bluuebunny/crossref_metadata_2025 huggingface dataset:
Explaining the pseudogap through damping and antidamping on the Fermi surface by imaginary spin scattering
Authors: Krien Friedrich , Worm Paul , Chalupa-Gantner Patrick , Toschi Alessandro , Held Karsten
Published: December 2022

The mechanism of the pseudogap observed in hole-doped cuprates remains one of the central puzzles in condensed matter physics. We analyze this phenomenon via a Feynman-diagrammatic inspection of the Hubbard model. Our approach captures the pivotal interplay between Mott localization and Fermi surface topology beyond weak-coupling spin fluctuations, which would open a spectral gap near hot spots. We show that strong coupling and particle-hole asymmetry trigger a very different mechanism: a large imaginary part of the spin-fermion vertex promotes damping of antinodal fermions and, at the same time, protects the nodal Fermi arcs (antidamping). Our analysis naturally explains puzzling features of the pseudogap observed in experiments, such as Fermi arcs being cut off at the antiferromagnetic zone boundary and the subordinate role of hot spots.
Rechargeable and highly stable Mn metal batteries based on organic electrolyte
Authors: He Xincheng , Li Zipeng , Tang Run , Chen Yingying , Meng Xin , Zheng Feize , Zhang Yinghe , Liu Jun
Published: December 2022

Mn metal batteries are rarely reported due to the lack of a stable electrolyte.
Microcrystal electron diffraction (MicroED) structure determination of a mechanochemically synthesized co-crystal not affordable from solution crystallization
Authors: Sasaki Toshiyuki , Nakane Takanori , Kawamoto Akihiro , Nishizawa Tomohiro , Kurisu Genji
Published: December 2022

A mechano-distinctive crystal structure of a co-crystal of 2-aminopyrimidine and succinic acid was successfully determined by MicroED.
Silver thiolate nanoclusters as support for chiral ligands: application in heterogeneous phase asymmetric catalysis
Authors: Primitivo Ludovica , De Angelis Martina , Necci Andrea , Di Pietro Federica , Ricelli Alessandra , Caschera Daniela , Pilloni Luciano , Suber Lorenza , Righi Giuliana
Published: December 2022

A nanocatalyst with chiral amino alcohol catalytic function was efficiently employed in the Henry reaction, easily recovered by centrifugation and reused without loss of activity.
A narrowband red-emitting asymmetric iridium(iii) complex featuring B- and N-embedded π-conjugation units: structure, photophysics and OLED application
Authors: Wu Meng , Li Nengquan , Shi Chao , Song Jialiang , Zeng Ruoqi , Li Feiyang , Li Qiuxia , Yuan Aihua , Yang Chuluo
Published: December 2022

A new B- and N-embedded asymmetric iridium complex IrBNacac has been prepared. It exhibited an effective red emission in solid films with a very narrow full width at half maximum (FWHM = 50 nm) and finally achieved a good OLED device performance.
Theoretical and experimental progress of metal electrocatalysts for the nitrogen reduction reaction
Authors: Zhang Shishi , Zhang Xiaoxue , Liu Chengguang , Pan Lun , Shi Chengxiang , Zhang Xiangwen , Huang Zhen-Feng , Zou Ji-Jun
Published: December 2022

We reviewed the NRR performance of metal-based electrocatalysts with different sizes, further discussing the modulating strategies of highly efficient electrocatalysts.
Activity-driven tissue alignment in proliferating spheroids
Authors: Ruske Liam J. , Yeomans Julia M.
Published: December 2022

We extend the continuum theory of active nematic fluids to study cell flow and tissue dynamics inside multicellular spheroids, which are spherical, self-assembled cell aggregates widely used as model systems to study tumour dynamics.
Multivalent ruthenium immobilized by self-supported NiFe–organic frameworks for efficient electrocatalytic overall water splitting
Authors: Jiang Wei , Wang Jia , Jiang Yu , Wu Yuanyuan , Liu Bo , Chu Xianyu , Liu Chunbo , Che Guangbo , Lu Yang
Published: December 2022

A Ru-doped and self-supported metal–organic framework/nickel–iron foam electrode demonstrates an efficient and durable electrocatalytic activity for overall water splitting.
Improving the intrinsic conductivity of δ-MnO2 by indium doping for high-performance neutral aqueous sodium-ion supercapacitors with commercial-level mass-loading
Authors: Li Borui , Chu Yanfang , Xie Bin , Sun Yuchen , Zhang Lin , Zhao Hongmei , Zhao Lei , Liu Peng-Fei , He Junjie
Published: December 2022

Indium is introduced to δ-MnO2 for the first time. The conductivity of δ-MnO2 can be doubled and a high specific capacity can be achieved at a commercial-level mass loading.
Growth modulation of nonlayered 2D-MnTe and MnTe/WS2 heterojunctions for high-performance photodetectors
Authors: Wang Taikun , Sun Fapeng , Hong Wenting , Jian Chuanyong , Ju Qinkun , He Xu , Cai Qian , Liu Wei
Published: December 2022

A comparison between the photoelectric performance of a two-dimensional MnTe-based photodetector and a two-dimensional MnTe–WS2-based photodetector.
Design and characterisation of the high‐current DC breaker driven by explosive
Authors: Tang Cunwen , Li Hua , Song Zhiquan , Ye Jifei , Xu Meng , Hu Xingguang , Peng Fu
Published: December 2022

