bluuebunny/crossref_metadata_2025 huggingface dataset:
Economics of Dutch Elm Disease Control: A Model and Case Study
Authors: Baughman Melvin J.
Published: April 2024

A discounted cash-flow model is used to compare the economic efficiency of sanitation controls for Dutch elm disease. A case study in Minneapolis, Minnesota, considers intensive sanitation, winter sanitation, and minimum control. Costs and benefits are projected for each alternative over a period of ten years. Benefits are defined as savings from either intensive or winter sanitation over minimum control costs. Intensive sanitation produces the highest net present worth and saves the most trees at the lowest cost ($31.19 less per-tree saved than winter sanitation). Sensitivity analysis shows that reasonable changes in tree-loss rates, tree-removal costs, or the discount rate do not change the economic preference for intensive sanitation.
The Role of Indigenous Burning in Land Management
Authors: Kimmerer R.W. , Lake F.K.
Published: April 2024

This article highlights the findings of the literature on aboriginal fire from the human- and the land-centered disciplines, and suggests that the traditional knowledge of indigenous peoples be incorporated into plans for reintroducing fire to the nation's forests. Traditional knowledge represents the outcome of long experimentation with application of fire by indigenous people, which can inform contemporary policy discussions.
Genetic Engineering: FSC Says Risks Are Still Too Great
Authors: Cauley H.
Published: April 2024

The arguments of Strauss et al. (this issue) have reinforced my belief that the Forest Stewardship Council's embrace of genetic modification (GM) technology would be ill advised. More research is needed to identify the direct and indirect social, economic, and ecological implications at all scales of the introduction of GM technology. GM research must be carried out under high levels of security, and we must gain more insights, through the research process, of who may benefit when, to what degree, and at what costs to others.
Extension in Pennsylvania: Diverse Partners Working Together
Authors: Finley J.C. , Jacobson M.G.
Published: April 2024

At the turn of the 20th century, timber harvesting and other factors resulted in the high-value hardwood forests we see in Pennsylvania. One-half million private forest landowners own three-quarters of this forested area. Providing resource management information of these forest landowners demands that agencies and organizations cooperate to use limited human and fiscal resources effectively. This article describes a statewide commitment of diverse partners working together to support private forest landowners and sustain the state's hardwood forests.
Carbon Sequestration in Forests: Addressing the Scale Question
Authors: Harmon M.E.
Published: April 2024

Forests may have an important role to play in removing carbon dioxide from the atmosphere. However, the extent of their role depends not only on the area available but also the management system that is applied and whether it is based on sound scientific principles, including those of basic ecosystem science. One aspect of ecosystem science that generally has been overlooked in forestry-related carbon projects is that of scale. By paying closer attention to scale, seemingly contradictory statements concerning forest management and carbon sequestration can be resolved, which can lead to the development of a viable carbon sequestration policy.
Forest Parcelization in the United States: A Study of Contributing Factors
Authors: Mehmood S.R. , Zhang D.
Published: April 2024

Over the past few decades, the number of nonindustrial private forest landowners in the United States has been increasing while the average size of parcels has been decreasing. This trend is often referred to as forest parcelization. This article reviews the causes of parcelization suggested in the existing literature and attempts to provide some empirical evidence concerning their validity. Death, urbanization, income, regulatory uncertainty, and financial assistance for landowners are found to have significant impacts on the change in average parcel size in the United States.
Oak Wilt: A Potential Threat to Southern and Western Oak Forests
Authors: Wilson A.D.
Published: April 2024

Oak wilt is recognized as one of the most destructive diseases to afflict oak species in the United States. The distribution and development of oak wilt in our eastern and midwestern oak forests has been closely linked to changes in forest stand composition, forest management practices, and pathogen dissemination facilitated by human and vector activity. The potential for oak wilt to spread into southern and western states and its possible impacts are discussed. The Texas experience with an oak wilt epidemic provides useful perspectives and suppression alternatives for other states not yet touched by this malady.
Book Review: Aldo Leopold—For the Health of the Land: Previously Unpublished Essays and Other Writings
Authors: Miller C.
Published: April 2024

Aldo Leopold—For the Health of the Land: Previously Unpublished Essays and Other Writings edited by J. Baird Callicott and Eric T. Freyfogle, is the latest testament to Leopold's creative powers, a collection of essays about the midwestern landscape that once were little read because they were obscurely published.
Forests and Forestry in Ukraine: Standing on the Brink of a Market Economy
Authors: Strochinskii A.A. , Pozyvailo Y.M. , Jungst S.E.
Published: April 2024

The breakup of the former Soviet Union has provided increased opportunities for exchanges between foresters in the United States and those in the former Soviet Union. Foresters in Ukraine manage state forestlands for many of the same goods and services as do foresters in the United States, but under a significantly different system. All forests in Ukraine are state-owned, and harvest activities, where permitted, are strictly regulated. Transition to a market economy in the forestry sector is considered by the State Committee on Forestry to be a matter of great importance, but strong state involvement in regulations relating to environmental protection will certainly be a part of that transition.
Efficacy of anifrolumab in long-term intractable alopecia due to discoid lupus erythematosus
Authors: Azuma Naoto , Natsuaki Masaru , Hashimoto Naoaki , Abe Takeo , Ueda Suzu , Ohno Yuko , Jinnin Masatoshi , Matsui Kiyoshi
Published: April 2024

