bluuebunny/crossref_metadata_2025 huggingface dataset:
AdaBoost-MICNN: a new network framework for pulsar candidate selection
Authors: Zhao Hongyang , Jin Jing , Liu Yi , Shen Yi , Jiang Yu
Published: March 2022

Pulsar observation and research are of great significance. With the gradual increase in the performance and quantity of observing equipment, the received pulsar observation data also increase geometrically. Machine learning can mine large-scale pulsar data sets to realize automatic pulsar candidate identification. However, the pulsar candidate and non-pulsar candidate data sets are highly imbalanced. The traditional classifier trained on the data set with imbalanced class distribution usually shows poor generalization performance, which will cause the classifier to be biased towards negative instances. To address the problem of poor identification algorithm performance caused by sample imbalance, we describe a new framework, namely AdaBoost-multi-input-CNN (AdaBoost-MICNN). In AdaBoost, multiple baseline models are trained sequentially, and the weight of each training sample changes as the training progresses. Especially the minority samples, which are more easily ignored, will get more attention in subsequent baseline models. This will solve the problem of imbalanced classification. Meanwhile, there are usually four pulsar diagnostic plots. To automatically extract and integrate these four diagnostic plots features, we use multi-input-CNN (MICNN) as the baseline model of AdaBoost. The attention mechanism is introduced to enhance the performance of MICNN’s extraction of features, and design an objective function that adds the maximum mean discrepancy to enhance the anti-interference ability of the model. Finally, the proposed method is tested in the High Time Resolution Universe Medlat Data, and the experimental results verify the effectiveness and efficiency of the method.
Xenogeneic nucleoid-associated EnrR thwarts H-NS silencing of bacterial virulence with unique DNA binding
Authors: Ma Ruiqing , Liu Yabo , Gan Jianhua , Qiao Haoxian , Ma Jiabao , Zhang Yi , Bu Yifan , Shao Shuai , Zhang Yuanxing , Wang Qiyao
Published: March 2022

Type III and type VI secretion systems (T3/T6SS) are encoded in horizontally acquired genomic islands (GIs) that play crucial roles in evolution and virulence in bacterial pathogens. T3/T6SS expression is subjected to tight control by the host xenogeneic silencer H-NS, but how this mechanism is counteracted remains to be illuminated. Here, we report that xenogeneic nucleoid-associated protein EnrR encoded in a GI is essential for virulence in pathogenic bacteria Edwardsiella and Salmonella. We showed that EnrR plays critical roles in T3/T6SS expression in these bacteria. Various biochemical and genetic analyses demonstrated that EnrR binds and derepresses the promoter of esrB, the critical regulator of T3/T6SS, to promote their expression by competing with H-NS. Additionally, EnrR targets AT-rich regions, globally modulates the expression of ∼363 genes and is involved in various cellular processes. Crystal structures of EnrR in complex with a specific AT-rich palindromic DNA revealed a new DNA-binding mode that involves conserved HTH-mediated interactions with the major groove and contacts of its N-terminal extension to the minor groove in the symmetry-related duplex. Collectively, these data demonstrate that EnrR is a virulence activator that can antagonize H-NS, highlighting a unique mechanism by which bacterial xenogeneic regulators recognize and regulate foreign DNA.
Generation and network analysis of an RNA-seq transcriptional atlas for the rat
Authors: Summers Kim M , Bush Stephen J , Wu Chunlei , Hume David A
Published: March 2022

The laboratory rat is an important model for biomedical research. To generate a comprehensive rat transcriptomic atlas, we curated and downloaded 7700 rat RNA-seq datasets from public repositories, downsampled them to a common depth and quantified expression. Data from 585 rat tissues and cells, averaged from each BioProject, can be visualized and queried at http://biogps.org/ratatlas. Gene co-expression network (GCN) analysis revealed clusters of transcripts that were tissue or cell type restricted and contained transcription factors implicated in lineage determination. Other clusters were enriched for transcripts associated with biological processes. Many of these clusters overlap with previous data from analysis of other species, while some (e.g. expressed specifically in immune cells, retina/pineal gland, pituitary and germ cells) are unique to these data. GCN analysis on large subsets of the data related specifically to liver, nervous system, kidney, musculoskeletal system and cardiovascular system enabled deconvolution of cell type-specific signatures. The approach is extensible and the dataset can be used as a point of reference from which to analyse the transcriptomes of cell types and tissues that have not yet been sampled. Sets of strictly co-expressed transcripts provide a resource for critical interpretation of single-cell RNA-seq data.
Data-driven identification of inherent features of eukaryotic stress-responsive genes
Authors: Latorre Pablo , Böttcher René , Nadal-Ribelles Mariona , Li Constance H , Solé Carme , Martínez-Cebrián Gerard , Boutros Paul C , Posas Francesc , de Nadal Eulàlia
Published: March 2022

Living organisms are continuously challenged by changes in their environment that can propagate to stresses at the cellular level, such as rapid changes in osmolarity or oxygen tension. To survive these sudden changes, cells have developed stress-responsive mechanisms that tune cellular processes. The response of Saccharomyces cerevisiae to osmostress includes a massive reprogramming of gene expression. Identifying the inherent features of stress-responsive genes is of significant interest for understanding the basic principles underlying the rewiring of gene expression upon stress. Here, we generated a comprehensive catalog of osmostress-responsive genes from 5 independent RNA-seq experiments. We explored 30 features of yeast genes and found that 25 (83%) were distinct in osmostress-responsive genes. We then identified 13 non-redundant minimal osmostress gene traits and used statistical modeling to rank the most stress-predictive features. Intriguingly, the most relevant features of osmostress-responsive genes are the number of transcription factors targeting them and gene conservation. Using data on HeLa samples, we showed that the same features that define yeast osmostress-responsive genes can predict osmostress-responsive genes in humans, but with changes in the rank-ordering of feature-importance. Our study provides a holistic understanding of the basic principles of the regulation of stress-responsive gene expression across eukaryotes.
What the Tortoise Says about Statutory Interpretation: The Semantic Canons of Construction Do Not Tip the Balance
Authors: Afrouzi Amin Ebrahimi
Published: March 2022

