bluuebunny/crossref_metadata_2025 huggingface dataset:
International Regulation of the Banking Sector
Authors: Herdegen Matthias
Published: June 2024

This chapter covers the international regulation of the banking sector. It highlights the need for enhanced cooperation of supervisory authorities and harmonized standards, citing that the banking sector is always extensively engaged in cross-border transactions. The global financial crisis (GFC) highlighted the urgent need to strengthen international cooperation and coordinate standards for supervision. Thus, the Financial Stability Board (FSB) was established to coordinate at international levels with national financial authorities and international standard-setting bodies (SSBs) to develop and promote the implementation of effective regulatory, supervisory, and other financial sector policies. The chapter then references the Basel Accords to elaborate on global regulatory standards for adequate bank capital.
Candida parapsilosis: Heterogeneous and strain-specific expression of secreted aspartic proteases (Sapp1 and Sapp2)
Authors: Gandra Rafael M , Ramos Lívia S , Cruz Lucas P S , Souza Lucieri O P , Branquinha Marta H , Santos André L S
Published: June 2024

The increasing prevalence of Candida parapsilosis as a causative agent of fungal infections underscores the need to comprehensively understand its virulence factors. Secreted aspartic proteases (Saps) play a significant role in adhesion events, promoting biofilm formation, causing tissue damage and evading the host’s immune response. In C. parapsilosis, three Saps have been identified: Sapp1, Sapp2 and Sapp3. The present study investigates the production dynamics of Sapp1 and Sapp2 across 10 clinical isolates of C. parapsilosis using various approaches. Each fungal isolate demonstrated the capability to utilize bovine serum albumin (BSA) as the sole nitrogen source, as evidenced by its degradation in a cell-free culture medium, forming low molecular mass polypeptides. Interestingly, the degradation of different proteinaceous substrates, such as BSA, human serum albumin (HSA), gelatin and hemoglobin, was typically isolate-dependent. Notably, higher proteolysis of HSA compared to BSA, gelatin and hemoglobin was observed. A quantitative assay revealed that the cleavage of a peptide fluorogenic substrate (cathepsin D) was isolate-specific, ranging from 44.15 to 270.61 fluorescence arbitrary units (FAU), with a mean proteolysis of 150.7 FAU. The presence of both Sapp1 and Sapp2 antigens on the cell surface of these fungal isolates was confirmed through immunological detection employing specific anti-Sapp1 and anti-Sapp2 antibodies. The surface levels of Sapp1 were consistently higher, up to fourfold, compared to Sapp2. Similarly, higher levels of Sapp1 than Sapp2 were detected in fungal secretions. This study provides insights into the dynamic expression and regulation of Sapps in C. parapsilosis, highlighting a known virulence factor that is considered a potential target for drug development against this increasingly prominent pathogen.
The response of the cometary ionosphere to space weather forcing
Authors: Timar Aniko , Nemeth Zoltan , Burch James L
Published: June 2024

The Rosetta spacecraft observed the temporal evolution of the ion populations within the ionosphere of comet 67P/Churyumov–Gerasimenko. A striking feature of the ion spectrum is represented by the so-called medium-energy ion peaks, which recurrently emerge from the low-energy ion background with their energy levels typically reaching 50 to 1000 eV before their energy gradually decreases, and they disappear from the measurements. These peaks are believed to be caused by space weather forcing, but there was no conclusive evidence until now. We investigated the characteristics of these ions, paying special attention to the connection between the solar wind dynamic pressure and the amount and energy of the medium-energy ions. Our findings reveal a strikingly accurate direct correlation between the dynamic pressure of the solar wind at the position of the comet and the amount of medium-energy ions measured by Rosetta. The ion energy also unquestionably reacts to the effects of solar wind pressure variation, but this parameter is strongly affected by the production rate and the distance from the nucleus as well. We explain these close correlations between cometary ion and solar wind characteristics using the well-founded assumption that certain boundary layers of the magnetosphere can move in and out under the influence of higher and lower solar wind pressure.
Measuring the spin of black hole transient 4U 1543–47 Using Insight-HXMT
Authors: Yang Jun , Jia Nan , Qiao Erlin , Song Yujia , Gou Lijun
Published: June 2024

We provided a comprehensive study of the properties of the black hole in the low-mass X-ray binary system 4U 1543-47, specifically focusing on the 2021 outburst (MJD 59380–59470). Using observations from the Insight-HXMT mission, we employed X-ray reflection fitting method and analysed spectral data to estimate key black hole parameters. Through our investigation redbased on 6 out of the 52 available observations, we estimated the spin parameter of the black hole to be $0.902_{-0.053}^{+0.054}$ and the inclination angle of the accretion disc to be $28.91_{-1.24}^{+1.82}$° (90 per cent confidence limits, statistical only), then we discussed the influence of high luminosity. Based on the relxill series models are not suitable for thick disc scenario, and in comparison with findings from other studies, we propose that our estimation of the spin value may be exaggerated.
On the lack of X-ray pulsation in most neutron star low-mass X-ray binaries
Authors: Niang N , Ertan Ü , Gençali A A , Toyran O , Ulubay A , Devlen E , Alpar M A , Gügercinoğlu E
Published: June 2024

