bluuebunny/crossref_metadata_2025 huggingface dataset:
Comprehensive toxicological screening of common drugs of abuse, new psychoactive substances and cannabinoids in blood using supported liquid extraction and liquid chromatography–quadrupole time-of-flight mass spectrometry
Authors: Ayala Jessica , Kerrigan Sarah
Published: September 2023

Immunoassay (IA) is currently the most widely used technique for toxicological screening in drug-impaired driving investigations. However, practical limitations in the scope of testing, and the emergence of new psychoactive substances (NPSs), have highlighted the need for alternative approaches, particularly mass spectrometry-based screening. High-resolution mass spectrometry broadens the scope of testing to include NPSs and increases analyte specificity compared to IA. In addition, it provides a platform with increased flexibility and adaptability to incorporate emerging drugs of interest due to the transient drug market. In this study, a comprehensive screening procedure was developed to identify >200 drugs of interest, including cannabinoids and NPSs in whole blood. Supported liquid extraction and liquid chromatography–quadrupole time-of-flight mass spectrometry using All Ions data acquisition were used. The method was validated in accordance with published recommendations, and all compounds of interest were identified at recommended cutoffs for driving under the influence of drug investigations. Cannabinoids, including 11-nor-9-carboxy-∆9-tetrahydrocannabinol, fentanyl analogs, buprenorphine, novel synthetic opioids and synthetic cannabinoids, were identified at low- to sub-nanogram/milliliter concentrations in whole blood using both positive and negative electrospray ionization acquisition methods.
The Association Between Increased Maladaptive Health Behaviours and Elevated Mental Health Symptoms Among Persons with IBD During the COVID-19 Pandemic
Authors: Dolovich Casandra L , Shaffer Seth R , Graff Lesley A , Singh Harminder , El-Gabalawy Renée , Shaw Souradet , Bernstein Charles N
Published: September 2023

Aim

To assess the association between maladaptive health behaviours and elevated mental health (MH) symptoms during the COVID-19 pandemic among persons with inflammatory bowel disease (IBD).

Methods

Participants of the population-based University of Manitoba IBD Research Registry (n = 2,942) were invited to participate in a survey in November 2020, regarding their experiences during the COVID-19 pandemic. Maladaptive health behaviours included increased use of alcohol, marijuana, and cigarettes, and reduced exercise relative to pre-pandemic levels. Clinically significant MH symptoms were defined by the presence of elevated anxiety, depression, and/or post-traumatic stress. Adjusted logistic regression assessed the odds of elevated MH symptoms predicted by maladaptive health behaviours, stratified by gender.

Results

Of 1,363 (46%) respondents, 319 (23%) had elevated MH symptoms. Those with elevated MH symptoms were older (mean age 54) and predominantly females (70%). The odds of any elevated MH symptoms were approximately two to four times greater among those who experienced maladaptive health behaviours during the pandemic including: increased alcohol use [aOR 2.14, 95% CI (1.50–3.05)], males who increased marijuana use [aOR 4.18, 95% CI (1.18–14.74)], females who increased smoking cigarettes [aOR 3.68 95% CI (1.15–11.86)] and any maladaptive health behaviour [aOR 1.93 95% CI (1.44–2.60)].

Conclusion

During the COVID-19 pandemic, persons with IBD who experienced any maladaptive health behaviour was associated with double the likelihood of experiencing clinically significant MH symptoms. For persons with elevated MH symptoms, it is important for health care providers to recognize the association of increased maladaptive behaviours. Alternatively, if it is determined that MH symptoms predated maladaptive health behaviours then, inquiries into MH and providing appropriate referrals should be pursued.
Institutional work: how lenders transform land titles into collateral in urban Tanzania
Authors: Manara Martina , Pani Erica
Published: September 2023

We examine the ‘institutional configuration’ that makes land titles work as collateral in Tanzania’s nascent credit market, through the ‘institutional work’ of local lenders. This work is effective and precarious: while lenders seek out and create institutional complementarities across diverse domains, they also require higher-level regulation to help stabilise land titles’ fungibility as collateral. Our results contribute to knowledge on path-dependency, contingency and uneven trajectories in the property-credit nexus development, and advance understandings of institutional interdependencies and coevolution in the situated economy. By combining deep contextualisation and institutional analysis, we progress an empirical engagement with institutional research in economic geography.
Transmission electron microscopy study on the phase transformation of metastable precipitates to stable phases
Authors: Trang T T T , Heo Yoon-Uk
Published: September 2023

Nanosized precipitates play a critical role in increasing the strength of metallic alloys. There are many reports that the initial precipitates are metastable phases holding a different composition and crystal structure from the equilibrium precipitate. The metastable precipitate transforms to its stable phase during heat treatment. A transmission electron microscope enables researchers to study the phase transition of metastable precipitates to stable phases due to its fine resolution in identifying crystal structures and chemical compositions. This review introduces the various phase transformation mechanisms of metastable precipitates to stable phases obtained from the analysis using a transmission electron microscope. The role of dislocation movement in the phase transition is further discussed.
A fast asynchronous Markov chain Monte Carlo sampler for sparse Bayesian inference
Authors: Atchadé Yves , Wang Liwei
Published: September 2023

