bluuebunny/crossref_metadata_2025 huggingface dataset:
Offender-Focused Interventions
Authors: Murphy David
Published: February 2022

Although individuals with an autism spectrum disorder (ASD) are no more likely to offend than individuals without ASD, some individuals in specific circumstances can be vulnerable to engaging in law-breaking behavior. Offence behaviors can take many forms and are often directly linked to the associated features of ASD such as thinking styles, perspective-taking difficulties, emotional regulation difficulties, social naivete, and sensory-processing issues. Despite individuals with ASD representing a relatively small proportion of offenders within the criminal justice system, they are likely to be overrepresented relative to the general prevalence in the population, and they present as a diverse group with difficulties and needs that pose a challenge for mainstream services. Examining published research supplemented with clinical experience, this chapter reviews the provision of offence-focused interventions for adults with ASD. Key issues covered include the therapeutic adaptations to consider, potential factors influencing therapeutic engagement, and the role of organizational awareness of ASD.
Service User Experiences of SCM
Authors: Watts Robert , Maher Amy , Weaving Lisa , Potts Donna
Published: February 2022

This chapter describes a study undertaken in two National Health Service (NHS) mental healthcare providers in the United Kingdom. The aim of the study was to gather service users’ experiences of structured clinical management (SCM) to inform the continued development of SCM and to inform the implementation of SCM in the future. Service user involvement is an important part of the development of personality disorder and SCM programmes, on an organizational, individual, and treatment development level, as described in earlier chapters of this book. From the earliest level of service planning, through to implementation, services for people diagnosed with personality disorders are recommended to be co-developed between experts by experience (EBE) of living with personality disorder, people with expertise in caring for somebody diagnosed with a personality disorder, and experts by occupation (EBO).
Reflections, Synthesis, and Future Directions
Authors: Mitchell Stuart , Sampson Mark , Bateman Anthony
Published: February 2022

This chapter provides reflections on the process of writing the book on structured clinical management (SCM) and suggests areas where SCM may usefully be developed and applied further. Writing the book has been an eminently practical undertaking. It has involved gathering the collective wisdom of many practitioners, supervisors, trainers, service users, and carers delivering, supporting, or participating in SCM as a generalist treatment approach in the United Kingdom and Europe and integrating this into a coherent whole.
Analytic modelling of synchrotron self-Compton spectra: Application to GRB 190114C
Authors: Yamasaki Shotaro , Piran Tsvi
Published: February 2022

Observations of TeV emission from early gamma-ray burst (GRB) afterglows revealed the long sought for inverse Compton (IC) upscattering of the lower energy synchrotron. However, it turned out that the long hoped for ability to easily interpret the synchrotron self-Compton (SSC) spectra didn’t materialize. The TeV emission is in the Klein–Nishina (KN) regime and the simple Thomson regime SSC spectrum is modified, complicating the scene. We describe here a methodology to obtain an analytic approximation to an observed spectrum and infer the conditions at the emitting region. The methodology is general and can be used in any such source. As a test case we apply it to the observations of GRB 190114C. We find that the procedure of fitting the model parameters using the analytic SSC spectrum suffers from some generic problems. However, at the same time, it conveniently gives a useful insight into the conditions that shape the spectrum. Once we introduce a correction to the standard KN approximation, the best-fitting solution is consistent with the one found in detailed numerical simulations. As in the numerical analysis, we find a family of solutions that provide a good approximation to the data and satisfy roughly B ∝ Γ−3 between the magnetic field and the bulk Lorentz factor, and we provide a tentative explanation why such a family arises.
Non-halo structures and their effects on gravitational lensing
Authors: Richardson T R G , Stücker J , Angulo R E , Hahn O
Published: February 2022

Anomalies in the flux ratios of the images of quadruply-lensed quasars have been used to constrain the nature of dark matter. Assuming these lensing perturbations are caused by dark matter haloes, it is currently possible to constrain the mass of a hypothetical Warm Dark Matter (WDM) particle to be mχ > 5.2 keV. However, the assumption that perturbations are only caused by DM haloes might not be correct as other structures, such as filaments and pancakes, exist and make up a significant fraction of the mass in the Universe, ranging between 5  ${{\ \rm per\ cent}}$ and 50 ${{\ \rm per\ cent}}$ depending on the dark matter model. Using novel fragmentation-free simulations of 1 and 3 keV WDM cosmologies we study these ‘non-halo’ structures and estimate their impact on flux-ratio observations. We find that these structures display sharp density gradients with short correlation lengths, and can contribute more to the lensing signal than all haloes up to the half-mode mass combined, thus reducing the differences expected among WDM models. We estimate that non-halo structures can be the dominant cause of line-of-sight flux-ratio anomalies in very warm, but already excluded, $m_x \sim 1 \,\rm {keV}$ scenarios. For colder cases $m_x \gtrsim 3 \,\rm {keV}$, we estimate that non-haloes can contribute about $5 - 10{{\ \rm per\ cent}}$ of the total flux-ratio signal.
Low-metallicity globular clusters in the low-mass isolated spiral galaxy NGC 2403
Authors: Forbes Duncan A , Ferré-Mateu Anna , Gannon Jonah S , Romanowsky Aaron J , Carlin Jeffrey L , Brodie Jean P , Day Jacob
Published: February 2022

