bluuebunny/crossref_metadata_2025 huggingface dataset:
Understanding the electric field dependent channel migration for shorter channel length of multilayer rhenium disulfide (ReS2) FETs
Authors: Choi Hyeong Jin , Choi Yun Jae , Kim Gyu-Tae
Published: December 2024

Multilayer rhenium disulfide (ReS2) has attracted considerable attention due to the decoupled van der Waals interaction between its adjacent layers, leading to significantly higher interlayer resistance compared with other layered materials. While the carrier transport in multilayer materials can be well described by the interlayer resistance (R
Int) and Thomas–Fermi charge screening length (

λ

TF

) in resistor network models, the electric field scaling of the channel with the back gate voltage (V
BG) and the drain voltage (V
D) is limited in two-dimensional (2D) multilayer materials. In this report, we present the effects of V
BG and V
D on the channel migration of ReS2 field effect transistors (FETs) with channel lengths of 0.25, 2.4, and 4.4 μm. For shorter channels, the V
BG-dependent conductance (G = (drain current (I
D)/V
D)) increases with increasing V
D, different from the longer channels. Based on the resistor network model, the different behaviors with channel lengths were analyzed by considering the interlayer resistance (R
Int) versus the channel resistance and the Thomas–Fermi charge screening length (

λ

TF

). Lower back gate voltage (V
BG) in shorter channels builds the channel near the bottom layer close to the oxide, while high V
BG shifts the conductive channel to the top sheet exposed to ambient condition. In longer channels, due to the increased channel resistance (R
ch), the conductive channel forms near the bottom side close to the oxide. The increase of the threshold voltage (V
th) was observed at higher drain-source voltages (V
D), but in opposite for the top side channel, i.e. the decrease of threshold voltage with increasing V
D. This study will give a hint on establishing the electric field scaling of 2D material-based FETs with channel lengths and applied voltages of V
BG and V
D.
Prediction of laser-induced breakdown in sub-micron-thick dielectric targets for laser-ion acceleration
Authors: Assenbaum Stefan , Bock Stefan , Cowan Thomas E , Gebhardt René , Helbig Uwe , Kroll Florian , Metzkes-Ng Josefine , Püschel Thomas , Rehwald Martin , Schilz Joshua D , Schlenvoigt Hans-Peter , Schramm Ulrich , Štefaníková Radka , Streil Thomas , Umlandt Marvin E P , Vescovi Milenko , Wang Pengjie , Zeil Karl , Ziegler Tim , Bernert Constantin
Published: December 2024

In laser-ion acceleration experiments, the interaction of the rising flank of a high power laser pulse with the target can cause pre-ionization and subsequent target pre-expansion long before the arrival of the main laser peak. Exact knowledge of this target pre-expansion is required in order to understand the laser-plasma acceleration mechanisms with the help of numerical simulations. For dielectric targets, the starting point of target pre-expansion is characterized by the point in time at which the target undergoes laser-induced breakdown (LIB). In this work, we present a method to determine the time of LIB in sub-micron-thick Formvar targets during interaction with a specific high-power laser pulse. The required pulse-duration-dependent LIB threshold of Formvar is measured in a dedicated experiment. A comparison of LIB threshold to previously published data facilitates a generalization to other wide-band-gap dielectric targets for laser-ion acceleration.
A novel horizontal self-tuning piezoelectric energy harvester based on a beam-slider system
Authors: Xie Zhengqiu , Fang Gen , Ge Shuaishuai , Zhang Zhigang , Shu Ruizhi , Wang Zhiguo , Liu Ziqian , Huang Wenbin
Published: December 2024

With the rapid development of piezoelectric energy harvesting technologies, this approach is emerging as a promising power source for smart sensors. Despite this progress, a significant challenge remains in achieving a wider bandwidth while increasing the output power. In response to this challenge, this paper introduces a horizontal self-tuning beam-slider piezoelectric energy harvester (STBS-PEH). This innovative harvester employs a unilateral beam-slider mechanism to enable self-tuning of the energy harvesting by adjusting its resonant frequency to match the external excitation frequency. The electromechanical coupled dynamic model of this harvester has been established. Comprehensive simulations and experimental analysis have been conducted to demonstrate the wide bandwidth and high output power characteristics of the proposed harvester. Notably, the simulation results exhibit strong agreement with the experimental findings. The resonance response bandwidth of the STBS-PEH is particularly noteworthy, which is twice that of a conventional cantilever beam PEH. The root mean square voltage and output power of the developed STBS-PEH can reach 23.54 V and 194.61 µW, respectively, at a frequency of 21 Hz, with an excitation amplitude of 0.5 g. These results demonstrate that the STBS-PEH is capable of powering low-power electronic devices in a broadband vibrational environment.
Experimental investigation and parametric optimization of FSW of mineral-reinforced AA6061 matrix composite
Authors: Prabhu B Subramanya R , Herbert Mervin A
Published: December 2024

In this work, rutile reinforced AA 6061 matrix composites were joined using friction stir welding and the process variables were optimized using Taguchi L27 orthogonal design of experiments. The rotational speed, axial force and tool tilt angle were the parameters taken into consideration. The optimum process variables were determined with reference to tensile strength, impact strength and hardness of the joint. The predicted optimal value of output responses was confirmed by conducting the confirmation run using optimum parameters. The optimal process variables combination values that resulted in improved mechanical properties were observed at a tool rotational speed of 1400 rpm, a tool tilt angle of 2 degree, and an axial force of 3KN. Scanning electron microscopy (SEM) analysis were used to probe the microstructures.
Cobordism of 𝐺-manifolds
Authors: Carlisle Jack
Published: December 2024