The development of a high‐current DC breaker is very important for the protection of the expensive superconducting magnet. A kind of an economic switch called pyrobreaker, which is driven by explosive detonation waves, has been used as the backup quench protection due to its inherent reliability and fast response. A prototype pyrobreaker with a special structure that can withstand and break 100 kA is discussed. The numerical material model is taken to calculate the fracture demand of contact and the mass demand of explosive. Then, the detonation wave and contact breaking process are simulated by the ANSYS software. The performance of the design and characterisation during dynamic breaking are compared with simulation and no‐load experiment test. At the end, the temperature rise test and the breaking test under 100 kA are completed successfully. These results demonstrate that the design of 100 kA pyrobreaker is reliable.
Topology review of doubly grounded transformer‐less single‐phase inverters
Authors: Yao Zhilei
Published: December 2022

Photovoltaic (PV) transformer‐less single‐phase inverters are widely used in the solar generation systems because of low cost, high power density, and high efficiency. However, there is a common mode leakage current in the transformer‐less inverters, which may endanger personal safety. In order to reduce the common mode leakage current, extra semiconductors should be added into the PV inverters to decouple the dc side from the ac side. However, the common mode leakage current is affected by the environmental condition and parameters of power devices. Since grounds of the PV array and the output terminal of the inverter are shorted, the common mode leakage current in the doubly grounded inverters can be eliminated thoroughly. Topologies of the doubly grounded inverters are reviewed in this paper, which can be divided into two categories, that is, hybrid topologies and topologies using energy storage elements. Derivation of the reviewed topologies is given. Different topologies of doubly grounded transformer‐less single‐phase inverters are compared.
Ein fallbasiertes Unterrichtskonzept mit praktischen Übungen im Fach Hygiene und Mikrobiologie: ein nachhaltiges Unterrichtskonzept zur Umsetzung der neuen Approbationsordnung in klinisch-theoretischen Fächern
Authors: Himmels Jan P.W. , Sterz Jasmina , Rüsseler Miriam , Kempf Volkhard A.J. , Brandt Claudia
Published: December 2022

Hintergrund Im Rahmen eines Lehrverbesserungsprojekts an der Goethe-Universität, Frankfurt am Main wurde das Praktikum Hygiene und Mikrobiologie für Studierende der Humanmedizin von einem Organsystem-bezogenen auf ein fallbasiertes Unterrichtsmodell umgestellt. Begleitend wurde diese Umstellung im Hinblick auf eine Verbesserung der Lernwahrnehmung und des Lernerfolgs untersucht.

Methoden An dem Projekt nahmen 54 Personen teil. In homogenen Fokusgruppen wurden 45 Studierende mit bis zu fünf Personen interviewt. Neun der Teilnehmenden waren Ärztinnen oder Ärzte, die in Einzelinterviews befragt wurden. Die Interviews wurden anhand eines Leitfadens offen durchgeführt, anschließend anonym transkribiert und einer strukturierten qualitativen Inhaltsanalyse unterzogen.

Ergebnis Die Ergebnisse belegen, dass sowohl Studierende als auch Ärztinnen und Ärzte im Praktikum Hygiene und Mikrobiologie eine fallbasierte Unterrichtsführung in Kombination mit dem Erwerb praktischer Kompetenzen präferieren. Studierende, die fallorientiert unterrichtet wurden, waren zufriedener und beklagten einen geringeren nachfolgenden Verlust des erworbenen theoretischen Fachwissens. Praktische Übungen im Fach Hygiene und Mikrobiologie waren allen Teilnehmenden auch noch nach langer Zeit gut erinnerlich. Unabhängig vom Unterrichtskonzept wurden die Dozenten als motivierende Schlüsselfigur identifiziert.

Schlussfolgerung Die Umstellung von einem Organsystem-bezogenen auf ein fallbasiertes Unterrichtskonzept mit praktischen Übungen führt im Fach Hygiene und Mikrobiologie zu einem besseren Verständnis für die Relevanz der Lerninhalte und zu einer subjektiven Steigerung des Lernerfolgs. Aufgrund der klinisch-theoretischen Verknüpfungen stellt das Unterrichtsmodell im Praktikum Hygiene und Mikrobiologie entsprechend den Vorgaben der neuen Approbationsordnung eine nachhaltige Unterrichtsalternative für klinisch-theoretische Fächer dar.
Evaluation des Prototyps eines neuen intraoperativen Aberrometers für die Vorhersage der postoperativen Zielrefraktion
Authors: Tandogan Tamer , Khoramnia Ramin , Choi Chul Young , Auffarth Gerd U.
Published: December 2022

Bei allen Fortschritten der präoperativen Biometrie in der Kataraktchirurgie und der refraktiven Linsenchirurgie sowie den verschiedenen heute gebräuchlichen Kalkulationsformeln gehören
„refraktive Überraschungen“ nach wie vor zum klinischen Alltag. Besonders nachteilig und enttäuschend ist ein Abweichen von der Zielrefraktion für Patienten, die sich für eine spezielle
Linse wie eine Multifokal- oder EDOF-IOL entschieden haben sowie vor allem für Patienten, die eine torische IOL implantiert bekommen, bei der schon leichte Abweichungen von der Zielachse die
Sehschärfe nachteilig beeinflussen können. Die intraoperative Aberrometrie ist eine Methode, die es dem Chirurgen ohne zusätzlichen größeren Aufwand erlaubt, die Refraktion des aphaken Auges
(nach Entfernung der natürlichen Linse) und kurz darauf des nunmehr pseudophaken Auges zu überprüfen. Die Methode, für die es zurzeit 3 unterschiedliche Geräte gibt, zeigt in den meisten
Evaluationen eine deutlich geringere Abweichung von der Zielrefraktion als die präoperative Biometrie. Neben einer Evaluation des Prototyps des I-O-W-A-Systems zur Ausmessung des Auges
während der Operation werden eigene Ergebnisse über den Einfluss des Anästhesieverfahrens und des IOL-Typs vorgestellt.
Evaluation of a Microsurgery Training Curriculum
Authors: Cuteanu Anita , Hellich Agathe , Cardinal Alba Le , Thomas Maeve , Valchanova Anna , Vara Sital , Horbury Gwynn , Boal Matt , Ghamrawi Walaa , Slim Naim , Francis Nader ,   On behalf of the Microsurgery Training Group at The Griffin Institute
Published: December 2022

Background Microsurgery is one of the most challenging areas of surgery with a steep learning curve. To address this educational need, microsurgery curricula have been developed and validated, with the majority focus on technical skills only. The aim of this study was to report on the evaluation of a well-established curriculum using the Kirkpatrick model.

