bluuebunny/crossref_metadata_2025 huggingface dataset:
Navigating Amaryllidaceae alkaloids: bridging gaps and charting biosynthetic territories
Authors: Liyanage Nuwan Sameera , Awwad Fatima , Gonçalves dos Santos Karen Cristine , Jayawardena Thilina U , Mérindol Natacha , Desgagné-Penix Isabel
Published: April 2024

Amaryllidaceae alkaloid (AA) biosynthesis has garnered significant attention in recent years, particularly with the commercialization of galanthamine as a treatment for the symptoms of Alzheimer’s disease. A significant amount of research work over the last eight decades has focused on the understanding of AA biosynthesis, starting from early radiolabelling studies to recent multi-omics analysis with modern biotechnological advancements. Those studies enabled the identification of hundreds of metabolites, the characterization of biochemical pathways, and an understanding of the environmental stimuli and of the molecular regulation of these pharmaceutically and agriculturally important metabolites. Despite numerous studies, there remain significant gaps in understanding the biosynthesis of AAs in Amaryllidaceae plants. As such, further research is needed to fully elucidate the metabolic pathways and facilitate their production. This review aims to provide a comprehensive summary of the current state of knowledge on AA biosynthesis, from elicitation of expression of transcription factors in the cell nucleus to alkaloid transport in the apoplast, and to highlight the challenges that need to be overcome for further advancement.
Modelling stochastic and quasi-periodic behaviour in stellar time-series: Gaussian process regression versus power-spectrum fitting
Authors: O’Sullivan Niamh K , Aigrain Suzanne
Published: April 2024

As the hunt for an Earth-like exoplanets has intensified in recent years, so has the effort to characterize and model the stellar signals that can hide or mimic small planetary signals. Stellar variability arises from a number of sources, including granulation, supergranulation, oscillations, and activity, all of which result in quasi-periodic or stochastic behaviour in photometric and/or radial velocity observations. Traditionally, the characterization of these signals has mostly been done in the frequency domain. However, the recent development of scalable Gaussian process regression methods makes direct time-domain modelling of stochastic processes a feasible and arguably preferable alternative, obviating the need to estimate the power spectral density of the data before modelling it. In this paper, we compare the two approaches using a series of experiments on simulated data. We show that frequency-domain modelling can lead to inaccurate results, especially when the time-sampling is irregular. By contrast, Gaussian process regression results are often more precise, and systematically more accurate, in both the regular and irregular time-sampling regimes. While this work was motivated by the analysis of radial velocity and photometry observations of main-sequence stars in the context of planet searches, we note that our results may also have applications for the study of other types of astrophysical variability such as quasi-periodic oscillations in X-ray binaries and active galactic nuclei variability.
Evidence for a nearly orthogonal rotator in GX 301–2 with phase-resolved cyclotron resonant scattering features
Authors: Chen Xiao , Ding Yuanze , Wang Wei , Nishimura Osamu , Liu Qi , Zhang Shuang-Nan , Ge Mingyu , Lu Fangjun , Qu Jinlu , Song Liming , Zhang Shu
Published: April 2024

Cyclotron resonant scattering features (CRSFs) are the absorption features in the X-ray spectra of strongly magnetized accretion neutron stars (NSs), which are probably the most reliable probe to the surface magnetic fields of NSs. The high-mass X-ray binary GX 301–2 exhibits a very wide, variable, and complicated CRSF in the average spectra, which should be two absorption lines based on Nuclear Spectroscopic Telescope Array (NuStar) and Hard X-ray Modulation Telescope (Insight-HXMT) observations. With the Insight-HXMT frequent observations, we performed the phase-resolved spectroscopy and confirmed two cyclotron absorption lines in the phase-resolved spectra, with their centroid energy ratio ∼1.6–1.7 in the supercritical luminosity case. A major hindrance in understanding those CRSFs is the very poorly constrained magnetic inclination angle, which is also a fundamental property of an NS and key to understanding the emission characteristics of a pulsar. Comparing the phase-resolved CRSF with simulated X-ray spectra, the magnetic inclination angle is found to be ≳70°, i.e. nearly orthogonal between the NS’s spin and magnetic axis. The implications of an orthogonal rotator and magnetic structure evolution in the accreting X-ray binary are also discussed.
The formation of transiting circumplanetary debris discs from the disruption of satellite systems during planet–planet scattering
Authors: Mustill Alexander J , Davies Melvyn B , Kenworthy Matthew A
Published: April 2024

Several stars show deep transits consistent with discs of roughly $1\mathrm{\, R}_\odot$ seen at moderate inclinations, likely surrounding planets on eccentric orbits. We show that this configuration arises naturally as a result of planet–planet scattering when the planets possess satellite systems. Planet–planet scattering explains the orbital eccentricities of the discs’ host bodies, while the close encounters during scattering lead to the exchange of satellites between planets and/or their destabilization. This leads to collisions between satellites and their tidal disruption close to the planet. Both of these events lead to large quantities of debris being produced, which in time will settle into a disc such as those observed. The mass of debris required is comparable to a Ceres-sized satellite. Through N-body simulations of planets with clones of the Galilean satellite system undergoing scattering, we show that 90 per cent of planets undergoing scattering will possess debris from satellite destruction. Extrapolating to smaller numbers of satellites suggests that tens of per cent of such planets should still possess circumplanetary debris discs. The debris trails arising from these events are often tilted at tens of degrees to the planetary orbit, consistent with the inclinations of the observed discs. Disruption of satellite systems during scattering thus simultaneously explains the existence of debris, the tilt of the discs, and the eccentricity of the planets they orbit.
Synchronized Expansion and Contraction of Olfactory, Vomeronasal, and Taste Receptor Gene Families in Hystricomorph Rodents
Authors: Niimura Yoshihito , Biswa Bhim B , Kishida Takushi , Toyoda Atsushi , Fujiwara Kazumichi , Ito Masato , Touhara Kazushige , Inoue-Murayama Miho , Jenkins Scott H , Adenyo Christopher , Kayang Boniface B , Koide Tsuyoshi
Published: April 2024

