bluuebunny/crossref_metadata_2025 huggingface dataset:
Surgical Experiences From a French Forward Surgical Team on Board of the Landing Helicopter Deck MISTRAL
Authors: Ghabi Ammar , De Geofroy Bernard , Gorin Cécile , Candoni Philippe , Blomme Edouard , Ezanno Anne Cecile
Published: February 2023

Introduction

Onboard surface ships like destroyers and frigates, there is ROLE 1, whereas on a three-landing helicopter deck (LHD) and aircraft carrier, there is ROLE 2, with a surgical team. At sea, evacuation takes more time than on any other theater of operation. It also costs more money, so we wanted to analyze how many patients have been maintained onboard, thanks to ROLE 2. Moreover, we wanted to analyze the surgical activities on the LHD MISTRAL ROLE 2.

Methods

We performed a retrospective observational study. We retrospectively analyzed all surgery cases performed on the MISTRAL between January 1, 2011, and June 30, 2022. During this period, there were only 21 months with a surgical team ROLE 2 onboard. We included all consecutive patients who underwent minor or major surgery onboard.

Results

A total of 57 procedures were performed during the period, involving 54 patients (52 males and 2 females) with an average age of 24.4 ± 1.9 years. The most frequent pathology was abscess (pilonidal sinus abscess, axillary abscess, or perineal abscess) (n = 32; 59.2%). Only two Medical Evacuations were conducted because of surgery; the other patients who underwent surgery were maintained onboard.

Conclusions

We have shown that using ROLE 2 aboard the LHD MISTRAL decreases the use of Medical Evacuation. It also helps to perform surgery under better conditions for our sailors. Doing everything to keep sailors onboard seems to be an important point.
Neutron-capture elements in NGC 6752 multiple populations
Authors: Schiappacasse-Ulloa J , Lucatello S
Published: February 2023

Globular clusters have been widely studied in terms of light element variations present in their different stellar populations. However, the nature of the polluter(s) responsible for this phenomenon is still debated. The study of heavy elements and their relation to light ones can provide further constraints. In particular, we aim to explore the possible contribution of asymptotic giant branch stars of different stellar masses to the internal pollution in the cluster. We derive abundances of elements from different nucleosynthetic chains, such as Na, Mg, Ca, Sc, Cu, Y, and Ba. We did not find clear relations between the light s-process elements (represented by Y ii) or heavy ones (represented by Ba ii) with light elements (Li, Na, or Al). This indicates that the polluter(s) responsible for the Na (Al) or Li production does not produce large amounts of Y ii and Ba ii. Furthermore, the comparison with models discards a possible significant contribution to the cluster pollution from AGB stars with masses lower than 5 M⊙. In addition, we found a potential CH star in our sample.
Constraints on galactic outflows from the metallicity–stellar mass–SFR relation of EAGLE simulation andSDSSgalaxies
Authors: Lin Yuanye , Zu Ying
Published: February 2023

Stellar feedback-driven outflows regulate the stellar formation and chemical enrichment of galaxies, yet the underlying dependence of mass outflow rate on galaxy properties remains largely unknown. We develop a simple yet comprehensive non-equilibrium chemical evolution model (NE-CEM) to constrain the mass-loading factor η of outflows using the metallicity-stellar mass–SFR relation observed by Sloan Digital Sky Survey (SDSS) at z = 0. Our NE-CEM predicts the chemical enrichment by explicitly tracking both the histories of star formation and mass-loading. After exploring the eagle simulation, we discover a compact yet flexible model that accurately describes the average star formation histories of galaxies. Applying a novel method of chemically measuring η to eagle, we find η can be parametrized by its dependence on stellar mass and specific SFR as $\log \eta \propto M_*^{\alpha }s{\mathrm{SFR}}^{\beta }$, with α = − 0.12 and β = 0.32 in eagle. Our chemically inferred η agrees remarkably well with the kinematic measurements by Mitchell et al. After extensive tests with eagle, we apply an NE-CEM Bayesian analysis to the SDSS data, yielding a tight constraint of $\log (\eta /0.631) = 0.731{\pm }0.002\times (M_*/10^{9.5}\, \mathrm{M}_{\odot })^{-0.222\pm 0.004} (s{\mathrm{SFR}}/10^{-9.5}\, \mathrm{yr}^{-1})^{0.078\pm 0.003}$, in good agreement with the down-the-barrel measurements. Our best-fitting NE-CEM not only accurately describes the metallicity-stellar mass–SFR relation at z = 0, but also successfully reproduce the so-called ‘fundamental metallicity relation’ at higher redshifts. Our results reveal that different galaxies form stars and enrich their gas in a non-equilibrium but strikingly coherent fashion across cosmic time.
Reconstructing cosmological initial conditions from late-time structure with convolutional neural networks
Authors: Shallue Christopher J , Eisenstein Daniel J
Published: February 2023

