bluuebunny/crossref_metadata_2025_split huggingface dataset:
Phylogeny of a new ciliate family Clampidae fam. nov. (Protista: Ciliophora), with notes on morphology and morphogenesis
Authors: Xu Wenxin , Ma Jiyang , Li Yuan , Bourland William A , Petroni Giulio , Luo Xiaotian , Song Weibo 
Published: October 2021

Abstract
Hypotrichs comprise a highly differentiated and diversified group of ciliates with an evolutionary history characterized by an exceptional number of convergences and reversions. A new hypotrich ciliate from a freshwater fishpond is investigated based on morphological, morphogenetic and molecular data. The phylogenetic analyses reveal that the new species is closely related to Simplicitergida despite the absence of zigzag-patterned midventral cirral pairs, a common feature of simplicitergids. The phylogenetic position of this atypical simplicitergid species is strongly supported by the conserved features of dorsal ciliature and nuclear apparatus, which are probably more informative than cirral patterns for higher-rank classification. The close phylogenetic relationships among those Simplicitergida with varied cirral patterns could be explained by evolutionary convergences and reversions. The new species is recognized mainly by three frontoventral rows, several short midventral rows, two long midventral rows and the absence of zigzag-patterned midventral cirral pairs. Based on comprehensive phylogenetic analyses, together with detailed morphological and morphogenetic comparisons, a new family, Clampidae fam. nov., is proposed for the new genus and species, Clampia sinica gen. et sp. nov. In addition, an emended diagnosis of the morphologically similar family Epiclintidae is provided.
Specialist Aphid Feeding Causes Local Activation of Salicylic and Jasmonic Acid Signaling in Arabidopsis Veins
Authors: Rubil Nikoleta , Kalachova Tetiana , Hauser Thure Pavlo , Burketová Lenka 
Published: October 2021

Aphids, the phloem sap feeders, probe into leaf tissues and activate a complex network of plant defense responses. Phytohormonal signaling plays a major role in this network; however, the dynamics of the signal spreading is yet to be clarified. Despite the growing knowledge about transcriptomic changes upon infestation, results often differ due to sampling, varying strongly between the tissues collected at the single feeding site, individual leaves, pooled infested leaves, or whole plant rosettes. This study focuses on activation of salicylic acid (SA) and jasmonic acid (JA) signals in Arabidopsis leaves during infestation by cabbage aphid (Brevicoryne brassicae) in high spatio-temporal resolution. We used genetically encoded fluorescent biosensors, histochemistry, and quantitative reverse transcription-PCR to precisely map activation of distinct branches of phytohormonal signaling. We found a rapid induction of SA and JA signaling markers in cells surrounding stylet puncture, colocalizing with callose deposition. For both PR1 and JAZ10, we detected activation at 24 h postinfestation (hpi), increasing and spreading along the veins until 72 hpi and, to a lesser extent, within the epidermal pavement cells. The SA signaling wave appeared in parallel with JA-associated signaling and continued to increase in time. Our results first show a local activation of SA- and JA-related responses after stylet penetration of Arabidopsis leaves and bring a detailed insight into the spatio-temporal complexity of plant defense activation during specialist aphid attack. [Formula: see text] Copyright © 2022 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Reopening a Student-Run Free Clinic During the COVID-19 Pandemic to Provide Care for People Experiencing Homelessness
Authors: Weiss Caitlin , Traczuk Ashley , Motley Robert 
Published: October 2021

Problem
Student-run free clinics (SRFCs) provide health and outreach services to underserved populations while offering medical students opportunities for service and education. Many SRFCs were forced to suspend in-person operations in early 2020 due to the COVID-19 pandemic. Before March 2020, JeffHOPE, the SRFC at Sidney Kimmel Medical College at Thomas Jefferson University, operated an evening clinic at 5 locations throughout Philadelphia each week.

Approach
JeffHOPE’s response to challenges posed by COVID-19 focused on a redesign for a pilot clinic at a shelter site that expressed interest in resuming operations. The student leaders conducted a needs assessment with shelter stakeholders, including administrators and long-term residents, to identify service priorities. They also developed a list of key components for safe patient engagement and care delivery. A hybrid telehealth approach was developed to reduce in-person exposure for patients and volunteers and to involve preclinical medical students remotely. Three iPads were acquired via an internal grant.

