bluuebunny/crossref_metadata_2025 huggingface dataset:
Cold-priming causes dampening of oxylipin biosynthesis and signalling during the early cold- and light-triggering response ofArabidopsis thaliana
Authors: Bittner Andras , Hause Bettina , Baier Margarete
Published: June 2021

Cold-priming uncouples cold and light regulation of otherwise tightly co-regulated genes. In this study, we focused on the early regulatory processes in Arabidopsis within the first 2 h in cold and in high light after a 5-d lag-phase at 20 °C and 24 h cold-priming at 4 °C. Priming quickly modified gene expression in a trigger-specific manner. In the early stress-response phase during cold and high-light triggering, it reduced the regulatory amplitudes of many up- and down-regulated genes. A third of the priming-regulated genes were jasmonate-sensitive, including the full set of genes required for oxylipin biosynthesis. Analysis of wild-type and mutant plants based on qPCR demonstrated that biosynthesis of the jasmonic acid (JA) precursor 12-oxo phytenoic acid (OPDA) relative to the availability of JA dampened the response of the genes for oxylipin biosynthesis. In oxylipin biosynthetic mutants, cold-priming more strongly affected genes involved in the biosynthesis of OPDA than in its conversion to JA. In addition, priming-dependent dampening of the triggering response was more linked to OPDA than to regulation of the JA concentration. Spray application of OPDA prior to triggering counteracted the priming effect. Regulation of the oxylipin hub was controlled by modulation of the oxylipin-sensitivity of the genes for OPDA biosynthesis, but it was insensitive to priming-induced accumulation of thylakoid ascorbate peroxidase, thus identifying a parallel-acting cold-priming pathway.
Chameleon brokers: A translocal take on migration industries in the Thai-Swedish wild berry business
Authors: van Eerbeek Peter , Hedberg Charlotta
Published: June 2021

Migrant brokers constitute a substantial node in the industries that underpin contemporary global migration processes, including seasonal labour migrants in agri-food businesses. This article adds a translocal perspective to the role of migrant brokers, while emphasising the multi-sited embeddedness of brokers in sending and receiving countries, and their role in sustaining transnational migration flows. The example of the Swedish wild berry industry shows how two groups of translocal brokers operate in multi-sited space, first, Thai women brokers residing in rural Sweden, and second, local brokers, residing in rural Thailand. This article emphasises how translocal brokers are giving migration industries access to multi-sited embeddedness, both at the site of recruitment in Thai villages and at the site of work in Sweden. The translocal embeddedness is noticed in how moral economies and trust are at play in recruitment processes, and how moral economies are then transferred across space to the site of work. Also, it accentuates how translocal brokers are main subjects, in how their biographical histories are creating translocal relations across space. Lastly, we show how spatial divisions of labour are creating social hierarchies among workers, where the brokers themselves incorporate shifting, ‘chameleon’ roles in multi-sited space. The analysis brings the moral complexity of brokers to the surface, while showing how the social relations of their ‘moral economies’ are commodified within profit-seeking migration industries.
Gas-phase metallicity gradients of TNG50 star-forming galaxies
Authors: Hemler Z S , Torrey Paul , Qi Jia , Hernquist Lars , Vogelsberger Mark , Ma Xiangcheng , Kewley Lisa J , Nelson Dylan , Pillepich Annalisa , Pakmor Rüdiger , Marinacci Federico
Published: June 2021

We present the radial gas-phase, mass-weighted metallicity profiles and gradients of the TNG50 star-forming galaxy population measured at redshifts z = 0–3. We investigate the redshift evolution of gradients and examine relations between gradient (negative) steepness and galaxy properties. We find that TNG50 gradients are predominantly negative at all redshifts, although we observe significant diversity among these negative gradients. We determine that the gradients of all galaxies grow more negative with redshift at a roughly constant rate of approximately $-0.02\ \mathrm{dex\, kpc^{-1}}/\Delta z$. This rate does not vary significantly with galaxy mass. We observe a weak negative correlation between gradient (negative) steepness and galaxy stellar mass at z < 2. However, when we normalize gradients by a characteristic radius defined by the galactic star formation distribution, we find that these normalized gradients do not vary significantly with either stellar mass or redshift. We place our results in the context of previous simulations and show that TNG50 high-redshift gradients are more negative than those of models featuring burstier feedback, which may further highlight high-redshift gradients as important discriminators of galaxy formation models. We also find that z = 0 and z = 0.5 TNG50 gradients are consistent with the gradients observed in galaxies at these redshifts, although the preference for flat gradients observed in redshift z ≳ 1 galaxies is not present in TNG50. If future JWST (James Webb Space Telescope) and ELT (Extremely Large Telescope) observations validate these flat gradients, it may indicate a need for simulation models to implement more powerful radial gas mixing within the ISM (interstellar medium), possibly via turbulence and/or stronger winds.
Molecular Clocks and Archeogenomics of a Late Period Egyptian Date Palm Leaf Reveal Introgression from Wild Relatives and Add Timestamps on the Domestication
Authors: Pérez-Escobar Oscar A , Bellot Sidonie , Przelomska Natalia A S , Flowers Jonathan M , Nesbitt Mark , Ryan Philippa , Gutaker Rafal M , Gros-Balthazard Muriel , Wells Tom , Kuhnhäuser Benedikt G , Schley Rowan , Bogarín Diego , Dodsworth Steven , Diaz Rudy , Lehmann Manuela , Petoe Peter , Eiserhardt Wolf L , Preick Michaela , Hofreiter Michael , Hajdas Irka , Purugganan Michael , Antonelli Alexandre , Gravendeel Barbara , Leitch Ilia J , Jimenez Maria Fernanda Torres , Papadopulos Alexander S T , Chomicki Guillaume , Renner Susanne S , Baker William J
Published: June 2021