We propose a very fast approximate Markov chain Monte Carlo sampling framework that is applicable to a large class of sparse Bayesian inference problems. The computational cost per iteration in several regression models is of order O(n(s+J)), where n is the sample size, s is the underlying sparsity of the model, and J is the size of a randomly selected subset of regressors. This cost can be further reduced by data sub-sampling when stochastic gradient Langevin dynamics are employed. The algorithm is an extension of the asynchronous Gibbs sampler of Johnson et al. [(2013). Analyzing Hogwild parallel Gaussian Gibbs sampling. In Proceedings of the 26th International Conference on Neural Information Processing Systems (NIPS’13) (Vol. 2, pp. 2715–2723)], but can be viewed from a statistical perspective as a form of Bayesian iterated sure independent screening [Fan, J., Samworth, R., & Wu, Y. (2009). Ultrahigh dimensional feature selection: Beyond the linear model. Journal of Machine Learning Research, 10, 2013–2038]. We show that in high-dimensional linear regression problems, the Markov chain generated by the proposed algorithm admits an invariant distribution that recovers correctly the main signal with high probability under some statistical assumptions. Furthermore, we show that its mixing time is at most linear in the number of regressors. We illustrate the algorithm with several models.
Femaleness for improving grain yield potential and hybrid production in barley
Authors: Huang Yongyu , Schnurbusch Thorsten
Published: September 2023

This article comments on:

Selva C, Yang X, Shirley NJ, Whitford R, Baumann U, Tucker MR. 2023. HvSL1 and HvMADS16 promote stamen identity to restrict multiple ovary formation in barley. Journal of Experimental Botany 74, 5039–5057.
Establishment of the Clinician-Scientist Investigator Opportunity Network to Develop Military Medical Research Leaders
Authors: Maddry Joseph K , Mallory Amber , Araña Allyson A , Morris Michael J , Clemons Melissa Ann R , Burdette Alexander J , True Mark W , Niemeyer Debra , Weitzel Erik K
Published: September 2023

Introduction

The ability of military clinicians to conduct military medical research is often limited because of competing priorities and a lack of research mentorship. The Clinician-Scientist Investigator Opportunity Network (CSION) was developed with the intent of training clinicians how to engage in requirements-driven research within the DoD.

Materials and Methods

Three to five academic medical faculties were selected from a pool of applicants each year to participate in a 2-year research fellowship. To be eligible for the CSION program, applicants had to meet the following criteria: (1) Completed residency graduate medical education training, (2) not be currently enrolled as a graduate medical education trainee, and (3) obtained permission from their department leadership to focus 25% of their duty hours on CSION participation to include didactic and research efforts. The remaining 75% of fellows’ time was dedicated to clinical duties. Monthly didactics, intensive mentorship, and consistent support were offered to each fellow by the CSION leadership team. Metrics were recorded to include both research and clinical productivity.

Results

Between January 2019 and December 2022, 12 CSION fellows graduated from the program (four in the class of 2020, three in 2021, and five in 2022). From 2019 to 2021, the 12 CSION fellows initiated 204 research protocols, generated 489 publications/presentations, and secured 33 research grants. All graduates of the program remain active in clinical research with multiple graduates currently assigned to research positions.

Conclusions

The CSION research education program is a 2-year additional duty research fellowship producing clinician-scientists conducting military-relevant medical research and publications and may be considered a low-cost/highly efficient alternative to achieve the reported benefits of the MD–PhD tract. The expansion of the CSION program may improve the quality of military medical research and health care.
Polarized microwave emission from space particles in the upper atmosphere of the Earth
Authors: López-Viejobueno Jennifer , Beitia-Antero Leire , Gómez de Castro Ana I
Published: September 2023

Tons of space particles enter the Earth atmosphere every year, being detected when they produce fireballs, meteor showers, or when they impact the Earth surface. Particle detection in the showers could also be attempted from space using satellites in low Earth orbit. Measuring the polarization would provide extra crucial information on the dominant alignment mechanisms and the properties of the meteor families. In this article, we evaluate the expected signal to aid in the design of space probes for this purpose. We have used the radmc-3d code to simulate the polarized microwave emission of aligned dust particles with different compositions: silicates, carbonates, and irons. We have assumed a constant spatial particle density distribution of 0.22 cm−3, based on particle density measurements carried during meteor showers. Four different grain size distributions with power indices ranging from −3.5 to −2.0 and dust particles with radius ranging from 0.01 $\mathrm{\mu }$m to 1 cm have been considered for the simulations. Silicates and carbonates align their minor axis with the direction of the solar radiation field; during the flight time into the Earth atmosphere, iron grains get oriented with the Earth’s magnetic field depending on their size. Alignment direction is reflected in the Q-Stokes parameter and in the polarization variation along the orbit. Polarization depends on the composition and on the size distribution of the particles. The simulations show that some specific particle populations might be detectable even with a small probe equipped with high-sensitivity, photon-counting microwave detectors operating in low Earth orbit.
Determination of dynamical ages of open clusters through the A+ parameter – II
Authors: Rao Khushboo K , Vaidya Kaushar , Agarwal Manan , Balan Shanmugha , Bhattacharya Souradeep
Published: September 2023