We have investigated whether the lack of X-ray pulsations from most neutron star (NS) low-mass X-ray binaries (LMXBs) could be due to the extension of their inner disc to the NS surface. To estimate the inner disc radii, we have employed the model, recently proposed to account for the torque reversals of LMXBs. In this model, the inner disc radius depends on the spin period as well as the dipole moment and the mass inflow rate of the disc. Our model results indicate that most LMXBs have mass accretion rates above the minimum critical rates required for the inner disc to reach down to the NS surface and thereby quench the pulsed X-ray emission. For most sources X-ray pulsations are allowed when the period decreases below a certain critical value. For the same parameters, the model is also consistent with the observed X-ray luminosity ranges of the individual accreting millisecond X-ray pulsars (AMXPs). The paucity of AMXPs compared to the majority population of non-pulsing LMXBs is explained, as well as the fact that AMXPs are transient sources.
Overview and public data release of the augmented Auriga Project: cosmological simulations of dwarf and Milky Way-mass galaxies
Authors: Grand Robert J J , Fragkoudi Francesca , Gómez Facundo A , Jenkins Adrian , Marinacci Federico , Pakmor Rüdiger , Springel Volker
Published: June 2024

We present an extended suite of the Auriga cosmological gravo-magnetohydrodynamical ‘zoom-in’ simulations of 40 Milky Way-mass haloes and 26 dwarf galaxy–mass haloes run with the moving-mesh code arepo. Auriga adopts the Lambda cold dark matter cosmogony and includes a comprehensive galaxy formation physics model following the coupled cosmic evolution of dark matter, gas, stars, and supermassive black holes which has been shown to produce numerically well-converged galaxy properties for Milky Way-mass systems. We describe the first public data release of this augmented suite of Auriga simulations, which includes raw snapshots, group catalogues, merger trees, initial conditions, and supplementary data, as well as public analysis tools with worked examples of how to use the data. To demonstrate the value and robustness of the simulation predictions, we analyse a series of low-redshift global properties that compare well with many observed scaling relations, such as the Tully–Fisher relation, the star-forming (SF) main sequence, and H i gas fraction/disc thickness. Finally, we show that SF gas discs appear to build rotation and velocity dispersion rapidly for $z\gtrsim 3$ before they ‘settle’ into ever-increasing rotation-dispersion ratios ($V/\sigma$). This evolution appears to be in rough agreement with some kinematic measurements from H$\alpha$ observations, and demonstrates an application of how to utilize the released data.
The Role of Harm Visibility for Pictorial Health Warning Labels on Cigars
Authors: Clark Sonia A , Kowitt Sarah D , Jarman Kristen L , Lazard Allison J , Queen Tara L , Ranney Leah M , Cornacchione Ross Jennifer , Sheeran Paschal , Thrasher James F , Goldstein Adam O
Published: June 2024

Introduction

Pictorial health warning labels (HWLs) can communicate the harms of tobacco product use, yet little research exists for cigars. We sought to identify the most effective types of images to pair with newly developed cigar HWLs.

Aims and Methods

In September 2021, we conducted an online survey experiment with US adults who reported using little cigars, cigarillos, or large cigars in the past 30 days (n = 753). After developing nine statements about health effects of cigar use, we randomized participants to view one of three levels of harm visibility paired with each statement, either: (1) an image depicting internal harm not visible outside the body, (2) an image depicting external harm visible outside of the body, or (3) two images depicting both internal and external harm. After viewing each image, participants answered questions on perceived message effectiveness (PME), negative affect, and visual-verbal redundancy (VVR). We used linear mixed models to examine the effect of harm visibility on each outcome, controlling for warning statement.

Results

Warnings with both and external harm depictions performed significantly better than the internal harm depictions across all outcomes, including PME (B = 0.21 and B = 0.17), negative affect (B = 0.26 and B = 0.25), and VVR (B = 0.24 and B = 0.17), respectively (all p < .001). Compared to both, the external depiction of harm did not significantly change PME or negative affect but did significantly lower VVR (B = −0.07, p = .01).

Conclusions

Future cigar pictorial HWLs may benefit from including images depicting both or external harm depictions. Future research should examine harm visibility’s effect for other tobacco pictorial HWLs.

Implications

The cigar health warning labels (HWLs) proposed by the US Food and Drug Administration are text-only. We conducted an online survey experiment among people who use cigars to examine the effectiveness of warnings with images depicting different levels of harm visibility. We found HWLs with images depicting both an internal and external depiction of cigar harm, or an external depiction of harm alone, performed better overall than images portraying internal depictions of harm. These findings provide important regulatory evidence regarding what type of images may increase warning effectiveness and offer a promising route for future cigar HWL development.
NRC Immune receptor networks show diversified hierarchical genetic architecture across plant lineages
Authors: Goh Foong-Jing , Huang Ching-Yi , Derevnina Lida , Wu Chih-Hang
Published: June 2024

Plants' complex immune systems include nucleotide-binding domain and leucine-rich repeat-containing (NLR) proteins, which help recognize invading pathogens. In solanaceous plants, the NRC (NLR required for cell death) family includes helper NLRs that form a complex genetic network with multiple sensor NLRs to provide resistance against pathogens. However, the evolution and function of NRC networks outside solanaceous plants are currently unclear. Here, we conducted phylogenomic and macroevolutionary analyses comparing NLRs identified from different asterid lineages and found that NRC networks expanded significantly in most lamiids but not in Ericales and campanulids. Using transient expression assays in Nicotiana benthamiana, we showed that NRC networks are simple in Ericales and campanulids, but have high complexity in lamiids. Phylogenetic analyses grouped the NRC helper NLRs into three NRC0 subclades that are conserved, and several family-specific NRC subclades of lamiids that show signatures of diversifying selection. Functional analyses revealed that members of the NRC0 subclades are partially interchangeable, whereas family-specific NRC members in lamiids lack interchangeability. Our findings highlight the distinctive evolutionary patterns of the NRC networks in asterids and provide potential insights into transferring disease resistance across plant lineages.
Is a keystone Bone Anomaly the Main Cause of Flatfoot (Pes Planus)?
Authors: Payas Ahmet , Batin Sabri
Published: June 2024

Background:

Flatfoot (pes planus) is a decrease or loss of longitudinal medial arch height. The cause of symptomatic flatfoot occurring in adolescents is still unclear. In this study, the relationship between adolescent pes planus and foot bone shape was investigated. For this purpose, the volume and superficial area data of the foot bones of adolescent individuals with flatfoot deformity and individuals without any foot deformity were compared.