We survey some results in the field of equivariant cobordism. In particular, we use methods from equivariant stable homotopy theory to calculate the unoriented

C
2

C_2

-equivariant bordism ring

Ω
∗

C
2

\Omega ^{C_2}_*

, which was originally calculated by Alexander using other methods. Our proof method generalizes well to other settings, such as equivariant complex cobordism, and affords a formal group theoretic interpretation of Alexander’s calculation.
Low-dimensional GKM theory
Authors: Goertsches Oliver , Konstantis Panagiotis , Zoller Leopold
Published: December 2024

GKM theory is a powerful tool in equivariant topology and geometry that can be used to generalize classical ideas from (quasi)toric manifolds to more general torus actions. After an introduction to the topic this survey focuses on recent results in low dimensions, where the interaction between geometry and combinatorics turns out to be particularly fruitful.
Sexual History-Taking in a Surgery Clerkship Assessment: A Stubborn Clinical Skills Gap With Reproductive Health Care Implications
Authors: Coleman Taylen , Adamson Dylan T. , Marshall Hannah , Smith Jensen , Wright Tiffany , Bohnert Carrie A. , Shaw M. Ann , Weingartner Laura A.
Published: December 2024

Purpose

Patients present with sexual and reproductive health needs in a variety of clinical settings, so knowing when and how to elicit a relevant sexual history is critical in any specialty. This work examined whether reinforcing the surgical relevance of sexual health with an integrated training improved third-year medical students’ sexual history-taking.

Method

Third-year surgery clerkship standardized patient assessments were video coded from a 2021-2022 comparison and 2022-2023 intervention cohort (University of Louisville School of Medicine). The case used for both cohorts involved a 38-year-old patient assigned female at birth presenting with acute right lower abdominal pain. Before the assessment, the intervention cohort received an additional clerkship didactic session focused on evaluation and assessment of the acute abdomen emphasizing the importance of sexual history-taking for surgical patients. The frequency of sexual histories attempted, number of questions, topics discussed, and differential diagnoses were compared.

Results

There was not a significant difference between cohorts’ sexual history-taking frequency: 61% (72/119) of students in the comparison cohort, compared to 65% (86/132) in the intervention cohort. On average, students in the intervention group asked 6 questions related to sexual health, compared to 3 questions by students in the comparison group (P < .001). Across cohorts, 66% (104/158) of students who took a sexual history considered sexual diagnoses on their differential, compared to only 23% (21/93) of students who did not take a sexual history (P < .001).

Conclusions

Reinforcing the clinical relevance of sexual history-taking for surgical patients was associated with higher-quality histories and broader differentials but not higher rates of sexual history-taking. Because there is now variability in how reproductive health care can be delivered across the United States, medical educators must refocus on sexual history-taking skills in a variety of settings and work to address barriers preventing students from collecting this information.
Efforts in Undergraduate Medical Education to Improve Socioeconomic Status Diversity
Authors: Velasquez David E. , Shrestha Anmol , Matias Wilfredo R.
Published: December 2024

Purpose

Despite the importance of socioeconomic status (SES) diversity within the health care workforce, little progress has been made toward this elusive goal. Although centuries of structural disadvantage underlie this stagnation, medical schools are well positioned to increase enrollment and retention of students from low-SES backgrounds. In this research report, the authors investigate existing efforts in undergraduate medical education to improve SES diversity.

Method

The authors analyzed the Association of American Medical Colleges Medical School Admissions Requirements database, the American Association of Colleges of Osteopathic Medicine Choose DO Explorer tool, and official medical school websites from December 2022 to May 2023 to examine undergraduate medical education initiatives across 156 allopathic and 56 osteopathic medical schools. They searched for SES diversity efforts in 4 domains: publication of student body demographics (including low-SES or first-generation status), need-based financial aid, low-SES support or affinity groups, and faculty or alumni mentorship programs for low-SES students.

Results

The authors found that 18 medical schools (8.5%) publicly report SES demographic information, 33 (15.6%) report having mentorship programs for low-SES students, 52 (24.5%) report having support or affinity groups for these students, and 154 (72.6%) report offering some level of need-based financial assistance. A greater proportion of MD and public medical schools (128 [82.1%] and 84 [80.0%], respectively) had any kind of SES initiative when compared with DO schools and private medical schools (40 [71.4%] and 84 [78.5%], respectively).

Conclusions

Medical schools can support students from lower-SES backgrounds by publicly reporting classwide SES demographics, dedicating staff and faculty to diversity, equity, and inclusion efforts, measuring and reporting debt burden by stratified student demographics, and introducing innovative financing solutions.
The Use of Oral Phenobarbital Loading for the Management of Alcohol Withdrawal Syndrome in an Outpatient Setting: A Case Report
Authors: Hamilton Erin , Bouchard Braden
Published: December 2024

Alcohol withdrawal syndrome is most frequently treated with benzodiazepines, but due to their short half-life, tapering prescriptions are frequently required for outpatients, which presents challenges to both clinicians and patients. Our local health system has had significant success treating alcohol withdrawal in the emergency department with phenobarbital loading doses. As patients also present in alcohol withdrawal to our outpatient addictions clinic, we have adapted our emergency department intravenous protocol to a staggered, oral loading protocol for the treatment of mild and moderate alcohol withdrawal syndrome in the community setting. In this case report, we successfully treat a 36-year-old man with mild alcohol withdrawal symptoms using this approach and without requiring a tapering sedative prescription.
Morphologic Development of the Posterior Sloping Angle of the Proximal Femoral Epiphysis in Children: What Is the Peak Risk Age for Slipping?
Authors: Wu Jingyu , Federico Canavese , Li Lianyong
Published: December 2024

Objective:

The purpose of this study was to describe the developmental patterns of the posterior sloping angle (PSA) of the proximal femoral epiphyseal growth plate (PFEP) in a cohort of healthy Chinese children aged 5 to 14 years.