Outcomes
The pilot clinic reopened in September 2020. Over the first 13 weeks of operation, 44 unique patients received care across 98 visits. Of these visits, 21 were in-person only with a clinical student and preceptor, while 77 also used the hybrid telehealth model to connect via iPad with a preclinical student. Patient visit volume was approximately 35%–40% of the pre–COVID-19 level. Of the 58 total volunteers, 11 were preclinical students who participated remotely.

Next Steps
Three additional JeffHOPE clinic sites have reopened since December 2020 using this hybrid telehealth model. Patient feedback, via surveys and interviews, will determine which components are retained. Other SRFCs should be encouraged to innovate and develop plans for safe resumption of services, with an appropriate approach and organizational support, despite the challenges posed by the pandemic.
The Function Assessment Scale for Spinal Deformity
Authors: Severijns Pieter , Overbergh Thomas , Ackermans Thijs , Beaucage-Gauvreau Erica , Brumagne Simon , Desloovere Kaat , Scheys Lennart , Moke Lieven 
Published: October 2021

Study Design.
Cross-sectional study.

Objective.
The aim of this study was to develop and validate the Function Assessment scale for Spinal Deformity (FASD).

Summary of Background Data.
Spinal malalignment impacts daily functioning. Standard evaluation of adult spinal deformity (ASD) is based on static radiography and patient-reported scores, which fail to assess functional impairments. A clinical scale, quantifying function and balance of patients with ASD, could increase our insights on the impact of ASD on functioning.

Methods.
To develop the FASD, 70 ASD patients and 20 controls were measured to identify the most discriminating items of the Balance Evaluation Systems Test and Trunk Control Measurement Scale. Discussions between experts on the clinical relevance of selected items led to further item reduction. The FASD's discriminative ability was established between 43 patients and 19 controls, as well as between three deformity subgroups. For its responsiveness to treatment, 10 patients were reevaluated 6 months postoperatively. Concurrent validity was assessed through correlation analysis with radiographic parameters (pelvic tilt; sagittal vertical axis [SVA]; pelvic incidence minus lumbar lordosis [PI-LL]; coronal vertical axis) and patient-reported scores [Oswestry Disability Index]; Scoliosis Research Society outcome questionnaire; Falls Efficacy Scale-International). Test–retest and interrater reliability were tested on two groups of ten patients using intraclass correlation coefficients (ICC).

Results.
Patients with ASD, mainly with sagittal malalignment, scored worse compared to controls on FASD (P < 0.001) and its subscales. No significant improvement was observed 6 months postoperatively (P = 0.758). FASD correlated significantly to all patient-reported scores and to SVA and PI-LL. Reliability between sessions (ICC = 0.97) and raters (ICC = 0.93) was excellent. Subscales also showed good to excellent reliability, except FASD 1 on “spinal mobility and balance” between sessions (ICC = 0.71).

Conclusion.
FASD proved to be a valid and reliable clinical scale for evaluation of functional impairments in ASD. Objective information on function and balance might ultimately guide physiotherapeutic treatment toward improved functioning.

Level of Evidence: 2
Diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging for distinguishing pseudoprogression from glioma recurrence: a meta-analysis
Authors: Qiu Jun , Tao Zhen-Chao , Deng Ke-Xue , Wang Peng , Chen Chuan-Yu , Xiao Fang , Luo Yi , Yuan Shu-Ya , Chen Hao , Huang Huan 
Published: October 2021

Abstract

Background:
It is crucial to differentiate accurately glioma recurrence and pseudoprogression which have entirely different prognosis and require different treatment strategies. This study aimed to assess the diagnostic accuracy of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) as a tool for distinguishing glioma recurrence and pseudoprogression.

