bluuebunny/crossref_metadata_2025_split huggingface dataset:
Absence of Aerosol Indirect Effect Dependence on Background Climate State in NCAR CESM2
Authors: White Kayla , Liu Dunyu , Persad Geeta 
Published: September 2024

Abstract
The aerosol indirect effect (AIE) dominates uncertainty in total anthropogenic aerosol forcing in phase 6 of the Coupled Model Intercomparison Project (CMIP6) models. AIE strength depends on meteorological conditions that have been shown to change between preindustrial (PI) and present-day (PD) climates, such as cloud cover and atmospheric moisture. Hence, AIE strength may depend on background climate state, impacting the dependence of model-based AIE estimates on experiment design or the evolution of AIE strength with intensifying climate change, which has not previously been explicitly evaluated. Using atmosphere-only simulations with prescribed observed sea surface temperatures (SSTs) and sea ice in the National Center for Atmospheric Research (NCAR) Community Earth System Model 2, version 2.1.3 (CESM2), Community Atmosphere Model, version 6.0 (CAM6), model, we impose a PD (2000) aerosol perturbation onto a PI (1850), PD, and PD with a uniform 4 K increase in the SST (PD + 4 K) background climate to assess the dependence of the total aerosol effective radiative forcing (ERF) and AIE on background climate. We find statistically insignificant increases in aerosol ERF when estimated in the different background climates, almost entirely from increases in direct ERF but with some regionally significant compensating signals in PD + 4 K. The absence of an AIE dependence on background climate in our PD simulation may be tied to documented differences in cloud responses to the observed SSTs used in our simulations versus SSTs produced by the fully coupled models from which most cloud feedback studies are derived, known as the “pattern effect.” Our findings indicate that AIE and aerosol forcing overall may not have a strong dependence on the background climate state in the near future but could regionally under extreme climate change.

Significance Statement
Diverse model representations of aerosol–cloud interactions strongly contribute to uncertainty in historical anthropogenic aerosol forcing and are associated with uncertainty in climate sensitivity. This study aims to highlight the dependence of aerosol indirect effects on the background climate state in Community Earth System Model 2, version 2.1.3 (CESM2), Community Atmosphere Model, version 6.0 (CAM6), by identifying microphysical and meteorological changes between aerosol-driven atmospheric responses in present-day and preindustrial climate states to understand anthropogenic aerosol-driven forcing more thoroughly.
Portfolio Diversification Opportunities between Europe and India do Exist
Authors: Mohapatra Arup Bramha , Bhanotu Venkateswara Rao 
Published: September 2024

In this article, a humble effort has been made to check the volatility transmission from European stock markets (FTSE100, DAX30, CAC40 and SMI20) to the Indian stock market (NIFTY50) to determine whether there is any opportunity for portfolio managers to diversify their portfolio. Various statistical tools and econometric models, such as vector autoregression (VAR) and dynamic conditional correlation (DCC)-multivariate generalised autoregressive conditional heteroscedasticity (MGARCH), are used to detect the volatility transmission from the European market to the Indian market. The FTSE100 and the NIFTY50 have been found to have bidirectional causality. VAR results suggest that only the DAX30 and SMI20 (Germany and Switzerland) markets have an impact on the Indian market. Finally, using DCC-MGARCH, the researcher found that information spillover takes place from all European countries to India over a longer period of time, but portfolio diversification between the London market (FTSE) and the Indian market (NIFTY) and German market (DAX) with Indian market (NIFTY) is possible over a shorter period of time. JEL Codes: C01, G1, G17
Development and Validation of a Workshop-Based Educational Module: “Basic Course in Electroconvulsive Therapy” for Medical Students
Authors: Praharaj Samir Kumar , Udupa Suma T. , Jammigumpula Ashok , Vadakedom Suresh S. 
Published: September 2024

Background: Electroconvulsive therapy (ECT) is a safe and effective treatment option for various psychiatric disorders. However, its widespread use is limited by prevalent negative attitudes and stigma, not only within the general public but also among healthcare professionals. This study aimed to develop and validate a workshop-based educational module, titled the “Basic Course in ECT,” for medical students. Methods: The curriculum development framework was used to develop the educational module. The content of the educational module was developed through expert consensus involving two rounds of the Delphi method. Faculty members provided feedback to validate the workshop content. A total 33 interns participated in the workshop. Student satisfaction was assessed using a feedback questionnaire. Results: Eight content areas were identified through a literature review. The Delphi consensus with 15 experts resulted in 10 topics being incorporated into the educational module. The module demonstrated strong face validity, as indicated by a content validity index of 1. Participants expressed high satisfaction with the workshop module regarding content, teaching methods, and time allocation. Feedback indicated an improvement in knowledge and a positive attitude toward ECT. Conclusions: The “Basic Course in ECT” was developed using expert consensus and validated for use with medical students. It can be integrated into the undergraduate curriculum.
Influence of panic disorder and paroxetine on brain functional hubs in drug-free patients
Authors: Zhang Yingying , Yan Haohao , Han Yiding , Shan Xiaoxiao , Li Huabing , Liu Feng , Li Ping , Zhao Jingping , Guo Wenbin 
Published: September 2024

