bluuebunny/crossref_metadata_2025 huggingface dataset:
Photoluminescence in mammal fur: 111 years of research
Authors: Reinhold Linda M , Rymer Tasmin L , Helgen Kristofer M , Wilson David T
Published: April 2023

Photoluminescence in the pelage of mammals, a topic that has gained considerable recent research interest, was first documented in the 1700s and reported sporadically in the literature over the last century. The first detailed species accounts were of rabbits and humans, published 111 years ago in 1911. Recent studies have largely overlooked this earlier research into photoluminescent mammalian taxa and their luminophores. Here we provide a comprehensive update on existing research on photoluminescence in mammal fur, with the intention of drawing attention to earlier pioneering research in this field. We provide an overview on appropriate terminology, explain the physics of photoluminescence, and explore pigmentation and the ubiquitous photoluminescence of animal tissues, before touching on the emerging debate regarding visual function. We then provide a chronological account of research into mammalian fur photoluminescence, from the earliest discoveries and identification of luminophores to the most recent studies. While all mammal fur is likely to have a general low-level photoluminescence due to the presence of the protein keratin, fur glows luminously under ultraviolet light if it contains significant concentrations of tryptophan metabolites or porphyrins. Finally, we briefly discuss issues associated with preserved museum specimens in studies of photoluminescence. The study of mammal fur photoluminescence has a substantial history, which provides a broad foundation on which future studies can be grounded.
Analysis of particle therapy registries based on a unified treatment policy for esophageal cancer
Authors: Tokumaru Sunao , Ishikawa Hitoshi , Soejima Toshinori , Kimoto Takuya , Takakusagi Yosuke , Tamamura Hiroyasu , Wada Hitoshi , Taguchi Hiroshi , Uchinami Yusuke , Hiroshima Yuichi , Hojo Hidehiro , Kamei Takashi , Muto Manabu , Igeta Masataka
Published: April 2023

This study aimed to evaluate the efficacy and safety of particle therapy (proton beam therapy and carbon-ion radiotherapy) for esophageal cancer by analyzing prospective nationwide registry data from particle therapy facilities throughout Japan. Patients diagnosed with esophageal cancer who received particle therapy between May 2016 and June 2018 were recruited from the registries of 12 particle therapy centers in Japan. Eventually, we enrolled 174 patients who met the inclusion criteria. Of the 174 patients, 137 (78.7%) were male, with a median age of 69 years (range: 41–88 years). Clinical stages included I (n = 55; 31.6%), II (n = 31; 17.8%), III (n = 82; 47.1%), IV (n = 3; 1.7%) and unknown (n = 3; 1.7%) (Union for International Cancer Control, seventh edition), and the median follow-up period was 908 days (range: 76–1669 days) for all patients. The 3-year overall survival (OS) rate, the 3-year progression-free survival (PFS) rate and the 3-year local control (LC) rates were 60.5, 53.2 and 72.7%, respectively. For each clinical stage, the 3-year OS rates were I, 84.8%; II, 60.3% and III, 42.9%; the 3-year PFS rates were I, 71.9%; II, 58.3% and III, 37.0% and the 3-year LC were I, 78.4%; II, 79.8% and III, 65.2%, respectively. Notably, four patients (2.3%) with ≥Grade 3 cardiopulmonary toxicities were observed (Common Terminology Criteria for Adverse Events, version 5.0). Our study showed that particle therapy for esophageal cancer has lower rates of adverse cardiopulmonary events than X-ray radiotherapy.
A qualitative analysis of female patient perspectives on physician communication regarding sexual dysfunction associated with pelvic radiotherapy
Authors: Morgan Orly , Schnur Julie , Caban-Martinez Alberto J , Duenas-Lopez Mariana , Huang Marilyn , Portelance Lorraine , Elkhadem Adam , Marshall Deborah C
Published: April 2023

Background

Sexual dysfunction is a known side effect of pelvic radiotherapy, resulting from a complex intersection of physiologic and psychosocial factors. Maintaining sexual function is relevant to long-term quality of life and is an important aspect of survivorship. Many female patients report being insufficiently informed before treatment about the potential sexual side effects of radiation therapy.

Aim

To elucidate how radiation oncologists communicate sexual function side effects with their female patients and how discussing sexual side effects of cancer treatment can positively affect patient-physician rapport.

Methods

Semistructured interviews in English and Spanish were conducted with 20 female participants who received pelvic radiation as part of their cancer treatment. Patients responded to advertisements or were referred by physicians. All interviews were conducted virtually between June and October 2021. Thematic analysis was conducted with NVivo. Patients also completed an online demographics survey in REDCap.

Outcomes

We found 4 primary themes addressing patient perspectives on patient-physician communication of sexual dysfunction and how it affected the cancer care experience.

Results

Theme 1: This may be expected, but I didn’t expect it! The participants who were not properly informed about sexual side effects felt blindsided and embarrassed about their symptoms. Theme 2: I do not feel like a woman anymore . . . The psychological impact included lower self-esteem and no longer feeling sexy nor like a woman. Theme 3: Fine, I’ll deal with this myself! Patients turned to the internet rather than their doctors for answers once they began experiencing symptoms, and they found information, normalization, and community online. Theme 4: Ask me about my sex life and find out if sex is a priority for me. Participants emphasized that their radiation oncologist should take a sexual history early to monitor sexual dysfunction and to identify individual patient priorities surrounding sex posttreatment.