The globular cluster (GC) systems of low-mass late-type galaxies, such as NGC 2403, have been poorly studied to date. As a low mass galaxy (M*  = 7 × 109 M⊙), cosmological simulations predict NGC 2403 to contain few, if any, accreted GCs. It is also isolated, with a remarkably undisturbed HI disc. Based on candidates from the literature, Sloan Digital Sky Survey and Hyper Suprime-Cam imaging, we selected several GCs for follow-up spectroscopy using the Keck Cosmic Web Imager. From their radial velocities and other properties, we identify eight bona-fide GCs associated with either the inner halo or the disc of this bulgeless galaxy. A stellar population analysis suggests a wide range of GC ages from shortly after the big bang until the present day. We find all of the old GCs to be metal-poor with [Fe/H] ≤ −1. The age–metallicity relation for the observed GCs suggests that they were formed over many Gyr from gas with a low effective yield, similar to that observed in the SMC. Outflows of enriched material may have contributed to the low yield. With a total system of ∼50 GCs expected, our study is the first step in fully mapping the star cluster history of NGC 2403 in both space and time.
Spatially resolved gas flows around the Milky Way
Authors: Clark Sean , Bordoloi Rongmon , Fox Andrew J
Published: February 2022

We present spatially resolved measurements of cool gas flowing into and out of the Milky Way (MW), using archival ultraviolet spectra of background quasars from the Hubble Space Telescope/Cosmic Origins Spectrograph. We co-add spectra of different background sources at close projected angular separation on the sky. This novel stacking technique dramatically increases the signal-to-noise ratio of the spectra, allowing the detection of low-column-density gas (down to EW > 2 mÅ). We identify absorption as inflowing or outflowing, by using blue/redshifted high-velocity cloud absorption components in the Galactocentric rest frame, respectively. The mass surface densities of both inflowing and outflowing gases vary by more than an order of magnitude across the sky, with mean values of 〈Σin〉 ≳ 104.6 ± 0.1$\mathrm{ M}_{\odot }\, \mathrm{kpc}^{-2}$ for inflowing gas and 〈Σout〉 ≳ 103.5 ± 0.1$\mathrm{ M}_{\odot }\, \mathrm{kpc}^{-2}$ for outflowing gas. The mass flow rate surface densities (mass flow rates per unit area) also show large variation across the sky, with $\langle \dot{\Sigma }(d)_{\rm in}\rangle \gtrsim (10^{-3.6\pm 0.1})(d/12\, \mathrm{kpc})^{-1}$ $\mathrm{ M}_{\odot }\, \mathrm{kpc}^{-2}\, \mathrm{yr}^{-1}$ for inflowing gas and $\langle \dot{\Sigma }(d)_{\rm out}\rangle \gtrsim (10^{-4.8\pm 0.1})(d/12\, \mathrm{kpc})^{-1}$ $\mathrm{ M}_{\odot }\, \mathrm{kpc}^{-2}\, \mathrm{yr}^{-1}$ for outflowing gas. The regions with highest surface mass density of inflowing gas are clustered at smaller angular scales (θ < 40°). This indicates that most of the mass in inflowing gas is confined to small, well-defined structures, whereas the distribution of outflowing gas is spread more uniformly throughout the sky. Our study confirms that the MW is predominantly accreting gas, but it is also losing a non-negligible mass of gas via outflow.
Gamma-ray polarimetry of the Crab pulsar observed by POLAR
Authors: Li Han-Cheng , Produit Nicolas , Zhang Shuang-Nan , Kole Merlin , Sun Jian-Chao , Ge Ming-Yu , De Angelis Nicolas , Hulsman Johannes , Li Zheng-Heng , Song Li-Ming , Tymieniecka Teresa , Wu Bo-Bing , Wu Xin , Wang Yuan-Hao , Xiong Shao-Lin , Zhang Yong-Jie , Zhao Yi , Zheng Shi-Jie
Published: February 2022

The X/gamma-ray polarimetry of the Crab pulsar/nebula is believed to hold crucial information on their emission models. In the past, several missions have shown evidence of polarized emission from the Crab. The significance of these measurements remains, however, limited. New measurements are therefore required. POLAR is a wide Field of View Compton-scattering polarimeter (sensitive in 50–500 keV) onboard the Chinese spacelab Tiangong-2 that took data from 2016 September to 2017 April. Although not designed to perform polarization measurements of pulsars, we present here a novel method, which can be applied to POLAR as well as that of other wide Field of View polarimeters. The novel polarimetric joint-fitting method for the Crab pulsar observations with POLAR, allows us to obtain constraining measurements of the pulsar component. The best-fitting values and corresponding 1σ deviations for the averaged phase interval: (PD = $14\substack{+15 \\-10}$ per cent, PA = $108\substack{+33 \\-54} ^{\circ }$), for Peak 1: (PD = $17\substack{+18 \\-12}$ per cent, PA = $174\substack{+39 \\-36} ^{\circ }$) and for Peak 2: (PD = $16\substack{+16 \\-11}$ per cent, PA = $78\substack{+39 \\-30} ^{\circ }$). Furthermore, the 3σ upper limits on the polarization degree are for the averaged phase interval (55 per cent), Peak 1 (66 per cent) and Peak 2 (57 per cent). Finally, to illustrate the capabilities of this method in the future, we simulated 2 yr observation to the Crab pulsar with POLAR-2. The results show that POLAR-2 is able to confirm the emission to be polarized with 5σ and 4σ confidence level if the Crab pulsar is polarized at $20{{\,\rm per\,cent}}$ and $10{{\,\rm per\,cent}}$, respectively.
Radio spectra of narrow-line Seyfert 1 galaxies observed with Australia Telescope Compact Array and Very Large Array Sky Survey
Authors: Chen Sina , Stevens Jamie B , Edwards Philip G , Laor Ari , Gu Minfeng , Berton Marco , Järvelä Emilia , Kharb Preeti , Behar Ehud , Su Renzhi
Published: February 2022