Karl Llewellyn’s critique of the canons of statutory interpretation led to a decline in their use for several decades. His critique, however, faced sustained resistance from some corners of the academy and the judiciary. Although this resistance has had only a selective uptake, it animated a gradual revival of the canons and brought the state of scholarship to an impasse that is for the most part partisan. In this article, I examine the semantic canons from a deeper level and argue that a universal assumption about them is false. Said assumption is that, although not dispositive, the semantic canons at least offer some reasons in favour of or against a candidate interpretation. Inclinations to rely on the semantic canons are also based on this assumption, although it is an assumption that the critics of the canons also share. I argue that this assumption is false because the semantic canons are a class of rules that are by nature not reason-giving. This provides a new ground against giving the semantic canons deliberative weight in questions of statutory interpretation.
La prise en charge de la persistance du canal artériel chez les nouveau-nés prématurés
Authors: Mitra Souvik , Weisz Dany , Jain Amish , Jong Geert ‘t
Published: March 2022

La prise en charge de la persistance du canal artériel est l’un des aspects les plus litigieux des soins aux nouveau-nés prématurés. On peut la classer en deux grandes catégories : la prophylaxie et le traitement en cas de symptômes. L’administration prophylactique d’indométacine par voie intraveineuse chez les nouveau-nés d’extrême petit poids à la naissance peut limiter les graves hémorragies intraventriculaires. L’échocardiographie est systématiquement recommandée pour confirmer une persistance du canal artériel avant d’envisager le traitement en cas de symptômes, qui peut prendre la forme d’un traitement conservateur, d’une pharmacothérapie ou d’une fermeture invasive. L’ibuprofène doit être considéré comme le traitement pharmacologique de première intention dans cette situation. Une forte dose peut être à privilégier, particulièrement chez les nouveau-nés prématurés de plus de trois à cinq jours de vie. Si deux traitements pharmacologiques consécutifs échouent ou si la pharmacothérapie est contre-indiquée, on peut envisager une fermeture invasive en cas de symptômes marqués lorsque l’échocardiographie révèle des signes de shunt à fort volume à travers le canal artériel et de circulation pulmonaire excessive.
Transforming social perspectives with cognitive maps
Authors: Arzy Shahar , Kaplan Raphael
Published: March 2022

Growing evidence suggests that cognitive maps represent relations between social knowledge similar to how spatial locations are represented in an environment. Notably, the extant human medial temporal lobe literature assumes associations between social stimuli follow a linear associative mapping from an egocentric viewpoint to a cognitive map. Yet, this form of associative social memory does not account for a core phenomenon of social interactions in which social knowledge learned via comparisons to the self, other individuals or social networks are assimilated within a single frame of reference. We argue that hippocampal–entorhinal coordinate transformations, known to integrate egocentric and allocentric spatial cues, inform social perspective switching between the self and others. We present evidence that the hippocampal formation helps inform social interactions by relating self vs other social attribute comparisons to society in general, which can afford rapid and flexible assimilation of knowledge about the relationship between the self and social networks of varying proximities. We conclude by discussing the ramifications of cognitive maps in aiding this social perspective transformation process in states of health and disease.
Prefrontal cortical thickness, emotion regulation strategy use and COVID-19 mental health
Authors: Dimanova Plamina , Borbás Réka , Schnider Cilly Bernardette , Fehlbaum Lynn Valérie , Raschle Nora Maria
Published: March 2022

Coronavirus disease 2019 (COVID-19) and associated restrictions have been linked to negative mental health outcomes across the globe. Cognitive emotion regulation strategies, neurally supported by prefrontal and limbic regions, constitute means to mitigate negative affects resulting from adverse life experiences. Variations in cognitive emotion regulation strategy use, anxiety, and depression were assessed in 43 adults (31♀/12♂, age = 35.14 ± 9.20 years) during the first months following COVID-19 onset and at the end of 2020 (seven assessments). Direct and indirect effects of emotion regulatory brain structures assessed prior to the pandemic and emotion regulation strategy use during the pandemic were assessed in relation to mental well-being. Varying levels of anxiety and depression were observed. While adaptive emotion regulation strategies were most frequently employed, maladaptive strategies explained the highest variation in anxiety and depression scores. The effectiveness of specific emotion regulation strategies varied. Momentary emotion regulation strategy use mediated the association between cortical thickness in right lateral prefrontal cortex assessed prior to the pandemic and mental health during the pandemic. Early mental health measures impacted later mental well-being. Maladaptive strategies have a negative effect on mental health during prolonged stress as induced by pandemics, providing possible targets for intervention.
Current Status and Perspectives of Allogeneic Hematopoietic Stem Cell Transplantation in Elderly Patients with Acute Myeloid Leukemia
Authors: Servais Sophie , Beguin Yves , Baron Frédéric
Published: March 2022