Methods:

Between September 2022 and June 2023, 30 individuals with adolescent pes planus with a medial arch angle greater than 145 degrees and 30 individuals without any foot deformity were included in the study. Computed tomography (CT) images of the participants’ feet were obtained with a General Electric brand IQ model 32 detector CT device with a section thickness of 0.625 mm in accordance with the bone protocol. Using the 3D Slicer program on CT images, foot bones were segmented and the volume and surface area ratios of each foot bone were determined.

Results:

Cuneiforme mediale and cuneiforme intermediale volume ratios in individuals with flatfoot deformity decreased by 14% and 24%, respectively, compared with the control group (P<0.05). Cuneiforme mediale and cuneiforme intermediale superficial area ratios were found to be 10% and 30% lower in the flatfoot group compared with the control group, respectively (P<0.05). There was no difference in the volume and superficial area ratios of other foot bones between the groups (P>0.05).

Conclusions:

The study results suggest that symptomatic adolescent flatfoot deformity may be associated with developmental anomalies of the os cuneiforme mediale and os cuneiforme intermedium.
Lung-Protective Ventilation for Pediatric Acute Respiratory Distress Syndrome: A Nonrandomized Controlled Trial*
Authors: Wong Judith Ju Ming , Dang Hongxing , Gan Chin Seng , Phan Phuc Huu , Kurosawa Hiroshi , Aoki Kazunori , Lee Siew Wah , Ong Jacqueline Soo May , Fan Li Jia , Tai Chian Wern , Chuah Soo Lin , Lee Pei Chuen , Chor Yek Kee , Ngu Louise , Anantasit Nattachai , Liu Chunfeng , Xu Wei , Wati Dyah Kanya , Gede Suparyatha Ida Bagus , Jayashree Muralidharan , Liauw Felix , Pon Kah Min , Huang Li , Chong Jia Yueh , Zhu Xuemei , Hon Kam Lun Ellis , Leung Karen Ka Yan , Samransamruajkit Rujipat , Cheung Yin Bun , Lee Jan Hau ,   for the Pediatric Acute & Critical Care Medicine Asian Network (PACCMAN)
Published: June 2024

OBJECTIVES:

Despite the recommendation for lung-protective mechanical ventilation (LPMV) in pediatric acute respiratory distress syndrome (PARDS), there is a lack of robust supporting data and variable adherence in clinical practice. This study evaluates the impact of an LPMV protocol vs. standard care and adherence to LPMV elements on mortality. We hypothesized that LPMV strategies deployed as a pragmatic protocol reduces mortality in PARDS.

DESIGN:

Multicenter prospective before-and-after comparison design study.

SETTING:

Twenty-one PICUs.

PATIENTS:

Patients fulfilled the Pediatric Acute Lung Injury Consensus Conference 2015 definition of PARDS and were on invasive mechanical ventilation.

INTERVENTIONS:

The LPMV protocol included a limit on peak inspiratory pressure (PIP), delta/driving pressure (DP), tidal volume, positive end-expiratory pressure (PEEP) to Fio
2 combinations of the low PEEP acute respiratory distress syndrome network table, permissive hypercarbia, and conservative oxygen targets.

MEASUREMENTS AND MAIN RESULTS:

There were 285 of 693 (41·1%) and 408 of 693 (58·9%) patients treated with and without the LPMV protocol, respectively. Median age and oxygenation index was 1.5 years (0.4–5.3 yr) and 10.9 years (7.0–18.6 yr), respectively. There was no difference in 60-day mortality between LPMV and non-LPMV protocol groups (65/285 [22.8%] vs. 115/406 [28.3%]; p = 0.104). However, total adherence score did improve in the LPMV compared to non-LPMV group (57.1 [40.0–66.7] vs. 47.6 [31.0–58.3]; p < 0·001). After adjusting for confounders, adherence to LPMV strategies (adjusted hazard ratio, 0.98; 95% CI, 0.97–0.99; p = 0.004) but not the LPMV protocol itself was associated with a reduced risk of 60-day mortality. Adherence to PIP, DP, and PEEP/Fio
2 combinations were associated with reduced mortality.

CONCLUSIONS:

Adherence to LPMV elements over the first week of PARDS was associated with reduced mortality. Future work is needed to improve implementation of LPMV in order to improve adherence.
First Case of Interstitial Keratitis Secondary to Anaplasma phagocytophilum Infection
Authors: Fabregas-Sanchez-Woodworth Daniela , Eskenazi-Betech Ruth , Valente-Acosta Benjamín , Ramirez-Miranda Arturo , Navas Alejandro , Müller-Morales Carlos Adolfo , Graue-Hernández Enrique O.
Published: June 2024

Purpose:

To describe the first case of interstitial keratitis (IK) secondary to Anaplasma phagocytophilum infection.