Alopecia associated with lupus erythematosus is broadly classified into reversible nonscarring alopecia seen in the acute phase, such as worsening of systemic lupus erythematosus (SLE) and cicatricial alopecia seen in chronic cutaneous lupus erythematosus represented by discoid lupus erythematosus (DLE). In DLE-induced alopecia, early therapeutic intervention before developing scarring alopecia is important, but the condition is often resistant to conventional treatment. Anifrolumab (ANI), a novel therapeutic agent for SLE that inhibits Type I interferon activity, has been shown to be effective against acute skin lesions, including alopecia, in patients with SLE. However, there are very few reports on the effect of ANI on alopecia due to DLE. We report on a 27-year-old Japanese woman with SLE whose alopecia due to chronic DLE was refractory to topical therapy and systemic therapy with oral glucocorticoid, multiple immunosuppressants, and belimumab for ∼8 years after onset and whose alopecia improved with ANI. ANI can be considered to be an effective treatment option in lupus patients presenting with alopecia due to DLE, even in the chronic refractory stage.
NetActivity enhances transcriptional signals by combining gene expression into robust gene set activity scores through interpretable autoencoders
Authors: Ruiz-Arenas Carlos , Marín-Goñi Irene , Wang Liewei , Ochoa Idoia , Pérez-Jurado Luis A , Hernaez Mikel
Published: April 2024

Grouping gene expression into gene set activity scores (GSAS) provides better biological insights than studying individual genes. However, existing gene set projection methods cannot return representative, robust, and interpretable GSAS. We developed NetActivity, a machine learning framework that generates GSAS based on a sparsely-connected autoencoder, where each neuron in the inner layer represents a gene set. We proposed a three-tier training that yielded representative, robust, and interpretable GSAS. NetActivity model was trained with 1518 GO biological processes terms and KEGG pathways and all GTEx samples. NetActivity generates GSAS robust to the initialization parameters and representative of the original transcriptome, and assigned higher importance to more biologically relevant genes. Moreover, NetActivity returns GSAS with a more consistent definition and higher interpretability than GSVA and hipathia, state-of-the-art gene set projection methods. Finally, NetActivity enables combining bulk RNA-seq and microarray datasets in a meta-analysis of prostate cancer progression, highlighting gene sets related to cell division, key for disease progression. When applied to metastatic prostate cancer, gene sets associated with cancer progression were also altered due to drug resistance, while a classical enrichment analysis identified gene sets irrelevant to the phenotype. NetActivity is publicly available in Bioconductor and GitHub.
Definition of the binding specificity of the T7 bacteriophage primase by analysis of a protein binding microarray using a thermodynamic model
Authors: Lipps Georg
Published: April 2024

Protein binding microarrays (PBM), SELEX, RNAcompete and chromatin-immunoprecipitation have been intensively used to determine the specificity of nucleic acid binding proteins. While the specificity of proteins with pronounced sequence specificity is straightforward, the determination of the sequence specificity of proteins of modest sequence specificity is more difficult. In this work, an explorative data analysis workflow for nucleic acid binding data was developed that can be used by scientists that want to analyse their binding data. The workflow is based on a regressor realized in scikit-learn, the major machine learning module for the scripting language Python. The regressor is built on a thermodynamic model of nucleic acid binding and describes the sequence specificity with base- and position-specific energies. The regressor was used to determine the binding specificity of the T7 primase. For this, we reanalysed the binding data of the T7 primase obtained with a custom PBM. The binding specificity of the T7 primase agrees with the priming specificity (5′-GTC) and the template (5′-GGGTC) for the preferentially synthesized tetraribonucleotide primer (5′-pppACCC) but is more relaxed. The dominant contribution of two positions in the motif can be explained by the involvement of the initiating and elongating nucleotides for template binding.
HELLS regulates transcription in T-cell lymphomas by reducing unscheduled R-loops and by facilitating RNAPII progression
Authors: Tameni Annalisa , Mallia Selene , Manicardi Veronica , Donati Benedetta , Torricelli Federica , Vitale Emanuele , Salviato Elisa , Gambarelli Giulia , Muccioli Silvia , Zanelli Magda , Ascani Stefano , Martino Giovanni , Sanguedolce Francesca , Sauta Elisabetta , Tamagnini Ione , Puccio Noemi , Neri Antonino , Ciarrocchi Alessia , Fragliasso Valentina
Published: April 2024