Chemical senses, including olfaction, pheromones, and taste, are crucial for the survival of most animals. There has long been a debate about whether different types of senses might influence each other. For instance, primates with a strong sense of vision are thought to have weakened olfactory abilities, although the oversimplified trade-off theory is now being questioned. It is uncertain whether such interactions between different chemical senses occur during evolution. To address this question, we examined four receptor gene families related to olfaction, pheromones, and taste: olfactory receptor (OR), vomeronasal receptor type 1 and type 2 (V1R and V2R), and bitter taste receptor (T2R) genes in Hystricomorpha, which is morphologically and ecologically the most diverse group of rodents. We also sequenced and assembled the genome of the grasscutter, Thryonomys swinderianus. By examining 16 available genome assemblies alongside the grasscutter genome, we identified orthologous gene groups among hystricomorph rodents for these gene families to separate the gene gain and loss events in each phylogenetic branch of the Hystricomorpha evolutionary tree. Our analysis revealed that the expansion or contraction of the four gene families occurred synchronously, indicating that when one chemical sense develops or deteriorates, the others follow suit. The results also showed that V1R/V2R genes underwent the fastest evolution, followed by OR genes, and T2R genes were the most evolutionarily stable. This variation likely reflects the difference in ligands of V1R/V2Rs, ORs, and T2Rs: species-specific pheromones, environment-based scents, and toxic substances common to many animals, respectively.
The world’s psychiatrists update their position on Workforce mental health
Authors: Heron Richard J L , Kawakami Norito , Thirumalai Rajgopal , Morganstein Joshua C , Jetly Rakesh , Glozier Nick , Greenberg Neil
Published: April 2024

Aside from personal impacts, costs to employers and national economies of mental health can be measured in trillions of dollars. With volatility, uncertainty, complexity and ambiguity increasingly describing the new normal workplace, the need for evidence-based interventions for sustained mental health at work to be developed, evaluated and implemented by specialists in psychiatry and occupational health could not be greater, nor an updated position statement on work and mental health from the World Psychiatric Association.
A tale of two pumps: Blue light and abscisic acid alter Arabidopsis leaf hydraulics via bundle sheath cell H+-ATPases
Authors: Torne-Srivastava Tanmayee , Grunwald Yael , Dalal Ahan , Yaaran Adi , Moshelion Menachem , Moran Nava
Published: April 2024

The bundle sheath cell (BSC) layer tightly enveloping the xylem throughout the leaf is recognized as a major signal-perceiving “valve” in series with stomata, regulating leaf hydraulic conductance (Kleaf) and thereby radial water flow via the transpiring leaf. The BSC blue light (BL) signaling pathway increases Kleaf and the underlying BSC water permeability. Here, we explored the hypothesis that BSCs also harbor a Kleaf-downregulating signaling pathway related to the stress phytohormone abscisic acid (ABA). We employed fluorescence imaging of xylem sap in detached leaves and BSC protoplasts from different genotypes of Arabidopsis (Arabidopsis thaliana) plants, using pH and membrane potential probes to monitor physiological responses to ABA and BL in combination with pharmacological agents. We found that BL-enhanced Kleaf required elevated BSC cytosolic Ca2+. ABA inhibited BL-activated xylem-sap-acidifying BSC H+-ATPase AHA2 (Arabidopsis H+-ATPase 2), resulting in depolarized BSCs and alkalinized xylem sap. ABA also stimulated BSC vacuolar H+-ATPase (VHA), which alkalinized the BSC cytosol. Each pump stimulation, AHA2 by BL and VHA by ABA (under BL), also required Ca2+. ABA stimulated VHA in the dark depending on Ca2+, but only in an alkaline external medium. Taken together with earlier findings on the pH sensitivity of BSC osmotic water permeability (i.e. aquaporin activity), our results suggest a Ca2+-dependent and pH-mediated causative link between the BL- and ABA-regulated activities of two BSC H+-ATPases and Kleaf.
Umeclidinium plus vilanterol versus fluticasone propionate plus salmeterol for chronic obstructive pulmonary disease: a meta-analysis of randomized, controlled trials
Authors: Zhai Chunjuan , Wang Fen , Xu Ruie , Sun Xia , Ma Wenbin , Wang Li
Published: April 2024

Purpose

Umeclidinium plus vilanterol (UMEC/VI) is an inhaled long-acting muscarinic antagonist/long-acting beta2-agonist (LAMA/LABA), recently approved as once-daily maintenance therapy for chronic obstructive pulmonary disease (COPD). This meta-analysis aims to assess the efficacy and safety of UMEC/VI compared with fluticasone propionate plus salmeterol (FP/SAL).

Methods

A systematic search was conducted by a trained medical research librarian across MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials (CENTRAL), and Chinese Biomedical Literature Database (CBM) for randomized controlled trials comparing UMEC/VI with FP/SAL in COPD patients. Two reviewers independently assessed the risk of bias and extracted data. The primary outcome was 0–24 h weighted mean (wm) forced expiratory volume in the first second (FEV1), trough FEV1. The secondary outcomes were other lung functions, symptoms, quality of life, and safety.

