bluuebunny/crossref_metadata_2025 huggingface dataset:
Whose Revisionism, Which International Order? Social Structure and Its Discontents
Authors: Kustermans Jorg , de Carvalho Benjamin , Beaumont Paul
Published: March 2023

While the distinction between status quo and revisionist states is well established in International Relations, only more recently have scholars begun to refine the concept of revisionism itself, emphasizing that revisionism comes in different forms. A number of typologies have been introduced to capture this diversity. In this article, we offer a critique of these typologies, highlighting how many of these works elide the rule-governed and contextual nature of what counts as revisionism. Building on an understanding of international orders as social structures, we argue that the revisionist character of state conduct can only be determined with reference to the conception of the legitimate ends and means current in a particular international order. This leads us to distinguish between three types of revisionism: competitive revisionism that is transgressive of the legitimate means; creative revisionism that is transgressive of the legitimate ends; and revolutionary revisionism that is transgressive of legitimate ends and means. We further emphasize that determining the revisionist character of state conduct always involves interpretation and judgment. The concern for analytical precision conveyed by the development of different typologies of revisionism must therefore be followed by an equally deliberate concern for the politics of revisionism—in both theory and practice.
Trophic preferences of Anopheles coluzzii (Diptera: Culicidae): what implications for malaria vector control in Benin?
Authors: Padonou Germain Gil , Zoungbédji David Mahouton , Sovi Arthur , Salako Albert Sourou , Konkon Alphonse Keller , Yovogan Boulais , Adoha Constantin Jesukèdè , Odjo Esdras Mahoutin , Osse Razaki , Sina Haziz , Govoétchan Renaud , Kpanou Casimir Dossou , Sagbohan Hermann W , Baba-Moussa Lamine , Akogbéto Martin
Published: March 2023

The main objective of the present study is to assess the preferences in terms of vertebrate hosts of Anopheles coluzzii, the main malaria vector in the pastoral area of Malanville, Benin, where rice cultivation and livestock are the main source of income for the populations. Adult mosquitoes were collected through pyrethrum spray catch, and human landing catch in two communes in Benin: Malanville, a pastoral area, and Porto-Novo, a nonpastoral area. Molecular species identification was performed through PCR within the Anopheles gambiae complex. Blood meal origin and P. falciparum sporozoite infection were determined using ELISA blood meal and circumsporozoite protein tests, respectively. Overall, 97% of females of An. gambiae s.l. were An. coluzzii, with biting behavior more pronounced outdoors in the pastoral area. In Malanville, the main vertebrate hosts on which females An. coluzzii blood fed were goats (44%), humans (24.29%), bovines (22%), and pigs (1.4%). Our results also showed that single-host blood meals (human: 24.29% or animal: 68%) were mostly observed compared to mixed blood meals (8.58%). The human biting rate (HBR) and P. falciparum sporozoite rate (SR) of An. coluzzii were 66.25 bites/man/night and 0.77%, respectively. However, in the nonpastoral zone (Porto-novo), 93.98% of samples were An. coluzzii. The latter blood-fed mostly (86.84%) on humans, with an estimated HBR of 21.53 b/m/n and SR of 5.81%. The present study revealed an opportunistic and zoophagic behavior of An. coluzzii in the Malanville area with an overall low mean SR.
The Efficiency ofSchistosoma mansoniCrude Antigens in Inhibition of Heat Shock Protein, Apoptosis, and Lysosomal Activity: An Immunohistochemical Study
Authors: Alnasser Sulaiman Mohammed , Alotaibi Meshal , Ramadan Nancy K , Abd ElHafeez Hanan H , Abdel-Hakeem Sara Salah
Published: March 2023

The adverse impact of schistosomiasis on tissues is considered in generating a schistosomal vaccine. The purpose of this study was to evaluate the effectiveness of Schistosoma mansoni crude antigens as a therapeutic and prophylactic formulation in the inhibition of heat shock protein, apoptosis, and CD3/CD20 expression in a liver and spleen mouse models using the immunohistochemistry method. A total of 65 mice were divided into five groups: (i) infected untreated group (G1), (ii) therapeutic treated group (G2) with egg soluble egg antigen (SEA), and soluble worm antigen preparation (SWAP), (iii) prophylactically treated group (G3) with cercarial antigen preparation (CAP), (iv) combined treated group with three antigens (G4), and (v) control group (G5). The results we obtained showed that CAP, SEA, and SWAP antigens mitigated the deterioration and inflammation induced by infection. Apoptosis and sinusoidal injuries were significantly reduced when treated with CAP antigen before infection. After infection, using SEA and SWAP antigens may help lighten the liver's load. A high degree of activation in T and B cells in the liver and spleen is linked to this. Our findings shed light on the immunological mechanisms that contribute to the recovery from therapy and vaccination against schistosome damage.
Unusual enantioselective cytoplasm-to-nucleus translocation and photosensitization of the chiral Ru(II) cationic complex via simple ion-pairing with lipophilic weak acid counter-anions
Authors: Chao Xi-Juan , Huang Chun-Hua , Tang Miao , Yan Zhu-Ying , Huang Rong , Li Yan , Zhu Ben-Zhan
Published: March 2023