Clinical Implications

This evidence provides a guide to patient-physician communication that may help to mitigate the impacts of radiotherapy on female sexual function as well as the negative impact that the absence of communication about sexual dysfunction may have on patient-physician trust.

Strengths and Limitations

While this project did have a small sample size, there is considerable diversity in race, education level, and age, with interviews conducted in Spanish and English.

Conclusion

Overall these findings provide physicians with important information about the unmet information needs of patients and their preferences for how to help them feel more prepared and less distressed when sexual dysfunction occurs.
The once-invisible legacy of Elizabeth L. Kerr, a naturalist in the early 20th century, and her contributions to Colombian ornithology
Authors: Soto-Patiño Juliana , Certuche-Cubillos Katherine , Díaz-Cárdenas Jessica , Garzón-Lozano Daniela , Guzmán-Moreno Estefanía , Niño-Rodríguez Nelsy , Pérez-Amaya Natalia , Ocampo-Peñuela Natalia
Published: April 2023

Mrs. Elizabeth L. Kerr was a bird and mammal collector who traveled to Colombia in the early 20th century when women had very limited access to education or scientific expeditions. Despite her notable contributions to Colombian ornithology, including collecting the holotype of a new species to science (Chocó Tinamou—Crypturellus kerriae), her name is not mentioned in historical accounts of ornithology in Colombia. Here, we describe what we know about Kerr’s life as a collector and her legacy in the study of Colombian birds. We highlight the fact that Kerr has become a role model for female naturalists and provide a short account of an all-female ornithological expedition to resurvey one of Kerr’s collecting sites. By bringing Kerr’s legacy to the public eye, we hope to raise awareness of implicit bias and barriers faced by women in science.
N6-methyladenosine RNA methylation modulates liquid‒liquid phase separation in plants
Authors: Kang Hunseung , Xu Tao
Published: April 2023

Membraneless biomolecular condensates form distinct subcellular compartments that enable a cell to orchestrate numerous biochemical reactions in a spatiotemporal-specific and dynamic manner. Liquid‒liquid phase separation (LLPS) facilitates the formation of membraneless biomolecular condensates, which are crucial for many cellular processes in plants, including embryogenesis, the floral transition, photosynthesis, pathogen defense, and stress responses. The main component required for LLPS is a protein harboring key characteristic features, such as intrinsically disordered regions, low-complexity sequence domains, and prion-like domains. RNA is an additional component involved in LLPS. Increasing evidence indicates that modifications in proteins and RNAs play pivotal roles in LLPS. In particular, recent studies have indicated that N6-methyladenosine (m6A) modification of messenger RNA is crucial for LLPS in plants and animals. In this review, we provide an overview of recent developments in the role of mRNA methylation in LLPS in plant cells. Moreover, we highlight the major challenges in understanding the pivotal roles of RNA modifications and elucidating how m6A marks are interpreted by RNA-binding proteins crucial for LLPS.
Age-Related Differences in Job Search Behavior: Do Older Jobseekers Need a Larger Social Network?
Authors: Guillemyn Inés , Horemans Jeroen
Published: April 2023

Increasing the employment rate of individuals aged 55+ is a key challenge in many OECD countries. While labor market discrimination and policy measures have been put forward as possible explanations, the role of job search remains largely unexplored. Yet, it determines to a large extent the match between supply and demand on the labor market. In this paper, we examine age-related differences in job search behavior. As skills have often become outdated for older workers, but job mobility may enhance their employment, we analyze search behavior for the unemployed as well as the employed adopting multiple parameters: job search intensity, use of the public employment agency, and social networking. The results indicate that jobseekers of different age employ different search methods, and that this relationship should be analyzed within the employment context of the jobseeker.
A 15-Year Review of 260 Children With Auditory Neuropathy Spectrum Disorder: I. Demographic and Diagnostic Characteristics
Authors: Morlet Thierry , Parkes William , Pritchett Cedric , Venskytis Emily , DeVore Brooke , O’Reilly Robert C.
Published: April 2023

Objectives:

The aim of the study was to review the demographic and clinical characteristics of all pediatric patients diagnosed with auditory neuropathy spectrum disorder (ANSD) by a pediatric health care system from 2005 to 2020 and examine whether or not our diagnostic capabilities in an ANSD population have evolved as our institutional experience has grown and knowledge in the field has expanded.

Design:

This was a retrospective study reviewing the demographic data, medical history, imaging studies, audiological and speech-language data, type of audiological intervention and mode of communication in 260 pediatric patients diagnosed with ANSD over a 15-year period.

Results:

The study revealed that male and female children were equally affected with all levels of hearing detection being represented and that about 40% of affected children were premature and most were admitted to the neonatal intensive care unit. More than a third of our patients presented with a complex medical history and/or neural involvement while about 30% were full-term newborns with normal pregnancy, no prenatal complications or infections, normal birth weight, no neonatal intensive care unit need, no hyperbilirubinemia, no respiratory distress requiring ventilation, and no known syndrome. Review of audiological findings confirms that otoacoustic emissions are not always present in ANSD cases, and that the presence of an abnormal wave V on the auditory brainstem response tracings (only present at high intensities and with an absent intensity/latency function) is not a rare finding and should not immediately be dismissed as not being a case of ANSD.