We present radio spectral analyses for a sample of 29 radio-quiet (RQ) and three radio-loud (RL) narrow-line Seyfert 1 galaxies (NLS1s) detected with the Australia Telescope Compact Array at both 5.5 and 9.0 GHz. The sample is characterized by Lbol/LEdd > 0.15. The radio slopes in 25 of the 29 RQ NLS1s are steep (α5.5–9.0 < −0.5), as found in earlier studies of RQ high Lbol/LEdd active galactic nuclei (AGN). This steep radio emission may be related to AGN-driven outflows, which are likely more prevalent in high Lbol/LEdd AGN. In two of the three RL NLS1s, the radio slopes are flat or inverted (α5.5–9.0 > −0.5), indicating a compact optically thick source, likely a relativistic jet. Archival data at 3.0, 1.4, and 0.843 GHz are also compiled, yielding a sample of 17 NLS1s detected in three bands or more. In nine objects, the radio spectra flatten at lower frequencies, with median slopes of α5.5–9.0 = −1.21 ± 0.17, flattening to α3.0–5.5 = −0.97 ± 0.27, and to α1.4–3.0 = −0.63 ± 0.16. A parabolic fit suggests a median spectral turnover of ∼1 GHz, which implies synchrotron self-absorption in a source with a size of only a fraction of 1 pc, possibly a compact wind or a weak jet. Two objects show significant spectral steepening to α < −2 above 3 or 5 GHz, which may suggest relic emission from past ejection of radio emitting plasma, of the order of a few years to a few decades ago. Finally, two objects present a single spectral slope consistent with star-forming activity.
Transcription Factors Evolve Faster Than Their Structural Gene Targets in the Flavonoid Pigment Pathway
Authors: Wheeler Lucas C , Walker Joseph F , Ng Julienne , Deanna Rocío , Dunbar-Wallis Amy , Backes Alice , Pezzi Pedro H , Palchetti M Virginia , Robertson Holly M , Monaghan Andrew , de Freitas Loreta Brandão , Barboza Gloria E , Moyroud Edwige , Smith Stacey D
Published: February 2022

Dissecting the relationship between gene function and substitution rates is key to understanding genome-wide patterns of molecular evolution. Biochemical pathways provide powerful systems for investigating this relationship because the functional role of each gene is often well characterized. Here, we investigate the evolution of the flavonoid pigment pathway in the colorful Petunieae clade of the tomato family (Solanaceae). This pathway is broadly conserved in plants, both in terms of its structural elements and its MYB, basic helix–loop–helix, and WD40 transcriptional regulators, and its function has been extensively studied, particularly in model species of petunia. We built a phylotranscriptomic data set for 69 species of Petunieae to infer patterns of molecular evolution across pathway genes and across lineages. We found that transcription factors exhibit faster rates of molecular evolution (dN/dS) than their targets, with the highly specialized MYB genes evolving fastest. Using the largest comparative data set to date, we recovered little support for the hypothesis that upstream enzymes evolve slower than those occupying more downstream positions, although expression levels do predict molecular evolutionary rates. Although shifts in floral pigmentation were only weakly related to changes affecting coding regions, we found a strong relationship with the presence/absence patterns of MYB transcripts. Intensely pigmented species express all three main MYB anthocyanin activators in petals, whereas pale or white species express few or none. Our findings reinforce the notion that pathway regulators have a dynamic history, involving higher rates of molecular evolution than structural components, along with frequent changes in expression during color transitions.
A Brief Measure Assessing Adolescents’ Daily In-Hospital Function Predicts Pain and Health Outcomes at Home After Major Surgery
Authors: Powelson Elisabeth B , Chandra Nuria Alina , Jessen-Fiddick Tricia , Zhou, PhD Chuan , Rabbitts Jennifer
Published: February 2022

Objective

Pain-related function is not routinely assessed in the hospital. This prospective cohort study examined whether patients’ daily pain-related function during hospitalization, based on the validated Youth Acute Pain Functional Ability Questionnaire (YAPFAQ), is associated with pain and quality of life.

Design

The YAPFAQ is a 12-item measure assessing functional parameters of recovery related to pain and has been validated in children and adolescents with sickle cell disease and after surgery. Adolescents undergoing major musculoskeletal surgery (n = 93) completed the YAPFAQ daily for up to 3 days after surgery. Adolescents self-reported health-related quality of life on the Pediatric Quality of Life Inventory and pain intensity on a numeric rating scale at home 2 weeks after surgery.

Results

Higher YAPFAQ scores, representing poorer function, were associated with higher pain intensity (β = 0.2, P = 0.04) and poorer health-related quality of life (β = –0.3, P = 0.01) at home 2 weeks after surgery. This functional measure could be clinically relevant to providers to identify adolescents at risk of difficulty with pain and recovery at home after surgery who might need further intervention to minimize functional impairment and delayed recovery.