Targeted and enantioselective delivery of chiral diagnostic-probes and therapeutics into specific compartments inside cells is of utmost importance in the improvement of disease detection and treatment. The classical DNA ‘light-switch’ ruthenium(II)-polypyridyl complex, [Ru(DIP)2(dppz)]Cl2 (DIP = 4,7-diphenyl-1,10-phenanthroline, dppz = dipyridophenazine) has been shown to be accumulated only in the cytoplasm and membrane, but excluded from its intended nuclear DNA target. In this study, the cationic [Ru(DIP)2(dppz)]2+ is found to be redirected into live-cell nucleus in the presence of lipophilic 3,5-dichlorophenolate or flufenamate counter-anions via ion-pairing mechanism, while maintaining its original DNA recognition characteristics. Interestingly and unexpectedly, further studies show that only the Δ-enantiomer is selectively translocated into nucleus while the Λ-enantiomer remains trapped in cytoplasm, which is found to be mainly due to their differential enantioselective binding affinities with cytoplasmic proteins and nuclear DNA. More importantly, only the nucleus-relocalized Δ-enantiomer can induce obvious DNA damage and cell apoptosis upon prolonged visible-light irradiation. Thus, the use of Δ-enantiomer can significantly reduce the dosage needed for maximal treatment effect. This represents the first report of enantioselective targeting and photosensitization of classical Ru(II) complex via simple ion-pairing with suitable weak acid counter-anions, which opens new opportunities for more effective enantioselective cancer treatment.
The molecular grammar of protein disorder guiding genome-binding locations
Authors: Jonas Felix , Carmi Miri , Krupkin Beniamin , Steinberger Joseph , Brodsky Sagie , Jana Tamar , Barkai Naama
Published: March 2023

Intrinsically disordered regions (IDRs) direct transcription factors (TFs) towards selected genomic occurrences of their binding motif, as exemplified by budding yeast's Msn2. However, the sequence basis of IDR-directed TF binding selectivity remains unknown. To reveal this sequence grammar, we analyze the genomic localizations of >100 designed IDR mutants, each carrying up to 122 mutations within this 567-AA region. Our data points at multivalent interactions, carried by hydrophobic—mostly aliphatic—residues dispersed within a disordered environment and independent of linear sequence motifs, as the key determinants of Msn2 genomic localization. The implications of our results for the mechanistic basis of IDR-based TF binding preferences are discussed.
Automating microbial taxonomy workflows with PHANTASM: PHylogenomic ANalyses for the TAxonomy and Systematics of Microbes
Authors: Wirth Joseph S , Bush Eliot C
Published: March 2023

The nucleotide sequences of 16S ribosomal RNA (rRNA) genes have been used to inform the taxonomic placement of prokaryotes for several decades. Whole-genome approaches can better resolve evolutionary relationships of organisms, but these analyses often require computational proficiencies that are uncommon among microbiologists. PHANTASM is a new tool capable of automating these workflows. This tool was designed to work for a wide range of prokaryotes and is the first example of an automated reconciliation of NCBI’s Taxonomy database with that of the List of Prokaryotic names with Standing in Nomenclature (LPSN). In this study, we describe the workflow of PHANTASM and provide several examples of results generated by it. The source code is freely-available on GitHub. In order to facilitate the ease-of-access for researchers, PHANTASM is also available as a Docker image. While other tools exist to facilitate starting points for these analyses, PHANTASM provides users with a greater degree of control and produces outputs that can be used to make publication-quality figures.
Geographies of the Future
Authors: Simandan Dragos
Published: March 2023

Geographers have become increasingly preoccupied with the problematic of the future in recent decades, but it would be misleading and premature to think of this emerging, diffuse, inchoate area of research as a distinct subdiscipline. One can point out multiple clues that indicate this preformal, undefined status. Firstly, there are no geography journals exclusively dedicated to this research area. Secondly, there are few if any geographers who self-identify on their professional webpages as having expertise in the geographies of the future. Thirdly, when one reads the reference lists of papers published on the geographies of the future, there is often a striking contrast between the abundance of references to geographic scholarship and the paucity of references to the interdisciplinary field of futures studies and its main journals (Futures; Foresight; International Journal of Forecasting; Futures & Foresight Science; Journal of Futures Studies; and Technological Forecasting and Social Change). In other words, if one reads, for example, a paper on the cultural geography of the future, most of its references are likely to be drawn from cultural geography, with few, if any drawn from the established interdisciplinary area of futures studies. It remains to be seen if in the next decades the diffuse research domain of the geographies of the future will become more conscious of itself, more self-aware, and more connected with the communities of practice associated with interdisciplinary futures studies. In this context, this chapter can be seen not as a neutral description of a research area of geography, but as a performative intervention that might contribute to bringing this field into being, or at least to stabilizing it into an academic entity that can become a sufficiently distinct object of reflection, with its own community of practice. Leaving aside the general overviews of the field, this chapter structures the presentation of the current state of the geographies of the future into six interrelated clusters of scholarship: (1) Historical and Cultural Geographies of the Future (2) Geographies of Uncertainty, Risk, and Contingency; (3) Geographies of Algorithms, Artificial Intelligence, Automation, and Autonomous Vehicles; (4) The Future as a Problem for Neoliberal Governmentality; (5) Geographies of Postcapitalist Futures; and (6) Race, Gender, and the Future.
High-Quality Genome Assembly and Annotation Resource of Elsinoë annonae, Causing Fruit Scab on Camellia oleifera
Authors: Bao Jiandong , Su Jiyu , Wang Yinping , Liang Xinyu , Yu Hao , Zhu Xueming , Li Lin , Hu Hongli
Published: March 2023