Chromatin modifiers are emerging as major determinants of many types of cancers, including Anaplastic Large Cell Lymphomas (ALCL), a family of highly heterogeneous T-cell lymphomas for which therapeutic options are still limited. HELLS is a multifunctional chromatin remodeling protein that affects genomic instability by participating in the DNA damage response. Although the transcriptional function of HELLS has been suggested, no clues on how HELLS controls transcription are currently available. In this study, by integrating different multi-omics and functional approaches, we characterized the transcriptional landscape of HELLS in ALCL. We explored the clinical impact of its transcriptional program in a large cohort of 44 patients with ALCL. We demonstrated that HELLS, loaded at the level of intronic regions of target promoters, facilitates RNA Polymerase II (RNAPII) progression along the gene bodies by reducing the persistence of co-transcriptional R-loops and promoting DNA damage resolution. Importantly, selective knockdown of HELLS sensitizes ALCL cells to different chemotherapeutic agents, showing a synergistic effect. Collectively, our work unveils the role of HELLS in acting as a gatekeeper of ALCL genome stability providing a rationale for drug design.
JASMINE: Near-infrared astrometry and time-series photometry science
Authors: Kawata Daisuke , Kawahara Hajime , Gouda Naoteru , Secrest Nathan J , Kano Ryouhei , Kataza Hirokazu , Isobe Naoki , Ohsawa Ryou , Usui Fumihiko , Yamada Yoshiyuki , Graham Alister W , Pettitt Alex R , Asada Hideki , Baba Junichi , Bekki Kenji , Dorland Bryan N , Fujii Michiko , Fukui Akihiko , Hattori Kohei , Hirano Teruyuki , Kamizuka Takafumi , Kashima Shingo , Kawanaka Norita , Kawashima Yui , Klioner Sergei A , Kodama Takanori , Koshimoto Naoki , Kotani Takayuki , Kuzuhara Masayuki , Levine Stephen E , Majewski Steven R , Masuda Kento , Matsunaga Noriyuki , Miyakawa Kohei , Miyoshi Makoko , Morihana Kumiko , Nishi Ryoichi , Notsu Yuta , Omiya Masashi , Sanders Jason , Tanikawa Ataru , Tsujimoto Masahiro , Yano Taihei , Aizawa Masataka , Arimatsu Ko , Biermann Michael , Boehm Celine , Chiba Masashi , Debattista Victor P , Gerhard Ortwin , Hirabayashi Masayuki , Hobbs David , Ikenoue Bungo , Izumiura Hideyuki , Jordi Carme , Kohara Naoki , Löffler Wolfgang , Luri Xavier , Mase Ichiro , Miglio Andrea , Mitsuda Kazuhisa , Newswander Trent , Nishiyama Shogo , Obuchi Yoshiyuki , Ootsubo Takafumi , Ouchi Masami , Ozaki Masanobu , Perryman Michael , Prusti Timo , Ramos Pau , Read Justin I , Rich R Michael , Schönrich Ralph , Shikauchi Minori , Shimizu Risa , Suematsu Yoshinori , Tada Shotaro , Takahashi Aoi , Tatekawa Takayuki , Tatsumi Daisuke , Tsujimoto Takuji , Tsuzuki Toshihiro , Urakawa Seitaro , Uraguchi Fumihiro , Utsunomiya Shin , Van Eylen Vincent , van Leeuwen Floor , Wada Takehiko , Walton Nicholas A
Published: April 2024

The Japan Astrometry Satellite Mission for INfrared Exploration (JASMINE) is a planned M-class science space mission by the Institute of Space and Astronautical Science, the Japan Aerospace Exploration Agency. JASMINE has two main science goals. One is Galactic archaeology with a Galactic Center survey, which aims to reveal the Milky Way’s central core structure and formation history from Gaia-level (∼25 ${\mu} $as) astrometry in the near-infrared (NIR) Hw band (1.0–1.6 ${\mu} $m). The other is an exoplanet survey, which aims to discover transiting Earth-like exoplanets in the habitable zone from NIR time-series photometry of M dwarfs when the Galactic Center is not accessible. We introduce the mission, review many science objectives, and present the instrument concept. JASMINE will be the first dedicated NIR astrometry space mission and provide precise astrometric information on the stars in the Galactic Center, taking advantage of the significantly lower extinction in the NIR. The precise astrometry is obtained by taking many short-exposure images. Hence, the JASMINE Galactic Center survey data will be valuable for studies of exoplanet transits, asteroseismology, variable stars, and microlensing studies, including discovery of (intermediate-mass) black holes. We highlight a swath of such potential science, and also describe synergies with other missions.
Regulation of the transcription factor CdnL promotes adaptation to nutrient stress in Caulobacter
Authors: Smith Erika L , Panis Gaël , Woldemeskel Selamawit Abi , Viollier Patrick H , Chien Peter , Goley Erin D
Published: April 2024

In response to nutrient deprivation, bacteria activate a conserved stress response pathway called the stringent response (SR). During SR activation in Caulobacter crescentus, SpoT synthesizes the secondary messengers guanosine 5′-diphosphate 3′-diphosphate and guanosine 5′-triphosphate 3′-diphosphate (collectively known as (p)ppGpp), which affect transcription by binding RNA polymerase (RNAP) to down-regulate anabolic genes. (p)ppGpp also impacts the expression of anabolic genes by controlling the levels and activities of their transcriptional regulators. In Caulobacter, a major regulator of anabolic genes is the transcription factor CdnL. If and how CdnL is controlled during the SR and why that might be functionally important are unclear. In this study, we show that CdnL is down-regulated posttranslationally during starvation in a manner dependent on SpoT and the ClpXP protease. Artificial stabilization of CdnL during starvation causes misregulation of ribosomal and metabolic genes. Functionally, we demonstrate that the combined action of SR transcriptional regulators and CdnL clearance allows for rapid adaptation to nutrient repletion. Moreover, cells that are unable to clear CdnL during starvation are outcompeted by wild-type cells when subjected to nutrient fluctuations. We hypothesize that clearance of CdnL during the SR, in conjunction with direct binding of (p)ppGpp and DksA to RNAP, is critical for altering the transcriptome in order to permit cell survival during nutrient stress.
Deep learning enables automatic detection of joint damage progression in rheumatoid arthritis—model development and external validation
Authors: Venäläinen Mikko S , Biehl Alexander , Holstila Milja , Kuusalo Laura , Elo Laura L
Published: April 2024

Objectives

Although deep learning has demonstrated substantial potential in automatic quantification of joint damage in RA, evidence for detecting longitudinal changes at an individual patient level is lacking. Here, we introduce and externally validate our automated RA scoring algorithm (AuRA), and demonstrate its utility for monitoring radiographic progression in a real-world setting.

Methods

The algorithm, originally developed during the Rheumatoid Arthritis 2–Dialogue for Reverse Engineering Assessment and Methods (RA2-DREAM) challenge, was trained to predict expert-curated Sharp–van der Heijde total scores in hand and foot radiographs from two previous clinical studies (n = 367). We externally validated AuRA against data (n = 205) from Turku University Hospital and compared the performance against two top-performing RA2-DREAM solutions. Finally, for 54 patients, we extracted additional radiograph sets from another control visit to the clinic (average time interval of 4.6 years).