Results

Three studies with 2119 patients were included in the meta-analysis. UMEC/VI showed improvement in 0–24 h wm FEV1 (mean difference (MD) 0.08 L, 95% confidence interval (CI) 0.06 to 0.10, P < 0.01, moderate quality) and trough FEV1 (MD 0.09 L, 95% CI 0.07 to 0.11, P < 0.01, moderate quality) in comparison with FP/SAL. UMEC/VI statistically significantly improved all other lung functions compared with FP/SAL. However, there were no significant differences between UMEC/VI and FP/SAL in rescue-medication use, symptomatic endpoints, and health outcomes. UMEC/VI also demonstrated fewer drug-related adverse effects (risk ratio 0.47, 95% CI 0.27 to 0.82, P = 0.01, low quality).

Conclusions

UMEC/VI, when compared with FP/SAL, demonstrated significant improvements in lung functions with fewer drug-related adverse effects. However, the conclusion was limited by the scarcity of studies and long-term trials.
PyExoCross: a Python program for generating spectra and cross-sections from molecular line lists
Authors: Zhang Jingxin , Tennyson Jonathan , Yurchenko Sergei N
Published: April 2024

PyExoCross is a Python adaptation of the ExoCross Fortran application, PyExoCross is designed for post-processing the huge molecular line lists generated by the ExoMol project and other similar initiatives such as the HITRAN and HITEMP data bases. PyExoCross generates absorption and emission stick spectra, cross-sections, and other properties (partition functions, specific heats, cooling functions, lifetimes, and oscillator strengths) based on molecular line lists. PyExoCross calculates cross-sections with four line profiles: Doppler, Gaussian, Lorentzian, and Voigt profiles in both sampling and binned methods; a number of options are available for computing Voigt profiles which we test for speed and accuracy. PyExoCross supports importing and exporting line lists in the ExoMol and HITRAN/HITEMP formats. PyExoCross also provides conversion between the ExoMol and HITRAN data formats. In addition, PyExoCross has extra code for users to automate the batch download of line list files from the ExoMol data base.
Radiological environmental impact analysis of the uranium mining site in Mika, Nigeria using time series forecast model
Authors: Bakut Victor Ntyak , Kim Juyoul
Published: April 2024

This study employs time series forecasting, specifically Seasonal Auto-Regressive Integrated Moving Average, to predict the radiological impact of uranium mining in Mika, Nigeria. By utilizing meteorological data to model the dispersion of radioactive emissions to receptors, allowing for a comprehensive assessment of potential health and environmental consequences. The study observed a slight change in the Total Effective Dose Equivalent (TEDE) at the nearest residence northeast receptor between the actual and the forecasted data. The findings could be largely because of the basement complex rock formations that characterized the Mika region. The study recommend proper monitoring and evaluation should be done before full-scale mining can be carried out. However, the TEDE is generally below the International Atomic Energy Agency recommended level of 1 mSv per y for public exposure. The research demonstrates the significance of predictive modeling in managing and mitigating the radiological risks associated with uranium mining activities. Findings contribute to informed decision-making and sustainable resource extraction practices in Mika, Nigeria.
Are cisnormative surveys adequate to assess sexual well-being in trans men post–genital gender-affirming surgery?
Authors: Loria Matthew , Van Dorn Chloe , Bobrow Aidan , Gautam Aishwarya , Fraiman Elad , McNamara Megan , Gupta Shubham , Mishra Kirtishri
Published: April 2024

Introduction

For transmasculine spectrum individuals, there is a lack of validated surveys to assess sexual well-being (SWB) post–genital gender-affirming surgery. Currently, either providers are designing their own SWB surveys or surveys designed for cisgender men are being used.

Objective

This study investigated the applicability of SWB surveys validated for cisgender men to transmasculine spectrum individuals post–genital gender-affirming surgery (TMSX). Recognizing the paucity of validated tools for assessing SWB in transmasculine individuals post–genital gender-affirming surgery (TMSX), we evaluated current surveys for their inclusiveness and relevance to this population.

Methods

Our methodology involved analyzing surveys validated in English-speaking North American cisgender men. We conducted a systematic review, yielding 31 surveys, out of which 12 met our inclusion criteria. These were then assessed against the 10 domains of holistic SWB as identified by Özer et al. Each survey was scored based on its reflection of these domains, thus generating an SWB score. Additionally, we performed a thematic analysis to identify areas needing modification for better applicability to TMSX.

Results

Our findings indicate an average SWB score of 5.17 out of 10 across the surveys. The surveys predominantly addressed sexual function, with a marked underrepresentation of domains like quality of life, sexuality, and sexual pleasure. This underscores the tendency of these surveys to focus more on the biological mechanisms of sex, rather than on a nuanced biopsychosocial understanding. Thematic analysis revealed significant gaps, such as the irrelevance of questions about erections and ejaculations for TMSX, and the need for greater emphasis on psychosocial factors.

Conclusion

Given these gaps and the inadequacy of most cisnormative surveys, we recommend the creation of a novel, validated SWB survey specifically for TMSX. This should be developed in collaboration with a multidisciplinary panel and TMSX community advisory board, ensuring a tool that truly reflects the unique SWB needs of this population.
Clinical and Radiographic Results After Treatment of Traumatic Syndesmotic Instability Using a Novel Screw-Suture Syndesmotic Fixation Device
Authors: Shaath M. Kareem , Williams Warren A. , Kelly John J. , Garrett Christopher H. , Munro Mark W. , Avilucea Frank R. , Langford Joshua R. , Haidukewych George J.
Published: April 2024

OBJECTIVES:

The objective of this study was to report early outcomes of a novel screw-suture syndesmotic device compared with suture button fixation devices when treating traumatic syndesmotic instability.

