bluuebunny/crossref_metadata_2025 huggingface dataset:
Transforming finance for sustainability in energy: past, present and future of green bonds in China
Authors: Qian Xu
Published: July 2022

A coherent and robust framework for energy regulation at both national and international levels behaves as a vital cog in creating efficient energy mechanisms. This article explains that in a key country like China, green bonds are called to play an important role to serve the policy mandate for clean energy. The ubiquitous presence of green bonds has concerted the development of their principal prerogatives in the form of ‘Green Bond Principles’. As a consequence, China has been a dominant force in the market of green bonds. However, the article shows that this dominance is accompanied with functional loopholes, prominently characterized by the lack of diversity in the market.
A multiwavelength study of star formation in nearby galaxies: evidence for inside-out growth of the stellar disc
Authors: Smith Madison V , van Zee L , Dale D A , Hunter L C , Staudaher S , Wrock T
Published: July 2022

Global, radial, and local photometric measurements of several nearby low-mass galaxies are presented. Multiwavelength observations are used to trace the distributions of old and young stars, with the help of far-ultraviolet (FUV) to mid-infrared spectral energy distributions to derive star formation histories (SFHs). In addition to the surface brightness profiles, catalogues of UV-selected sources are created to better understand regions of galaxies with recent star formation. The clustering of these UV sources are studied in the dwarf irregular UGC 08188 (IC 4182) using a two-point correlation function. We find that the reddest of these UV sources are not clustered on any scale, but the bluer sources are clustered on scales approximately less than 1 kpc. We also find a possible negative radial gradient in the SFH parameter that marks the beginning of the younger stellar population’s formation (tburst) when analysing the entire sample of 3165 UV sources found across a total of 34 galaxies, giving quantitative evidence for the inside-out growth of galactic discs – a natural consequence of galaxy evolution in a Λ cold dark matter universe.
Pathogenic variant in ACTL7A causes severe teratozoospermia characterized by bubble-shaped acrosomes and male infertility
Authors: Dai Jing , Chen Yongzhe , Li Qi , Zhang Tianlei , Zhou Qinwei , Gong Fei , Lu Guangxiu , Zheng Wei , Lin Ge
Published: July 2022

Teratozoospermia is a common factor associated with male infertility. However, teratozoospermia characterized by bubble-shaped acrosomes (BSAs) has not yet been identified in men and the causative genes are unknown. The present study is of a patient with severe teratozoospermia characterized by BSA and carrying a variant (c.1204G>A, p.Gly402Ser) of actin-like 7A (ACTL7A). For further verification, we generated an Actl7a-mutated mouse model (p.Gly407Ser) carrying an equivalent variant to that in the patient. We found that homozygous Actl7a-mutated (Actl7aMut/Mut) male mice were sterile, and all their sperm showed acrosomal abnormalities. We detected by transmission electron microscopy that during acrosomal biogenesis, the acrosome detaches from the nuclear membrane in Actl7aMut/Mut mice. Furthermore, mutant ACTL7A failed to attach to the acroplaxome and was discharged by cytoplasmic droplets, which led to the absence of ACTL7A in epididymal spermatozoa in mice. The mutant sperm failed to activate the oocyte, and sperm-borne oocyte activation factor phospholipase C zeta (PLCζ) discharge accompanied by ACTL7A was observed, leading to total fertilization failure (TFF). Immunoprecipitation followed by liquid chromatography–mass spectrometry showed that several differentially expressed proteins participate in acrosome assembly and actin filament organization. Furthermore, assisted oocyte activation by calcium ionophore exposure successfully overcame TFF in the couple with an ACTL7A pathogenic variant. Our study defined a novel phenotype of an acrosomal abnormality characterized by BSA, revealed the underlying mechanism of a pathogenic variant in ACTL7A and provided a genetic marker and potential therapeutic option for male infertility.
ELF4 is a critical component of a miRNA-transcription factor network and is a bridge regulator of glioblastoma receptor signaling and lipid dynamics
Authors: Kosti Adam , Chiou Jennifer , Guardia Gabriela D A , Lei Xiufen , Balinda Henriette , Landry Tesha , Lu Xiyuan , Qiao Mei , Gilbert Andrea , Brenner Andrew , Galante Pedro A F , Tiziani Stefano , Penalva Luiz O F
Published: July 2022

Background

The loss of neurogenic tumor suppressor microRNAs miR-124, miR-128, and miR-137 is associated with glioblastoma’s undifferentiated state. Most of their impact comes via the repression of a network of oncogenic transcription factors. We conducted a high-throughput functional siRNA screen in glioblastoma cells and identify E74 like ETS transcription factor 4 (ELF4) as the leading contributor to oncogenic phenotypes.

Methods

In vitro and in vivo assays were used to assess ELF4 impact on cancer phenotypes. We characterized ELF4’s mechanism of action via genomic and lipidomic analyses. A MAPK reporter assay verified ELF4’s impact on MAPK signaling, and qRT-PCR and western blotting were used to corroborate ELF4 regulatory role on most relevant target genes.

Results

ELF4 knockdown resulted in significant proliferation delay and apoptosis in GBM cells and long-term growth delay and morphological changes in glioma stem cells (GSCs). Transcriptomic analyses revealed that ELF4 controls two interlinked pathways: 1) Receptor tyrosine kinase signaling and 2) Lipid dynamics. ELF4 modulation directly affected receptor tyrosine kinase (RTK) signaling, as mitogen-activated protein kinase (MAPK) activity was dependent upon ELF4 levels. Furthermore, shotgun lipidomics revealed that ELF4 depletion disrupted several phospholipid classes, highlighting ELF4’s importance in lipid homeostasis.