Methods:
According to particular criteria of inclusion and exclusion, related studies up to May 1, 2019, were thoroughly searched from several databases including PubMed, Embase, Cochrane Library, and Chinese biomedical databases. The quality assessment of diagnostic accuracy studies was applied to evaluate the quality of the included studies. By using the “mada” package in R, the heterogeneity, overall sensitivity, specificity, and diagnostic odds ratio were calculated. Moreover, funnel plots were used to visualize and estimate the publication bias in this study. The area under the summary receiver operating characteristic (SROC) curve was computed to display the diagnostic efficiency of DCE-MRI.

Results:
In the present meta-analysis, a total of 11 studies covering 616 patients were included. The results showed that the pooled sensitivity, specificity, and diagnostic odds ratio were 0.792 (95% confidence interval [CI] 0.707–0.857), 0.779 (95% CI 0.715–0.832), and 16.219 (97.5% CI 9.123–28.833), respectively. The value of the area under the SROC curve was 0.846. In addition, the SROC curve showed high sensitivities (>0.6) and low false positive rates (<0.5) from most of the included studies, which suggest that the results of our study were reliable. Furthermore, the funnel plot suggested the existence of publication bias.

Conclusions:
While the DCE-MRI is not the perfect diagnostic tool for distinguishing glioma recurrence and pseudoprogression, it was capable of improving diagnostic accuracy. Hence, further investigations combining DCE-MRI with other imaging modalities are required to establish an efficient diagnostic method for glioma patients.
Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction for bone sarcomas: long-term outcomes
Authors: Xu Li-Hui , Zhang Qing , Zhao Hai-Tao , Yu Feng , Niu Xiao-Hui 
Published: October 2021

Abstract

Background:
Computed tomography (CT) and magnetic resonance imaging (MRI) data can be fused to identify the tumor boundaries. This enables surgeons to set close but tumor-free surgical margins and excise the tumor more precisely. This study aimed to report our experience in performing computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction to treat bone sarcoma in the diaphysis and metaphysis of the femur and tibia.

Methods:
Between September 2008 and December 2015, 24 patients with bone sarcomas underwent surgical resection and joint-sparing reconstruction under image-guided computer navigation. The cohort comprised 16 males and eight females with a median age of 19.5 years (range: 12–48 years). The tumor location was the femoral diaphysis in three patients, distal femur in 19, and proximal tibia in two. The tumors were osteosarcoma (n = 15), chondrosarcoma (n = 3), Ewing sarcoma (n = 3), and other sarcomas (n = 3). We created a pre-operative plan for each patient using navigation system software and performed navigation-aided resection before reconstructing the defect with a custom-made prosthesis with extracortical plate fixation.

Results:
Pathological examination verified that all resected specimens had appropriate surgical margins. The median distance from the tumor resection margin to the joint was 30 mm (range: 13–80 mm). The median follow-up duration was 62.5 months (range: 24–134 months). Of the 24 patients, 21 remain disease free, one is alive with disease, and two died of the disease. One patient developed local recurrence. Complications requiring additional surgical procedures occurred in six patients, including one with wound hematoma, one with delayed wound healing, one with superficial infection, one with deep infection, and two with mechanical failure of the prosthesis. The mean Musculoskeletal Tumor Society score at the final follow-up was 91% (range: 80%–100%). The 5- and 10-year implant survival rates were 91.3% and 79.9%, respectively.

Conclusions:
Computer navigation-aided joint-preserving resection and custom-made endoprosthesis reconstruction with extracortical plate fixation is a reliable surgical treatment option for bone sarcoma in the diaphysis and metaphysis of the femur and tibia.
Discharge heart rate and 1-year clinical outcomes in heart failure patients with atrial fibrillation
Authors: Xing Fuwei , Zheng Xin , Zhang Lihua , Hu Shuang , Bai Xueke , Hu Danli , Li Bing , Li Jing 
Published: October 2021

Abstract

Background:
The association between heart rate and 1-year clinical outcomes in heart failure (HF) patients with atrial fibrillation (AF), and whether this association depends on left ventricular ejection fraction (LVEF), are unclear. We investigated the relationship between discharge heart rate and 1-year clinical outcomes after discharge among hospitalized HF patients with AF, and further explored this association that differ by LVEF level.

