bluuebunny/crossref_metadata_2025_split huggingface dataset:
hlh-12, a gene that is necessary and sufficient to promote migration of gonadal regulatory cells inCaenorhabditis elegans, evolved within theCaenorhabditisclade
Authors: Littleford Hana E , Kiontke Karin , Fitch David H A , Greenwald Iva 
Published: September 2021

AbstractSpecialized cells of the somatic gonad primordium of nematodes play important roles in the final form and function of the mature gonad. Caenorhabditis elegans hermaphrodites are somatic females that have a two-armed, U-shaped gonad that connects to the vulva at the midbody. The outgrowth of each gonad arm from the somatic gonad primordium is led by two female distal tip cells (fDTCs), while the anchor cell (AC) remains stationary and central to coordinate uterine and vulval development. The bHLH protein HLH-2 and its dimerization partners LIN-32 and HLH-12 had previously been shown to be required for fDTC specification. Here, we show that ectopic expression of both HLH-12 and LIN-32 in cells with AC potential transiently transforms them into fDTC-like cells. Furthermore, hlh-12 was known to be required for the fDTCs to sustain gonad arm outgrowth. Here, we show that ectopic expression of HLH-12 in the normally stationary AC causes displacement from its normal position and that displacement likely results from activation of the leader program of fDTCs because it requires genes necessary for gonad arm outgrowth. Thus, HLH-12 is both necessary and sufficient to promote gonadal regulatory cell migration. As differences in female gonadal morphology of different nematode species reflect differences in the fate or migratory properties of the fDTCs or of the AC, we hypothesized that evolutionary changes in the expression of hlh-12 may underlie the evolution of such morphological diversity. However, we were unable to identify an hlh-12 ortholog outside of Caenorhabditis. Instead, by performing a comprehensive phylogenetic analysis of all Class II bHLH proteins in multiple nematode species, we found that hlh-12 evolved within the Caenorhabditis clade, possibly by duplicative transposition of hlh-10. Our analysis suggests that control of gene regulatory hierarchies for gonadogenesis can be remarkably plastic during evolution without adverse phenotypic consequence.
Europe's far-right educational projects and their vision for the international order
Authors: Geva Dorit , Santos Felipe G 
Published: September 2021

Abstract
Figures like Hungarian Prime Minister Viktor Orbán and former French National Front leader Marion Maréchal are seeking to establish what we call a new globalist illiberal order. The globalist illiberal agenda extends elements of the globalist project while reclaiming a radicalized view of Christian democracy. Europe's far-right views the global order as composed of strong nations who need to defend their sovereignty on ‘cultural’ issues while protecting their common Christian roots. We trace their project by focusing on two new institutions of higher education, Hungary's National University of Public Service Ludovika (Ludovika-UPS) and the Institut de sciences sociales, économiques et politiques (Institute of Social Sciences, Economics and Politics—ISSEP), based in France and Spain. Through these institutions, globalist illiberals aim to cultivate new leaders outside the liberal ‘mainstream’ and redefine the meaning of Christian democracy. We conclude that surging nationalism among mid- to small powers is not resulting in deglobalization but is fostering illiberal globalization, which has no place for those who do not fit in their exclusionary vision of Christian Europe.
8-Formylophiopogonanone B induces ROS-mediated apoptosis in nasopharyngeal carcinoma CNE-1 cells
Authors: Zhang Ya-jing , Mu Zhen-lin , Deng Ping , Liang Yi-dan , Wu Li-chuan , Yang Ling-ling , Zhou Zhou , Yu Zheng-ping 
Published: September 2021