METHODS:

Design:

Retrospective chart review.

Setting:

Single academic Level 1 Trauma Center.

Patient Selection Criteria:

All adult patients who had syndesmotic fixation with the novel device [novel syndesmotic repair implant (NSRI) group] compared with a suture button device (SB group) between January 2018 and December 2022.

Outcome Measures and Comparisons:

Medial clear space and tibiofibular overlap measurements were compared immediately postoperatively and at the final follow-up. Patients were followed for a minimum of 1 year or skeletal healing.

RESULTS:

Fifty-nine patients (25 female) with an average age of 47 years (range 19–78 years) were in the NSRI group compared with 52 patients (20 female) with an average age of 41 years (range 18–73 years) in the SB group. There were no significant differences when comparing body mass index, diabetes, or smoking status between groups (P > 0.05). There was no difference when comparing the postoperative and final medial clear space measurements in the NSRI group compared with the SB group (P = 0.86; 95% confidence interval, −0.32 to 0.27). There was no difference when comparing the postoperative and final tibiofibular overlap measurements in the NSRI group compared with the SB group (P = 0.79; 95% confidence interval, −0.072 to 0.09). There were 3 cases of implant removal in the NSRI group compared with 2 in the SB group (P = 0.77). There was 1 failure in the NSRI group and none in the SB group. The remaining patients were all fully ambulatory at the final follow-up (P = 0.35).

CONCLUSIONS:

A novel screw-suture syndesmotic implant provides the fixation of a screw, and the flexibility of a suture had similar radiographic outcomes compared with suture button fixation devices in treating ankle syndesmotic instability.

LEVEL OF EVIDENCE:

Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
Pathogenic Gene Variants Identified in Patients Presenting With Perthes or Perthes-like Hip Disorder
Authors: Marchelli Gabrielle , Mercado Candelaria , Gill Corey S. , Kim Harry K.W.
Published: April 2024

Aims:

Legg-Calve-Perthes disease (LCPD) is a diagnosis of exclusion. Various conditions, such as skeletal dysplasias, can closely mimic LCPD and these must be ruled out to provide appropriate treatment, prognosis, and counseling. Traditionally, genetic testing has not been readily available in pediatric orthopaedic practice. Furthermore, the clinical value of genetic testing patients with LCPD is unclear. With the advance of next-generation sequencing (NGS) technology, genetic testing has become clinically available as a lab test. The purposes of this study were to assess the clinical utility of genetic testing in select patients with LCPD and to determine the patient characteristics of those who tested positive for skeletal dysplasia.

Methods:

This is an IRB-approved, retrospective study of 63 consecutive patients who presented with Perthes-like symptoms and/or x-ray findings and who had genetic testing. The reason(s) for genetic testing included bilateral hip disease, family history of LCPD, short stature, suspected skeletal dysplasia, atypical radiographic findings, and/or combinations of these reasons.

Results:

Of the 63 patients, 19 patients (30%) were found to have a pathogenic gene variant. In 8 of the 19, a variety of skeletal dysplasia was diagnosed. The remaining 11 patients were found to be carriers of autosomal recessive disorders. All 19 patients were referred for genetic counseling. Of the 8 patients found to have skeletal dysplasia, 3 had bilateral disease, 3 were <10 percentile in height, 1 had a family history of “LCPD,” and 3 had atypical x-ray findings. In addition to the pathogenic variants, numerous genetic variants of unknown significance were found with 2 gene variants showing exactly the same variant found in 2 unrelated patients.

Conclusions:

With 30% of the patients showing pathogenic results, genetic testing of select patients with Perthes-like disease is valuable in detecting an underlying genetic disorder or a carrier status of a genetic disorder.
Coping in Women With Breast Cancer Awaiting a Surgical Intervention: A Cross-Sectional Study
Authors: Fortunato Sarah , Danielis Matteo , Zanotti Renzo
Published: April 2024

Background:

Breast cancer affects a woman’s body and mind in complex ways and is more than just a physical condition that requires medical treatment.

Objective:

To investigate how women with breast cancer undergoing surgical treatment cope with and adjust to the disease.

Methods:

A cross-sectional study between April 12 and July 22, 2022. This study adhered to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines.

Results:

A total of 125 women participated (median age 52). Most (64.8%) responded rationally, 25.4% emotionally, and 9.8% nonprevailing. About 76.2% used problem-focused coping. Women living with others had better adaptation than those alone. Emotional appraisal increased the likelihood of poor adaptation compared to rational appraisal. Nonprevailing coping was linked to a 6-fold increase in psychosocial maladjustment (OR, 5.88; 95% CI,1.14-30.30).

Conclusions:

The study indicates that women with breast cancer tend to adopt problem-focused coping strategies, with rational responses correlating with better psychological adaptation outcomes, while emotional or nonprevailing responses may lead to poorer adjustment.

Implications for Practice:

Coping strategies should be shared by oncology nurses with targeted women, especially if their potential for postdiagnosis positive psychological change is considered.

What is Foundational:

Women diagnosed with breast cancer eligible for surgical treatment may undergo a positive psychological transformation, as the majority exhibit a problem-focused, rational approach to the disease.
Lasers for the Treatment of Nonmelanoma Skin Cancer: A Systematic Review of the Literature
Authors: Rosenthal Amanda , Juhasz Margit L.W. , Chang Crystal , Gharavi Nima M.
Published: April 2024

BACKGROUND

Lasers may present an alternative treatment modality for the management of nonmelanoma skin cancer (NMSC).

OBJECTIVE

To investigate lasers as a definitive treatment of NMSC.