Methods:

Pelvic frog-leg lateral radiographs of 400 healthy children (n=800 hips) were retrospectively analyzed. The cohort included 215 males and 185 females with a mean age of 9.5 years (5 to 14). PSA measurements of the PFEP were obtained bilaterally from frog leg lateral radiographs. Subjects were equally divided into 10 subgroups of 40 patients each (80 hips per group) based on age, starting at 5 years of age; in addition, sex and lateral differences, as well as age-related developmental patterns were analyzed.

Results:

The PSA was −2.6±3.1 degrees at 5 years of age, indicating mild anterior inclination of the femoral epiphysis. It increased to 6.2±4.6 degrees at 11 years of age, decreased to 3.9±4.3 degrees at 12 years of age, and then stabilized until 14 years of age. Before 11 years of age, there was no significant sex difference in PSA values, whereas, after 11 years of age, males had a PSA of 5.8±4.3 degrees compared with 3.7±5.0 degrees in females (P<0.001), with the former showing an average increase of ~2 to 3 degrees more. In addition, the left PSA was ~2 degrees greater than the right PSA in both men and women (P<0.001).

Conclusions:

Before puberty, PSA gradually increased with age, peaking at 11 years of age, followed by a slight decline and then stabilization. After the age of 11 years, males had higher PSA levels than females, with the PSA of the left side being significantly higher than that of the right side. Understanding these developmental patterns may aid in the assessment and monitoring of adolescent PFEP disorders.

Level of Evidence:

Level III—diagnostic studies.
Accuracy and Value of Time-resolved MRA for Spinal Vascular Malformations
Authors: Wei Xiao-Er , Zhu Jin-Yu , Li Ming-Hua , Wei Jianyong , Wei Liming , Zhu Yueqi , Li Yuehua
Published: December 2024

Study design.

Retrospective.

Objective.

To explore the value of time-resolved CE-MRA in evaluating and locating the SVM prior to digital subtraction angiography (DSA).

Summary of Background Data.

Spinal vascular malformations (SVM) can be detected with time-resolved contrast-enhanced MRA(CE-MRA).

Materials and Methods.

178 patients with suspected SVM who underwent time-resolved CE-MRA examination and DSA were included in this study. DSA served as the reference standard. The type of SVM, feeding arteries, fistula/nidus, and proximal segment of draining veins were evaluated on time-resolved CE-MRA. The diagnostic performance and classification performance of time-resolved CE-MRA in the diagnosis of SVM is summarized in terms of overall accuracy, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV). The difference of catheterized vessels during spinal vascular DSA between actual and estimated number was also analyzed.

Results.

147 patients were diagnosed with SVM (20 cervical, 118 thoracolumbar, and 9 deep lumbosacral) and 31 patients were diagnosed with non-SVM according to DSA findings. The diagnostic sensitivity, specificity, PPV, NPV, and accuracy of time-resolved CE-MRA for subtype of SVM were 0.961, 0.961, 0.993, 0.806 and 0.961, respectively. The overall accuracy of time-resolved CE-MRA for the diagnosis of SVM was 0.821, and was 0.783, 0.793, and 0.778 for cervical, thoracolumbar, and deep lumbosacral SVM, respectively. The actual number of catheterized vessels during spinal vascular DSA with time-resolved CE-MRA as the reference was lower than the estimated number of catheterized vessels in both SVM and non-SVM patients (P<0.001).

Conclusion.

Time-resolved CE-MRA could accurately evaluate SVM and reduce the number of catheterized vessels during spinal vascular DSA.
Perioperative Antidepressant Use is Associated with Symptomatic Pseudarthrosis after Lumbar Fusion
Authors: McCurdy Michael A. , Dalton Jonathan , Narayanan Rajkishen , Herczeg Chloe K. , Baidya Joydeep , Dawes Alexander , Melendez Manuel , Goldberg Marco , Wright Justin , Kaye Ian David , Woods Barrett , Cha Thomas , Canseco Jose A. , Hilibrand Alan S. , Vaccaro Alexander R. , Schroeder Gregory D. , Kepler Christopher K.
Published: December 2024

Study Design.

Retrospective cohort.

Objective.

To explore the relationship between symptomatic pseudoarthrosis requiring revision after lumbar fusion and antidepressant use.

Summary of Background Data.

Approximately 25% of patients undergoing spine surgery are taking antidepressants. Pseudoarthrosis is a significant complication of spinal fusion surgery that can lead to debilitating pain and revision surgery. Animal models have identified selective serotonin reuptake inhibitors/serotonin and norepinephrine reuptake inhibitors (SSRIs/SNRIs) as detrimental to bone healing, and one database study identified antidepressants as associated with lumbar pseudoarthrosis. However, no single-institution study has replicated these findings.

Methods.

A structured query language search identified patients from 2017-2022 with pseudoarthrosis after lumbar fusion—this was verified by pseudoarthrosis listed as the indication for revision surgery in operative notes and by reviewing preoperative computed tomography imaging. Patients were counted as taking antidepressants if an antidepressant was an active medication at their preoperative and first postoperative appointments. Control patients who had no radiographic indication of pseudoarthrosis at their last clinical follow-up were matched 3:1 with pseudoarthrosis patients requiring revision based on smoking status, levels fused, levels decompressed, and procedure type. Statistical analysis was performed to compare the two groups.

Results.

