bluuebunny/crossref_metadata_2025 huggingface dataset:
Women’s experiences of female ejaculation and/or squirting: a Swedish cross-sectional study
Authors: Påfs Jessica , Wahlberg Anna , Fugl-Meyer Kerstin S , Ziaei Shirin
Published: November 2024

Background

Women’s experiences of the expulsion of fluids during sexual stimulation, commonly referred to as female ejaculation/squirting, are not well comprehended in the existing literature.

Aim

To investigate women’s knowledge about and experiences of female ejaculation/squirting.

Methods

Data from 1568 women (aged 18 to 69) were collected using a cross-sectional online-based questionnaire (in Swedish).

Outcomes

The study focused on descriptive features of knowledge about, reactions to, occurrence of, and sensations around female ejaculation/squirting.

Results

Among the participants, 58% had experienced ejaculation/squirting (significantly more often among non-heterosexuals). Among women without such experience, only one-third would like it to happen. Among women with such experience, ejaculation/squirting occurred consistently during sexual practice for a small percentage (7%) and on a few occasions for about half (52%). Despite most (77%) rating it as primarily a positive sensation, many reacted with shock/shame (28%) or thought they had urinated (26%) the first time it occurred. Many (61%) reported orgasm occurring close to, or simultaneously, with ejaculation/squirting, and these women were more likely to report it as a positive sensation (P < .001). Despite overall positive aspects, 58% had wanted to avoid it at some point, mainly because it got too wet or due to insecurities about the content of the fluid. Having wanted to avoid it at some point was more likely among those who sensed the fluid as being expelled from the urethra (P < .001) or whose partner reacted negatively to it (P < .001).

Clinical Translation

This study contributes with a nuanced understanding of women’s experiences of ejaculation/squirting and related challenges.

Strengths and Limitations

This study is the first to explore women’s desire for ejaculation/squirting, their initial reactions, and reasons for avoidance. There are limitations due to the nature of the data collection, such as missing data and potential overrepresentation of women who are informed and open-minded about ejaculation/squirting.

Conclusion

Ejaculation/squirting is a common occurrence among women and, despite being perceived predominantly positively, particularly when linked with an orgasm, initial reactions, and avoidance underscore complexities related to excessive wetness and insecurities about the fluid’s content.
Giant cell arteritis: update on pathogenesis and clinical implications
Authors: Ibrahim Hafeez E. , De Bari Cosimo
Published: November 2024

Purpose of review

Giant cell arteritis (GCA) is an age-related autoimmune disease with a complex pathogenesis that involves several pathogenic mechanisms. This review provides recent critical insights into novel aspects of GCA pathogenesis.

Recent findings

The use of novel approaches, including multiomic techniques, has uncovered notable findings that broaden the understanding of GCA pathogenesis. TCF1hiCD4+ T cells have been identified as stem-like T cells residing in tertiary lymphoid structures in the adventitia of GCA aortic tissues, which likely supply the pathogenic effector T cells present in vasculitic lesions. Studies have demonstrated that fibroblasts present in GCA-inflamed arteries are not innocent bystanders, but they contribute to arterial inflammation via maintenance of Th1 and Th17 polarisation, cytokine secretion (IL-6, IL-1B, IL-12, and IL-23) and antigen presentation. Additionally, deregulated cellular senescence programs are present in GCA as an accumulation of IL-6 and matrix metalloproteinase 9-producing senescent cells have been identified in vasculitic lesions.

Recent studies have unravelled interesting findings with potentially significant clinical relevance. Stem-like T cells are likely key contributors to vascular disease persistence, and targeted depletion or modulation of these cells holds promise in GCA management. Fibroblast-targeting therapies and senotherapeutics are also exciting prospects in the treatment of GCA.
Benefit of Expedited Time to Hip Fracture Surgery Differs Based on Patient Risk Profile
Authors: Ganta Abhishek , Merrell Lauren A. , Herbosa Carolyn , Egol Kenneth A. , Konda Sanjit R.
Published: November 2024

OBJECTIVES:

To identify which hip fracture patients benefit the most from operative repair within 24 hours of Emergency Department presentation based on patient risk stratification.

METHODS:

Design:

Retrospective Cohort.

Setting:

Academic Medical Center.

Patient Selection Criteria:

Patients operatively treated for an AO/OTA 31 A, 31 B, or 32 A hip fracture.

Outcome Measures and Comparisons:

Each patient was placed into an “individualized risk quartile” (Individual Risk Quartile) using a validated risk stratification tool (The Score for Trauma Triage in the Geriatric and Middle-Aged [Score for Trauma Triage and Geriatric Middle Aged], a tool proven to predict inpatient mortality in trauma patients). Patients were risk stratified into minimal-, low-, moderate-, and high-risk IRQs. In each cohort, patients were separated into 3 groups based on their time from Emergency Department arrival to surgery (<24 hours, >24 hours and <48 hours, and >48 hours). Each of these 12 groups was analyzed for complications (minor inpatient complications included acute kidney injury, urinary tract infection, decubitus ulcer, and acute blood loss anemia, while major inpatient complications included sepsis or septic shock, pneumonia, acute respiratory failure, stroke, myocardial infarction, cardiac arrest, and deep vein thrombosis or pulmonary embolism), mortality rates, and hospital quality measures (length of stay and readmission rates). The results were compared across cohorts.

