Abraham , Bober Michael B. , Ditro Colleen , Campbell Jeffrey , Duker Angela L. , Jones Taylor , Passi Vandna , Barth Patrick , Schmidt Richard J. , Little Mary , Mackenzie Stuart , Tomatsu Shunji , Mackenzie William G.
Published: May 2023

BACKGROUND:

Recently, tracheal narrowing has been recognized as a significant comorbid condition in patients with Morquio A, also known as mucopolysaccharidosis IVA. We studied a large cohort of patients with Morquio A to describe the extent of their tracheal narrowing and its relationship to airway management during anesthesia care.

METHODS:

This is an observational study, collecting data retrospectively, of a cohort of patients with Morquio A. Ninety-two patients with Morquio A syndrome were enrolled, among whom 44 patients had their airway evaluated by computed tomography angiography and had undergone an anesthetic within a year of the evaluation. Our hypothesis was that the tracheal narrowing as evaluated by computed tomography angiography increases with age in patients with Morquio A. The primary aim of the study was to examine the degree of tracheal narrowing in patients with Morquio A and describe the difficulties encountered during airway management, thus increasing awareness of both the tracheal narrowing and airway management difficulties in this patient population. In addition, the degree of tracheal narrowing was evaluated for its association with age or spirometry parameters using Spearman’s rank correlation. Analysis of variance followed by the Bonferroni test was used to further examine the age-based differences in tracheal narrowing for the 3 age groups: 1 to 10 years, 11 to 20 years, and >21 years.

RESULTS:

Patient age showed a positive correlation with tracheal narrowing (r

s

= 0.415; 95% confidence interval [95% CI], 0.138–0.691; P = .005) with older patients having greater narrowing of the trachea. Among spirometry parameters, FEF25%–75% showed an inverse correlation with tracheal narrowing as follows: FEF25%–75% versus tracheal narrowing: (r

s
= −0.467; 95% CI, −0.877 to −0.057; P = .007). During anesthetic care, significant airway management difficulties were encountered, including cancelation of surgical procedures, awake intubation using flexible bronchoscope, and failed video laryngoscopy attempts.

CONCLUSIONS:

Clinically significant tracheal narrowing was present in patients with Morquio A, and the degree of such narrowing likely contributed to the difficulty with airway management during their anesthetic care. Tracheal narrowing worsens with age, but the progression appears to slow down after 20 years of age. In addition to tracheal narrowing, spirometry values of FEF25%–75% may be helpful in the overall evaluation of the airway in patients with Morquio A.
Anterior-To-Psoas Approach Measurements, Feasibility, Non-Neurological Structures at Risk and Influencing Factors: A Bilateral Analysis From L1-L5 Using Computed Tomography Imaging
Authors: Razzouk Jacob , Ramos Omar , Mehta Shaurya , Harianja Gideon , Wycliffe Nathaniel , Danisa Olumide , Cheng Wayne
Published: May 2023

BACKGROUND AND OBJECTIVES:

Spinal fusion through the anterior-to-psoas (ATP) technique harbors several approach-related risks. We used abdominal computed tomography imaging to analyze the L1-L5 ATP fusion approach measurements, feasibility, degree of obstruction by non-neurological structures, and the influence of patient characteristics on ATP approach dimensions.

METHODS:

The vascular window, psoas window, safe window, and incision line anterior and posterior margins for the ATP approach were measured on abdominal computed tomography imaging. The feasibility of approach and the presence of kidneys, ribs, liver, spleen, and iliac crests within the ATP approach were also measured. Correlation and regression models among radiographic measurements and patient age, height, weight, and body mass index (BMI) were analyzed as well as differences in approach measurements based on sex.

RESULTS:

Safe window and incision line measurements were more accommodating for the left-sided vs right-sided ATP approach. At L4-5, the ATP approach was not feasible 18% of the time on the left side vs 60% of the time on the right side. The spleen was present 22%, 10%, and 3% of the time from L1-4, while the liver was present 56%, 30%, and 9% of the time. The iliac crests were not observed within ATP parameters. Patient age, height, weight, and BMI did not strongly correlate with approach measurements, although ATP dimensions did differ based on sex.