METHODS

A comprehensive search was performed on MEDLINE, the Cochrane Library, and the National Institutes of Health (www.clinicaltrials.gov). The Preferred Reporting Items for Systematic Reviews and Meta-Analysis was used to finalize a list of relevant literature studies evaluating the role of laser therapy for NMSC. Articles published through May 1, 2023, were included.

RESULTS

The authors identified 37 studies investigating nonablative and ablative lasers alone and in combination with other lasers, noninvasive imaging, and additional modalities for the treatment of basal cell carcinomas, 10 focusing on squamous cell carcinoma in situ and 3 focusing on the treatment of both basal and squamous cell carcinomas.

CONCLUSION

Although surgical management continues to be superior to laser therapy for the management of high-risk and cosmetically sensitive tumors, laser therapy may be an acceptable alternative for low-risk lesions on the trunk and extremities. However, further studies are needed to optimize parameters, determine maximal efficacy, and provide long-term follow-up before the adoption of laser therapy for NMSC into daily clinical practice.
The association of race, ethnicity, and socioeconomic status on the severity of menopause symptoms: a study of 68,864 women
Authors: Kochersberger Alison , Coakley Aeowynn , Millheiser Leah , Morris Jerrine R. , Manneh Claire , Jackson Alicia , Garrison Jennifer L. , Hariton Eduardo
Published: April 2024

Objective

This study aimed to evaluate if and how race, ethnicity, and socioeconomic status (SES) are associated with the severity of menopause symptoms in a large, diverse sample of women.

Methods

For this cross-sectional study conducted between March 24, 2019, and January 13, 2023, a total of 68,864 women were enrolled from the Evernow online telehealth platform. Participants underwent a clinical intake survey, which encompassed demographic information, detailed medical questionnaires, and a modified Menopause Rating Scale. The modified scale was adapted for ease of use online and is available in the supplementary material along with the full intake. Symptom severity was evaluated using a multivariate binomial generalized linear model, accounting for factors such as race, ethnicity, age, body mass index, smoking status, bilateral oophorectomy status, and SES. Odds ratios (OR) and CIs were calculated based on the linear regression coefficients.

Results

Of the participants, 67,867 (98.6%) were included in the analysis after excluding outliers and those with unknown oophorectomy status. The majority of respondents identified as White (77.4%), followed by Hispanic (9.0%), Black (6.7%), two or more races/ethnicities (4.4%), Asian (1.2%), Indigenous/First Nations (0.8%), Middle Eastern (0.3%), and South Asian (0.2%). Notably, individuals identifying as Black (hot flashes OR, 1.91; 97.5% CI, 1.75-2.09;P< 0.001), Hispanic (skin/hair changes OR, 1.58; 97.5% CI, 1.45-1.71;P< 0.001), Indigenous/First Nations (painful sex OR, 1.39; 97.5% CI, 1.19-2.75;P= 0.007), Middle Eastern (weight changes OR, 2.22; 97.5% CI, 1.25-4.37;P= 0.01), or with two or more races/ethnicities (skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58;P< 0.001) reported higher levels of symptom severity compared with their White counterparts. Conversely, Asian and South Asian participants reported lower symptom severity. Even after incorporating SES into the linear model, racial and ethnic groups with lower SES (Black, Hispanic, Indigenous, and multiple ethnicities) exhibited slight shifts in OR while maintaining high statistical significance (Black [hot flashes OR, 1.87; 97.5% CI, 1.72-2.04;P< 0.001], Hispanic [skin/hair changes OR, 1.54; 97.5% CI, 1.42-1.68;P< 0.001], Indigenous/First Nations [painful sex OR, 1.74; 97.5% CI, 1.17-2.70;P= 0.009], multiple ethnicities [skin/hair changes OR, 1.41; 97.5% CI, 1.26-1.58;P< 0.001]).

Conclusions

Our study suggests that the relationship between race and ethnicity and the severity of menopause symptoms is not solely explained by differences in SES but is itself an independent factor. Understanding and addressing social, cultural, and economic factors are crucial to reduce disparities in menopausal symptoms.
Accuracy of Three-dimensional Scan Technology and Its Possible Function in the Field of Hand Surgery
Authors: Rudari Michele , Breuer Joseph , Lauer Hannes , Stepien Lukas , Lopez Elena , Dragu Adrian , Alawi Seyed A.
Published: April 2024

Background:

Three-dimensional (3D) technology has become a standard manufacturing element in many industries and has gained significant interest in plastic surgery. The 3D scans are widely used for patient communication, virtual surgery planning, and intraoperative tool manufacturing, providing a more comprehensive view of procedures and their outcomes compared with 2D visualization.

Methods:

We evaluated the performance of six commercially available 3D scanners by acquiring 3D models of a human hand and a 3D-printed replica of a human hand. We performed objective comparisons between the 3D models of the replica using color mapping techniques. Moreover, we compared the results of the human hand 3D scans.

Results:

We achieved the highest precision with the Artec Space Spider 3D scanner (Artec 3D) when scanning the 3D-printed replica. The SD was ±0.05 mm, and the scan did not have major defects that needed manual correction. On the human hand scan, we achieved the best results using the Artec Eva (Artec 3D), the resulting scan was an accurate digital representation of the scanned human hand.