RESULTS:

A total of 2472 patients were identified: the mean age of the cohort was 80.6 ± 10.3 and was predominantly female (69%) and white (71%). The data demonstrated improved outcomes (complications, mortality rates, hospital quality measures) across all patients (nonrisk stratified) for surgery within 24 hours compared with surgery between 24 hours and 48 hours and surgery greater than 48 hours (all outcomes P < 0.050). However, these effects were not evenly distributed among the IRQs. In the IRQ4 cohort, major complication rates progressed from 20% to 25% to 34% as a function of time to surgery (P = 0.007). IRQ1 did not demonstrate similar results (P = 0.756), with the rates essentially static across surgery time points (3%–2% to 4%). A similar trend was seen when analyzing mortality at 1 year for highest risk patients, with similar 1-year mortality rates across operating room windows of IRQs 1–3 (IRQ1: P = 0.061, IRQ2: P = 0.259, IRQ3: P = 0.524) but increased in IRQ4 with increasing time to surgery (21% vs. 33% vs. 33%, P = 0.006).

CONCLUSIONS:

This study demonstrates a differential impact of expedited time to surgery on patients when stratified by the risk profile. The lowest risk hip fracture patients do not fare worse if operated on within 48 hours as compared to 24 hours.

LEVEL OF EVIDENCE:

Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
A Prospective Study on Gait Impairment in Patients With Symptomatic Lumbar Canal Stenosis and Impact of Surgical Intervention on Gait Function
Authors: Verma Aman , Kandwal Pankaj , Gowda Aditya K.S , Yadav Rajkumar
Published: November 2024

Study Design:

Prospective observational cohort study.

Objective:

To analyze the effect of decompression surgery on gait characteristics in patients with stenosis. Also, to test the hypothesis that patient-reported functional outcomes and gait parameters (spatiotemporal, kinetic, and kinematic measures) will improve postoperatively and achieve normal values when compared with matched healthy controls.

Summary of Background Data:

Lumbar spinal stenosis is one of the leading causes of disability among elderly population. Gait impairment is one of the primary symptoms of degenerative conditions involving lumbar spine. Research suggests that decompressive surgery can positively influence gait parameters in patients with spinal stenosis. Studies have shown improvements in walking speed, stride length, and balance post-surgery.

Methods:

Thirty-two patients with single-level lumbar stenosis and 32 healthy volunteers were prospectively recruited. All patients underwent gait analysis preoperatively and 6 months postoperatively as per standard protocol. Spatiotemporal, kinematic, and kinetic parameters were analyzed. Stepwise linear regression models were used to detect significant relationships between changes in functional score (Visual Analogue Scale/Oswestry Disability Index) and gait parameters.

Results:

Significant improvement was noted in functional scores(P<0.05) 6 months post-surgery. Spatiotemporal (swing phase, mean velocity, cadence, stride length, step length, and step width) and kinetic parameters (hip, knee, and ankle power) were significantly better after surgery, reaching normal levels. Kinematic parameters significantly improved after surgery but did not reach normal levels when compared with controls. A significant correlation was found between changes in functional scores with changes in certain kinematic parameters (knee-power, ankle plantarflexion, swing time, peak ankle dorsiflexion in swing, peak-hip, and knee flexor moment).

Conclusion:

Decompression surgery in lumbar stenosis produces improvement in gait parameters, pain scores, and functional outcomes that significantly improve gait posture and speed.
High-Sensitivity Cardiac Troponin Assays in Acute Heart Failure, Moving Beyond Myocardial Infarction
Authors: Kumar Abhishek , Gupta Manisha , Kumar Muneshwar , Varshney Amratansh
Published: November 2024

Cardiac troponins are essential structural proteins found in the contractile apparatus of cardiac myocytes. During myocardial damage, such as in myocardial infarction (MI), these troponins are released into the bloodstream. As a result, they play a central role in the diagnosis of MI, serving as sensitive and specific markers for cardiac injury. Earlier assays that were used for measuring troponin levels were considered as a dichotomous test, categorizing patients as being positive or negative for MI. The recent introduction of high-sensitivity cardiac troponin assays has revolutionized cardiac troponin detection. These assays can detect troponin levels that are 100 times lower than what traditional methods can detect. Hence it is now considered a quantitative measure of cardiac myocyte injury not only in the setting of MI but also in subjects without MI such as heart failure, in whom it can be regarded as a marker for myocardial stress. This review aims to establish the relationship between high-sensitivity cardiac troponin levels and the prognosis of patients suffering from acute heart failure. Additionally, this seeks to identify other applications where the release of troponin from the cardiomyocyte can provide prognostic information. This information can be vital in determining the appropriate treatment options for patients, ultimately improving their quality of life and positively impacting health economics.
Alcohol consumption and preference in female rats induced by reward downshift reveals sex generality of the modulatory role of physical activity
Authors: Castejón Elena , Ambrosio Emilio , Pellón Ricardo , Torres Carmen
Published: November 2024

