bluuebunny/crossref_metadata_2025 huggingface dataset:
Gaia DR3 features of the phase spiral and its possible relation to internal perturbations
Authors: Li Chengdong , Siebert Arnaud , Monari Giacomo , Famaey Benoit , Rozier Simon
Published: July 2023

Disc stars from the Gaia DR3 RVS catalogue are selected to explore the phase spiral in the Galaxy. The data reveal a two-armed phase spiral pattern in the local z–vz plane inside the solar radius, which appears clearly when colour-coded by 〈vR〉(z, vz): this is characteristic of a breathing mode that can in principle be produced by in-plane non-axisymmetric perturbations. The phase spiral pattern becomes single armed outside the solar radius. When a realistic analytic model with a steadily rotating bar and 2-armed spiral arms as perturbation is used to perform particle test integrations, the pseudo-stars get a prominent spiral pattern in the 〈vR〉 map in the x–y plane. Additionally, clear breathing mode evidence at a few $\, \mathrm{km\, s}^{-1}$ level can be seen in the 〈vz〉 map on the x–z plane, confirming that such breathing modes are non-negligible in the joint presence of a bar and spiral arms. However, no phase spiral is perceptible in the (z, vz) plane. When an initial vertical perturbation is added to carry out the simulation, the one-armed phase spirals can clearly be seen 500 Myr after the perturbation and gradually disappear inside out. Finally, we show as a proof of concept how a toy model of a time-varying non-axisymmetric in-plane perturbation with varying pattern speed can produce a strong two-armed phase spiral. We conclude a time-varying strong internal perturbation together with an external vertical perturbation could perhaps explain the transition between the two-armed and one-armed phase spirals around the solar radius.
Strong lensed QSOs with variability detectable by LSST: How many are there?
Authors: Taak Yoon Chan , Treu Tommaso
Published: July 2023

Strong lensed quasi-stellar objects (QSOs) are valuable probes of the Universe in numerous aspects. Two of these applications, reverberation mapping and measuring time delays for determining cosmological parameters, require the source QSOs to be variable with sufficient amplitude. In this paper, we forecast the number of strong lensed QSOs with sufficient variability to be detected by the Vera C. Rubin Telescope Legacy Survey of Space and Time (LSST). The damped random walk model is employed to model the variability amplitude of lensed QSOs taken from a mock catalogue by Oguri & Marshall (2010). We expect 30–40 per cent of the mock lensed QSO sample, which corresponds to ∼1000, to exhibit variability detectable with LSST. A smaller subsample of 250 lensed QSOs will show larger variability of >0.15 mag for bright lensed images with i < 21 mag, allowing for monitoring with smaller telescopes. We discuss systematic uncertainties in the prediction by considering alternative prescriptions for variability and mock lens catalogue with respect to our fiducial model. Our study shows that a large-scale survey of lensed QSOs can be conducted for reverberation mapping and time delay measurements following up on LSST.
The UV luminosity functions of bright z > 8 galaxies: determination from ∼0.41 deg2 of HST observations along ∼300 independent sightlines
Authors: Leethochawalit Nicha , Roberts-Borsani Guido , Morishita Takahiro , Trenti Michele , Treu Tommaso
Published: July 2023

We determine the bright end of the rest-frame UV luminosity function (UVLF) at z = 8–10 by selecting bright z ≳ 8 photometric candidates from the largest systematic compilation of HST (pure-)parallel observations to date, the Super-Brightest-of-Reionizing-Galaxies (SuperBoRG) data set. The data set includes ∼300 independent sightlines from WFC3 observations, totalling 800–1300 arcmin2 (depending on redshift). We identify 31 z ≳ 8 candidates via colour selection and photo-z analysis with observed magnitude (24.1 < H160 < 26.6) and 1σ range probability of $58\!-\!95~{{\ \rm per\ cent}}$ of being true high-z galaxies. Following detailed completeness and source recovery simulations, as well as modelling of interloper contamination, we derive rest-frame UVLFs at z = 8–10 down to MUV ≃ −23. We find that the bright end of the galaxy luminosity function can be described both by a Schechter and by a double power-law function, with our space-based large area determination showing some tentative discrepancies with the luminosity functions derived from ground-based observations at the same redshifts. We identify two possible explanations. The first is that the UVLF includes a substantial contribution from AGNs at magnitudes MUV < −22. The UVLF we derive at z = 8 is consistent with no evolution of the bright end from z = 6–7 UVLFs that include AGNs. An alternative (and non-exclusive) possibility is that the dust content of the observed galaxies decreases with redshift, thereby countering the naturally expected decrease in the UV luminosity functions because of a decreased star-formation rate with increasing redshift. Both scenarios raise interesting prospects to further understand galaxy formation in extreme objects during the epoch of reionization.
Detecting cosmic voids via maps of geometric-optics parameters
Authors: Peper Marius , Roukema Boudewijn F , Bolejko Krzysztof
Published: July 2023