Conclusions

We found that ELF4 is critical for the GBM cell identity by controlling genes of two dependent pathways: RTK signaling (SRC, PTK2B, and TNK2) and lipid dynamics (LRP1, APOE, ABCA7, PLA2G6, and PITPNM2). Our data suggest that targeting these two pathways simultaneously may be therapeutically beneficial to GBM patients.
An affinity for brainstem microglia in pediatric high-grade gliomas of brainstem origin
Authors: Zats Liat Peretz , Ahmad Labiba , Casden Natania , Lee Meelim J , Belzer Vitali , Adato Orit , Bar Cohen Shaked , Ko Seung-Hyun B , Filbin Mariella G , Unger Ron , Lauffenburger Douglas A , Segal Rosalind A , Behar Oded
Published: July 2022

Background

High-grade gliomas (HGG) in children have a devastating prognosis and occur in a remarkable spatiotemporal pattern. Diffuse midline gliomas (DMG), including diffuse intrinsic pontine gliomas (DIPG), typically occur in mid-childhood, while cortical HGGs are more frequent in older children and adults. The mechanisms behind this pattern are not clear.

Methods

We used mouse organotypic slice cultures and glial cell cultures to test the impact of the microenvironment on human DIPG cells. Comparing the expression between brainstem and cortical microglia identified differentially expressed secreted proteins. The impact of some of these proteins on DIPGs was tested.

Results

DIPGs, pediatric HGGs of brainstem origin, survive and divide more in organotypic slice cultures originating in the brainstem as compared to the cortex. Moreover, brainstem microglia are better able to support tumors of brainstem origin. A comparison between the two microglial populations revealed differentially expressed genes. One such gene, interleukin-33 (IL33), is highly expressed in the pons of young mice and its DIPG receptor is upregulated in this context. Consistent with this observation, the expression levels of IL33 and its receptor, IL1RL1, are higher in DIPG biopsies compared to low-grade cortical gliomas. Furthermore, IL33 can enhance proliferation and clonability of HGGs of brainstem origin, while blocking IL33 in brainstem organotypic slice cultures reduced the proliferation of these tumor cells.

Conclusions

Crosstalk between DIPGs and the brainstem microenvironment, in particular microglia, through IL33 and other secreted factors, modulates spatiotemporal patterning of this HGG and could prove to be an important future therapeutic target.
OsAMT1;1 and OsAMT1;2 Coordinate Root Morphological and Physiological Responses to Ammonium for Efficient Nitrogen Foraging in Rice
Authors: Wu Xiangyu , Xie Xiaoxiao , Yang Shan , Yin Qianyu , Cao Huairong , Dong Xiaonan , Hui Jing , Liu Zhi , Jia Zhongtao , Mao Chuanzao , Yuan Lixing
Published: July 2022

Optimal plant growth and development rely on morphological and physiological adaptions of the root system to forage heterogeneously distributed nitrogen (N) in soils. Rice grows mainly in the paddy soil where ammonium (NH4+) is present as the major N source. Although root NH4+ foraging behaviors are expected to be agronomically relevant, the underlying mechanism remains largely unknown. Here, we showed that NH4+ supply transiently enhanced the high-affinity NH4+ uptake and stimulated lateral root (LR) branching and elongation. These synergistic physiological and morphological responses were closely related to NH4+-induced expression of NH4+ transporters OsAMT1;1 and OsAMT1;2 in roots. The two independent double mutants (dko) defective in OsAMT1;1 and OsAMT1;2 failed to induce NH4+ uptake and stimulate LR formation, suggesting that OsAMT1s conferred the substrate-dependent root NH4+ foraging. In dko plants, NH4+ was unable to activate the expression of OsPIN2, and the OsPIN2 mutant (lra1) exhibited a strong reduction in NH4+-triggered LR branching, suggesting that the auxin pathway was likely involved in OsAMT1s-dependent LR branching. Importantly, OsAMT1s-dependent root NH4+ foraging behaviors facilitated rice growth and N acquisition under fluctuating NH4+ supply. These results revealed an essential role of OsAMT1s in synergizing root morphological and physiological processes, allowing for efficient root NH4+ foraging to optimize N capture under fluctuating N availabilities.
The Role of Ubiquitination in Plant Immunity: Fine-Tuning Immune Signaling and Beyond
Authors: Gao Chenyang , Tang Dingzhong , Wang Wei
Published: July 2022

Ubiquitination is an essential posttranslational modification and plays a crucial role in regulating plant immunity by modulating protein activity, stability, abundance and interaction. Recently, major breakthroughs have been made in understanding the mechanisms associated with the regulation of immune signaling by ubiquitination. In this mini review, we highlight the recent advances in the role of ubiquitination in fine-tuning the resistance activated by plant pattern recognition receptors (PRRs) and intracellular nucleotide-binding site and leucine-rich repeat domain receptors (NLRs). We also discuss current understanding of the positive regulation of plant immunity by ubiquitination, including the modification of immune negative regulators and of the guardee proteins monitored by NLRs.
The nucleotide metabolome of germinating Arabidopsis thaliana seeds reveals a central role for thymidine phosphorylation in chloroplast development
Authors: Niehaus Markus , Straube Henryk , Specht André , Baccolini Chiara , Witte Claus-Peter , Herde Marco
Published: July 2022