The date palm, Phoenix dactylifera, has been a cornerstone of Middle Eastern and North African agriculture for millennia. It was first domesticated in the Persian Gulf, and its evolution appears to have been influenced by gene flow from two wild relatives, P. theophrasti, currently restricted to Crete and Turkey, and P. sylvestris, widespread from Bangladesh to the West Himalayas. Genomes of ancient date palm seeds show that gene flow from P. theophrasti to P. dactylifera may have occurred by ∼2,200 years ago, but traces of P. sylvestris could not be detected. We here integrate archeogenomics of a ∼2,100-year-old P. dactylifera leaf from Saqqara (Egypt), molecular-clock dating, and coalescence approaches with population genomic tests, to probe the hybridization between the date palm and its two closest relatives and provide minimum and maximum timestamps for its reticulated evolution. The Saqqara date palm shares a close genetic affinity with North African date palm populations, and we find clear genomic admixture from both P. theophrasti, and P. sylvestris, indicating that both had contributed to the date palm genome by 2,100 years ago. Molecular-clocks placed the divergence of P. theophrasti from P. dactylifera/P. sylvestris and that of P. dactylifera from P. sylvestris in the Upper Miocene, but strongly supported, conflicting topologies point to older gene flow between P. theophrasti and P. dactylifera, and P. sylvestris and P. dactylifera. Our work highlights the ancient hybrid origin of the date palms, and prompts the investigation of the functional significance of genetic material introgressed from both close relatives, which in turn could prove useful for modern date palm breeding.
A Crowdsourced Consensus on Supratotal Resection Versus Gross Total Resection for Anatomically Distinct Primary Glioblastoma
Authors: Khalafallah Adham M , Rakovec Maureen , Bettegowda Chetan , Jackson Christopher M , Gallia Gary L , Weingart Jon D , Lim Michael , Esquenazi Yoshua , Zacharia Brad E , Goldschmidt Ezequiel , Ziu Mateo , Ivan Michael E , Venteicher Andrew S , Nduom Edjah K , Mamelak Adam N , Chu Ray M , Yu John S , Sheehan Jason P , Nahed Brian V , Carter Bob S , Berger Mitchel S , Sawaya Raymond , Mukherjee Debraj
Published: June 2021

BACKGROUND

Gross total resection (GTR) of contrast-enhancing tumor is associated with increased survival in primary glioblastoma. Recently, there has been increasing interest in performing supratotal resections (SpTRs) for glioblastoma.

OBJECTIVE

To address the published results, which have varied in part due to lack of consensus on the definition and appropriate use of SpTR.

METHODS

A crowdsourcing approach was used to survey 21 neurosurgical oncologists representing 14 health systems nationwide. Participants were presented with 11 definitions of SpTR and asked to rate the appropriateness of each definition. Participants reviewed T1-weighed postcontrast and fluid-attenuated inversion-recovery magnetic resonance imaging for 22 anatomically distinct glioblastomas. Participants were asked to assess the tumor location's eloquence, the perceived equipoise of enrolling patients in a randomized trial comparing gross total to SpTR, and their personal treatment plans.

RESULTS

Most neurosurgeons surveyed (n = 18, 85.7%) agree that GTR plus resection of some noncontrast enhancement is an appropriate definition for SpTR. Overall, moderate inter-rater agreement existed regarding eloquence, equipoise, and personal treatment plans. The 4 neurosurgeons who had performed >10 SpTRs for glioblastomas in the past year were more likely to recommend it as their treatment plan (P < .005). Cases were divided into 3 anatomically distinct groups based upon perceived eloquence. Anterior temporal and right frontal glioblastomas were considered the best randomization candidates.

CONCLUSION

We established a consensus definition for SpTR of glioblastoma and identified anatomically distinct locations deemed most amenable to SpTR. These results may be used to plan prospective trials investigating the potential clinical utility of SpTR for glioblastoma.
Surgery for Degenerative Cervical Myelopathy: A Nationwide Registry-Based Observational Study With Patient-Reported Outcomes
Authors: Gulati Sasha , Vangen-Lønne Vetle , Nygaard Øystein P , Gulati Agnete M , Hammer Tommy A , Johansen Tonje O , Peul Wilco C , Salvesen Øyvind O , Solberg Tore K
Published: June 2021

BACKGROUND

Indications and optimal timing for surgical treatment of degenerative cervical myelopathy (DCM) remain unclear, and data from daily clinical practice are warranted.

OBJECTIVE

To investigate clinical outcomes following decompressive surgery for DCM.

METHODS

Data were obtained from the Norwegian Registry for Spine Surgery. The primary outcome was change in the neck disability index (NDI) 1 yr after surgery. Secondary endpoints were the European myelopathy score (EMS), quality of life (EuroQoL 5D [EQ-5D]), numeric rating scales (NRS) for headache, neck pain, and arm pain, complications, and perceived benefit of surgery assessed by the Global Perceived Effect (GPE) scale.