CONCLUSION:

This study reports characteristics of the ATP approach including approach measurements, feasibility, non-neurological structures at risk, and influencing factors to approach measurements. While incision line measurements are larger for male patients compared with female patients at the lower lumbar levels, safe window sizes are similar across all levels L1-L5. The kidneys, ribs, spleen, and liver are potential at-risk structures during the ATP approach, although the iliac crests pose limited concern for ATP technique. Patient characteristics such as age, height, weight, and BMI do not markedly affect ATP approach considerations.
Endoscopic Placement of Intracystic Catheters: A Technical Note
Authors: Peto Ivo , Reynolds Rebecca A. , Hartnett-Wright Sara , Rodriguez Luis F. , Jallo George I. , Smyth Matthew D. , Akbari S. Hassan A.
Published: May 2023

BACKGROUND:

Intraventricular neuroendoscopic surgery for tumor resection, biopsy, or cyst fenestration frequently requires precise placement of an intraventricular or intracystic catheter. Placement under direct visualization is not feasible because of small bore of working channel of the standard small ventriculoscope. Various techniques have been reported using a separate transcortical trajectory, endoluminal endoscope, or endovascular guide wire.

OBJECTIVE:

To describe a technique allowing precise placement of intraventricular/intracystic catheter using a small bore working ventriculoscope, without need for additional equipment.

METHODS:

Description of the technique including intraoperative photographs, video, and illustrative cases are provided.

RESULTS:

The peel-away sheath is peeled off approximately 1 to 2 cm to allow for the shaft of the endoscope to pass past its tip. Ventricular access is gained using the peel-away sheath. After the stylet is removed, the peel-away sheath is not peeled further or stapled to the skin. The endoscope is introduced into the ventricle through the peel-away sheath. After the required intraventricular work is performed, the endoscope is maneuvered into the location of the desired catheter position. The peel-away sheath is slowly advanced over the stationary endoscope past its tip. While the peel-away sheath is being held in place, the endoscope is removed. After the catheter has been introduced into the peel-away sheath to a premeasured depth, the peel-away sheath is peeled and removed. The catheter is then connected to collection system, reservoir or shunt system.

CONCLUSION:

The current technique allows for the precise placement of intraventricular/intracystic catheters without the need for additional equipment or a separate transcortical trajectory.
Ventral Subaxial Cervical Access Using Tailored Access Osteotomies, A Cadaveric Study
Authors: Scullen Tyler , Ng Christina , Mathkour Mansour , Iwanaga Jo , Glennon Steve , Tubbs R. Shane , Dumont Aaron , Kalyvas James
Published: May 2023

BACKGROUND:

Ventral lesions of the subaxial cervical spine are challenging because approaches must circumvent endodermal and neurovascular structures.

OBJECTIVE:

To use cadaveric study to describe 4 posterolateral approaches to the ventral subaxial cervical spine with various facilitating techniques and osteotomies.

METHODS:

Three cadaveric specimens of the cervical spine were sequentially subjected to multilevel laminectomy (Type 1), transfacet (Type 2), transpedicular (Type 3), and extreme lateral transforaminal (Type 4) approaches. Approach working angles and proportion of visualized zones were compared, the former calculated using trigonometric methods.

RESULTS:

There was a significant stepwise increase in working angle in the ventral space, associated with increasing osteotomy type, from an average of 3.7° in single-level type 1 to 19.47° in the type 4 osteotomy. Regarding anatomic zones, proportional partial and total visualization achieved with Type 2 to 4 approaches were significantly greater than with Type 1. Complex osteotomies allowed superior access to be obtained to contributing and adjacent vessels of the ventral spinal axis.