Curved space–time geometric-optics maps derived from a deep photometric survey should contain information about the 3D matter distribution and thus about cosmic voids in the survey, despite projection effects. We explore to what degree sky-plane geometric-optics maps can reveal the presence of intrinsic 3D voids. We carry out a cosmological N-body simulation and place it further than a gigaparsec from the observer, at redshift 0.5. We infer 3D void structures using the watershed algorithm. Independently, we calculate a surface overdensity map and maps of weak gravitational lensing and geometric-optics scalars. We propose and implement a heuristic algorithm for detecting (projected) radial void profiles from these maps. We find in our simulation that given the sky-plane centres of the 3D watershed-detected voids, there is significant evidence of finding corresponding void centres in the surface overdensity Σ, the averaged weak-lensing tangential shear $\overline{{\gamma }_{\perp }}$, the Sachs expansion θ, and the Sachs shear modulus |σ|. Recovering the centres of the 3D voids from the sky-plane information alone is significant given the Sachs expansion θ, or the Sachs shear |σ|, mildly significant given the weak-lensing shear $\overline{{\gamma }_{\perp }}$, and not significant for the surface overdensity Σ. Void radii are uncorrelated between 3D and 2D voids; our algorithm is not designed to distinguish voids that are nearly concentric in projection. This investigation shows preliminary evidence encouraging observational studies of gravitational lensing through individual voids, either blind or with spectroscopic/photometric redshifts. The former case – blind searches – should generate falsifiable predictions of intrinsic 3D void centres.
Density streams in the disc winds of Classical T Tauri stars
Authors: Petrov P P , Grankin K N , Babina E V , Artemenko S A , Romanova M M , Gorda S Yu , Djupvik A A , Gameiro J F
Published: July 2023

Spectral and photometric variability of the Classical T Tauri stars RY Tau and SU Aur from 2013 to 2022 is analysed. We find that in SU Aur the H α line’s flux at radial velocity RV  = −50 ± 7  km s−1 varies with a period P = 255 ± 5 d. A similar effect previously discovered in RY Tau is confirmed with these new data: P = 21.6 d at RV  = −95 ± 5  km s. In both stars, the radial velocity of these variations, the period, and the mass of the star turn out to be related by Kepler’s law, suggesting structural features on the disc plane orbiting at radii of 0.2 au in RY Tau and 0.9 au in SU Aur, respectively. Both stars have a large inclination of the accretion disc to the line of sight – so that the line of sight passes through the region of the disc wind. We propose there is an azimuthal asymmetry in the disc wind, presumably in the form of ‘density streams,’ caused by substructures of the accretion disc surface. These streams cannot dissipate until they go beyond the Alfven surface in the disc’s magnetic field. These findings open up the possibility to learn about the structure of the inner accretion disc of CTTS on scales less than 1 au and to reveal the orbital distances related to the planet’s formation.
A search for gravitationally lensed supernovae within the Zwicky transient facility public survey
Authors: Magee M R , Sainz de Murieta A , Collett T E , Enzi W
Published: July 2023

Strong gravitational lensing of supernovae is exceedingly rare. To date, only a handful of lensed supernovae are known. Despite this, lensed supernovae have emerged as a promising method for measuring the current expansion rate of the Universe and breaking the Hubble tension. We present an extensive search for gravitationally lensed supernovae within the Zwicky Transient Facility (ZTF) public survey, covering 15 215 transients with good light curves discovered during 4 yr of observations. We cross-match a catalogue of known and candidate lens galaxies with our sample and find three coincident sources, which were due to chance alignment. To search for supernovae magnified by unknown lenses, we test multiple methods suggested in the literature for the first time on real data. This includes selecting objects with extremely red colours, those that appear inconsistent with the host galaxy redshift, and those with bright absolute magnitudes inferred from the host galaxy redshift. We find a few hundred candidates, most of which are due to contamination from activate galactic nuclei, bogus detections, or unlensed supernovae. The false positive rate from these methods presents significant challenges for future surveys. In total, 132 unique transients were identified across all of our selection methods that required detailed manual rejection, which would be infeasible for larger samples. Overall, we do not find any compelling candidates for lensed supernovae, which is broadly consistent with previous estimates for the rate of lensed supernovae from the ZTF public survey alone and the number expected to pass the selection cuts we apply.
A giant radio galaxy with three cycles of episodic jet activity from LoTSS DR2
Authors: Chavan Kshitij , Dabhade Pratik , Saikia D J
Published: July 2023

The excellent sensitivity and optimum resolution of LoTSS DR2 at 144 MHz has enabled us to discover a giant radio galaxy (J1225+4011) with three distinct episodes of jet activity, making it a member of a class of objects called triple-double radio galaxies (TDRGs). The source extends overall up to 1.35 Mpc in projected size, with the second episode extending to 572 kpc, and the inner episode to 118 kpc. J1225+4011 is only the fourth radio source showing a triple-double radio structure. All four sources have overall sizes greater than 700 kpc, making them giants. We also present the LoTSS 144 MHz map of the TDRG J0929+4146 and report its updated size. Lastly, we have summarized and discussed the radio properties of all TDRGs for the first time to understand their growth and evolution. Our observations suggest that the power of their jets may decrease with time.
Integrative Omics Reveals Rapidly Evolving Regulatory Sequences Driving Primate Brain Evolution
Authors: Zhuang Xiao-Lin , Zhang Jin-Jin , Shao Yong , Ye Yaxin , Chen Chun-Yan , Zhou Long , Wang Zheng-bo , Luo Xin , Su Bing , Yao Yong-Gang , Cooper David N , Hu Ben-Xia , Wang Lu , Qi Xiao-Guang , Lin Jiangwei , Zhang Guo-Jie , Wang Wen , Sheng Nengyin , Wu Dong-Dong
Published: July 2023