Abstract
Cancer is one of the leading causes of death in the world. It is very important to find drugs with high efficiency, low toxicity, and low side effects for the treatment of cancer. Flavonoids and their derivatives with broad biological functions have been recognized as anti-tumor chemicals. 8-Formylophiopogonanone B (8-FOB), a naturally existed homoisoflavonoids with rarely known biological functions, needs pharmacological evaluation. In order to explore the possible anti-tumor action of 8-FOB, we used six types of tumor cells to evaluate in vitro effects of this agent on cell viability and tested the effects on clone formation ability, scratching wound-healing, and apoptosis. In an attempt to elucidate the mechanism of pharmacological action, we examined 8-FOB-induced intracellular oxidative stress and -disrupted mitochondrial function. Results suggested that 8-FOB could suppress tumor cell viability, inhibit cell migration and invasion, induce apoptosis, and elicit intracellular ROS production. Among these six types of tumor cells, the nasopharyngeal carcinoma CNE-1 cells were the most sensitive cancer cells to 8-FOB treatment. Intracellular ROS production played a pivotal role in the anti-tumor action of 8-FOB. Our present study is the first to document that 8-FOB has anti-tumor activity in vitro and increases intracellular ROS production, which might be responsible for its anti-tumor action. The anti-tumor pharmacological effect of 8-FOB is worthy of further investigation.
Extending “Helping Babies Breathe” to an Academic Setting in Fiji: A Project Involving American Nursing Faculty and Graduate and Undergraduate Nursing Students
Authors: Macintosh Janelle L. B. , Ferrara Ashley L. , Ray Gaye , Luthy Karlen E. (Beth) , Beckstrand Renea L. 
Published: September 2021

Abstract
Approximately 2.5 million neonates died worldwide in 2018. Over one quarter of neonatal deaths are caused by birth asphyxia. Helping Babies Breathe (HBB) was created to teach basic neonatal resuscitation steps in limited-resource settings. Fifteen Fijian faculty members attended a master teacher class. Nine undergraduate nursing students from the western United States assisted in teaching two HBB classes for Fijian nursing students. Fijian faculty and student knowledge increased significantly posteducation. Educational settings provide ideal locations for future nurses to learn and practice evidence-based neonatal resuscitation skills. Implementing HBB in an academic setting, though novel, may ensure educators are familiar with current guidelines.
Physical Fitness and Skeletal Muscle Mass During Neoadjuvant Chemoradiotherapy in Patients with Locally Advanced Rectal Cancer: An Observational Study
Authors: Heldens Aniek F. J. M. , Bongers Bart C. , de Vos-Geelen Judith , Minis-Rutten Iris J. , Stassen Laurents P. , Buhre Wolfgang F. , van Meeteren Nico L. 
Published: September 2021

Background:
Patients with locally advanced rectal cancer are often considered for neoadjuvant chemoradiotherapy before resection. This presurgical treatment can have negative effects on physical fitness, muscle mass, and treatment compliance, which can negatively influence clinical outcomes.

Objective:
The aim of this study was to evaluate physical fitness and skeletal muscle mass before and after neoadjuvant chemoradiotherapy in single subjects with locally advanced rectal cancer.

Design:
An observational longitudinal study of single subjects.

Methods:
Routine care data were retrospectively analyzed. Data consisted of tumor characteristics, clinical data (eg, side effects and toxicity of the neoadjuvant chemoradiotherapy, loss of body mass), data on performance-based physical fitness, and computed tomography–derived skeletal muscle mass. An independent-samples t test or its nonparametric equivalent was performed on outcome measures to test for significant differences between T
0 and T
1. For comparing several subgroups in this cohort, the Mann-Whitney U test was performed and correlations were studied using the Pearson or Spearman correlation coefficient, as appropriate.

Results:
Data from 25 single subjects were available. Aerobic capacity (n = 25, P = .033) and skeletal muscle mass (n = 16, P = .005) were significantly reduced after neoadjuvant chemoradiotherapy. Although not statistically significant, a large number of patients demonstrated a decrease in muscle strength and functional mobility after completing neoadjuvant chemoradiotherapy. In 14 patients (56%), adverse events, dose-limiting toxicity, or early termination of treatment occurred.

Conclusions:
Aerobic capacity and skeletal muscle mass decreased following neoadjuvant chemoradiotherapy, with large interindividual differences concerning the changes in physical fitness and muscle mass. This between-subject variability indicates the importance of a personalized treatment approach.
Predictors of Nonelective Surgery for Spinal Metastases
Authors: Khan Hammad A. , Rabah Nicholas M. , Chakravarthy Vikram , Tripathi Raghav , Krishnaney Ajit A. 
Published: September 2021

Study Design.
Secondary analysis of a national all-payer database.

Objective.
Our objectives were to identify patient- and hospital-level factors independently associated with the receipt of nonelective surgery and determine whether nonelective surgery portends differences in perioperative outcomes compared to elective surgery for spinal metastases.