36 patients were identified that had revision for symptomatic pseudoarthrosis after primary, elective lumbar fusion. These patients were compared to 108 patients who had lumbar fusion without pseudoarthrosis. Patients with pseudoarthrosis had higher rates of diagnosed depression (P=0.019), anxiety (P=0.007), and antidepressant use (P=0.001). Logistic regression identified SSRI/SNRI use as an independent predictor of requiring revision surgery for symptomatic lumbar pseudoarthrosis (OR 3.95, CI 1.66-9.45, P=0.002).

Conclusions.

Patients requiring revision surgery for lumbar pseudoarthrosis had a higher rate of depression, anxiety, and antidepressant use. SSRI/SNRI use was identified as an independent predictor of requiring revision surgery for lumbar pseudoarthrosis. Future, prospective studies are needed to further evaluate this association.

Level of Evidence:

III
Serum protein risk stratification score for diagnostic evaluation of metabolic dysfunction–associated steatohepatitis
Authors: Lai Michelle , Dillon Simon T. , Gu Xuesong , Morhardt Tina L. , Xu Yuyan , Chan Noel Y. , Xiong Beibei , Can Handan , Ngo Long H. , Jin Lina , Zhang Xuehong , Moreira Claudia C. , Leite Nathalie C. , Villela-Nogueira Cristiane A. , Otu Hasan H. , Schattenberg Jörn M. , Schuppan Detlef , Afdhal Nezam H. , Libermann Towia A.
Published: December 2024

Background:

Reliable, noninvasive tools to diagnose at-risk metabolic dysfunction–associated steatohepatitis (MASH) are urgently needed to improve management. We developed a risk stratification score incorporating proteomics-derived serum markers with clinical variables to identify high-risk patients with MASH (NAFLD activity score >4 and fibrosis score >2).

Methods:

In this 3-phase proteomic study of biopsy-proven metabolic dysfunction–associated steatotic fatty liver disease, we first developed a multi-protein predictor for discriminating NAFLD activity score >4 based on SOMAscan proteomics quantifying 1305 serum proteins from 57 US patients. Four key predictor proteins were verified by ELISA in the expanded US cohort (N = 168) and enhanced by adding clinical variables to create the 9-feature MASH Dx score, which predicted MASH and also high-risk MASH (F2+). The MASH Dx score was validated in 2 independent, external cohorts from Germany (N = 139) and Brazil (N = 177).

Results:

The discovery phase identified a 6-protein classifier that achieved an AUC of 0.93 for identifying MASH. Significant elevation of 4 proteins (THBS2, GDF15, SELE, and IGFBP7) was verified by ELISA in the expanded discovery and independently in the 2 external cohorts. MASH Dx score incorporated these proteins with established MASH risk factors (age, body mass index, ALT, diabetes, and hypertension) to achieve good discrimination between MASH and metabolic dysfunction–associated steatotic fatty liver disease without MASH (AUC: 0.87—discovery; 0.83—pooled external validation cohorts), with similar performance when evaluating high-risk MASH F2-4 (vs. MASH F0-1 and metabolic dysfunction–associated steatotic fatty liver disease without MASH).

Conclusions:

The MASH Dx score offers the first reliable noninvasive approach combining novel, biologically plausible ELISA-based fibrosis markers and clinical parameters to detect high-risk MASH in patient cohorts from the United States, Brazil, and Europe.
Missense variants in the TRPM7 α-kinase domain are associated with recurrent pediatric acute liver failure
Authors: Schlieben Lea D. , Achleitner Melanie T. , Bourke Billy , Diesner Max , Feichtinger René G. , Fichtner Alexander , Flechtenmacher Christa , Hadzic Nedim , Hegarty Robert , Heilos Andreas , Janecke Andreas , Konstantopoulou Vassiliki , Lenz Dominic , Mayr Johannes A. , Müller Thomas , Prokisch Holger , Vogel Georg F.
Published: December 2024

Background:

Pediatric acute liver failure (PALF) is a rare and life-threatening condition. In up to 50% of PALF cases, the underlying etiology remains unknown during routine clinical testing. This lack of knowledge complicates clinical management and liver transplantation decisions. Recently, whole-exome sequencing has identified genetic disorders in a large number of cases without specific laboratory biomarkers or metabolic fingerprints.

Methods:

We describe how further analysis of whole-exome sequencing data combined with proteomic analyses in 5 previously unsolved PALF patients, where no pathogenic variants in genes previously associated with acute liver failure were identified, revealed rare biallelic variants in transient receptor potential cation channel subfamily M member 7 (TRPM7).

Results:

We establishe TRPM7 as a novel disease gene for PALF. Yet, the cation channel kinase TRPM7 has not been associated with any Mendelian disorder. No homozygous loss-of-function variants were found in in-house exomes or publicly available databases. Rare biallelic TRPM7-variants were significantly enriched in the PALF cohort compared with a pediatric control cohort. Viral infections preceded the majority of PALF episodes. Recurrent PALF episodes characterized the disease course with rapid progression, leading to early death in 3 cases. Proteomic analyses of patient fibroblasts unveiled significantly reduced TRPM7 protein levels, indicative of functional impairment. Severely reduced Mg2+ levels in one individual with a mutation in the channel domain suggests a potential interaction between disturbed Mg2+ homeostasis and PALF. The consistent presence of mutations in the TRPM7 protein-kinase-domain across all patients suggests its specific relevance in PALF.