Perspective

This article provides conceptual validation of a functional score for pediatric pain, the YAPFAQ, to assess pain intensity and health-related quality of life in the subacute period.
Time of Soybean Sudden Death Syndrome Foliar Symptom Onset Influences Final Disease Intensity, Yield, and Yield Components
Authors: Raza Muhammad M. , Kaiser Mark S. , Eggenberger Sharon K. , Nutter Forest W. , Leandro Leonor F. S.
Published: February 2022

Sudden death syndrome (SDS), caused by Fusarium virguliforme, causes substantial yield losses in soybean. However, relationships between soybean yield and components of disease progress, including time of disease onset, are poorly understood. Individual soybean plants (2018) and quadrats (2016 to 2018) were monitored in commercial fields and experimental plots in Iowa to quantify the impact of SDS foliar symptom onset on final SDS intensity, soybean yield components, and yield. The date when SDS foliar symptoms were first detected (onset time) and progress of SDS incidence and severity were recorded weekly. Individual soybean plants and quadrats were harvested at the end of each season. Beta-regression showed that date of SDS onset had a consistent and stable effect on final disease intensity both at individual plant and quadrat levels. The slope of the relationship between date of SDS onset and final SDS severity was common across all field sites and years. Weighted linear regression revealed that SDS onset explained 60 to 83% of the variation in number of pods, number of seeds, and total seed weight in individual plants, and 94 to 97% of the variation in seed yield in quadrats. Soybean yield damage functions (slopes) indicated that for each day SDS onset was delayed, soybean yield increased by 30.5 to 31.3 kg/ha. This new quantitative information improves understanding of the impact of SDS on final disease intensity and soybean yield. Further experiments are needed to determine how this relationship is affected by site-specific factors.
Palliative care for patients with advanced dementia
Authors: Navia R. Osvaldo , Constantine Lori Anne
Published: February 2022

Dementia is currently the seventh leading cause of death and one of the major causes of disability and dependency among older adults globally. Its final stages are complicated by a multitude of problems that can cause immense suffering. This article explores the interconnection between advanced dementia and palliative care and the role of nurses in providing end-of-life care for these patients.
Traumatic Abdominal Wall Hernia Repair with Dermal Autograft within a Morel-Lavallée Lesion
Authors: Le Paulina B. , Mayan Danel , Mujadzic Tarik , Mujadzic Mirsad M.
Published: February 2022

Morel-Lavallée lesions and traumatic abdominal wall hernias seldom present together and have no standardized guidelines for treatment. We present a unique case of a traumatic abdominal wall hernia present within a patient’s abdominal Morel-Lavallée lesion, which was reduced and repaired with a dermal autograft. This is a novel approach to repairing a rare and unusual injury. The literature suggests that tension-free repairs with mesh should be used on delayed repairs of traumatic abdominal wall hernias. However, some advocate for primary repairs due to an up to 50% increased risk of wound infection in these injuries, even without the use of mesh. Although infection rates with the use of biologic mesh (acellular dermal matrices) in a contaminated field are lower than that of synthetic mesh, infections still occur and tend to be higher in repairs without mesh. The lack of foreign material and innate immunogenicity of the patient’s own dermis may theoretically decrease the risk of infection compared with other commercially-available and biologically-derived products. The patient is a 47-year-old woman who was in a motor vehicle accident with prolonged extrication time. She was hospitalized for approximately 6 months due to extensive injuries, but had no further complications from her Morel-Lavallée lesion or repair of her traumatic abdominal wall hernia with her own dermis.
Postoperative Cutaneous Manifestations as the First Presentation of COVID-19 Infection or a Postvaccination Sequel
Authors: El Minawi Hisham , Abdelgawad Ahmed , El Saloussy Yasmeen , Abdelgawad Belal Ahmed
Published: February 2022

Since its first emergence, coronavirus disease 2019 (COVID-19) took the world by surprise, causing more than two million deaths and 100 million infections to date. The virus’s most prevalent clinical symptoms have become well known, yet the rarer symptoms, on the other hand, need to be more widely recognized. Various studies have reflected the possibilities of potential skin lesions being the presenting signs of COVID-19 infection. Acquaintance with the cutaneous presentations of COVID-19 may help in early diagnosis and management of infected patients. Herein we report two cases that presented for plastic surgical interventions in which skin manifestations were the first indicators of COVID-19 infection or postvaccination sequel. The cases were operated upon in different hospitals by different surgical teams.
Comparative Study of Radiation-induced Lung Injury Model in Two Strains of Mice
Authors: Niu Shiying , Zhang Yuehua , Cong Changsheng , Wu Zhicheng , Wang Zhaopeng , Sun Meili , Yao Chengfang , Zhang Yueying
Published: February 2022

Radiation-induced lung injury (RILI) is a common complication of radiotherapy for thoracic tumor. Its incidence rate is as high as 20%. At present, there is no effective treatment in clinical practice. However, to study the mechanism of radiation-induced lung injury, we should first establish an appropriate animal model. In a series of scientific studies on RILI, mice are the animals most often chosen by researchers. However, there are few reports on which strain of mice is more suitable as a model of RILI. In this study, Kunming (KM) and C57BL/6 strains of mice were used as research objects to find the most suitable mice to replicate the RILI model. C57BL/6 mice and KM mice were exposed to irradiation at a dose of 20 Gy. The lung tissue of C57BL/6 mice exposed to radiation showed dilation and hyperemia of capillaries, infiltration of inflammatory cells, and thickening of alveolar septum, while the lung tissue of KM mice exposed to radiation was not as obvious as that of C57BL/6 mice. After irradiation, the expression of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) in the lung tissue of C57BL/6 mice was significantly increased, while the expression of IL–6 and TNF-α in KM mice was almost unchanged. These studies showed that C57BL/6 mice are more suitable for the model of radiation-induced lung injury because of sensitive inflammatory reaction and the pathological changes of lung tissue.
Trends and Disparities in the Use of Telehealth Among Injured Workers During the COVID-19 Pandemic
Authors: Le Vi T. , Fulton-Kehoe Deborah , Sears Jeanne M. , Nkyekyer Esi W. , Ehde Dawn M. , Young Morgan , Franklin Gary M.
Published: February 2022

Objective:

To describe telehealth trends within a population-based workers’ compensation system during the COVID-19 pandemic, and to assess telehealth utilization by sociodemographic characteristics.