Blue straggler stars (BSS), one of the most massive members of star clusters, have been used for over a decade to investigate mass segregation and estimate the dynamical ages of globular clusters (GCs) and open clusters (OCs). This work is an extension of our previous study, in which we investigated a correlation between theoretically estimated dynamical ages and the observed $A^+_{\mathrm{rh}}$ values, which represent the sedimentation level of BSS with respect to the reference population. Here, we use the ML-MOC algorithm on Gaia EDR3 data to extend this analysis to 23 OCs. Using cluster properties and identified members, we estimate their dynamical and physical parameters. In order to estimate the $A^+_{\mathrm{rh}}$ values, we use the main sequence and main sequence turnoff stars as the reference population. OCs are observed to exhibit a wide range of degrees of dynamical evolution, ranging from dynamically young to late stages of intermediate dynamical age. Hence, we classify OCs into three distinct dynamical stages based on their relationship to $A^+_{\mathrm{rh}}$ and Nrelax. NGC 2682 and King 2 are discovered to be the most evolved OCs, like Family III GCs, while Berkeley 18 is the least evolved OC. Melotte 66 and Berkeley 31 are peculiar OCs because none of their dynamical and physical parameters correlate with their BSS segregation levels.
Asteroseismological analysis of the polluted ZZ Ceti star G 29 − 38 with TESS
Authors: Uzundag Murat , De Gerónimo Francisco C , Córsico Alejandro H , Silvotti Roberto , Bradley Paul A , Montgomery Michael H , Catelan Márcio , Toloza Odette , Bell Keaton J , Kepler S O , Althaus Leandro G , Kleinman Scot J , Kilic Mukremin , Mullally Susan E , Gänsicke Boris T , Bąkowska Karolina , Barber Sam , Nitta Atsuko
Published: September 2023

G 29 − 38 (TIC 422526868) is one of the brightest (V = 13.1) and closest (d = 17.51 pc) pulsating white dwarfs with a hydrogen-rich atmosphere (DAV/ZZ Ceti class). It was observed by the TESS spacecraft in sectors 42 and 56. The atmosphere of G 29 − 38 is polluted by heavy elements that are expected to sink out of visible layers on short time-scales. The photometric TESS data set spans ∼51 d in total, and from this, we identified 56 significant pulsation frequencies, that include rotational frequency multiplets. In addition, we identified 30 combination frequencies in each sector. The oscillation frequencies that we found are associated with g-mode pulsations, with periods spanning from ∼ 260 to ∼ 1400 s. We identified rotational frequency triplets with a mean separation δνℓ = 1 of 4.67 μHz and a quintuplet with a mean separation δνℓ = 2 of 6.67 μHz, from which we estimated a rotation period of about 1.35 ± 0.1 d. We determined a constant period spacing of 41.20 s for ℓ = 1 modes and 22.58 s for ℓ = 2 modes. We performed period-to-period fit analyses and found an asteroseismological model with M⋆/M⊙ = 0.632 ± 0.03, $T_{\rm eff}=11\, 635\pm 178$ K, and log g = 8.048 ± 0.005 (with a hydrogen envelope mass of MH ∼ 5.6 × 10−5M⋆), in good agreement with the values derived from spectroscopy. We obtained an asteroseismic distance of 17.54 pc, which is in excellent agreement with that provided by Gaia (17.51 pc).
Nitrogen addition delays the emergence of an aridity-induced threshold for plant biomass
Authors: Li Hailing , Terrer César , Berdugo Miguel , Maestre Fernando T , Zhu Zaichun , Peñuelas Josep , Yu Kailiang , Luo Lin , Gong Jie-Yu , Ye Jian-Sheng
Published: September 2023

Crossing certain aridity thresholds in global drylands can lead to abrupt decays of ecosystem attributes such as plant productivity, potentially causing land degradation and desertification. It is largely unknown, however, whether these thresholds can be altered by other key global change drivers known to affect the water-use efficiency and productivity of vegetation, such as elevated CO2 and nitrogen (N). Using >5000 empirical measurements of plant biomass, we showed that crossing an aridity (1–precipitation/potential evapotranspiration) threshold of ∼0.50, which marks the transition from dry sub-humid to semi-arid climates, led to abrupt declines in aboveground biomass (AGB) and progressive increases in root:shoot ratios, thus importantly affecting carbon stocks and their distribution. N addition significantly increased AGB and delayed the emergence of its aridity threshold from 0.49 to 0.55 (P < 0.05). By coupling remote sensing estimates of leaf area index with simulations from multiple models, we found that CO2 enrichment did not alter the observed aridity threshold. By 2100, and under the RCP 8.5 scenario, we forecast a 0.3% net increase in the global land area exceeding the aridity threshold detected under a scenario that includes N deposition, in comparison to a 2.9% net increase if the N effect is not considered. Our study thus indicates that N addition could mitigate to a great extent the negative impact of increasing aridity on plant biomass in drylands. These findings are critical for improving forecasts of abrupt vegetation changes in response to ongoing global environmental change.
Plastid Inheritance Revisited: Emerging Role of Organelle DNA Degradation in Angiosperms
Authors: Sakamoto Wataru , Takami Tsuneaki
Published: September 2023