RESULTS

We included 905 patients operated between January 2012 and June 2018. There were significant improvements in all patient-reported outcome measures (PROMs) including NDI (mean −10.0, 95% CI −11.5 to −8.4, P < .001), EMS (mean 1.0, 95% CI 0.8-1.1, P < .001), EQ-5D index score (mean 0.16, 95% CI 0.13-0.19, P < .001), EQ-5D visual analogue scale (mean 13.8, 95% CI 11.7-15.9, P < .001), headache NRS (mean −1.1, 95% CI −1.4 to −0.8, P < .001), neck pain NRS (mean −1.8, 95% CI −2.0 to −1.5, P < .001), and arm pain NRS (mean −1.7, 95% CI −1.9 to −1.4, P < .001). According to GPE scale assessments, 229/513 patients (44.6%) experienced “complete recovery” or felt “much better” at 1 yr. There were significant improvements in all PROMs for both mild and moderate-to-severe DCM. A total of 251 patients (27.7%) experienced adverse effects within 3 mo.

CONCLUSION

Surgery for DCM is associated with significant and clinically meaningful improvement across a wide range of PROMs.
Care Facilitation Advances Movement Along the Hepatitis C Care Continuum for Persons With Human Immunodeficiency Virus, Hepatitis C, and Substance Use: A Randomized Clinical Trial (CTN-0064)
Authors: Metsch Lisa R , Feaster Daniel J , Gooden Lauren K , Masson Carmen , Perlman David C , Jain Mamta K , Matheson Tim , Nelson C Mindy , Jacobs Petra , Tross Susan , Haynes Louise , Lucas Gregory M , Colasanti Jonathan A , Rodriguez Allan , Drainoni Mari-Lynn , Osorio Georgina , Nijhawan Ank E , Jacobson Jeffrey M , Sullivan Meg , Metzger David , Vergara-Rodriguez Pamela , Lubelchek Ronald , Duan Rui , Batycki Jacob N , Matthews Abigail G , Munoz Felipe , Jelstrom Eve , Mandler Raul , del Rio Carlos
Published: June 2021

Background

Direct-acting antivirals can cure hepatitis C virus (HCV). Persons with HCV/HIV and living with substance use are disadvantaged in benefiting from advances in HCV treatment.

Methods

In this randomized controlled trial, participants with HCV/HIV were randomized between February 2016 and January 2017 to either care facilitation or control. Twelve-month follow-up assessments were completed in January 2018.

Care facilitation group participants received motivation and strengths-based case management addressing retrieval of HCV viral load results, engagement in HCV/HIV care, and medication adherence. Control group participants received referral to HCV evaluation and an offer of assistance in making care appointments. Primary outcome was number of steps achieved along a series of 8 clinical steps (eg, receiving HCV results, initiating treatment, sustained virologic response [SVR]) of the HCV/HIV care continuum over 12 months postrandomization.

Results

Three hundred eighty-one individuals were screened and 113 randomized. Median age was 51 years; 58.4% of participants were male and 72.6% were Black/African American. Median HIV-1 viral load was 27 209 copies/mL, with 69% having a detectable viral load. Mean number of steps completed was statistically significantly higher in the intervention group vs controls (2.44 vs 1.68 steps; χ 2 [1] = 7.36, P = .0067). Men in the intervention group completed a statistically significantly higher number of steps than controls. Eleven participants achieved SVR with no difference by treatment group.

Conclusions

The care facilitation intervention increased progress along the HCV/HIV care continuum, as observed for men and not women. Study findings also highlight continued challenges to achieve individual-patient SVR and population-level HCV elimination.

Clinical Trials Registration

NCT02641158.
Absence of Antibody Reponses and Severe COVID-19 in Patients on Hemodialysis Following mRNA Vaccination
Authors: Michael Miriam B , Mahgoub Siham M , Khan Reiad , Mellman Thomas A , Mere Constance C , Mehari Alem , Naab Tammey J , Nwagowugwu Uzoamake , Ihaegwara Susan , Maxwell Celia J
Published: June 2021

Inpatient dialysis patients cannot isolate, resulting in a higher rate of coronavirus disease 2019 (COVID-19) infections, with increased severity and higher mortality rate [1]. We present 2 African American dialysis patients who developed severe COVID-19 infections after vaccination. Both patients had not mounted antibody response to the COVID-19 vaccine or to hepatitis B vaccination.
Development of an In Vitro Chloroplast Splicing System: Sequences Required for Correct pre-mRNA Splicing
Authors: Inaba-Hasegawa Keiko , Ohmura Ayumi , Nomura Masayo , Sugiura Masahiro
Published: June 2021

Chloroplast genomes in land plants include approximately 20 intron-containing genes. Most of the introns are similar to the group II introns found in fungi, algae and some bacteria, but no self-splicing has been reported. To analyze splicing reactions in chloroplasts, we developed a tobacco (Nicotiana tabacum) chloroplast-based in vitro system. We optimized the splicing reaction using atpF precursor messenger RNA (pre-mRNA). Our system requires a high ATP concentration, whereas ATP is not necessary for self-splicing group II introns. Self-splicing group II introns possess two exon-binding sites (EBS1 and 2) complementary to two intron-binding sites (IBS1 and 2) in the 3′ end of 5′ exons, which are involved in 5′ splice-site selection. Using our in vitro system and atpF pre-mRNA, we analyzed short sequences corresponding to the above EBSs and IBSs. Mutation analyses revealed that EBS1–IBS1 pairing is essential, while EBS2–IBS2 pairing is important but not crucial for splicing. The first 3′ exon nucleotide determines the 3′ splice sites of self-splicing introns. However, mutations to this nucleotide in atpF pre-mRNA did not affect splicing. This result suggests that the mechanism underlying chloroplast pre-mRNA splicing differs partly from that mediating the self-splicing of group II introns.
Domain Extension and Ideal Elements in Mathematics
Authors: Bellomo Anna
Published: June 2021