Conclusions:

This review of ANSD diagnosis over a 15-year period clearly reveals the drastic improvements made in the identification of ANSD, with a drastic decrease in the age at diagnosis and a reduction in the percentage of misdiagnosed patients. The study also stresses the need for continued improvement in different areas such as genetic studies and physiological measures to help clinicians distinguish between pre- and postsynaptic ANSD.
Osteosarcopenia in the Spine Beyond Bone Mineral Density
Authors: Haffer Henryk , Muellner Maximilian , Chiapparelli Erika , Dodo Yusuke , Zhu Jiaqi , Han Yi Xin , Donnelly Eve , Tan Ek T. , Shue Jennifer , Sama Andrew A. , Cammisa Frank P. , Girardi Federico P. , Hughes Alexander P.
Published: April 2023

Study Design.

Prospective cross-sectional study.

Objective.

To determine if an accumulation of advanced glycation endproducts (AGEs) is associated with impaired paraspinal muscle composition.

Background.

Impaired bone integrity and muscle function are described as osteosarcopenia. Osteosarcopenia is associated with falls, fragility fractures, and reduced quality of life. Bone integrity is influenced by bone quantity (bone mineral density) and quality (microarchitecture and collagen). The accumulation of AGEs stiffens collagen fibers and increases bone fragility. The relationship between paraspinal muscle composition and bone collagen properties has not been evaluated.

Methods.

Intraoperative bone biopsies from the posterior superior iliac spine were obtained and evaluated with multiphoton microscopy for fluorescent AGE cross-link density (fAGEs). Preoperative magnetic resonance imaging measurements at level L4 included the musculus (m.) psoas and combined m. multifidus and m. erector spinae (posterior paraspinal musculature, PPM). Muscle segmentation on axial images (cross-sectional area, CSA) and calculation of a pixel intensity threshold method to differentiate muscle (functional cross-sectional area, fCSA) and intramuscular fat (FAT). Quantitative computed tomography was performed at the lumbar spine. Univariate and multivariable regression models were used to investigate associations between fAGEs and paraspinal musculature.

Results:

One hundred seven prospectively enrolled patients (50.5% female, age 60.7 y, BMI 28.9 kg/m2) were analyzed. In all, 41.1% and 15.0% of the patients demonstrated osteopenia and osteoporosis, respectively. Univariate linear regression analysis demonstrated a significant association between cortical fAGEs and CSA in the psoas (ρ=0.220, P=0.039) but not in the PPM. Trabecular fAGEs revealed no significant associations to PPM or psoas musculature. In the multivariable analysis, higher cortical fAGEs were associated with increased FAT (β=1.556; P=0.002) and CSA (β=1.305; P=0.005) in the PPM after adjusting for covariates.

Conclusion.

This is the first investigation demonstrating that an accumulation of nonenzymatic collagen cross-linking product fAGEs in cortical bone is associated with increased intramuscular fat in the lumbar paraspinal musculature.
Median Nerve Neuropathy Caused by Persistent Median Artery Thrombosis
Authors: Miyashima Yusuke , Gotani Hiroyuki , Okamoto Kotaro , Yagi Hirohisa , Tanaka Yoshitaka
Published: April 2023

Persistent median artery thrombosis mimicking carpal tunnel syndrome is rare. Here, we report the pathological, ultrasonography, and intraoperative findings of a case of persistent median artery thrombosis mimicking carpal tunnel syndrome. A 34-year-old man reported to our clinic with a complaint of numbness in his left thumb, index finger, and middle finger, which are innervated by the left median nerve. He also reported that he felt pain in his left wrist and distal forearm while working. Although findings of the usual provocative tests and nerve conduction studies were normal, ultrasonography revealed arterial thrombosis at the carpal tunnel level, whereas magnetic imaging showed persistent median artery thrombosis in the carpal tunnel. Three months after surgical resection of the thrombosed section of the artery, the patient fully recovered with no residual pain or limitations in the use of the affected arm. His patient-reported outcomes improved as well. It is important to investigate the existence of persistent median artery thrombosis if a patient presents with atypical symptoms of carpal tunnel syndrome. Ultrasonography is useful for the diagnosis of persistent median artery thrombosis. Surgical resection of a thrombosed persistent median artery in patients with carpal tunnel syndrome yields good results.
Inducing Ulnar Nerve Function while Eliminating Claw Hand and Reducing Chronic Neuropathic Pain
Authors: Foy Christian A. , Micheo William F. , Kuffler Damien P.
Published: April 2023

Ulnar nerve injury induces chronic neuropathic pain and is frequently devastating due to loss of cupping the hand around objects (finger clawing) and diminished grip strength. There is little chance of restoring good function, eliminating finger clawing, or reducing the pain. A novel technique was tested for its efficacy in promoting ulnar nerve function and reducing finger clawing and chronic neuropathic pain. A 25-year-old subject presented 5.7 months after a wrist gunshot that created three nerve gaps proximal to the deep ulnar nerve branch. He sought restoration of function due to developing ulnar nerve injury-induced claw hand and increasingly severe chronic neuropathic pain. After resection of the scarred nerve tissue, each gap was 10 cm long. The gaps were bridged with two nonreversed sural nerve grafts within a PRP-filled NeuroMend collagen tube (Collagen Matrix, Oakland, N.J.). Some axons regenerated entirely across all three 10-cm-long repaired nerve gaps, restoring excellent topographically correct sensitivity of S4, including two-point discrimination of 4 mm, good M4 motor function, and full ROM. The ulnar nerve injury-induced finger clawing was eliminated, and the chronic neuropathic pain of 7 was reduced to 0 on a 0–10 validated scale and did not return over the following 3.75 years. Thus, this novel technique induces good sensory and motor function, despite repairing three 10-cm-long nerve gaps while eliminating ulnar nerve injury-induced hand clawing and chronic neuropathic pain. Further studies are required to determine whether the effects were due to PRP.
Risk Management-Obstetrics and Gynecology Perspective
Authors: Painter Lisa M. , Biggans Keirstyn A. , Turner Chatón T.
Published: April 2023