Results

In the external validation cohort, with a root mean square error (RMSE) of 23.6, AuRA outperformed both top-performing RA2-DREAM algorithms (RMSEs 35.0 and 35.6). The improved performance was explained mostly by lower errors at higher expert-assessed scores. The longitudinal changes predicted by our algorithm were significantly correlated with changes in expert-assessed scores (Pearson’s R = 0.74, P < 0.001).

Conclusion

AuRA had the best external validation performance and demonstrated potential for detecting longitudinal changes in joint damage. Available from https://hub.docker.com/r/elolab/aura, our algorithm can easily be applied for automatic detection of radiographic progression in the future, reducing the need for laborious manual scoring.
A Calcium-Dependent Protein Kinase Regulates the Defense Response in Citrus sinensis
Authors: Zhang Jinghan , Sun Lifan , Wang Yu , Li Baiyang , Li Xiangguo , Ye Ziqin , Zhang Jie
Published: April 2024

Citrus Huanglongbing (HLB), which is caused by ‘ Candidatus Liberibacter asiaticus’ (CLas), is one of the most destructive citrus diseases worldwide, and defense-related Citrus sinensis gene resources remain largely unexplored. Calcium signaling plays an important role in diverse biological processes. In plants, a few calcium-dependent protein kinases (CDPKs/CPKs) have been shown to contribute to defense against pathogenic microbes. The genome of C. sinensis encodes dozens of CPKs. In this study, the role of C. sinensis calcium-dependent protein kinases (CsCPKs) in C. sinensis defense was investigated. Silencing of CsCPK6 compromised the induction of defense-related genes in C. sinensis. Expression of a constitutively active form of CsCPK6 (CsCPK6CA) triggered the activation of defense-related genes in C. sinensis. Complementation of CsCPK6 rescued the defense-related gene induction in an Arabidopsis thaliana cpk4/11 mutant, indicating that CsCPK6 carries CPK activity and is capable of functioning as a CPK in Arabidopsis. Moreover, an effector derived from CLas inhibits defense induced by the expression of CsCPK6CA and autophosphorylation of CsCPK6, which suggests the involvement of CsCPK6 and calcium signaling in defense. These results support a positive role for CsCPK6 in C. sinensis defense against CLas, and the autoinhibitory regulation of CsCPK6 provides a potential genome-editing target for improving C. sinensis defense.

[Formula: see text] Copyright © 2024 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Binding Mode and Molecular Mechanism of the Two-Component Histidine Kinase Bos1 of Botrytis cinerea to Fludioxonil and Iprodione
Authors: Yin Xueru , Li Pengfei , Wang Zongwei , Wang Jing , Fang Anfei , Tian Binnian , Yang Yuheng , Yu Yang , Bi Chaowei
Published: April 2024

Gray mold caused by Botrytis cinerea is among the 10 most serious fungal diseases worldwide. Fludioxonil is widely used to prevent and control gray mold due to its low toxicity and high efficiency; however, resistance caused by long-term use has become increasingly prominent. Therefore, exploring the resistance mechanism of fungicides provides a theoretical basis for delaying the occurrence of diseases and controlling gray mold. In this study, fludioxonil-resistant strains were obtained through indoor drug domestication, and the mutation sites were determined by sequencing. Strains obtained by site-directed mutagenesis were subjected to biological analysis, and the binding modes of fludioxonil and iprodione to Botrytis cinerea Bos1 BcBos1 were predicted by molecular docking. The results showed that F127S, I365S/N, F127S + I365N, and I376M mutations on the Bos1 protein led to a decrease in the binding energy between the drug and BcBos1. The A1259T mutation did not lead to a decrease in the binding energy, which was not the cause of drug resistance. The biological fitness of the fludioxonil- and point mutation-resistant strains decreased, and their growth rate, sporulation rate, and pathogenicity decreased significantly. The glycerol content of the sensitive strains was significantly lower than that of the resistant strains and increased significantly after treatment with 0.1 μg/ml of fludioxonil, whereas that of the resistant strains decreased. The osmotic sensitivity of the resistant strains was significantly lower than that of the sensitive strains. Positive cross-resistance was observed between fludioxonil and iprodione. These results will help to understand the resistance mechanism of fludioxonil in Botrytis cinerea more deeply.
Highest Achievable Outcomes for Adult Spinal Deformity Corrective Surgery
Authors: Passias Peter G. , Onafowokan Oluwatobi O. , Tretiakov Peter , Williamson Tyler , Kummer Nicholas , Mir Jamshaid , Das Ankita , Krol Oscar , Passfall Lara , Joujon-Roche Rachel , Imbo Bailey , Yee Timothy , Sciubba Daniel , Paulino Carl B. , Schoenfeld Andrew J. , Smith Justin S. , Lafage Renaud , Lafage Virginie
Published: April 2024

Study Design.

Retrospective single-center study.

Objective.

To assess the influence of frailty on optimal outcome following ASD corrective surgery.

Summary of Background Data.

Frailty is a determining factor in outcomes after ASD surgery and may exert a ceiling effect on the best possible outcome.

Methods.

ASD patients with frailty measures, baseline, and 2-year ODI included. Frailty was classified as Not Frail (NF), Frail (F) and Severely Frail (SF) based on the modified Frailty Index, then stratified into quartiles based on two-year ODI improvement (most improved designated “Highest”). Logistic regression analyzed relationships between frailty and ODI score and improvement, maintenance, or deterioration. A Kaplan-Meier survival curve was used to analyze differences in time to complication or reoperation.

Results.