We present a method to reconstruct the initial linear-regime matter density field from the late-time non-linearly evolved density field in which we channel the output of standard first-order reconstruction to a convolutional neural network (CNN). Our method shows dramatic improvement over the reconstruction of either component alone. We show why CNNs are not well-suited for reconstructing the initial density directly from the late-time density: CNNs are local models, but the relationship between initial and late-time density is not local. Our method leverages standard reconstruction as a preprocessing step, which inverts bulk gravitational flows sourced over very large scales, transforming the residual reconstruction problem from long-range to local and making it ideally suited for a CNN. We develop additional techniques to account for redshift distortions, which warp the density fields measured by galaxy surveys. Our method improves the range of scales of high-fidelity reconstruction by a factor of 2 in wavenumber above standard reconstruction, corresponding to a factor of 8 increase in the number of well-reconstructed modes. In addition, our method almost completely eliminates the anisotropy caused by redshift distortions. As galaxy surveys continue to map the Universe in increasingly greater detail, our results demonstrate the opportunity offered by CNNs to untangle the non-linear clustering at intermediate scales more accurately than ever before.
Unravelling the mass spectrum of destroyed dwarf galaxies with the metallicity distribution function
Authors: Deason Alis J , Koposov Sergey E , Fattahi Azadeh , Grand Robert J J
Published: February 2023

Accreted stellar populations are comprised of the remnants of destroyed galaxies, and often dominate the ‘stellar haloes’ of galaxies such as the Milky Way (MW). This ensemble of external contributors is a key indicator of the past assembly history of a galaxy. We introduce a novel statistical method that uses the unbinned metallicity distribution function (MDF) of a stellar population to estimate the mass spectrum of its progenitors. Our model makes use of the well-known mass–metallicity relation of galaxies and assumes Gaussian MDF distributions for individual progenitors: the overall MDF is thus a mixture of MDFs from smaller galaxies. We apply the method to the stellar halo of the MW, as well as the classical MW satellite galaxies. The stellar components of the satellite galaxies have relatively small sample sizes, but we do not find any evidence for accreted populations with L > Lhost/100. We find that the MW stellar halo has N ∼ 1−3 massive progenitors (L ≳ 108L⊙) within 10 kpc, and likely several hundred progenitors in total. We also test our method on simulations of MW-mass haloes, and find that our method is able to recover the true accreted population within a factor of 2. Future data sets will provide MDFs with orders of magnitude more stars, and this method could be a powerful technique to quantify the accreted populations down to the ultra-faint dwarf mass scale for both the MW and its satellites.
A dual-activity topoisomerase complex promotes both transcriptional activation and repression in response to starvation
Authors: Su Shuaikun , Xue Yutong , Lee Seung Kyu , Zhang Yongqing , Fan Jinshui , De Supriyo , Sharov Alexei , Wang Weidong
Published: February 2023

Topoisomerases are required to release topological stress generated by RNA polymerase II (RNAPII) during transcription. Here, we show that in response to starvation, the complex of topoisomerase 3b (TOP3B) and TDRD3 can enhance not only transcriptional activation, but also repression, which mimics other topoisomerases that can also alter transcription in both directions. The genes enhanced by TOP3B–TDRD3 are enriched with long and highly-expressed ones, which are also preferentially stimulated by other topoisomerases, suggesting that different topoisomerases may recognize their targets through a similar mechanism. Specifically, human HCT116 cells individually inactivated for TOP3B, TDRD3 or TOP3B topoisomerase activity, exhibit similarly disrupted transcription for both starvation-activated genes (SAGs) and starvation-repressed genes (SRGs). Responding to starvation, both TOP3B–TDRD3 and the elongating form of RNAPII exhibit concomitantly increased binding to TOP3B-dependent SAGs, at binding sites that overlap. Notably, TOP3B inactivation decreases the binding of elongating RNAPII to TOP3B-dependent SAGs while increased it to SRGs. Furthermore, TOP3B-ablated cells display reduced transcription of several autophagy-associated genes and autophagy per se. Our data suggest that TOP3B–TDRD3 can promote both transcriptional activation and repression by regulating RNAPII distribution. In addition, the findings that it can facilitate autophagy may account for the shortened lifespan of Top3b-KO mice.
How ETFs Amplify the Global Financial Cycle in Emerging Markets
Authors: Converse Nathan , Levy-Yeyati Eduardo , Williams Tomas
Published: February 2023

We study how the growth of exchange-traded funds (ETFs) affects the sensitivity of international capital flows to the global financial cycle. Using comprehensive fund-level data on investor flows, we show that their sensitivity to global financial conditions for equity (bond) ETFs is 2.5 (2.25) times higher than for equity (bond) mutual funds. This higher sensitivity can be directly linked to ETFs underlying shorter-trading-horizon clientele that trades more often in response to shocks. Using country-level data, we find that where ETFs hold a larger share of financial assets, equity inflows and prices become more sensitive to global risk.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online.
Proper purposes in trustee decision-making: Grand View Private Trust Co Ltd v Wen-Young Wong [2022] UKPC 47
Authors: Moppett William
Published: February 2023

In Grand View Private Trust Co Ltd v Wen-Young Wong [2022] UKPC 47, the Privy Council considered the proper approach to reviewing a Bermudan discretionary trustee’s exercise of a power to add and exclude objects where it was alleged that the power was exercised for an improper purpose. The Privy Council analysed the relevance to this inquiry of the trust’s overarching purpose, and considered the recently-prominent question of the existence of a so-called ‘substratum rule’. The decision is an important contribution to the ongoing conversation in the law of trusts and other fiduciaries regarding the review of powers for improper purposes.
A phylogenetic study of dengue virus in urban Vietnam shows long-term persistence of endemic strains
Authors: Ashall James , Shah Sonal , Biggs Joseph R , Chang Jui-Ning R , Jafari Yalda , Brady Oliver J , Mai Huynh Kim , Lien Le Thuy , Do Thai Hung , Nguyen Hien Anh Thi , Anh Dang Duc , Iwasaki Chihiro , Kitamura Noriko , Van Loock Marnix , Herrera-Taracena Guillermo , Rasschaert Freya , Van Wesenbeeck Liesbeth , Yoshida Lay-Myint , Hafalla Julius Clemence R , Hue Stephane , Hibberd Martin L
Published: February 2023