Elsinoë annonae is a fungal pathogen that causes fruit scab disease in the edible-oil (tea oil) plant (Camellia oleifera Abel). The absence of genome resources for this fungus hampers functional genetic studies of the pathogenesis mechanism of E. annonae. This study reports the genome assembly of E. annonae strain SM-YC-2 collected from tea oil tree fruit with scab disease in Fujian Province, China. Combining 16.44 Gb of PacBio Sequel II long reads and 5.13 Gb of Illumina NovaSeq reads, we generated a 25.93-Mb (99.19% of expected genome size) high-quality genome assembly with 52.66% GC content, 5.05% repeats, and over 98% Benchmarking Universal Single-Copy Orthologs completeness for E. annonae strain SM-YC-2. These high-quality genome assembly resources will facilitate functional genomic characterization studies, enhance insights into the pathogenicity mechanism of E. annonae, and support the development of molecular-based control strategies.
Concurrent Control of Two Aphid-Borne Potyviruses in Cucurbits by Two-in-One Vaccine
Authors: Tran Thi-Ngoc-Bich , Cheng Hao-Wen , Xie Xing-Yun , Raja Joseph A. J. , Yeh Shyi-Dong
Published: March 2023

The application of attenuated viruses has been widely practiced for protecting crops from infection by related severe strains of the same species. Papaya ringspot virus W-type (PRSV W) and zucchini yellow mosaic virus (ZYMV) devastate cucurbits worldwide. However, the prevailing of these two viruses in cucurbits cannot be prevented by a single protective virus. In this study, we disclosed that co-infection of horn melon plants by two mild strains, PRSV P-type (PRSV P) HA5-1 and ZYMV-ZAC (a previously developed mild mutant of ZYMV) confers concurrent protection against PRSV P and ZYMV. Consequently, mild mutants of PRSV W were created by site-directed mutagenesis through modifications of the pathogenicity motifs FRNK and PD in helper component-protease (HC-Pro). A stable PRSV W mutant WAC (PRSV-WAC) with R181I and D397N mutations in HC-Pro was generated, inducing mild mottling, followed by symptomless recovery in cucurbits. Horn melon plants pre-infected by PRSV-WAC and ZYMV-ZAC showed no apparent interference on viral accumulation with no synergistic effects on symptoms. An agroinfiltration assay of mixed HC-Pros of WACHC-Pro + ZACHC-Pro revealed no additive effect of RNA silencing suppression. PRSV-WAC or ZYMV-ZAC alone only antagonized a severe strain of homologous virus, while co-infection with these two mild strains provided complete protection against both PRSV W and ZYMV. Similar results were reproduced in muskmelon and watermelon plants, indicating the feasibility of a two-in-one vaccine for concurrent control of PRSV W and ZYMV in cucurbits.
Genome Sequence Resource for Xanthomonas oryzae pv. oryzae (Causal Agent of Bacterial Leaf Blight of Rice) Isolated from Pakistan
Authors: Ejaz Khansa , Zakria Muhammad , Tapia Jose Huguet , Zhang Peiqi , Faiq Ali , Ahsan Rafia , Arif M. , Asif M. , White Frank F. , Yasmin Sumera
Published: March 2023

Bacterial leaf blight, one of the most destructive diseases of rice, is prevalent in the major rice-growing regions of the world. Bacterial leaf blight is caused by Xanthomonas oryzae pv. oryzae ( Xoo) and greatly affects the quantity and quality of the rice crop. We sequenced the whole genome of Xoo isolated from a Basmati rice-growing region of Pakistan using long-read Oxford Nanopore sequencing technology. About 637 MB of data was retrieved, corresponding to 133× genome sequencing coverage. The final assembly yields a circular chromosome of 4,930,682 bp. The complete genome of the Xoo isolate from Pakistan will enhance sequence resources for global comparison of Xoo diversity across the region.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
The Value of Applying a Continuous Nursing Model Based on Virtual Platforms for Patients with Colostomy or Ileostomy
Authors: Hao Ju , Xu Yanyan , Li Huiyan
Published: March 2023

OBJECTIVE

To explore the application potential of continuous nursing training based on a comprehensive virtual platform in patients with colostomy or ileostomy.

METHODS

A total of 100 patients with colostomy or ileostomy were equally divided into two groups. Patients in the control group received standardized routine care, whereas patients in the experimental group received continuous nursing care through the virtual platform. Both the control group and the experimental group were followed up by regular telephone calls once per week and completed the following questionnaires both 1 week after discharge and 3 months after discharge: Stoma Care Self-efficacy Scale, Exercise of Self-care Agency Scale, State-Trait Anxiety Inventory, Short Form-36 Health Survey Questionnaire, and a questionnaire on postoperative complications.

RESULTS

Patients in the experimental group, who received continuous care, exhibited significantly higher scores in self-efficacy (P = .029), self-care responsibility (P = 0.030), state anxiety and trait anxiety (both Ps < .001), and mental health (P < .001) 1 week after discharge in comparison with patients in the control group. At 3 months postdischarge, compared with the control group, the experimental group showed significant advantages in all dimensions of self-efficacy, self-care ability, mental health, and quality-of-life questionnaires (P < .001). In addition, the incidence of complications in the experimental group was significantly lower (P < .0001).

CONCLUSIONS

The virtual platform-based continuous nursing model effectively improves the self-care ability and self-efficacy of patients with a colostomy or ileostomy after colorectal cancer, thereby promoting an improved quality of life and psychological state while simultaneously reducing the incidence of complications after discharge.
Association Between the Bone Density of Posterior Fusion Mass and Mechanical Complications After Thoracolumbar Three-Column Osteotomy for Adult Spinal Deformity
Authors: Cho Jae Hwan , Lau Darryl , Ashayeri Kimberly , Deviren Vedat , Ames Christopher P.
Published: March 2023

Study Design.