Plastids are essential organelles in angiosperms and show non-Mendelian inheritance due to their evolution as endosymbionts. In approximately 80% of angiosperms, plastids are thought to be inherited from the maternal parent, whereas other species transmit plastids biparentally. Maternal inheritance can be generally explained by the stochastic segregation of maternal plastids after fertilization because the zygote is overwhelmed by the maternal cytoplasm. In contrast, biparental inheritance shows the transmission of organelles from both parents. In some species, maternal inheritance is not absolute and paternal leakage occurs at a very low frequency (∼10−5). A key process controlling the inheritance mode lies in the behavior of plastids during male gametophyte (pollen) development, with accumulating evidence indicating that the plastids themselves or their DNAs are eliminated during pollen maturation or at fertilization. Cytological observations in numerous angiosperm species have revealed several critical steps that mutually influence the degree of plastid transmission quantitatively among different species. This review revisits plastid inheritance from a mechanistic viewpoint. Particularly, we focus on a recent finding demonstrating that both low temperature and plastid DNA degradation mediated by the organelle exonuclease DEFECTIVE IN POLLEN ORGANELLE DNA DEGRADATION1 (DPD1) influence the degree of paternal leakage significantly in tobacco. Given these findings, we also highlight the emerging role of DPD1 in organelle DNA degradation.
Brazil: cross-border marital agreements
Authors: Sanches Humberto , Pacheco Danilovic Adriane
Published: September 2023

This article aims at providing an overview of cross border marriages from a Brazilian law perspective. Topics such as (i) marriages under Brazilian law, (ii) rights of spouses and partners, (iii) scope and enforceability of prenuptial agreements and civil law marriage agreements, (iv) trusts and business interests, (v) family dynamics, (vi) taxes and (vii) take away tips, are addressed from a practical standpoint to navigate readers through this sensitive matter.

Love has no boundaries is an expression shifted to a whole new level in today’s world. Transportation between countries and continents ceased to be a concern a long-time ago, and the Internet and social media are bringing people closer and closer in absolute disregard of their place of residency. Cross-border marriages are one of the natural side effects of this reality. And if happily ever after is not for everyone, cross-border divorces are side effects as well. In this sense, this article examines marriages from a Brazilian law perspective, including topics involving the rights of spouses and partners under Brazilian law and prenuptial agreements and civil law marriage agreements.
Diagnostic accuracy of carboxyhemoglobin saturation with pulse CO-oximetry in patients with carbon monoxide poisoning
Authors: Babacan Arzu
Published: September 2023

Objective

Carboxyhemoglobin saturation (SpCO)with pulse CO-oximetry is an alternative method in CO poisoning; however, the correlation of it with blood carboxyhemoglobin level (COHb) is still debated.The study aimed to evaluate the correlation between SpCO and venous COHb level and factors associated with the diagnostic accuracy of SpCO.

Material and methods

SpCO and venous COHb levels of patients with CO poisoning, according to a COHb level was 3%, were evaluated. The sensitivity, specificity, 95% CI (confidence interval), and the cut-off value of SpCO were calculated using ROC analysis at a 10% threshold for COHb. Agreement levels were calculated with Bland-Altman analysis. Risk factors affecting diagnostic accuracy were analyzed using logistic regression analysis.

Results

If the 10% threshold of COHb was accepted as the diagnostic threshold for CO poisoning, the sensitivity and specificity of SpCO were 98.4% and 100% (95% CI: 0.996-1.000) at the 6.85 cut-off point of SpCO. The scatter plot of COHb and SpCO showed a strong positive relationship at values of presentation and discharge (r = .979, p<0.001; r = .969, p<0.001). With a bias of 3.1% for the mean difference between-COHb and SpCO, the limits of agreement from Bland- Altman analysis were −0.7 to 7.1. For the 10% threshold, age and male gender have significantly increased false negativity rates (B = .074, p = 0.010, and B = 0.252, p = 0.011, respectively).

Conclusion

SpCO is a reliable method with high sensitivity and specificity; therefore, a lower cut-off points of SpCO compared to COHb level may be accepted to diagnose and follow-up CO poisoning.
Occupational Lead Exposure Ototoxicity Evaluated With Distortion-Product Otoacoustic Emissions
Authors: Solis-Angeles Soledad , Del Razo Luz María , Aguilar-Madrid Guadalupe , Jiménez-Ramírez Carmina , Coco Laura , Cabello-López Alejandro , Juárez-Pérez Cuauhtémoc Arturo
Published: September 2023

Objectives:

To evaluate the extent of hearing loss among pottery workers in Mexico exposed to lead.

Design:

The authors conducted a cross-sectional study including 315 adult pottery workers. Auditory function was evaluated by air conduction pure-tone audiometry (pure-tone average) and distortion-product otoacoustic emission (DPOAE) levels (amplitude and signal-to-noise ratio). Lead exposure was assessed with a single blood sample test and classified as low, medium, and high according to blood lead tertiles. Logistic regression models were calculated for the association between blood lead levels, pure-tone average, and DPOAE records.

Results:

Median (25th–75th) blood lead levels were 14 μg/dL (7.5–22.6 μg/dL). The audiometric pattern and DPOAE records were similar across blood lead levels groups in all frequencies, and no statistically significant differences were found. Adjusted logistic regression models showed no increase in the odds for hearing thresholds >25 dB (HL) and DPOAE absence associated with blood lead levels, and no dose-response pattern was observed (p > 0.05).

Conclusions:

Given the results from this cross-sectional study, no association was found between blood lead levels and hearing loss assessed with DPOAE. Future longitudinal work should consider chronic lead exposure estimates among underrepresented populations, which can potentially inform safer work practices to minimize the risk of ototoxicity.
Management of Pediatric and Adolescent Sublime Tubercle Injuries: Isolated and Complex Patterns Demonstrate Distinct Etiologies and Radiographic Outcomes
Authors: Mitchell Brendon C. , Fogleman Sarah A. , Carroll Alyssa N. , Leek Bryan T. , Edmonds Eric W. , Fronek Jan , Pennock Andrew T.
Published: September 2023

Background:

The aim of this study was to assess the patient demographics, epidemiology, mechanism of injury, and natural history of sublime tubercle avulsion injuries.