Thymidylates are generated by several partially overlapping metabolic pathways in different subcellular locations. This interconnectedness complicates an understanding of how thymidylates are formed in vivo. Analyzing a comprehensive collection of mutants and double mutants on the phenotypic and metabolic level, we report the effect of de novo thymidylate synthesis, salvage of thymidine, and conversion of cytidylates to thymidylates on thymidylate homeostasis during seed germination and seedling establishment in Arabidopsis (Arabidopsis thaliana). During germination, the salvage of thymidine in organelles contributes predominantly to the thymidylate pools and a mutant lacking organellar (mitochondrial and plastidic) thymidine kinase has severely altered deoxyribonucleotide levels, less chloroplast DNA, and chlorotic cotyledons. This phenotype is aggravated when mitochondrial thymidylate de novo synthesis is additionally compromised. We also discovered an organellar deoxyuridine-triphosphate pyrophosphatase and show that its main function is not thymidylate synthesis but probably the removal of noncanonical nucleotide triphosphates. Interestingly, cytosolic thymidylate synthesis can only compensate defective organellar thymidine salvage in seedlings but not during germination. This study provides a comprehensive insight into the nucleotide metabolome of germinating seeds and demonstrates the unique role of enzymes that seem redundant at first glance.
The phospholipid flippase ALA3 regulates pollen tube growth and guidance in Arabidopsis
Authors: Yang Yang , Niu Yue , Chen Tao , Zhang Hongkai , Zhang Jingxia , Qian Dong , Bi Mengmeng , Fan Yuemin , An Lizhe , Xiang Yun
Published: July 2022

Pollen tube guidance regulates the growth direction and ovule targeting of pollen tubes in pistils, which is crucial for the completion of sexual reproduction in flowering plants. The Arabidopsis (Arabidopsis thaliana) pollen-specific receptor kinase (PRK) family members PRK3 and PRK6 are specifically tip-localized and essential for pollen tube growth and guidance. However, the mechanisms controlling the polar localization of PRKs at the pollen tube tip are unclear. The Arabidopsis P4-ATPase ALA3 helps establish the polar localization of apical phosphatidylserine (PS) in pollen tubes. Here, we discovered that loss of ALA3 function caused pollen tube defects in growth and ovule targeting and significantly affected the polar localization pattern of PRK3 and PRK6. Both PRK3 and PRK6 contain two polybasic clusters in the intracellular juxtamembrane domain, and they bound to PS in vitro. PRK3 and PRK6 with polybasic cluster mutations showed reduced or abolished binding to PS and altered polar localization patterns, and they failed to effectively complement the pollen tube-related phenotypes of prk mutants. These results suggest that ALA3 influences the precise localization of PRK3, PRK6, and other PRKs by regulating the distribution of PS, which plays a key role in regulating pollen tube growth and guidance.
SlSPX1-SlPHR complexes mediate the suppression of arbuscular mycorrhizal symbiosis by phosphate repletion in tomato
Authors: Liao Dehua , Sun Chao , Liang Haiyan , Wang Yang , Bian Xinxin , Dong Chaoqun , Niu Xufang , Yang Meina , Xu Guohua , Chen Aiqun , Wu Shuang
Published: July 2022

Forming mutualistic symbioses with arbuscular mycorrhizae (AMs) improves the acquisition of mineral nutrients for most terrestrial plants. However, the formation of AM symbiosis usually occurs under phosphate (Pi)-deficient conditions. Here, we identify SlSPX1 (SYG1 (suppressor of yeast GPA1)/Pho81(phosphate 81)/XPR1 (xenotropic and polytropic retrovirus receptor 1) as the major repressor of the AM symbiosis in tomato (Solanum lycopersicum) under phosphate-replete conditions. Loss of SlSPX1 function promotes direct Pi uptake and enhances AM colonization under phosphate-replete conditions. We determine that SlSPX1 integrates Pi signaling and AM symbiosis by directly interacting with a set of arbuscule-induced SlPHR proteins (SlPHR1, SlPHR4, SlPHR10, SlPHR11, and SlPHR12). The association with SlSPX1 represses the ability of SlPHR proteins to activate AM marker genes required for the arbuscular mycorrhizal symbiosis. SlPHR proteins exhibit functional redundancy, and no defective AM symbiosis was detected in the single mutant of SlPHR proteins. However, silencing SlPHR4 in the Slphr1 mutant background led to reduced AM colonization. Therefore, our results support the conclusion that SlSPX1-SlPHRs form a Pi-sensing module to coordinate the AM symbiosis under different Pi-availability conditions.
High prevalence of fatigue in patients with Takayasu arteritis: a case–control study in a Brazilian centre
Authors: dos Santos Alexandre Moura , Misse Rafael Giovani , Borges Isabela Bruna Pires , Gomes da Silva Sarah Luiza , Kim Ana Woo Sook , Pereira Rosa Maria R , Shinjo Samuel Katsuyuki
Published: July 2022

Objectives

Several studies have shown not only a high prevalence of fatigue but also a reduction in health-related quality of life (HRQoL) in patients with rheumatic diseases. Owing to insufficient research in this area, we aimed to assess the prevalence of fatigue and its contribution to impairment of HRQoL in patients with Takayasu arteritis (TAK).