Summary of Background Data.
Spinal metastases may progress to symptomatic epidural spinal cord compression that warrants urgent surgical intervention. Although nonelective surgery for spinal metastases has been associated with poor postoperative outcomes, literature evaluating disparities in the receipt of nonelective versus elective surgery in this population is lacking.

Methods.
The National Inpatient Sample (2012–2015) was queried for patients who underwent surgical intervention for spinal metastases. Multivariable logistic regression models were constructed to evaluate the association of patient- and hospital-level factors with the receipt of nonelective surgery, as well as to evaluate the influence of admission status on perioperative outcomes.

Results.
After adjusting for disease-related factors and other baseline covariates, our multivariable logistic regression model revealed several sociodemographic differences in the receipt of nonelective surgery. Patients of black (odds ratio [OR] = 1.38, 95% confidence interval [CI]: 1.03–1.84, P = 0.032) and other race (OR = 1.50, 95% CI: 1.13–1.98, P = 0.005) had greater odds of undergoing nonelective surgery than their white counterparts. Patients of lower income (OR = 1.40, 95% CI: 1.06–1.84, P = 0.019) and public insurance status (OR = 1.56, 95% CI: 1.26–1.93, P < 0.001) were more likely to receive nonelective surgery than higher income and privately insured patients, respectively. Higher comorbidity burden was also associated with greater odds of non-elective admission (OR = 2.94, 95% CI: 2.07–4.16, P
< 0.001). With respect to perioperative outcomes, multivariable analysis revealed that patients receiving nonelective surgery were more likely to experience nonroutine discharge (OR = 2.50, 95% CI: 2.09–2.98, P
< 0.001) and extended length of stay [LOS] (OR = 2.45, 95% CI: 1.91–3.16, P < 0.001).

Conclusion.
The present study demonstrates substantial disparities in the receipt of nonelective surgery across sociodemographic groups and highlights its association with nonroutine discharge and extended LOS.

Level of Evidence: 3
Normal Anatomy of the Lumbar Sublaminar Ridge in the Lateral Recess with Potential Implications to Surgical Technique in Degenerative Spinal Stenosis
Authors: Bednar Drew A. , Son Heewon Elizabeth , Wainman Bruce 
Published: September 2021

Study Design.
This is an anatomic study using cadaveric material.

Objective.
To provide anatomic descriptions of the normal lumbar sublaminar ridge in the lateral recess and its potential to impact on the exiting nerve root there, with implications to surgical technique in lumbar spinal stenosis.

Summary of Background Data.
The lateral extent of the sublaminar ridge—the bony, superior insertion site of the ligamenta flava—and its topological relationship to the nerve root are not described in the literature. In the setting of degenerative lumbar stenosis this structure can hypertrophy and impinge the nerve root within the lateral recess even after excision of the corresponding ligamentum flavum. Failure to address this may contribute to failed lateral recess decompression.

Methods.
Fifteen lumbar vertebrae, not obviously degenerated, were resected en bloc from three fixed adult human cadavers and then transected through the pedicles, leaving the posterior column and neural elements intact and articulated. The shape of the sublaminar ridge in the lateral recess and its relationship to the exiting nerve root were carefully examined.

Results.
The exiting nerve root consistently crosses the sublami- nar ridge immediately inferior to the mid-pedicle, lateral to the subarticular gutter, and on the medial aspect of the true intervertebral foramen. A hypertrophic ridge can compress the exiting root by elevating the nerve root superiorly against the bony underside of the pedicle or displacing it anteriorly against the disc or vertebral body.

Conclusion.
The sublaminar ridge in the lateral recess may contribute to degenerative lumbar stenosis. Comprehensive appreciation of this anatomy may facilitate thorough lateral recess decompression.

Level of Evidence: 4
Intraoperative Ultrasound in Spine Decompression Surgery
Authors: Tat Jimmy , Tat Jessica , Yoon Samuel , Yee Albert J.M. , Larouche Jeremie 
Published: September 2021

Study Design.
Systematic review.

Objective.
The aim of this study was to review the current spine surgery literature to establish a definition for adequate spine decompression using intraoperative ultrasound (IOUS) imaging.

Summary of Background Data.
IOUS remains one of the few imaging modalities that allows spine surgeons to continuously monitor the spinal cord in real-time, while also allowing visualization of surrounding soft tissue anatomy during an operation. Although this has valuable applications for decompression surgery in spinal canal stenosis, it remains unclear how to best characterize adequacy of spinal decompression using IOUS.