Methods:

This cross-sectional study used Washington State workers’ compensation claims and medical billing data from January 2019 to October 2020.

Results:

Telehealth use averaged 1.2% of medical bills pre-pandemic, peaked in April 2020 at 8.8%, and leveled off to around 3.6% from July to October 2020. Telehealth utilization differed significantly by age, sex, number of dependents, injury, industry, and receipt of interpreter services. Workers residing in counties with higher population, lower poverty rates, and greater Internet access had higher telehealth usage.

Conclusions:

There were dramatic shifts in telehealth; usage differed by sociodemographic characteristics. Further studies evaluating disparities in tele-health access among injured workers are needed.
Intraoperative Use of Electrical Stapedius Reflex Testing for Cochlear Nerve Monitoring During Simultaneous Translabyrinthine Resection of Vestibular Schwannoma and Cochlear Implantation
Authors: Kocharyan Armine , Daher Ghazal S. , Nassiri Ashley M. , Khandalavala Karl R. , Saoji Aniket A. , Van Gompel Jamie J. , Carlson Matthew L.
Published: February 2022

Objective:

To report the novel use of intraoperative electrically evoked stapedial reflex (eSR) for cochlear nerve monitoring during simultaneous translabyrinthine resection of vestibular schwannoma (VS) and cochlear implantation.

Study Design:

Clinical capsule report with video demonstration.

Setting:

Tertiary academic referral center.

Patient:

A 58-year-old female presented with a small right intracanalicular VS with associated asymmetrical right moderate to severe sensorineural hearing loss, poor word recognition, tinnitus, and disequilibrium. Based on patient symptomatology and goals, simultaneous CI with translabyrinthine resection of the VS was performed.

Intervention:

Cochlear implantation before the tumor was resected facilitated intraoperative eSRs by delivering repeated single-electrode stimulations through the cochlear implant (CI) electrode during tumor resection. A pulse duration of 50-us and a current amplitude of 200-CL or 648-us was used to elicit eSRs visible through the facial recess. Intraoperative eSR was monitored in conjunction with electrically evoked compound action potentials via neural response telemetry and electrical auditory brainstem response.

Results:

Despite the transient evoked compound action potentials amplitude and electrical auditory brainstem response latency changes, the visually observed eSR was preserved and remained robust throughout tumor dissection, indicating an intact cochlear nerve. Four weeks postoperatively, the patient exhibited open-set speech capacity (14% CNC and 36% AzBio in quiet).

Conclusion:

The current study demonstrates the feasibility of using intraoperative eSR via a CI electrode to monitor cochlear nerve integrity during VS resection, which may indicate successful CI outcomes. These preliminary findings require further substantiation in a larger study.
The Use of Intraoperative Frozen Sections in Guiding the Extent of Pancreatic Resections for Intraductal Papillary Mucinous Neoplasms
Authors: Chi Zhikai , Dhall Deepti , Mertens Richard
Published: February 2022

Objectives

The utility of frozen section evaluation of the pancreatic parenchymal resection margin(s) in the surgical management of intraductal papillary mucinous neoplasm (IPMN) remains controversial. We investigated the frequency of its use in IPMN resections and its impact on achievement of negative final parenchymal margin(s).

Methods

Sixty-two IPMN resections (11 with invasive carcinoma) performed over a 12-year period were studied.

Results

Frozen sections of the parenchymal margin(s) were performed on 44 of the 62 resections (71%), 30 (68%) of which had 10 positive and 22 indefinite margins on frozen section. Additional margin resections were performed in 14 of these 30 cases (47%), boosting the complete resection rate from 14% (2 of 14) on the initial margin(s) to 71% (10 of 14) on the final margin(s) (P = 0.002). Overall, negative final parenchymal margin(s) were achieved more frequently when evaluation of the initial margin(s) by frozen section was performed (35 of 44; 80%) than when it was not (11 of 18; 61%) (P = 0.13).

Conclusions

In the intraoperative management of IPMN, frozen sections are highly reliable for margin evaluation and are useful for guiding the extent of pancreatic resection.
The Effects of NLRP3 Inflammasome Inhibition in Experimental Acute Pancreatitis
Authors: Gao Lin , Chong Eric , Pendharkar Sayali , Hong Jiwon , Windsor John A. , Ke Lu , Li Weiqin , Phillips Anthony
Published: February 2022

Acute pancreatitis (AP) is an inflammatory disease, and NLRP3 inflammasome activation is involved in the pathogenesis of AP. Previous research showed that inhibition of NLRP3 inflammasome may exert protective effects on animal models of AP and reduces disease severity. The aim of this systematic review and meta-analysis is to evaluate the effects of drug treatment of NLRP3 inflammasome on the outcomes of experimental AP. PubMed, Embase, Medline, and Web of Science databases were searched for relevant articles without language restrictions. The main outcomes for this study included local pancreatic injury, the incidence of systemic inflammatory responses, and the incidence of organ failure. Twenty-eight animal studies including 556 animals with AP were included in the meta-analysis. Compared with controls, inhibition of NLRP3 inflammasome significantly reduced the pancreatic histopathological scores, serum amylase, and lipase levels. In addition, inhibition of NLRP3 inflammasome reduced the levels of circulating inflammatory cytokines, as well as mitigating severity of AP-associated acute lung injury and acute intestinal injury. To conclude, inhibition of NLRP3 inflammasome has protective effects on AP by mitigating organ injury and systemic inflammation in animal studies, indicating that NLRP3 inflammasome holds promise as a target for specific AP therapy.
Mesonephric-like Endometrial Carcinoma
Authors: Mills Anne M. , Jenkins Taylor M. , Howitt Brooke E. , Fan Jinbo , Ring Kari L. , Cook Ian
Published: February 2022