Methods A training curriculum was delivered over 5 days between 2017 and 2020 focusing on (1) microscopic field manipulation, (2) knot tying, nondominant hand usage, (3) 3-D models/anastomosis, and (4) tissue experience. The Kirkpatrick model was applied to evaluate the curriculum at four levels: (1) participants' feedback (2) skills development using a validated, objective assessment tool (Global Assessment Score form) and CUSUM charts were constructed to model proficiency gain (3) and (4) assessing skill retention/long-term impact.

Results In total, 155 participants undertook the curriculum, totaling 5,425 hours of training. More than 75% of students reported the course as excellent, with the remaining voting for “good.” All participants agreed that the curriculum met expectations and would recommend it. Significant improvement in anastomosis attainment scores between days 1 and 3 (median score 4) and days 4 and 5 (median score 5) (W = 494.5, p = 0.00170). The frequency of errors reduced with successive attempts (chi square = 9.81, p = 0.00174). The steepest learning curve was in anastomosis and patency domains, requiring 11 attempts on average to reach proficiency. In total, 88.5% survey respondents could apply the skills learnt and 76.9% applied the skills learnt within 6 months. Key areas of improvement were identified from this evaluation, and actions to address them were implemented in the following programs.

Conclusion Robust evaluation of curriculum can be applied to microsurgery training demonstrating its efficacy in reducing surgical errors with an improvement in overall technical skills that can extend to impact clinical practice. It allows the identification of areas of improvement, driving the refinement of training programs.
Predictors and Consequences of Intraoperative Anastomotic Failure in DIEP Flaps
Authors: Chen Jonlin , Varagur Kaamya , Xun Helen , Wallam Sara , Karius Alexander , Ospino Rafael , Ji Jenny , Sanka Sai Anusha , Daines John , Skladman Rachel , Aliu Oluseyi , Sacks Justin M.
Published: December 2022

Background Successful intraoperative microvascular anastomoses are essential for deep inferior epigastric perforator (DIEP) flap survival. This study identifies factors associated with anastomotic failure during DIEP flap reconstruction and analyzes the impact of these anastomotic failures on postoperative patient outcomes and surgical costs.

Methods A retrospective cohort study was conducted of patients undergoing DIEP flap reconstruction at two high-volume tertiary care centers from January 2017 to December 2020. Patient demographics, intraoperative management, anastomotic technique, and postoperative outcomes were collected. Data were analyzed using Student's t-tests, Chi-square analysis, and multivariate logistic regression.

Results Of the 270 patients included in our study (mean age 52, majority Caucasian [74.5%]), intraoperative anastomotic failure occurred in 26 (9.6%) patients. Increased number of circulating nurses increased risk of anastomotic failure (odds ratio [OR] 1.02, 95% confidence Interval [CI] 1.00–1.03, p <0.05). Presence of a junior resident also increased risk of anastomotic failure (OR 2.42, 95% CI 1.01–6.34, p <0.05). Increased surgeon years in practice was associated with decreased failures (OR 0.12, CI 0.02–0.60, p <0.05). Intraoperative anastomotic failure increased the odds of postoperative hematoma (OR 8.85, CI 1.35–59.1, p <0.05) and was associated with longer operating room times (bilateral DIEP: 2.25 hours longer, p <0.05), longer hospital stays (2.2 days longer, p <0.05), and higher total operating room cost ($28,529.50 vs. $37,272.80, p <0.05).

Conclusion Intraoperative anastomotic failures during DIEP flap reconstruction are associated with longer, more expensive cases and increased rates of postoperative complications. Presence of increased numbers of circulators and junior residents was associated with increased risk of anastomotic failure. Future research is necessary to develop practice guidelines for optimizing patient and surgical factors for intraoperative anastomotic success.
Outcomes of Palliative Colonic Stent Placement in Malignant Colonic Obstruction: Experience from a Tertiary Care Oncology Center in India
Authors: Sundaram Sridhar , Rathod Raosaheb , Patil Prachi , Mane Kiran , Seth Vishal , Saklani Avanish , Desouza Ashwin , Mehta Shaesta
Published: December 2022

Introduction Colonic self-expanding metal stent (SEMS) placement is the preferred method for palliation of malignant colonic obstruction. We analyzed outcomes of patients who underwent colonic SEMS placement for palliation at a tertiary care oncology center in Western India.

Methods Retrospective review of the endoscopy database was done for patients who underwent colonic SEMS placement at our center between January 2013 and September 2021. Demographic details, intent of stent placement, site of obstruction, length of stricture, technical success of stenting, clinical success, and complications (both immediate and long term) were noted.