Methods:

A multicenter retrospective study was performed in which sublime tubercle avulsion injuries were identified by surgeon records and database query of radiology reports. Demographic data and imaging were reviewed for each case, and injuries were classified as type 1 (isolated injuries with a simple bony avulsion or periosteal stripping) or type 2 (complex injuries with an associated elbow fracture or dislocation). Treatment modality and evidence of radiographic healing at a minimum of 3 months were collected.

Results:

Forty patients (78% male) with a median age of 15 years (range, 8 to 19 years) were identified with sublime tubercle avulsion injuries. Sixty-eight percent of cases (n=27) were determined to be type 1 injuries, and 32% (n=13) were classified as type 2 injuries. The majority of type 1 injuries (59%) occurred via a noncontact mechanism in overhead-throwing athletes, whereas 100% of the type 2 injuries were sustained via a contact mechanism. Type 1 injuries presented in a delayed manner in 19% of cases, whereas no type 2 injuries (0%) were delayed in presentation. Type 1 injuries infrequently underwent surgical intervention (19%), whereas 54% of type 2 injuries required surgery. Of those that did not undergo initial surgical management at a minimum of 3-month radiographic follow-up, 9/11 (82%) of type 1 injuries and 0/4 (0%) of type 2 injuries demonstrated evidence of healing. Only 1 case required reoperation (type 2 injury).

Conclusions:

This series of adolescents with sublime tubercle avulsion injuries expands our understanding of the epidemiology of this rare injury, which was previously only described as a noncontact injury in baseball players. Type 1 injuries are more likely to occur via a noncontact mechanism and generally demonstrate radiographic evidence of healing after a period of rigid immobilization. Conversely, type 2 injuries are more likely to undergo initial surgical intervention, and those managed nonoperatively are less likely to achieve radiographic healing. Further studies are needed to elucidate treatment protocols and long-term functional outcomes.

Level of Evidence:

Level IV—case series.
Reverse Wafer Procedure for Ulnar Impaction Syndrome
Authors: Ozcelik Ismail Bulent , Jusoh Mohd Hanifah , Cavit Ali
Published: September 2023

Ulnar impaction syndrome occurs when excessive load across the ulnocarpal joints results in pathologic changes, especially over the articular surface of the ulnar head and proximal ulnar corner of the lunate. The 2 main surgical options in ulnar impaction syndrome are ulnar shortening osteotomy and wafer procedure, whether open or arthroscopically, to decompress the ulnocarpal joint load. However, all of these techniques have their shortcomings and drawbacks. The current study demonstrates a novel technique to decompress the ulnocarpal joint load: the “reverse wafer procedure” for ulnar impaction syndrome. In this surgical technique, we resected the proximal ulnar side of the lunate instead of partial resection of the thin wafer of the distal ulnar head dome in the standard wafer procedure. This technique avoids iatrogenic central tear of triangular fibrocartilage and distal radioulnar joint portal arthroscopy, which is technically demanding while preserving the distal radioulnar joint.
Chilblain-Like Eruption Unveiling Cutaneous Aleukemic Relapse of Acute Myeloid Leukemia
Authors: Brazão Cláudia , Mancha Dora , Antunes-Duarte Sofia , Kempf Werner , Soares-de-Almeida Luís
Published: September 2023

Leukemia cutis corresponds to skin infiltration by malignant hematopoietic cells. It is most commonly reported in acute myeloid leukemia, particularly in subtypes with a monocytic component. Its clinical manifestations are extremely variable, and histopathologic diagnosis of cutaneous leukemic infiltrates may be challenging. We report the first case of cutaneous, that is, extramedullary, aleukemic relapse of acute myeloid leukemia within an unusual chilblain-like eruption that imposed a challenging clinical and histopathologic diagnosis. Primary chilblains are uncommon in the elderly, and a systemic underlying cause should be thoroughly investigated. In patients presenting with atypical chilblains (ie, persistent chilblains developing even without exposure to cold temperatures and/or refractory to therapy) and with a history of hematologic disorders such as leukemias, histopathologic examination is crucial to identify leukemic or aleukemic phases of relapse of underlying leukemia and initiate timely treatment.
Successful Shoulder Disarticulation under Local Anesthesia in the COVID-19 Era
Authors: Mbabazi Pitman , Mwaniki Mercy , Wambua Gloria , Kagua Samuel , Kamau Rosemary Wangari , Daggett Justin , Nthumba Peter M.
Published: September 2023

The use of the wide-awake local anesthesia no tourniquet, a tumescent local anesthetic technique in recent years, emerged as a powerful tool primarily in hand surgery. It has been adopted in many low- and middle-income countries where it was applied to an increasingly broad group of procedures. We report the case of an older patient with an arm liposarcoma for which surgery under general or regional anesthesia was deemed unsafe, but was successfully managed with a curative right shoulder disarticulation using tumescent local anesthesia.
Postoperative Hematoma-induced Vasospasm after Sarcoma Reconstruction Using a Pedicled Anterolateral Thigh Flap
Authors: Matsuoka Yuki , Karakawa Ryo , Yoshimatsu Hidehiko , Yano Tomoyuki
Published: September 2023