Retrospective comparative study

Objective.

To assess the relationship of fusion mass bone density on computed tomography (CT) and the development of rod fractures (RFs) and proximal junctional kyphosis (PJK).

Summary of Background Data.

Few studies have evaluated the relationship of fusion mass bone density to mechanical complications.

Materials and Methods

A retrospective review of adult spinal deformity patients who underwent thoracolumbar three-column osteotomy from 2007 to 2017 was performed. All patients underwent routine 1-year CT imaging and had at least 24 months follow-up. Posterior fusion mass bone density was evaluated by measuring hounsfield unit (HU) on CT in three different regions [upper instrumented vertebra (UIV), lower instrumented vertebra, and osteotomy site], and were compared between patients with and without mechanical complications.

Results:

A total of 165 patients (63.2 years, 33.5% male) were included. Overall PJK rate was 18.8%, and 35.5% of these underwent PJK revision. There was significantly lower density of posterior fusion mass at the UIV in patients who experienced PJK compared with patients without PJK (431.5HU vs. 537.4HU, P=0.026). Overall RF rate was 34.5% and 61.4% of these underwent revision for RFs. Among 57 patients with RFs, 71.9% had pseudarthrosis. Fusion mass density did not differ between patients with or without RFs. However, in RF patients with pseudarthrosis, there was significantly higher bone mass density near the osteotomy compared with those without pseudarthrosis (515.7HU vs. 354.2HU, P=0.012). There were no differences in radiographic sagittal measures between the patients with and without RF or PJK.

Conclusions:

Patients with PJK tend to have less dense posterior fusion mass at the UIV. Fusion mass density does not correlate with RF, but greater bone density near the osteotomy was correlated with accompanying pseudarthrosis in patients with RFs. Assessing density of posterior fusion mass on CT may be helpful in assessing risk for PJK and provide insight as to the causes of RFs.
Trends in Racial, Ethnic, and Gender Diversity in Orthopedic Surgery Spine Fellowships From 2007 to 2021
Authors: Trenchfield Delano , Murdock Christopher J. , Destine Henson , Jain Amit , Lord Elizabeth , Aiyer Amiethab
Published: March 2023

Study Design.

Descriptive

Objective.

The objective of this study is to analyze trends in racial, ethnic, and gender diversity in orthopedic spine surgery fellowship trainees.

Summary of Background Data.

Orthopedic surgery has consistently been labeled as one of the least diverse fields in Medicine. Although some effort has been made to combat this in recent years at the residency level, it is uncertain whether spine fellowships have had any changes in fellow demographics.

Materials and Methods.

Fellowship demographic data were collected through the Accreditation Council for Graduate Medical Education. Data collected included gender (male, female, and not reported) and race (White, Asian, Black, Hispanic, Native Hawaiians, American Indian or Alaskan Native, other, and unknown). Percentage equivalents were calculated for each group from 2007 to 2008 to 2020 to 2021. A χ2 test for trend (Cochran-Armitage test) was done to determine whether there was a significant change in percentages of each race and gender during the study period. The results were considered statistically significant at P<0.05.

Results.

White, Non-Hispanic males represent the largest proportion of orthopedic spine fellowship positions each year. From 2007 to 2021, there were no significant changes in the representation of any race or gender of orthopedic spine fellows. Males ranged from 81% to 95%, Whites from 28% to 66%, Asians from 9% to 28%, Blacks from 3% to 16%, and Hispanics from 0% to 10%. Native Hawaiians and American Indians remained at 0% for all years included in the study. Females and all races, excluding Whites, continue to be under-represented in orthopedic spine fellowship.

Conclusions.

Orthopedic spine surgery fellowship programs have not made substantial progress in diversifying its population. More attention is needed to increase diversity in residency programs through pipeline programs, increased mentorship and sponsorship, and early exposure to the field.

Level of Evidence.

1.
Recognition of Critically Ill Patients by Acute Healthcare Providers: A Multicenter Observational Study*
Authors: Kuit Merijn , Veldhuis Lars Ingmar , Hollmann Markus , Nanayakkara Prabath , Ridderikhof Milan
Published: March 2023

OBJECTIVES:

Although the Modified Early Warning Score (MEWS) is increasingly being used in the acute care chain to recognize disease severity, its superiority compared with clinical gestalt remains unproven. Therefore, the aim of this study was to compare the accuracy of medical caregivers and MEWS in predicting the development of critical illness.

DESIGN:

This was a multicenter observational prospective study.

SETTING:

It was performed in a level-1 trauma center with two different sites and emergency departments (EDs) with a combined capacity of about 50.000 patients annually.

PATIENTS:

It included all adult patients presented to the ED by Emergency Medical Services (EMS).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

For all patients, the acute caregivers were asked several standardized questions regarding clinical predicted outcome (clinical gestalt), and the MEWS was calculated. The primary outcome was the occurrence of critical illness, defined as ICU admission, serious adverse events, and mortality within 72 hours. The sensitivity, specificity, and discriminative power of both clinical gestalt and MEWS for the occurrence of critical illness were calculated as the area under the receiver operating characteristic curve (AUROC). Among the total of 800 included patients, 113 patients (14.1%) suffered from critical illness. The specificity for predicting three-day critical illness for all caregivers (for EMS nurses, ED nurses, and physicians) was 93.2%; 97.3%, and 96.8%, respectively, and was significantly (p < 0.01) better than an MEWS score of 3 or higher (70.4%). The sensitivity was significantly lower for EMS and ED nurses, but not significantly different for physicians compared with MEWS. The AUROCs for prediction of 3-day critical illness by both the ED nurses (AUROC = 0.809) and the physicians (AUROC = 0.848) were significantly higher (p = 0.032 and p = 0.010, respectively) compared with MEWS (AUROC = 0.731).