Although the continual expansion of the brain during primate evolution accounts for our enhanced cognitive capabilities, the drivers of brain evolution have scarcely been explored in these ancestral nodes. Here, we performed large-scale comparative genomic, transcriptomic, and epigenomic analyses to investigate the evolutionary alterations acquired by brain genes and provide comprehensive listings of innovatory genetic elements along the evolutionary path from ancestral primates to human. The regulatory sequences associated with brain-expressed genes experienced rapid change, particularly in the ancestor of the Simiiformes. Extensive comparisons of single-cell and bulk transcriptomic data between primate and nonprimate brains revealed that these regulatory sequences may drive the high expression of certain genes in primate brains. Employing in utero electroporation into mouse embryonic cortex, we show that the primate-specific brain-biased gene BMP7 was recruited, probably in the ancestor of the Simiiformes, to regulate neuronal proliferation in the primate ventricular zone. Our study provides a comprehensive listing of genes and regulatory changes along the brain evolution lineage of ancestral primates leading to human. These data should be invaluable for future functional studies that will deepen our understanding not only of the genetic basis of human brain evolution but also of inherited disease.
Effects of Ovarian Hormone Levels on Stress, Cigarette Craving, and Smoking in a Laboratory Relapse Paradigm Among Females Who Smoke Daily
Authors: Schick Melissa R , Baker Nathaniel L , Hood Caitlyn O , Tomko Rachel L , Gray Kevin M , Ramakrishnan Viswanathan R , Saladin Michael E , McClure Erin A
Published: July 2023

Introduction

Females, versus males, have shown a slower decline in smoking prevalence, greater smoking-related mortality and morbidity, and tend to have more difficulty achieving and maintaining abstinence. Identifying sex-specific risk factors is needed to improve outcomes. Though ovarian hormones have been evaluated for their role in smoking and relapse, measures tend to be static and infrequent, failing to capture the influence of increasing or decreasing levels.

Aims and Methods

The present study evaluated the effect of static and fluctuating levels of ovarian hormones (ie, progesterone, estradiol, and estrogen to progesterone [E/P] ratio) on stress reactivity, cigarette craving, and smoking during a laboratory relapse paradigm. Female participants (assigned female at birth) reporting daily cigarette smoking (N = 91, ages 18–45) were recruited from the community. Participants provided daily salivary ovarian hormone levels leading up to a laboratory session, in which stress was induced and stress reactivity, cigarette craving, latency to smoke, and ad-libitum smoking were measured.

Results

Static levels of estradiol were associated with stress reactivity (β = 0.28, SE = 0.13) and static E/P ratio was associated with smoking in the laboratory (HR = 1.4). Preceding 3-day changes in estradiol and E/P ratio, but neither static levels nor preceding 3-day changes in progesterone were associated with stress reactivity, cigarette craving, or smoking in a relapse paradigm.

Conclusions

Ovarian hormones are among several sex-specific factors involved in the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.

Implications

Findings of the present study provide novel information regarding the role of ovarian hormones among female participants who smoke daily in stress reactivity and smoking in the context of a laboratory relapse paradigm and highlight several avenues for future research. We found that same-day estradiol levels were associated with increased subjective stress reactivity and same-day estrogen to progesterone ratio was associated with increased likelihood of smoking in a relapse paradigm. Ovarian hormones are among several sex-specific factors contributing to the complex neuroendocrine response to stress, and their interaction with other biological, social, and psychological factors in the real-world environment is not yet fully understood.
Clinical Profile and Diagnosis of Recurrent Cutaneous Leishmaniasis
Authors: Arruda Sérgio , Agra-Duarte Gabriela , Lago Jamile , Oliveira Lívia , Zacarias Evelyn , Carvalho Lucas P , Machado Paulo R L , de Oliveira Camila I , Carvalho Edgar M
Published: July 2023

This case-control study compared the clinical profile, parasite load, polymerase chain reaction positivity, and response to therapy in patients with recurrent cutaneous leishmaniasis (RCL) with primary cutaneous leishmaniasis (CL). The RCL patients had milder diseases with lower parasite loads, a lower number of lesions, and more self-healing diseases than primary CL patients.
Heart failure and the heart–brain axis
Authors: Doehner Wolfram , Čelutkienė Jelena , Yilmaz Mehmet Birhan , Coats Andrew J S
Published: July 2023

In heart failure (HF) strong haemodynamic and neuronal signalling feedback interactions between the heart and the central nervous system (CNS) exist that are able to mutually provoke acute or chronic functional impairment. Cerebral injury secondary to HF may include acute stroke, cognitive decline and dementia and depressive disorders. Also brain stem functions are involved in the cardiac-cerebral interaction in HF as neurohormonal control and neuronal reflex circuits are known to be impaired or imbalanced in HF. In turn, impaired cerebral functions may account for direct and indirect myocardial injury and may contribute to symptomatic severity of HF, to disease progression and to increased mortality. Despite the clinical and pathophysiologic significance of the heart—CNS interaction, this relevant field of HF comorbidity is clinically under-recognized with regard to both diagnostic workup and treatment efforts. Here, principal aspects of pathophysiologic heart—CNS interactions related to HF are discussed such as stroke, effects on cognitive function, on depressive disorder and neurovegetative control and neuronal cardiovascular reflex regulation. Aspects of (limited) treatment options for cerebral functional interactions in HF are examined.
Pyrin variant E148Q potentiates inflammasome activation and the effect of pathogenic mutations in cis
Authors: Reygaerts Thomas , Laohamonthonkul Pawat , Hrovat-Schaale Katja , Moghaddas Fiona , Baker Paul J , Gray Paul E , Masters Seth L
Published: July 2023

Objective

The p.E148Q variant in pyrin is present in different populations at a frequency of up to 29%, and has been associated with diseases, including vasculitis and FMF. The pathogenicity of p.E148Q in FMF is unclear, even when observed in cis or in trans to a single, typically recessive, pathogenic mutation. We performed functional validation to determine whether p.E148Q increases the ability of pyrin to form an active inflammasome complex in cell lines.