Hematoma-induced vasospasm is a significant factor that can compromise the success of flap reconstructive surgery. Despite advances in microsurgical techniques and knowledge, vasospasm remains a direct cause of flap loss. Hematoma-induced vasospasm occurs due to the presence of blood breakdown products, which can lead to arterial constriction and reduced blood flow to the transplanted tissue. A 77-year-old man with a history of coronary angina developed soft tissue sarcoma on the right groin. Postoperative hematoma-induced vasospasm occurred subsequent to the reconstruction using a pedicled anterolateral thigh flap for the defect after wide resection. The hematoma was evacuated, and blood flow to the flap was restored with topical application of warm saline and vasodilators. Postoperative administration of intravenous alprostadil was used to counteract the vasospasm, and the flap completely survived without any problems with blood flow. It is important to recognize the triggers of vasospasm, such as hematomas, which may occur intra- or postoperatively, and to take appropriate measures to prevent or treat them. Treatment of vasospasm includes the intraoperative topical application of warm saline or vasodilators and the administration of intravenous alprostadil or 4% lidocaine postoperatively. Nevertheless, in the case of hematoma-induced vasospasm, it is important to remove the hematoma.
Synchronous Melanoma: Definition, Prognosis, and Implications. A Comprehensive Review of Literature
Authors: Kang Ajaipal S. , Rajput Rahul , Kang Genelia
Published: September 2023

Background:

Although multiple primary melanomas (MPMs) have been reported in the literature, the subgroup of synchronous melanomas (SMs) remains understudied.

Methods:

We conducted a comprehensive systematic review of the English literature from 1972 to 2023 to characterize SM. Our objective was to clarify the definition, determine incidence and prognosis, and present recommendations.

Results:

We found 18 case series articles and six case reports that met our criteria. Twelve of eighteen studies defined SM as a second primary melanoma identified within 1 month. The total number of SM patients reported was 1083. The cumulative percentage of MPM in total melanoma patients was 2.9 %, and the cumulative percentage of SM patients in MPM patients was 31.3%. SM patients trended toward higher body anatomical concordance, older age, and male sex. Despite limited data, SMs do not show a worse prognosis for patients compared with single melanomas.

Conclusions:

Despite a lack of consensus in the past, we recommend that SM be defined as a second primary melanoma detected within 1 month of the initial diagnosis. SMs comprise almost one-third of MPM cases and do not seem to carry any worse prognosis than the patients presenting with single melanoma. We believe older age and male sex may be more prone to SM. We recommend patient education, self-skin evaluations and TSE at initial and follow-up visits. Neither randomized controlled trials nor meta-analyses on SM exist. Ideally, further studies with a large cohort of patients are needed to accurately define SM.
Additional predictors of the lower limit of cerebral autoregulation during cardiac surgery
Authors: Gavish Benjamin , Gottschalk Allan , Hogue Charles W. , Steppan Jochen
Published: September 2023

Objectives:

The lower limit of autoregulation (LLA) of cerebral blood flow was previously shown to vary directly with the Ambulatory Arterial Stiffness Index (AASI) redefined as 1-regression slope of DBP-versus-SBP readings invasively measured from the radial artery before the bypass. We aimed expanding the predictive capacity of the LLA with AASI by combining it with additional predictors and provide new indications whether mean arterial pressure (MAP) is above/below the LLA.

Design and method:

In 181 patients undergoing cardiac surgery, mean (SD) age 71 (8) years), we identified from the demographic, preoperative and intraoperative characteristics independent and statistically significant ‘single predictors’ of the LLA (including AASI). This was achieved using multivariate linear regression with a backward-elimination technique. The single predictors combined with 1-AASI generated new multiplicative and additive composite predictors of the LLA. Indicators for the MAP-to-LLA difference (DIF) were determined using DIF-versus-predictor plots. The odds ratio (OR) for the DIF sign (Outcome = 1 for DIF≤0) and predictor-minus-median sign (Exposure = 1 for Predictor  ≤ Median) were calculated using logistic regression.

Results:

BMI, 1-AASI and systolic coefficient of variation were identified single predictors that correlated similarly with the LLA (r = −0.26 to −0.27, P < 0.001). The multiplicative and additive composite predictors displayed higher correlation with LLA (r = −0.41 and r = −0.43, respectively, P < 0.001) and improved LLA estimation. The adjusted OR for the composite predictors was nearly twice that of the single predictors.

Conclusion:

The novel composite predictors may enhance the LLA estimation and the ability to maintain MAP in the cerebral autoregulatory range during cardiac surgery.
In Vitro Effect of Propofol on the Expression of Genes Involved in Inflammation and Apoptosis in Corneal Activated Keratocytes
Authors: Sanie-Jahromi Fatemeh , Sanie Jahromi Mohammad Sadegh
Published: September 2023

Purpose:

We investigated the effect of propofol (0.5, 5, and 50 μM) on the gene expression of inflammatory cytokines [IL-1β, IL-6, transforming growth factor β (TGF-β), and LIF] and apoptosis process (BCL-2 and Bax) in corneal activated keratocytes (CAKs).