Results Sixty-one patients underwent colonic SEMS placement during the study period (mean age 53.6 years, 50.7% men). Obstruction was due to primary colonic malignancy in 43 (70.5%) patients and extracolonic malignancies in 18 (29.5%) patients. Most common extracolonic malignancy was gallbladder cancer in 8 (44.4%) patients. Most common site of obstruction was sigmoid colon in 18 (29.5%) patients. Proximal colonic obstruction was seen in 17 (27.9%) patients. Peritoneal metastases were seen in 26 (42.6%) patients. Colonoscopy revealed an impassable stenosis in 58 (95.1%) patients. Median length of stricture was 5 cm (range 2–9 cm). Technical success was achieved in 98.3% (60/61). Clinical success was achieved in 51 (86.4%) patients. Perforation during colonic SEMS placement was seen in 2 (3.4%) patients. Stent migration was seen in 3 (5.9%) patients, needing surgery for retrieval in all 3 patients. Over a median follow-up of 9 months (0–21 months), stent block was seen in 7 (13.7%) patients. Stent block developed after a median period of 6 months. Of these patients, three patients underwent SEMS placement within the SEMS and the other four patients underwent surgery.

Conclusion Colonic SEMS placement achieves good palliation of malignant colonic obstruction in approximately 87% patients. Long-term complications like obstruction occur in a few patients after a median duration of 6 months.
Reductive Umpolung and Defunctionalization Reactions through Higher-Order Titanium(III) Catalysis
Authors: Streuff Jan
Published: December 2022

The single-electron transfer from an in situ formed titanium(III) catalyst to ketones, imines, nitriles, Michael acceptors, and many other functions has enabled a large number of intra- and intermolecular reductive umpolung reactions. Likewise, it allows the homolytic cleavage of functional groups for selective defunctionalizations. These reactions often take place with the participation of two titanium(III) species, avoiding free-radical pathways and enabling high catalyst control of the reaction selectivity. This account discusses the development of the individual reactions together with the fundamental mechanistic discoveries that led to a better understanding of such titanium(III)-catalyzed processes in general.

1 Introduction

2 Active Titanium(III) Species and Additives

3 Ketone-Nitrile Couplings

4 Further Reductive Umpolung Reactions

5 Catalytic Homolytic C–CN and C–SO2R Cleavage

6 Conclusion
Endobiliary and Pancreatic Radiofrequency Ablations
Authors: Lavekar Anurag , Mukewar Saurabh
Published: December 2022

Radio frequency ablation (RFA) involves use of thermal energy to perform ablation of tissues. It has a wide range of application in gastrointestinal tract. Over the last few years, several studies have reported successful and safe application in the biliary and pancreatic tissues. It is particularly beneficial in patients with biliary malignancies in whom it has shown to improve survival. Additionally, it can be applied in occluded metal stents secondary to tumor ingrowth to prolong the patency of stents. In pancreas, RFA can successfully ablate cystic lesions and neuroendocrine tumors. It has also been applied in unresectable pancreatic cancers. This review discusses the application of endobiliary and pancreatic RFAs.
Addition of Tibial Tubercle Osteotomy to Combined MPFL Reconstruction and Lateral Retinacular Release not Recommended for Recurrent Patellar Dislocation in Patients with 15 to 20 mm TT-TG
Authors: Zhang Yuankai , Nan Kai , Zhao Yan , Zhang Xin , Song Qichun , Fan Lihong , Shi Zhibin , Dang Xiaoqian
Published: December 2022

Surgery is the primary treatment for recurrent patellar dislocation. However, there is still a lack of consensus regarding the choice of combined surgical methods due to the complexity of the anatomical factors. This study aimed to investigate the efficacy and radiological changes in medial patellofemoral ligament reconstruction (MPFLR) and lateral retinacular release (LRR) with and without tibial tubercle osteotomy (TTO) for recurrent patellar dislocation in patients with a tibial tubercle-trochlear groove (TT-TG) distance of 15 to 20 mm. Fifty-four patients were enrolled in this retrospective study between 2010 and 2014. The average patient age was 21.6 ± 5.0 years. All patients underwent MPFLR and LRR, and in 18 patients, these procedures were combined with TTO. Patients were evaluated preoperatively and postoperatively for patellar lateral shift, patellar tilt angle, TT-TG distance, Q-angle, Caton–Deschamps index (CDI), Kujala, and Lysholm scores. The minimally clinical important difference was used to compare clinical outcomes between two groups. In the mean follow-up of 82.6 ± 15.9 months, functional scores improved significantly in both groups (p < 0.01). There were no significant differences in postoperative function scores between the two groups (Kujala, p = 0.25, mean difference = 1.5, 95% confidence interval [CI]: –1.4–4.4; Lysholm, p = 0.76, mean difference = –0.6, 95% CI: –5.9–4.7). Additionally, TTO significantly decreased Q-angle (23.6 ± 2.4 vs. 17.4 ± 2.9, p < 0.01), TT-TG (17.1 ± 1.5 vs. 10.4 ± 1.8, p < 0.01), and CDI (1.18 ± 0.12 vs. 1.08 ± 0.07, p < 0.01). Combined MPFLR and LRR with and without TTO are both effective techniques for recurrent patellar dislocation. Additional osteotomy can correct patellar alta and tibial tubercle lateralization. However, given that there were no significant differences in postoperative functional scores or recurrence rate between groups, we may not recommend TTO in addition to MPFLR and LRR in patients with TT-TG of 15 to 20 mm. Long-term and prospective cohort studies are required to assess further outcomes.
Concomitant Lateral Meniscus Tear is Associated with Residual Rotatory Knee Instability 1 Year after Anterior Cruciate Ligament Reconstruction: Case-cohort Study
Authors: Chiba Daisuke , Yamamoto Yuji , Kimura Yuka , Sasaki Shizuka , Sasaki Eiji , Yamauchi Shohei , Tsuda Eiichi , Ishibashi Yasuyuki
Published: December 2022