Increased voluntary consumption of alcohol has been demonstrated in male rats exposed to frustrative reward downshift (the emotional self-medication effect). Access to a wheel for voluntary running abolished this effect in male rats, suggesting an attenuating effect of physical exercise on the negative affect induced by reward downshift and its consequences on drug intake. The present study analyzed this effect in female rats. Sixty-four food-deprived female Wistar rats received 32% sucrose [4% (Experiment 1) or 2% (Experiment 2) in controls] during 10, 5-min preshift sessions followed by 4% (Experiment 1) or 2% (Experiment 2) sucrose during 5 postshift sessions. Immediately after each consummatory session, animals were exposed to a 2-h, two-bottle preference test involving 32% alcohol vs. water. Half of the animals also had access to a running wheel during the preference test. The results showed (a) lower sucrose consumption in the downshifted groups (32–4% and 32–2%) compared to the unshifted controls (4–4% and 2–2%, respectively); (b) higher alcohol preference in downshifted groups without access to a wheel compared with downshifted groups with access to the wheel (Experiments 1 and 2); and (c) increased alcohol intake (g/kg) after experiencing reward downshift in animals without access to the wheel (Experiment 1). Voluntary wheel running thus reduced alcohol intake in female rats experiencing reward downshift. These findings are comparable to previous results reported in male rats and support the usefulness of physical exercise to prevent alcohol self-medication induced by frustrative nonreward.
Electret Production and Applications with Special Regard to Health Physics Dosimetry: A Review
Authors: Sohrabi Mehdi , Rabiee Sahel
Published: November 2024

An electret detector is a piece of dielectric material film charged or polarized by a specific charging method to induce a quasi-permanent electric field. Electret films perform unique characteristics for production and applications in many areas of science and technology, especially in health physics dosimetry. A charged electret detector, when placed in an ionized environment, collects negative or positive ions depending on its original charging state, which reduces its original charge. The number of charges reduced in the ionized field is usually proportional to the absorbed radiation dose. In this paper, the state-of-the-art information on the type of electrets, production methods, some applications in particular in health physics dosimetry, and relevant concepts are reviewed.
Effects of Dialectical Behavior Therapy on Cognitive and Executive Functions in Men With Substance Use Disorder Under Methadone Maintenance Treatment
Authors: Khezrian Kiamars , Zanjani Zahra , Rasouli Azad Morad
Published: November 2024

Substance use disorder is a major public health problem, and its treatment is one of the most challenging issues facing clinical professionals. This clinical trial study investigated the effects of the dialectical behavior therapy (DBT) on cognitive and executive functions in patients under methadone maintenance treatment (MMT). Participants included 50 people under MMT who referred to addiction treatment clinics in Kashan in 2018. They were randomly assigned to intervention (DBT + MMT) and control (MMT) groups. Participants in the intervention group received twelve 90-minute sessions of the DBT skills. The used assessments included Structured Clinical Interview for DSM-5 Axis I Disorders, Iowa Gambling Task, Wisconsin Card Sorting Task, and Tower of London Task. The results showed that DBT improved cognitive and executive function. Risky decision making (F = 4.1, p = 0.04), attention (F = 18.2, p = 0.001), cognitive flexibility (F = 18.5, p = 0.001), problem-solving (F = 18.5, p = 0.001), and planning (F = 14.10, p = 0.003) showed improvement in the intervention group following DBT. Therefore, it can be said that DBT alongside the MMT can be useful for patients under MMT.
Characterizing Risk Factors Associated With Recurrent Pleural Effusions in the Lung Transplant Recipients
Authors: Krumm Ilana Roberts , Malcolm Katherine , Vella Maya , Oates Aris , Hays Steve , Kukreja Jasleen , Gesthalter Yaron B.
Published: November 2024

Background:

Pleural effusions remain a common postoperative complication following lung transplantation, occurring in 10% to 26% of cases. We aimed to explore potential clinical or radiographic features associated with clinically significant post-lung transplant pleural effusions requiring repeat interventions for their management.

Methods:

Lung transplantation recipients who underwent thoracentesis at our institution between June 2012 and October 2022 were reviewed. In total, 77 patients were included. Data were collected via the electronic health record and adjudicated through direct chart review. Patients were stratified by the need for a single thoracentesis (control group) or additional interventions, including serial thoracentesis, pigtail placement, and surgery (composite group). The computed tomography (CT) of the chest before the first thoracentesis was reviewed by a thoracic radiologist who was blinded to patient outcome.

Results:

Single thoracentesis was used to manage 25 (32.5%) patients, 4 (5.2%) required multiple thoracenteses, 42 (54.5%) required a pigtail catheter, and 6 (7.8%) required decortication for definitive management. In the composite group compared with the control group, who were managed by a single thoracentesis, there was an increased incidence of loculations (36.8% vs. 8%, P=0.01), rounded atelectasis (22.8% vs. 4%, P=0.05), and larger effusion size (P=0.01). The composite group had higher pleural fluid eosinophils (0.33% vs. 0% in control, P = <0.01) and monocytes (14.8% vs. 7.3%, P=0.04) levels.