Methods:

We present a case of IK secondary to A. phagocytophilum infection diagnosed using nested polymerase chain reaction.

Results:

A 32-year-old man with an unremarkable medical history presented with a 6-month history of bilateral decreased vision and ocular redness associated with a progressively enlarging white spot in the left eye. The patient was diagnosed with bilateral IK, and a thorough systemic workup was performed. The final diagnosis of A. phagocytophilum was made based on whole-blood Nested-PCR. Doxycycline was initiated with 100-mg BID tablets for 3 weeks. On completion of oral treatment, a left penetrating keratoplasty was performed. The excised cornea showed infiltration of inflammatory cells and scar tissue as well as superficial and deep stromal neovascularization.

Conclusions:

A. phagocytophilum is an underdiagnosed entity, and IK may be associated with its clinical manifestations. We hope that this illustration of a rather atypical finding adds to the clinical spectrum of ophthalmic conditions that can be observed in association with the disease.
The Impact of Loving-Kindness Meditation on Job-Related Burnout of Nurses Working in Neonatal Intensive Care Unit
Authors: Asadollah Fatemeh , Nikfarid Lida , Nourian Manijeh , Hashemi Fatemeh
Published: June 2024

Job-related burnout is one health outcome in nurses working in neonatal intensive care units (NICUs) due to the heavy workload, which results in negative physical and psychological consequences. One newly introduced approach to improve coping is loving-kindness meditation (LKM). Some studies have shown the effectiveness of the LKM on the mental health of nurses, though more evidence is required to support them. This study aimed to investigate the effectiveness of the LKM on job-related burnout of nurses working in NICU. This clustered controlled randomized clinical trial assessed job-related burnout before and after a month of practicing LKM guided through a virtual method. A total of 66 eligible NICU nurses from 2 referral children hospitals in Tehran were randomly assigned to 2 control (n = 33) and intervention (n = 33) groups. The intervention was performed 3 times a week for 1 month in the form of 20-minute audio files of LKM for the intervention group, and educational files on mental health during the COVID-19 pandemic were sent to the control group. The instruments used in this study were the demographic information questionnaire and the Maslach Burnout Inventory, which participants completed before and after the intervention. The mean difference in the overall scores of burnout before and after the intervention in the intervention group was significantly reduced (P = .003), but no significant difference was observed in the control group (P = .018). These findings support the benefit of LKM in NICU nurses in reducing burnout.
Eco-sustainability in ophthalmology
Authors: Lee Gabriela G. , Menean Matteo , Williams Basil K. , Di Nicola Maura
Published: June 2024

Purpose of review

The purpose of this review is to evaluate the current state of eco-sustainability in ophthalmology, highlighting key practices, recent advancements, and areas requiring improvement. This review aims to provide ophthalmologists with a comprehensive overview of sustainable practices that can reduce environmental impact.

Recent findings

Recent studies have identified several areas within ophthalmology where sustainable practices can be implemented including multidose eyedrops, adjusting surgical packs, making package inserts available electronically, and reusing surgical instruments. Moreover, there is an increasing emphasis on waste reduction both in the surgical and clinical setting, by decreasing the use of unnecessary materials and implementing more efficient use of recycling programs. Telemedicine has also emerged as a sustainable option, reducing the carbon footprint associated with patient travel. Despite these advancements, significant challenges remain, particularly in balancing the cost and accessibility of sustainable options with traditional practices.

Eco-sustainability in ophthalmology is gaining momentum as the medical community aims to reduce its environmental impact. While progress has been made, further efforts are required to overcome financial and logistical barriers to widespread implementation. Continued research, education, and policy development are essential to advancing eco-sustainable practices, ensuring that environmental considerations become an integral part of ophthalmic care.
Symptomatic treatment of mosquito bites with a thermo-therapeutic medical device: a prospective, intraindividual compared, placebo-controlled, randomized clinical trial
Authors: Wilhelm Dorothea , Lozanovska Ivana , Kapoor Katharina , Ruwe David , Mentel Tim
Published: June 2024

Objective:

Agonizing itching (pruritus), heat, and burning are common symptoms of mosquito bites. In this study, we present a thermo-therapeutic medical device for the symptomatic treatment of mosquito bites. Current research suggests the potential of a thermal (heat) stimulus for pruriceptor counter-stimulation and reduced histamine-signaling to relieve the symptoms of mosquito bites. The purpose of this clinical investigation was to investigate the efficacy and safety of the thermo-therapeutic medical device (class II) in the symptomatic treatment of mosquito bites in an intraindividual comparison to a placebo device (PD) examined under standardized conditions. This was achieved by assessing pruritus and wheal size over time after induction of a mosquito bite on the volar forearm.

Methods:

The itching was rated on a Visual Analog Scale ranging from 0 mm (no itching) to 100 mm (worst imaginable itching).

The wheal size was measured in approximation to the area of an eclipse before and ~30 minutes after the treatment with the investigational device.

Local tolerability was assessed by the investigator according to a score ranging from 0 (no irritation) to 4 (very strong irritation) and the subjects stated if the itching sensation was completely gone after treatment (yes/no question).

Results:

The mean area under the curve of the difference to baseline for the treatment with the medical device was statistically significantly bigger than for the treatment with the PD (1311.71 vs 914.61, respectively; P = 0.0127).