Methods:

CAKs (106 cells/10 cm2) were exposed to propofol at a concentration of 0.5, 5, and 50 μM for 24 hours at 37°C. The control group did not receive propofol at the same time or under the same condition. Ribonucleic acid (RNA) extraction, complementary DNA (cDNA) synthesis, and real-time polymerase chain reaction (PCR) were performed to quantify the relative expression of IL-1β, IL-6, TGF-β, LIF, BCL-2, and Bax expression in the treated versus control cells.

Result:

The results of this study showed that propofol treatment (0.5 and 5 μM) led to the downregulation of IL-1β and IL-6 gene expression in CAKs. TGF-β (with a role in fibrogenesis) was not changed in 0.5 and 5 μM propofol-treated CAKs, whereas CAKs treated with 50 μM propofol showed upregulation of the TGF-β gene. LIF (with a role in regeneration) was upregulated in 0.5 and 5 μM propofol-treated CAKs. The BCL-2/Bax ratio (as the antiapoptosis index) was increased in CAKs treated with 0.5 μM propofol and indicated the induction of an antiapoptotic effect.

Conclusions:

We showed that CAKs treatment with propofol, at concentrations of 0.5 and 5 μM, could decrease the expression of genes related to inflammation and enhance the genes associated with cell regeneration. While 50 μM propofol treatment might induce CAK fibrogenesis. This proof-of-concept study could preserve a groundwork for future drug design for the treatment of corneal stromal diseases and ocular regenerative medicine.
Reimagining the Past: A Future for Antibiotic Drug Discovery in Ophthalmology
Authors: Chen Eric R. , Wozniak Rachel A. F.
Published: September 2023

Antibiotic resistance has emerged as a critical threat for the treatment of bacterial ocular infections. To address the critical need for novel therapeutics, antibiotic drug repurposing holds significant promise. As such, examples of existing FDA-approved drugs currently under development for new applications, novel combinations, and improved delivery systems are discussed.
Inequities in the Training Environment and Health of Female Golfers Participating in the 2022 International Golf Federation World Amateur Team Championships
Authors: Mountjoy Margo , Schamasch Patrick , Murray Andrew , Hawkes Roger , Hospel Tomas , Thomas Bruce , Samson Ethan , Junge Astrid
Published: September 2023

Objective:

To assess health problems and training environment of female golfers participating in the 2022 World Amateur Team Championships (WATC) and to compare golfers (a) with and without health problems prior the WATC and (b) living and training in countries ranking in the upper versus lower 50% of the team results at the 2022 WATC.

Design:

Cross-sectional cohort study using an anonymous questionnaire.

Setting:

International Golf Federation WATC.

Participants:

One hundred sixty-two female golfers from 56 countries.

Interventions:

N/A.

Main Outcome Measures:

Golfers’ answers on the presence and characteristics of health problems, their training environment, and to the Oslo Sport Trauma Research Centre Questionnaire.

Results:

Almost all golfers (n = 162; 96%) answered the questionnaire. In the 4 weeks before the WATC, 101 golfers (63.1%) experienced 186 musculoskeletal complaints, mainly at the lumbar spine/lower back, wrist, or shoulder. Just half of the golfers (50.6%) performed injury prevention exercises always or often. More than a third (37.4%) of the golfers reported illness complaints and 32.5% mental health problems in the 4 weeks preceding the WATC. General anxiety, performance anxiety, and low mood/depression were the most frequent mental health problems. Golfers with injury complaints rated their daily training environment poorer. Golfers ranking in the lower 50% at the WATC had significantly less support staff, rated their training environment poorer, and had a higher prevalence of illness complaints and mental health problems.

Conclusions:

Effective illness and injury prevention programs should be implemented and better access to education and health support in the daily training environment provided.
Impact of Trauma-Informed Care Training on Attitudes Among Emergency Department Personnel, Staff Advocates, and Nursing Students
Authors: Wholeben Melissa , Castro Yessenia , Salazar Gloria , Field Craig
Published: September 2023

BACKGROUND:

Health care providers may risk retraumatizing patients and intensifying patient distress unless they practice trauma-informed care. As the first line of defense in assisting trauma survivors' physical and emotional recovery, health care providers must use a strengths-based framework that promotes resilience and expands on the trauma survivor's existing resources.

OBJECTIVE:

This study aimed to compare the effect of trauma-informed care training on the attitudes of emergency department personnel, staff advocates, and nursing students toward trauma-informed care.

METHODS:

This study used a pretest–posttest design. Assessment of attitudes toward trauma-informed care was done before and after trauma-informed care training. Data collection occurred from February 2021 through August 2021. Participants included three cohorts of emergency department staff, advocates for trauma survivors, and nursing students. Attitudes toward trauma-informed care were measured using the Attitudes Related to Trauma-Informed Care (ARTIC) Scale.

RESULTS:

A total of 433 participants were studied, including 88 emergency department staff, 123 staff advocates, and 222 nursing students. All three cohorts significantly increased ARTIC Scale scores posttraining (p < .001). At preintervention, all three cohorts significantly differed from each other on ARTIC Scale scores (p < .01). In contrast, postintervention, ARTIC Scale scores did not significantly differ between nursing students and advocates (p = .99). Nursing students showed a significant increase in scores from pre- to postintervention compared with either advocates or emergency department staff.