Lateral meniscus tear (LMT) accompanied by anterior cruciate ligament (ACL) injuries has been reported to provoke rotatory instability of the affected knee joint. Unfortunately, these previous papers did not determine whether LMT-derived rotatory knee instability is residual because only preoperative or time zero data exists. This study aimed to longitudinally investigate how the prevalence of comorbid LMT is associated with residual rotatory knee instability (RKI) 1 year after ACL reconstruction (ACLR). A total of 327 patients who underwent double-bundle ACLR (average age: 23.4 years, body mass index: 23.5 kg/m2, 215 females). The patients were divided into three groups based on arthroscopy: 1) intact lateral meniscus (LM); 2) unrepaired LMT; 3) repaired LMT. At the 1-year follow-up, the pivot-shift test was performed. The prevalence of RKI, determined according to IKDC grades (grade ≥1 denoted RKI), was compared with chi-square or Fisher's exact tests. Thirty-eight patients (11.6%) had RKI; 203 subjects (62.1%) showed LMT, and 124 patients were diagnosed with an intact LM. Out of the 203 patients, 79 (38.9%) underwent LM repair. RKI was more prevalent in the LMT group than in the intact group (13.8% versus 8.1%, p = 0.117; Odds ratio: 1.499 [95%CI: 0.864 - 2.600]). In addition, the prevalence of RKI was significantly higher in the LM-repair group than in the intact-LM group (17.7% versus 8.1%, p = 0.038; Odds Ratio: 2.455 [95%CI: 1.032 - 5.842]). Medial meniscus tear (MMT) was detected in 113 patients (34.6%); RKI prevalence was not statistically different between the intact-MM group and the MMT group (12.2% versus 10.6%, p = 0.681). The current cohort study clarified that LMT comorbid with ACL injury was longitudinally associated with increased RKI prevalence 1 year after ACLR. Therefore, patients who underwent both ACLR and LM repair demonstrated a significantly higher prevalence of residual RKI.
Clinical and Electrophysiological Features Predicting Response to Antiseizure Medications in Juvenile Absence Epilepsy
Authors: Karaoğlu Pakize , Tekin Hande Gazeteci
Published: December 2022

Background We aimed to evaluate the clinical findings and electroencephalographic (EEG) characteristics of patients with juvenile absence epilepsy (JAE) and to determine the factors that predict response to antiseizure medications (ASMs) in JAE.

Methods We reviewed the medical records of 29 patients with JAE. The patients who were seizure-free during the last 12 months of their follow-up and who did not have generalized spike waves on their last EEG were considered as the treatment-responsive group, and the patients whose clinical seizures persisted during the last 12 months of their follow-up or who had generalized spike waves on their follow-up EEGs were considered as patients who did not respond to ASMs.

Results There were 29 patients, 20 girls and nine boys, with a mean age of 13.34 ± 2.17 years and a follow-up time of 32.1 ± 11.9 months. Twenty-two cases (75.8%) were evaluated as responsive to treatment. Generalized tonic–clonic seizures (GTCS) were statistically more common in patients who did not respond to ASM. Epileptic seizures began at a younger age in the group that responded to medication. Occipital intermittent rhythmic delta activity (OIRDA) in EEG was significantly higher in the group that responded to the medication.

Conclusion Our study shows that concomitant GTCS may predict poorer response to ASMs in JAE. Younger age at diagnosis and OIRDA on EEG may be associated with better response to treatment. Our findings need to be confirmed by further prospective and long-term studies.
Supratentorial Demyelinating Lesions Following Severe Acute Respiratory Syndrome Coronavirus-2 Infection: A Pediatric Case Report
Authors: Boeri Silvia , Martinez Popple Marina , Giacomini Thea , Bellini Tommaso , Severino Mariasavina , Rossi Andrea , Debbia Carla , Ancona Silvana , Aldera Elena , Nobili Lino , Siri Laura
Published: December 2022

Introduction Most coronavirus disease 2019 (COVID-19) pediatric patients are asymptomatic; however, several neurological manifestations associated with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection have been reported. Demyelinating events such as acute disseminated encephalomyelitis have been recently included among potential complications of COVID-19.

Case Report We describe the case of a 12-year-old boy who developed central nervous system demyelinating lesions following SARS-CoV-2 infection. Two months prior he had been diagnosed with panuveitis but was otherwise healthy. Three weeks after testing positive for SARS-CoV-2, he started to complain of right temporal headache associated with right orbital pain without vision impairment. Brain magnetic resonance imaging showed large leukodystrophy-like demyelinating lesions. Standard electroencephalogram revealed a slow activity on the right hemisphere. His clinical and electroencephalographic course was favorable, with a good response to corticosteroid therapy and infusions of intravenous immunoglobulins. Delayed but complete resolution of brain lesions was noted on imaging.

Conclusion Our case contributes to broaden the knowledge regarding the spectrum of possible complications of SARS-CoV-2 infection. The relative lack of clinical manifestations in our patient can be seen as a warning not to underestimate even mild neurological symptoms correlated with COVID-19.
Is Preoperative Facial Palsy a Deterrent to Facial Nerve Preservation after Gross-Total Removal of Giant Vestibular Schwannomas?
Authors: Sahana Debabrata , Kumar Sanjeev , Rathore Lavlesh , Mittal Jatinder , Sahu Rajiv K. , Jain Amit K. , Tawari Manish
Published: December 2022

Background Although rare in small vestibular schwannomas, preoperative facial nerve paresis is often present in giant schwannomas. Preserving facial nerve function in these cases remains a herculean task. This study evaluates the facial functions after complete tumor removal and whether preoperative facial nerve involvement affects postoperative functional status.