Conclusions:

Treatment of a mosquito bite with a thermo-therapeutic medical device significantly reduced pruritus and led to a faster reduction of the itching sensation as compared with PD. A significant itch reduction started immediately (1 min) after treatment with the medical device (post hoc analysis). The treatment with the medical device was well tolerated by all subjects and no adverse events related to the medical device occurred.
Predictors of renal replacement therapy following isolated coronary artery surgery: a retrospective case–controlled study
Authors: Krauchuk Alena , Hrapkowicz Tomasz , Suwalski Piotr , Perek Bartłomiej , Jasiński Marek , Hirnle Tomasz , Nadziakiewicz Paweł , Knapik Piotr
Published: June 2024

Objectives:

Severe acute kidney injury (AKI) requiring postoperative renal replacement therapy (RRT) is associated with increased morbidity and mortality rates following cardiac surgery. Our study aimed to analyze patients requiring postoperative RRT in a population undergoing isolated coronary artery surgery.

Methods:

Following exclusions, we analyzed 124 944 consecutive patients in the Polish National Registry of Cardiac Surgical Procedures (KROK Registry), scheduled for isolated coronary artery surgery between January 2010 and December 2019. Patients who underwent preoperative chronic dialysis were excluded from the study. Data of patients requiring postoperative RRT and patients without postoperative RRT were compared.

Results:

In the analyzed population, 1668 patients (1.3%) developed AKI requiring RRT. In-hospital mortality among patients with and without postoperative RRT was 40.1 and 1.6%, respectively (P<0.001). Patients requiring postoperative RRT had significantly more preoperative co-morbidities and more frequent postoperative complications. Preoperative chronic renal failure and cardiogenic shock were the two most prominent independent risk factors for postoperative RRT in these patients (OR: 5.0, 95% CI: 3.9–6.4, P<0.001 and OR: 3.9, 95% CI: 2.8–5.6, P<0.001, respectively).

Conclusion:

Severe AKI requiring postoperative RRT dramatically increases in-hospital mortality and is associated with the development of serious postoperative complications. The need for postoperative RRT is clearly associated with the presence of preoperative co-morbidities. Preoperative chronic renal failure and cardiogenic shock were particularly related to the development of this complication.
Prognosis Prediction of Sudden Sensorineural Hearing Loss Using Ensemble Artificial Intelligence Learning Models
Authors: Li Kuan-Hui , Chien Chen-Yu , Tai Shu-Yu , Chan Leong-Perng , Chang Ning-Chia , Wang Ling-Feng , Ho Kuen-Yao , Lien Yu-Jui , Ho Wen-Hsien
Published: June 2024

Objective

We used simple variables to construct prognostic prediction ensemble learning models for patients with sudden sensorineural hearing loss (SSNHL).

Study Design

Retrospectively study.

Setting

Tertiary medical center.

Patients

1,572 patients with SSNHL.

Intervention

Prognostic.

Main Outcome Measures

We selected four variables, namely, age, days after onset of hearing loss, vertigo, and type of hearing loss. We also compared the accuracy between different ensemble learning models based on the boosting, bagging, AdaBoost, and stacking algorithms.

Results

We enrolled 1,572 patients with SSNHL; 73.5% of them showed improving and 26.5% did not. Significant between-group differences were noted in terms of age (p = 0.011), days after onset of hearing loss (p < 0.001), and concurrent vertigo (p < 0.001), indicating that the patients who showed improving to treatment were younger and had fewer days after onset and fewer vertigo symptoms. Among ensemble learning models, the AdaBoost algorithm, compared with the other algorithms, achieved higher accuracy (82.89%), higher precision (86.66%), a higher F1 score (89.20), and a larger area under the receiver operating characteristics curve (0.79), as indicated by test results of a dataset with 10 independent runs. Furthermore, Gini scores indicated that age and days after onset are two key parameters of the predictive model.

Conclusions

The AdaBoost model is an effective model for predicting SSNHL. The use of simple parameters can increase its practicality and applicability in remote medical care. Moreover, age may be a key factor influencing prognosis.
Female Adnexal Tumor of Probable Wolffian Origin (Wolffian Tumor)
Authors: Keyhanian Kianoosh , Mack Tanner , Forgo Erna , Tazelaar Henry , Longacre Teri A.
Published: June 2024

Wolffian tumor and its nosologic relative, the recently defined STK11 adnexal tumor are rare neoplasms thought to arise from mesonephric remnants. These tumors typically arise in the broad ligament, fallopian tube, and ovarian hilum and although most are associated with a good prognosis, up to 50% of STK11 adnexal tumors demonstrate aggressive clinical behavior. The chief differential diagnoses include endometrioid adenocarcinoma and sex cord stromal tumors. However, the morphologic and immunohistochemical features of these tumors exhibit considerable overlap with peritoneal mesothelioma. To fully characterize their immunophenotypic signature, we examined a total of 21 cases (18 Wolffian and 3 STK11 adnexal tumors) with standard markers used in the diagnosis of mesothelioma. Morphologic and immunohistochemical (IHC) features were reviewed and additional IHC performed for cases with available material. Patient age ranged from 25 to 73 (mean: 51) years. Sites included adnexa/broad ligament (6, 28%), paratubal (5, 24%), ovary/paraovarian (5, 24%), tubal (intraluminal) (2, 9.5%), pelvis (2, 9.5%), and liver (1, 5%). The mean tumor size was 9.3 cm (range: 0.2 to 22 cm). The histomorphology in most cases (14/21, 66%) consisted of tubular to solid sheets of neoplastic cells lined by columnar to cuboidal cells containing uniform round to oval nuclei. Compressed tubules with slit-like lumens and sieve-like pattern were also seen in at least 7 (33%) cases. Three cases demonstrated interanastomosing cords and trabeculae of epithelioid cells with cribriform and microacinar patterns growing within prominent myxoid stroma as described in STK11 adnexal tumors. In the cases with available IHC for 3 mesothelial markers (calretinin, WT1, D2-40), 55.5% (5 of 9) showed reactivity with all 3 markers. In cases with at least 2 available mesothelial markers, 69% (11/16) were positive for 2 markers (mostly calretinin and WT1). Claudin-4, MOC31, and BER-EP4 were negative in most cases tested (78% [7/9], 71.4% [5/7], and 100% [6/6], respectively). Given the resemblance to mesothelioma, there was initial strong consideration and/or actual misdiagnosis of mesothelioma in 3 cases (14%). In summary, the morphologic and immunohistochemical features of Wolffian tumor and its recently defined relative, STK11 adnexal tumor, can lead to misdiagnosis of mesothelioma, particularly when encountered in the disseminated or metastatic setting. Wolffian tumor and STK11 adnexal tumor should be considered in the differential diagnosis of all pelvic and peritoneal mesotheliomas.
Characteristics, Treatment, and Prognosis of Pediatric Symphyseal/Parasymphyseal–Condylar Fractures
Authors: Zhu Yanfei , Du Changxin , Tang Yanmei , Wu Yanqi , Zhang Bojun , Zhang Shilei , Zhu Min
Published: June 2024