Conclusions:

Our data extend the genetic spectrum of recurrent PALF and prompt consideration of TRPM7 in children with unexplained liver failure.
Cardiovascular Health Disparities in Adults of Color Aged 18 to 50
Authors: Howard Quiana , Adeyinka Sharon , Martin Shemaine , Griggs Stephanie
Published: December 2024

Background

Although cardiovascular disease is the leading cause of death among US adults of color, there is a limited understanding of cardiovascular health status, including health behaviors (sleep health, diet, physical activity, and nicotine exposure) and health factors (body mass index, blood lipids, blood glucose, and blood pressure).

Purpose/Methods

The objective of this systematic review was to synthesize original research on racial and ethnic disparities in CVH among US adults aged 18 to 50 years using Life's Simple 7 and Life's Essential 8 metrics. Multiple electronic databases (PubMed, PsycINFO, and CINAHL) were searched for relevant original studies published in English until March 28, 2023.

Results

Fifteen original descriptive studies were selected (N = 364 426, mean age = 39.2 ± 8.4 years, 64.6% female, 65.4% non-Hispanic White [NHW], 10.7% non-Hispanic Black [NHB], 11.7% Hispanic, 6.2% multiracial 0.6% non-Hispanic Asian, and <1% American). There were race-, sex-, and age-based differences in CVH scores. People of color had lower CVH scores when compared with NHW, and NHB had the lowest CVH of all racial groups. Males had lower CVH and higher rates of low CVH across most racial groups. However, NHB women had lower CVH scores than NHB men on average compared with these other groups.

Conclusions/Clinical Implications

The findings of this review contribute to understanding CVH disparities among US adults of color. Ideal CVH is associated with a lower cardiovascular disease risk; therefore, further research is needed to estimate CVH among a racially and ethnically representative sample of US adults.
Intraoperative Epoprostenol in Type II Heparin-Induced Thrombocytopenia During Left-Ventricular Assist Device Implantation: A Case Series and Review of Literature
Authors: Chandra Akhil Avunoori , Pandya Vidish , Martina Luis Pina , Freilich Michael , Sims Daniel B. , Vukelic Sasa , Leff Jonathan D. , Goldstein Daniel J. , Murthy Sandhya , Jorde Ulrich P. , Saeed Omar
Published: December 2024

Type II heparin-induced thrombocytopenia and thrombosis (type II HITT) is a rare but serious complication in patients receiving heparin for anticoagulation. In type II HITT, an immune-mediated reaction against platelet factor four-heparin complexes results in thrombocytopenia and an elevated risk of thrombosis. This poses significant challenges for patients with advanced heart failure requiring urgent left-ventricular assist device (LVAD) implantation. The use of direct thrombin inhibitors, the typical alternative to heparin, is associated with increased bleeding risk and lacks a reversal agent, limiting their use in cardiac surgery. We present two cases of intraoperative epoprostenol to facilitate implantation of a durable LVAD in type II HITT, of which one case underwent preoperative plasmapheresis and intravenous immunoglobulin (IVIG) therapy. Epoprostenol, a prostacyclin analog, was used intraoperatively during LVAD implantation to inhibit platelet activation and allowed for the safe administration of heparin during cardiopulmonary bypass. Both patients underwent successful LVAD implantation without thrombotic or major bleeding complications. These cases highlight the potential of using intraoperative epoprostenol in conjunction with preoperative plasma exchange (PLEX) and IVIG to mitigate the risks associated with heparin use in patients with type II HITT, offering an alternative approach for this high-risk group requiring urgent cardiac surgery.
Return on Investment of Incorporating Simulation into a New Graduate Nurse Emergency Department Residency Program
Authors: Kutzin Jared M. , Collins Lauren
Published: December 2024

Ensuring a smooth transition from education to practice for new nurses is essential in helping stem the flow of nurses out of the profession. However, traditional nurse residency education has only included didactic education sessions. In a novel new graduate emergency Nurse Residency Program, simulation-based education was ranked as the best part of the new graduate Nurse Residency Program. The result of incorporating simulation experiences was increased satisfaction by program participants and a decrease in turnover.
Enhancing Clinical Practice Through Simulation
Authors: Grimley Karen A.
Published: December 2024

Nurse leaders are obligated to ensure that nurses are prepared to engage in the provision of safe high-quality nursing care by creating a learning environment where their clinical knowledge and critical reasoning can be safely developed and refined. Simulated educational experiences can accelerate learning and provide nurse’s the ability to confidently and competently deliver clinical care in a highly efficient manner.
Expansive Arterial Remodeling and Its Risk Factors in Cerebral Infarction
Authors: Gong Bingzheng , Pian Ying , Yang Qichao , Zhang Jingjun
Published: December 2024

Objective:

Cerebral infarction (CI) is a prevalent and frequently occurring condition. However, the association between expansive remodeling in the carotid artery system and CI is still uncertain. This study aims to investigate the significance of the carotid artery system and aortic arch (AA) remodeling for the prevention and treatment of CI.

Methods:

We collected data from 821 patients who underwent computed tomography angiography at our hospital, performed statistical analysis, and compared it with various clinical data.

Results:

We found that the diameters and detection rates of the common carotid artery (CCA), internal carotid artery (ICA), carotid bifurcation, and AA were significantly greater in the CI group than in the without CI group (P<0.05). The number of carotid sinus plaque (CSP) and the length of aortic arch plaque (AAP) were considered to be 2 important factors in predicting CCA remodeling. Moreover, the thickness of AAP was considered to be an important factor in predicting AA remodeling.