As in younger patients, allogeneic stem cell transplantation (alloHSCT) offers the best chance for durable remission in older patients (≥60 years) with acute myeloid leukemia (AML). However, defining the best treatment strategy (and in particular, whether or not to proceed to alloHSCT) for elderly patients with AML remains a difficult decision for the hematologist, since potential toxicity of conditioning regimens, risks of graft-versus-host disease, impaired immune reconstitution and the need for prolonged immunosuppression may be of major concern in these vulnerable patients with complex needs. Hopefully, significant progress has been made over the past decade in alloHSCT for elderly patients and current evidence suggests that chronological age per se (between 60 and 75) is not a reliable predictor of outcome after alloHSCT. Here, we review the current state of alloHSCT in elderly patients with AML and also discuss the different approaches currently being investigated to improve both accessibility to as well as success of alloHSCT in these patients.
The Virome of Piper nigrum: Identification, Genomic Characterization, Prevalence, and Transmission of Three New Viruses of Black Pepper in China
Authors: Ma Yuxin , Xing Fei , Che Haiyan , Gao Shengfeng , Lin Yating , Li Shifang
Published: March 2022

Viral diseases are one of the main categories of diseases that cause substantial yield losses in black pepper. Disease symptoms in black pepper are generally complex and are often caused by both known and undescribed viruses. To identify and clarify the etiology of viral diseases in black pepper in Hainan, China, we conducted high-throughput sequencing (HTS) by targeting purified double-stranded RNA (dsRNA) and ribosomal RNA depleted total RNA (rRNA-depleted totRNA). Analysis of the data revealed the presence of one known virus, piper yellow mottle virus (PYMoV), and three newly identified viruses: black pepper virus F (BPVF) in the genus Fabavirus, black pepper virus E (BPVE) in the genus Enamovirus, and black pepper virus B (BPVB) in the genus Badnavirus. The dominant viruses in P. nigrum sampled in Hainan are PYMoV, with an incidence of 100%, followed by BPVF (84%, 133 of 158) and BPVB (66%, 105 of 158). Mechanical inoculation of sap extracts from source plants containing PYMoV, BPVF, and BPVB gave negative results on both herbaceous and woody host plants 60 days postinoculation (dpi). BPVF and PYMoV were successfully transmitted to virus-free seedlings of black pepper through bark grafting, while BPVB was experimentally undetectable up to 150 dpi. Seed transmission experiments showed that no target viruses were present in all 59 germinated seedlings. This study provides information on diagnosis, prevalence, and transmission of black-pepper-associated viruses.
A Diagnostic Guide for Laurel Wilt Disease in Avocado
Authors: Navia-Urrutia Monica , Sánchez-Pinzón Laura , Parra Pedro Pablo , Gazis Romina
Published: March 2022

Laurel wilt disease (LWD), caused by the ambrosia fungus Raffaelea lauricola, is a deadly vascular disease affecting numerous hosts in the Lauraceae family, including important forest species and avocado trees. The fungal pathogen is spread by beetle-vectors and through root grafts. Symptoms include leaf wilting, foliar desiccation, stem and limb dieback, and depending on the host, localized or systemic vascular damage. R. lauricola and its main vector, Xyleborus glabratus (Redbay Ambrosia Beetle), are invasive species that were introduced into the United States in 2002. This guide describes methods used to diagnose LWD in avocado. R. lauricola is isolated from infected sapwood or ambrosia beetles using the semi-selective medium CSMA (cycloheximide–streptomycin malt agar). Molecular identification is based on the amplification of the LSU (Large Subunit of the ribosomal cassette) or of the species-specific microsatellites IFW and CHK by conventional PCR. More current detection methods use DNA extracted directly from infected material and include the amplification of specific DNA regions through conventional PCR, qPCR, or LAMP. However, to date, there is no method that can detect the pathogen early in the infection process (<3 days) when the vascular tissue remains asymptomatic. Besides detailed protocols on how to diagnose the disease and confirm the presence of the causal agent, we include protocols on pathogen preservation and inoculation. Although this guide focuses on avocado, the techniques included here can be implemented to diagnose LWD in other susceptible species.
Mapping Quantitative Trait Loci for Lettuce Resistance to Verticillium dahliae Race 3, Plant Development, and Leaf Color Using an Ultra-High-Density Bin Map Constructed from F2 Progeny
Authors: Simko Ivan , Puri Krishna D. , Dhar Nikhilesh , Peng Hui , Subbarao Krishna V.
Published: March 2022

Verticillium wilt is one of the most devastating soilborne diseases in lettuce, and the use of host resistance is the most optimal choice for its management. This study focused on identifying and mapping the genetic loci for resistance against Verticillium dahliae race 3 in a mapping population of 200 F2:3 families developed from a cross between moderately resistant red-leaf lettuce ‘Sentry’ and susceptible green-leaf lettuce ‘La Brillante’. The population was genotyped using the tunable genotyping-by-sequencing (tGBS) approach. An ultra-high-density genetic linkage map containing 34,838 single nucleotide polymorphism markers grouped into 1,734 bins was constructed using F2 progeny and a sliding window approach. Three quantitative trait loci (QTLs) for resistance to V. dahliae race 3 were located on linkage groups (LGs) LG 2 ( qVR3-2.1) and LG 4 ( qVR3-4.1 and qVR3-4.2). Each of these QTLs explained up to ∼10% of the total phenotypic variation for the trait. At each locus, the resistance alleles were derived from cultivar Sentry that is partially resistant to the pathogen. Additional loci resistant to the disease are expected in this population, and transgressive segregation indicates that some of those loci could originate from the susceptible cultivar La Brillante. In addition, two QTLs for plant development were identified on LG 2 ( qIPD-2.1) and LG 7 ( qIPD-7.1), although no relationship was detected between resistance in these genotypes and the rate of plant growth. A major effect of QTL for red leaf color was detected on LG 9 ( qRLC-9.1). Candidate genes linked to some of the QTLs for V. dahliae race 3 resistance, plant development, and leaf color were identified. The QTLs for resistance identified in Sentry could diversify the resistance gene pool and provide an alternative tool to manage a newly emerged V. dahliae race 3.

[Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Two-stage Bone Lengthening With Reuse of a Single Intramedullary Telescopic Nail in Patients With Achondroplasia
Authors: Alonso-Hernández Javier , Galán-Olleros María , Miranda-Gorozarri Carlos , Egea-Gámez Rosa M. , Palazón-Quevedo Ángel
Published: March 2022

Background:

Patients with achondroplasia may benefit from limb-lengthening surgery with telescopic intramedullary nails (TIMNs). However, the 5-cm maximum length of the nails used in these patients in their original design may be insufficient. The aim of this research is to analyze the outcomes and complications after reusing the same TIMN for a second consecutive 5-cm lengthening in patients with achondroplasia.

Methods:

Retrospective study of 26 bones (16 femurs and 10 tibias) in 9 patients with achondroplasia treated for bilateral 2-stage sequential lengthening reusing the same TIMN. On completion of a first stage of 5 cm of elongation, the nail was unlocked, retracted, and re-locked; a second stage of 5 cm of distraction followed. Radiologic and clinical parameters were measured preoperatively and postoperatively, and complications were recorded.

Results:

The median age of patients at first surgery was 13.54 (12.9 to 16.3) years; 55% were males. The median preoperative height was 121 (117.5 to 127) cm, and the median healing index was 18.12 (14.5 to 32.8) and 26.96 (23.3 to 31.6) d/cm, while time to weight bearing was 185.5 (144.8 to 308.5) and 242.5 (208.5 to 293.8) days for femurs and tibias, respectively. Major complications included 3 cases of moderate ankle equinus, 2 cases of hardware failure (failure to relengthen), 2 premature consolidations, 1 common peroneal neurapraxia, and 2 valgus deformities. Femoral procedures had significantly fewer complications than tibial interventions (7 vs. 15, P=0.03), whereas patients who underwent lengthening of both the femur and tibia did not have significantly higher complication rates (14 vs. 8, P=0.6).

Conclusions:

This study analyzes lower-limb lengthening in a series of achondroplastic patients using TIMN with the novelty of nail reuse to relengthen the bone. The complication rate found is acceptable, among which, potential damage to the internal lengthening mechanism must be considered, though this complication can usually be easily resolved. Overall, nail reuse seems advisable in cases where bone elongation is indicated, and the size and design of the nail limits the extent of lengthening.

Level of Evidence:

Level III, retrospective comparative study, before and after intervention.
Bretschneider Solution and Two Antianginal Drugs Protect Peripheral Tissue in an Animal Model of Hemorrhagic Shock
Authors: Ortiz Fragola Juan P. , Cao Gabriel , Tumarkin Mariano , Moriondo Marisa , Muller Angélica , Sangiorgio Martin , Azzato Francisco , Ambrosio Giuseppe , Milei José
Published: March 2022

Shock and subsequent resuscitation provoke ischemia-reperfusion injury. Trimetazidine (TMZ), allopurinol (ALO), and histidine–tryptophan–ketoglutarate (HTK) solution, can protect from ischemia-reperfusion injury in chronic coronary syndromes and in transplantation. The objective of the current study is to compare, in a hemorrhagic shock and standard resuscitation animal model, organ damage parameters between placebo and treatment with TMZ, ALO, or HTK. Shock was induced in Wistar rats by controlled arterial bleeding, maintaining mean arterial pressure between 38 and 42 mm Hg for 60 minutes; then, drawn blood was reinfused. Animals were divided into: Sham (n = 4), Control (n = 6), TMZ (n = 7), ALO (n = 9), and HTK (n = 7). At the end of the experiment, animals were sacrificed and tissue harvested. TMZ, ALO and HTK decreased histopathologic damage in heart [Control: 1.72 (1.7–1.77); TMZ: 1.75 (1.72–1.79); ALO: 1.75 (1.74–1.8); HTK: 1.82 (1.78–1.85); all P < 0.05], kidney [Control: 3 (2–3); TMZ: 1 (1–2); ALO: 1 (1-1); HTK: 1(1-1); all P < 0.05] and intestine [Control: 3 (2–3); TMZ: 1 (1–2); ALO: 1 (1-1); HTK: 1 (0–2); all P < 0.05]. Also, treatment with TMZ, ALO, and HTK increased immunohistochemical expression of thioredoxin-1 in heart [Control: 6.6 (5.6–7.4); TMZ: 9.5 (8.1–9.7); ALO: 9.1 (8.4–10.2); HTK: 14.2 (12.6–15); all P < 0.05]; and kidney [Control: 4.6 (4–5.1); TMZ: 9.7 (9.3–9.9); ALO: 9.6 (9–9.9); HTK: 16.7 (16.1–17); all P < 0.05]. In an experimental model of hemorrhagic shock, TMZ, ALO, and HTK solution attenuated cell damage in multiple parenchyma and increased antioxidant defenses.
Distal Internal Maxillary Artery Occlusion with Palatal Necrosis following Cheek Injection with Calcium Hydroxylapatite
Authors: Soares Danny J. , Blevins Larry W.
Published: March 2022