Methods

This single-centre case–control study included 53 TAK patients who were matched by age, BMI and sex with 100 healthy individuals. Aside from the patients’ general data, the following information was collected: disease activity, level of activities of daily living (HAQ), physical activity levels and chronic fatigue.

Results

The TAK patients and healthy individuals were comparable in terms of current age, BMI and sex distribution. The median disease duration of TAK was 13.0 (7.0–20.0) years, and 11 (20.8%) patients had active disease. Compared with healthy individuals, patients with TAK had a higher prevalence of fatigue and lower HAQ score, physical activity level and intensity, and physical and psychosocial domains of the modified fatigue impact scale (P < 0.01). Moreover, TAK patients had increased fatigue rates compared with the healthy individuals (fatigue severity scale: odds ratio = 2.6; 95% CI = 1.2, 5.4; modified fatigue impact scale: odds ratio = 2.6; 95% CI = 1.2, 5.5). Fatigue was positively correlated with worsening HAQ, CRP levels, daily prednisone dose and disease activity, and negatively correlated with disease duration.

Conclusion

TAK patients have a higher prevalence of fatigue, which affects different aspects of the disease, including physical function. Thus, fatigue-focused treatments should also be considered in clinical practice.

Trial registration

The Brazilian Clinical Trials Registry (ReBEC), https://ensaiosclinicos.gov.br/, RBR-9n4z2hh.
Effect of Different Solvents on the Optically Stimulated Luminescence Signal from MgB4O7:Ce,Li-Loaded Polymer Films
Authors: Santos Caroline C , Valença João V B , d’Errico Francesco , Machado Rogério , Caldas Linda V E , Souza Susana O
Published: July 2022

The detailed dose analysis at the extremities remains a challenge, without affecting operators’ mobility and their tactile sense. Using films loaded with optically stimulated luminescence (OSL) crystals have been studied in order to overcome some of these challenges in 2D dosimetry. In this work, we investigated flexible polymeric films loaded with MgB4O7:Ce,Li to acquire a better understanding of the dependence of the dosimetric signal characteristics on the production process and the influence of using different powder grain sizes. In film production, five different solvents were used: acetone–benzene, dichloromethane, chloroform, tetrahydrofuran and formic acid. Our results indicate that acetone–benzene is the solvent mixture that less influences the signal emitted by treated crystals, in comparison with the signal emitted by the pristine crystal powder. Conversely, by using formic acid, the crystalline structure of the sample was most severely modified, leading to a drastic reduction of the emitted OSL signal. We found that the extent of the grain surface in contact with the solvent in the process is important and should be taken into consideration when choosing the proper grain size to be used.

Highlights  Polymeric films loaded with MgB4O7:Ce,Li crystals were produced using different solvents.Different effect on the OSL signal was found depending on the used solvent.Among the evaluated solvents, acetone–benzene was the one that less affected the OSL signal.
Machine Learning and Artificial Intelligence in Toxicological Sciences
Authors: Lin Zhoumeng , Chou Wei-Chun
Published: July 2022

Machine learning and artificial intelligence approaches have revolutionized multiple disciplines, including toxicology. This review summarizes representative recent applications of machine learning and artificial intelligence approaches in different areas of toxicology, including physiologically based pharmacokinetic (PBPK) modeling, quantitative structure-activity relationship modeling for toxicity prediction, adverse outcome pathway analysis, high-throughput screening, toxicogenomics, big data, and toxicological databases. By leveraging machine learning and artificial intelligence approaches, now it is possible to develop PBPK models for hundreds of chemicals efficiently, to create in silico models to predict toxicity for a large number of chemicals with similar accuracies compared with in vivo animal experiments, and to analyze a large amount of different types of data (toxicogenomics, high-content image data, etc.) to generate new insights into toxicity mechanisms rapidly, which was impossible by manual approaches in the past. To continue advancing the field of toxicological sciences, several challenges should be considered: (1) not all machine learning models are equally useful for a particular type of toxicology data, and thus it is important to test different methods to determine the optimal approach; (2) current toxicity prediction is mainly on bioactivity classification (yes/no), so additional studies are needed to predict the intensity of effect or dose-response relationship; (3) as more data become available, it is crucial to perform rigorous data quality check and develop infrastructure to store, share, analyze, evaluate, and manage big data; and (4) it is important to convert machine learning models to user-friendly interfaces to facilitate their applications by both computational and bench scientists.
Branch xylem vascular adjustments in European beech in response to decreasing water availability across a precipitation gradient
Authors: Weithmann Greta , Paligi Sharath Shyamappa , Schuldt Bernhard , Leuschner Christoph
Published: July 2022