CONCLUSION:

Ventral subaxial cervical lesions are difficult to access. We report increased working angles using quantified cadaveric data in increasingly complex posterior and posterolateral approaches graded as type 1 through 4. We advocate continued translational research in such approaches to lesions often considered to lie in surgically inaccessible locations.
Lateral Transorbital Approach for Repair of Lateral Sphenoid Sinus Meningoencephaloceles in Proximity to Foramen Rotundum: Cadaveric Study and Case Report
Authors: Mathios Dimitrios , Bobeff Ernest J. , Longo Davide , Tabaee Abtin , Anand Vijay K. , Godfrey Kyle J. , Schwartz Theodore H.
Published: May 2023

BACKGROUND:

The repair of lateral sphenoid sinus cerebrospinal fluid leaks is routinely accomplished through the use of the endonasal endoscopic approach (EEA) with a transpterygoidal extension. This approach can incur sinus morbidity, damage to the vidian, palatine and trigeminal nerves, and the contents of the pterygopalatine fossa, particularly if the encephalocele is lateral to the foramen rotundum (FR) and V2.

OBJECTIVE:

To investigate the use of the lateral transorbital approach (LTOA) as an alternative approach for repair of lateral sphenoid sinus encephaloceles that avoids the potential morbidity of EEA.

METHODS:

We performed cadaveric dissections of 2 specimens (4 sides) and present one of the first cases of a lateral sphenoid sinus encephalocele repair lateral to the FR in a patient through an ipsilateral LTOA.

RESULTS:

We find that the LTOA provides a shorter distance to target compared with the EEA (56 vs 89.5 mm, P = .002). The LTOA field of view also affords excellent visualization of both the medial and lateral aspects of V2, whereas the EEA is less effective at exposing lateral to V2, even after sacrifice of the vidian nerve and maximal pterygopalatine fossa content retraction. We report a case of LTOA to repair a meningoencephalocele lateral to V2 in the sphenoid sinus.

CONCLUSION:

The LTOA to the foramen rotundum is a more direct approach that minimizes the morbidity associated with EEA to repair meningoencephaloceles both medial and lateral to foramen rotundum.
Risk Factors for Adjacent Segment Disease in Short Segment Lumbar Interbody Fusion—A Case Series
Authors: Flores-Milan Gabriel , Cuello César Carballo , Pressman Elliot , Marek Jenna , Krafft Paul R. , McBride Paul , Gassie Kelly , Hayman Erik , Alikhani Puya
Published: May 2023

BACKGROUND:

Adjacent segment disease (ASD) is a common problem after lumbar spinal fusions. Ways to reduce the rates of ASD are highly sought after to reduce the need for reoperation.

OBJECTIVE:

To find predisposing factors of ASD after lumbar interbody fusions, especially in mismatch of pelvic incidence and lumbar lordosis (PI-LL).

METHODS:

We conducted a retrospective cohort study of all patients undergoing lumbar interbody fusions of less than 4 levels from June 2015 to July 2020 with at least 1 year of follow-up and in those who had obtained postoperative standing X-rays.

RESULTS:

We found 243 patients who fit inclusion and exclusion criteria. Fourteen patients (5.8%) developed ASD, at a median of 24 months. Postoperative lumbar lordosis was significantly higher in the non-ASD cohort (median 46.4° ± 1.4° vs 36.9° ± 3.6°, P < .001), pelvic tilt was significantly lower in the non-ASD cohort (16.0° ± 0.66° vs 20.3° ± 2.4°, P = .002), PI-LL mismatch was significantly lower in the non-ASD cohort (5.28° ± 1.0° vs 17.1° ± 2.0°, P < .001), and age-appropriate PI-LL mismatch was less common in the non-ASD cohort (34 patients [14.8%] vs 13 [92.9%] of patients with high mismatch, P < .001). Using multivariate analysis, greater PI-LL mismatch was predictive of ASD (95% odds ratio CI = 1.393-2.458, P < .001) and age-appropriate PI-LL mismatch was predictive of ASD (95% odds ratio CI = 10.8-970.4, P < .001).