Accidental intravascular injection of cosmetic fillers resulting in dermal infarction represents one of the most feared complications in aesthetic medicine. Despite the infrequency of these injuries, the rapid rise in filler use has caused a sudden increase in the incidence of filler-induced skin necrosis. Because the complex vascular anatomy of the face subserves a wide range of cutaneous and mucosal tissues, it has been surmised that occult injuries affecting the oronasal cavities could occur as a result of accidental intravascular injection of dermal fillers. We report an instance of ischemic skin injury of the infraorbital territory of the face with hemi-palatal mucosal necrosis secondary to vascular occlusion with calcium hydroxylapatite.
Negative Pressure Wound Therapy Prevents Hernia Recurrence in Simultaneous Ventral Hernia Repair and Panniculectomy
Authors: Deldar Romina , Abu El Hawa Areeg A. , Bovill John D. , Hipolito Dionisio , Tefera Eshetu , Bhanot Parag , Fan Kenneth L. , Evans Karen K.
Published: March 2022

Background:

Simultaneous ventral hernia repair with panniculectomy (VHR-PAN) is associated with a high rate of wound complications. Closed incision negative pressure wound therapy (ciNPWT) has been shown to lower complications in high-risk wounds. There is a debate in the literature as to whether ciNPWT is effective at preventing complications in VHR-PAN. The aim of our study was to evaluate if ciNPWT improves outcomes of VHR-PAN.

Methods:

A retrospective review of patients who underwent VHR-PAN between 2009 and 2021 was conducted. Patients were divided into two groups: (1) those who received standard sterile dressings (SSD), or (2) ciNPWT. Primary outcomes were postoperative complications, including surgical site occurrences (SSO) and hernia recurrence.

Results:

A total of 114 patients were identified: 57 patients each in the SSD group and ciNPWT group. The groups were similar in demographics and comorbidities. There were more smokers in the SSD group (22.8% versus 5.3%, P = 0.013). Hernia defect size was significantly larger in patients who received ciNPWT (202.0 versus 143.4 cm2, P = 0.010). Overall SSO was similar between the two groups (23.2% versus 26.3%, P = 0.663). At a mean follow-up of 6.6 months, hernia recurrence rate was significantly higher in the SSD group compared with that in the ciNPWT group. (10.5% versus 0%, P = 0.027). Smoking, diabetes, component separation, mesh type, and location were not significantly associated with hernia recurrence.

Conclusions:

Application of incisional NPWT is beneficial in decreasing hernia recurrence in VHR-PAN, compared with standard dressings. Larger prospective studies are warranted to further elucidate the utility of ciNPWT in abdominal wall reconstruction.
Impact of the Coarse Indoor Non-radioactive Aerosols on the Background Radon Progenies’ Compensation of a Continuous Air Monitor
Authors: Hoarau Gwenaël , Dougniaux Grégoire , Gensdarmes François , Cassette Philippe , Ranchoux Gilles
Published: March 2022

This paper addresses the problem of false positive alarm when using a continuous air monitor (CAM) in decommissioning sites of nuclear facilities. CAMs are used to measure airborne activity and play an important role in the radiation protection of workers likely to be exposed to radioactive aerosols. Monitors usually sample aerosols on a membrane filter. Radioactive particles sampled are detected through the alpha and beta decays that they emit. These latter ionizing particles are measured online by spectrometry thanks to a Passivated Implanted Planar Silicon detector (PIPS). Alpha and beta decays, in this context, come mainly from the natural radon progeny (218Po, 214Pb, and so on) and, in the case of radioactive contamination, also from artificial radionuclides such as 239Pu or 137Cs. The aim of the CAM is to alert the workers when the artificial airborne activity occurs, always considering the presence of a variable background due to the natural particulate airborne activity. The CAM-specific algorithm considers this background dynamically and continuously, often by using a constant parameter. However, non-radioactive aerosols are also sampled on the membrane filter. These latter make the discrimination more difficult as they lead to the deterioration of the alpha-energy spectrum. In this paper, the effect of coarse non-radioactive aerosols on the CAM response is highlighted with four aerosol size-distributions. The evolution of the background is characterized as a function of the aerosol mass sampled, with the example of a simple algorithm. Thus, in this paper, results show a positive correlation of the background with the aerosol mass sampled by the CAM. In addition, results highlight at least two different evolutionary trends according to the aerosol size distribution. An explanation of these evolutions is given by considering the penetration profile of the natural radioactive aerosols in the granular deposit above the CAM filter. The main consequence of these results is that the background could not be considered as proportional to radon progeny as it is currently used.
A UNIQUE INDOCYANINE GREEN ANGIOGRAPHY FEATURE IN SARCOIDOSIS
Authors: Hossain Homaira Ayesha , O'Keefe Ghazala
Published: March 2022

Purpose:

To describe a unique indocyanine green angiography (ICGA) feature in sarcoidosis-associated choroidal vasculitis in a 33-year-old woman.

Methods:

Case report.

Results:

A 33-year-old woman with sarcoidosis was referred for the evaluation of blurry vision in both eyes. On ocular examination of both eyes, slit-lamp biomicroscopy and ophthalmoscopy revealed 0.5+ anterior chamber cell, 1+ vitreous cell, and no vitreous haze. Also noted were areas of venous perivascular sheathing and multiple (3–5) inferior snowballs. Fluorescein angiography showed optic disk hyperfluorescence, retinal phlebitis, and hyperfluorescence with late leakage in the periphery (Figure 1). Indocyanine green angiography showed small hypofluorescent spots. Also noted on the ICGA images were multiple, sharp, linear hyperfluorescent areas signifying areas of choroidal vasculitis (Figure 2). The patient was referred to rheumatology for the initiation of immunomodulatory therapy.