The Obstetrics and Gynecology physician’s likelihood to experience medical malpractice claims are higher than in other medical specialties. We will review the basic principles of health care risk management, the role of the risk manager, and the importance of health care risk management in risk mitigation for obstetrics and gynecology physicians. Attention is focused on medical record documentation, disclosure of adverse events, second victim programs, grievance management techniques, alternative dispute resolution concepts, regulatory inquiries including state licensure investigations, product failures, and electronic media strategies. Concluding, health care risk management may be used as a claim avoidance tool and provider protective vehicle for physicians.
Expression of Human Papillomavirus and the p16 Gene in Oral Potentially Malignant Disorders (OPMD): a Comparative Study With Oral Squamous Cell Carcinoma
Authors: Baddevithana Asinsala K. , Jayasinghe Ruwan D. , Tilakaratne Wanninayake M. , Illeperuma Rasika P. , Siriwardena Bogahawatte S.M.S.
Published: April 2023

Background:

The incidence of oral squamous cell carcinoma (OSCC) of the tongue is increasing in the younger population without traditional risk habits that lead researchers to find other related factors such as diet and viruses, especially human papillomavirus (HPV). It is noteworthy that many OSCCs develop from oral potentially malignant disorders (OPMDs). Correct diagnosis and timely management of OPMDs may help to prevent malignant transformation, and therefore it is worth seeing the involvement of HPV in OPMDs and oral cancers, as the preventive and curative measures in HPV-induced cancer types are different from the conventional types of OPMDs and OSCCs. Therefore, the main objective of this study was to identify a relationship between HPV and p16 in OPMDs and compare it with OSCC.

Methods:

This study was conducted on 83 cases of known OSCCs and OPMDs (oral submucous fibrosis, leukoplakia, and oral lichen planus). Assays, such as polymerized chain reaction (PCR) and reverse transcription-PCR, were carried out for HPV and p16. The results were compared with clinical information and with the literature. The results were analyzed using SPSS 16.0 for windows.

Results:

P16 expression was mostly seen in males than in female patients. Out of 21 cases of keratosis with dysplasia, 19% expressed p16. Of 26 oral lichen planus patients, 29% showed the p16 gene with immunohistochemistry. Interestingly, a high percentage of OSF cases expressed p16 (48.27%). Minimal expression was observed in OSCC (6.25%). HPV DNA was detected in 2.4% of the total sample. Both p16 and HPV were detected in a single case of OSCC. OPMDs expressed a significant amount of the p16 gene by immunohistochemistry and reverse transcription-PCR technique when compared with malignant lesions, suggesting a possible inactivation of the p16 gene. HPV and p16 are mostly negative in our OSCC sample, exhibiting low prevalence.

Conclusions:

OPMDs expressed a significant amount of the p16 gene when compared with malignant lesions, suggesting a possible inactivation of the p16 gene. Although OSF expressed p16, HPV was not detected, suggesting that over-expression could be independent of HPV. OSCC shows low HPV prevalence.
Moving from Vaccine Hesitancy to Acceptance: Engaging Underrepresented Employees in a Pediatric Academic Medical Center
Authors: Connor Jean A. , Fynn-Thompson Francis , Horgan James J. , Luff Donna , Hickey Patricia A. , Ward Valerie L.
Published: April 2023

Introduction:

Underrepresented populations historically underserved by the healthcare system and/or marginalized by systematic policies regionally and nationally were particularly vulnerable during the COVID-19 pandemic. While vaccine hesitancy has been described among hospital employees, the employees’ experiences from an underrepresented population cohort have not been reported. We, therefore, sought to understand employees’ vaccine experiences, hesitancy, and ways to enhance ongoing COVID-19 vaccine education and communication to build a hospital-wide culture of vaccine acceptance.

Methods:

We invited interprofessional staff from 5 clinical departments to participate in qualitative focus groups. Guiding questions were used to explore the experiences and perceptions of the staff. Using content analysis, we identified themes and recommendations for improvement.

Results:

We conducted 5 focus group sessions with over 50 participants. Four themes emerged; “Vaccine Fears Past and Present,” “Access to Information,” “Worries for Families,” and “Our Hospital is a Trusted Name.” Participants also provided recommendations for improvement in the messaging around the vaccine rollout. Consideration of how different employees access information, listening to staff needs, and recognizing the role of race and history were critical to engaging and improving the underrepresented employees’ vaccine acceptance.