Methods.
We conducted a systematic search of multiple databases including: Medline, Embase, and Cochrane Central Register of Controlled Trials Strategy. Our search terms were spine, spinal cord diseases, decompression surgery, ultrasonogra-phy, and intraoperative period. We were interested in studies that used intraoperative use of ultrasound imaging in spinal decompression surgery for the cervical, thoracic, and lumbar spine. Study quality was evaluated using the Methodological Index for Non-Randomized Studies (MINORS).

Results.
Our search strategy yielded 985 of potentially relevant publications, 776 underwent title and abstract screening, and 31 full-text articles were reviewed. We found IOUS to be useful in spine surgery for decompression of degenerative cases in all regions of the spine. The thoracic spine was unique for IOUS-guided decompression of fractures, and the lumbar spine for decompressing nerve roots. Although we did not identify a universal definition for adequate decompression, there was common description of decompression that qualitatively described the ventral aspect of the spinal cord being “free floating” within the cerebrospinal fluid. Other measurable definitions, such as spinal cord diameter or spinal cord pulsatility, were not good definitions given there was insufficient evidence and/or poor reliability.

Conclusion.
The systematic review examines the current literature on IOUS and spinal decompression surgery. We identified a common qualitative definition for adequate decompression involving a “free floating” spinal cord within the cerebrospinal fluid which indicates that the spinal cord is free from contact of the anterior elements.

Level of Evidence: 1
Characteristics of Tc-MEP Waveforms for Different Locations of Intradural Extramedullary Tumors
Authors: Kobayashi Kazuyoshi , Imagama Shiro , Ando Kei , Yoshida Go , Ando Muneharu , Kawabata Shigenori , Yamada Kei , Kanchiku Tsukasa , Fujiwara Yasushi , Taniguchi Shinichirou , Iwasaki Hiroshi , Shigematsu Hideki , Tadokoro Nobuaki , Takahashi Masahito , Wada Kanichiro , Yamamoto Naoya , Funaba Masahiro , Yasuda Akimasa , Ushirozako Hiroki , Hashimoto Jun , Morito Shinji , Takatani Tsunenori , Tani Toshikazu , Matsuyama Yukihiro 
Published: September 2021

Study Design.
Prospective multicenter study.

Objective.
To examine transcranial motor-evoked potential (Tc-MEP) waveforms in intraoperative neurophysiological monitoring in surgery for intradural extramedullary (IDEM) tumors, focused on the characteristics for cervical, thoracic, and conus lesions.

Summary of Background Data.
IDEM tumors are normally curable after resection, but neurological deterioration may occur after surgery. Intraoperative neurophysiological monitoring using Tc-MEPs during surgery is important for timely detection of possible neurological injury.

Methods.
The subjects were 233 patients with IDEM tumors treated surgically with Tc-MEP monitoring at 9 centers. The alarm threshold was ≥70% waveform deterioration from baseline. A case with a Tc-MEP alert that normalized and had no new motor deficits postoperatively was defined as a rescue case. A deterioration of manual muscle test score ≥1 compared to the preoperative value was defined as postoperative worsening of motor status.

Results.
The 233 patients (92 males, 39%) had a mean age of 58.1 ± 18.1 years, and 185 (79%), 46 (20%), and 2 (1%) had schwannoma, meningioma, and neurofibroma. These lesions had cervical (C1–7), thoracic (Th1–10), and conus (Th11-L2) locations in 82 (35%), 96 (41%), and 55 (24%) cases. There were no significant differences in preoperative motor deficit among the lesion levels. Thoracic lesions had a significantly higher rate of poor baseline waveform derivation (0% cervical, 6% thoracic, 0% conus, P < 0.05) and significantly more frequent intraoperative alarms (20%, 31%, 15%, P < 0.05). Use of Tc-MEPs for predicting neurological deficits after IDEM surgery had sensitivity of 87% and specificity of 89%; however, the positive predictive value was low.

Conclusion.
Poor derivation of waveforms, appearance of alarms, and worse final waveforms were all significantly more frequent for thoracic lesions. Thus, amplification of the waveform amplitude, using multimodal monitoring, and more appropriate interventions after an alarm may be particularly important in surgery for thoracic IDEM tumors.