CONCLUSION:

Higher PI-LL mismatch, both age-independent and when adjusted for age, after lumbar interbody fusion was predictive for developing ASD. In lumbar degenerative disease, correction of spinopelvic parameters should be a main goal of surgical correction.
The role of angiotensin receptor blocker (losartan) on decreasing fibrotic process of corpora cavernosa in priapism model of wistar rats
Authors: Siregar Safendra , Rulianov Rulianov , Ksatriapraja Rangga Adhazi , Stefanus Dicky
Published: May 2023

Background: Priapism induces regulation of Transforming Growth Factor-β1 (TGF-β1) expression and collagen-type-1 deposition. This will replace the normal corpora cavernosa with fibrotic tissue which eventually resulted in erectile dysfunction. It is also known that the fibrosis process of corpora cavernosa is related to Renin-Angiotensin II System (RAS). Angiotensin II receptor blockers (ARB), especially losartan, inhibit the inflammation process and fibrotic tissue formation. This study evaluated the effect of losartan in reducing fibrosis in priapism by evaluating TGF-β1 and collagen-type-1 in cavernous tissue and determined the effect of losartan in preventing fibrosis in priapism model of Wistar rats assessed by the metavir score.

Methods: A total of eighteen male Wistar rats mean were divided into five groups. For the priapism models, we applied negative pressure on the penis to make an artificial erection to mimic the priapism process. The control groups were observed and the treatment groups were orally given losartan 15 mg/kg/day. Corpora cavernosa was harvested for TGF-β1 and collagen-type-1 measurement using an enzyme-linked immunosorbent assay (ELISA). The fibrotic tissue of each rat was then collected and assessed histopathologically with the metavir scoring system.

Results: Penile TGF-β1 concentration in the losartan-treated group was not significantly different on day 10 and day 28 of observation (p10=0,30; p28=0,17). Meanwhile, collagen-type-1 concentration was significantly lower compared to control group (p10=0,002; p28=0,01). There was a significant difference in metavir scores in rats that received losartan and those who did not (p<0,05).

Conclusion: Losartan could suppress the fibrosis process in the priapism model. It could decrease the collagen type 1 deposition during corpora cavernosa tissue regeneration. Based on the metavir score, the group receiving losartan therapy was better than the control group.
Assessment of quality of life in patients with surgically treated maxillofacial fractures
Authors: Nayak Sunil S , Gadicherla Srikant , Roy Sreea , Chichra Muskaan , Dhaundiyal Shriya , Nayak Vanishri S , Kamath Vinayak
Published: May 2023

Background: The complex nature of maxillofacial injuries can affect the surgical treatment outcomes and general well-being of the patient. To evaluate the efficiency of the surgical treatment, assessment of the quality of life (QOL) of the patients is of vital importance. Due to the absence of an exclusive QOL assessment tool for maxillofacial fractures, we introduce the ‘Twenty-point quality of life assessment in facial trauma patients in Indian population'. The aim of this study was to assess and evaluate the QOL following surgical management of maxillofacial trauma patients based on the severity of the injury.

Methods: The study consisted of 182 subjects divided into two groups of 91 each (Group A: severe facial injury and Group B: mild to moderate facial injury). The Facial Injury Severity Scale (FISS) was used to determine the severity of facial fractures and injuries. The twenty–point quality of life assessment tool includes Zone 1 (Psychosocial impact) and Zone 2 (Functional and aesthetic impact), with ten domains each to assess QOL.

Results: In Zone 1, the mean scores for Group A and Group B were 38.6 and 39.26, respectively. In Zone 2, Group B (44.56) had higher mean scores compared to Group A (32.92) (p< 0.001). Group B (83.8) had higher mean scores compared to Group A (71.58) when the total of both Zone 1 and Zone 2 were taken into consideration (p<0,001). In Group A, 9 out of 91 patients had a total score of 81- 100 compared to 68 in the same range in Group B.