A total of 393 ASD patients were isolated (55.2% NF, 31.0% F, and 13.7% SF), then classified as 12.5% NF-Highest, 17.8% F-Highest, and 3.1% SF-Highest. The SF group had the highest rate of deterioration (16.7%, P=0.025) in the second postoperative year, but the groups were similar in improvement (NF: 10.1%, F: 11.5%, SF: 9.3%, P=0.886). Improvement of SF patients was greatest at six months (ΔODI of −22.6±18.0, P<0.001), but NF and F patients reached maximal ODI at 2 years (ΔODI of −15.7±17.9 and −20.5±18.4, respectively). SF patients initially showed the greatest improvement in ODI (NF: −4.8±19.0, F: −12.4±19.3, SF: −22.6±18.0 at six months, P<0.001). A Kaplan-Meier survival curve showed a trend of less time to major complication or reoperation by 2 years with increasing frailty (NF: 7.5±0.381 yr, F: 6.7±0.511 yr, SF: 5.8±0.757 yr; P=0.113).

Conclusions.

Increasing frailty had a negative effect on maximal improvement, where severely frail patients exhibited a parabolic effect with greater initial improvement due to higher baseline disability, but reached a ceiling effect with less overall maximal improvement. Severe frailty may exert a ceiling effect on improvement and impair maintenance of improvement following surgery.

Level of Evidence.

Level III.
Laminectomy Adjacent to Instrumented Fusion Increases Adjacent Segment Disease
Authors: Simonetta Brandon , Adeniyi Biodun , Corbett Andrew , Crandall Dennis , Chang Michael
Published: April 2024

Study Design.

Retrospective cohort.

Objective.

To determine if performing a simultaneous laminectomy at an unfused level adjacent to an instrumented fusion increases the risk of adjacent segment disease (ASD).

Summary of Background Data.

Laminectomy adjacent to instrumented fusion has uncertain outcomes. The increased mechanical forces at the unfused laminectomy may lead to more ASD. Few studies have examined the development of ASD with regard to laminectomy performed adjacent to instrumented fusions.

Materials and Methods.

Seven hundred eighty-nine patients underwent instrumented lumbar fusion and laminectomy at the same level(s) (n=676) or with an additional adjacent level laminectomy (n=113) with a minimum of 2-year follow-up. Diagnoses were degenerative spondylosis (n=241), degenerative spondylolisthesis (n=485), and isthmic spondylolisthesis (n=63) in addition to central stenosis. Primary outcome measures included development of ASD, time to development of ASD, revision surgery, and time to revision surgery.

Results.

The adjacent laminectomy group developed ASD at a significantly greater rate of 57.5% (n=65), compared with 35.2% (n=238) of the nonadjacent laminectomy group (P<0.001). The revision surgery rate was also greater in the adjacent laminectomy group (22.1% vs. 13.5%, P<0.001). There was no difference in time to revision surgery (31.1 vs. 32.6 mo, P=0.71) or time to ASD development (31.2 vs. 32.3 mo, P=0.72). ODI and VAS scores did not differ, nor did patient baseline demographics including sex, BMI, Charleston Comorbidity Index, and tobacco use. The exception was the average age of the adjacent laminectomy group was 67.6 years while the average age of the nonadjacent laminectomy group was 62.3 years (P<0.001). However, age was not found to be an independent predictor of ASD development (P=0.44).

Conclusion.

Surgeons should be cautious when performing a laminectomy adjacent to an instrumented fusion, as this increases the rate of ASD as well as revision surgery.

Level of Evidence.

Therapeutic Level—II
Ransomware Cyberattack Associated With Cardiac Arrest Incidence and Outcomes at Untargeted, Adjacent Hospitals
Authors: Pham Thaidan T. , Loo Theoren M. , Malhotra Atul , Longhurst Christopher A. , Hylton Diana , Dameff Christian , Tully Jeffrey , Wardi Gabriel , Sell Rebecca E. , Pearce Alex K.
Published: April 2024

OBJECTIVES:

Healthcare ransomware cyberattacks have been associated with major regional hospital disruptions, but data reporting patient-oriented outcomes in critical conditions such as cardiac arrest (CA) are limited. This study examined the CA incidence and outcomes of untargeted hospitals adjacent to a ransomware-infected healthcare delivery organization (HDO).

DESIGN, SETTING, AND PATIENTS:

This cohort study compared the CA incidence and outcomes of two untargeted academic hospitals adjacent to an HDO under a ransomware cyberattack during the pre-attack (April 3–30, 2021), attack (May 1–28, 2021), and post-attack (May 29, 2021–June 25, 2021) phases.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Emergency department and hospital mean daily census, number of CAs, mean daily CA incidence per 1,000 admissions, return of spontaneous circulation, survival to discharge, and survival with favorable neurologic outcome were measured. The study evaluated 78 total CAs: 44 out-of-hospital CAs (OHCAs) and 34 in-hospital CAs. The number of total CAs increased from the pre-attack to attack phase (21 vs. 38; p = 0.03), followed by a decrease in the post-attack phase (38 vs. 19; p = 0.01). The number of total CAs exceeded the cyberattack month forecast (May 2021: 41 observed vs. 27 forecasted cases; 95% CI, 17.0–37.4). OHCA cases also exceeded the forecast (May 2021: 24 observed vs. 12 forecasted cases; 95% CI, 6.0–18.8). Survival with favorable neurologic outcome rates for all CAs decreased, driven by increases in OHCA mortality: survival with favorable neurologic rates for OHCAs decreased from the pre-attack phase to attack phase (40.0% vs. 4.5%; p = 0.02) followed by an increase in the post-attack phase (4.5% vs. 41.2%; p = 0.01).