Conclusions:

Exploring the concerns and fears of the COVID-19 vaccine within groups of underrepresented staff members through qualitative methods was key to understanding their vaccine hesitancy and implementing strategies to move toward vaccine acceptance in the hospital.
Short-term Quality of Life after Autologous Compared to Alloplastic Breast Reconstruction: A Prospective Study
Authors: Sadok Nadia , Krabbe-Timmerman Irene S. , Buisman Nina H. , van Aalst Vera C. , de Bock Geertruida H. , Werker Paul M.N.
Published: April 2023

Background:

The aim of this prospective multi-center study was to evaluate whether autologous breast reconstruction (BR) leads to lower short-term Quality of Life (QoL) compared to alloplastic BR, due the more physically demanding surgery and increased risk of severe complications of autologous BR.

Methods:

Changes in QoL following BR were measured in this prospective multi-center study using the Breast-Q questionnaire which was administered preoperatively, and at six weeks and six months postoperatively. Characteristics and complications, classified according to Clavien-Dindo (CD), were compared between alloplastic and autologous groups. Profile plots and generalized Linear regression models were constructed to analyze the Breast-Q subscales over time for both BR groups.

Results:

Preoperatively, women undergoing autologous BR scored lower on all Breast-Q scales compared to women undergoing alloplastic BR, regardless whether they underwent immediate or delayed BR. Women undergoing autologous BR scored higher at six weeks and six months postoperative on “satisfaction with breasts” (p=0.001), “psychosocial well-being” (p=0.024) and “sexual well-being” (p=0.007). Postoperative “physical well-being: chest” was similar between both groups (p=0.533). CD grade ≥III complications occurred more often among women in the autologous group (27% versus 12%, p=0.042). Complications were not associated with worse Breast-Q scores on any of the subscales.

Conclusion:

In contrast to our expectations and despite the higher incidence of severe complications and lower preoperative breast satisfaction and QoL scores, women undergoing autologous BR have higher levels of breast satisfaction, and psychosocial and sexual well-being, both at six weeks and six months after BR compared to women undergoing alloplastic BR.
Mini-Shaped Kiss Flap Design for Palmar and Digital Soft Tissue Resurfacing
Authors: Zheng Youmao , Hallock Geoffrey G. , Levin L. Scott , Zhang Yixin , Min Peiru
Published: April 2023

Background:

Although palmar and digital soft tissue resurfacing with intrinsic flaps may provide functional and aesthetic reconstruction, the donor site may result in a tight closure or need for a skin graft once the flap is raised. In this series, the “mini-shaped kiss” flap was utilized to increase the resurfacing efficiency while preserving hand function.

Methods:

The mini-shaped kiss flaps based on common palmar digital arteries, princeps pollicis artery and ulnar palmar digital artery were developed for the resurfacing of distal or proximal finger areas. The tiny skin paddles were kissed together and transferred as pedicled in proposed dimensions and shape. The flap size, donor/recipient site, perforator source, whether free or pedicled, surgical outcome and donor site morbidity were evaluated.

Results:

20 mini-shaped kiss flaps were harvested for the purpose of palmar and digital resurfacing. The flap sizes varied from 3×1.2cm to 5×2cm. All 19 patients aged 6 to 52 years (mean 35 years) achieved successful reconstruction without major complications after 6 to12 months follow-up.

Conclusions:

The mini-shaped kiss flap technique exhibited favorable surgical outcomes with excellent color and texture match to the recipient sites. The reverse midpalm, thenar and hypothenar island flap can be raised at the cost of an unnoticeable linear scar with minimized functional compromise in the donor area.

CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
Vascularized Origami Medial Femoral Condyle Flap for Finger Joint Reconstruction
Authors: Hachisuka Hiroki , Ishibashi Shigeki , Shimose Shoji , Adachi Nobuo
Published: April 2023

Total finger joint reconstruction is challenging. Vascularized toe joint transfer is currently used for reconstruction, but it is difficult to perform, fails to achieve maximal joint flexibility, and is associated with donor site complications. As an alternative, we developed a vascularized medial femoral condyle flap technique, wherein the vascularized cortico-periosteum is shaped via origami, folding the donor tissue to fit the recipient site. Herein, we describe the use of this method for reconstruction of interphalangeal and metacarpophalangeal joints with a reduced range of motion. In our study, the mean age of the patients (three men, four women) was 51 years (range, 36–68 years), and the mean follow-up period was 3 years and 1 month (range, 4 months to 5 years). In the reconstructed joints, the mean range of motion; disabilities of the arm, shoulder, and hand score; and pinch strength of the unaffected side were 55° (range, 24°–90°), 2.3 (range, 0–6), and 98% (range, 70%–138%), respectively. No donor site morbidities were observed. Radiography and computed tomography revealed joint-like grafted tissue remodeling. The study findings suggest that the origami medial femoral condyle flap is useful for functional finger joint reconstruction. The procedure requires fabrication before grafting, but tissue harvest is relatively easy.

Level of Evidence: Therapeutic Level IV
Fingertip Replantation – Surgical Technique, and Tips and Tricks –
Authors: Hayashi Kota , Hattori Yasunori , Chia Dawn Sinn Yii , Sakamoto Sotetsu , Sonezaki Shicho , Doi Kazuteru
Published: April 2023

Successful replantation of fingertip amputations restores the original tissue and is the ideal treatment to provide the best aesthetic and functional outcome. However, successful fingertip replantation is considered challenging because it requires supermicrosurgery techniques.