Conclusion:

Baseline imaging, such as larger effusion size, loculations and rounded atelectasis, and pleural fluid cell profile with increased eosinophils and monocytes, can potentially identify clinically significant and refractory pleural effusions.
Sarcoid Vasculitis in the Skin
Authors: Chen Ko-Ron , Miura Keiko , Inazumi Toyoko , Nakamura Yoshio , Nakajima Hideki , Takahashi Hayato , Yamamoto Toshiyuki
Published: November 2024

While the skin is a common target organ for sarcoidosis, cutaneous granulomatous vasculitis is rare among patients with sarcoidosis. Due to the lack of detailed studies on cutaneous sarcoid vasculitis, both dermatologists and pathologists remain unfamiliar with this rare but important vasculitic disorder. We clinicopathologically evaluated eight cases with biopsy-proven cutaneous vasculitis and cutaneous sarcoidosis and analyzed morphologic changes in the process of vasculitis for both small vessels and muscular vessels in detail. The various skin lesions ranged from papulonodular erythema, annular erythema, maculopapular erythema, livedo reticularis-like eruptions, erythema nodosum-like lesions, subcutaneous nodules to ulcerative lesions. The extremities were the most frequently affected sites. Bilateral hilar lymphadenopathy with pulmonary sarcoidosis was the most common extracutaneous comorbidity. Skin-limited sarcoidosis was identified in 3 cases. All cases demonstrated a common histopathologic feature with sarcoid granulomas impinging on the target vessels with resultant vessel destruction. Perivascular infiltration of sarcoid granulomas resulted in compression and destruction of small vessels. In muscular arteries and veins, sarcoid granulomas closely attached to the muscular vessel wall, infiltrated the muscular layers and either occupied or penetrated the vessel walls, eventually invading the vascular lumen and replacing the entire muscular layers. The intimal infiltration of sarcoid granulomas resulted in a marked luminal narrowing. The scarcity of reports on cutaneous sarcoid vasculitis may be due to the overlooking or misinterpretation of vascular destruction caused by sarcoid granuloma infiltration as a feature of sarcoid granuloma masses.
Science or Spectacle? A Critical Evaluation of the decade of Aesthetic Medicine Conferences using Punctuated Equilibrium Framework
Authors: Rahman Eqram , Sayed Karim , Rao Parinitha , Yu Nanze , Wang Keming , Garcia Patricia E , Ioannidis Sotirios , Philipp-Dormston Wolfgang G , Carruthers Jean D A , Webb William Richard
Published: November 2024

Introduction:

The global aesthetic medicine industry is rapidly expanding, with conferences serving as crucial platforms for knowledge exchange and collaboration. However, concerns have emerged about the increasing prioritisation of commercial content over scientifically rigorous presentations. This study critically evaluates the balance between commercial and scientific content at aesthetic medicine conferences, utilising artificial intelligence (AI) tools to analyse the impact of industry sponsorship and live procedural demonstrations on educational value.

Method:

Using the Punctuated Equilibrium Framework (PEF), AI-driven content analysis, social network analysis (SNA), and sentiment analysis were applied to evaluate conference data, including programs, sponsorship details, speaker affiliations, and attendee engagement metrics. The study analysed global and regional aesthetic medicine conferences from 2014 to 2024, identifying patterns and punctuated shifts in the balance between scientific and commercially driven content.

Results:

AI-based analysis of 487 conferences, comprising over 28,000 sessions and 2 million social media posts, revealed an increasing trend towards commercially focused content, particularly in industry-sponsored events. Approximately 44% of sessions were commercially oriented, with significant spikes during product launches. Academic and clinical speakers were more prevalent in scientific conferences, while industry-affiliated speakers dominated commercial sessions. Social media sentiment, analysed using AI tools, reflected high engagement with procedural demonstrations but also highlighted concerns about educational quality.

Conclusion:

While industry-driven sessions garnered higher immediate engagement, they reduced long-term cognitive retention and compromised the educational integrity of conferences. The use of AI in this study enabled a deeper understanding of content trends and their effects. Aesthetic medicine conferences must recalibrate the balance between commercial interests and scientific rigour to ensure sustainable professional development and patient safety.

Evidence Level:

IV
“The Ultrathin Parascapular Flap: Proof of Concept and Use in Plantar Foot Reconstruction”
Authors: Felder John M. , Tawaklna Kenan , Said Abdullah M. , Lohasammakul Suphalerk , Saraswat Nirvana B. , Hong Joon Pio
Published: November 2024

Optimal reconstruction of weight-bearing plantar foot defects is challenging due to the need for relatively thin coverage with simultaneous durability. The medial plantar flap provides an excellent tissue match but is not always available or appropriate (Figure 1, 2). Microsurgical free flap reconstruction provides many options for coverage. However, few skin flaps are thin enough to contour appropriately but still provide thick dermis for durable weight-bearing; particularly in patients with an average or obese body habitus.1 Lately, the suprascarpal (“superthin”) plane of elevation has been increasingly used to provide tailored coverage with appropriate thickness matching to the surrounding tissues.2,3 Even thinner “ultrathin flaps” are raised within the subcutaneous fat superficial to the Scarpa’s layer.4 The superficial circumflex iliac artery (SCIP) and anterolateral thigh (ALT) perforator flaps are commonly suprascarpally elevated,5,6 and the ultrathin SIEA flap has been recently described.7 The scapular and parascapular flaps have many ideal characteristics, including thick skin,8 minimal donor site morbidity, simple pedicle dissection, and a lengthy robust pedicle. Obese subcutaneous tissue typically precludes use, and para-/scapular flaps may be overlooked for ultrathin elevation. We describe the utility of ultrathin parascapular flaps (UPF) in weight-bearing plantar foot defects.
“A Video-Based Learning Module is an Effective Way to Teach the Interpretation of Pre-Operative Electrodiagnostic Studies”
Authors: Taylor Ruby L. , Zhang Justin K. , Patterson J. Megan M. , Llaneras Noah S. , Pripotnev Stahs , Wu Kitty Y. , Mackinnon Susan E.
Published: November 2024

Background:

Electrodiagnostic (EDX) studies are critical for surgical decision-making in nerve injuries. Surgeons typically rely on the electrodiagnostician’s reports and lack formal training in EDX interpretation. This knowledge gap highlights a need for accessible and effective educational resources for surgeons to improve their understanding of EDX and enhance patient care.