CONCLUSIONS:

Untargeted hospitals adjacent to ransomware-infected HDOs may see worse outcomes for patients suffering from OHCA. These findings highlight the critical need for cybersecurity disaster planning and resiliency.
The correlation between the intraoperative employment of indocyanine green videoangiography and incidences of residual aneurysm and parent vessel trauma: A retrospective analysis from a single center
Authors: Lin Kai-Chun , Hsieh Cheng-Ta , Chen Shiu-Jau , Tsai Cheng-Chia , Cheng Sheng-Yu , Lin Jui-Feng , Yang Chih-Chuan , Hu Chao-Kai , Chan Yun-Kai , Lin Hsin-Yao
Published: April 2024

Background

Mitigating residual cerebral aneurysm and parent artery trauma during the microsurgical treatment of aneurysms, specifically clipping, is of paramount importance to enhance patient outcomes. This study examines the effectiveness of intraoperative indocyanine green videoangiography (ICG-VA) as a strategic tool to attenuate these surgical complications.

Materials and Methods

We conducted a retrospective analysis of patient medical records who underwent cerebral aneurysm surgery in our institution from January 2012 to July 2018. The characteristic variables were juxtaposed between cohorts who had undergone intraoperative ICG-VA and those who had not, employing the independent-samples Student t test and χ
2 test for statistical comparison. The Sindou grading system was utilized to categorize aneurysm remnants, whereas injury to the parent artery was determined jointly by a neurosurgeon and a neuroradiologist. Logistic regression models were utilized to investigate the correlation between intraoperative ICG-VA usage and the presence of aneurysm remnants and parent artery injury.

Results

A total of 127 patients, harboring 131 aneurysms, underwent surgical treatment. Among these patients, 55 had intraoperative ICG-VA utilized. The occurrence rates of residual aneurysm and parent artery injury were documented at 30.5% and 6.9%, respectively. With regard to the Sindou grades I–III aneurysm remnants, interpreted as favorable outcomes, such results were observed in 14 (82.4%) patients in the non–ICG-VA group and 21 (91.3%) patients in the ICG-VA group, with no significant difference discerned between the two groups (P = 0.406; odds ratio [OR], 2.250; 95% confidence interval [CI], 0.332–15.236). Without parent artery injury, there were 64 (88.9%) patients in the non–ICG-VA group and 58 (98.3%) patients in the ICG-VA group, presenting a significant difference (P = 0.038; OR, 10.793; 95% CI, 1.134–102.691).

Conclusions

The utilization of intraoperative ICG-VA during microsurgical aneurysm-clipping could notably decrease the incidence of parent artery injury. Nonetheless, when considering the presence of aneurysm remnants, the expertise of the neurosurgeon may play a more influential role compared with the use of ICG-VA.
Does everyday discrimination account for the increased risk of vasomotor symptoms in Black women?: the Study of Women's Health Across the Nation (SWAN)
Authors: Reeves Alexis N. , Lewis Tené T. , Hood Michelle M. , Thurston Rebecca C. , Avis Nancy E. , Burnett-Bowie Sherri-Ann M. , Cortés Yamnia I. , Neal-Perry Genevieve , Harlow Siobán D.
Published: April 2024

Objectives

Vasomotor symptoms (VMS), including hot flashes and night sweats, are hallmark symptoms of the menopause transition. Previous research has documented greater frequency, duration, and severity of VMS in Black women compared with women from other racial/ethnic groups, even after accounting for other factors. This analysis examined the association between discrimination and VMS and the extent to which discrimination accounts for the disproportionate burden of VMS in Black women.

Methods

Using available discrimination and VMS data from the SWAN cohort study (n = 2,377, 48% White, 32% Black, 6% Japanese, 4% Chinese, and 9% Hispanic women) followed approximately yearly in midlife from premenopause (42-52 y) through postmenopause (~20 y), we assessed concurrent associations between discrimination and VMS frequency in the past 2 weeks using weighted generalized mixed models. We also assessed associations between chronic discrimination across first four visits and VMS trajectories from premenopause to postmenopause using weighted multinomial logistic regression. Models were adjusted for known risk factors for VMS.

Results

Higher levels of discrimination were associated with concurrent reporting of any (odds ratio [OR], 1.57 [1.31-1.89]) and frequent (≥6 d) VMS (OR, 1.55 [1.21-1.99]). After adjustment, associations remained significant for any (OR, 1.30 [1.09-1.54]) but not frequent VMS. For any VMS trajectories, chronic discrimination was associated with “continuously high” (OR, 1.69 [1.03-2.77]) and “high pre-FMP-decline post-FMP” (OR, 1.70 [1.01-2.88]) versus “FMP-onset low” trajectories. After adjusting for discrimination, odds of reporting any, frequent, and of being in the “continuously high” any VMS trajectory remained elevated for Black versus White women.

Conclusions

Discrimination is associated with greater concurrent risk of any (but not frequent) VMS, and chronic discrimination is associated with a continuously high reporting of any VMS over time, independent of known risk factors. Adjusting for discrimination attenuates but does not eliminate the increased risk of VMS for Black women.
ASSOCIATIONS BETWEEN CHOROIDAL ALTERATIONS AND EARLY NEURODEGENERATION IN DIABETES WITHOUT DIABETIC RETINOPATHY
Authors: Li Zhenping , Yang Fan , Deng Xiaowen , Yang Yao , Gong Haijun , Lan Yuqing
Published: April 2024

Purpose:

To identify associations between choroidal alterations and the reduction of peripapillary retinal nerve fiber layer (pRNFL) thickness in diabetes without diabetic retinopathy (nondiabetic retinopathy, NDR).