Background:

Pediatric condylar fractures combined with symphyseal or parasymphyseal fractures are common but challenging to manage. The authors present fracture characteristics, propose a treatment algorithm, and evaluate the treatment prognosis of pediatric symphyseal/parasymphyseal–condylar fractures.

Methods:

A retrospective review was conducted on pediatric patients who underwent treatment for symphyseal/parasymphyseal–condylar fractures in a trauma center between January of 2006 and January of 2021. Demographic and fracture characteristics were recorded. Complications and functional evaluations, including maximum interincisal opening, Helkimo anamnestic index, and clinical dysfunction index, were assessed after at least 1 year of follow-up.

Results:

After screening, 104 participants met the inclusion criteria. Among them, 50.96% received open reduction and internal fixation for symphyseal/parasymphyseal fractures and closed treatment for condylar fractures, 45.19% were treated by liquid diet and functional exercise, and the remaining 3.85% with severe malocclusion were treated with the assistance of orthodontic appliances. During follow-up, the average maximum interincisal opening of the patients increased from 17 ± 6.29 mm to 41.64 ± 6.33 mm. No subjective symptoms were observed in 86.54% of the patients and 79.81% showed no or mild clinical symptoms. Except for 1 patient who developed temporomandibular joint ankylosis, no other severe complication was reported. Postfracture remodeling of the nonfractured condyle was noted in 3 cases.

Conclusions:

Pediatric symphyseal/parasymphyseal–condylar fractures present unique biomechanical and anatomic challenges that require special consideration during management. In this study, satisfactory functional prognosis was achieved following implementation of the treatment algorithm.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Beyond the Signature: Informed Consent from a Legal Perspective and Its Implications for Plastic Surgery
Authors: Shaheen Mohammed S. , Lane Megan , Chung Kevin C.
Published: June 2024

Informed consent is the principal tool that bridges the gap between clinical practice and our society’s ethical ideals. The intricacies of informed consent, however, are frequently misunderstood, and its effective implementation can be challenging in practice. The continuous stream of innovations, wide array of procedures, and other characteristics inherent to the practice of plastic surgery compound the challenges of implementing informed consent. Unfortunately, there remains a dearth of literature to provide a comprehensive overview of informed consent as it relates to plastic surgery. In this article, the authors highlight the history, legal components, and challenges of informed consent within plastic surgery and offer recommendations on how to approach them. A deeper understanding of informed consent helps enhance patient care, mitigates unnecessary malpractice risk, and leads to better physician-patient relationships.
Predicting Outcome of Patients With Cerebral Hemorrhage Using a Computed Tomography–Based Interpretable Radiomics Model: A Multicenter Study
Authors: Yang Yun-Feng , Zhang Hao , Song Xue-Lin , Yang Chao , Hu Hai-Jian , Fang Tian-Shu , Zhang Zi-Hao , Zhu Xia , Yang Yuan-Yuan
Published: June 2024

Objective

The aim of this study was to develop and validate an interpretable and highly generalizable multimodal radiomics model for predicting the prognosis of patients with cerebral hemorrhage.

Methods

This retrospective study involved 237 patients with cerebral hemorrhage from 3 medical centers, of which a training cohort of 186 patients (medical center 1) was selected and 51 patients from medical center 2 and medical center 3 were used as an external testing cohort. A total of 1762 radiomics features were extracted from nonenhanced computed tomography using Pyradiomics, and the relevant macroscopic imaging features and clinical factors were evaluated by 2 experienced radiologists. A radiomics model was established based on radiomics features using the random forest algorithm, and a radiomics-clinical model was further trained by combining radiomics features, clinical factors, and macroscopic imaging features. The performance of the models was evaluated using area under the curve (AUC), sensitivity, specificity, and calibration curves. Additionally, a novel SHAP (SHAPley Additive exPlanations) method was used to provide quantitative interpretability analysis for the optimal model.

Results

The radiomics-clinical model demonstrated superior predictive performance overall, with an AUC of 0.88 (95% confidence interval, 0.76–0.95; P < 0.01). Compared with the radiomics model (AUC, 0.85; 95% confidence interval, 0.72–0.94; P < 0.01), there was a 0.03 improvement in AUC. Furthermore, SHAP analysis revealed that the fusion features, rad score and clinical rad score, made significant contributions to the model's decision-making process.