Conclusions:

In our study, the Artec Space Spider 3D scanner demonstrated superior precision when scanning a 3D-printed replica, deviating only slightly from the original data, making it an optimal choice for nonmoving objects such as casts or medical instruments. For scanning human hands, the Artec Eva 3D scanner exhibited the highest performance, offering accuracy comparable to the Artec Space Spider, but with the added benefit of being able to scan larger objects.
Cost-Effectiveness of Sleep Apnea Diagnosis and Treatment in Hospitalized Persons With Moderate to Severe Traumatic Brain Injury
Authors: Tsalatsanis Athanasios , Dismuke-Greer Clara , Kumar Ambuj , Hoffman Jeanne , Monden Kimberley R. , Magalang Ulysses , Schwartz Daniel , Martin Aaron M. , Nakase-Richardson Risa
Published: April 2024

Objective:

To assess the cost-effectiveness of alternative approaches to diagnose and treat obstructive sleep apnea (OSA) in patients with traumatic brain injury (TBI) during inpatient rehabilitation.

Setting:

Data collected during the Comparison of Sleep Apnea Assessment Strategies to Maximize TBI Rehabilitation Participation and Outcome (C-SAS) clinical trial (NCT03033901) on an inpatient rehabilitation TBI cohort were used in this study.

Study Design:

Decision tree analysis was used to determine the cost-effectiveness of approaches to diagnosing and treating sleep apnea. Costs were determined using 2021 Centers for Medicare and Medicaid Services reimbursement codes. Effectiveness was defined in terms of the appropriateness of treatment. Costs averted were extracted from the literature. A sensitivity analysis was performed to account for uncertainty. Analyses were performed for all severity levels of OSA and a subgroup of those with moderate to severe OSA. Six inpatient approaches using various phases of screening, testing, and treatment that conform to usual care or guideline-endorsed interventions were evaluated: (1) usual care; (2) portable diagnostic testing followed by laboratory-quality testing; (3) screening with the snoring, tiredness, observed apnea, high BP, BMI, age, neck circumference, and male gender (STOP-Bang) questionnaire; (4) Multivariable Apnea Prediction Index (MAPI) followed by portable diagnostic testing and laboratory-quality testing; (5) laboratory-quality testing for all; and (6) treatment for all patients.

Main Measures:

Cost, Effectiveness, and Incremental Cost-Effectiveness Ratio (ICER).

Results:

Phased approaches utilizing screening and diagnostic tools were more effective in diagnosing and allocating treatment for OSA than all alternatives in patients with mild to severe and moderate to severe OSA. Usual care was more costly and less effective than all other approaches for mild to severe and moderate to severe OSA.

Conclusions:

Diagnosing and treating OSA in patients with TBI is a cost-effective strategy when compared with usual care.
Intraoperative trypan blue central landmark and its use in capsulotomy and capsulorhexis centration
Authors: Stodulka Pavel , Packard Richard , Mordaunt David
Published: April 2024

Purpose:

To compare 3 capsulotomy centration methods.

Setting:

Private clinic, Zlin, Czech Republic.

Design:

Prospective, consecutive case series.

Methods:

180 eyes undergoing cataract surgery had anterior capsule staining with microfiltered 0.4% trypan blue solution before selective laser capsulotomy. The first 60 eyes (Group 1) had mydriatic dilated pupil centered capsulotomies. The next 60 eyes (Group 2) were centered on the trypan blue central landmark (TCL). The final 60 capsulotomies (Group 3) were centered on the patient fixated coaxial Purkinje reflex (CPR). Measurements between key anatomical landmarks and the TCL, CPR capsulotomies, and implanted intraocular lens (IOL) center were made.

Results:

The TCL, observed in >94% of eyes in the study, coincided with the CPR with a displacement of <0.1 ± 0.1 mm. Group 1 capsulotomies were noticeably decentered on the IOLs by 0.3 ± 0.2 mm. The Group 2 symmetrical IOL relationship was maintained with a decentration of 0.15 ± 0.1 mm. Group 3 had a similar decentration with the IOLs with 0.15 ± 0.1 mm. Verification with IOLMaster 700 data and CALLISTO Eye System showed that the CPR and the TCL were coincident with the measured visual axis.

Conclusions:

The clearly visible TCL served as an alternate landmark to the patient fixated CPR, and being on the anterior capsule was not sensitive to tilt. Further patient compliance was not required. Both were superior to dilated pupil centration, to achieve symmetric IOL coverage. This has application for both capsulotomies and capsulorhexes.
Assessment of iodine nutritional status and gestational thyroid function reference ranges during the first trimester of pregnancy in Taiwan
Authors: Su Guan-Yu , Yeh Chang-Ching , Yang Shun-Jie , Yang Chen-Chang , Hwu Chii-Min , Wang Fan-Fen , Huang Chun-Jui
Published: April 2024

Background:

Iodine nutrition is critical for fetal neurodevelopment in the first trimester of pregnancy, a period associated with dramatic changes in thyroid function. The aim of this study was to evaluate iodine nutritional status and thyroid function reference ranges in the first trimester in Taiwan.

Methods:

Pregnant women aged 20 years and above in the first trimester were recruited in Taipei Veterans General Hospital, Taiwan from March 2019 to July 2022. Each participant provided a spot urine sample for measurement of urinary iodine concentration (UIC) and a blood sample for checkup of thyroid function and thyroid autoantibodies. A simple food frequency questionnaire was also completed.

Results:

A total of 209 women with a mean age of 32.9 ± 4.4 years were enrolled. The median UIC was 160.9 μg/L (interquartile range [IQR]: 105.0-246.2 μg/L), indicating overall iodine sufficiency. The gestational thyroid function reference ranges were: thyroid stimulating hormone (TSH) (median: 0.93 [0.007-2.9] µIU/mL), free T4 (1.3 [0.93-2.2] ng/dL), free T3 (3.0 [2.3-5.0] ng/dL), total T4 (9.9 [6.4-16.9] ng/dL), and total T3 (135 [88-231] ng/dL). If the nonpregnant reference range of serum TSH was used, eight women (4.8%) would be misclassified as having subclinical hyperthyroidism, and two women (1.2%) with subclinical hypothyroidism would be missed. In multivariate analysis, nulliparous (adjusted odds ratio [OR] from model 1-3: 2.02, 2.05, 2.02; 95% CI, 1.08-3.77, 1.10-3.81, 1.11-3.66; p = 0.027, 0.023, 0.022, respectively) and multivitamin nonusers (adjusted OR from model 1-3: 1.86, 1.85, 1.78; 95% CI, 1.04-3.34, 1.03-3.32, 1.004-3.71; p = 0.038, 0.039, 0.049, respectively) had increased odds of having lower UIC levels <150 μg/L.