CONCLUSIONS:

For patients admitted to the ED by EMS, medical professionals can predict the development of critical illness within 3 days significantly better than the MEWS. Although MEWS is able to correctly predict those patients that become critically ill, its use leads to overestimation due to a substantial number of false positives.
Lymphomatoid Papulosis “Type E” Affecting the Palate: A Detailed Case Report and Review of Literature
Authors: Silveira Heitor Albergoni , Ragusa Silva Paula Verona , Pimentel Bruna Gonçalves , Nogueira Gustavo Milhomens , Chahud Fernando , Brunaldi Mariângela Ottoboni , León Jorge Esquiche
Published: March 2023

Lymphomatoid papulosis (LyP) belongs to the spectrum of primary cutaneous CD30+ lymphoproliferative disorders, characterized by chronic, recurrent, self-healing papules, small nodules, or ulcers. The clinicopathological features of LyP can mimic overt lymphomas. To date, about 27 intraoral LyP cases have been reported. Of them, only 2 cases were diagnosed as angioinvasive LyP (type E). Herein, we report a 24-year-old Brazilian man who presented a large ulcerated lesion on the hard palate with rapid evolution. Remarkably, there was no involvement of the skin or other mucous membranes. Microscopy revealed a lymphoid infiltrate constituted by medium-sized to large atypical cells, with angiocentric and angiodestructive features. The atypical cells showed immunopositivity for CD3, CD8, CD30, CD56, granzyme B, perforin, and focally for MUM1/IRF4. Ki-67 highlighted almost all atypical lymphoid cells, whereas EBER1/2 was negative. After 2 months of follow-up, the lesion healed completely. Although rare, LyP type E should be included in the differential diagnosis of oral ulcers.
Agminated Halo Nevus: A Novel Presentation
Authors: Hassab-El-Naby Hussein M. M. , Rageh Mahmoud A.
Published: March 2023

Halo nevus is a benign type of melanocytic nevi commonly found in children and manifests as a central pigmented part surrounded by a well-defined hypopigmented area. Halo nevi are commonly located on the trunk. The central nevus may show partial or complete regression, whereas the associated halo may persist or enlarge. The term ‘agminated nevus’ refers to a cluster of melanocytic nevi restricted to an area of the body and commonly reported with acquired melanocytic nevi, blue nevi, and Spitz nevi. To the best of our knowledge, agminated halo nevus has not been previously described. We hereby report 2 cases with clinical and histopathologic findings consistent with the diagnosis of agminated halo nevus.
Effect of paediatric caudal injection volume on optic nerve sheath diameter and regional cerebral oximetry
Authors: Gönen Aybike Onur , Kaya Güner , Tütüncü Ayşe Çiğdem , Özcan Rahşan , Emre Şenol , Kendigelen Pinar
Published: March 2023

BACKGROUND

Caudal injections commonly used for neuraxial anaesthesia in children can displace cerebrospinal fluid cranially causing safety concerns in terms of raised intracranial pressure. Optic nerve sheath diameter (ONSD) is a noninvasive surrogate for the measurement of intracranial pressure. Regional cerebral oximetry (CrSO2) can monitor brain oxygenation, which may decrease by a reduction in cerebral flow due to increased intracranial pressure.

OBJECTIVES

Comparing how caudal injection volumes of 0.8 and 1.25 ml kg−1 influence ONSD and CrSO2 within the first 30 min after injection.

DESIGN

Prospective, randomised and parallel group trial.

SETTING

Operating room.

PATIENTS

Fifty-eight elective paediatric surgical patients between ages 1 and 7 years old, ASA class I or II, without previous intracranial or ocular pathology and surgery appropriate for single-shot caudal anaesthesia.

INTERVENTION

Single-shot caudal anaesthesia with 0.8 ml kg−1 (group L, n = 29) and 1.25 ml kg−1 (group H, n = 29) of 2 mg kg−1 bupivacaine solution.

MAIN OUTCOME MEASURES

Optic nerve sheath diameter measured with ultrasonography and regional cerebral oximetry measured by near-infrared spectroscopy before (NIRS), immediately after, 10, 20 and 30 min after the block.

RESULTS

Mean ONSD values increased from a baseline of 4.4 ± 0.2 mm to a maximum of 4.5 ± 0.2 mm 20 min after injection in group L and from a baseline of 4.5 ± 0.3 mm to a maximum of 4.8 ± 0.3 mm 10 min after injection in group H. Eight of 29 patients in group H and none in group L had an ONSD increase by more than 10%. Both groups had a reduction of less than 2.5% in CrSO2.