Methods

We interrogated the Australian Autoinflammatory Disease RegistrY (AADRY) to find candidate inheritance patterns for the p.E148Q variant in pyrin. Different pyrin variant combinations were tested in HEK293T cells stably expressing the adaptor protein apoptosis-associated speck-like (ASC), which were analysed by flow cytometry to visualize inflammasome formation, with and without stimulation by Clostridioides difficile toxin B (TcdB). Inflammasome-dependent cytokine secretion was also quantified by ELISA of supernatants from THP-1 cells transduced with lentiviral expression vectors.

Results

In AADRY, we observed the p.E148Q allele in individuals with autoinflammatory diseases alone or in conjunction with other pyrin variants. Two FMF families harboured the allele p.E148Q-M694I in cis with dominant heritability. In vitro, p.E148Q pyrin could spontaneously potentiate inflammasome formation, with increased IL-1β and IL-18 secretion. p.E148Q in cis to classical FMF mutations provided significant potentiation of inflammasome formation.

Conclusion

The p.E148Q variant in pyrin potentiates inflammasome activation in vitro. In cis, this effect is additive to known pathogenic FMF mutations. In some families, this increased effect could explain why FMF segregates as an apparently dominant disease.
Taxonomy and molecular phylogenetic position of new species and new records of Coelosphaeridae (Demospongiae: Poecilosclerida) from the Mexican Pacific
Authors: Cruz-Barraza José Antonio , Carballo José Luis , Aguilar-Camacho José María
Published: July 2023

Poecilosclerida is the largest and the most diverse order in the class Demospongiae and one of the least studied in the tropical Pacific Ocean. In this study, two new species and two new faunistic records of Coelosphaeridae are described from the Mexican Pacific Ocean. Celtodoryx chichiltik sp. nov. and Lissodendoryx (Anomodoryx) incrustans sp. nov. also constitute the first records of the monotypic genus Celtodoryx and the subgenus Anomodoryx from the Eastern Pacific Region. In addition, the re-description of Lissodendoryx (Waldoschmittia) hawaiiana and Lissodendoryx (Lissodendoryx) albemarlensis with new regional records are included. The cytochrome c oxidase subunit I (COI) mtDNA and 28S rDNA (C1–D2 domains) were sequenced, and molecular phylogenetic analyses of the two loci revealed that Coelosphaeridae is not monophyletic. In the 28S tree topology, neither Lissodendoryx nor Celtodoryx are monophyletic, and sequences of the two genera are members of two distinct clades containing sequences of other Poecilosclerida species. 28S sequences of L. (W.) hawaiiana show high similarities between specimens from the Mexican Pacific and a specimen from Hawaii (type locality), suggesting a wide distribution range of this sponge species in the Pacific Ocean. COI topology shows that the majority of Lissodendoryx (including our sequences) were grouped within the same molecular clade.
Surgical Treatment of Congenital Muscular Torticollis: Significant Improvement in Health-related Quality of Life Among a 2-year Follow-up Cohort of Children, Adolescents, and Young Adults
Authors: Høiness Per Reidar , Medbøe Anja
Published: July 2023

Objective:

Surgical treatment of congenital muscular torticollis (CMT) has been proven clinically effective in cases that fail to normalize after conservative treatment, but reports on self-reported outcome and quality of life have been scarce. This study aimed to assess health-related quality of life (HRQoL) in children, adolescents, and young adults undergoing surgical treatment for CMT, comparing HRQoL with clinical outcomes.

Methods:

We conducted a level 2 prospective observational study on a surgically treated CMT cohort at a single tertiary center. The surgeries focused on releasing all tightness, and the medial head was routinely elongated to preserve cosmetic function. Patients underwent rigorous pre/postoperative assessments and follow-up. A strict postoperative protocol entailing stretching, physiotherapy, and positional exercises was adhered to for a minimum of 6 months. The Cheng and Tang torticollis scoring system and PedsQLTM 4.0 generic core scales were used to evaluate clinical outcome and HRQoL, respectively.

Results:

The study included 31 patients, averaging 11.4 years. Significant improvements in range of motion, deformities, and overall subjective satisfaction were observed 2 years postoperatively. The Cheng and Tang score improved overall significantly from fair (9.9 points) to excellent (17.9 points) after 2 years (P<0.001). The oldest patients showed less improvement than the youngest ones, especially regarding craniofacial asymmetry (P=0.004). Patient PedsQL scores significantly improved 2 years post-surgery (P=0.040), with no discernable age differences.

Conclusion:

Our findings demonstrated significant improvements in both HRQoL and clinical outcomes after surgical treatment of CMT. The PedsQL score seemed sensitive to the clinical changes.
Efficacy of Varying Surgical Approaches on Achieving Optimal Alignment in Adult Spinal Deformity Surgery
Authors: Passias Peter G. , Ahmad Waleed , Williamson Tyler K. , Lebovic Jordan , Kebaish Khaled , Lafage Renaud , Lafage Virginie , Line Breton , Schoenfeld Andrew J. , Diebo Bassel G. , Klineberg Eric O. , Kim Han Jo , Ames Christopher P. , Daniels Alan H. , Smith Justin S. , Shaffrey Christopher I. , Burton Douglas C. , Hart Robert A. , Bess Shay , Schwab Frank J. , Gupta Munish C. ,   International Spine Study Group
Published: July 2023

Background:

The Roussouly, SRS-Schwab, and Global Alignment and Proportion (GAP) classifications define alignment by spinal shape and deformity severity. The efficacy of different surgical approaches and techniques to successfully achieve these goals is not well understood.

Purpose:

Identify the impact of surgical approach and/or technique on meeting complex realignment goals in adult spinal deformity (ASD) corrective surgery.

Study Design/Setting:

Retrospective study.