Methods This retrospective study from January 2014 to August 2021 excluded nongiant tumors (< 4 cm), neurofibromatosis type 2 cases, incomplete removals, redo surgeries, deaths, and cases done without nerve monitoring. These were grouped into preoperative facial palsy present (PFP) and no preoperative facial palsy (NFP). Facial nerve functions were assessed on first postoperative day, at the time of discharge, and at last follow-up and dichotomized into two groups: nondisfiguring (House–Brackmann [HB] grades I–III) and disfiguring (HB grades IV–VI). The cohort outcomes of patients with nondisfiguring PFP (HB grades I–III) were also analyzed.

Results There were 88 cases (PFP, n = 57; NFP, n = 31). Facial nerve was preserved anatomically in 62 (70.45%) patients (PFP, n = 38; NFP, n = 24) without any statistical difference (p = 0.29). Statistically significant disfiguring facial outcomes (HB IV, V, VI) were seen in patients with preoperative facial palsy (p = 0.01); however, a comparison of facial functions in patients with only nondisfiguring PFP with those in NFP group did not show the statistical difference (p = 0.12).

Conclusion Facial nerve palsy present before surgery does not seem to be a deterrent to intraoperative preservation of facial nerve during complete removal of giant vestibular schwannomas. Patients with nondisfiguring facial palsies have postoperative facial functions comparable to those without facial palsy.
Multivariate Sequential Analytics for Cardiovascular Disease Event Prediction
Authors: Hsu William , Warren Jim , Riddle Patricia
Published: December 2022

Background Automated clinical decision support for risk assessment is a powerful tool in combating cardiovascular disease (CVD), enabling targeted early intervention that could avoid issues of overtreatment or undertreatment. However, current CVD risk prediction models use observations at baseline without explicitly representing patient history as a time series.

Objective The aim of this study is to examine whether by explicitly modelling the temporal dimension of patient history event prediction may be improved.

Methods This study investigates methods for multivariate sequential modelling with a particular emphasis on long short-term memory (LSTM) recurrent neural networks. Data from a CVD decision support tool is linked to routinely collected national datasets including pharmaceutical dispensing, hospitalization, laboratory test results, and deaths. The study uses a 2-year observation and a 5-year prediction window. Selected methods are applied to the linked dataset. The experiments performed focus on CVD event prediction. CVD death or hospitalization in a 5-year interval was predicted for patients with history of lipid-lowering therapy.

Results The results of the experiments showed temporal models are valuable for CVD event prediction over a 5-year interval. This is especially the case for LSTM, which produced the best predictive performance among all models compared achieving AUROC of 0.801 and average precision of 0.425. The non-temporal model comparator ridge classifier (RC) trained using all quarterly data or by aggregating quarterly data (averaging time-varying features) was highly competitive achieving AUROC of 0.799 and average precision of 0.420 and AUROC of 0.800 and average precision of 0.421, respectively.

Conclusion This study provides evidence that the use of deep temporal models particularly LSTM in clinical decision support for chronic disease would be advantageous with LSTM significantly improving on commonly used regression models such as logistic regression and Cox proportional hazards on the task of CVD event prediction.
The Association of Patient and Procedural Factors on Improved Outcomes: A Cluster Analysis on 853 Total Knee Arthroplasty Patients
Authors: Hampp Emily , Shi Sarah , Scholl Laura , Taylor Kelly B. , Marchand Kevin B. , Kahan Michael E. , Chen Zhongming , Marchand Robert C. , Mont Michael A.
Published: December 2022

Many studies involving robotic-assisted total knee arthroplasty (RATKA) have demonstrated superiority regarding soft tissue balance and consistency with alignment target achievement. However, studies investigating whether RATKA is associated with improved patient outcomes regarding physical function and pain are also important. Therefore, we performed a cluster analysis and examined factors that contributed to differences in patient-reported outcome measures (PROMs). Specifically, we analyzed: (1) reduced WOMAC (rWOMAC) scores regarding pain and function; (2) usage of RATKA; (3) common patient comorbidities; as well as (4) patient demographic factors. The rWOMAC score is an abbreviated PROM that includes pain and physical function domains. This study analyzed 853 patients (95 conventional and 758 robotic-assisted) who had completed preoperative, 6-month, and 1-year postoperative rWOMAC surveys. Two clusters were constructed using rWOMAC pain and function scores at 1 year. Cluster 1 included 753 patients who had better outcomes at 1 year (mean rWOMAC pain = 0.9, mean rWOMAC function = 1.4), and cluster 2 included 100 patients who had worse outcomes at 1 year (mean rWOMAC pain = 7.7, mean rWOMAC function = 10.4). The clusters were compared to determine (1) how scores improved and (2) what patient characteristics were significantly different between clusters. Cluster 1 demonstrated greater improvement from preoperative to 6 months or 1 year (p = 0.0013 for pain preoperative to 6 months, p< 0.0001 for other measures) and 6 months to 1 year (p< 0.0001). Comparisons demonstrated that cluster 1 had older patients (67 vs. 65 years, p = 0.0479) who had lower body mass index or BMIs (31.8 vs. 33.9 kg/m2, p = 0.0042) and no significant differences in sex (p = 0.7849). Cluster 1 also had a significantly higher percentage of RATKA patients (90 vs. 79%, p< 0.001). Cluster analyses provided differentiating factors which were associated with improved postoperative rWOMAC pain and function scores at 1 year. Patients undergoing robotic-assisted TKA were associated with better rWOMAC pain and function scores from preoperative to 6 months and 1 year.
When Do We Perform Elective Total Knee Arthroplasty? General and Demographic-Specific Trends of Preoperative Pain and Function among 10,327 Patients
Authors: Soares Rui W. , Emara Ahmed K. , Orr Melissa , Klika Alison K. , Rullán Pedro J. , Pumo Thomas J. , Krebs Viktor E. , Molloy Robert M. , Piuzzi Nicolas S.
Published: December 2022