Dengue virus (DENV) causes repeated outbreaks of disease in endemic areas, with patterns of local transmission strongly influenced by seasonality, importation via human movement, immunity, and vector control efforts. An understanding of how each of these interacts to enable endemic transmission (continual circulation of local virus strains) is largely unknown. There are times of the year when no cases are reported, often for extended periods of time, perhaps wrongly implying the successful eradication of a local strain from that area. Individuals who presented at a clinic or hospital in four communes in Nha Trang, Vietnam, were initially tested for DENV antigen presence. Enrolled positive individuals then had their corresponding household members invited to participate, and those who enrolled were tested for DENV. The presence of viral nucleic acid in all samples was confirmed using quantitative polymerase chain reaction, and positive samples were then whole-genome sequenced using an amplicon and target enrichment library preparation techniques and Illumina MiSeq sequencing technology. Generated consensus genome sequences were then analysed using phylogenetic tree reconstruction to categorise sequences into clades with a common ancestor, enabling investigations of both viral clade persistence and introductions. Hypothetical introduction dates were additionally assessed using a molecular clock model that calculated the time to the most recent common ancestor (TMRCA). We obtained 511 DENV whole-genome sequences covering four serotypes and more than ten distinct viral clades. For five of these clades, we had sufficient data to show that the same viral lineage persisted for at least several months. We noted that some clades persisted longer than others during the sampling time, and by comparison with other published sequences from elsewhere in Vietnam and around the world, we saw that at least two different viral lineages were introduced into the population during the study period (April 2017–2019). Next, by inferring the TMRCA from the construction of molecular clock phylogenies, we predicted that two of the viral lineages had been present in the study population for over a decade. We observed five viral lineages co-circulating in Nha Trang from three DENV serotypes, with two likely to have remained as uninterrupted transmission chains for a decade. This suggests clade cryptic persistence in the area, even during periods of low reported incidence.
Soft tissue compartment bleed—the iceberg phenomenon: a case report
Authors: Vaidyanathan Ramesh , Dar Parvez Mohi Ud Din , Bagaria Dinesh , Gupta Amit
Published: February 2023

Introduction

Hemorrhage control is the essence of trauma care. Conventional teaching is 1 on the floor (ie, external bleeding) and 4 more (thoracic cavity, abdomen, retroperitoneum, and long bones). In this case report, we present a unique case with concealed bleeding into the soft tissue compartment leading to shock. This case triggered to consider the soft tissue compartment as the sixth potential bleeding site in trauma patients in hemorrhagic shock.

Case presentation

We present the case with concealed bleeding into the soft tissue compartment posing a challenge in management. On presentation, he had a pulse rate of 117 beats/min, a blood pressure of 90/60 mmHg, and a Glasgow Coma Scale (GCS) score of 9. During resuscitation, the patient's blood pressure dropped to 70/46 mmHg with a GCS of 7 of 15. He was then intubated and reevaluated. Contrast-enhanced computed tomography of the torso revealed a right scapular fracture with a large soft tissue hematoma along the right side of the neck and chest wall, extending up to the right lumbar region.

Conclusion

We suggest that the soft tissue compartment is the sixth potential site of internal bleeding in trauma patients, which should not be overlooked after having ruled out the other 5 sites.
Emergency department overcrowding: causes and solutions
Authors: Butun Ahmet , Kafdag Elif Ece , Gunduz Hilal , Zincir Vedat , Batibay Mehmet , Ciftci Kubra , Demir Dilan , Bayram Ramazan , Yigit Elanur
Published: February 2023

Background

Emergency department (ED) overcrowding is among the biggest and most important problems experienced by ED staff. The number of ED visits is on the increase and remains an unresolved problem. Emergency department overcrowding has become an important problem for emergency care services worldwide. There is a relationship between overcrowding and patients’ negative experiences of using ED and therefore reporting reduced patients’ satisfaction. This study aimed to identify the causes of ED overcrowding, determine the reasons for people’s use of EDs, and develop solutions for reducing ED overcrowding.

Methods

This study used quantitative methods using a descriptive approach. The participants were patients who visited the ED. A questionnaire was administered to 296 participants between December 2021 and February 2022. The study included 5 different hospitals in Turkey. The data were analyzed using descriptive statistics.

Results

This study identified the most common presenting medical problems in the ED and why patients used the ED. Reasons for using the ED included patients perceiving their condition as really urgent (62.8%), the ED being open for 24 hours (36.1%), and receiving faster care in the ED (31.4%). This study also developed recommendations for alleviating ED overcrowding.

Conclusion

This study identified causes of ED overcrowding and some solutions for alleviating the issue. Emergency department overcrowding should be perceived as an international problem, and initiatives for solutions should be implemented quickly.
Duct ectasia of bilateral accessory breast associated with pituitary microadenoma: a case report and literature review
Authors: Liu Jie , Cong Han , Chen Xu , Deng Yan , Shang Mengmeng , Ma Rong , Li Pengyu , Ma Kunrun , Zhang Lei , Zhu Jiang
Published: February 2023

Background

Mammary duct ectasia is an acute or chronic inflammatory breast disease that occurs mainly in nonlactating women. It rarely occurs in the accessory breast. The etiology of this condition remains unclear. The long course and complex clinical manifestations of this disease in some patients make it easy to misdiagnose.