Domain extension in mathematics occurs whenever a given mathematical domain is augmented so as to include new elements. Manders argues that the advantages of important cases of domain extension are captured by the model-theoretic notions of existential closure and model completion. In the specific case of domain extension via ideal elements, I argue, Manders’s proposed explanation does not suffice. I then develop and formalize a different approach to domain extension based on Dedekind’s Habilitationsrede, to which Manders’s account is compared. I conclude with an examination of three possible stances towards extensions via ideal elements.
Reduced cognitive ability in people with rheumatoid arthritis compared with age-matched healthy controls
Authors: Gwinnutt James M , Toyoda Task , Jeffs Stephen , Flanagan Emma , Chipping Jacqueline R , Dainty Jack R , Mioshi Eneida , Hornberger Michael , MacGregor Alex
Published: June 2021

Objective

The aim was to compare the cognitive ability of people with RA with healthy controls (HCs).

Methods

People with RA were recruited from the Norfolk Arthritis Register (NOAR), a population-based cohort study of people with inflammatory arthritis. Data on aged-matched HCs (people with no cognitive impairment) came from the comparison arm of The Dementia Research and Care Clinic Study (TRACC). People with RA and HCs performed a range of cognitive ability tasks to assess attention, memory, verbal fluency, language, visuospatial skills, emotional recognition, executive function and theory of mind. A score of <88 on the Addenbrooke’s Cognitive Examination III was considered cognitive impairment. Scores were compared using linear regression adjusting for age, sex, smoking status, education, BMI, anxiety and depression.

Results

Thirty-eight people with RA [mean (S.D.) age: 69.1 (8.0) years; 25 (65.8%) women] were matched with 28 HCs [mean (S.D.) age: 68.2 (6.4) years; 15 (53.6%) women]. Twenty-three (60.5%) people with RA were considered to have mild cognitive impairment [mean (S.D.) Addenbrooke’s Cognitive Examination III: RA = 85.2 (7.4), HC = 96.0 (2.5)]. People with RA had impairments in memory, verbal fluency, visuospatial functioning, executive function and emotional recognition in faces compared with HCs, after adjustment for confounders.

Conclusion

People with RA had cognitive impairments in a range of domains. People with RA might benefit from cognitive impairment screening to allow for early administration of appropriate interventions.
Neural substrates of shared visual experiences: a hyperscanning fMRI study
Authors: Yoshioka Ayumi , Tanabe Hiroki C , Sumiya Motofumi , Nakagawa Eri , Okazaki Shuntaro , Koike Takahiko , Sadato Norihiro
Published: June 2021

Sharing experience is a fundamental human social cognition. Since visual experience is a mental state directed toward the world, we hypothesized that sharing visual experience is mediated by joint attention (JA) for sharing directedness and mentalizing for mental state inferences. We conducted a hyperscanning functional magnetic resonance imaging with 44 healthy adult volunteers to test this hypothesis. We employed spoken-language-cued spatial and feature-based JA tasks. The initiator attracts the partner’s attention by a verbal command to a spatial location or an object feature to which the responder directs their attention. Pair-specific inter-individual neural synchronization of task-specific activities was found in the right anterior insular cortex (AIC)–inferior frontal gyrus (IFG) complex, the core node of JA and salience network, and the right posterior superior temporal sulcus, which represents the shared categories of the target. The right AIC-IFG also showed inter-individual synchronization of the residual time-series data, along with the right temporoparietal junction and dorsomedial prefrontal cortex—the core components for mentalization and the default mode network (DMN). This background synchronization represents sharing the belief of sharing the situation. Thus, shared visual experiences are represented by coherent coordination between the DMN and salience network linked through the right AIC-IFG.
From Utopia Through Dystopia: Charting a Course for Learning Analytics in Competency-Based Medical Education
Authors: Thoma Brent , Ellaway Rachel H. , Chan Teresa M.
Published: June 2021

The transition to the assessment of entrustable professional activities as part of competency-based medical education (CBME) has substantially increased the number of assessments completed on each trainee. Many CBME programs are having difficulty synthesizing the increased amount of assessment data. Learning analytics are a way of addressing this by systematically drawing inferences from large datasets to support trainee learning, faculty development, and program evaluation. Early work in this field has tended to emphasize the significant potential of analytics in medical education. However, concerns have been raised regarding data security, data ownership, validity, and other issues that could transform these dreams into nightmares. In this paper, the authors explore these contrasting perspectives by alternately describing utopian and dystopian futures for learning analytics within CBME. Seeing learning analytics as an important way to maximize the value of CBME assessment data for organizational development, they argue that their implementation should continue within the guidance of an ethical framework.
Selective periarticular blocks for postoperative pain after hip and knee arthroplasty
Authors: Balocco Angela Lucia , Claes Eveline , Lopez Ana , Van Herreweghe Imré
Published: June 2021

Purpose of review

This review aims to provide an overview of selective periarticular blocks for postoperative pain after hip and knee arthroplasty and the current evidence for their use.