Total knee arthroplasty (TKA) is the sole disease-modifying intervention for end-stage osteoarthritis. However, the temporal trends and stratification of age and patient demographics of pain and function levels at which surgeons perform TKA have not been characterized. The present investigation aimed to analyze the temporal trends of preoperative pain and functional patient-reported outcomes measures (PROMs) over the past 5 years when stratifying patient demographics. A prospective cohort of all patients who underwent primary elective TKA between January 2016 and December 2020 at a North American integrated tertiary health care system was retrospectively reviewed. The primary outcome was quarterly baseline (preoperative) pain and function PROM values before primary elective TKA. Evaluated PROMs included Knee Osteoarthritis Outcome Score (KOOS)-pain and KOOS-physical function shortform (PS) for the 5-year study period and were stratified by patient demographics (age, sex, race, and body mass index [BMI]). A total of 10,327 patients were analyzed. Preoperative pain levels remained unchanged over the study period for patients in the 45- to 64-year category (P-trend = 0.922). Conversely, there was a significant improvement in preoperative pain levels in the 65+ years group. Sex-stratified trends between males and females did not demonstrate a significant change in pre-TKA baseline pain over the study period (P-trend = 0.347 and P-trend = 0.0744). Both white and black patients demonstrated consistent KOOS-pain levels throughout the study period (P-trend = 0.0855 and P-trend = 0.626). Only white patients demonstrated improving preoperative KOOS-PS (P-trend = 0.0001), while black and “other” patients demonstrated consistent lower preoperative functional levels throughout the study period (P-trend = 0.456 and P-trend = 0.871). All BMI categories demonstrated relatively consistent preoperative KOOS-pain and KOOS-PS except for overweight and obese patients who demonstrated progressive improvement in preoperative KOOS-PS over the study period. Patients and surgeons are electing to perform primary TKA at higher levels of preoperative function. Stratification by race showed black patients did not experience a similar trend of improving function and exhibited a consistently lower functional level versus white patients. This disparity is likely to be multifactorial but may indicate underlying barriers to TKA access.
Gastrointestinal Bleeding Caused by Atrioesophageal Fistula Secondary to Atrial Fibrillation Ablation
Authors: Tejerizo-García Laura , Meníndez-Ramos Ana , Villar-Lucas Carmen , Velasco-Guardado Antonio
Published: December 2022

We present the case of a patient with upper gastrointestinal bleeding caused by an atrioesophageal fistula secondary to radiofrequency ablation for the treatment of refractory atrial fibrillation. Atrioesophageal fistula is a rare but serious complication. The endoscopic treatment is not established in the case of vascular-enteric fistulas and is still a challenge for endoscopists, which requires in most cases a multidisciplinary approach.
Endoscopic Submucosal Dissection for Esophageal Squamous Cell High-grade Dysplasia in a Patient with Plummer Vinson Syndrome
Authors: Patil Gaurav , Vadgaonkar Amol , Dalal Ankit , Parekh Sanil , Shah Animesh , Haridas Poorva , Gupte Prajakta , Vora Sehajad , Maydeo Amit
Published: December 2022

A 35-year female with Plummer Vinson syndrome (PVS) presented with a history of progressive dysphagia over six months, not responding to iron therapy and endoscopic dilatations. Her upper gastrointestinal endoscopy showed a post-cricoid web dilated using a Savary-Gilliard dilator. On NBI, a long segment circumferential lesion with abnormal microvascular architecture was noted in the mid esophagus. Biopsy showed high-grade dysplastic squamous epithelium. The patient underwent minimally invasive, circumferential endoscopic submucosal dissection (ESD) and received oral prednisolone to prevent stricture formation. Resected margins were free of dysplasia. At follow-up there was no evidence of recurrence or stricture formation. To our knowledge, this is the first case of PVS with squamous proliferation with high-grade dysplasia that was successfully treated with circumferential ESD. Screening endoscopy helps in the downstaging of early cancer, and timely intervention helps to treat this with a minimally invasive approach like ESD.
Lower Eyelid Management in Facial Paralysis
Authors: Jowett Nate
Published: December 2022

Correction of lower eyelid retraction is necessary to restore adequate blink in paralytic lagophthalmos. A plethora of static and dynamic surgical techniques have been described for lower eyelid repositioning. This article provides an approach to management of the paralytic lower eyelid, including a summary of existing techniques, case examples, and surgical technique for in-office lower eyelid suspension using a palmaris longus tendon graft.
Impact of the Location of Nasal Septal Deviation on the Nasal Airflow and Air Conditioning Characteristics
Authors: Na Yang , Kwon Kyung Won , Jang Yong Ju
Published: December 2022

The location of nasal septal deviation (NSD) directly impacts nasal physiology. The objective is to examine, using computational fluid dynamics (CFD), the difference in the airflow and air conditioning characteristics according to the location of NSD. Twenty patients with septal deviation were divided into two: 10 caudal septal deviation (CSD) and 10 posterior septal deviation (PSD). Physiological variables were compared and numerical models for nasal cavity were created with CT scans. Cases with CSD had distinctive features including restricted airflow partition, larger nasal resistance, and decreased surface heat flux in the more obstructed side (MOS), and lower humidity and air temperature in the lesser obstructed side (LOS). Physiological differences were observed according to the location of septal deviation, CSD cases exhibit significantly more asymmetric airflow characteristics and air conditioning capacity between LOS and MOS.
Emerging Health Disparities during the COVID-19 Pandemic
Authors: Mheidly Nour , Fares Nadine Y. , Fares Mohamad Y. , Fares Jawad
Published: December 2022