Methods:
In this analysis, we enrolled 1760 hospitalized HF patients with AF from the China Patient-centered Evaluative Assessment of Cardiac Events Prospective Heart Failure study from August 2016 to May 2018. Patients were categorized into three groups with low (<65 beats per minute [bpm]), moderate (65–85 bpm), and high (≥86 bpm) heart rate measured at discharge. Cox proportional hazard models were employed to explore the association between heart rate and 1-year primary outcome, which was defined as a composite outcome of all-cause death and HF rehospitalization.

Results:
Among 1760 patients, 723 (41.1%) were women, the median age was 69 (interquartile range [IQR]: 60–77) years, median discharge heart rate was 75 (IQR: 69–84) bpm, and 934 (53.1%) had an LVEF <50%. During 1-year follow-up, a total of 792 (45.0%) individuals died or had at least one HF hospitalization. After adjusting for demographic characteristics, smoking status, medical history, anthropometric characteristics, and medications used at discharge, the groups with low (hazard ratio [HR]: 1.32, 95% confidence interval [CI]: 1.05–1.68, P = 0.020) and high (HR: 1.34, 95% CI: 1.07–1.67, P = 0.009) heart rate were associated with a higher risk of 1-year primary outcome compared with the moderate group. A significant interaction between discharge heart rate and LVEF for the primary outcome was observed (P for interaction was 0.045). Among the patients with LVEF ≥50%, only those with high heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.38, 95% CI: 1.01–1.89, P = 0.046), whereas there was no difference between the groups with low and moderate heart rate. Among the patients with LVEF <50%, only those with low heart rate were associated with a higher risk of primary outcome compared with the group with moderate heart rate (HR: 1.46, 95% CI: 1.09–1.96, P = 0.012), whereas there was no difference between the groups with high and moderate heart rate.

Conclusions:
Among the overall HF patients with AF, both low (<65 bpm) and high (≥86 bpm) heart rates were associated with poorer outcomes as compared with moderate (65–85 bpm) heart rate. Among patients with LVEF ≥50%, only a high heart rate was associated with higher risk; while among those with LVEF <50%, only a low heart rate was associated with higher risk as compared with the group with moderate heart rate.

Trail Registration:
Clinicaltrials.gov; NCT02878811.
Impact of conventional vs. goal-directed fluid therapy on urethral tissue perfusion in patients undergoing liver surgery
Authors: Chirnoaga Dragos , Coeckelenbergh Sean , Ickx Brigitte , Van Obbergh Luc , Lucidi Valerio , Desebbe Olivier , Carrier François Martin , Michard Frederic , Vincent Jean-Louis , Duranteau Jacques , Van der Linden Philippe , Joosten Alexandre 
Published: October 2021

BACKGROUND
Although fluid administration is a key strategy to optimise haemodynamic status and tissue perfusion, optimal fluid administration during liver surgery remains controversial.

OBJECTIVE
To test the hypothesis that a goal-directed fluid therapy (GDFT) strategy, when compared with a conventional fluid strategy, would better optimise systemic blood flow and lead to improved urethral tissue perfusion (a new variable to assess peripheral blood flow), without increasing blood loss.

DESIGN
Single-centre prospective randomised controlled superiority study.

SETTING
Erasme Hospital.

PATIENTS
Patients undergoing liver surgery.

INTERVENTION
Forty patients were randomised into two groups: all received a basal crystalloid infusion (maximum 2 ml kg−1 h−1). In the conventional fluid group, the goal was to maintain central venous pressure (CVP) as low as possible during the dissection phase by giving minimal additional fluid, while in the posttransection phase, anaesthetists were free to compensate for any presumed fluid deficit. In the GDFT group, patients received in addition to the basal infusion, multiple minifluid challenges of crystalloid to maintain stroke volume (SV) variation less than 13%. Noradrenaline infusion was titrated to keep mean arterial pressure more than 65 mmHg in all patients.

MAIN OUTCOME MEASURE
The mean intra-operative urethral perfusion index.