Conclusions:

Patients with CI exhibited a significant increase in the diameter of the carotid system and AA, which correlated with certain features of arterial plaque. Hence, early detection of arterial plaques, along with interventions to delay or potentially reverse expansive arterial remodeling, may be effective in preventing and treating CI.
The Spectrum of B-cell and Plasma Cell Proliferations in Nodal T Follicular Helper Cell Lymphomas
Authors: Segura-Rivera Roman , Dcunha Nicholas Joseph , Dimopoulos Yiannis Petros , Mundhada Aniruddha , Sainz Tania P. , Kettlun Claudia , Sahu Vishal , Sarami Iman , Miranda Roberto N. , Lin Pei , Medeiros Leonard Jeffrey , Vega Francisco
Published: December 2024

B-cell and plasma cell proliferations are frequently observed in nodal T follicular helper (nTfh) cell lymphomas and can present a diagnostic challenge. These proliferations can be monotypic or monoclonal and morphologically resemble lymphoma or plasmacytoma, but their clinical behavior is poorly defined. In this study, we reviewed 414 cases of nTfh lymphoma seen over the past decade at our institution. We identified 78 (19%) cases that exhibited B-cell or plasma cell proliferation detected by morphology, flow cytometry, immunohistochemistry, and/or molecular techniques. The B-cell/plasma cell proliferations occurred before (22%), concurrently with (50%), or after (28%) the diagnosis of nTfh lymphoma. We divided them into 3 categories: (1) focal or scattered B-immunoblastic proliferations recognized morphologically without a monotypic/monoclonal B-cell population (17%), (2) monotypic/monoclonal B-cell/plasma cells identified solely by flow cytometry or molecular clonality studies without morphologic confirmation (11%), and (3) unequivocal B-cell/plasma cell expansions recognized by morphologic assessment (72%). We further subdivided group 3 into proliferations associated with and possibly dependent on neoplastic Tfh cells versus those proliferations occurring in the absence of neoplastic Tfh cells and likely bona fide lymphomas. Follow-up biopsy specimens showed persistence of B-cell/plasma cell proliferations in various patient subcategories, with transformation to higher-grade B-cell proliferation or persistence without Tfh cells in some cases. In conclusion, our data support the notion that most B-cell and plasma cell proliferations associated with neoplastic Tfh clones have little impact on the clinical course of patients with nTfh lymphoma and likely do not constitute an independent B-cell lymphoma, especially those of small B cells of plasma cells. However, B-cell expansions exhibiting aggressive morphologic features may represent an independent B-cell lymphoma.
A little goes a long way: A comparison of enterolithotomy versus single-stage cholecystectomy in the management of gallstone ileus
Authors: Khurshid Muhammad Haris , Hejazi Omar , Spencer Audrey L. , Nelson Adam , Stewart Collin , Colosimo Christina , Ditillo Micheal , Matthews Marc R. , Magnotti Louis J. , Joseph Bellal
Published: December 2024

INTRODUCTION

Gallstone ileus is an infrequent complication of cholelithiasis with no specific guidelines for its management. This study aims to compare the outcomes of patients with gallstone ileus managed with both enterolithotomy with cholecystectomy (EL-CCY) versus those managed with enterolithotomy (EL) only.

METHODS

In this retrospective analysis of 2011–2017 Nationwide Readmissions Database, all patients with an index admission diagnosis of gallstone ileus were included. Patients were stratified based on the type of intervention received for gallstone ileus into those who underwent EL-CCY and those who underwent EL alone and compared. Primary outcomes were in-hospital complications (surgical site infections, sepsis, pneumonia, cardiac arrest, deep vein thrombosis, intestinal obstruction) and mortality. Secondary outcomes were hospital length of stay, hospital costs, and readmissions rate and cause of readmissions. Multivariable logistic regression analysis was performed.

RESULTS

A total of 1,960 patients were identified. The mean age was 67 years and 67% were female. Two hundred eighty-nine patients (14.7%) were managed with EL-CCY, whereas 1,671 patients (85.3%) underwent EL only. Overall, the readmission rate was 4.8%, whereas mortality was 4.2%. There was no significant difference between groups in terms of index-admission complications (24.8% vs. 21.7%, p = 0.415), mortality (6.2% vs. 3.9%, p = 0.068), rates of readmission (3.5% vs. 5.1%, p = 0.22), and cause of readmission (p > 0.05). Enterolithotomy and cholecystectomy group had significantly longer hospital length of stay (10 vs. 8 days, p < 0.001) and median hospital costs ($70,959 vs. $52,147, p < 0.001). On multivariable logistic regression analysis, female sex was a predictor of undergoing EL-CCY, whereas increasing age and higher grade of all-patient redefined diagnosis-related groups risk of mortality were independently associated with lower odds of undergoing EL-CCY.

CONCLUSION

Our findings suggest no difference between EL compared with EL-CCY in terms of complications, readmissions, and mortality. However, patients managed with EL-CCY had a longer hospital stay and higher hospital costs compared with EL. Further prospective studies are needed to validate these findings and develop management protocols for gallstone ileus.

LEVEL OF EVIDENCE

Therapeutic/Care Management; Level III.
Similar Associated Risk of Complications and Death for Adolescent Gunshot Wounds Treated at Pediatric Only Hospitals when Compared to Combined Pediatric and Adult Centers
Authors: Nguyen Lily , Grigorian Areg , Lee Carlin , Goodman Laura F , Guner Yigit , Kuza Catherine , Swentek Lourdes , Nahmias Jeffry
Published: December 2024

Background:

Adult trauma centers, including combined pediatric/adult centers (CPACs), see high volumes of penetrating trauma. Few studies have compared outcomes of adolescents presenting with gunshot wounds (GSWSs) at CPACs vs. pediatric only hospitals (POHs). This study aimed to compare injury patterns, complications, and mortality for adolescents sustaining GSWs presenting to CPACs vs POHs, hypothesizing decreased associated risk of complications and mortality at CPACs.