Mesonephric-like endometrial carcinoma is a rare but frequently misclassified and aggressive malignancy. KRAS mutations, limited estrogen receptor (ER) expression, and TTF-1, GATA3, and luminal CD10 expression are described in these tumors, but an immunohistochemistry-based screening approach has not been studied. We assessed 300 endometrial carcinomas/carcinosarcomas to ascertain the specificity of TTF-1/GATA3/luminal CD10 expression with or without ER staining for this diagnosis. Next-generation sequencing and morphologic review were performed on screen-positive cases. In all, 3% (9/300) were TTF-1+; 2 coexpressed GATA3. No cases expressed luminal CD10 or GATA3 in isolation. Two TTF-1+/ER− cases, one of which was also GATA3+, were reclassified as mesonephric-like based on morphology and molecular results (KRAS mutations without mismatch repair deficiency, TP53 mutations, or PTEN mutations): these represented 0.7% of all cases (2/300). The reclassified cases were originally diagnosed as grade 1 and 2 endometrioid carcinoma, and the latter had pulmonary metastases and pelvic recurrences. Six TTF-1+ cases retained their original serous (3) and endometrioid (3) diagnoses; 1 was reclassified as dedifferentiated. All had negative or low ER. KRAS mutations were identified in 4 TTF-1+ non–mesonephric-like cases, including 1 serous and 1 grade 3 endometrioid with p53 abnormalities, 1 mismatch repair–deficient endometrioid with a complex molecular profile, and 1 endometrioid with mucinous differentiation. These findings suggest that TTF-1 and ER are good first-line screens for mesonephric-like carcinoma, but caution that a TTF-1+/ER− immunoprofile is not specific, even in the setting of KRAS mutations. A final diagnosis of mesonephric-like carcinoma requires integration of morphologic and immunohistochemical features, with molecular support when relevant.
Impact of Chemotherapy and Radiation Therapy on Inflammatory Response, Neovascularization, and Capsule Formation of Acellular Dermal Matrix in Breast Reconstruction: Analysis of the BREASTrial Biopsy Specimens
Authors: Mendenhall Shaun D. , Graham Emily M. , Anderson Layla A. , Ying Jian , Liu Ting , Agarwal Jayant P.
Published: February 2022

Background:

The Breast Reconstruction Evaluation of Acellular Dermal Matrix as a Sling Trial is a single-center, blinded, prospective, randomized, controlled trial established to compare outcomes using two popular types of acellular dermal matrices, AlloDerm and DermaMatrix, in tissue expander breast reconstruction. This study used the acellular dermal matrix biopsy specimens from the trial to evaluate how adjuvant therapy influences inflammation, neovascularization, and capsule formation of the acellular dermal matrix.

Methods:

Punch biopsy specimens were taken at the time of expander exchange and were analyzed by a blinded pathologist. The inflammatory response was quantified by the number of fibroblasts, giant cells, and lymphocytes. Neovascularization and capsule formation were similarly quantified by the number of new capillaries and capsule presence and thickness, respectively.

Results:

Histology specimens were collected from 109 patients (170 breasts). In the absence of adjuvant therapy, there was no significant difference between AlloDerm and DermaMatrix in terms of inflammation, neovascularization, or capsule thickness. Both acellular dermal matrices showed a significant decrease in inflammation and neovascularization with adjuvant therapy. When chemotherapy and radiation therapy were used, the decrease in inflammation was greatest for the group reconstructed with DermaMatrix (p < 0.039).

Conclusions:

Adjuvant therapy influences the inflammatory response, neovascularization, and capsule formation in both acellular dermal matrices. Adjuvant therapy has a protective effect on the inflammatory response toward both acellular dermal matrices in breast reconstruction. In the setting of chemotherapy and radiation therapy, DermaMatrix produced the greatest reduction in inflammation.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, II.
Preoperative Body Image Factors Are Associated with Complications after Breast Reconstruction
Authors: Lewis Holly C. , Hart Alexandra L. , Fobare Amanda , Styblo Toncred M. , Losken Albert
Published: February 2022

Background:

Psychological factors are broadly understood to contribute to overall health, but their contribution to wound healing is less well defined. Limited data exist on the association of preoperative psychological factors such as body image and postoperative complications. The present study analyzed the association between preoperative body image factors and postoperative complications following breast reconstruction.

Methods:

This was a prospective cohort study of 302 breast cancer patients undergoing breast reconstruction from 2011 to 2015. All patients completed the BREAST-Q; demographics, surgical details, and postoperative complications were recorded. The association of body image factors by means of the BREAST-Q and postoperative complications was analyzed.

Results:

On univariate analysis, patients who reported lower preoperative satisfaction with how they appeared in the mirror unclothed, or felt less self-confident or attractive, were significantly more likely to develop an infection postoperatively. Preoperative satisfaction scores were not associated with complications when analyzed in a multivariate fashion. On binomial logistic regression analysis, after controlling for age, body mass index, reconstruction technique, and use of radiotherapy, patients who reported less preoperative satisfaction with how comfortably bras fit or how they appeared in a mirror unclothed were at an increased risk for delayed wound healing.