Methods:

The educational module consisted of a pre-lecture knowledge assessment, a 42-minute video lecture on interpreting electrodiagnostic studies, and a post-lecture knowledge assessment. Knowledge retention was assessed via an additional survey distributed three months after module completion.

Results:

This study, involving 119 participants (79% attending surgeons, 8% fellows, 9% surgical residents, and 2% who described their position as “other”), demonstrated that a 42-minute video-based learning module significantly improved knowledge of EDX interpretation. Median scores increased from 7 to 9 (p<0.001), with improvement persisting at three months (median retention score of 11, p<0.025). Notably, among surgeons completing the three-month assessment, 65.5% reported that knowledge gained from the module had changed their clinical practice.

Conclusion:

This study demonstrates that a concise, video-based learning module can effectively enhance surgeon knowledge of EDX interpretation and may serve as a valuable tool for surgical education and improving patient selection in nerve surgery.
Bacterial comparison study of prosthetic liners
Authors: Dupler Keera L. , Miller Hailey C. , Seeland Esther C. , Tan Philip M.
Published: November 2024

Background:

Amputee patients in low-resource settings face a heightened risk of skin infections at the skin–liner interface of their residual limb, which can develop into a variety of serious complications. Most research comparing prosthetic liners has focused on mechanical and aesthetic properties. However, the relative propensity of different liner types to host bacterial growth has yet to be explored.

Methods:

To address this question, we performed a bacterial comparison study across a traditional sock–EVA combination liner, an advanced Ossur Iceross silicone liner, and a novel silicone liner designed for low-resource hospitals in developing nations. We cultured Staphylococcus aureus within a novel physical model of the skin–liner interface, incorporating a replicate skin layer suspended over a self-regulating heat source. After culturing bacteria for 24 h, we collected and quantified cells in solution.

Results:

Statistical analysis of the bacterial growth concentration from 9 trials revealed relative consistency of growth across the 3 liner types, suggesting that none of the liners pose heightened risks of infection, relative to the others.

Conclusions:

These results suggest that certain innovative prosthetic materials may safely be considered for fabrication of prosthetic liners in low-resource environments. The in vitro skin–liner model and test method for bacterial growth characterization introduced herein may be useful for future dermatological simulations.
Improved MR Detection of Optic Nerve Demyelination With MP2RAGE-FLAWS Compared With T2-Weighted Fat-Saturated Sequences
Authors: Aichour Randa , Emorine Thibaut , Oubaya Nadia , Megdiche Imen , Créange Alain , Lecler Augustin , Kober Tobias , Massire Aurélien , Bapst Blanche
Published: November 2024

Objectives

Nonenhanced T1-w sequences such as magnetization-prepared 2 rapid acquisition gradient echo (MP2RAGE) and derived fluid and white matter suppression (FLAWS) have demonstrated high performance for detecting brain parenchymal and cervical spine demyelinating lesions in multiple sclerosis. However, their potential for identifying optic nerve (ON) demyelination remains unexplored. The aim of this study was to evaluate the performance of compressed sensing–accelerated (CS) MP2RAGE-FLAWS imaging for detection of ON demyelination lesions compared with T2-w fat-saturated (FS) TSE imaging in a clinical setting.

Materials and Methods

We conducted a retrospective study of magnetic resonance scans acquired on patients with central nervous system demyelinating disorders between January and December 2022. Inclusion criteria were the acquisition in the same session of a brain CS-MP2RAGE-FLAWS imaging and a combination of axial + coronal T2-w FS orbital sequences. A 4-step radiological analysis—including blinded and consensus readings—assessed ON lesion detection. The reference standard was the final reading session of radiologists using the entire patient file. Sensitivities and specificities of both sequences were computed and compared using McNemar χ2 tests.

Results

Thirty-nine patients (mean age: 43 ± 14 years; 25 women) were analyzed, including 34 with multiple sclerosis, 2 with MOGAD (myelin oligodendrocyte glycoprotein antibody–associated disease), 1 with NMOSD (neuromyelitis optica spectrum disorder), and 2 with indeterminate demyelinating disease. Among the 78 ONs analyzed, 64 lesions were detected with CS-MP2RAGE-FLAWS as opposed to 37 with 2D T2-w FS imaging, corresponding to a total of 41 and 27 affected nerves, respectively. CS-MP2RAGE-FLAWS exhibited higher sensitivity for overall detection of ON lesions compared with 2D T2-w FS imaging (97.5% vs 67.5%, P = 0.001) without reducing the specificity. Improved lesion detectability with CS-MP2RAGE-FLAWS was significant compared with 2D T2-w FS in intraorbital and intracanalicular segments (respectively, 92.3% vs 50% and 96.3% vs 66.7%; P < 0.05). There was no difference in sensitivity (P = 0.69) or specificity (P = 0.99) regarding the intracranial segment analysis.