Study Design:

The 2017-2021 Trauma Quality Improvement Program database was queried for adolescents (aged 12-17) with isolated GSWs. Patients transferred or with brain injury were excluded. CPACs included centers with adult and pediatric ACS-verification while POHs only had pediatric ACS-verification. Multivariable logistic regression analysis was performed to identify risk factors associated with in-hospital complications and mortality, controlling for age, injury severity score (ISS), vitals, surgery, and blood transfusions.

Results:

Of 3,064 adolescents presenting with GSWs, 1,512 (49.3%) presented to CPACs. When compared to POH, CPAC patients were slightly older (median, 16 vs. 15 years old, p<0.001) had increased ISS (median: 9 vs. 4, p<0.001), and injuries to the spine (9.3% vs. 5.7%, p<0.001), heart (2.3% vs. 0.7%, p<0.001), lung (19.1% vs. 10.6%, p<0.001), liver (8.5% vs. 4.8%, p<0.001), and spleen (3.2% vs. 1.5%, p=0.002). CPAC adolescents also had increased rates of emergent operations (31.9% vs. 23.5%, p<0.001). However, on multivariable analysis, CPAC adolescents had a similar associated risk of in-hospital complications (OR 0.91, CI 0.59-1.41, p=0.68) and mortality (OR 0.76, CI 0.40-1.48, p=0.42).

Conclusions:

Adolescent GSW patients had similar associated risk of mortality and complications when comparing POHs to CPACs. This suggests that adolescents with GSWs receive similar care at both CPACs and POHs. Additional research is warranted to corroborate these findings.
Cost-Effectiveness of Laparoscopic vs Open Liver Resection: A Propensity Score-Matched Single-Center Analysis of 920 Cases
Authors: Koh Ye Xin , Zhao Yun , Tan Ivan En-Howe , Tan Hwee Leong , Chua Darren Weiquan , Tan Ek Khoon , Teo Jin Yao , Ang Kwok Ann , Au Marianne Kit Har , Goh Brian Kim Poh
Published: December 2024

Background:

This study compared the clinical and economic outcomes of laparoscopic (LLR) and open liver resection (OLR) for all hepatectomies, including minor and major hepatectomies.

Study Design:

This retrospective study included 920 consecutive elective patients undergoing liver resection from 2017 to 2023. Patient demographics, postoperative surgical outcomes, postoperative length of stay (LOS), and costs were compared between LLR and OLR before and after propensity score matching (PSM). A decision model was developed to assess the cost-effectiveness of LLR versus OLR.

Results:

After PSM, LLR was associated with significantly fewer postoperative transfusions for all hepatectomies (P < 0.001) and major hepatectomy (P = 0.001). LLR was associated with a shorter postoperative median LOS (P < 0.001), lower 30-day readmission (P = 0.022) and reoperation (P = 0.044) rates, and significantly reduced postoperative pneumonia (P = 0.038), unplanned intubation (P = 0.020), sepsis (P = 0.041), and major complications (P < 0.001) for all hepatectomies. This clinical superiority was complemented by a significant reduction in total costs for all (P < 0.001), minor (P = 0.001), and major (P < 0.001) hepatectomies. Cost-effectiveness analysis revealed that LLR was dominant over OLR, with a negative incremental cost-effectiveness ratio (-$2120.72) and an increased net monetary benefit ($75,015.92) at the willingness-to-pay (WTP) threshold of $25,000. The probability of LLR being cost-effective was 99.8% across various WTP thresholds.

Conclusions:

LLR is a safe and cost-effective alternative to OLR. While LLR has higher initial procedural costs, these are offset by significant reductions in postoperative major complications, LOS, and total costs.
Yamadazyma oleae f.a. sp. nov. and Yamadazyma molendinolei f.a. sp. nov., two novel ascomycetous yeast species isolated from olive oil mills in Italy, and reassignment of 11 Candida species to the genus Yamadazyma
Authors: Avesani Michele , Zapparoli Giacomo , Jindamorakot Sasitorn , Limtong Savitree
Published: December 2024

Three yeast strains were isolated from an olive paste sample (CBS 18661) and two samples of olive oil (CBS 18662 and CBS 18660) were collected in two different mills in Verona province, Italy. The sequence comparison of the D1/D2 domains of the LSU rRNA gene and the internal transcribed space (ITS) regions indicated that these strains belonged to the genus Yamadazyma. Phylogenetic analysis of concatenated sequences of the ITS regions and the D1/D2 domains indicated that they represented members of two distinct species. Strain CBS 18661 and CBS 18662 showed sequence divergence of 2.7–2.8% (13–15 nucleotide substitutions) in the D1/D2 domains from the holotype of Yamadazyma luoyangensis, Yamadazyma ovata, Yamadazyma siamensis and Candida kanchanaburiensis and 5.9–6.2% identities (36–38 nucleotide substitutions) in the ITS regions from Yamadazyma akitaenisis and Yamadazyma nakazawae. Strain CBS 18660 showed sequence divergence of 0.75–1.1% (4–6 nucleotide substitutions) from Y. ovata, Candida trypodendri and Candida insectorum and 3.2–4.1% (18–24 nucleotide substitutions) in the ITS regions from Yamadazyma dushanensis, Yamadazyma terventina, Yamadazyma mexicana and C. trypodendri. The strains CBS 18661T (PP391581-PP375117) and CBS 18662 (PP391582-PP375118) are named Yamadazyma oleae f.a. sp. nov., whereas CBS 18660T (PP149061-PP130150) is assigned as Yamadazyma molendinolei f.a. sp. nov. The MycoBank numbers are MB 854683 and MB 854684, respectively. In addition, 11 Candida species belonging to the Yamadazyma clade have been reassigned to the genus Yamadazyma with the proposal of the following new combinations: Yamadazyma aaseri comb. nov., Yamadazyma conglobata comb. nov., Yamadazyma dendronema comb. nov., Yamadazyma diddensiae comb. nov., Yamadazyma germanica comb. nov., Yamadazyma insectorum comb. nov., Yamadazyma kanchanaburiensis comb. nov., Yamadazyma naeodendra comb. nov., Yamadazyma pseudoaaseri comb. nov., Yamadazyma trypodendri comb. nov. and Yamadazyma vaughaniae comb. nov.
A Cell Autonomous Free fatty acid receptor 4 - ChemR23 Signaling Cascade Protects Cardiac Myocytes from Ischemic Injury
Authors: Puccini Sara J. , Healy Chastity L. , Harsch Brian A. , Ahmed Ahmed R. , Shearer Gregory C. , O’Connell Timothy D.
Published: December 2024