CONCLUSION:

The results strongly suggest that health care providers can improve attitudes toward trauma-informed care after completing training on the principles and application of trauma-informed care.
Probiotics for Infection Prevention in Critically Ill and Trauma Patients: A Concise Review
Authors: Vitko Heather A. , Troxell Jordan J. , Sherwood Paula R.
Published: September 2023

BACKGROUND:

Critically ill trauma patients are at an increased risk for infection, which can increase morbidity and mortality. The use of probiotic preparations for infection prevention is promising, yet the results of their effectiveness are mixed.

OBJECTIVES:

To synthesize current research regarding the use of probiotics to prevent and possibly treat infection in the critically ill adult trauma population.

METHODS:

DATA SOURCES:

The medicine and nursing databases PubMed, CINAHL, and ProQuest were searched for this review.

STUDY SELECTION:

Studies addressed the efficacy of probiotics in the critically ill in reducing health care–associated infection rates, with particular emphasis on patients who experienced severe trauma.

DATA EXTRACTION:

Studies were reviewed and included through the consensus of the authors. Each study's population, design, methodology, results, and conclusions were analyzed for relevance. Of 170 publications retrieved and reviewed, 21 articles were identified for use in this review, including original research, meta-analyses, and reviews.

RESULTS:

DATA SYNTHESIS:

There is a lack of homogeneity of studies concerning probiotic species/strain selection and frequency and timing of dosing in the current body of literature.

KEY THEMES:

There is also a lack of consensus on what constitutes a “health care–associated infection,” with few studies identifying specific types of infection and the role probiotics may play in preventing these infections.

CONCLUSION:

Upon reviewing the current body of evidence, one cannot definitively conclude that probiotic supplementation in the critically-ill trauma population decreases health care–associated infection rates and improves outcomes, but most published evidence supports their use.
Robotic-assisted Navigation Bronchoscopy
Authors: Pyarali Fahim F. , Hakami-Majd Niv , Sabbahi Wesam , Chaux George
Published: September 2023

Background:

Robotic-assisted navigation bronchoscopy (RANB) is a novel method to biopsy lung nodules, with initial reports demonstrating excellent accuracy. We aimed to evaluate pooled estimates of diagnostic yields and complication rates with RANB by performing a meta-analysis of the available literature.

Methods:

We searched 3 databases, including PubMed, EmBase, and Web of Science. The resulting abstracts were reviewed by 2 investigators. Analyses were performed using random effects models, and diagnostic yield and complication rates were estimated after the Freeman-Tukey transformation.

Results:

A total of 23 articles, comprising 1409 patients and 1541 nodules, were included in the final analysis. Mean ages ranged from 63.2 to 69.3 years. The average size of the nodules ranged between 5.9 and 25.0 mm. Most patients (54.0% to 92.0%) had a current or prior smoking history in studies that reported them (n=8). The pooled diagnostic yield was 81.9% (12 studies, 838 nodules, 95% CI: 83.4%-91.0%), and the pooled sensitivity for malignancy was 87.6% (8 studies, 699 nodules, 95% CI: 81.3%-89.5%). The pooled incidence of pneumothorax rates was 0.60% (95% CI: 0.11%-1.35%). The pooled incidence of major bleeding was <0.01%.

Conclusion:

Diagnostic yield for patients with pulmonary nodules undergoing RANB is high, though may be impacted by the prevalence of malignancy, participant selection, and publication bias. Complication rates, including pneumothoraces and bleeding rates, appear low across all studies. If RANB is available, clinicians should consider utilizing this platform to biopsy pulmonary nodules.
G-EYE Improves Polyp, Adenoma, and Serrated Polyp Detection Rates in Colonoscopy
Authors: Haghbin Hossein , Zakirkhodjaev Nurruddinkhodja , Beran Azizullah , Lee Smith Wade , Aziz Muhammad
Published: September 2023

Background:

Colonoscopy is the gold-standard test to decrease mortality from colorectal cancer (CRC). G-EYE is an inflated balloon on the bending section of the scope with the ability to flatten the folds to improve the adenoma detection rate (ADR). We performed this meta-analysis to evaluate the efficacy of G-EYE in improving ADR and other quality indicators of colonoscopy.

Methods:

A literature search was performed through March 21, 2023, on databases including Embase, Medline, Cochrane Central Register of Controlled Trials, Web of Science Core Collection, KCI—Korean Journal Index, and Global Index Medicus. Core concepts of G-EYE, colonoscopy, ADR, polyp detection rate (PDR), serrated polyp detection rate (SPDR), and withdrawal time were searched. Statistical analysis was performed with OpenMeta[Analyst]. The odds ratio (OR) for the proportional variable and mean difference for the continuous variable along with 95% CI was used with a P-value <0.05 considered statistically significant. We used the DerSimonian-Laird method and random effects model for pooling data.

Results:

The search strategy yielded a total of 143 articles. Three studies with 3868 total colonoscopies were finalized. The pooled ADR, PDR, and SPDR showed statistical improvement with G-EYE (OR: 1.744, 95% CI: 1.534-1.984, P<0.001; OR: 1.766, 95% CI: 1.547-2.015, P<0.001; and OR: 1.603, 95% CI: 1.176-2.185, P=0.003). The withdrawal time was also noted to be higher in the G-EYE group (mean difference: 0.114, CI: 0.041-0.186, P=0.002).

Conclusions:

This meta-analysis suggests that G-EYE can improve ADR, PDR, and SPDR. Further studies are needed to evaluate the effect of G-EYE on interval CRC and mortality rate.