CONCLUSION

Caudal injection with 1.25 ml kg−1 increased ONSD, an indirect measurement of ICP, more than 0.8 ml kg−1 and neither volume caused a clinically important reduction in CrSO2.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT04491032
Emerging targets for therapy in ALD: Lessons from NASH
Authors: Singal Ashwani K. , Shah Vijay H. , Malhi Harmeet
Published: March 2023

Alcohol-associated liver disease due to harmful alcohol use and NAFLD associated with metabolic syndrome are the 2 most common liver diseases worldwide. Control of respective risk factors is the cornerstone in the long-term management of these diseases. Furthermore, there are no effective therapies. Both diseases are characterized by metabolic derangements; thus, the focus of this review was to broaden our understanding of metabolic targets investigated in NAFLD, and how these can be applied to alcohol-associated liver disease. Conserved pathogenic pathways such as dysregulated lipid metabolism, cell death pathways including apoptosis and activation of innate immune cells, and stellate cells mediate both alcohol and NAFLDs, resulting in histological abnormalities of steatosis, inflammation, fibrosis, and cirrhosis. However, pathways such as gut microbiome changes, glucose metabolism and insulin resistance, inflammatory signaling, and microRNA abnormalities are distinct in these 2 diseases. In this review article, we describe conserved and distinct pathogenic pathways highlighting therapeutic targets that may be of potential in both diseases and those that are unique to each disease.
RECURRENT FLOATERS AFTER LIMITED VITRECTOMY FOR VISION DEGRADING MYODESOPSIA
Authors: Boneva Stefaniya K. , Nguyen Justin H. , Gui Wei , Hoerig Cameron , Mamou Jonathan , Ketterling Jeffrey A. , Chong Lawrence P. , Sebag J.
Published: March 2023

Purpose:

Limited vitrectomy improves vision degrading myodesopsia, but the incidence of recurrent floaters postoperatively is not known. We studied patients with recurrent central floaters using ultrasonography and contrast sensitivity (CS) testing to characterize this subgroup and identify the clinical profile of patients at risk of recurrent floaters.

Methods:

A total of 286 eyes (203 patients, 60.6 ± 12.9 years) undergoing limited vitrectomy for vision degrading myodesopsia were studied retrospectively. Sutureless 25G vitrectomy was performed without intentional surgical posterior vitreous detachment (PVD) induction. CS (Freiburg Acuity Contrast test: Weber index, %W) and vitreous echodensity (quantitative ultrasonography) were assessed prospectively.

Results:

No eyes (0/179) with preoperative PVD experienced new floaters. Recurrent central floaters occurred in 14/99 eyes (14.1%) without complete preoperative PVD (mean follow-up = 39 months vs. 31 months in 85 eyes without recurrent floaters). Ultrasonography identified new-onset PVD in all 14 (100%) recurrent cases. Young (younger than 52 years; 71.4%), myopic (≥-3D; 85.7%), phakic (100%) men (92.9%) predominated. Reoperation was elected by 11 patients, who had partial PVD preoperatively in 5/11 (45.5%). At study entry, CS was degraded (3.55 ± 1.79 %W) but improved postoperatively by 45.6% (1.93 ± 0.86 %W, P = 0.033), while vitreous echodensity reduced by 86.6% (P = 0.016). New-onset PVD postoperatively degraded CS anew, by 49.4% (3.28 ± 0.96 %W; P = 0.009) in patients electing reoperation. Repeat vitrectomy normalized CS to 2.00 ± 0.74%W (P = 0.018).

Conclusion:

Recurrent floaters after limited vitrectomy for vision degrading myodesopsia are caused by new-onset PVD, with younger age, male sex, myopia, and phakic status as risk factors. Inducing surgical PVD at the primary operation should be considered in these select patients to mitigate recurrent floaters.
Association of clear vs blue-light filtering intraocular lenses with mental and behavioral disorders and diseases of the nervous system among patients receiving bilateral cataract surgery
Authors: Karesvuo Minna , Kanclerz Piotr , Hecht Idan , Achiron Asaf , Tuuminen Raimo
Published: March 2023

Purpose:

To analyze new-onset mental and behavioral disorders and nervous system diseases in patients with cataract implanted with either non–blue-light filtering (BLF) or BLF intraocular lenses (IOLs) in both eyes.

Setting:

Department of Ophthalmology, Kymenlaakso Central Hospital, Kotka, Finland.

Design:

A retrospective registry-based cohort study of patients operated between September 2007 and December 2018 who were followed until December 2021. We included 4986 patients who underwent bilateral cataract surgery.

Methods:

Patients were implanted with either non-BLF IOLs (N = 2609) or BLF IOLs (N = 2377) in both eyes. Follow-up before the first-eye surgery and between the first-eye and the second-eye surgery was performed to acknowledge the preexisting disorders and diseases. After the second-eye surgery, the groups were analyzed for the new-onset mental and behavioral disorders and diseases of the nervous system subcategorized by the International Classification of Diseases codes.

Results:

1707 male and 3279 female patients, aged 73.2 ± 8.6 years at the first-eye surgery and 74.3 ± 8.8 years at the second-eye surgery, were identified. In univariate log-rank tests, the use of BLF IOLs showed no association in overall new-onset disorders or diseases over non-BLF IOLs, in any subtype diagnosis codes except for sleep disorders, which favored BLF IOLs (P = .003). A multivariate analysis adjusted for age and sex identified no associations in any new-onset disorders or diseases. Multivariate analysis of sleep disorders showed a nonsignificant advantage for BLF-IOLs (hazard ratio 0.756, 95% CI 0.534-1.070, P = .114).