Level of Evidence: 3
Pseudarthrosis Following Lumbar and Lumbosacral Fusion Using the Antepsoas Technique
Authors: Tannoury Chadi , Bhale Rahul , Vora Molly , Saade Aziz , Kortbawi Rabih , Orlando Giuseppe , Das Avilash , Tannoury Tony 
Published: September 2021

Study Design.
Retrospective case–control study.

Objective.
The aim of this study was to evaluate the prevalence of pseudarthrosis following antepsoas (ATP) lumbar and lumbosacral fusions.

Summary of Background Data.
Pseudarthrosis is a feared complication following spinal fusions and may affect their clinical outcomes. To date there are no sufficient data on the fusion rate following ATP lumbar and lumbosacral arthrodesis.

Methods.
This is a retrospective review of 220 patients who underwent lumbar minimally invasive antepsoas (MIS-ATP) fusions between January 2008 and February 2019 who have at least 1-year postoperative computed tomography (CT) follow-up scans. Fusion was graded using CT scans imaging and adopting a 1–4 grading scale (1, definitely fused; 2, likely fused; 3, likely not fused; 4, definitely not fused/nonunion). Grades 3 or 4 indicate pseudarthrosis.

Results.
A total of 220 patients (average age: 66 years, 82 males (37.2%), and 127 (57.7%) smokers) were included. Eight patients (3.6%) developed pseudarthrosis. A total of 693 discs were addressed using the ATP approach. Of those, 681 (98.3%) were considered fused (641 levels [92.5%] were “definitely fused” and 40 levels [5.8%] were “Likely fused”) and 12 discs (1.7%) developed pseudarthrosis (seven levels [1.0%] were “likely not fused” and five levels (0.7%) were “definitely not fused”). The highest rate of pseudarthrosis was found at L5-S1 (4.8%) compared to the L1-L5 discs (0–2%). Of 127 smokers, six developed pseudarthrosis (odds ratio = 2.3, P = 0.3). The fusion rates were 95.3% and 97.8% for smokers and nonsmokers, respectively. Of the eight patients who developed pseudarthrosis, only four (50%) were symptomatic, of whom two (25%) required revision surgery. Both of these patients were smokers. The overall revision rate due to pseudarthrosis was 0.9% (two of 220 patients).

Conclusion.
The MIS-ATP technique results in a high fusion rate (96.4% of patients; 98.3% of levels). Pseudarthrosis was noted mostly at the L5-S1 discs and in smokers.

Level of Evidence: 4
A Roadmap for Successful State Sepsis Regulations—Lessons From New York
Authors: Gigli Kristin Hittle , Rak Kimberly J. , Hershey Tina Batra , Martsolf Grant R. , Kahn Jeremy M. 
Published: September 2021

OBJECTIVES:
New York state implemented the first state-level sepsis regulations in 2013. These regulations were associated with improved mortality, leading other states to consider similar steps. Our objective was to provide insight into New York state’s sepsis policy making process, creating a roadmap for policymakers in other states considering similar regulations.

DESIGN:
Qualitative study using semistructured interviews.

SETTING:
We recruited key stakeholders who had knowledge of the New York state sepsis regulations.

SUBJECTS:
Thirteen key stakeholders from three groups included four New York state policymakers and seven clinicians and hospital association leaders involved in the creation and implementation of the 2013 New York state sepsis regulations, as well as two members of patient advocacy groups engaged in sepsis advocacy.

INTERVENTIONS:
None.

MEASUREMENTS AND MAIN RESULTS:
We used iterative, inductive thematic analysis to identify themes related to participant perceptions of the New York state sepsis policy, factors that influenced the policy’s perceived successes, and opportunities for improvement. We identified several factors that facilitated success. Among these were that policymakers engaged a diverse array of stakeholders in development, allowing them to address potential barriers to implementation and create early buy-in. Policymakers also paid specific attention to the balance between the desire for comprehensive reporting and the burden of data collection, narrowly focusing on “essential” sepsis-related data elements to reduce the burden on hospitals. In addition, the regulations touched on all three major domains of sepsis quality—structure, process, and outcomes—going beyond a data collection to give hospitals tools to improve sepsis care.

CONCLUSIONS:
We identified factors that distinguish the New York sepsis regulations from less successful sepsis polices at the federal level. Ultimately, lessons from New York state provide valuable guidance to policymakers and hospital officials seeking to develop and implement policies that will improve sepsis quality.