Conclusions:

Patients with lower preoperative body satisfaction were found to have an increased incidence of infections and delayed wound healing. Although postoperative outcomes are multifactorial, the data suggest that baseline psychological factors such as body image may play a role in postoperative outcomes. Broader use of prehabilitative therapies, targeted at psychosocial factors, may warrant further investigation to optimize postoperative outcomes.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Risk, III.
Applying Health Utility Outcome Measures and Quality-Adjusted Life-Years to Compare Hand Allotransplantation and Myoelectric Prostheses for Upper Extremity Amputations
Authors: Efanov Johnny I. , Izadpanah Ali , Bou-Merhi Joseph , Lin Samuel J. , Danino Michel A.
Published: February 2022

Background:

An amputation of the upper extremity not only is devastating for the patient’s physical, emotional, and social well-being but also constitutes a financial stress for both the patient and the health care system. The objective of this study was to determine the utility and quality-adjusted life-years of hand allotransplantation versus myoelectric prostheses and to compare these measures in patients afflicted with unilateral versus bilateral amputations.

Methods:

A survey was administered on bilateral amputees, unilateral amputees, replantation patients, and healthy controls. Patient demographics, functional patient-reported outcomes, quality-of-life questionnaires, and utility outcome measures were calculated for four different scenarios: hand transplantation and myoelectric prostheses with or without complications.

Results:

Five bilateral amputees, 12 unilateral amputees, nine replantation patients, and 45 healthy controls completed the survey. The highest quality-adjusted life-years were obtained in the replantation patient group for the scenario of myoelectric prosthesis without complications (mean, 34.8 years). Altogether, there was no statistically significant difference between hand transplantation and myoelectric prostheses (p = 0.36). On subgroup analysis, unilateral amputees reported significantly higher quality-adjusted life-years for myoelectric prostheses rather than hand transplantation (6.4; p = 0.0015), whereas bilateral amputees did not demonstrate a significant difference (−2.4; p = 0.299).

Conclusions:

Utility and quality-adjusted life-years do not differ significantly between hand transplantation and myoelectric prostheses, except in unilateral amputees with myoelectric prostheses, who had higher quality-of-life scores. Based on trends from this pilot study, myoelectric prostheses may be considered for unilateral amputees, whereas no superiority can be demonstrated between both treatments in bilateral amputees.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Enrichment of Nanofiber Hydrogel Composite with Fractionated Fat Promotes Regenerative Macrophage Polarization and Vascularization for Soft-Tissue Engineering
Authors: Henn Dominic , Fischer Katharina S. , Chen Kellen , Greco Autumn H. , Martin Russell A. , Sivaraj Dharshan , Trotsyuk Artem A. , Mao Hai-Quan , Reddy Sashank K. , Kneser Ulrich , Gurtner Geoffrey C. , Schmidt Volker J. , Sacks Justin M.
Published: February 2022

Background:

Fractionated fat has been shown to promote dermal regeneration; however, the use of fat grafting for reconstruction of soft-tissue defects is limited because of volume loss over time. The authors have developed a novel approach for engineering of vascularized soft tissue using an injectable nanofiber hydrogel composite enriched with fractionated fat.

Methods:

Fractionated fat was generated by emulsification of groin fat pads from rats and mixed in a 3:1 ratio with nanofiber hydrogel composite (nanofiber hydrogel composite with fractionated fat). Nanofiber hydrogel composite with fractionated fat or nanofiber hydrogel composite alone was placed into isolation chambers together with arteriovenous loops, which were subcutaneously implanted into the groin of rats (n = 8 per group). After 21 days, animals were euthanized and systemically perfused with ink, and tissue was explanted for histologic analysis. Immunofluorescent staining and confocal laser scanning microscopy were used to quantify CD34+ progenitor cell and macrophage subpopulations.

Results:

Nanofiber hydrogel composite with fractionated fat tissue maintained its shape without shrinking and showed a significantly stronger functional vascularization compared to composite alone after 21 days of implantation (mean vessel count, 833.5 ± 206.1 versus 296.5 ± 114.1; p = 0.04). Tissue heterogeneity and cell count were greater in composite with fractionated fat (mean cell count, 49,707 ± 18,491 versus 9263 ± 3790; p = 0.005), with a significantly higher number of progenitor cells and regenerative CD163+ macrophages compared to composite alone.

Conclusions:

Fractionated fat–enriched nanofiber hydrogel composite transforms into highly vascularized soft tissue over 21 days without signs of shrinking and promotes macrophage polarization toward regenerative phenotypes. Enrichment of injectable nanofiber hydrogel composite with fractionated fat represents a promising approach for durable reconstruction of soft-tissue defects.

Clinical Relevance Statement:

The authors' approach for tissue engineering may ultimately lay the groundwork for clinically relevant applications with the goal of generating large volumes of vascularized soft tissue for defect reconstruction without donor site morbidity.
Bedaquiline Adherence Measured by Electronic Dose Monitoring Predicts Clinical Outcomes in the Treatment of Patients With Multidrug-Resistant Tuberculosis and HIV/AIDS
Authors: O'Donnell Max R. , Padayatchi Nesri , Wolf Allison , Zelnick Jennifer , Daftary Amrita , Orrell Catherine , Nimmo Camus , Baldwin Matthew , Boodhram Resha , Maharaj Bhavna , Amico K. Rivet , Naidoo Kogieleum , Friedland Gerald
Published: February 2022

Background:

Novel regimens have revolutionized multidrug-resistant tuberculosis (MDR-TB) treatment; however, medication adherence remains challenging and poorly characterized. We hypothesized that bedaquiline adherence, measured using electronic dose monitoring, would predict MDR-TB treatment outcomes.