Conclusions:

BLF IOLs were not associated with mental and behavioral disorders or diseases of the nervous system.
Converting patients from warfarin to non-vitamin K antagonist oral anticoagulants
Authors: Romanelli Sarah , Rivera Veronica
Published: March 2023

Background:

Non-vitamin K antagonist oral anticoagulants (NOACs) are favorable in stroke prevention for geriatric patients with nonvalvular atrial fibrillation versus warfarin. These anticoagulants do not require international normalized ratio (INR) monitoring and have lower food/drug interactions. In addition, NOACs have risk reduction in bleeding and all-cause mortality compared with warfarin.

Local problem:

At a geriatric primary care practice, two registered nurses manage 88 patients on warfarin for INR monitoring. Nurse practitioners (NPs) provide oversight for warfarin titration after abnormal results. The goal of this quality-improvement project was to decrease the time spent monitoring patients on warfarin.

Methods:

Primary care providers and cardiologists of patients on warfarin were contacted to gain approval of transition to a NOAC. The NP reviewed patients' renal function and the indication for anticoagulation and then created a list of eligible patients for transition.

Interventions:

Patients eligible for transition to NOACs were contacted for their consent. The transition process included stopping warfarin, ordering apixaban, ordering INR level, educating about starting apixaban, and coordinating appropriate follow-up.

Results:

Of 88 patients on warfarin, 21 were eligible for conversion from warfarin to apixaban. Of these 21 patients, 66% (n = 14) consented to the conversion. Of those who were not converted to apixaban, five declined due to cost and two were lost to follow-up.

Conclusion:

There was a reduction in nurses' monthly monitoring of patients on warfarin by 22%. Transition to NOAC was not only beneficial for patient safety and efficacy but also reduced nursing clinical time for anticoagulation encounters.
Unilateral alveolar cleft size on prenatal 2-D ultrasonography predicts cleft of the secondary palate in fetal unilateral cleft lip: A Pilot Study.
Authors: Rubio Eva , Mantilla-Rivas Esperanza , Manrique Monica , Fan Kenneth L , Blask Anna , Rada Erin M. , Bulas Dorothy , White Marney A. , Rogers Gary F. , Oh Albert K.
Published: March 2023

BACKGROUND:

Prenatal diagnosis of cleft palate (CP) is challenging. The current study’s objective was to investigate if prenatal alveolar cleft width is associated with the likelihood of a cleft of the secondary palate in unilateral cleft lip (CL).

METHODS:

The authors reviewed 2D US images in fetuses with unilateral CL from 1/2012-2/2016. Images of the fetal face were obtained with a linear and/or curved probe in the axial and coronal planes. Measurements of the alveolar ridge gap were taken by the senior radiologist. Post-natal phenotype findings were compared with prenatal findings.

RESULTS:

Thirty patients with unilateral CL met inclusion criteria; average gestational age was 26.67 ± 5.11 weeks (range 20.71, 36.57 weeks). Ten fetuses were found to have an intact alveolar ridge by prenatal US; postnatal exam confirmed intact secondary palate in all. Small alveolar defects <4 mm were noted in 3 fetuses; postnatal examination documented CP in a single patient. CP was confirmed in 15 of the remaining 17 fetuses who had alveolar cleft width >4 mm. An alveolar defect ≥ 4 mm on prenatal US was associated with greater likelihood of a cleft of the secondary palate (c 2 (2, n=30) = 20.23, p<.001).

CONCLUSION:

In the setting of unilateral CL, prenatal US documentation of alveolar defects ≥4 mm are highly predictive of the presence of a cleft of the secondary palate. Conversely, an intact alveolar ridge is associated with an intact secondary palate.
An Optimizing Surgical Procedures for Correcting Severe Constricted Ears: Helix Costal Cartilage Scaffold Combined With V-Y Advanced Flap
Authors: Wu Huanhuan , Dong Guoxuan , Liu Tun , Qian Jin , Wang Bingqing , Wang Yue
Published: March 2023

Purpose:

A constricted ear is a deformity that is distinguished by curling of the upper portion of the ear, which includes the helix, scapha, and antihelix. The treatment for severely constricted ears seems to be quite invasive. To reduce invasiveness and fully utilize the folded cartilage, the authors used a helix costal cartilage scaffold combined with a single V-Y advanced flap in the correction of Tanzer type IIB constricted ear deformity to investigate the clinical effect.

Materials and Methods:

From 2020 to 2021, autologous costal cartilage helix stent combined with local V-Y advanced flap was applied to correct the constricted ear malformation in 18 patients admitted to the Plastic Surgery Hospital of the Chinese Academy of Medical Sciences.

Results:

All patients were followed for a duration of 6 to 12 months (average 7 months). Reconstructed auricles were cosmetically satisfying, with a natural-looking helix and enlarged cavum conchae cavity, as well as auricle sizes that were close to normal and near symmetry between both ears.

Conclusions:

With satisfactory clinical results, our technique can be used to repair types IIB cup ear deformities. It has a broad range of practical applications.
Coronavirus Disease 2019 and the Yale Response: A Semistructured Interview Study on Plastic Surgery Resident Education and Departmental Adaptation to the Lockdown
Authors: Sasson Daniel C. , Hsia Henry C.
Published: March 2023

Background:

Sooner-than-expected progression to statewide lockdown at the height of the coronavirus disease 2019 pandemic left minimal time for medical specialty boards, including The American Board of Plastic Surgery, to issue guidance for their respective programs. As a result, programs were tasked with developing creative alternatives to their standard resident curricula and department schedules.

Objective:

To capture attending and resident experience of the coronavirus disease 2019 lockdown in narrative form and to understand what specific changes enacted to maintain adequate education should be considered for continuation after the pandemic’s conclusion.