Recent findings

Most interventional analgesia techniques for hip and knee arthroplasty result in a motor block and muscle weakness. Therefore, these are not well suited for fast-track protocols. In contrast, selective pericapsular infiltration techniques provide selective joint sensory block without an associated motor block. This facilitates postoperative pain management and avoids impairing ambulation and early rehabilitation.

The pericapsular blocks of the hip (pericapsular nerve group block, iliopsoas plane block, hip block), genicular nerves block, and infiltration between the popliteal artery and the capsule of the knee play an increasingly important role in providing postoperative analgesia after hip and knee arthroplasty without impeding fast-track protocols.
Targeted radionuclide therapy: an emerging field in solid tumours
Authors: Artigas Carlos , Mileva Magdalena , Flamen Patrick , Karfis Ioannis
Published: June 2021

Purpose of review

Targeted radionuclide therapy (TRNT) is characterized by systemic administration of radiolabelled drugs, targeting specific molecular alterations expressed on the tumour cells. Small molecules, labelled with β- or α- emitting radioisotopes, are used to deliver radiation directly to the tumour sites. Pretreatment imaging to visualize whole body biodistribution of the target, using the same drugs labelled with positron or γ-emitting radionuclides, completes the concept of theranostic. This review will briefly summarize the current clinical research findings and applications of TRNT in solid tumours, mostly focusing on neuroendocrine and prostate neoplasms.

Recent findings

Peptide receptor radionuclide therapy is a major component in the management of gastroentropancreatic neuroendocrine tumours, with favourable safety profile, quality-of-life improvement and survival benefit. On the NETTER-1 study, it proved to be more effective than high-dose long-acting-release octreotide, leading to its regulatory approval. Prostate-specific membrane antigen (PSMA) is an excellent target for TRNT in prostate cancer. 177Lu-PSMA radioligand therapy demonstrated higher response rates in patients with metastatic castration resistant prostate cancer, when compared with second-line chemotherapy. New developments, including targeting of fibroblast activation proteins overexpressed in the tumour stroma, show promising preliminary results in the theranostic setting.

Recent research has demonstrated and consolidated the use of TRNT against well established targets in neuroendocrine tumours and prostate cancer. The identification of new promising molecular targets for TRNT, will further expand the theranostic applications of radionuclides in the field of nuclear medicine.
A Pilot Study of Perioperative Cisplatin-Capecitabine Chemotherapy With Preoperative Chemoradiation for Resectable Gastric Cancers
Authors: Misra Shagun , Yeshala Susheel Kumar , Singh Shalini , Singh Rajneesh K. , Maria Das Koipillai Joseph , Kumar Senthil , Kumar Shaleen
Published: June 2021

Objectives:

The standard of care for resectable gastric cancers (GCs) includes perioperative chemotherapy (CT) or postoperative chemo/chemoradiotherapy (CRT) strategies. Poor treatment compliance postsurgery suggests that intensified surgical adjuvant treatment is more likely deliverable preceding surgery and, therefore, the safety and efficacy of perioperative cisplatin-capecitabine (CX) with preoperative chemoradiation (preopCRT) were ascertained.

Materials and Methods:

Between January 2017 and December 2018, 28 potentially resectable locally advanced GC patients were offered neoadjuvant CT—2 cycles of CX at 3-weekly intervals, followed by preopCRT 45 Gy/25 fractions/5 weeks and concurrent capecitabine, followed by surgical resection and 3 adjuvant cycles of CX.

Results:

Neoadjuvant CT was commenced in 28 patients (100%), preopCRT in 18 patients (64%), and surgery performed in 13 patients (46%). At each treatment step, decreasing patient numbers were due mainly to disease progression (12 [43%]) or other reasons, including (3 [11%]) from treatment-related toxicity. The R0 resection rate was 92% (12/13); a median of 18 nodes was obtained after D2 nodal clearance in 92% (12/13). There were 20%/4%/4% grade 3/4/5 toxicities. The median radiotherapy dose/duration was 45 Gy/5.4 weeks. Adjuvant CT was started in 11 patients (39%) and the third cycle was received by 7 patients (25%). No tumor (ypT0N0) was noted in 23% of the operated patients (3/13), or 11% of the intention-to-treat population (3/28). The median, 1-year, and 2-year survivals were 12 months, 53%, and 32%, respectively.

Conclusions:

Intensified preoperative treatment is doable in relatively unselected advanced GC patients in real-world settings of a public-sector hospital from a low-middle-income country. Disease progression during preoperative therapy allows patients destined for early clinical evidence of disease dissemination to avoid futile surgery, as opposed to a surgery-first strategy, without an overt increase in surgical morbidity or mortality, with encouraging R0 resection rates.
Don’t be STUMPed: description and management of uncommon pathologies encountered on specimens from benign gynecologic surgery
Authors: Chaves Katherine , Curlin Howard , Harvey Lara , Limperg Tobias , Podoll Mirna
Published: June 2021

Purpose of review

In this review, we aim to describe uncommon pathologies that gynecologic surgeons may reasonably encounter on surgical specimens following benign gynecologic surgery.