Materials and Methods:

Included patients with ASD fused to pelvis with 2-year data. Patients were categorized by: (1) Roussouly: matching current and theoretical spinal shapes, (2) improving in SRS-Schwab modifiers (0, +, ++), and (3) improving GAP proportionality by 2 years. Analysis of covariance and multivariable logistic regression analyses controlling for age, levels fused, baseline deformity, and 3-column osteotomy usage compared the effect of different surgical approaches, interbody, and osteotomy use on meeting realignment goals.

Results:

A total of 693 patients with ASD were included. By surgical approach, 65.7% were posterior-only and 34.3% underwent anterior-posterior approach with 76% receiving an osteotomy (21.8% 3-column osteotomy). By 2 years, 34% matched Roussouly, 58% improved in GAP, 45% in SRS-Schwab pelvic tilt (PT), 62% sagittal vertical axis, and 70% pelvic incidence-lumbar lordosis. Combined approaches were most effective for improvement in PT [odds ratio (OR): 1.7 (1.1–2.5)] and GAP [OR: 2.2 (1.5–3.2)]. Specifically, anterior lumbar interbody fusion (ALIF) below L3 demonstrated higher rates of improvement versus TLIFs in Roussouly [OR: 1.7 (1.1–2.5)] and GAP [OR: 1.9 (1.3–2.7)]. Patients undergoing pedicle subtraction osteotomy at L3 or L4 were more likely to improve in PT [OR: 2.0 (1.0–5.2)] and pelvic incidence-lumbar lordosis [OR: 3.8 (1.4–9.8)]. Clinically, patients undergoing the combined approach demonstrated higher rates of meeting SCB in Oswestry Disability Index by 2 years while minimizing rates of proximal junctional failure, most often with an ALIF at L5-S1 [Oswestry Disability Index-SCB: OR: 1.4 (1.1–2.0); proximal junctional failure: OR: 0.4 (0.2–0.8)].

Conclusions:

Among patients undergoing ASD realignment, optimal lumbar shape and proportion can be achieved more often with a combined approach. Although TLIFs, incorporating a 3-column osteotomy, at L3 and L4 can restore lordosis and normalize pelvic compensation, ALIFs at L5-S1 were most likely to achieve complex realignment goals with an added clinical benefit and mitigation of junctional failure.
Single-institution Series of Hirayama Disease in North America
Authors: Lynch Benjamin T. , Slingerland Anna L. , Robson Caroline D. , Ghosh Partha S. , Hedequist Daniel J. , Proctor Mark R. , Fehnel Katie P.
Published: July 2023

Study Design:

A retrospective chart review.

Objective:

The aims of this study were to review pathophysiology, workup, and treatment for Hirayama disease (HD); and to assess outcomes from a single institution.

Summary of Background Data:

HD is a rare, painless, cervical myelopathy with distal upper extremity weakness, muscle wasting, and spinal cord atrophy. Disease progression—a consequence of repeat flexion injury—occurs up to 5 years from the initial diagnosis.

Methods:

Single-institution review of pediatric HD patients from 2010 to 2020.

Results:

Patients (n=10 male, n=2 female) presented in the second decade (14–20 y) with painless progressive distal upper extremity weakness and atrophy without sensory loss. Electromyography (n=12) demonstrated denervation in C7–T1 myotomes and flexion/extension magnetic resonance imaging showed focal cord atrophy and anterior displacement of the posterior dura with epidural enhancement in flexion. Treatment included observation and external orthoses (n=9) and anterior cervical discectomy with fusion (n=3). One of the 9 patients managed conservatively experienced further deterioration; no patient who underwent anterior cervical discectomy with fusion progressed.

Conclusions:

Patients with HD require a multidisciplinary approach to diagnosis and treatment to preserve function. Treatment is preventive and aims to minimize flexion injury by inhibiting motion across involved joints. First-line management is avoidance of neck flexion and use of rigid orthosis; in cases of failed conservative management and/or rapid clinical deterioration, surgical fixation can be offered.
Human Beauty according to Artificial Intelligence
Authors: Kenig Nitzan , Monton Echeverria Javier , Muntaner Vives Aina
Published: July 2023

This work explores the upcoming era of artificial intelligence (AI), its potential impact on societal norms and aesthetics, and the biases inherent in AI systems. With the ability to generate realistic human-like art and language, AI entities like DALL·E or Midjourney have significant cultural and economic implications, particularly in creative sectors. However, our study highlights potential biases in AI, demonstrated through a text-to-image model called Craiyon, which was found to generate oversized and sexually suggestive images of breasts when prompted with certain phrases. These results underline the influence of societal norms on AI and the risk of perpetuating harmful stereotypes or unrealistic beauty standards. We emphasize the need for vigilance in monitoring AI’s learning processes and potential biases, particularly as AI starts playing a crucial role in shaping societal perceptions of beauty and self. More inclusive and diverse AI models are needed to better represent the complexity of human beauty and to avoid biases.
Thiopurines Maintenance Therapy in Children With Ulcerative Colitis: A Multicenter Retrospective Study
Authors: Abu Hanna Firas , Atia Ohad , Yerushalmy Feler Anat , Shouval Dror , Weiss Batia , Mresat Hadeel , Magen-Rimon Ramit , Zifman Eyal , Turner Dan , Rinawi Firas
Published: July 2023

Background and Aims:

Thiopurines are an established treatment for pediatric ulcerative colitis (UC). However, data regarding safety and efficacy are lacking. We aimed to determine short and long-term outcome following thiopurines use in children with UC.