Conclusion:

The iodine nutritional status in the first trimester is adequate in Taiwan; however, certain subgroups such as nulliparous and multivitamin nonusers are still at risk for iodine deficiency. Gestational thyroid function reference ranges are needed for correct diagnosis of thyroid dysfunction in pregnancy.
Unraveling variations and enhancing prediction of successful sphincter-preserving resection for low rectal cancer: a post hoc analysis of the multicentre LASRE randomized clinical trial
Authors: Wang Xiaojie , Jiang Weizhong , Deng Yu , Chen Zhifen , Zheng Zhifang , Sun Yanwu , Xie Zhongdong , Lu Xingrong , Huang Shenghui , Lin Yu , Huang Ying , Chi Pan
Published: April 2024

Background:

Accurate prediction of successful sphincter-preserving resection (SSPR) for low rectal cancer enables peer institutions to scrutinize their own performance and potentially avoid unnecessary permanent colostomy. The aim of this study is to evaluate the variation in SSPR and present the first artificial intelligence (AI) models to predict SSPR in low rectal cancer patients.

Study design:

This was a retrospective post hoc analysis of a multicenter, non-inferiority randomized clinical trial (LASRE, NCT01899547) conducted in 22 tertiary hospitals across China. A total of 604 patients who underwent neoadjuvant chemoradiotherapy (CRT) followed by radical resection of low rectal cancer were included as the study cohort, which was then split into a training set (67%) and a testing set (33%). The primary end point of this post hoc analysis was SSPR, which was defined as meeting all the following criteria: (1) sphincter-preserving resection; (2) complete or nearly complete TME, (3) a clear CRM (distance between margin and tumour of 1 mm or more), and (4) a clear DRM (distance between margin and tumour of 1 mm or more). Seven AI algorithms, namely, support vector machine (SVM), logistic regression (LR), extreme gradient boosting (XGB), light gradient boosting (LGB), decision tree classifier (DTC), random forest (RF) classifier, and multilayer perceptron (MLP), were employed to construct predictive models for SSPR. Evaluation of accuracy in the independent testing set included measures of discrimination, calibration, and clinical applicability.

Results:

The SSPR rate for the entire cohort was 71.9% (434/604 patients). Significant variation in the rate of SSPR, ranging from 37.7 to 94.4%, was observed among the hospitals. The optimal set of selected features included tumour distance from the anal verge before and after CRT, the occurrence of clinical T downstaging, post-CRT weight and clinical N stage measured by magnetic resonance imaging. The seven different AI algorithms were developed and applied to the independent testing set. The LR, LGB, MLP and XGB models showed excellent discrimination with area under the receiver operating characteristic (AUROC) values of 0.825, 0.819, 0.819 and 0.805, respectively. The DTC, RF and SVM models had acceptable discrimination with AUROC values of 0.797, 0.766 and 0.744, respectively. LR and LGB showed the best discrimination, and all seven AI models had superior overall net benefits within the range of 0.3–0.8 threshold probabilities. Finally, we developed an online calculator based on the LGB model to facilitate clinical use.

Conclusions:

The rate of SSPR exhibits substantial variation, and the application of AI models has demonstrated the ability to predict SSPR for low rectal cancers with commendable accuracy.
Diagnostic accuracy of artificial intelligence assisted clinical imaging in the detection of oral potentially malignant disorders and oral cancer: a systematic review and meta-analysis
Authors: Li JingWen , Kot Wai Ying , McGrath Colman Patrick , Chan Bik Wan Amy , Ho Joshua Wing Kei , Zheng Li Wu
Published: April 2024

Background:

The objective of this study is to examine the application of artificial intelligence (AI) algorithms in detecting oral potentially malignant disorders (OPMD) and oral cancerous lesions, and to evaluate the accuracy variations among different imaging tools employed in these diagnostic processes.

Materials and methods:

A systematic search was conducted in four databases: Embase, Web of Science, PubMed, and Scopus. The inclusion criteria included studies using machine learning algorithms to provide diagnostic information on specific oral lesions, prospective or retrospective design, and inclusion of OPMD. Sensitivity and specificity analyses were also required. Forest plots were generated to display overall diagnostic odds ratio (DOR), sensitivity, specificity, negative predictive values, and summary receiver operating characteristic (SROC) curves. Meta-regression analysis was conducted to examine potential differences among different imaging tools.

Results:

The overall DOR for AI-based screening of OPMD and oral mucosal cancerous lesions from normal mucosa was 68.438 (95% CI= [39.484–118.623], I
2=86%). The area under the SROC curve was 0.938, indicating excellent diagnostic performance. AI-assisted screening showed a sensitivity of 89.9% (95% CI= [0.866–0.925]; I
2=81%), specificity of 89.2% (95% CI= [0.851–0.922], I
2=79%), and a high negative predictive value of 89.5% (95% CI= [0.851–0.927], I
2=96%). Meta-regression analysis revealed no significant difference among the three image tools. After generating a GOSH plot, the DOR was calculated to be 49.30, and the area under the SROC curve was 0.877. Additionally, sensitivity, specificity, and negative predictive value were 90.5% (95% CI [0.873–0.929], I
2=4%), 87.0% (95% CI [0.813–0.912], I
2=49%) and 90.1% (95% CI [0.860–0.931], I
2=57%), respectively. Subgroup analysis showed that clinical photography had the highest diagnostic accuracy.