RESULTS
The mean urethral perfusion index was significantly higher in the GDFT group than in the conventional fluid group (8.70 [5.72 to 13.10] vs. 6.05 [4.95 to 8.75], P = 0.046). SV index (ml m−2) and cardiac index (l min−1 m−2) were higher in the GDFT group (48 ± 9 vs. 33 ± 7 and 3.5 ± 0.7 vs. 2.4 ± 0.4, respectively; P < 0.001). Although CVP was higher in the GDFT group (9.3 ± 2.5 vs. 6.5 ± 2.9 mmHg; P = 0.003), intra-operative blood loss was not significantly different in the two groups.

CONCLUSION
In patients undergoing liver surgery, a GDFT strategy resulted in a higher mean urethral perfusion index than did a conventional fluid strategy and did not increase blood loss despite higher CVP.

TRIAL REGISTRATION
NCT04092608.
Teleconsultation for preoperative evaluation during the coronavirus disease 2019 pandemic
Authors: Wienhold Jan , Mösch Lucas , Rossaint Rolf , Kemper Ilka , Derwall Matthias , Czaplik Michael , Follmann Andreas 
Published: October 2021

BACKGROUND
During the surge in coronavirus disease 2019 (COVID-19) infections in early 2020, many medical organisations began developing strategies for implementing teleconsultation to maintain medical services during lockdown and to limit physical contact. Therefore, we developed a teleconsultation preoperative evaluation platform to replace on-site preoperative meetings.

OBJECTIVE
This study assessed the feasibility of a teleconsultation for preoperative evaluation and procedure-associated adverse events.

DESIGN
Implementation study.

SETTING
A tertiary care university hospital in Germany from April 2020 to October 2020.

PATIENTS
One hundred and eleven patients scheduled for elective surgery.

INTERVENTION
Patients were assigned to receive teleconsultation for preoperative evaluation and to complete a subsequent survey.

MAIN OUTCOME MEASURES
Primary endpoints were medical and technical feasibility, user satisfaction and time savings.

RESULTS
For 100 out of 111 patients, telepreoperative consultations allowed for adequate perioperative risk assessment, patient education and also for effective collection of legal signatures. For six patients (5.4%), consultations could not be started because of technical issues, whereas for five patients (4.8%), clearance for surgery could not be granted because of medical reasons. A clear majority of anaesthetists (93.7%) rated the telepreoperative evaluations as equivalent to on-site meetings. The majority of the patients considered teleconsultation for preoperative evaluation as convenient as an on-site meeting (98.2%) and would choose a teleconsultation again (97.9%). Median travel time saved by patients was 60 min (Q1 40, Q3 80). We registered one adverse event: we detected atrial fibrillation in one patient only immediately prior to surgery.

CONCLUSION
Telepreoperative evaluations are medically and technically feasible, yielding high satisfaction rates on both sides. However, regarding patient safety, not every patient is equally well suited. Overall, implementation of teleconsultation for preoperative evaluation into clinical routine could help maintain medical care during the COVID-19 pandemic.

TRIAL REGISTRATION
NCT04518514, ClinicalTrials.gov
The Impossible Anastomosis: Intima-to-adventitia Suture Technique for Microanastomosis of Severely Calcified Arteries
Authors: Cai Aijia , Horch Raymund E. , Arkudas Andreas 
Published: October 2021

Summary:
Microsurgery in patients with advanced atherosclerosis is challenging. Calcified vessels can hinder microanastomosis, which precludes free flap reconstruction in those patients. We present a case of a female patient with stage 4 peripheral artery disease who had undergone mastectomy because of invasive breast cancer. During autologous breast reconstruction with a muscle-sparing transverse rectus abdominis free flap, we experienced difficulties during microanastomosis due to complicated plaques in an extremely calcified inferior epigastric artery. Also, the intima presented completely detached from the media, leading to a collapse of the vessel lumen. To prevent curling of the intima and prolapse of the atherosclerotic plaques into the vessel lumen, the intima was sutured to the adventitia by interrupted stitches. This maneuver led to eversion of the intima and facilitated the otherwise unfeasible anastomosis. The reconstructed breast showed adequate perfusion during the postoperative course. We present a technique to facilitate microanastomosis in severely calcified and fragile arteries.