Setting:

This is a prospective cohort study conducted in KwaZulu-Natal, South Africa.

Methods:

Adults with MDR-TB and HIV initiating bedaquiline and on antiretroviral therapy (ART) were eligible. Separate electronic dose monitoring devices measured bedaquiline and ART adherence through 6 months, calculated as observed versus expected doses. Whole-genome sequencing was performed to identify bedaquiline resistance–associated variants.

Results:

From November 2016 through February 2018, 199 participants with MDR-TB and HIV were enrolled and followed up through treatment completion (median 17.2 months interquartile range 12.2–19.6). The median bedaquiline adherence was higher than ART adherence (97 vs. 89%, P < 0.001) but correlated (r2 = 0.68, P < 0.001). High bedaquiline adherence (≥90%) compared with lower adherence was associated with improved end of treatment successful outcome (83.4% vs. 46.3%, P < 0.001), decreased mortality (11.0% vs. 29.6% P = 0.004), and improved retention in care through end of treatment (94.5% vs. 79.6% P = 0.002). Modeling identified a highly significant but linear association between bedaquiline adherence and outcome. On multivariable analysis, bedaquiline adherence was independently associated with mortality and outcome. Bedaquiline resistance–associated variants were seen in 12% (7/57) of sequenced isolates (7% baseline, 5% emergent) with only 28.6% experiencing successful treatment outcome.

Conclusions:

Bedaquiline adherence through 6 months independently predicted end of MDR-TB treatment outcome, but a specific bedaquiline adherence threshold was not identified. Interventions to optimize bedaquiline adherence are urgently needed to improve MDR-TB HIV treatment outcomes.
“The armor phenomenon” in obese patients with penetrating thoracoabdominal injuries: A systematic review and meta-analysis
Authors: Chen Andy Ze Lin , Lee Tae Hwan , Hsu Jeremy , Pang Tony
Published: February 2022

BACKGROUND

Obesity represents a growing global health threat, which generally portends increased morbidity and mortality in the context of traumatic injuries. We hypothesized that there may exist a protective effect related to increased weight and truncal girth provided for obese patients in penetrating torso injuries, although this may not exert a significant positive impact overall upon clinical outcomes.

METHODS

A comprehensive review of the literature was conducted across five databases up to March 2021 (Medline, Pubmed, Embase, Web of Science and the Cochrane library) to examine the effect of obesity on penetrating thoracoabdominal injuries. The primary outcome was to determine the rate of nonsignificant injury and injury patterns. Secondary outcomes examined were lengths of stay, complications, and mortality. Comparisons were drawn by meta-analysis. The study protocol was registered with PROSPERO under CRD42020216277.

RESULTS

There were 2,952 publications assessed with 12 meeting the inclusion criteria for review. Nine studies were included for quantitative analysis, including 5,013 patients sustaining penetrating thoracoabdominal injuries, of which 29.6% were obese. Obese patients that sustained stab injuries underwent more nontherapeutic operations. Obese patients that sustained gunshot injuries had longer intensive care and total hospital length of stay. Obese patients suffered more respiratory complications and were at an increased risk of death during their admission.

CONCLUSION

The “armor phenomenon” does not truly protect obese patients, a population that experiences increased morbidity and mortality following penetrating thoracoabdominal injuries.

LEVEL OF EVIDENCE

Systematic Review and Meta-Analysis; Level IV.
Mortality and pulmonary complications in emergency general surgery patients with COVID-19: A large international multicenter study
Authors:   COVIDSurg Collaborative
Published: February 2022

OBJECTIVES

The outcomes of emergency general surgery (EGS) patients with concomitant COVID-19 infection remain unknown. With a multicenter study in 361 hospitals from 52 countries, we sought to study the mortality and pulmonary complications of COVID-19 patients undergoing EGS.

METHODS

All patients 17 years or older and diagnosed preoperatively with COVID-19 between February and July 2020 were included. Emergency general surgery was defined as the urgent/emergent performance of appendectomy, cholecystectomy, or laparotomy. The main outcomes were 30-day mortality and 30-day pulmonary complications (a composite of acute respiratory distress syndrome, unexpected mechanical ventilation, or pneumonia). Planned subgroup analyses were performed based on presence of preoperative COVID-related respiratory findings (e.g., cough, dyspnea, need for oxygen therapy, chest radiology abnormality).

RESULTS

A total of 1,045 patients were included, of which 40.1% were female and 50.0% were older than 50 years; 461 (44.1%), 145 (13.9%), and 439 (42.0%) underwent appendectomy, cholecystectomy, and laparotomy, respectively. The overall mortality rate was 15.1% (158 of 1,045 patients), and the overall pulmonary complication rate was 32.9% (344 of 1,045 patients); in the subgroup of laparotomy patients, the rates were 30.6% (134 of 438 patients) and 59.2% (260 of 439 patients), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings.

CONCLUSION

COVID-19 patients undergoing EGS have significantly high rates of mortality and pulmonary complications, but the risk is most pronounced in those with preoperative respiratory findings.

LEVEL OF EVIDENCE

Prognostic and Epidemiologic; Level IV.