This article provides a detailed surgical technique for fingertip replantation and our preferences and recommendations. In our experience, the most important factors for successful fingertip replantation are meticulous vascular dissection, reliable arterial repair and venous anastomosis to avoid postoperative venous congestion. Proximal arterial dissection until pulsatile bleeding is encountered avoids the zone of vascular injury, and is particularly important in crush or avulsion amputations. Distal arterial dissection is performed until undamaged intima is identified. We believe anastomosis to the central artery is reliable even in Tamai zoneⅡ amputation. When an arterial defect is present, we recommend using a vein graft to anastomose to the central artery. In additional, we highly recommend at least one venous anastomosis to avoid postoperative venous congestion. In Tamai zoneⅠ, available veins can be found on the palmar side of the pulp. It is important to search directly below the dermis and remove adipose tissue around the vessels to secure space for anastomosis. We consider nerve suture in Tamai zoneⅠ and Ⅱ replantations inessential, because spontaneous sensory recovery can be expected. Postoperative management of venous congestion, spasm in artery, and arterial thrombosis are as important as surgery.
Prognosis of Performing Split-Rib Bone Graft for Cranial Bone Defects
Authors: Hong Hyun Ki , Ryu Jeong Yeop , Lee Joon seok , Yang Jung Dug , Chung Ho Yun , Cho Byung Chae , Choi Kang Young
Published: April 2023

Background:

Frontal sinus anterior wall defects occur because of various diseases, causing not only aesthetic problems, such as forehead bulging and upper eyelid ptosis, but also exerting physical pressure on the brain or optic nerve. Therefore, this study aimed to evaluate the prognosis of performing split-rib bone graft for frontal sinus anterior wall defect.

Methods:

This study included 30 patients who received a split-rib bone graft for a frontal sinus anterior wall defect. The siz es and volumes of the defects and grafts were measured using three-dimensional computed tomography before, after, and every 6 months for 2 years after the surgery. The Medical Imaging Interaction Toolkit was used for analysis.

Results:

The average size and volume of the graft were 27.29 cm 2 and 5.88 cm 3, whereas they were 23.76 cm 2 and 4.80 cm 3 at 24 months after the surgery, respectively. In a graft size and volume of <27 cm 2 or 6 cm 3, the rate of graft take was >80% during long-term observation. The younger the age, the higher the rate of graft take. No difference was found in the defect causes. Absorption occurred for up to 18 months.

Conclusions:

Frontal bone defect reconstruction revealed the stable results of the split-rib bone graft over a long period when the size and volume were <27 cm 2 and 6 cm 3, respectively. Furthermore, bone resorption was seen in more than 20%–30% of the patients, and the rate of resorption increased with age; thus, it is appropriate to consider overcorrection and other reconstruction methods.
Adverse Tumour and Host Biology May Explain the Poorer Outcomes Seen in Emergency Presentations of Colon Cancer
Authors: Golder Allan M. , Conlan Owen , McMillan Donald C. , Mansouri David , Horgan Paul G. , Roxburgh Campbell S.
Published: April 2023

Objective:

To examine the association between tumor/host factors (including the systemic inflammatory response), mode of presentation, and short/long-term outcomes in patients undergoing curative resectional surgery for TNM I to III colon cancer.

Background:

Emergency presentations of colon cancer are associated with worse long-term outcomes than elective presentations despite adjustment for TNM stage. A number of differences in tumor and host factors have been identified between elective and emergency presentations and it may be these factors that are associated with adverse outcomes.

Methods:

Patients undergoing curative surgery for TNM I to III colon cancer in the West of Scotland from 2011 to 2014 were identified. Tumor/host factors independently associated with the emergency presentation were identified and entered into a subsequent survival model to determine those that were independently associated with overall survival/cancer-specific survival (OS/CSS).

Results:

A total of 2705 patients were identified. The emergency presentation was associated with a worse 3-year OS and CSS compared with elective presentations (70% vs 86% and 91% vs 75%). T stage, age, systemic inflammatory grade, anemia (all P < 0.001), N stage (P = 0.077), extramural venous invasion (P = 0.003), body mass index (P = 0.001), and American Society of Anesthesiologists Classification classification (P = 0.021) were independently associated with emergency presentation. Of these, body mass index [hazard ratio (HR), 0.82], American Society of Anesthesiologists Classification (HR, 1.45), anemia (HR, 1.29), systemic inflammatory grade (HR. 1.11), T stage (HR, 1.57), N stage (HR, 1.80), and adjuvant chemotherapy (HR, 0.47) were independently associated with OS. Similar results were observed for CSS.

Conclusions:

Within patients undergoing curative surgery for colon cancer, the emergency presentation was not independently associated with worse OS/CSS. Rather, a combination of tumor and host factors account for the worse outcomes observed.
Pre-existing left bundle branch block and clinical outcomes after transcatheter aortic valve replacement
Authors: Saito Tetsuya , Inohara Taku , Tsuruta Hikaru , Yashima Fumiaki , Shimizu Hideyuki , Fukuda Keiichi , Ohno Yohei , Nishina Hidetaka , Nakajima Yoshifumi , Izumo Masaki , Asami Masahiko , Naganuma Toru , Mizutani Kazuki , Yamawaki Masahiro , Tada Norio , Yamanaka Futoshi , Shirai Shinichi , Noguchi Masahiko , Ueno Hiroshi , Takagi Kensuke , Watanabe Yusuke , Yamamoto Masanori , Hayashida Kentaro
Published: April 2023

Background

There are currently few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR). Nor are there any studies comparing patients with new onset LBBB to those with pre-existing LBBB. This study aimed to investigate the association with pre-existing or new-onset LBBB and clinical outcomes after TAVR.