Recent findings

Herein, we describe uncommon pathologic findings of the uterus (e.g. squamous morular metaplasia, fibroid variants, stromal tumor of uncertain malignant potential), peritoneum and adnexa (e.g. endosalpingiosis, serous tubal intraepithelial carcinoma), endometriosis (e.g. stromal endometriosis, atypical endometriosis), and findings of particular interest in postmenopausal women (e.g. ovarian cortical stromal hyperplasia, tubal metaplasia). The majority of pathologic findings presented in this article are inherently benign, although they can present diagnostic challenges. If properly classified, additional treatment and/or extended follow-up is often not required; exceptions are highlighted.

The gynecologic surgeon may encounter uncommon pathologies during a career. Inherent diagnostic difficulties, as well as nonstandardized or outdated terminology, can introduce further uncertainty. Whenever such a situation arises, the surgeon and pathologist should discuss the diagnosis to ensure appropriate treatment options.
Perioperative management for gynecologic minimally invasive surgery during the COVID-19 pandemic
Authors: García-Ruiz Nuria S. , Ramirez-Caban Laura , Malekzadeh Maral , Padilla Pamela Frazzini
Published: June 2021

Purpose of review

This article will review current guidelines regarding surgical protocols for elective and nonelective surgeries during the severe acute respiratory syndrome coronavirus 2 pandemic.

Recent findings

Perioperative management for surgical patients should be modified to promote the safety and wellbeing of patients and caregivers amidst the COVID-19 pandemic. COVID-19 testing should be performed preoperatively with subsequent preprocedure quarantine. Nonemergent or nonlife-threatening surgery should be postponed for COVID-19 positive patients. The consensus of surgical societies is to use a laparoscopic surgical approach for COVID-19 positive patients when appropriate and to avoid port venting at the end of procedures. For COVID-19 positive patients requiring an emergent procedure, the use of personal protective equipment is strongly recommended.

After over a year of the COVID-19 pandemic, effective protocols and precautions have been established to decrease the morbidity and mortality of patients undergoing surgery and to promote the safety of healthcare personnel. Continued investigations are necessary as cases of new, possibly more virulent, strains of the virus arise.
Omental Free Flap Coverage for Extracavitary Vascular Bypass Graft Salvage
Authors: Robinson Jordan N. , Marturano Matthew N. , Calarese Adam , Briggs Charles , Madjarov Jeko , Fisher David C. , Kulkarni Snehankita G.
Published: June 2021

Background:

Prosthetic vascular graft infection is a serious complication associated with significant morbidity and mortality often requiring graft excision and numerous additional operations. Pedicled flaps are often used for the coverage of exposed deep tissue or hardware for graft salvage. In the absence of pedicled options, the properties of omentum make it an excellent choice for free flap tissue coverage, particularly in cases involving implanted prostheses.

Methods:

A 63-year-old woman developed a mycotic right subclavian arterial aneurysm requiring ligation and extra-anatomic bypass grafting to restore right-sided intracranial and right upper extremity arterial perfusion. Subsequent wound breakdown and poor healing left the grafts exposed, resulting in contamination. Given the profound risks associated with graft excision in this patient, salvage was attempted with IV antibiotics, serial wound/graft washouts, and graft coverage with an omental free flap.

Results:

The patient tolerated the procedure well. The remainder of her hospital course was uneventful, and she was discharged home in good clinical condition. She will remain on long-term suppressive antibiotics per Infectious Disease recommendations.

Conclusions:

Contemporary literature reporting novel and effective applications of omental free flap coverage is rare. This report demonstrates that omental free flap coverage is safe and can provide healthy tissue to protect implanted grafts and even aid in the salvage of infected extra-anatomic bypass grafts.
Effects of Aerobic Exercise on Cognitive Function in Women With Methamphetamine Dependence in a Detoxification Program in Tianjin, China: A Randomized Controlled Trial
Authors: LIU Jingjing , CHEN Chen , LIU Maojie , ZHUANG Shumei
Published: June 2021

Background

Cognitive impairment is prevalent among individuals, especially women, with methamphetamine dependence. Although aerobic exercise has been shown to affect cognitive function in humans and animals, few related studies have focused on subjects with methamphetamine dependence.

Purpose

The aim of this study was to assess the detoxification-related effects of aerobic exercise on cognitive function in women with methamphetamine dependence.

Methods

A randomized controlled trial was used with 98 women with methamphetamine dependence undergoing a detoxification program at a mental hospital. The women were distributed using a computer-generated grouping random method into either the study or control group. The investigator conducting the baseline questionnaire, the neuropsychologist assessing the cognitive function, and the data analyst were blinded to group assignment. In addition to hospital routine care, the study group received an aerobic exercise intervention for 3 months. The control group only received hospital routine care. Attention and working memory were measured using the Trail Making Test and Digit Span Test, verbal memory was measured using Logical Memory (LM) and Memory for Persons Data (MPD), and executive function was measured using the Color-Word Stroop Test.

Results

Forty-nine participants were randomized into each group, and the valid data of 43 participants in the study group and 46 in the control group were analyzed. The study group showed significantly more improvement over time in terms of Digit Span Test, Trail Making Test, LM-delayed, MPD-5 minutes delayed, MPD-30 minutes delayed, and Color-Word Stroop Test than the control group (p < .05). LM-immediate and MPD-immediate scores showed that the effects of time and the interaction between time and group were significant but that the main effect of group was not.