Conclusion:

To the best of our knowledge, this ICGA pattern of multiple, sharp, linear hyperfluorescent areas has not been previously described in patients with sarcoidosis. This ICGA pattern represents areas of sarcoidosis associated choroidal vasculitis.
Lid Margin Score Is the Strongest Predictor of Meibomian Area Loss
Authors: Zhou Nanyu , Edwards Katie , Colorado Luisa H. , Schmid Katrina L.
Published: March 2022

Purpose:

Although meibography provides direct evidence of gland dropout in meibomian gland dysfunction, this specialized technique is not available in most clinics. The primary aim was to determine which clinical ocular marker was most related to meibomian area loss. A secondary aim was to determine associations with confocal microscopy imaging of the lid margin.

Methods:

One hundred participants from age 18 to 65 years were recruited. Measurements of the right eye and its upper eyelid, where relevant, included noninvasive tear break-up time, bulbar and limbal redness scores, blepharitis score, lipid layer thickness, number of parallel conjunctival folds, tear osmolarity, corneal fluorescein staining, phenol red thread test, lid margin score, meibography, and in vivo confocal microscopy. Participants also completed the Ocular Surface Disease Index questionnaire. The relationships between the measurements were determined using the Spearman correlation. The receiver operating characteristic curve and area under the receiver operating characteristic curve were used to determine the cutoff value of clinical markers.

Results:

Significant correlations were found between meibomian area and lid margin score (r = −0.47, P < 0.01), and meibomian tortuosity and lid signs of blepharitis (r = −0.32, P < 0.01). Area under the receiver operating characteristic curve analysis revealed that a lid margin score of ≥1.70 detected meibomian area loss with a sensitivity of 0.58 and a specificity of 0.86. There were significant correlations between meibomian area and orifice area at 30 μm depth (r = −0.25, P = 0.01).

Conclusions:

The lid margin score was most related to the meibomian area and thus the best predictor of undiagnosed meibomian area loss.
Traumatic intraocular lens ectopia from a nonadhesive capsule
Authors: Chen Zeli , Wu Yan , Chen Maosheng , Liu Zhen
Published: March 2022

Introduction:

This study describes a case of traumatic intraocular lens (IOL) ectopia with retention in the pupil that occurred 2 years after cataract surgery.

Patient and Clinical Findings:

A 55-year-old man, who underwent cataract surgery 2 years ago, sustained an ocular injury while slapping a bug on the left eyelid, following which he had decreased vision. His IOL shifted out of the capsule and was retained in the pupil.

Diagnosis, Intervention, and Outcomes:

The patient was diagnosed with IOL ectopia with retention in the pupil. An IOL reposition operation was performed successfully. The IOL was completely returned into the capsule, and postoperatively, his uncorrected distance visual acuity immediately improved to 0.097 logMAR.

Conclusions:

An IOL could slide out of the nonadhesive capsule under external force even if the capsulorhexis is performed perfectly with a continuous curvilinear circle at the center and the anterior capsule covers the IOL optical surface.
A Pilot Proteomic Study of Vestibular Fluid From Patients With Vulvodynia
Authors: MacNeill Colin , Umstead Todd , Shearer Debra , Weisz Judith , Phelps David S. , Floros Joanna
Published: March 2022

Objective

Many women are affected by vulvodynia, but medical therapies to date have proven ineffective. We performed a pilot study using gel-based proteomics to develop a map of proteins present in vaginal/vestibular secretions and identify proteins that could be considered for future evaluation as potential therapeutic targets.

Materials and Methods

We collected vestibular fluid from 4 controls and 4 patients with vulvodynia by placing a cotton swab in the vestibule and extracting the absorbed proteins. The proteins underwent 2-dimensional difference gel electrophoresis and mass spectrometry to develop a protein map. Immunohistochemistry was used to validate proteomic findings.

Results

A map was constructed of 32 of the more abundant proteins in vestibular fluid and their levels compared in control subjects and vulvodynia patients. Among these were annexin A1, interleukin 1 receptor antagonist, protein S100 A9, and a number of antiproteases and proteases. Many of these proteins differed by at least 50% between groups, but only annexin A1, one of the protease inhibitors, and immunoglobulin G κ chain were significantly different. The results with annexin A1 were validated by similar findings with immunohistochemistry.

Conclusions

The findings of this pilot study demonstrate a set of vestibule mucosa proteins that differ significantly—either increasing or decreasing—in vulvodynia patients compared with controls, and several others that exhibited greater than 1.5-fold change but did not reach statistical significance. This study constitutes a proof-of-principle that an open, unbiased proteomic approach can identify molecular participants in vulvodynia, some of which had not been identified to date by hypothesis-driven studies.
The Affordable Care Act Medicaid Expansion, Social Disadvantage, and the Practice Location Choices of New General Internists
Authors: Escarce José J. , Wozniak Gregory D. , Tsipas Stavros , Pane Joseph D. , Ma Yanlei , Brotherton Sarah E. , Yu Hao
Published: March 2022

Background:

A recent study found that states that expanded Medicaid under the Affordable Care Act (ACA) gained new general internists who were establishing their first practices, whereas nonexpansion states lost them.

Objective:

The objective of this study was to examine the level of social disadvantage of the areas of expansion states that gained new physicians and the areas of nonexpansion states that lost them.