Methods:

We conducted a retrospective review of children (2–18 years) with UC treated with thiopurines between January 2008 and January 2019 at 7 medical centers in Israel. The primary outcome was corticosteroid (CS)-free clinical remission at week 52 following thiopurines initiation without the need for rescue therapy (infliximab, calcineurin inhibitors, or colectomy).

Results:

A total of 133 children were included [median age at diagnosis of 12.4 (interquartile range 11.0–15.8) years, 30 (23%) left-sided colitis, 113 (85%) with moderate or severe disease at diagnosis]. At diagnosis 58 patients (44%) were treated with 5-aminosalicylates and 72 (54%) with CS. Sixty patients (45%) received thiopurines as 1st line maintenance therapy. Seventy-four patients (56%) had CS-free clinical remission at week 52 without rescue therapy. Predictors of clinical remission were not identified. In a sub-analysis among patients with steroid-responsive moderate to severe UC, 59 (55%) patients achieved this outcome. The likelihood of remaining free of rescue therapy among thiopurines-treated patients was 83%, 62%, 45%, and 37% at 1, 2, 3, and 4 years, respectively.

Conclusion:

More than half of children with UC starting thiopurines without previous or concomitant biologic therapy have CS-free clinical remission at 52 weeks later without the need for rescue therapy. Thiopurines are effective in pediatric UC and could be considered prior to biologics.
OPG/RANK/RANKL Axis in Egyptian Children With Acute Lymphoblastic Leukemia After Maintenance Therapy: Relationship to Bone Mineral and Vitamin D Status
Authors: Hablas Nahed M. , Keshk Walaa A.
Published: July 2023

Policies to maximize peak bone mass in survivor’s children of acute lymphoblastic leukemia (ALL) have been recognized as a priority area for research. The present study aimed to evaluate the relationship between osteoprotegerin (OPG)/receptor activator of nuclear factor kappa-B (RANK)/RANK ligand (RANKL) axis, vitamin D status, and serum magnesium in ALL survivors. Sixty ALL survivors treated with chemotherapy and 60 age and sex-matched controls were included. Vitamin D and parathyroid hormone, RANK, RANKL, and OPG levels were immunoassayed, in addition to serum calcium, phosphorus, magnesium levels, and alkaline phosphatase activity assessment. Furthermore, standard anthropometric measurement, history of fractures since treatment and clinical assessment were recorded. History of bone fractures after the start of therapy was detected in 17 ALL subjects (28.33%). Significantly lower vitamin D, magnesium, calcium, and OPG levels, meanwhile, significantly higher serum parathyroid hormone, RANK, and RANKL levels were detected in survivors compared with the control group. Vitamin D level was significantly positively correlated with magnesium, calcium, and OPG levels. Meanwhile, negatively correlated with RANK and RANKL levels. ALL survivors had a high prevalence of impaired vitamin D status, decreased Mg, and altered OPG/RANK/RANKL axis with impaired bone remodeling. The results herein may open the door for new interventional actions in ALL survivors to protect against bone resorption.
Prolonged Survival Using Outpatient Palliative Chemotherapy in Two Children With Refractory Acute Myelogenous Leukemia
Authors: MacDonell-Yilmaz Rebecca E. , Sampino Emily Vistica , Moynihan Laura , Chang Wen-i , Sprinz Philippa G.
Published: July 2023

Background:

Therapy options for relapsed/refractory acute myelogenous leukemia (AML) are limited. Palliative chemotherapy options have been explored in adult patients, but little evidence exists in children.

Objectives:

Describe the clinical course of 2 pediatric patients with refractory AML who transitioned to outpatient palliative chemotherapy with good disease control and quality of life on these regimens.

Patients and Methods:

Patient 1 was a 2-year-old girl who received a total of 4 cycles of standard chemotherapy with multiple complications and 15% to 20% blasts on marrow subsequent evaluation. An outpatient regimen of decitabine and vorinostat was consequently chosen for her. Patient 2 was a 16-year-old boy with residual disease after induction 1 with arm A with cytarabine, daunorubicin, and etoposide. His induction 2 course was complicated by multiorgan failure secondary to multiple infections including Klebsiella pneumonia and radiographically identified pulmonary fungal disease. On recovery, the marrow showed no disease but after the toxicities of initial therapy, the patient pursued a palliative regimen with azacitidine and lenalidomide.

Results:

Patient 1 tolerated her regimen for 14 months, requiring weekly blood products and only one hospitalization for a central-line infection. Her blast count then increased precipitously, the disease progressed, and she died comfortably while receiving hospital-based end-of-life care. Patient 2 tolerated 14 months of his regimen. On a surveillance marrow sample, he was found to have 0.02% minimal residual disease. He then elected to pursue marrow transplantation. He maintained remission until his 6-month posttransplant surveillance bone marrow biopsy, which revealed 0.04% minimal residual disease.

Conclusion:

We describe 2 pediatric patients with relapsed/refractory AML who achieved disease control and acceptable quality of life utilizing outpatient palliative chemotherapy for over 12 months. These regimens should be considered in patients who no longer desire cytotoxic chemotherapy or are ineligible for further aggressive approaches.
Is It Necessary to Wake Patients for Overnight Vital Signs Following Total Joint Arthroplasty?
Authors: Sawires Andrew N. , Weiner Travis R. , Shah Roshan P. , Geller Jeffrey A. , Cooper H. John
Published: July 2023