The coronavirus disease 2019 (COVID-19) pandemic has underscored social and racial discrimination in global health, showing that health equity is still a goal to be achieved. Understanding the impact of COVID-19 on public health potential is vital to present a fair opportunity for people of different backgrounds to be as healthy as possible. As such, this communication discusses the emerging health disparities in light of the COVID-19 pandemic and analyzes their implications. Original research, effective health communication, and promotion strategies ought to be leveraged to step closer toward national and international health equity.
COVID-19 and science advice on the ‘Grand Stage’: the metadata and linguistic choices in a scientific advisory groups’ meeting minutes
Authors: Baker Hannah , Concannon Shauna , Meller Matthias , Cohen Katie , Millington Alice , Ward Samuel , So Emily
Published: December 2022

Science advice for governments attracted great scrutiny during the COVID-19 pandemic, with the public spotlight on institutions and individual experts—putting science advice on the ‘Grand Stage’. A review of the academic literature identified transparency, a plurality of expertise, the science and policy ‘boundary’, and consensus whilst addressing uncertainty as key themes. The Scientific Advisory Group for Emergencies (SAGE) has been the primary provider of coordinated scientific and technical advice to the UK Government during emergencies since 2009. Using the first 89 of SAGE’s meeting minutes (study period: 22 January 2020–13 May 2021), the ‘metadata’ and linguistic choices are analysed to identify how SAGE’s role and protocols are communicated. This includes understanding which experts were regularly taking part in discussions, the role of scientific experts in the science advisory system and their influence on policy choices, and the degree of consensus and uncertainty within this group of experts—all of which relate to the degree of transparency with the public. In addition, a temporal analysis examines how these practices, such as linguistically marking uncertainty, developed over the period studied. Linguistic markers indexing certainty and uncertainty increased, demonstrating a commitment to precise and accurate communication of the science, including ambiguities and the unknown. However, self-references to SAGE decreased over the period studied. The study highlights how linguistic analysis can be a useful approach for developing an understanding of science communication practices and scientific ambiguity. By considering how SAGE presents to those outside the process, the research calls attention to what remains ‘behind the scenes’ and consequently limits the public’s understanding of SAGE’s role in the COVID-19 response.
Hirschsprung Disease for the Practicing Surgical Pathologist
Authors: Matsukuma Karen , Gui Dorina , Saadai Payam
Published: December 2022

Objectives

Hirschsprung disease (HD) is a congenital condition defined by the absence of ganglion cells in the distal-most portion of the gastrointestinal tract. Biopsies and resections for HD can be adrenaline inducing for the general surgical pathologist because specimens are infrequent; HD is 1 of only a few neuroanatomic diseases that general surgical pathologists diagnose; numerous preanalytic factors (eg, biopsy adequacy, surgeon sampling protocol, processing artifacts) can affect histologic interpretation; and most importantly, the diagnosis has high stakes.

Methods

We provide a comprehensive overview of the background, relevant clinical procedures, and pathologic assessment of HD. Grossing and frozen section protocols, an algorithmic approach to diagnosis, and histologic pearls and pitfalls are also discussed.

Results

Evaluation and recognition of the features of HD have evolved significantly in the past 2 decades with the discovery of the value of calretinin immunohistochemistry in the late 2000s and the recent development of straightforward and reproducible histologic criteria for identification of the HD transition zone.

Conclusions

These advancements have substantially improved the pathologist’s ability to reliably evaluate for HD. Nonetheless, as with any high-stakes surgical pathology specimen, clear communication with the clinical team is essential.
God Became Human So That Humans Could Become Posthuman?
Authors: Parks Benjamin N
Published: December 2022

Taking a cue from Teilhard de Chardin's Christologically inflected speculation, the key question in this issue is whether the project of transhumanism is compatible with Christianity and the Incarnation of Christ. Two articles focus on theological anthropology and the limits, if any, of human perfection in light of Christ's perfection. Another article examines the ontological claims about human nature in transhumanism and its incompatibility with a Christian ontology. The last two turn from more abstract concerns to consider how the use of technology can inhibit or help human moral and spiritual development.
Tirzepatide and prevention of chronic kidney disease
Authors: Bosch Catalina , Carriazo Sol , Soler María José , Ortiz Alberto , Fernandez-Fernandez Beatriz
Published: December 2022

Tirzepatide is a twincretin recently approved to improve glycemic control in type 2 diabetes mellitus (T2DM). More specifically, tirzepatide is an agonist of both the glucose-dependent insulinotropic polypeptide (GIP) and the glucagon-like peptide-1 (GLP1) receptors. In recent clinical trials in persons with obesity or overweight with associated conditions, tirzepatide decreased body weight and other cardiorenal risk factors (blood pressure, low-density lipoprotein cholesterol, glycated hemoglobin and albuminuria). Moreover, in a post hoc analysis of the SURPASS-4 randomized clinical trial, tirzepatide decreased albuminuria and total estimated glomerular filtration rate (eGFR) slopes and nearly halved the risk of a pre-specified composite kidney endpoint (eGFR decline ≥40%, renal death, kidney failure or new-onset macroalbuminuria) in participants with T2DM and high cardiovascular risk when compared with insulin glargine. Similar to other kidney-protective drugs, tirzepatide, alone or combined with sodium-glucose co-transporter 2 inhibitors, caused an early dip in eGFR. Moreover, tirzepatide also decreased eGFR slopes in participants with eGFR >60 mL/min/1.73 m2 or with normoalbuminuria. We now review the potential kidney health implications of tirzepatide, addressing its structure and function, relationship to current GLP1 receptor agonists, impact of recent results for the treatment and prevention of kidney disease, and expectations for the future.