Conclusions/Implications for Practice

Women undergoing detoxification for methamphetamine dependence may practice aerobic exercise to improve attention, working memory, executive function, and parts of verbal memory. Aerobic exercise may be incorporated into detoxification treatment programs to facilitate the recovery of cognitive functions in women.
Nutritional considerations in severe primary chronic small intestinal dysmotility
Authors: Conley Thomas Edward , Lal Simon
Published: June 2021

Purpose of review

To provide an update on the recent evidence underpinning the approach to nutritional care in patients with severe primary chronic small bowel dysmotility.

Recent findings

Patients with severe chronic small intestinal dysmotility suffer nutritional and nonnutritional morbidity, both as a result of their underlying polysymptomatic, poorly understood condition and the interventions required. A proportion require artificial nutrition support; however, this is associated with impaired quality of life and associated complications. The approach to nutritional support must therefore engage a multidisciplinary team (MDT) to ensure that decisions to escalate beyond oral nutrition reflect individualised risk-benefit discussions while adopting a holistic approach to symptom management. Since nutritional outcomes are worse in those with the chronic intestinal pseudo-obstruction (CIPO) phenotype, differentiation into CIPO and non-CIPO subgroups, using a pragmatic diagnostic approach rather than invasive/poorly tolerated investigations, can be an important step in achieving nutritional care tailored to the individual.

Malnutrition in patients with severe chronic small intestinal dysmotility is multifactorial. Early engagement of a broad team that includes dietitians, psychologists and pain management experts is crucial to achieving the most beneficial and least harmful patient-centred nutritional care outcomes.
Shifting gears: the search for group 3 pulmonary hypertension treatment
Authors: Keen Jennifer L. , Thenappan Thenappan
Published: June 2021

Purpose of review

Treatment options for Group 3 pulmonary hypertension, characterized as secondary to chronic hypoxia or lung disease, remain an elusive holy grail for physicians and patients alike. Despite increasing identification and investigation into this pulmonary vasculopathy group with the second-highest frequency and highest mortality, there are no therapeutic interventions that offer the significant improvements in morbidity and mortality comparable to those benefiting other pulmonary hypertension groups including pulmonary arterial hypertension. This review examines the data on available and emerging Group 3 pulmonary hypertension treatments.

Recent findings

Pulmonary vasodilators have yielded equivocal results in this patient population, although recent evidence shows modestly improved outcomes with inhaled treprostinil in interstitial lung disease-associated pulmonary hypertension. With pulmonary vasodilators providing limited benefit, emerging data support the right ventricle as a potential treatment target in Group 3 pulmonary hypertension.

Group 3 pulmonary hypertension is associated with significant morbidity and mortality. Pulmonary vasodilators offer only limited haemodynamic and exertional benefits, and lung transplantation remains the only cure for this deadly disease. The right ventricle may provide a novel intervention target.
The emerging role of inorganic elements as potential antigens in sarcoidosis
Authors: Beijer Els , Veltkamp Marcel
Published: June 2021

Purpose of review

Previous studies mainly described a role for organic agents as possible triggers for sarcoidosis. In this review, we address recent studies suggesting a possible role for inorganic elements, such as metals or silica in sarcoidosis pathogenesis.

Recent findings

Several epidemiological papers suggest that inorganic agents, either by environmental exposures or occupational activities, could trigger sarcoidosis. Association between inorganics and sarcoidosis is also described in several recently published case reports and studies demonstrating immunological sensitization to inorganic agents in sarcoidosis patients.

Studies comparing chronic beryllium disease (CBD) and sarcoidosis suggest that although antigenic triggers may differ, underlying processes may be comparable.

Besides the fact that a growing number of studies show a possible role for inorganic triggers, it is also suggested that inorganic triggered sarcoidosis may result in a more severe phenotype, including pulmonary fibrosis.

We can use the knowledge already gained on CBD pathogenesis to conduct further research into role of inorganics, such as metals and silica as antigens in sarcoidosis. Given the importance of a lymphocyte proliferation test (LPT) in diagnosing CBD, it seems obvious to also implement this test in the diagnostic work-up of sarcoidosis to identify patients with an inorganic antigenic trigger of their disease.
Genetics in sarcoidosis
Authors: Spagnolo Paolo , Maier Lisa A.
Published: June 2021

Purpose of review

Epidemiological and clinical observations as well as familial clustering support the existence of a genetic predisposition to sarcoidosis. In this article, we review the most recent findings in genetics of sarcoidosis and discuss how the identification of risk alleles may help advancing our understanding of disease etiology and development.

Recent findings

Genetic studies of sarcoidosis phenotypes have identified novel and ancestry-specific associations. Gene-environment interaction studies highlighted the importance of integrating genetic information when assessing the relationship between sarcoidosis and environmental exposures. A case-control-family study revealed that the heritability of sarcoidosis is only 49%, suggesting the existence of additional important contributors to disease risk. The application of whole-exome sequencing has identified associations with disease activity and prognosis. Finally, gene expression studies of circulating immune cells have identified shared and unique pathways between sarcoidosis and other granulomatous diseases.