Case Presentation

Herein, we report a case of bilateral accessory breast duct ectasia. A 34-year-old nonlactating Chinese woman presented with a mass in the right axilla. Physical examination and ultrasonography revealed inflammatory lesions in both accessory breasts. Laboratory data and magnetic resonance imaging revealed hyperprolactinemia and pituitary microadenoma. Penicillin and bromocriptine were administered to prevent infection and reduce serum prolactin levels. We performed a simple mastectomy of the bilateral accessory breasts. The outcome was satisfactory.

Conclusion

This article reports the first case of bilateral accessory breast associated with pituitary microadenoma and reviews the literature to provide a reference for clinicians.
Randomized Double-Masked Placebo-Controlled Trial for the Management of Pythium Keratitis: Combination of Antibiotics Versus Monotherapy
Authors: Tanna Vishakha , Bagga Bhupesh , Sharma Savitri , Ahirwar Lalit Kishore , Kate Anahita , Mohamed Ashik , Joseph Joveeta
Published: February 2023

Purpose:

The aim of this study was to compare the efficacy of monotherapy (topical linezolid 0.2%) versus a combination of antibiotics (topical linezolid 0.2% and topical azithromycin 1%) for the treatment of Pythium insidiosum keratitis.

Methods:

Cases of P. insidiosum keratitis were prospectively randomized into group A on topical 0.2% linezolid along with topical placebo (sodium carboxymethyl cellulose [CMC] 0.5%) and group B on a combination of topical 0.2% linezolid and topical 1% azithromycin. Both groups were compared by proportion of both clinical resolution and worsening of keratitis along with the number of therapeutic penetrating keratoplasty (TPK) performed at 3 months.

Results:

We initially planned N = 66 patients but later limited to 20 (N = 10 in each group) patients owing to one interim analysis. The average size of the infiltrate in group A and B was 5.6 ± 1.5 mm and 4.8 ± 2.0 mm, respectively, with a mean Logarithm of the Minimum Angle of Resolution (logMAR) visual acuity of 2.74 ± 0.55 and 1.79 ± 1.19. At 3 months, from group A, 7 (70%) patients needed TPK and 2 patients had signs of resolution, whereas from group B, 6 (60%) patients achieved complete resolution (P = 0.0003) and 2 were improving while only 1 needed TPK (P = 0.02). The median duration of treatment in group A and B, with the study drugs, was 31 days (17.8–47.8) and 101.5 days (80–123.3), P value = 0.003, respectively. Final visual acuity at 3 months was 2.50 ± 0.81 and 0.75 ± 0.87, P = 0.02, respectively.

Conclusions:

A combination of topical linezolid and topical azithromycin was found to have superior efficacy than the monotherapy with topical linezolid for the management of Pythium keratitis.
Delayed Suprachoroidal Hemorrhage After Xen45 Gel Stent
Authors: Pham Anh H. , Junk Anna K.
Published: February 2023

Précis:

In patients with significant preoperative comorbidities, prolonged activity restrictions beyond 2 weeks after Xen45 surgery may mitigate the risks of delayed SCH.

Purpose:

To report the first case to date of delayed suprachoroidal hemorrhage (SCH) not associated with hypotony 2 weeks after the placement of the Xen45 gel stent.

Case Summary:

An 84-year-old white man with significant cardiovascular comorbidities underwent uneventful ab externo implantation of a Xen45 gel stent for asymmetric progression of severe primary open angle glaucoma. The patient had a reduction in intraocular pressure by 11 mm Hg on postoperative day 1 and maintained preoperative visual acuity. The intraocular pressure remained stable at 8 mm Hg on multiple postoperative visits until the patient developed a SCH at postoperative week 2 immediately after a light session of physical therapy. The patient was treated medically with topical cycloplegic, steroid, and aqueous suppressants. He maintained preoperative visual acuity throughout the postoperative course and had resolving SCH without the need for surgical intervention.

Conclusions:

This is the first report of a delayed presentation of SCH in the absence of hypotony after ab externo implantation of the Xen45 device. The possibility of this vision-threatening complication should be considered as part of the risk assessment and included in the consent process for the gel stent. In patients with significant preoperative comorbidities, prolonged activity restrictions beyond 2 weeks after Xen45 surgery may mitigate the risks of delayed SCH.
Utility of SARS-CoV-2 Genomic Sequencing for Understanding Transmission and School Outbreaks
Authors: Campigotto Aaron , Chris Allison , Orkin Julia , Lau Lynette , Marshall Christian , Bitnun Ari , Buchan Sarah A , MacDonald Liane , Thampi Nisha , McCready Janine , Juni Peter , Parekh Rulan S , Science Michelle
Published: February 2023

Objective:

An understanding of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission in schools is important. It is often difficult, using epidemiological information alone, to determine whether cases associated with schools represent multiple introductions from the community or transmission within the school. We describe the use of whole genome sequencing (WGS) in multiple schools to investigate outbreaks of SARS-CoV-2 in the pre-Omicron period.

Study Design:

School outbreaks were identified for sequencing by local public health units based on multiple cases without known epidemiological links. Cases of SARS-CoV-2 from students and staff from 4 school outbreaks in Ontario underwent WGS and phylogenetic analysis. The epidemiological clinical cohort data and genomic cluster data are described to help further characterize these outbreaks.