Methods:

Qualitative, semistructured interviews of residents, fellows, and faculty of the Section of Plastic and Reconstructive Surgery during 2019 to 2020 academic year were conducted on the following topics: (1) general reflection on lockdown, (2) resident maintenance of daily logs, (3) multi-institutional collaborative lectures, (4) modified didactic curriculum, (5) virtual 3-dimensional craniofacial planning sessions, (6) maintenance of department camaraderie, and (7) effect on preparation to become a surgeon.

Results:

Twenty interviews (response rate 77%) were conducted between October 2020 and February 2021. Of residents, 100% felt observing the craniofacial planning sessions was beneficial, with many explicitly noting it provided a unique perspective into the surgeon’s thought process behind planned manipulations, to which they usually are not privy. Of residents, 100% felt confident at the time of the interview that the lockdown would have no lasting effects on their preparation to become a surgeon.

Conclusions:

Rapid changes enacted at Yale enabled resident training to advance, and documentation of the success of these changes can inform future curriculum design.
The early rise and spread of evolutionary game theory: perspectives based on recollections of early workers
Authors: Grodwohl Jean-Baptiste , Parker Geoff A.
Published: March 2023

Though the first attempts to introduce game theory into evolutionary biology failed, new formalism by Maynard Smith and Price in 1973 had almost instant success. We use information supplied by early workers to analyse how and why evolutionary game theory (EGT) spread so rapidly in its earliest years. EGT was a major tool for the rapidly expanding discipline of behavioural ecology in the 1970s; each catalysed the other. The first models were applied to animal contests, and early workers sought to improve their biological reality to compare predictions with observations. Furthermore, it was quickly realized that EGT provided a general evolutionary modelling method; not only was it swiftly applied to diverse phenotypic adaptations in evolutionary biology, it also attracted researchers from other disciplines such as mathematics and economics, for which game theory was first devised. Lastly, we pay attention to exchanges with population geneticists, considering tensions between the two modelling methods, as well as efforts to bring them closer.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
The evolutionarily stable strategy, animal contests, parasitoids, pest control and sociality
Authors: Hardy Ian C. W. , Mesterton-Gibbons Mike
Published: March 2023

The evolutionarily stable strategy, ESS, concept was first used in biology to understand sex ratio bias and, shortly afterwards, to explore the logic of contests over essential and indivisible resources. ESS models formed the basis of much subsequent research on animal behaviour and placed game-theoretic thinking firmly within the behavioural ecology approach. Among behavioural ecologists studying parasitoids, it was those asking questions about the evolution of sex ratios who first made extensive use of the game-theoretic approach. A later growth of interest in parasitoid host defence and fighting behaviour made use of these tractable study species to explore contests and their connections to further aspects of life-history evolution plus some pest control applications. Our aims are to (i) introduce the topic of contests, which are engaged in by a very wide array of animal taxa, and the importance, both historical and conceptual, of the game-theoretic approach to their study, and (ii) review recent studies of parasitoid contests, including those that have considered the context of social evolution and the performance of parasitoids as agents of biological control. We consider that game-theoretic models are eminently testable and applicable and will likely endure as valuable tools in studies of parasitoid biology.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
The rarer-sex effect
Authors: Gardner Andy
Published: March 2023

The study of sex allocation—that is, the investment of resources into male versus female reproductive effort—yields among the best quantitative evidence for Darwinian adaptation, and has long enjoyed a tight and productive interplay of theoretical and empirical research. The fitness consequences of an individual's sex allocation decisions depend crucially upon the sex allocation behaviour of others and, accordingly, sex allocation is readily conceptualized in terms of an evolutionary game. Here, I investigate the historical development of understanding of a fundamental driver of the evolution of sex allocation—the rarer-sex effect—from its inception in the writing of Charles Darwin in 1871 through to its explicit framing in terms of consanguinity and reproductive value by William D. Hamilton in 1972. I show that step-wise development of theory proceeded through refinements in the conceptualization of the strategy set, the payoff function and the unbeatable strategy.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.
Nutrients and flow shape the cyclic dominance games between
Escherichia coli
strains
Authors: Kuhn Thierry , Junier Pilar , Bshary Redouan , Terrettaz Céline , Gonzalez Diego , Richter Xiang-Yi Li
Published: March 2023

Evolutionary game theory has provided various models to explain the coexistence of competing strategies, one of which is the rock–paper–scissors (RPS) game. A system of three
Escherichia coli
strains—a toxin-producer, a resistant and a sensitive—has become a classic experimental model for studying RPS games. Previous experimental and theoretical studies, however, often ignored the influence of ecological factors such as nutrients and toxin dynamics on the evolutionary game dynamics. In this work, we combine experiments and modelling to study how these factors affect competition dynamics. Using three-dimensional printed mini-bioreactors, we tracked the frequency of the three strains in different culturing media and under different flow regimes. Although our experimental system fulfilled the requirements of cyclic dominance, we did not observe clear cycles or long-term coexistence between strains. We found that both nutrients and flow rates strongly impacted population dynamics. In our simulations, we explicitly modelled the release, removal and diffusion of toxin. We showed that the amount of toxin that is retained in the system is a simple indicator that can predict competition outcomes across broad parameter space. Moreover, our simulation results suggest that high rates of toxin diffusion might have prevented cyclic patterns from emerging in our experimental system.

This article is part of the theme issue ‘Half a century of evolutionary games: a synthesis of theory, application and future directions’.