Benefits of sleep are well-established in postoperative recovery; however, patients undergoing total joint arthroplasty (TJA) often experience poor sleep during hospitalization. While multifactorial, among the major reasons are the frequent and ritualized overnight vital sign checks. In the absence of data in support of or against this practice, we asked whether it remains necessary. We retrospectively analyzed a cohort of 419 primary TJA patients. Demographics, comorbidities, operative, and vital sign data were collected through postoperative Day 3. Correlation between daytime (6:00 a.m. to 10:00 p.m.) and nighttime (10:01 p.m. to 5:59 a.m.) vitals was examined. The vast majority of nighttime vitals fell within normal ranges, including O2 saturation (O2; 99.4%), temperature (TEMP; 97.8%), heart rate (HR; 87.5%), systolic blood pressure (SBP; 85.8%), and diastolic blood pressure (DBP; 84.4%). Predictors of abnormal nighttime vitals included American Society of Anesthesiologists (ASA) score (abnormal SBP; odds ratio [OR] 1.64, p = .045), obesity (abnormal DBP; OR: 0.37, p = .011), and smoking status (elevated temperature; OR: 2.79, p = .042). Estimated blood loss was predictive of an abnormal nighttime TEMP (OR: 1.002; p < .001). Postoperatively, there were several correlations between abnormal daytime and nighttime vitals, including SBP (OR: 6.23, p < .001), DBP (OR: 4.31, p < .001), and HR (OR: 10.35; p < .001). Of the 419 patients, only 9 (2.1%) received any intervention based on abnormal nighttime vitals. Each exhibited daytime vital sign abnormalities prior to the abnormal nighttime readings. Patients with abnormal nighttime vitals can be predicted on the basis of medical comorbidities and abnormal daytime vitals. These findings suggest that healthy post-TJA patients with normal daytime vitals may not need to be routinely woken at night.
The Evolving Spectrum of Endometrial Glandular Proliferations With Corded and Hyalinized Features
Authors: Pors Jennifer , Weiel Julianna J. , Ryan Emily , Longacre Teri A.
Published: July 2023

We present the clinicopathologic and immunohistochemical features of 14 endometrial glandular proliferations with conspicuous corded and hyalinized (CH) features comprised entirely or predominantly of endometrial hyperplasia. Endometrial glandular lesions ranged in severity from endometrial hyperplasia with and without cytologic atypia (5/14 [36%]) to hyperplasia with architectural complexity bordering on well-differentiated endometrioid adenocarcinoma (3/14 [21%]) to frank corded and hyalinized endometrial carcinoma (“CHEC”) (6/14 [43%]). In addition to sex cord–like growth and hyalinized stroma, other common histologic features included prominent spindle cells (11/14 [79%]), keratinizing and/or morular squamous differentiation (10/14 [71%]), and osseous metaplasia (6/14 [43%]). Immunohistochemical characterization revealed aberrant nuclear beta-catenin in all cases (14/14 [100%]); additionally, all cases demonstrated positive estrogen receptors, intact PTEN, PMS2 and MSH6, and wild-type p53 expression. Patients ranged in age from 24 to 58 (mean 38) years. Of 5 patients with hyperplasia with CH features, 2 experienced complete resolution after progestin therapy and none progressed to adenocarcinoma (mean follow-up 15.6 mo, range 2 to 64). By contrast, of 2 patients with hyperplasia bordering on CHEC and with available follow-up, both subsequently developed adenocarcinoma, suggesting that even focal increased architectural complexity may predict an elevated risk of malignancy. We conclude that CH morphology is not limited to endometrioid carcinoma and may occur across a spectrum of neoplastic proliferations, including those without sufficient architectural complexity or cytologic atypia to warrant classification as adenocarcinoma. We propose the term “corded and hyalinized endometrial hyperplasia” to describe this precursor lesion and report favorable outcomes with conservative treatment.
Adamantinoma-like Ewing Sarcoma (ALES) May Harbor FUS Rearrangements
Authors: Palsgrove Doreen N. , Foss Robert D. , Yu Wengdong , Garcia Joaquin , Rooper Lisa M. , Rekhtman Natasha , Antonescu Cristina , Gagan Jeffrey , Agaimy Abbas , Bishop Justin A.
Published: July 2023

Adamantinoma-like Ewing sarcoma (ALES) is a rare malignancy currently considered a variant of Ewing sarcoma with most known cases harboringEWSR1rearrangements. Herein we present a series of 6 cases ofEWSR1-negative ALES. The tumors arose in the sinonasal tract (n=3), major salivary glands (submandibular gland=1; parotid=1), and anterior mediastinum (n=1) in patients ranging from 25 to 79 years of age. Most tumors were basaloid in appearance, growing in large nests separated by interlobular fibrosis without overt squamous pearls. However, 1 case closely resembled a well-differentiated neuroendocrine tumor with uniformly round nuclei, eosinophilic cytoplasm, and trabecular architecture. All cases were diffusely positive for pan-cytokeratin, p40 or p63, and CD99. A subset of cases showed diffuse reactivity for synaptophysin, including 1 sinonasal tumor which also demonstrated sustentacular S100 protein expression. Molecular testing showedFUSrearrangements in all cases. Gene partners included known ETS family membersFEV(n=2) andFLI1(n=1). Our results expand the molecular diagnostic considerations for ALES to includeFUSrearrangements. We also show that ALES may harborFUS::FLI1fusion, which has not been previously reported in the Ewing family of tumors. Furthermore, ALES may show unusual histologic and immunophenotypic features that can overlap with olfactory carcinoma including S100-positive sustentacular cells. ALES should be considered in the diagnostic differential of small round cell tumors and tumors with neuroendocrine differentiation with immunohistochemical workup to include p40 and CD99/NKX2.2.
Evaluating the Long-term Impact of Implementing Standardized Postoperative Opioid Prescribing Recommendations Following Pelvic Organ Prolapse Surgery
Authors: Olive Elizabeth J. , Glasgow Amy E. , Habermann Elizabeth B. , Gebhart John B. , Occhino John A. , Trabuco Emanuel C. , Linder Brian J.
Published: July 2023

Importance

Improving opioid stewardship is important, given the common use of opioids and resultant adverse events. Evidence-based prescribing recommendations for surgeons may help reduce opioid prescribing after specific procedures.