Results:

A total of 132 positive SARS-CoV-2 cases among students and staff from 4 school outbreaks were identified with 65 (49%) of cases able to be sequenced with high-quality genomic data. The 4 school outbreaks consisted of 53, 37, 21 and 21 positive cases; within each outbreak there were between 8 and 28 different clinical cohorts identified. Among the sequenced cases, between 3 and 7 genetic clusters, defined as different strains, were identified in each outbreak. We found genetically different viruses within several clinical cohorts.

Conclusions:

WGS, together with public health investigation, is a useful tool to investigate SARS-CoV-2 transmission within schools. Its early use has the potential to better understand when transmission may have occurred, can aid in evaluating how well mitigation interventions are working and has the potential to reduce unnecessary school closures when multiple genetic clusters are identified.
Non-neuropsychiatric Long COVID Symptoms in Children Visiting a Pediatric Infectious Disease Clinic After an Omicron Surge
Authors: Ahn Bin , Choi Sung Hwan , Yun Ki Wook
Published: February 2023

Although much interest has emerged regarding post-COVID conditions, data on children and adolescents are limited. The prevalence of long COVID and common symptoms were analyzed in this case-control study of 274 children. Prolonged non-neuropsychiatric symptoms were more frequent in the case group (17.0% and 4.8%, P = 0.004). Abdominal pain (6.6%) was the most common long COVID symptom.
MRI in Preoperative Planning for the Repair of Pelvic Fracture Urethral Distraction Defects: A New Tool for Determining Reconstructive Options
Authors: Eber Jackson , Peterson Andrew
Published: February 2023

Pelvic fracture urethral distraction defects are typically imaged with retrograde urethrogram and voiding cystourethrogram during the work up for delayed posterior urethroplasty following trauma. The imaging results often dictate the decision-making regarding treatment options. Magnetic resonance imaging can offer a more detailed picture of the defect and can aid in preoperative planning. We present the case of an individual who was deemed unrepairable by routine imaging, however, the MRI indicated that surgery was possible.
Nipple-Sparing Gigantomastia Breast Reduction
Authors: Zelko Ian , DeLeonibus Anthony , Haidar Jalal , Bahat Daniel , Bishop Sarah N.
Published: February 2023

Introduction

There remains an unclear definition of the term “gigantomastia,” with many studies using different parameters and measurements. Currently, the operative management and patient education for gigantomastia are outdated. The historical teaching that a free nipple graft is necessary in elongated pedicles to avoid nipple necrosis may not be factual. The principal goal of our review aims to determine the safety of nipple-sparing breast reductions on large ptotic breasts via complication rate analysis.

Methods

The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines of conduct for systematic review and meta-analysis. In October 2021, PubMed was used to search the US National Library of Medicine database. Rayyan Intelligent Systematic Review aided in screening studies by title then abstract. If inclusion criteria were met, the entire article was reviewed.

Results

Twenty-two articles satisfied the inclusion and exclusion criteria. The study was composed of 1689 total patients with a mean body mass index of 32.9 (±3.4). Mean midclavicle-to-nipple distance and resection weight per breast was 39 cm (±3.8) and 1423.8 g (±268.9), respectively. A Wise pattern was preferred in 77.3% of the studies, with an inferior (45.5%) and superomedial (45.5%) pedicle used most commonly. Complete nipple areolar complex necrosis (1.7%) was found in 4 studies, whereas partial (5.9%) was observed in 11. More common complications included delayed wound healing (17.4%), surgical site infection (14.3%), seroma (10.5%), scar hypertrophy (9.9%), and wound dehiscence (9.2%).

Conclusion

Nipple-sparing breast reduction surgery can be safely performed on hypertrophic and severely ptotic breasts with nipple areolar complications, such as partial or complete nipple areolar complex loss, at a rate less than previously believed.
Twelve Years of Establishing the Strategies for Tongue Reconstruction
Authors: Nguyen Khoi A.
Published: February 2023

Background

Reconstruction after resection of malignant tongue tumors remains one of the most difficult problems in head and neck oncology. Recent trends in tongue reconstruction have focused on optimizing speech and swallowing functions and maximizing quality of life. In the recent literature, several reconstructive strategies including regional flaps and free flaps have been described.

Patients and Methods

A case series of 328 patients underwent oral tongue reconstruction between March 2011 and March 2022. Functional evaluation was performed in all patients 3 months after reconstruction (where the patients required no adjuvant radiotherapy) or after radiotherapy.

Results

Total flap necrosis was seen in 5 patients with free flap reconstruction (2 radial forearm flaps, 1 lateral arm flap, and 2 anterolateral thigh flaps), 5 patients with infrahyoid myocutaneous flap, and 1 patient reconstructed with a supraclavicular flap. Our success rate is 96.6%; partial flap necrosis was observed in 11 patients with infrahyoid myocutaneous flap and 2 patients with a supraclavicular flap. Most patients with subtotal glossectomy or smaller defects (type II–IVA defects) could communicate on the phone and had the near-normal capacity for an oral diet. The remaining patients (type IVB–V defects) had significantly lower speech scores. The majority of patients could eat liquid and semiliquid foods.