Research Design:

We used American Community Survey data to classify commuting zones as high, medium, or low social disadvantage. Using 2009–2019 data from the AMA Physician Masterfile and information on states’ Medicaid expansion status, we estimated conditional logit models to compare where new physicians located during the 6 years following the expansion to where they located during the 5 years preceding the expansion.

Subjects:

A total of 32,102 new general internists.

Results:

Compared with preexpansion patterns, new general internists were more likely to locate in expansion states after the expansion, a finding that held for high, medium, and low disadvantage areas. We estimated that, between 2014 and 2019, nonexpansion states lost 371 new general internists (95% confidence interval, 203–540) to expansion states. However, 62.5% of the physicians lost by nonexpansion states were lost from high disadvantage areas even though these areas only accounted for 17.9% of the population of nonexpansion states.

Conclusions:

States that opted not to expand Medicaid lost new general internists to expansion states. A highly disproportionate share of the physicians lost by nonexpansion states were lost from high disadvantage areas, potentially compromising access for all residents irrespective of insurance coverage.
Renal Cell Carcinoma With Fibromyomatous Stroma—The Whole Story
Authors: Shah Rajal B.
Published: March 2022

Renal cell carcinoma (RCC) with fibromyomatous stroma (FMS) was included as an “emerging/provisional” entity in the 2016 World Health Organization (WHO) classification as a “RCC with (angio) leiomyomatous stroma.” It has been debated whether RCCFMS represents a separate entity or a group of RCCs with overlapping morphologies. Accordingly, various names have been used to refer to the RCCs that exhibited clear cells and prominent smooth muscle and fibromatous stroma. Recent studies have demonstrated that RCCFMS indeed represents a distinct entity with subtle but distinguishable features that can be separated from other RCCs that exhibit clear cells, as well as tubulopapillary morphology and smooth muscle/fibromatous stroma, such as clear cell RCC and clear cell papillary RCC. Microscopically, the epithelial component forms tumor nodules composed of elongated and frequently branching tubules, lined by clear or mildly eosinophilic cells containing voluminous cytoplasm. Focal papillary morphology is also frequently present. Diffuse CK7 positivity is typical and is required for the diagnosis. Molecular analysis of these tumors demonstrated recurrent mutations involving the TSC/mTOR pathway. A subset of tumors with similar morphology has shown mutations involving ELOC (previously referred to as TCEB1), typically associated with monosomy 8. Finally, in addition to the more common RCCFMS that are sporadic, essentially identical tumors have been found in patients with tuberous sclerosis complex, suggesting the existence of hereditary and sporadic counterparts of this tumor. It is currently debated whether TSC/mTOR and ELOC mutated RCCFMS should be grouped together, based on their shared and overlapping morphology and common CK7 reactivity, despite the differing molecular alterations. This review outlines evidence supporting the recognition of RCCFMS as a novel subtype of RCC with morphologic, immunohistochemical, and molecular characteristics distinct from clear cell RCC and clear cell papillary RCC.
Identifying Long-Term Morbidities and Health Trajectories After Prolonged Mechanical Ventilation in Children Using State All Payer Claims Data*
Authors: Maddux Aline B. , Mourani Peter M. , Miller Kristen , Carpenter Todd C. , LaVelle Jaime , Pyle Laura L. , Watson R. Scott , Bennett Tellen D.
Published: March 2022

OBJECTIVES:

To identify postdischarge outcome phenotypes and risk factors for poor outcomes using insurance claims data.

DESIGN:

Retrospective cohort study.

SETTING:

Single quaternary center.

PATIENTS:

Children without preexisting tracheostomy who required greater than or equal to 3 days of invasive mechanical ventilation, survived the hospitalization, and had postdischarge insurance eligibility in Colorado’s All Payer Claims Database.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

We used unsupervised machine learning to identify functional outcome phenotypes based on claims data representative of postdischarge morbidities. We assessed health trajectory by comparing change in the number of insurance claims between quarters 1 and 4 of the postdischarge year. Regression analyses identified variables associated with unfavorable outcomes. The 381 subjects had median age 3.3 years (interquartile range, 0.9–12 yr), and 147 (39%) had a complex chronic condition. Primary diagnoses were respiratory (41%), injury (23%), and neurologic (11%). We identified three phenotypes: lower morbidity (n = 300), higher morbidity (n = 62), and 1-year nonsurvivors (n = 19). Complex chronic conditions most strongly predicted the nonsurvivor phenotype. Longer PICU stays and tracheostomy placement most strongly predicted the higher morbidity phenotype. Patients with high but improving postdischarge resource use were differentiated by high illness severity and long PICU stays. Patients with persistently high or increasing resource use were differentiated by complex chronic conditions and tracheostomy placement.

CONCLUSIONS:

New morbidities are common after prolonged mechanical ventilation. Identifying phenotypes at high risk of postdischarge morbidity may facilitate prognostic enrichment in clinical trials.
The Impact Oncoplastic Reduction Has on Long-Term Recurrence in Breast Conservation Therapy
Authors: Losken Albert , Smearman Erica L. , Hart Alexandra M. , Broecker Justine S. , Carlson Grant W. , Styblo Toncred M.
Published: March 2022

Background:

The use of oncoplastic reduction techniques have many proven benefits over lumpectomy alone in the management of women with breast cancer. The impact it has on tumor recurrence is unclear. The purpose of this review was to evaluate the incidence of recurrence in patients who underwent oncoplastic reduction techniques compared to lumpectomy alone.