Conclusions: Proper surgical management with adequate care to the hard and soft tissues can improve the QOL by reducing postoperative psychosocial and functional complications. Aesthetic outcomes play an important role in determining the QOL. Mild/ Moderate injuries show better QOL compared to severe maxillofacial injuries.
Morphometry of pyramidalis muscle and its role in reconstructive surgeries: A cadaveric study
Authors: Sumalatha Suhani , Rao Sharanya , Ankolekar Vrinda Hari
Published: May 2023

Background: The pyramidalis muscle is a tiny triangular-shaped muscle that is located in the anterior abdominal wall, which originates from the body of the pubis and pubic symphysis and is inserted into linea alba. This study aimed to measure the different parameters of the pyramidalis muscle in adult cadavers.

Methods: This study was carried out on 31 adults (26 males and five females) 10% formalin embalmed cadavers of both sexes from the Department of Anatomy at Kasturba Medical College, Manipal.

Results: The mean length of the right pyramidalis muscle was 64.44 ± 12.52 mm and the left pyramidalis muscle was 64.73 ± 12.81 mm. The mean width of the muscle was 15 ± 4.18 mm and 15.03 ± 3.52 mm on the right and left sides, respectively. The mean thickness of the muscle was 1.32 ± 0.55 mm and 1.4 ± 0.80 mm on the right and left sides, respectively. The distance between the umbilicus to pubic symphysis ranged from 130–192 mm and their mean was calculated to be 159.77 ± 15.36. The distance between the umbilicus and the apex of the muscle ranged from 72–123 mm.

Conclusions: The measured parameters like length, width and thickness may help the surgeons to locate the muscle during infra umbilical surgeries.
The balancing act: A qualitative study on remote work and childcare during the COVID-19 lockdown in South Africa
Authors: Scholtz Salome
Published: May 2023

Background: The coronavirus disease 2019 (COVID-19) pandemic has impacted many employees' world by forcing some to remote work while caring for children.

Methods: This study explored the remote working experiences of child caregivers in balancing work and childcare during the South African COVID-19 lockdown period (from 26 March 2020 to 31 December 2020). A qualitative descriptive design was employed to collect data through an online qualitative questionnaire with semi-structured questions. A final sample of 22 participants was included using purposive and snowball sampling.

Results: Findings indicate that White South African employees experienced difficulty balancing work and childcare, which prompted them to use personal and organisational resources to restore work-life balance. These resources included people, spaces and time.

Conclusions: This study provides insight for employers and healthcare workers into how remote workers balance work and childcare and can promote conversations or interventions on improving employee remote work experiences - especially in the unique South African context.
Computed tomography-based analysis of the characteristics of fifth metacarpal neck fractures and its clinical applications
Authors: Kwak Donghee , Shin Seung Min , Ryoo Hyun Jae , Choi In Cheul , Park Jong Woong
Published: May 2023

Purpose: Understanding the configuration and characteristics of the comminuted fifth metacarpal neck fractures is essential for successful operative treatment, especially for antegrade intramedullary Kirchner wire (K-wire) fixation. This study aimed to investigate the characteristics and shape of comminuted fragments in fifth metacarpal neck fractures and suggest the appropriate K-wire position.Methods: Forty-one cases of fifth metacarpal neck fractures operated from January 2010 to April 2022 were enrolled in this study. The length and width of the comminuted fragments were measured, as well as the distance from the articular surface of the fifth metacarpal head to the comminuted fragment (Da-c) and the distance from the articular surface to the proximal end of the metacarpal head (Da-h). The location of the comminuted fragments was categorized in terms of four quadrants: dorsal-ulnar (DU), dorsal-radial (DR), palmar-radial, and palmar-ulnar.Results: Among 41 patients with fifth metacarpal neck fractures, comminuted fracture fragments were observed in 35 cases (85.4%). The mean length and width of the comminuted fragments were 7.5±2.3 mm and 3.2±0.8 mm, respectively. The comminuted fragments were on the dorsal aspect of the fracture in all cases; 27 (77.1%) in the DU quadrant and 8 (22.9%) in the DR quadrant. The mean Da-c and Da-h were 5.3±1.6 mm and 10.9±1.5 mm, respectively.Conclusion: To ensure stable K-wire fixation, it is essential to identify the location and characteristics of the comminuted fracture fragments before surgery and subsequently choose an appropriate K-wire position.
Are parents ready to be parents?
Authors: Celinska Angelica
Published: May 2023