Conclusion

Tongue cancer surgery and subsequent reconstruction posed exciting challenges for the surgeon to optimize tongue function and quality of life for patients. Attention to the principles of tongue reconstruction and choosing appropriate flap for each defect achieve better functional results.
Management of Hardware-Exposed Soft Tissue Defects Using Dermal Substitutes and Negative Pressure Wound Therapy
Authors: Lee Sang Ki , An Young Sun , Choy Won Sik
Published: February 2023

Introduction

Reconstruction of complex injuries of the extremities with full-thickness wounds is a challenging but important task. If primary closure is not feasible, more complex procedures are required, such as split-thickness skin graft or flap surgery. Recently, several studies have shown good results when combined with negative pressure wound therapy (NPWT) and artificial dermal replacement therapy after extensive surgical debridement and NPWT administration for severe complex wounds accompanied by tendon or bone exposure. However, flap surgery remains the only treatment for wounds in which the hardware is exposed after fracture fixation. Therefore, in this study, we attempted to prove the usefulness of the combined treatment using artificial dermal substitutes (MatriDerm) and NPWT by focusing on hardware-exposed wounds, which have not been studied before.

Methods

From 2019 to 2021, we treated with our wound management procedure 14 patients with hardware-exposing wounds after internal fixation using plates, out of 48 patients with full-thickness posttraumatic skin defect. Before skin grafting, after surgical debridement and thorough washouts, MatriDerm was placed and NPWT was applied over it. This staged approach aimed at conditioning even the most complex wounds so that closure with MatriDerm-augmented skin grafting would become possible in a one-step approach.

Results

We stratified the duration of treatment and number of replacements in NPWT according to the type of injury. Cases with open fractures required significantly longer NPWT than those with closed fractures (P = 0.01); however, there was no significant difference between the Gustilo-Anderson classification within open fractures (P > 0.05). Patients with open fractures underwent a mean of 6.6 changes while those with closed fractures underwent 2.5 (P = 0.002) until the final wound closure with MatriDerm-augmented skin grafting was performed. There was no significant difference in the treatment period based on the location and size of the wound, and there was no significant difference in the number of NPWT replacements. Skin grafting was successful in all 14 patients.

Conclusions

This study revealed that NPWT and artificial dermis-augmented skin grafting after combined treatment with NPWT and artificial dermis were sufficiently useful for hardware-exposed wounds, where flap surgery has been considered the only treatment to date.
Prehospital stroke management and mobile stroke units
Authors: Fassbender Klaus , Lesmeister Martin , Merzou Fatma
Published: February 2023

Purpose of review

Delayed presentation at the hospital contributes to poorer patient outcomes and undertreatment of acute stroke patients. This review will discuss recent developments in prehospital stroke management and mobile stroke units aimed to improve timely access to treatment within the past 2 years and will point towards future directions.

Recent findings

Recent progress in research into prehospital stroke management and mobile stroke units ranges from interventions aimed at improving patients’ help-seeking behaviour, to the education of emergency medical services team members, to the use of innovative referral methods, such as diagnostic scales, and finally to evidence of improved outcomes by the use of mobile stroke units.

Understanding is increasing about the need for optimizing stroke management over the entire stroke rescue chain with the goal of improving access to highly effective time-sensitive treatment. In the future, we can expect that novel digital technologies and artificial intelligence will become relevant in effective interaction between prehospital and in-hospital stroke-treating teams, with beneficial effects on patients’ outcomes.
Generalized fractional Wentzel–Kramers–Brillouin approximation for electron tunnelling across rough metal interface
Authors: Ramzan M. W. , Riaz K. , Mehmood M. Q. , Zubair M. , Massoud Y.
Published: February 2023

The conductive rough surfaces act as an integral part of several electron devices and systems. Electron tunnelling through the potential barrier imposed by the rough metal-vacuum interface is an important mechanism of charge transport in vacuum electron devices. Here, we analytically derive a generalized current–voltage relationship with a fractional image potential barrier that considers the reduced space-dimensionality encountered by the tunnelling electrons at a rough interface, in an effective manner. The traditional Schottky–Nordhiem equation based on the Schottky image potential barrier is shown to be a limiting case of our model for a perfectly flat surface. The fractional-dimension parameter used in this model accounts for the barrier reduction due to the geometrical roughness and it can be determined by fitting our model to a given current–voltage measurement. It is shown that the application of this model could reduce the error between measured current–voltage response and theoretical estimates based on the conventional model. This work provides an analytical framework for efficient design and engineering of quantum tunnelling in practical electron devices.
Sneathiella marina sp. nov., isolated from a sea anemone in the Western Pacific Ocean
Authors: Wei Mengjiao , Li Guizhen , Lai Qiliang , Liu Tianqi , Shao Zongze
Published: February 2023

A novel marine bacterium designated strain PHK-P5T was isolated from a sea anemone (Actinostolidae sp. 1). Phylogenetic analysis based on 16S rRNA gene sequences indicated that strain PHK-P5T belonged to the genus

Sneathiella

. The bacterium was Gram-stain-negative, aerobic, oxidase- and catalase- positive, oval- to rod-shaped, and motile. Growth was observed at pH 6.0–9.0, salinities of 2.0–9.0 % and temperatures of 4–37 °C. The G+C content of the chromosomal DNA was 49.2 %. The respiratory quinone was determined to be Q-10. The principal fatty acids of strain PHK-P5T were C19 : 0cyclo ω8c (25.19 %), C16 : 0 (22.76 %), summed feature 8 (C18 : 1
 ω7c/ω6c; 16.14 %), C14 : 0 (8.81 %), C17 : 0cyclo (8.10 %), summed feature 2 (C12 : 0 aldehyde and/or unknown 10.928; 7.19 %) and C18 : 1
 ω7c 11-methyl (5.03 %). The major polar lipids were diphosphatidylglycerol, phosphatidylethanolamine and phosphatidylglycerol. The average nucleotide identity and digital DNA–DNA hybridization values among the genomes of strain PHK-P5T and the reference strains were 68.7–70.9 % and 17.4–18.1 %, respectively. The combined genotypic and phenotypic data showed that strain PHK-P5T represents a novel species within the genus