Crucial for the climate adaptation of trees is a xylem anatomical structure capable of adjusting to changing water regimes. Although species comparisons across climate zones have demonstrated anatomical change in response to altered water availability and tree height, less is known about the adaptability of tree vascular systems to increasing water deficits at the intraspecific level. Information on the between-population and within-population variability of xylem traits helps assessing a species’ ability to cope with climate change. We investigated the variability of wood anatomical and related hydraulic traits in terminal branches of European beech (Fagus sylvatica L.) trees across a precipitation gradient (520–890 mm year−1) and examined the influence of climatic water balance (CWB), soil water capacity (AWC), neighborhood competition (CI), tree height and branch age on these traits. Furthermore, the relationship between xylem anatomical traits and embolism resistance (P50) was tested. Within-population trait variation was larger than between-population variation. Vessel diameter, lumen-to-sapwood area ratio and potential conductivity of terminal branches decreased with decreasing CWB, but these traits were not affected by AWC, whereas vessel density increased with an AWC decrease. In contrast, none of the studied anatomical traits were influenced by variation in tree height (21–34 m) or CI. Branch age was highly variable (2–22 years) despite equal diameter and position in the flow path, suggesting different growth trajectories in the past. Vessel diameter decreased, and vessel density increased, with increasing branch age, reflecting negative annual radial growth trends. Although vessel diameter was not related to P50, vessel grouping index and lumen-to-sapwood area ratio showed a weak, though highly significant, positive relationship to P50. We conclude that the xylem anatomy of terminal tree-top branches in European beech is modified in response to increasing climatic aridity and/or decreasing soil water availability, independent of a tree height effect.
OTC Products Promoted for Joint, Bone, and Muscle Conditions May Contain Potentially Dangerous Active Drug Ingredients
Authors: Aschenbrenner Diane S.
Published: July 2022

Over-the-counter products sold under the names Artri or Ortiga may contain active drugs that are not listed on the products' labeling. Adverse effects from these hidden ingredients are possible.
New Second-Line Treatment for B-Cell Lymphoma
Authors: Aschenbrenner Diane S.
Published: July 2022

Axicabtagene ciloleucel (Yescarta) has been approved for use as a second-line drug in patients with large B-cell lymphoma who are resistant to, or who relapse within 12 months of, first-line chemoimmunotherapy.

Confirming the patient's identity and matching it to the drug are critical as this is an autologous infusion. Nurses should premedicate patients to minimize the risk of hypersensitivity reactions.
Alternating Pressure Mattresses Is Not Superior for Pressure Injury Prevention
Authors: Rosenberg Karen
Published: July 2022

According to this study:

Alternating pressure mattresses can be used in patients at risk for pressure injuries, but there is insufficient evidence to suggest they're more effective than other supporting surfaces.

Changing a patient's position is important regardless of support surface.
QI Intervention Can Improve Diabetes Prevention after Gestational Diabetes
Authors: Rosenberg Karen
Published: July 2022

According to this study:

Successful diabetes prevention in women who've had gestational diabetes requires proactive building of critical improvement factors and audit feedback into routine care.
Morphology of the anterior mesorectum: a new predictor for local recurrence in patients with rectal cancer
Authors: Wang Xiaojie , Zheng Zhifang , Chen Min , Lin Jing , Lu Xingrong , Huang Ying , Huang Shenghui , Chi Pan
Published: July 2022

Background:

Pre-operative assessment with high-resolution magnetic resonance imaging (MRI) is useful for assessing the risk of local recurrence (LR) and survival in rectal cancer. However, few studies have explored the clinical importance of the morphology of the anterior mesorectum, especially in patients with anterior cancer. Hence, the study aimed to investigate the impact of the morphology of the anterior mesorectum on LR in patients with primary rectal cancer.

Methods:

A retrospective study was performed on 176 patients who underwent neoadjuvant treatment and curative-intent surgery. Patients were divided into two groups according to the morphology of the anterior mesorectum on sagittal MRI: (1) linear type: the anterior mesorectum was thin and linear; and (2) triangular type: the anterior mesorectum was thick and had a unique triangular shape. Clinicopathological and LR data were compared between patients with linear type anterior mesorectal morphology and patients with triangular type anterior mesorectal morphology.

Results:

Morphometric analysis showed that 90 (51.1%) patients had linear type anterior mesorectal morphology, while 86 (48.9%) had triangular type anterior mesorectal morphology. Compared to triangular type anterior mesorectal morphology, linear type anterior mesorectal morphology was more common in females and was associated with a higher risk of circumferential resection margin involvement measured by MRI (35.6% [32/90] vs. 16.3% [14/86], P 
= 0.004) and a higher 5-year LR rate (12.2% vs. 3.5%, P 
= 0.030). In addition, the combination of linear type anterior mesorectal morphology and anterior tumors was confirmed as an independent risk factor for LR (odds ratio = 4.283, P = 0.014).

Conclusions:

The classification established in this study was a simple way to describe morphological characteristics of the anterior mesorectum. The combination of linear type anterior mesorectal morphology and anterior tumors was an independent risk factor for LR and may act as a tool to assist with LR risk stratification and treatment selection.
The Mediating Effects of Mindfulness on Perceived Stress From HIV Stigma in People Living With HIV in Myanmar: A Cross-sectional Study
Authors: Huang Feifei , Chen Wei-Ti , Shiu Cheng-Shi , Lin Sai Htun , Tun Min San , Nwe Thet Wai , Oo Yin Thet Nu , Oo Htun Nyunt
Published: July 2022

HIV is a highly stigmatized and stressful condition for people with HIV (PWH). As a country heavily influenced by religion, especially Buddhism, we explore how the perceived stress from HIV stigma interacts with the mediator of mindfulness on PWH in Myanmar. From January to July 2020, a sample of 248 eligible PWH was recruited by quasi-random sampling methods from a private Facebook group in Myanmar. Data on demographics, HIV stigma, mindfulness, and perceived stress were collected. The bias-corrected percentile bootstrap method was used to test multiple mediation analyses. The path from perceived HIV stigma to perceived stress (direct effect β = 0.16) and the mediating effect of mindfulness on that stress were significant (indirect effect accounts for 45.15% of total effect). The findings indicate that interventions enhancing mindfulness-based practice should be considered to reduce HIV stigma and, therefore, lower perceived stress among PWH in Myanmar.
Cochlear Implant Outcomes in Patients With Otosclerosis: A Systematic Review
Authors: Lam Chon Meng , Cornwall Hannah Louisa , Chaudhry Abdullah , Muzaffar Jameel , Bance Manohar , Monksfield Peter
Published: July 2022

Objective

This study aimed to establish hearing outcomes after cochlear implantation in patients with otosclerosis.