Acute myocardial infarction (AMI) causes ischemic damage and cardiac remodeling that ultimately progresses into ischemic cardiomyopathy (ICM). Coronary revascularization reduces morbidity and mortality from an MI, however, reperfusion also induces oxidative stress that drives cardiac myocyte (CM) dysfunction and ICM. Oxidative stress in CMs leads to reactive oxygen species (ROS) production and mitochondrial damage. Free fatty acid receptor 4 (Ffar4) is a GPCR for long chain fatty acids (FA) that is expressed in multiple cell types including CMs. We have recently shown that CM-specific overexpression of Ffar4 protects the heart from systolic dysfunction in the context of ischemic injury. Mechanistically, in CMs, Ffar4 increases the levels of 18-hydroxyeicosapentaenoic acid (18-HEPE), an eicosapentaenoic acid (EPA)-derived, cardioprotective oxylipin (oxidatively modified FA). 18-HEPE is the precursor for resolvin E1 (RvE1), a cardioprotective, specialized pro-resolving mediator (SPM) that activates the GPCR ChemR23. We hypothesize Ffar4 in CMs protects the heart from oxidative stress and ischemic injury through activation of a CM-autonomous, Ffar4-ChemR23 cardioprotective signaling pathway. Here, we developed anin vitrohypoxia reoxygenation (H/R) model (3 hours of hypoxia, 17 hours of reoxygenation) in adult CMs as a model for ischemic injury. In adult CMs subjected to H/R, TUG-891, an Ffar4 agonist, attenuated ROS generation and TUG-891, 18-HEPE, and RvE1 protected CMs from H/R-induced cell death. More importantly, we found that the ChemR23 antagonist α-NETA prevented TUG-891 cytoprotection in adult CMs subjected to H/R, demonstrating that ChemR23 is required for Ffar4 cardioprotection. In summary, our data demonstrate co-expression of Ffar4 and ChemR23 in the same CM, that Ffar4, 18-HEPE, and RvE1 attenuate H/R-induced CM death, and that ChemR23 is required for Ffar4 cardioprotection in H/R support a CM-autonomous Ffar4-ChemR23 cardioprotective signaling pathway.
Electroretinograms as a functional readout of neuronal integrity in neurodegeneration models of Drosophila melanogaster
Authors: Manuel Nikhil , Mallipudi Malav , Gajwani Arya , Gopalkrishna Shetty Sreenivasa Murthy Sravan , Jupiter Daniel C. , Krishnan Balaji
Published: December 2024

The current protocol leverages the intrinsic potential of electroretinograms (ERGs) in Drosophila melanogaster, extending their application by using aged flies and the GAL4- UAS system to attempt to understand human gene effects on neuronal transmission. ERGs model neuronal vulnerability and developmental changes, providing a robust tool for examining altered neurological states. The current protocols sheds insights into the strengths and pitfalls in the analysis of human gene pathways in progression of neurodegenerative states, with additional information on novel parameters that can be tapped. This technique enhances our ability to use neurophysiological recordings for gaining insights into the molecular mechanisms underlying the role of the gene in neuronal function, thus complementing ex vivo and in vitro systems using mouse and cell culture models. - Genetics and aging to studying neurodegeneration- Traditional ERG parameters - Additional parameters. Our technique builds on the robust background of several techniques to provide additional parameters such as aging the flies (1-5 weeks) and the response characteristics associated with creating transgenic models using the w1118 background. Lastly, we also provide a different way to explore the results by identifying zones and derivatives that may improve our electrophysiological of the genetic influences on neuronal responses better.
A forest is more than its trees: haplotypes and ancestral recombination graphs
Authors: Fritze Halley , Pope Nathaniel , Kelleher Jerome , Ralph Peter
Published: December 2024

Foreshadowing haplotype-based methods of the genomics era, it is an old observation that the “junction” between two distinct haplotypes produced by recombination is inherited as a Mendelian marker. In a genealogical context, this recombination-mediated information reflects the persistence of ancestral haplotypes across local genealogical trees in which they do not represent coalescences. We show how these non-coalescing haplotypes (“locally-unary nodes”) may be inserted into ancestral recombination graphs (ARGs), a compact but information-rich data structure describing the genealogical relationships among recombinant sequences. The resulting ARGs are smaller, faster to compute with, and the additional ancestral information that is inserted is nearly always correct where the initial ARG is correct. We provide efficient algorithms to infer locally-unary nodes within existing ARGs, and explore some consequences for ARGs inferred from real data. To do this, we introduce new metrics of agreement and disagreement between ARGs that, unlike previous methods, consider ARGs as describing relationships between haplotypes rather than just a collection of trees.