Conclusions

CS-MP2RAGE-FLAWS sequence improves ON lesion detection compared with conventional 2D T2-w FS, especially in the intraorbital segment, while simultaneously providing whole-brain and cervical spinal cord imaging at no additional time cost.
131I Accumulation Due to an Intrauterine Device in a Papillary Thyroid Carcinoma Patient
Authors: Feng Yuan , Lan Xiaoli , Zhang Xiao
Published: November 2024

A 46-year-old woman underwent 131I radiotherapy following thyroidectomy for papillary thyroid carcinoma. Posttherapeutic 131I scintigraphy was performed 4 days later. Both attenuation-corrected and non–attenuation-corrected 131I tomography images elucidated an intrauterine device with avid 131I uptake in her uterus. This case illustrated that an intrauterine device should be considered as a potential cause of false-positive results in posttherapeutic 131I scintigraphy, highlighting the need for accurate image interpretation to avoid unnecessary treatment.
Incidental Ovarian Uptake in Bone Scintigraphy
Authors: Saber Tanha Amin , Hosseini Sareh , Soltani Ehsan , Akbari Oryani Mahsa , Askari Emran
Published: November 2024

A 47-year-old woman, recently diagnosed with breast cancer, underwent staging. A whole-body bone scan revealed an unexpected focal 99mTc-MDP uptake in her right ovary. Extensive literature review suggested various malignant pathologies for this incidental ovarian uptake. Despite inconclusive results from other imaging modalities, the multidisciplinary tumor board recommended right ovarian resection due to a history of abnormal uterine bleeding. The final pathology confirmed an adult-type granulosa cell tumor. Interestingly, subsequent surgery performed for staging purposes found no additional tumor sources. This case highlights the enhanced diagnostic value of hybrid imaging in bone scintigraphy.
Immediate Reconstruction With Autologous Temporoparietal Fascia After Enucleation of Infected or Extruded Alloplastic Nasal Implants
Authors: Kuo Chia-I , Xiao Peng , Chang Sophia Chia-Ning
Published: November 2024

Simultaneous reconstruction after removal of nasal silicone implants was published as diced, autologous rib and ear auricular cartilages, and each had their shortcomings. Temporoparietal fascial grafts were used for facial and nasal contouring, vascularized tissue coverage, and augmentation the nose, lip. The temporoparietal fascia graft may be considered for in-time replacement of allografts and remaining bulkiness. From 2006 until 2008, the temporoparietal fascial graft was used in 20 referred patients with nasal allografts in a medical center. The female-to-male ratio is 17:3. The mean age is around 32.6 years old. All the patients refused disfigurement after the removal of the implants for at least 3 months. All the patients were followed up for 5 years. All patients recovered within 1 to 2 weeks. The nasal skin envelop was preserved or healed. There was neither graft exposure, nor recurred infection. The procedure is a useful method of eliminating inflammatory squeals. The temporoparietal fascial graft used, was able to bridge the 3-month gap without the implant. The smooth nasal dorsum skin was regained with adequate nasal projection. All patients were followed up in plastic surgery clinics without recurrence. There are no reports in the English literature of the use of temporoparietal fascial grafts to treat nasal implant infection. The temporoparietal fascial graft is a simple and reliable method to provide thin, broad, pliable, easy neovascularized, adequate coverage, contour, and bulk on the cartilage dorsum of the nose, an inconspicuous donor site, consistency, and minimal resorption.
Opioid Use Following Open Reduction and Internal Fixation of Mandibular Fractures
Authors: Rancu Albert L. , Salib Andrew , Kammien Alexander J. , Lizardi Juan J. , Allam Omar , Grauer Jonathan N. , Alperovich Michael
Published: November 2024

A mandible fracture is a common traumatic craniofacial injury for which surgery is sometimes indicated. Post-fracture and postoperative pain are often controlled through prescribed narcotics, which have received increased attention for potential abuse. The current work identified 90-day opioid prescribing patterns following surgically treated mandible fractures. Patients who underwent open reduction and internal fixation to treat a closed mandible fracture between 2011 and 2021 were identified in the PearlDiver Mariner165 database. Exclusion criteria included: (1) patients with records active for fewer than 180 days before the injury and 90 days post-fracture, (2) age younger than 18, and (3) those with long bone fracture within 30 days of mandible fracture. Variables associated with filling an opioid prescription and utilizing excess morphine milligram equivalents (MMEs) were identified through multivariate regression. Prescribing patterns between 2011 and 2021 were analyzed using simple linear regression. A total of 15,049 patients were identified. Of these patients, opioid prescriptions were filled by 10,389 (69.0%). Greater MMEs were filled for those with greater age, prior opioid use, and history of chronic pain (P < 0.01 for all). The proportion of patients who received opioids decreased from 2011 to 2021 (73.3% versus 61.9%) during which declines were also seen for median MMEs (225.0 versus 128.4) and mean number of filled prescriptions (4.1 versus 2.8). The present work identified age and preexisting risk factors as significantly associated with excess MMEs following open reduction and internal fixation–treated mandible fracture. The decreasing proportion of patients receiving opioids along with decreasing MMEs suggests more refined practice with regard to their use.
Exploring agent interaction patterns in the comment sections of fake and real news
Authors: Zhu Kailun , Peng Songtao , Nie Jiaqi , Ruan Zhongyuan , Yu Shanqing , Xuan Qi
Published: November 2024