Materials and Methods

We conducted a systematic review and narrative synthesis. Databases searched were as follows: MEDLINE, PubMed, Embase, Web of Science, Cochrane Collection, and ClinicalTrials.gov. No limits were placed on language or year of publication. The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.

Results

Searches identified 474 abstracts and 180 full texts, with 68 studies meeting the inclusion criteria and reporting outcomes in a minimum of 481 patients with at least 516 implants. Patient-reported outcome measures (PROMs) were reported in five studies involving 51 patients. Intraoperative adverse events/surgical approach details and preoperative radiological assessment were reported in 46 and 38 studies, respectively. The methodological quality of included studies was modest, predominantly consisting of case reports and noncontrolled case series with small numbers of patients. Most studies were Oxford Centre for Evidence Based Medicine grade IV.

Discussion

Access to good rehabilitation support is essential to achieving the good hearing outcomes and PROMs that can be expected by 12 months after implantation in most cases. There was a significant association between the radiological severity of otosclerosis and an increase in surgical and postoperative complications. Postoperative facial nerve stimulation can occur and may require deactivation of electrodes and subsequent hearing detriment.

Conclusions

Hearing outcomes are typically good, but patients should be counseled on associated surgical complications that may compromise hearing. Modern diagnostic techniques may help to identify potentially difficult cases to aid operative planning and patient counseling. Further work is needed to characterize PROMs in this population.
Can Electrocochleography Help Preserve Hearing After Cochlear Implantation With Full Electrode Insertion?
Authors: Harris Michael S. , Koka Kanth , Riggs William J. , Saleh Shaza , Holder Jourdan T. , Dwyer Robert T. , Prentiss Sandra , Lefler Shannon , Kozlowski Kristin , Hiss Megan M. , Ortmann Amanda J. , Nelson-Bakkum Erin , Büchner Andreas , Salcher Rolf , Harvey Steven A. , Hoffer Michael E. , Bohorquez Jorge E. , Alzhrani Farid , Alshihri Rana , Fida Almuhawas , Danner Christopher J. , Friedland David R. , Seidman Michael D. , Lenarz Thomas , Telischi Fred F. , Labadie Robert F. , Buchman Craig A. , Adunka Oliver F.
Published: July 2022

Objectives

To evaluate the utility of intracochlear electrocochleography (ECochG) monitoring during cochlear implant (CI) surgery on postoperative hearing preservation.

Study Design

Prospective, randomized clinical trial.

Setting

Ten high-volume, tertiary care CI centers.

Patients

Adult patients with sensorineural hearing loss meeting the CI criteria who selected an Advanced Bionics CI.

Methods

Patients were randomized to CI surgery either with audible ECochG monitoring available to the surgeon during electrode insertion or without ECochG monitoring. Hearing preservation was determined by comparing preoperative unaided low-frequency (125-, 250-, and 500-Hz) pure-tone average (LF-PTA) to postoperative LF-PTA at CI activation. Pre- and post-CI computed tomography was used to determine electrode scalar location and electrode translocation.

Results

Eighty-five adult CI candidates were enrolled. The mean (standard deviation [SD]) unaided preoperative LF-PTA across the sample was 54 (17) dB HL. For the whole sample, hearing preservation was “good” (i.e., LF-PTA change 0–15 dB) in 34.5%, “fair” (i.e., LF-PTA change >15–29 dB) in 22.5%, and “poor” (i.e., LF-PTA change ≥30 dB) in 43%. For patients randomized to ECochG “on,” mean (SD) LF-PTA change was 27 (20) dB compared with 27 (23) dB for patients randomized to ECochG “off” (p = 0.89). Seven percent of patients, all of whom were randomized to ECochG off, showed electrode translocation from the scala tympani into the scala vestibuli.

Conclusions

Although intracochlear ECochG during CI surgery has important prognostic utility, our data did not show significantly better hearing preservation in patients randomized to ECochG “on” compared with ECochG “off.”
Four-point Impedance Changes in the Early Post-Operative Period After Cochlear Implantation
Authors: Razmovski Tayla , Bester Christofer , Collins Aaron , O’Leary Stephen J.
Published: July 2022

Objective

Monitoring four-point impedance changes after cochlear implantation with comparison to conventional impedance measurements. Four-point impedance provides information regarding the bulk biological environment surrounding the electrode array, which is not discernible with conventional impedances.

Study Design

Prospective observational.

Setting

Hospital.

Patients

Adult cochlear implant recipients with no measurable hearing before implantation and implanted with a perimodiolar cochlear implant.

Main Outcome Measure(s)

Mean values for four-point and common ground impedances were calculated for all electrode contacts at intra-operative, 1 day, 1 week, 4 to 6 weeks, and 3 months post implantation. Linear mixed models were applied to the impedance data to compare between impedances and time points. Furthermore, patients were divided into groups dependent on the normalized change in four-point impedance from intra-operative to 1 day post-operative. The normalized change was then calculated for all other time points and compared across the two groups.