Methods:

This retrospective cross-sectional study included 143 eyes from 83 patients with NDR and 124 eyes from 82 matched healthy controls. Ultra-widefield swept-source optical coherence tomography angiography was used to automatically measure retinal and choroidal thickness (ChT), retinal vascular density, and choroidal vascular metrics. Data were analyzed using Student’s t-tests, generalized estimating equations, and generalized linear mixed models.

Results:

Patients with NDR exhibited significant reductions in perifoveal ChT (e.g., perifoveal inferior region: 253.42 ± 86.59 µm vs. 281.01 ± 80.25 µm, P = 0.026 in GEE test) compared with the controls. The NDR group showed a significant decrease in the choroidal vascular index (P = 0.012 in GEE test), and an increase in the choroidal stromal index (P = 0.012 in GEE test). The average pRNFL thickness significantly decreased in patients with NDR (114.58 ± 11.88 µm vs. 120.25 ± 16.36 µm, P = 0.005 in GEE test). The thickness of the outer nuclear layer and total retina significantly decreased in patients with NDR (P < 0.05). In multivariate models, ChT was significantly correlated with pRNFL thickness (β = 0.041, P = 0.001), even after adjusting by confounding factors (β = 0.056, P = 0.001).

Conclusion:

In NDR, there were decreases in ChT, choroidal vascular index, pRNFL thickness, and outer nuclear layer thickness. The reduction in ChT was independently associated with the reduction in pRNFL thickness, suggesting that ChT could serve as a predictor of retinal neurodegeneration in NDR.
Potential role of the light-adjustable lens in flanged intrascleral haptic fixation
Authors: LoBue Stephen A. , Saba Nicholas , Catapano Thomas M. , Martin Curtis R. , Shelby Christopher L. , Coleman Wyche T.
Published: April 2024

Purpose:

To compare maximum tensile strength between commonly used 3-piece intraocular lens (IOL) for flanged intrascleral haptic fixation (FISHF).

Setting:

Willis-Knight Eye Institute, Shreveport, Louisiana.

Design:

Laboratory investigation.

Methods:

Haptic tensile strength was compared with MA60AC, CT Lucia 602, AR40E, and the light-adjustable lens (LAL). Haptic strength with a 24-diopter (D) IOL was compared across all lenses, as well as across a range of 10 to 30 D with the MA60AC. A custom device was created to hold the IOL in correct haptic orientation. The maximum tension (mean ± SD) was recorded in Newtons (N) when the haptic lost tension or broke.

Results:

CT Lucia was the strongest at 1.53 ± 0.11 N vs 1.00 ± 0.15 (MA60AC), 0.87 ± 0.19 (AR40E), and 0.83 ± 0.14 N (LAL) (P < .001). The LAL and AR40E were similar to a 9-0 polypropylene suture while being significantly stronger than 10-0 polypropylene suture (P < .001). No difference in haptic tension for the MA60AC from 10 to 30 D (P > .05). High magnification revealed the highest haptic fractures for MA60AC at 40% compared with LAL, AR40E, and CT Lucia at 0%. CT Lucia and AR40E had 100% of haptics disinserted from the IOL without any damage compared with 60% LAL and 60% MA60AC. CT Lucia, AR40E, and LAL have a flatter haptic angulation at 5 degrees.

Conclusions:

Haptic strength, durability, and angulation of the LAL may support the possibility of FISHF in the hands of experienced surgeons. However, further testing is strongly recommended to verify whether physiologic conditions or light treatments may compromise long-term haptic stability.
Phacoemulsification using an active fluidics system at physiologic vs high intraocular pressure: impact on anterior and posterior segment physiology
Authors: Rauen Matthew P. , Joiner Hillery , Kohler Robyn A. , O'Connor Sara
Published: April 2024

Purpose:

Evaluate the impact of high vs low intraoperative intraocular pressure (IOP) during phacoemulsification on anterior and posterior physiology.

Setting:

Private practice in Des Moines, Iowa.

Design:

Prospective, randomized, paired-eye clinical trial of patients anticipating bilateral cataract surgery.

Methods:

27 participants randomized at the time of their first cataract surgery to either low IOP or high IOP group. The subsequent cataract surgery was performed under the alternate condition. During phacoemulsification and cortex removal, IOP was maintained either at low (≤28 mm Hg) or at high (≥55 to 60 mm Hg) levels. The primary outcome was fluid usage, with secondary outcomes of central corneal thickness, foveal avascular zone area, foveal and macular thickness, endothelial cell density (ECD), and postoperative inflammation.

Results:

Surgery with low IOP settings used less fluid (40.0 mL vs 55.6 mL, P < .0001). Corneal thickness changes were smaller in low IOP eyes at 1 day and 1 week (3.0% vs 8.1%, P = .01; 3.1% vs 4.4%, P = .01) but were similar by 1 and 3 months. ECD dropped less in low IOP eyes at 1 and 3 months (−1.7% vs −12.3%, P = .001, 2.1% vs −8.9%, P = .0003.) IOP remained a significant predictor of ECD change when relationship was controlled for fluid use and phacoemulsification energy. Retinal parameters did not vary among all eyes or when compared by IOP setting. Visual acuity was similar at all timepoints.

Conclusions:

Low IOP settings resulted in less inflammation and less corneal trauma, as evidenced by a smaller drop in ECD and less postoperative corneal edema, when compared with high IOP settings. Retinal parameters did not change significantly. The different outcomes did not result in a difference in visual acuity.
Comparing the oncologic outcomes of local tumor destruction vs. local tumor excision vs. partial nephrectomy in T1a solid renal masses: a population-based cohort study from the SEER database
Authors: Guo Run-Qi , Zhao Peng-Jin , Sun Jie , Li Yuan-Ming
Published: April 2024

Background:

There are few large-scale analyses comparing local tumor destruction (LTD) or local tumor enucleation/excision (LTE) relative to partial nephrectomy (PN) for patients with T1a renal masses in terms of cancer-specific survival (CSS) and overall survival (OS). The authors aimed to compare CSS and OS after LTD versus LTE versus PN.