User comments on social media have been recognized as a crucial factor in distinguishing between fake and real news, with many studies focusing on the textual content of user reactions. However, the interactions among agents in the comment sections for fake and real news have not been fully explored. In this study, we analyse a dataset comprising both fake and real news from Reddit to investigate agent interaction patterns, considering both the network structure and the sentiment of the nodes. Our main findings reveal that, compared with fake news, where users generate more negative sentiment, real news tends to elicit more neutral and positive sentiments. Additionally, nodes with similar sentiments cluster together more tightly than anticipated. From a dynamic perspective, we found that the sentiment distribution among nodes stabilizes early and remains stable over time. These findings have both theoretical and practical implications, particularly for the early detection of real and fake news within social networks.
Evolutionary mechanisms that promote cooperation may not promote social welfare
Authors: Han The Anh , Duong Manh Hong , Perc Matjaz
Published: November 2024

Understanding the emergence of prosocial behaviours among self-interested individuals is an important problem in many scientific disciplines. Various mechanisms have been proposed to explain the evolution of such behaviours, primarily seeking the conditions under which a given mechanism can induce highest levels of cooperation. As these mechanisms usually involve costs that alter individual pay-offs, it is, however, possible that aiming for highest levels of cooperation might be detrimental for social welfare—the latter broadly defined as the total population pay-off, taking into account all costs involved for inducing increased prosocial behaviours. Herein, by comparing stochastic evolutionary models of two well-established mechanisms of prosocial behaviour—namely, peer and institutional incentives—we demonstrate that the objectives of maximizing cooperation and of maximizing social welfare are often misaligned. First, while peer punishment is often more effective than peer reward in promoting cooperation—especially with a higher impact-to-cost ratio—the opposite is true for social welfare. In fact, welfare typically decreases (increases) with this ratio for punishment (reward). Second, for institutional incentives, while maintaining similar levels of cooperation, rewards result in positive social welfare across a much broader range of parameters. Furthermore, both types of incentives often achieve optimal social welfare when their impact is moderate rather than maximal, indicating that careful planning is essential for costly institutional mechanisms to optimize social outcomes. These findings are consistent across varying mutation rates, selection intensities and game configurations. Overall, we argue for the need of adopting social welfare as the main optimization objective when designing and implementing evolutionary mechanisms for social and collective goods.
Characterizing the mechanics of rectangular peg–hole disassembly and the effect of the active compliance centre on the extraction force
Authors: Goli Farzaneh , Aflakian Ali , Qu Mo , Zang Yue , Saadat Mozafar , Pham Duc Truong , Wang Yongjing
Published: November 2024

This paper aimed at facilitating robotized disassembly for remanufacturing by focusing on the challenge of rectangular peg–hole disassembly. The study explores all potential contact states during the rectangular peg–hole disassembly process and identifies 26 distinct conditions, 16 of which are related to jamming. The contact conditions are categorized into five groups based on the number of contacts with the surface. Thereafter, it provides an in-depth analysis of jamming phenomena during the extraction process, employing both geometrical and quasistatic analyses to establish boundary conditions for jamming. Furthermore, the efficacy of the active compliance centre position in preventing jamming area is explored, considering critical variables such as compliance degree, centre location and initial position errors. The outcomes highlight that positioning the compliance centre at the end of the peg is the most effective strategy for reducing the jamming area and extraction force. Finally, the simulated results are confirmed by experiments and demonstrated 77.1% reduction to the maximum extraction force with the correct active compliance centre position, as opposed to when it is placed at the top of the peg. The findings contribute insights into the intricate dynamics of disassembly, revealing potential avenues for optimizing automated robotic systems in remanufacturing.
Slow travelling wave solutions of the mixed local–non-local Fisher–KPP equation can have multiple sharp wavefronts
Authors: Lee Jia Yin , Billingham John
Published: November 2024

In this paper, we study slow travelling wave solutions of the mixed local–non-local Fisher–KPP equation, which satisfy

D

U

z
z

+

c

U
z

+

U

{

1
−
α
U

−

(

1
−
α

)

ϕ
∗
U

}

=
0
,

with

D
≪
1

and

c
≪
1

. Here

ϕ
∗
u
≡

∫

−
∞

∞

ϕ
(
z
−
y
)
U
(
y
)

d
y

is the convolution of the dimensionless population density,

U
(
z
)

, with a continuous, symmetric, strictly positive kernel,

ϕ
(
y
)

, which is decreasing for

y
>
0

and has a finite derivative as

y
→

0
+

, normalized so that

∫

−
∞

∞

ϕ

(
y
)

d
y

=

1

. The dimensionless parameter

α

, with

0
≤
α
≤
1

, measures the strength of local competition relative to that of non-local competition. Through numerical and asymptotic analysis when

c
≪
1

, we show that as

α

, and hence local competition, increases, the spikes that characterize the solution of the non-local travelling wave equation are successively suppressed. We also show that when

α
=
O
(
c
)

, the spikes are affected at leading order by the local interaction and develop a sharp wavefront when

c
≪
α

. In this latter case, for example, with the Gaussian kernel,

ϕ
(
y
)
=

1

2

π

e

−

1
4

y
2

, the travelling wave solution can contain multiple sharp wavefronts, all propagating at the same speed, qualitatively similar in form to a roll wave in fluid mechanics, although the underlying physics is very different.
Homophily in social and demographic traits predict association patterns in female western and mountain gorillas
Authors: Young Christopher , Robbins Martha M.
Published: November 2024