Results

Significant increases in four-point impedance occurred 1 day and 3 months after surgery, particularly in the basal half of the array. Four-point impedance at 1 day was highly predictive of four-point impedance at 3 months. Four-point impedance at the other time points showed marginal or no increases from intra-operative. Patients with an average increase higher than 10% in four-point impedance from intra-operative to 1 day, had significantly higher values at 3 months (p = 0.012). These patterns were not observed in common ground impedance.

Conclusion

This is the first study to report increases in four-point impedance within 24 hours of cochlear implantation. The increases at 1 day and 3 months align with the natural timeline of an acute and chronic inflammatory responses.
Role of extracorporeal membrane oxygenation and surgical embolectomy in acute pulmonary embolism
Authors: de Perrot Marc
Published: July 2022

Purpose of review

Surgery is an important option to consider in patients with massive and submassive pulmonary emboli. Earlier intervention, better patient selection, improved surgical techniques and the use of veno-arterial extracorporeal membrane oxygenation (VA ECMO) have contributed to improve the safety of surgery for pulmonary emboli.

Recent findings

VA ECMO is rapidly changing the initial management of patients with massive pulmonary emboli, providing an opportunity for stabilization and optimization before intervention. The early and long-term consequences of acute pulmonary emboli are better understood, in particular with regard to the risks of chronic thromboembolic pulmonary hypertension (CTEPH), an entity that should be identified in the acute setting as much as possible. The presence of chronic thromboembolic pulmonary disease can be associated with persistent haemodynamic instability despite removal of the acute thrombi, particularly if pulmonary hypertension is established. The pulmonary embolism response team (PERT) is an important component in the management of massive and submassive acute pulmonary emboli to determine the best treatment options for each patient depending on their clinical presentation.

Three types of surgery can be performed for pulmonary emboli depending on the extent and degree of organization of the thrombi (pulmonary embolectomy, pulmonary thrombo-embolectomy and pulmonary thrombo-endarterectomy). Other treatment options in the context of acute pulmonary emboli include thrombolysis and catheter-directed embolectomy. Future research should determine how best to integrate VA ECMO as a bridging strategy to recovery or intervention in the treatment algorithm of patients with acute massive pulmonary emboli.
Interception of chronic medication discrepancies by the clinical pharmacist in the emergency department
Authors: Van Cauwenberghe Linde , Van Kemseke Saskia , Oudaert Ellen , Pauwels Sofie , Steurbaut Stephane , Van Laere Sven , Hubloue Ives
Published: July 2022

The emergency department (ED) is a high-risk setting for the occurrence of medication discrepancies (MDs) due to inconsistencies between real and documented chronic medication therapies. A clinical pharmacist (CP) improves medication safety by performing a structured medication reconciliation on ED admission. The main objective was to identify the frequency and type of MDs in the chronic medication therapy by comparing the medication displayed in the home medication module of the electronic medical record and in the genereal practitioner’s (GP) referral letter with the best possible medication history by performing a structured medication reconciliation on ED admission. This prospective, monocentric, interventional study was carried out in the ED of a tertiary care university hospital in Brussels, Belgium. Inclusion criteria were patients of at least 65 years, polypharmacy, ED admission between 8 a.m. and 4 p.m. on weekdays, hospitalization and signed informed consent. During 24 days, a CP performed a structured medication reconciliation in order to obtain the best possible medication history and registered all MDs. The CP compared the best possible medication history with the home medication module and the GP’s referral letter and registered the different types of MDs. Eighty-three patients were included. The median number of medications in the home medication module and the best possible medication history was significantly different {7.0 [interquartile range (IQR), 5.0–11.0] vs. 8.0 (IQR, 6.0–11.0)/patient; P < 0.0001} with a median of 5.0 (IQR, 3.0–8.0) MDs per patient. Main MDs were omission (38.8%), addition (18.4%) and a deviant administration time (15.2%). Only 22.9% of patients (N = 19) had a GP’s referral letter containing their chronic medication therapy. The median number of medications in the GP’s referral letter and the best possible medication history were significantly different [6.0 (IQR, 4.0–9.0) vs. 8.0 (IQR, 7.0–11.0)/patient; P < 0.0001] with a median of 6.0 (IQR, 5.0–11.0) MDs per patient. Main MDs were omissions (39.9%), deviant frequencies (35.3%) and doses (16.7%). A CP, integrated in a multidisciplinary ED team, enhances medication safety by intercepting MDs on ED admission. Few patients possess a GP’s referral letter containing their chronic medication therapy and when they do, the accuracy and completeness are poor.
Do Individual Surgeon Preferences Affect Procedural Outcomes?
Authors: Mohamadipanah Hossein , Perumalla Calvin A. , Kearse LaDonna E. , Yang Su , Wise Brett J. , Goll Cassidi K. , Witt Anna K. , Korndorffer James R. , Pugh Carla M.
Published: July 2022

Objectives:

Surgeon preferences such as instrument and suture selection and idiosyncratic approaches to individual procedure steps have been largely viewed as minor differences in the surgical workflow. We hypothesized that idiosyncratic approaches could be quantified and shown to have measurable effects on procedural outcomes.