Materials and methods:

Within the Surveillance, Epidemiology, and End Results (SEER) database (2000–2019), the authors identified patients with clinical T1a renal masses and histologically confirmed kidney cancer treated with LTD, LTE, or PN. After 1:1 ratio propensity score matching (PSM), comparisons between the groups were conducted. Kaplan–Meier analysis and log-rank tests were used to compare survival in the matched population.

Results:

In the overall cohort of 3717 LTD patients versus 1993 LTE patients versus 26 935 PN patients, 77.3% of LTD-treated patients and 74.4% of LTE-treated patients were over 60 years old, while only 50.3% of PN-treated patients were over 60 years old. PN was more strongly associated with CSS [hazard ratio ((HR)=1.276, P<0.001) and OS (HR=1.112, P<0.001)] than was LTD, while PN was less strongly associated with CSS (HR=1.040, P=0.230) and OS (HR=0.888, P=0.002) than was LTE, not only in the PSM cohort but also in the subgroups of patients with a tumor size ≤3 cm and patients with a tumor size of 3.1–4 cm.

Conclusions:

In clinical T1a solid renal mass patients, LTD was associated with lower CSS and OS than LTE and PN, while LTE demonstrated noninferior CSS and superior OS to PN regardless of tumor size.
Hospital Capital Assets, Community Health, and the Utilization and Cost of Inpatient Care
Authors: Gaffney Adam , McCormick Danny , Bor David , Woolhandler Steffie , Himmelstein David U.
Published: April 2024

Background:

The provision of high-quality hospital care requires adequate space, buildings, and equipment, although redundant infrastructure could also drive service overprovision.

Objective:

To explore the distribution of physical hospital resources—that is, capital assets—in the United States; its correlation with indicators of community health and nonhealth factors; and the association between hospital capital density and regional hospital utilization and costs.

Research Design:

We created a dataset of n=1733 US counties by analyzing the 2019 Medicare Cost Reports; 2019 State Inpatient Database Community Inpatient Statistics; 2020–2021 Area Health Resource File; 2016–2020 American Community Survey; 2022 PLACES; and 2019 CDC WONDER. We first calculated aggregate hospital capital assets and investment at the county level. Next, we examined the correlation between community’s medical need (eg, chronic disease prevalence), ability to pay (eg, insurance), and supply factors with 4 metrics of capital availability. Finally, we examined the association between capital assets and hospital utilization/costs, adjusted for confounders.

Results:

Counties with older and sicker populations generally had less aggregate hospital capital per capita, per hospital day, and per hospital discharge, while counties with higher income or insurance coverage had more hospital capital. In linear regressions controlling for medical need and ability to pay, capital assets were associated with greater hospital utilization and costs, for example, an additional $1000 in capital assets per capita was associated with 73 additional discharges per 100,000 population (95% CI: 45–102) and $19 in spending per bed day (95% CI: 12–26).

Conclusions:

The level of investment in hospitals is linked to community wealth but not population health needs, and may drive use and costs.
Axial Spondyloarthritis: Does Magnetic Resonance Imaging Classification Improve Report Interpretation
Authors: O'Neill John , Dhillon Sandeep S. , Ma Christina Tianyun , Stubbs Euan Graeme Crowther , Khalidi Nader A. , Ioannidis George , Beattie Karen A. , Carmona Raj
Published: April 2024

Objective

The interpretation of magnetic resonance imaging (MRI) reports is crucial for the diagnosis of axial spondyloarthritis, but the subjective nature of narrative reports can lead to varying interpretations. This study presents a validation of a novel MRI reporting system for the sacroiliac joint in clinical practice.

Methods

A historical review was conducted on 130 consecutive patients referred by 2 rheumatologists for initial MRI assessment of possible axial spondyloarthritis. The original MRI reports were interpreted by the rheumatologists and the radiologist who originally read the images and then categorized according to the novel system. Two musculoskeletal radiologists then reinterpreted the original MRI scans using the new system, and the resulting reports were interpreted and categorized by the same rheumatologists. The quality of the new framework was assessed by comparing the interpretations of both reports.

Results

Ninety-two patients met the study criteria. The rheumatologists disagreed on the categorization of the original MRI reports in 12% of cases. The rheumatologists and original radiologists disagreed on the categorization of the initial report in 23.4% of cases. In contrast, there was 100% agreement between the rheumatologists and radiologists on the categorization of the new MRI report.

Conclusion

The new MRI categorization system significantly improved the agreement between the clinician and radiologist in report interpretation. The system provided a standard vocabulary for reporting, reduced variability in report interpretation, and may therefore improve clinical decision-making.
Intense 68Ga-OncoFAP Uptake as a New Promising Diagnostic Biomarker in Cardiac Sarcoidosis
Authors: Ventura David , Schäfers Michael , Yilmaz Ali , Eckardt Lars , Korthals Dennis
Published: April 2024

A 72-year-old man revealed typical findings of cardiac sarcoidosis on cardiovascular MRI. However, 18F-FDG PET showed no hypermetabolism. Therefore, immunosuppression was not initiated. After 2 years, ventricular arrhythmias and heart failure worsened. 68Ga–fibroblast activation protein inhibitor PET was initiated to evaluate potential adverse remodeling due to progressive myocardial fibrosis. A second 18F-FDG PET still revealed no hypermetabolism, and the patient received an implanted cardioverter defibrillator after electrophysiological risk stratification. We present a case of intense fibroblast activation despite a missing 18F-FDG uptake (mismatch).