Sneathiella

, for which the name Sneathiella marina sp. nov. is proposed, with the type strain PHK-P5T (=MCCC M21824T=KCTC 82924T).
Monitoring transmission intensity of trachoma with serology
Authors: Tedijanto Christine , Solomon Anthony W. , Martin Diana L. , Nash Scott D. , Keenan Jeremy D. , Lietman Thomas M. , Lammie Patrick J. , Aiemjoy Kristen , Amza Abdou , Aragie Solomon , Arzika Ahmed M. , Callahan E. Kelly , Carolan Sydney , Dawed Adisu Abebe , Goodhew E. Brook , Gwyn Sarah , Hammou Jaouad , Kadri Boubacar , Kalua Khumbo , Maliki Ramatou , Nassirou Beido , Seife Fikre , Tadesse Zerihun , West Sheila K. , Wittberg Dionna M. , Zeru Taye , Arnold Benjamin F.
Published: February 2023

Trachoma, caused by ocularChlamydia trachomatisinfection, is targeted for global elimination as a public health problem by 2030. To provide evidence for use of antibodies to monitorC. trachomatistransmission, we collated IgG responses to Pgp3 antigen, PCR positivity, and clinical observations from 19,811 children aged 1– 9 years in 14 populations. We demonstrate that age-seroprevalence curves consistently shift along a gradient of transmission intensity: rising steeply in populations with high levels of infection and active trachoma and becoming flat in populations near elimination. Seroprevalence (range: 0–54%) and seroconversion rates (range: 0–15 per 100 person-years) correlate with PCR prevalence (r: 0.87, 95% CI: 0.57, 0.97). A seroprevalence threshold of 13.5% (seroconversion rate 2.75 per 100 person-years) identifies clusters with any PCR-identified infection at high sensitivity (>90%) and moderate specificity (69-75%). Antibody responses in young children provide a robust, generalizable approach to monitor population progress toward and beyond trachoma elimination.
Kinetics and efficacy of antibody drug conjugates in 3D tumour models
Authors: Palma Chaundler Chloe S , Lu Haonan , Fu Ruisi , Wang Ning , Lou Hantao , de Almeida Gilberto Serrano , Hadi Layla Mohammad , Aboagye Eric O , Ghaem-Maghami Sadaf
Published: February 2023

Antibody-drug conjugates (ADCs) are emerging targeted agents against cancer. Current studies of ADCs are performed on monolayer cultures which do not mimic the biophysical property of a tumour. Hence,in vitromodels that can better predict the efficacy of ADCsin vivoare needed. In this study, we aim to optimise 3-dimentional cancer spheroid systems, which preserve the features of the tumour structure, to test the efficacy of two ADCs (T-DM1 and T-vcMMAE). Firstly, a set of reproducible spheroid models using epithelial ovarian cancer cell lines were established. Subsequently, phenotypic changes in spheroids were characterised upon ADC treatment. The penetration dynamics of ADCs into 3D tumour structure were also studied. Our data revealed that spheroids are less sensitive to ADCs compared to monolayer cultures. Interestingly, the small molecule component of ADCs-the cytotoxic payload-showed a similar decrease in efficacy in spheroids compared to monolayer cultures. Furthermore, we also gained new insight into ADC penetration dynamics and showed that ADCs can fully penetrate a tumour-like spheroid within 24h. The results suggest that although ADCs, as large molecule biological drugs, are likely to have slower penetration dynamics than small molecule compounds such as their cytotoxic payload, they could have comparable capability to kill cancer cells in 3D structures. This may be explained by the fact that multiple cytotoxic payloads are conjugated with each single antibody, which compensates the penetration deficiency of the large molecules. In conclusion, our work confirms that the tumour 3D structure could limit the therapeutic efficacy of ADCs. Nevertheless, optimising ADC design such as adjusting drug-to-antibody ratios could help to overcome this hurdle.
Post-COVID syndrome is associated with capillary alterations, macrophage infiltration and distinct transcriptomic signatures in skeletal muscles
Authors: Aschman Tom , Wyler Emanuel , Baum Oliver , Hentschel Andreas , Legler Franziska , Preusse Corinna , Meyer-Arndt Lil , Büttnerova Ivana , Förster Alexandra , Cengiz Derya , Teixeira Alves Luiz Gustavo , Schneider Julia , Kedor Claudia , Rust Rebecca , Bellmann-Strobl Judith , Aminaa Sanchin , Vajkoczy Peter , Goebel Hans-Hilmar , Landthaler Markus , Corman Victor , Roos Andreas , Heppner Frank L. , Radbruch Helena , Paul Friedemann , Scheibenbogen Carmen , Stenzel Werner , Dengler Nora F.
Published: February 2023