Methods:

At the American College of Surgeons (ACS) Clinical Congress, experienced surgeons volunteered to wear motion tracking sensors and be videotaped while evaluating a loop of porcine intestines to identify and repair 2 preconfigured, standardized enterotomies. Video annotation was used to identify individual surgeon preferences and motion data was used to quantify surgical actions. χ2 analysis was used to determine whether surgical preferences were associated with procedure outcomes (bowel leak).

Results:

Surgeons’ (N=255) preferences were categorized into 4 technical decisions. Three out of the 4 technical decisions (repaired injuries together, double-layer closure, corner-stitches vs no corner-stitches) played a significant role in outcomes, P<0.05. Running versus interrupted did not affect outcomes. Motion analysis revealed significant differences in average operative times (leak: 6.67 min vs no leak: 8.88 min, P=0.0004) and work effort (leak-path length=36.86 cm vs no leak-path length=49.99 cm, P=0.001). Surgeons who took the riskiest path but did not leak had better bimanual dexterity (leak=0.21/1.0 vs no leak=0.33/1.0, P=0.047) and placed more sutures during the repair (leak=4.69 sutures vs no leak=6.09 sutures, P=0.03).

Conclusions:

Our results show that individual preferences affect technical decisions and play a significant role in procedural outcomes. Future analysis in more complex procedures may make major contributions to our understanding of contributors to procedure outcomes.
High Dimensional Multiomics Reveals Unique Characteristics of Early Plasma Administration in Polytrauma Patients With TBI
Authors: Wu Junru , Moheimani Hamed , Li Shimena , Kar Upendra K. , Bonaroti Jillian , Miller Richard S. , Daley Brian J. , Harbrecht Brian G. , Claridge Jeffrey A. , Gruen Danielle S. , Phelan Herbert A. , Guyette Francis X. , Neal Matthew D. , Das Jishnu , Sperry Jason L. , Billiar Timothy R.
Published: July 2022

Objectives:

The authors sought to identify causal factors that explain the selective benefit of prehospital administration of thawed plasma (TP) in traumatic brain injury (TBI) patients using mediation analysis of a multiomic database.

Background:

The Prehospital Air Medical Plasma (PAMPer) Trial showed that patients with TBI and a pronounced systemic response to injury [defined as endotype 2 (E2)], have a survival benefit from prehospital administration of TP. An interrogation of high dimensional proteomics, lipidomics and metabolomics previously demonstrated unique patterns in circulating biomarkers in patients receiving prehospital TP, suggesting that a deeper analysis could reveal causal features specific to TBI patients.

Methods:

A novel proteomic database (SomaLogic Inc., aptamer-based assay, 7K platform) was generated using admission blood samples from a subset of patients (n=149) from the PAMPer Trial. This proteomic dataset was combined with previously reported metabolomic and lipidomic datasets from these same patients. A 2-step analysis was performed to identify factors that promote survival in E2-TBI patients who had received early TP. First, features were selected using both linear and multivariate-latent-factor regression analyses. Then, the selected features were entered into the causal mediation analysis.

Results:

Causal mediation analysis of observable features identified 16 proteins and 41 lipids with a high proportion of mediated effect (>50%) to explain the survival benefit of early TP in E2-TBI patients. The multivariate latent-factor regression analyses also uncovered 5 latent clusters of features with a proportion effect >30%, many in common with the observable features. Among the observable and latent features were protease inhibitors known to inhibit activated protein C and block fibrinolysis (SERPINA5 and CPB2), a clotting factor (factor XI), as well as proteins involved in lipid transport and metabolism (APOE3 and sPLA(2)-XIIA).

Conclusions:

These findings suggest that severely injured patients with TBI process exogenous plasma differently than those without TBI. The beneficial effects of early TP in E2-TBI patients may be the result of improved blood clotting and the effect of brain protective factors independent of coagulation.
Towards a Virtual “Global Academia of Surgeons”
Authors: Horisberger Karoline , Di Natale Samuela , Gutschow Christian A. , Clavien Pierre-Alain
Published: July 2022

Objective:

To explore the prospects of academic e-learning by evaluating our long-standing internet-based surgical learning program and to assess the impact of training on the presentation skills of our residents. The eventual goal is to search whether such models could be further developed by the European Surgical Association (ESA).

Background:

E-learning has become a major educational trend particularly during the COVID-19 pandemic. For more than a decade, our academic tertiary center has released weekly video-lectures covering the entire abdominal-surgical curriculum for residents. All lessons were prepared under the supervision of specialized experts and recorded and edited by a professional film team before being released on a dedicated YouTube channel (https://www.usz.ch/surgical-resident-lectures).

Methods:

To date, our channel includes 120 presentations with more than 619,000 views. We conducted a survey among online users with a medical background and tested the benefits and potential for improvements of local stakeholders to collect individual reviews.

Results:

A total of 708 users from 106 countries participated in the survey. Continuing medical education (49%), specific questions (38%), and exam preparation (33%) were the main motivations for video viewing. The preferred topics were current guidelines (69%), latest research topics (59%), and complex surgical conditions (52%). Ninety-four percent of our local audience reported a positive learning experience.

Conclusion:

E-learning can improve local academic training and promote the global visibility of strong academic centers. Providing free and unrestricted expertise via social media is a novel and groundbreaking opportunity that fills a global education gap by dissemination of surgical education on an unprecedented scale. Expert associations such as the ESA may adopt similar formats and foster their perception as true beacons of knowledge.