Methods:

A prospectively maintained database of patients at Emory Hospital who underwent oncoplastic reduction techniques at the time of tumor resection was queried. These patients were compared to a series of patients who had lumpectomy alone over a similar period. For inclusion in the study, patients were at least 10 years since the time of the tumor resection. The main outcome of interest was tumor recurrence.

Results:

There were 97 patients in the lumpectomy-only group and 95 patients in the oncoplastic reduction group, with an average follow-up of 7.8 years and 8.5 years, respectively. Patients in the oncoplastic group were younger (lumpectomy only, 61.4 years; oncoplastic reduction, 51.6 years; p < 0.001) and had larger tumors (lumpectomy only, 1.1 cm; oncoplastic reduction, 1.6 cm; p < 0.001). Local recurrence was 13 percent in the lumpectomy-only group and 9 percent in the oncoplastic reduction group (p = 0.34), and overall recurrence rates were similar (lumpectomy only, 15 percent; oncoplastic reduction, 24 percent; p = 0.13). Overall, surgical intervention (lumpectomy alone versus oncoplastic reduction) was not associated with local recurrence or any recurrence on univariate and multivariate analyses.

Conclusion:

Despite the oncoplastic reduction patients having a higher risk of recurrence and a more generous tumor resection, the long-term recurrence rates were equivalent when compared to breast-conserving therapy alone.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Reverse Lymphatic Mapping and Immediate Microsurgical Lymphatic Reconstruction Reduces Early Risk of Breast Cancer–Related Lymphedema
Authors: Weinstein Brielle , Le Nicole K. , Robertson Ellen , Zimmerman Amanda , Tavares Tina , Tran Thanh , Laronga Christine , Panetta Nicholas J.
Published: March 2022

Background:

Breast cancer–related lymphedema is a progressive disease that poses tremendous physical, psychosocial, and financial burden on patients. Immediate lymphaticovenular anastomosis at the time of axillary lymph node dissection is emerging as a potential therapeutic paradigm to decrease the incidence of breast cancer–related lymphedema in high-risk patients.

Methods:

Eighty-one consecutive patients underwent reverse lymphatic mapping and, when feasible, supermicrosurgical immediate lymphaticovenular anastomosis at the time of axillary lymph node dissection at a tertiary care cancer center. Patients were followed prospectively in a multidisciplinary lymphedema clinic (plastic surgery, certified lymphatic therapy, dietary, case management) at 3-month intervals with clinical examination, circumferential limb girth measurements, and bioimpedance spectroscopy. An institutional control cohort was assessed for the presence of objectively diagnosed and treated breast cancer–related lymphedema. Data were analyzed by a university statistician.

Results:

Seventy-eight patients met inclusion, and 66 underwent immediate lymphaticovenular anastomosis. Mean follow-up was 250 days. When compared to a retrospective control group, the rate of lymphedema in patients who underwent immediate lymphaticovenular anastomosis was significantly lower (6 percent versus 44 percent; p < 0.0001). Patients with 6-month follow-up treated with combined adjuvant radiation therapy and chemotherapy had significantly greater risk of developing breast cancer–related lymphedema (p = 0.04) compared to those without combined adjuvant therapy. Arborized anastomotic technique had a statistically shorter operative time than end-to-end anastomosis (p = 0.005).

Conclusions:

This series of consecutive patients demonstrate a 6 percent incidence of early-onset breast cancer–related lymphedema with immediate lymphaticovenular anastomosis and an increased risk in those undergoing combined adjuvant treatment. These early data represent an encouraging and substantial decrease of breast cancer–related lymphedema in high-risk patients.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Liver Stiffness Is Markedly Decreased After Chronic Hepatitis C Treatment
Authors: Gulumsek Erdinc , Sumbul Hilmi Erdem , Buyuksimsek Mahmut , Demir Kubra , Koc Ayse Selcan , Tas Adnan , Bulut Yurdaer , Kara Banu
Published: March 2022

Aim

The aim of the study was to demonstrate the liver stiffness (LS) change in chronic hepatitis C (CHC) patients obtained by elastography point quantification technique in before and after antiviral treatment (AVT).

Material and Methods

This prospective study included 84 patients diagnosed with CHC who had not previously received treatment for CHC and who had an indication for using direct-acting AVT. Necessary measurements were recorded with noninvasive liver fibrosis (LF) examinations. Posttreatment control of patients was carried out (ombitasvir + paritaprevir + ritonavir) + 3 months after the start of treatment for those treated with dasabuvir and 6 months after the start of treatment for patients treated with sofosbuvir + ribavirin. Liver stiffness changed after AVT is accepted as (Δ-LS), LS before AVT–LS after AVT.

Results

Basal LS was found to decrease significantly after AVT (8.00 ± 2.56 kPa vs 6.95 ± 2.86 kPa, P < 0.05). Similar aspartate aminotransferase–to–platelet ratio index and platelet number fibrosis 4 indices were observed before and after AVT (P > 0.05). It was observed that Δ-LS value after AVT was lower in patients with Child-Pugh class A cirrhosis than patients without cirrhosis (P < 0.05). In the comparison between Δ-LS value after AVT and LF score determined by liver biopsy, it was seen that the greatest Δ-LS value was in patients with fibrosis score of 3. An independent relationship was found between Δ-LS after AVT and LF score determined by biopsy (P < 0.05).

Conclusions

The LS value determined by the elastography point quantification technique is more effective than other noninvasive laboratory methods in demonstrating the CHC treatment response in clinical practice.