Affiliative relationships are a hallmark of social relationships in gregarious mammals, but what drives variation of association patterns when kin are absent remains unknown. Gorillas, where females may disperse multiple times in their lives, provide an interesting counterpoint to female philopatric species to examine the factors influencing variation in association patterns. We examined demographic and social factors that may predict association patterns of female western (
Gorilla gorilla gorilla
; Loango, Gabon) and mountain gorillas (
Gorilla beringei beringei
; Bwindi, Uganda). We looked at dyadic and individual strength scores of social proximity (37 group-years). For individuals, high dominance rank increased association scores while newly emigrated females had lower scores than resident females. For dyads, higher mean dominance rank and both partners having a dependent infant increased association scores, whereas a partner being an immigrant decreased scores. Furthermore, time-matched analysis of birth and immigration events confirmed the temporal nature of these associations. Overall, female gorilla association patterns show flexibility in strength based on real-time contingencies, namely social and demographic traits. Association patterns in species with female secondary dispersal may be governed by homophily, like that of modern humans. Understanding female gorilla social structure can enhance our knowledge of the evolutionary origins of sociality.
Supplemental oxygen costs and equipment utilization in a low-income population with ILD or COPD
Authors: Clark Kristopher P. , Kass Daniel J. , Degenholtz Howard B.
Published: November 2024

Rationale

Supplemental oxygen is often prescribed to patients with interstitial lung disease (ILD) and chronic obstructive pulmonary disease (COPD). The specific costs of oxygen therapy in these diseases have not been fully described in patients living in the United States.

Objectives

Estimate Medicaid/Medicare costs for supplemental oxygen, characterize differences in oxygen equipment utilization, and identify factors impacting the costs of supplemental oxygen therapy in ILD and COPD.

Methods

We reviewed claims data for years 2016-2020 for Pennsylvania residents with ILD or COPD who were dually eligible for Medicaid/Medicare and enrolled in traditional fee-for-service Medicare. A generalized estimated equation (GEE) model was used to identify variables associated with annual oxygen costs.

Measurements and Main Results

A greater proportion of paid claims in ILD were for oxygen services (40.3% vs 22.0%) and for high flow oxygen (4.2% vs 2.2%), though ILD represented the minority of paid oxygen claims (5.2%). Oxygen cost approximately $65/month for both groups. Most oxygen claims (≥94%) were for stationary concentrators. Liquid devices and stationary gas were the least utilized equipment. Lower costs were associated with living in a competitive bidding area and with markers of advanced age and worse health status.

Conclusions

Oxygen utilization is greater in ILD but is only a small portion of total oxygen claims compared to COPD. Costs and equipment utilization were similar between groups. Liquid oxygen claims were rare even among subjects requiring high flow. Oxygen therapy is common in these diseases and likely represents a significant contribution to total healthcare costs.
Virtual rehabilitation for individuals with Long COVID: a randomized controlled trial
Authors: Janaudis-Ferreira Tania , Beauchamp Marla K. , Rizk Amanda , Tansey Catherine M. , Sedeno Maria , Barreto Laura , Bourbeau Jean , Ross Bryan A. , Benedetti Andrea , Li Pei Zhi , Agarwal Kriti , Zucco Rebecca , Lopez Julie , Crowley Emily , Cloutier Julie
Published: November 2024

Background

Our primary objective was to investigate whether an 8-week virtual rehabilitation program for individuals with long COVID improves functional mobility compared to usual care.

Methods

Subjects were randomly assigned to receive either i) virtual rehabilitation plus usual outpatient care or ii) usual outpatient care. The intervention group underwent an 8-week virtual rehabilitation program which consisted of personalised and symptom-titrated functional aerobic and resistance exercises as well as long COVID educational sessions. The primary outcome was the Activity Measure for Post-Acute Care (AM-PAC) mobility score. Secondary outcomes included the Baseline and Transition Dyspnea Index (BDI/TDI), the Fatigue Visual Analog Scale, 12-item short-form, EuroQol 5 Dimension 5 Level (EQ-5D-5L), DePaul Symptom Questionnaire – PEM, physical function tests, questionnaires on mental health, acceptability and adverse events.

Findings

132 individuals with long COVID (mean age 48 ± 11.8; 75% female) were enrolled. The adherence rate was 96%; however, 25 participants (39%) in the intervention group were unable to progress their exercises through the FITT (frequency, intensity, time, and type) principle due to symptoms. No between group differences were found for change in AM-PAC mobility (95% CI –0.91 to 2.13). The proportion of participants achieving the minimal detectable change in the AM-PAC mobility at the end of the intervention period was higher in the intervention group (35.8% (SE 6.0%) vs. 17.0% (SE 4.7%)) (95% CI 3.9 to 33.8). Compared with controls, scores on the EQ-5D-5L pain/discomfort (95% CI –0.70 to –0.03), EQ-5D-5L VAS (95% CI 1.05 to 14.43), VAS fatigue (95% CI –1.78 to –0.02), as well as for the TDI functional (95% CI 0.07 to 0.72), effort (95% CI 0.10 to 1.12) and total scores (95% CI 0.10 to 2.37) were greater in the intervention group. There were no between-group differences in other outcomes and no serious adverse events.

Interpretation

An 8-week virtual rehabilitation program did not improve self-reported mobility for most patients with long COVID, however we did find improvements in health status and symptom persistence. Progression of exercise training is challenging in this population.