Methods

Using data from the Japanese multicenter registry, 5996 patients who underwent TAVR between October 2013 and December 2019 were included. Patients were classified into 3 groups: no LBBB, pre-existing LBBB and new onset LBBB. The 2-year clinical outcomes were compared between 3 groups using Cox proportinal hazard models and propensity score analysis to adjust the differences in baseline characteristics.

Results

Of 5996 patients who underwent TAVR, 280 patients (4.6%) had pre-existing LBBB and new onset LBBB occurred in 1658 patients (27.6%). Compared with no LBBB group, multivariable Cox regression analysis showed that pre-existing LBBB was associated with a higher 2-year all-cause (adjusted hazard ratio [aHR]: 1.39; 95% confidence interval [CI]: 1.06-1.82; p =0.015) and cardiovascular mortality (aHR: 1.62; 95% CI: 1.05-2.54; p =0.027), but also with higher all-cause (aHR:1.43, 95% CI:1.07-1.91; p =0.016) and cardiovascular mortality (aHR: 1.84, 95% CI: 1.14-2.98; p =0.012) than new onset LBBB group. Heart failure was the most common cause of cardiovascular death, with more heart failure deaths in the pre-existing LBBB group.

Conclusions

Pre-existing LBBB was independently associated with poor clinical outcomes reflecting increased risk of cardiovascular mortality after TAVR. Patients with pre-existing LBBB should be carefully monitored.

What is Known?

There are currently few reports on pre-existing left bundle branch block (LBBB) in patients undergoing transcatheter aortic valve replacement (TAVR). Nor are there any studies comparing patients with new onset LBBB to those with pre-existing LBBB.

What the Study Add?

Patients with pre-existing LBBB not only had a higher mortality than those without LBBB, but also had a worse prognosis than those with new onset LBBB.

This was because patients with pre-existing LBBB had more heart failure deaths.

Patients with pre-existing LBBB should be carefully monitored after TAVR. Further investigation will be required to corroborate our findings.
Associations between vitamin D and autoimmune diseases: Mendelian randomization analysis
Authors: Zhao Sizheng Steven , Mason Amy , Gjekmarkaj Eva , Yanaoka Haruyuki , Burgess Stephen
Published: April 2023

Objective

The VITAL trial of vitamin D supplementation suggested a possible protective effect for autoimmune diseases but uncertainties remain. We investigated potential causal effects of vitamin D on composite and individual autoimmune diseases using Mendelian randomization.

Methods

We used data from 332,984 participants of the UK Biobank of whom 23,089 had at least one autoimmune disease defined using ICD code and/or self-report. Diseases were further considered in mechanistic subgroups driven by “autoimmunity” (n=12,774) or “autoinflammation” (n=11,164), then individually. We selected variants within gene regions implicated in vitamin D biology to generate a weighted genetic score. We performed population-wide analysis using the ratio method, then examined non-linear effects across five quantiles based on 25-hydroxycholecalciferol levels.

Results

Genetically-predicted vitamin D was associated with lower risk of diseases in the autoinflammation group (OR 0.95 per 10ng/ml increase in 25-hydroxycholecalciferol; 95%CI 0.91-0.99; p=0.03) but not the autoimmunity group (OR 0.99; 95%CI 0.95-1.03; p=0.64) or combined. When considering individual diseases, genetically-predicted vitamin D was associated with lower risk of psoriasis (OR 0.91; 95%CI 0.85-0.97; p=0.005), the most common disease in the autoinflammation group, and suggestively with systemic lupus erythematosus (OR 0.84; 95%CI 0.69-1.02; p=0.08); results were replicated using data from independent studies. We found no evidence for a plausible non-linear relationship between vitamin D and any outcome.

Conclusions

We found genetic evidence to support a causal link between 25-hydroxycholecalciferol concentrations and psoriasis and systemic lupus erythematosus. These results have implications for potential disease prevention strategies, and the interpretation and design of vitamin D supplementation trials.
Dose-response relationship for the resistance of human insulin to degradation by insulin-degrading enzyme
Authors: Okumura Masaki , Kuramochi Tsubura , Lin Yuxi , Furukawa Ran , Mizutani Kenji , Yokoyama Takeshi , Kim Mingeun , Lim Mi Hee , Yi Hyon-Seung , Arai Kenta , Yamaguchi Hiroshi , Hojo Hironobu , Iwaoka Michio , Tanaka Yoshikazu , Park Sam-Yong , Inaba Kenji , Kanemura Shingo , Lee Young-Ho
Published: April 2023

Deeper understanding of the mechanism of the action of insulin and insulin-degrading enzyme (IDE) is a central theme in research into physiology and the pathophysiology of type 2 diabetes mellitus. Despite significant progress regarding the substrate recruitment, unfolding, digestion, and release by IDE, the structure and function of the insulin hexamer during the degradation cycle of IDE remain to be fully characterized. In the present study, we have characterized the behavior of human insulin hexamer in the absence of zinc. Using cryo-electron microscopy, we also observed that these hexamers represented a structure similar to that of T6insulin. More interestingly, we also observed complexes in which some of their monomeric insulin components are partially distorted at their hexametric symmetry. This ensures that insulin determines the kinetics of its degradation by IDE without the requirement for zinc. These findings provide new information regarding the molecular events in insulin assembly and disassembly that permit its selective digestion by IDE.
Risk of incident cardiovascular disease among patients with gastrointestinal disorder: prospective cohort study of 340,862 individuals
Authors: Chen Jie , Sun Yuhao , Fu Tian , Lu Shiyuan , Shi Wenming , Zhao Jianhui , Li Sen , Li Xue , Yuan Shuai , Larsson Susanna C.
Published: April 2023

Background and Aims

The associations between gastrointestinal diseases (GIs) and cardiovascular disease (CVD) were unclear. We conducted a prospective cohort study to explore their associations.