Angelica Celinska, lecturer and trainer, gives us an insight into her conversation around parenting with Matt Sanders, professor of clinical psychology. They discuss incidental teaching, supporting parental self-regulation, the stigma associated with parenting programmes and the role which educators play in all of this.
Keeping the individual child at the forefront of early years teaching
Authors: Roberts Elly
Published: May 2023

Specialist teacher and SEND specialist, Breda McKinney, discusses the importance of understanding the individual needs of the children she works with and how they learn best, when providing early years education. Breda shares how she is inspired in her work by knowing the difference she makes to children who otherwise might struggle to access the learning.
Supporting mark-making at home
Authors: Sanford Nicky
Published: May 2023

Learning to write is an essential skill for children, but it begins with development of muscles, movements and making marks. There are lots of easy, fun and active ways for you to support your child. These ideas will help your child to develop their body ready for the control needed to form letters.
On-chip clearing for live imaging of 3D cell cultures
Authors: Yu Tingting , Zhong Xiang , Yang Qihang , Gao Chao , Chen Wenyue , Liu Xiang , Liu Zhang , Zhu Tingting , Li Dongyu , Fei Peng , Chen Zaozao , Gu Zhongze , Zhu Dan
Published: May 2023

Three-dimensional (3D) cell cultures provide an important model for various biological studies by bridging the gap between two-dimensional (2D) cell cultures and animal tissues. Microfluidics has recently provided controllable platforms for handling and analyzing 3D cell cultures. However, on-chip imaging of 3D cell cultures within microfluidic devices is hindered by the inherent high scattering of 3D tissues. Tissue optical clearing techniques have been used to address this concern but remain limited to fixed samples. As such, there is still a need for an on-chip clearing method for imaging live 3D cell cultures. Here, to achieve on-chip clearing for live imaging of 3D cell cultures, we conceived a simple microfluidic device by integrating a U-shaped concave for culture, parallel channels with micropillars, and differentiated surface treatment to enable on-chip 3D cell culture, clearing, and live imaging with minimal disturbance. The on-chip tissue clearing increased the imaging performance of live 3D spheroids with no influence on cell viability or spheroid proliferation and demonstrated robust compatibility with several commonly used cell probes. It allowed dynamic tracking of lysosomes in live tumor spheroids and enabled quantitative analysis of their motility in the deeper layer. Our proposed method of on-chip clearing for live imaging of 3D cell cultures provides an alternative for dynamic monitoring of deep tissue on a microfluidic device and has the potential to be used in 3D culture-based assays for high-throughput applications.
Modeling of thin-film interference filters on structured substrates: microfacet-based BSDF versus ray tracing
Authors: Wessels Andreas , Christen Leonard , Callies Adrian , Kroyer Thomas , Höhn Oliver , Bläsi Benedikt
Published: May 2023

We compare two model approaches for the ray optical description of PV modules with coloring based on an interference layer system on the inside of the cover glass. The light scattering is described by a microfacet-based bidirectional scattering distribution function (BSDF) model on the one hand and ray tracing on the other hand. We show that the microfacet-based BSDF model is largely sufficient for the structures used in the context of the MorphoColor application. A structure inversion shows a significant influence only for extreme angles and very steep structures showing correlated heights and surface normal orientations. Regarding an angle-independent color appearance, the model-based comparison of possible module configurations shows a clear advantage of a structured layer system compared to planar interference layers in combination with a scattering structure on the front side of the glass.