Sarcoidosis genetic research has led to the identification of a number of associations with both sarcoidoses per se and disease phenotypes. Newer sequencing technologies are likely to increase the number of genetic variants associated with sarcoidosis. However, studying phenotypically and ethnically homogeneous patient subsets remains critically important regardless of the genetic approach used.
Chronic hypersensitivity pneumonitis: real world diagnostic criteria
Authors: Sharma Ashutosh , Ferraro Vincent , Renzoni Elisabetta A. , Morisset Julie
Published: June 2021

Purpose of review

Establishing a diagnosis of hypersensitivity pneumonitis (HP) and distinguishing it from other forms of interstitial lung diseases represents a common challenge in clinical practice. This review summarizes the latest literature and guidelines on HP while integrating some real-life conundrums.

Recent findings

Advances in the understanding of the pathobiology of fibrotic HP and other progressive pulmonary fibrosis have changed how we approach the diagnosis and treatment of interstitial lung disease. Classifications now embrace distinguishing two clinical phenotypes: nonfibrotic and fibrotic HP because of distinct disease behavior and prognosis implications. International guidelines on HP were recently published and proposed a framework and algorithm to guide the diagnostic process.

The diagnosis of HP relies on the integration of multiples domains: clinical assessment of exposure, imaging, bronchoalveolar lavage lymphocytosis and histopathological findings. These features are reviewed in multidisciplinary discussion and lead to an estimation of the degree of confidence for HP diagnosis. Further research is warranted to improve knowledge on the pathophysiology of HP and ultimately improve its diagnostic approaches.
New perspectives on the surgical treatment of posterior urethral obstruction
Authors: Bearrick Elizabeth N. , Findlay Bridget L. , Boswell Tim C. , Hebert Kevin J. , Viers Boyd R.
Published: June 2021

Purpose of review

Posterior urethral obstruction (PUO) from prostate surgery for benign and malignant conditions poses a significant reconstructive challenge. Endoscopic management demonstrates only modest success and often definitive reconstructive solutions are necessary to limit morbidity and firmly establish posterior urethral continuity. This often demands a combined abdominoperineal approach, pubic bone resection, and even sacrifice of the external urinary sphincter and anterior urethral blood supply. Recently, a robotic-assisted approach has been described. Enhanced instrument dexterity, magnified visualization, and adjunctive measures to assess tissue quality may enable the reconstructive surgeon to engage posterior strictures deep within the confines of the narrow male pelvis and optimize functional outcomes. The purpose of this review is to review the literature regarding endoscopic, open, and robotic management outcomes for the treatment of PUO, and provide an updated treatment algorithm based upon location and complexity of the stricture.

Recent findings

Contingent upon etiology, small case series suggest that robotic bladder neck reconstruction has durable reconstructive outcomes with acceptable rates of incontinence in carefully selected patients.

Initial reports suggest that robotic bladder neck reconstruction for recalcitrant PUO may offer novel reconstructive solutions and durable function outcomes in select patients.
Advancements in transurethral management of urethral stricture disease
Authors: Hughes Michael , Blakely Stephen , Nikolavsky Dmitriy
Published: June 2021

Purpose of review

To explore and report the recent evolution of transurethral management of urethral stricture disease.

Recent findings

In recent years, new promising techniques in the transurethral management of urethral stricture disease have emerged including adjuvant therapies to direct vision internal urethrotomy, regenerative therapy with buccal mucosa cells and minimally invasive transurethral urethroplasty procedures that avoid skin incisions.

Although further work is needed, the expanding field of transurethral therapies for urethral stricture disease demonstrates early promising results through a variety of modalities.
eLearning and transurethral prostate surgery: virtual tools for a real training
Authors: Leung David Ka-Wai , Yuen Steffi Kar-Kei , Lo Ka-Lun , Ng Chi-Fai , Teoh Jeremy Yuen-Chun
Published: June 2021

Purpose of review

In the recent two decades, technological breakthrough has tremendously expanded the scope of transurethral prostate surgery. New gadgets and energy devices keep emerging to tackle benign prostatic obstruction, which was dealt with mainly by transurethral resection of prostate in the old days. Although this trend appears fascinating, it also means that urologists need quality training to attain surgical safety in performing these new surgeries. E-learning and simulation training may play an important role in modern urology training.

Recent findings

In this review, we would describe, using up-to-date evidence, the key components of simulation training, the types of simulators currently in use and their respective advantages and limitations.

Modern simulation technology enables surgical training in a realistic, reproducible and risk-free environment. Simulation training has been proven to improve both performers’ confidence and objective scores in various transurethral prostate surgeries. Its use should therefore be advocated.
The Acceptability and Effect of a Communication-Based Advance Care Planning Program for Older Adults
Authors: Jo Minjeong , Park Mihyun , Park Eun-Jun , Choi Ji Yeon
Published: June 2021

This study was a preliminary study that assessed the acceptability of a communication-based advance care planning (ACP) intervention for older adults to improve decision making for treatment at the end of life. Twenty dyads were recruited, including patients who were older than 65 years and registered in a home health care center of a teaching hospital in South Korea and their surrogates. The intervention is a patient-centered ACP program with surrogates and a structured and guided discussion by home health care nurses as the trained interventionists. The acceptability of the intervention was assessed by a mixed method including a survey and a structured interview with participants. Findings in this study indicate that recruiting older adults with chronic diseases and their surrogates in a home health care center and conducting the intervention by home health care nurses is feasible. In addition, the outcomes of this study suggest that the intervention may have a potential impact on end-of-life care decision making for older adults in South Korea. A larger-scale trial is required to determine the effects of the ACP program when implemented with various groups. This study suggests that older adults need an ACP program as part of routine care.