Methods

This study included 340,862 individuals without baseline CVD from the UK Biobank cohort. Individuals with and without GIs were followed up until the ascertainment of incident CVDs, including coronary heart disease (CHD), cerebrovascular disease (CeVD), and peripheral artery disease (PAD). The diagnosis of diseases was confirmed with combination of the nationwide inpatient data, primary care data, and cancer registries. A multivariable Cox proportional hazard regression model was used to estimate the associations between GIs and the risk of incident CVD.

Results

During a median follow-up of 12.4 years, 28,787 incident CVD cases were diagnosed. Individuals with GIs had an elevated risk of CVD (hazard ratio 1.38; 95% confidence interval 1.35-1.42,P<0.001). Eleven out of fifteen GIs were associated with an increased risk of CVD after Bonferroni-correction, including cirrhosis, non-alcoholic fatty liver disease, gastritis and duodenitis, irritable bowel syndrome, gastroesophageal reflux disease, peptic ulcer, celiac disease, pancreatitis, diverticular disease, biliary disease, and appendicitis. The associations were stronger among women, individuals aged ≤ 60 years, and those with body mass index ≥ 25 kg/m2.

Conclusions

This large-scale prospective cohort study revealed the associations of GIs with an increased risk of incident CVD, in particular CHD and PAD. These findings support the reinforced secondary CVD prevention among patients with gastrointestinal disorders.
Epistasis meets pleiotropy in shaping biophysical protein subspaces associated with antimicrobial resistance
Authors: Ogbunugafor C. Brandon , Guerrero Rafael F. , Shakhnovich Eugene I. , Shoulders Matthew D.
Published: April 2023

Protein space is a rich analogy for genotype-phenotype maps, where amino acid sequence is organized into a high-dimensional space that highlights the connectivity between protein variants. It is a useful abstraction for understanding the process of evolution, and for efforts to engineer proteins towards desirable phenotypes. Few framings of protein space consider how higher-level protein phenotypes can be described in terms of their biophysical dimensions, nor do they rigorously interrogate how forces like epistasis—describing the nonlinear interaction between mutations and their phenotypic consequences—manifest across these dimensions. In this study, we deconstruct a low-dimensional protein space of a bacterial enzyme (dihydrofolate reductase; DHFR) into “subspaces” corresponding to a set of kinetic and thermodynamic traits [(kcat, KM,Ki, andTm(melting temperature)]. We then examine how three mutations (eight alleles in total) display pleiotropy in their interactions across these subspaces. We extend this approach to examine protein spaces across three orthologous DHFR enzymes (Escherichia coli, Listeria grayi, andChlamydia muridarum), adding a genotypic context dimension through which epistasis occurs across subspaces. In doing so, we reveal that protein space is a deceptively complex notion, and that the process of protein evolution and engineering should consider how interactions between amino acid substitutions manifest across different phenotypic subspaces.
The topology of interpersonal neural network in weak social ties
Authors: Kurihara Yuto , Takahashi Toru , Osu Rieko
Published: April 2023

People often have opportunities to engage in social interactions with strangers, which have been reported to contribute to their well-being. Although strategies for social interaction between strangers differ from those between acquaintances, the differences in neural basis of social interaction have not been fully elucidated. In this study, we examined the geometrical properties of interpersonal neural networks in pairs of strangers and acquaintances during joint tapping using dual electroencephalography (EEG). Twenty-one pairs of participants performed antiphase joint tapping under four different conditions. Intra-brain synchronizations were calculated using the weighted phase lag index (wPLI) for all possible intra-brain pairs of the 29 channels (29C2= 406), and inter-brain synchronizations were calculated using the phase locking value (PLV) for all possible inter-brain pairs of the 29 channels (29 × 29 = 841) in the theta, alpha, and beta frequency bands. Electrode pairs with larger wPLI and PLV than their surrogates were defined as the nodes (EEG channels) and edges (connections between nodes) of the neural networks. We then calculated the global efficiency, local efficiency, clustering coefficient, and modularity derived from graph theory for the combined intra- and inter-brain networks of each pair. No significant differences in the tapping phase variance were identified between the stranger and acquaintance pairs. However, in the combined intra- and inter-brain theta EEG (4–7 Hz) networks, stranger pairs showed larger local efficiency and cluster coefficients than acquaintance pairs, indicating that the two brains of stranger pairs were more densely connected. Moreover, in the beta EEG bands, the modularity of the two brains was low in the fast condition, indicating that the two brains were coupled when the task demand was high. Our results show that weak social ties promote more extensive social interactions and result in dense brain-to-brain coupling.