Objective

The aim of this study was to assess longitudinal prescribing patterns for patients undergoing pelvic organ prolapse surgery in the 2 years before and after implementing evidence-based opioid prescribing recommendations.

Study Design

In December 2017, a 3-tiered opioid prescribing recommendation was created based on prospective data on postoperative opioid use after pelvic organ prolapse surgery. For this follow-up study, prescribing patterns, including quantity of opioids prescribed (in oral morphine equivalents [OMEs]) and refill rates, were retrospectively compared for patients undergoing prolapse surgery before (November 2015–November 2017; n = 238) and after (December 2017–December 2019; n = 361) recommendation implementation. Univariate analysis was performed using the Wilcoxon rank sum and χ
2 tests. Cochran-Armitage trend tests and interrupted time-series analysis tested for significance in the change in OMEs prescribed before versus after recommendation implementation.

Results

After recommendation implementation, the quantity of postoperative opioids prescribed decreased from median 225 mg OME (interquartile range, 225, 300 mg OME) to 71.3 mg OME (interquartile range, 0, 112.5 mg OME; P < 0.0001). Decreases also occurred within each subgroup of prolapse surgery: native tissue vaginal repair (P < 0.0001), robotic sacrocolpopexy (P < 0.0001), open sacrocolpopexy (P < 0.0001), and colpocleisis (P < 0.003). The proportion of patients discharged following prolapse surgery without opioids increased (4.2% vs 36.6%; P < 0.0001), and the rate of opioid refills increased (2.1% vs 6.0%; P = 0.02).

Conclusions

With 2 years of postimplementation follow-up, the use of procedure-specific, tiered opioid prescribing recommendations at our institution was associated with a significant, sustained reduction in opioids prescribed. This study further supports using evidence-based recommendations for opioid prescribing.
The Impact of Vaginal Probiotics on Pessary Use: A Randomized Controlled Trial
Authors: Sappenfield Elisabeth C. , Mellen Colleen , Wilcox Jennifer , O'Hanlon Deirdre Elizabeth , O'Sullivan David M. , Tunitsky-Bitton Elena
Published: July 2023

Importance

Pessary-related adverse effects are common, and treatment options are limited. Probiotics may improve pessary-related adverse effects by altering the vaginal microenvironment.

Objective

This study aimed to evaluate the effect of a vaginal probiotic suppository on the vaginal microenvironment among pessary users.

Study Design

Women who used pessaries were randomized to vaginal probiotic suppository use versus without use. The intervention was a vaginal probiotic suppository and moisturizing vaginal gel. The vaginal microenvironment was assessed using Gram stain and Nugent's criteria at baseline and 3 months by a microbiologist blinded to group allocation. Symptoms and experience with use of the probiotic were assessed using questionnaires. The primary outcome was change in lactobacilli count on Nugent subscore at 3 months.

Results

A total of 147 postmenopausal women were randomized (86 to the intervention arm and 61 to the control arm), and 124 (87.9%) presented for a 3-month follow-up. There was no difference between the arms in age, race, body mass index, and Charlson Comorbidity Index. A majority of participants had the pessary managed by the health care professional (intervention arm vs control arm, 46 [76.7%] vs 55 [68.8%]; P = 0.30). Composition of the vaginal microenvironment did not differ with or without probiotic treatment at 3 months. Bother from vaginal symptoms, including discharge, itching, and discomfort, did not differ between arms. Adverse effects from the intervention were minor, resolved with discontinuation, and occurred at 39.1%.

Conclusion

Vaginal probiotic suppository use did not affect the composition of the vaginal microenvironment, patient satisfaction, or vaginal symptoms after 3 months of use in pessary users.
Pilot Study of a Novel At-Home Posterior Tibial Nerve System for Overactive Bladder Syndrome
Authors: Burton Claire S. , Sokol Eric R.
Published: July 2023

Importance

Urgency urinary incontinence and overactive bladder are common conditions. Third-line therapies are often underutilized because of either being too invasive or being burdensome for the patient.

Objective

We aimed to determine the efficacy and acceptability of a noninvasive, home-based posterior tibial nerve treatment system for the treatment of overactive bladder syndrome.

Study Design

In this pilot study, 10 postmenopausal women with urgency urinary incontinence were given the SoleStim System for home-based posterior tibial nerve stimulation. Symptoms at baseline and completion of the 8-week study were determined by 3-day voiding diary and quality-of-life questionnaire (Overactive Bladder Questionnaire) to assess for reduction in incontinence episodes.

Results

All patients were 100% adherent to the SoleStim System application over the 8-week period and reported statistically significant reductions in the mean number of voids (−16.3%, P = 0.022), urgency episodes (−31.2%, P = 0.02), and urgency urinary incontinence episodes (−31.4%, P = 0.045). Forty percent of participants reported a decrease of ≥50% in their urgency urinary incontinence episodes. SoleStim was scored a value of 1.8 ± 2.0 (mean ± SD) on a 10-point usability scale, indicating that it was highly acceptable from an ease-of-use perspective. No adverse events were reported.

Conclusions

The SoleStim System improved key overactive bladder (frequency, urgency, and urgency urinary incontinence episodes) and quality-of-life metrics. The results from this pilot study suggest that the SoleStim System may be a safe, effective, and highly acceptable at-home overactive bladder therapy.