Conclusions:

AI-based detection using clinical photography shows a high DOR and is easily accessible in the current era with billions of phone subscribers globally. This indicates that there is significant potential for AI to enhance the diagnostic capabilities of general practitioners to the level of specialists by utilizing clinical photographs, without the need for expensive specialized imaging equipment.
Aspirin versus low-molecular-weight heparin for thromboprophylaxis after orthopaedic surgery: a systematic review and meta-analysis
Authors: Wu Haichao , Zhou Long , Wang Qiang , Wang Tao , Liang Siyuan
Published: April 2024

The article aimed to compare the efficiency and safety of aspirin with low-molecular-weight heparin (LMWH) for thromboprophylaxis in orthopaedic surgery patients. According to the inclusion and exclusion criteria, PubMed, Embase and Cochrane Library database were searched for studies comparing aspirin and LMWH in venous thromboembolism (VTE) prophylaxis until 25 April 2023. The outcome measures included deep venous thrombosis(DVT)/Pulmonary embolism(PE) events, major bleeding events, wound complications, wound infection and death. Six studies met the requirements of our meta-analysis, including 12 470 patients in the aspirin group and 10 857 patients in the LMWH group. The meta-analysis showed that results showed that LMWH was superior to aspirin in preventing VTE events (odds ratio (OR) 1.44, 95% CI 1.24–1.68, P < 0.00001), whereas there was no significant difference between them in bleeding events (OR 0.95, 95% CI 0.86–1.05, P = 0.33), wound complication (OR 0.58, 95% CI 0.28–1.17, P = 0.13), wound infection (OR 1.12, 95% CI 0.86–1.47, P = 0.39) and mortality (OR 1.04, 95% CI 0.70–1.55, P = 0.83). In addition, subgroup analysis showed that compared with aspirin, LMWH was more likely to reduce the incidence of DVT events in orthopaedic surgery patients (OR 1.59, 95% CI 1.33–1.91, P < 0.00001), whereas there was no advantage in reducing the incidence of PE events (OR 1.22, 95% CI 0.62–2.40, P = 0.56). Despite the similar safety profiles, this meta-analysis showed that LMWH was significantly superior to aspirin in thromboprophylaxis after orthopaedic surgery. LMWH was still the first-line drug for thrombosis prevention in patients who underwent major orthopaedic surgeries.
Unveiling the Uncommon: A Unique Case of ALPS-like Syndrome Complicated by Plasma Cell Disorder
Authors: Brizini Meziane , Michon Bruno , Bédard Marc-Antoine
Published: April 2024

Multiple myeloma is a rare disease in pediatrics, where about 30 cases are described under 15 years old. It is even rarer when atypical multiple myeloma occurs in the context of autoimmunity. This case describes a 9-year-old female with autoimmune lymphoproliferative-like disease and combined immune deficiency that developed acute kidney failure with monoclonal peak associated with RAC2 and TNFRSF9 variants. An adapted protocol from the backbone adult multiple myeloma standard of care with the addition of an allogeneic hematopoietic stem cell transplant was used. The patient, now nearly a year posttransplant, shows 100% chimerism with no sign of relapse.
A Ropivacaine-Eluting Poly(Lactide-Co-Caprolactone) Wound Dressing Provided Enhanced Analgesia in Partial-Thickness Porcine Injuries
Authors: Niederauer Stefan , Beeman Mike , Cleveland Andrew , Wojtalewicz Susan , Erickson Sierra , Reilly Christopher A. , Rower Joseph E. , Garrett Caroline , Floyd Candace , Shea Jill , Agarwal Jay , Lade Caleb , Davis Brett
Published: April 2024

Background:

Partial-thickness skin wounds are some of the most painful injuries because of large areas of exposed nerve endings. These injuries often require systemic opioid treatment to manage pain adequately. However, the Centers for Disease Control and Prevention reported nearly 17,000 prescription opioid-related deaths in the United States in 2021 alone, highlighting the ongoing need for nonopioid treatment strategies. The authors developed a novel single-application ropivacaine-eluting primary wound dressing that could provide sustained ropivacaine delivery to partial-thickness wounds and assessed its in vivo feasibility for prolonged nonopioid analgesia.

Methods:

Sustained release of ropivacaine from a poly(lactide-co-caprolactone) matrix was first optimized in vitro using dissolution testing and a Box Behnken design of experiments. The optimized dressing was then tested against a clinical control silicone dressing in a porcine partial-thickness wound study to assess analgesic effect, pharmacokinetics, and wound healing.

Results:

The ropivacaine-eluting dressing showed a moderate analgesic effect in vivo, where normalized single pinprick scores significantly improved pain over the testing period (4 to 168 hours) (control versus treatment: 232 ± 25% versus 145 ± 16%; P < 0.0003). Ropivacaine blood plasma levels peaked at 8 hours after treatment, with a maximum concentration of 246 ± 74 ng/mL. No significant differences in wound healing were found when compared with control.

Conclusion:

The ropivacaine-loaded poly(lactide-co-caprolactone)–based wound dressing provided sustained delivery of ropivacaine to partial-thickness skin wounds and enhanced analgesic effect compared with a clinical standard control dressing.

Clinical Relevance Statement:

This article describes the development and porcine testing of an analgesic wound dressing for management of acute pain in partial-thickness dermal wounds.