Conclusion

Both proposed prognostic models for cerebral hemorrhage demonstrated high predictive levels, and the addition of macroscopic imaging features effectively improved the prognostic ability of the radiomics-clinical model. The radiomics-clinical model provides a higher level of predictive performance and model decision-making basis for the risk prognosis of cerebral hemorrhage.
Can Machine Learning Models Based on Computed Tomography Radiomics and Clinical Characteristics Provide Diagnostic Value for Epstein-Barr Virus–Associated Gastric Cancer?
Authors: Zong Ruilong , Ma Xijuan , Shi Yibing , Geng Li
Published: June 2024

Objective

The aim of this study was to explore whether machine learning model based on computed tomography (CT) radiomics and clinical characteristics can differentiate Epstein-Barr virus–associated gastric cancer (EBVaGC) from non-EBVaGC.

Methods

Contrast-enhanced CT images were collected from 158 patients with GC (46 EBV-positive, 112 EBV-negative) between April 2018 and February 2023. Radiomics features were extracted from the volumes of interest. A radiomics signature was built based on radiomics features by the least absolute shrinkage and selection operator logistic regression algorithm. Multivariate analyses were used to identify significant clinicoradiological variables. We developed 6 ML models for EBVaGC, including logistic regression, Extreme Gradient Boosting, random forest (RF), support vector machine, Gaussian Naive Bayes, and K-nearest neighbor algorithm. The area under the receiver operating characteristic curve (AUC), the area under the precision-recall curves (AP), calibration plots, and decision curve analysis were applied to assess the effectiveness of each model.

Results

Six ML models achieved AUC of 0.706–0.854 and AP of 0.480–0.793 for predicting EBV status in GC. With an AUC of 0.854 and an AP of 0.793, the RF model performed the best. The forest plot of the AUC score revealed that the RF model had the most stable performance, with a standard deviation of 0.003 for AUC score. RF also performed well in the testing dataset, with an AUC of 0.832 (95% confidence interval: 0.679–0.951), accuracy of 0.833, sensitivity of 0.857, and specificity of 0.824, respectively.

Conclusions

The RF model based on clinical variables and Rad_score can serve as a noninvasive tool to evaluate the EBV status of gastric cancer.
GDF11 OVEREXPRESSION ALLEVIATES SEPSIS-INDUCED LUNG MICROVASCULAR ENDOTHELIAL BARRIER DAMAGE BY ACTIVATING SIRT1/NOX4 SIGNALING TO INHIBIT FERROPTOSIS
Authors: Wu Zhixiang , Xi Qiong , Zhao Qin , Zhu Shan
Published: June 2024

Sepsis is a lethal clinical syndrome, and acute lung injury (ALI) is the earliest and most serious complication. We aimed to explore the role of growth differentiation factor 11 (GDF11) in sepsis-induced dysfunction of lung microvascular endothelial barrier in vivo and in vitro to elucidate its potential mechanism related to sirtuin 1 (SIRT1)/NADPH oxidase 4 (NOX4) signaling. Cecal ligation and puncture (CLP)-induced sepsis mice and lipopolysaccharide (LPS)-induced pulmonary microvascular endothelial cells (PMECs) were used in this study. Histopathological changes in lung tissues were tested by hematoxylin-eosin staining. Lung wet-to-dry weight ratio and inflammatory factors contents in bronchoalveolar lavage fluid were assessed. Evens blue index, trans-epithelial electrical resistance, and expression of zona occludens 1 (ZO-1), occludin-1, and claudin-1 were used to evaluate alveolar barrier integrity. Reactive oxygen species, lipid peroxidation, and ferroptosis markers were analyzed. Iron deposition in the lung tissues was assessed using Prussian blue staining. Intracellular Fe2+ level was detected using FerroOrange staining. Additionally, expression of GDF11, SIRT1, and NOX4 was estimated with western blot. Then, EX527, a SIRT1 inhibitor, was employed to treat GDF11-overexpressed PMECs with LPS stimulation to clarify the regulatory mechanism. Results showed that GDF11 overexpression attenuated sepsis-induced pathological changes and inflammation and maintained alveolar barrier integrity. Moreover, GDF11 overexpression inhibited ferroptosis, upregulated SIRT1 expression and downregulated NOX4 expression. Additionally, EX527 treatment relieved the impacts of GDF11 overexpression on ferroptosis and destruction of integrity of human pulmonary microvascular endothelial cells exposed to LPS. Taken together, GDF11 overexpression could alleviate sepsis-induced lung microvascular endothelial barrier damage by activating SIRT1/NOX4 signaling to inhibit ferroptosis. Our findings potentially provide new molecular target for clinical therapy of ALI.
Early Detection of Ventilator-associated Pneumonia From Exhaled Breath in Intensive Care Unit Patients
Authors: Bakali Umer , Killawala Chitvan , Monteagudo Evelise , Cobler-Lichter Michael D. , Tito Luciana , Delamater Jessica , Shagabayeva Larisa , Collie Brianna L. , Lyons Nicole B. , Dikici Emre , Deo Sapna K. , Daunert Sylvia , Schulman Carl I.
Published: June 2024

Objective:

Evaluate associations between volatile organic compounds (VOCs) in heat and moisture exchange (HME) filters and the presence of ventilator-associated pneumonia (VAP).