The SARS-CoV-2 pandemic not only resulted in millions of acute infections worldwide, but also caused innumerable cases of post-infectious syndromes, colloquially referred to as “long COVID”. Due to the heterogeneous nature of symptoms and scarcity of available tissue samples, little is known about the underlying mechanisms. We present an in-depth analysis of skeletal muscle biopsies obtained from eleven patients suffering from enduring fatigue and post-exertional malaise after an infection with SARS-CoV-2. Compared to two independent historical control cohorts, patients with post-COVID exertion intolerance had fewer capillaries, thicker capillary basement membranes and increased numbers of CD169+macrophages. SARS-CoV-2 RNA could not be detected in the muscle tissues, but transcriptomic analysis revealed distinct gene signatures compared to the two control cohorts, indicating immune dysregulations and altered metabolic pathways. We hypothesize that the initial viral infection may have caused immune-mediated structural changes of the microvasculature, potentially explaining the exercise-dependent fatigue and muscle pain.
Evolution of Life-Threatening COVID-19 as the SARS-CoV-2 Pandemic Has Progressed
Authors: Murthy Sudish C. , Lowry Ashley M. , Gordon Steven M. , Blackstone Eugene H.
Published: February 2023

Rationale

As the SARS-CoV-2 pandemic progressed, hospital mortality among patients admitted with COVID-19 decreased; however, its mechanism remains unclear.

Objective

To determine underlying factors that might explain the declining observed mortality of hospitalized patients with COVID-19.

Methods

This observational study used a prospective COVID-19 clinical database compiled by a 15-hospital health system. Participants were persons testing positive for SARS-CoV-2 (n=185,636), among whom 26,872 were hospitalized for COVID-19 from 3/1/2020 to 6/1/2022.

Measurements

Endpoints were hospital and 60-day mortality assessed by randomForests-for-survival machine learning using patient demographics, medical history, symptoms, and admission laboratory test results.

Main Results

Mortality of patients hospitalized with COVID-19 fell from 11% in 3/2020 to 3.7% in 3/2022; 60-day mortality was 17% in 5/2020 and 4.7% in 5/2022. Advanced age was the most important predictor of mortality, followed by admission laboratory test results. Risk-adjusted 60-day mortality was 15% had all patients been admitted in 3/2020, minimally unchanged at 12% had they been admitted in 5/2022. Dissociation between observed and predicted mortality was largely explained by change in admission patient profile, particularly admission laboratory test results. Transition to intensive care occurred rapidly for those predicted to do poorly.

Conclusion

Mortality from COVID-19 requiring hospitalization has declined as the pandemic has evolved, but surprisingly, persists for 60 days following admission. Demographics, medical history, and at-admission laboratory results continue to accurately predict mortality despite reduction of observed mortality and in spite of therapeutic advances. Importantly, rapid escalation of care can be predicted at admission using standardly obtained information. There has been a subtle but perceptible change in the at-risk population that explains these findings.
The influence of acute dietary nitrate supplementation on skeletal muscle fatigue and recovery in older women
Authors: Zoughaib William S. , Hoffman Richard L. , Yates Brandon A. , Moorthi Ranjani N. , Lim Kenneth , Coggan Andrew R.
Published: February 2023

Older individuals fatigue more rapidly during, and recover more slowly from, dynamic exercise. Women are particularly vulnerable to these deleterious effects of aging, which increases their risk of falling. We have shown that dietary nitrate (NO3-), a source of nitric oxide (NO) via the NO3-→ nitrite (NO2-) → NO pathway, enhances muscle speed and power in older individuals in the non-fatigued state; however, it is unclear if it reduces fatigability and/or improves recoverability in this population. Using a double-blind, placebo-controlled, crossover design, we studied 18 older (age 70 ± 4 y) women who were administered an acute dose of beetroot juice (BRJ) containing either 15.6±3.6 or <0.05 mmol of NO3-. Blood samples were drawn throughout each ∼3 h visit for plasma NO3-and NO2-analysis. Peak torque was measured during, and periodically for 10 min after, 50 maximal knee extensions performed at 3.14 rad/s on an isokinetic dynamometer. Ingestion of NO3--containing BRJ increased plasma NO3-and NO2-concentrations by 21±8 and 4±4 fold, respectively. However, there were no differences in muscle fatigue or recovery. Dietary NO3-increases plasma NO3-and NO2-concentrations but does not reduce fatigability during or enhance recoverability after high intensity exercise in older women.
Water, Sanitation and Cholera in sub-Saharan Africa
Authors: Sikder Mustafa , Deshpande Aniruddha , Hegde Sonia T. , Malembaka Espoir Bwenge , Gallandat Karin , Reiner Robert C. , Lessler Justin , Lee Elizabeth C. , Azman Andrew S.
Published: February 2023

Improvements in water and sanitation should reduce cholera risk. But it is unclear which water and sanitation access are associated with cholera risk. We estimated the association between eight water and sanitation measures and annual cholera incidence access across sub-Saharan Africa (2010-2016) for data aggregated at the country and district-level. We fit random forest regression and classification models to understand how well these measures combined might be able to predict cholera incidence rates and identify high cholera incidence areas. Across spatial scales, piped or “other improved” water access was inversely associated with cholera incidence. Access to piped water, piped sanitation, and piped or “other improved” sanitation were associated with decreased district-level cholera incidence. The classification model had moderate skill in identifying high cholera incidence areas (cross-validated-AUC 0.81 95%CI 0.78–0.83) with high negative predictive values (92.5–100.0%) indicating the utility of water and sanitation measures for screening out areas that are unlikely to be cholera hotspots. While comprehensive cholera risk assessments must incorporate other data sources (e.g., historical incidence), our results suggest that water and sanitation measures could alone be useful in narrowing the geographic focus for detailed risk assessments.

Synopsis

We quantified the relationship between high-resolution estimates of water and sanitation access and cholera incidence and assessed the utility of water and sanitation measures in identifying high risk geographic areas in sub-Saharan Africa.