Background:

Clinical diagnostic criteria for VAP have poor interobserver reliability, and cultures are slow to result. Exhaled breath contains VOCs related to gram-negative bacterial proliferation, the most identified organisms in VAP. We hypothesized that exhaled VOCs on HME filters can predict nascent VAP in mechanically ventilated intensive care unit patients.

Methods:

Gas chromatography-mass spectrometry was used to analyze 111 HME filters from 12 intubated patients who developed VAP. Identities and relative amounts of VOCs were associated with dates of clinical suspicion and culture confirmation of VAP. Matched pairs t tests were performed to compare VOC abundances in HME filters collected within 3 days pre and postclinical suspicion of VAP (pneumonia days), versus outside of these days (non-pneumonia days). A receiver operating characteristic curve was generated to determine the diagnostic potential of VOCs.

Results:

Carbon disulfide, associated with the proliferation of certain gram-negative bacteria, was found in samples collected during pneumonia days for 11 of 12 patients. Carbon disulfide levels were significantly greater (P = 0.0163) for filters on pneumonia days. The Area Under the Curve of the Reciever Operating Characteristic curve (AUC ROC) for carbon disulfide was 0.649 (95% CI: 0.419–0.88).

Conclusions:

Carbon disulfide associated with gram-negative VAP can be identified on HME filters up to 3 days before the initial clinical suspicion, and approximately a week before culture confirmation. This suggests VOC sensors may have potential as an adjunctive method for early detection of VAP.
Toward a Standardization of Learning Curve Assessment in Minimally Invasive Liver Surgery
Authors: Kuemmerli Christoph , Toti Johannes M.A. , Haak Fabian , Billeter Adrian T. , Nickel Felix , Guidetti Cristiano , Santibanes Martin , Vigano Luca , Lavanchy Joël L. , Kollmar Otto , Seehofer Daniel , Abu Hilal Mohammed , Di Benedetto Fabrizio , Clavien Pierre-Alain , Dutkowski Philipp , Müller Beat P. , Müller Philip C.
Published: June 2024

Objective:

The aim was to analyze the learning curves of minimal invasive liver surgery (MILS) and propose standardized reporting.

Background:

MILS offers benefits compared with open resections. For a safe introduction along the learning curve, formal training is recommended. However, definitions of learning curves and methods to assess it lack standardization.

Methods:

A systematic review of PubMed, Web of Science, and CENTRAL databases identified studies on learning curves in MILS. The primary outcome was the number needed to overcome the learning curve. Secondary outcomes included endpoints defining learning curves and characterization of different learning phases (competency, proficiency, and mastery).

Results:

Sixty articles with 12,241 patients and 102 learning curve analyses were included. The laparoscopic and robotic approach was evaluated in 71 and 18 analyses and both approaches combined in 13 analyses. Sixty-one analyses (60%) based the learning curve on statistical calculations. The most often used parameters to define learning curves were operative time (n=64), blood loss (n=54), conversion (n=42), and postoperative complications (n=38). Overall competency, proficiency, and mastery were reached after 34 [interquartile range (IQR) 19–56], 50 (IQR 24–74), and 58 (IQR 24–100) procedures, respectively. Intraoperative parameters improved earlier (operative time: competency to proficiency to mastery: −13%, 2%; blood loss: competency to proficiency to mastery: –33%, 0%; conversion rate (competency to proficiency to mastery; −21%, −29%), whereas postoperative complications improved later (competency to proficiency to mastery: −25%, −41%).

Conclusions:

This review summarizes the highest evidence on learning curves in MILS taking into account different definitions and confounding factors. A standardized 3-phase reporting of learning phases (competency, proficiency, and mastery) is proposed and should be followed.
Association of Daily Step Count and Postoperative Complication among All of Us Research Participants
Authors: Gehl Carson J , Verhagen Nathaniel B , Shaik Tahseen J , Nimmer Kaitlyn , Yang Xin , Xing Yun , Taylor Bradley W , Nataliansyah Mochamad M , Kerns Sarah L , Kothari Anai N
Published: June 2024

BACKGROUND:

The association between preoperative wearable device step counts and surgical outcomes has not been examined using commercial devices linked to electronic health records (EHRs). This study measured the association between daily preoperative step counts and postoperative complications.

STUDY DESIGN:

Data were obtained using the All of Us (AOU) Research program, a nationwide initiative to collect EHR and health-related data from the population. Patients who underwent a surgical procedure included in the NSQIP-targeted procedures dataset were included. Patients who did not have available physical activity FitBit data were excluded. Primary outcome was the development of a postoperative complication. All analyses were performed in the AOU researcher workbench.

RESULTS:

Of 27,150 patients who underwent a surgical procedure, 475 participants with preoperative wearable data were included: 74.7% were female and 85.2% were White. The average age was 57.2 years. The overall rate of postoperative complications was 12.6%. Patients averaging less than 7,500 daily steps were at increased odds for developing a postoperative complication (odds ratio 1.83, 95% CI 1.01 to 3.31). After adjustment for age, sex, race, comorbid disease, BMI, and relative procedure risk, patients with a baseline average steps per day less than 7,500 were at increased odds for postoperative complication (adjusted odds ratio 2.06, 95% CI 1.05 to 4.06).

CONCLUSIONS:

This study found an increase in overall postoperative complication rate in patients recording lower average preoperative step counts. Patients with a baseline of less than 7,500 steps per day had increased odds of postoperative complications in this cohort. These data support the use of wearable devices for surgical risk stratification and suggest step count may measure preoperative fitness.