Background:The effects of panic disorder (PD) and pharmacotherapy on brain functional hubs in drug-free patients, and the utility of their degree centrality (DC) in diagnosing and predicting treatment response (TR) for PD, remained unclear.Aims:This study aimed to assess the effects of PD and paroxetine on brain functional hubs in drug-free patients and to identify neuroimaging biomarkers for diagnosing and predicting TR in patients with PD.Methods:Imaging data from 54 medication-free PD patients and 54 matched healthy controls (HCs) underwent DC and functional connectivity (FC) analyses before and after a 4-week paroxetine treatment. Diagnosis and prediction of TR models for PD were constructed using support vector machine (SVM) and support vector regression (SVR), with DC as features.Results:Patients with PD showed aberrant DC and FC in the anterior cingulum, temporal, and occipital areas compared with HCs at baseline. After treatment, DC of the patients increased in the calcarine cortex, lingual gyrus, and cerebellum IV/V, along with improved clinical symptoms. Utilizing voxel-wise DC values at baseline, the SVM effectively distinguished patients with PD from HCs with an accuracy of 83.33%. In SVR, the predicted TR significantly correlated with the observed TR (correlation coefficient ( r) = 0.893, Mean Squared Error = 0.009).Conclusion:Patients with PD exhibited abnormal DC and FC, notably in the limbic network, temporal, and occipital regions. Paroxetine ameliorated patients’ symptoms while altering their brain FC. SVM and SVR models, utilizing baseline DC, effectively distinguished the patients from HCs and accurately predicted TR.
Orthodontic Extrusion of Fractured Tooth with Clear Retainer
Authors: Nagar Namit , Agarwal Shreya , Dave Anupa 
Published: September 2024

Tooth fracture at the cervical margin is frequently seen, and orthodontic extrusion of the same can be carried out to achieve a “ferrule effect” for successful restoration. Various techniques incorporating conventional removable and fixed orthodontics have been employed to facilitate orthodontic extrusion of the fractured tooth. The clear aligner can be used to facilitate the extrusion of a fractured tooth using the “bootstrap” arrangement. Bootstrap mechanics involve placing bonded buttons at the gingival margins on the facial, lingual, or both surfaces of a tooth that is lagging. In this pearl, an innovative and economical prerestorative orthodontic method, based on the biomechanical principles of the “bootstrap” arrangement used in aligners, is developed for the successful extrusion of a fractured tooth using a clear retainer and orthodontic elastics. The amount of extrusion of the fractured tooth was 2.5 mm and was achieved in a time frame of 3 weeks. The appliance is patient-friendly and cost-effective. Moreover, the appliance omitted the use of fixed orthodontic treatment mechanics.
Inflammatory markers related to survival in breast cancer patients: Peru
Authors: De La Cruz-Vargas Jhony Alberto , Roldán-Arbieto Luis , Malpartida Palomino Robert , Ferrer Ponce Diana , Fernández Anccas Cesar , Correa López Lucy , Beltrán Gárate Brady Ernesto , Vela Ruiz José Manuel 
Published: September 2024

Introduction Breast cancer is a disease with high global prevalence. Clinical inflammatory biomarkers have been proposed as prognostic indicators in oncology. This research aims to determine the relationship between inflammatory markers and overall survival in breast cancer patients from four representative hospitals in Lima, Peru. Methods This is a multicentric, analytical, longitudinal retrospective cohort study with survival analysis in female patients with breast cancer, from 2015 to 2020, who had received at least one complete treatment regimen. The dependent variable was overall survival, and the independent variables were inflammatory markers neutrophil lymphocyte ratio, platelet lymphocyte ratio (PLR), albumin, and red cell distribution width; intervening variables included age, clinical stage, molecular subtype, and other known prognostic factors. The Kaplan–Meier method was applied to generate survival curves with the Log-Rank test, and finally, Cox regression, to find crude and adjusted hazard ratios (HR). Results Of 705 evaluated patients, 618 were analyzed. The mean age was 56.6 ± 12.3 years, 18.0% of patients were pure HER2 positive, 39.3% luminal A, 29.9% luminal B, 11.0% triple-negative, and 81.4% showed overweight and obesity. The average overall survival was 51.1 months. In the multivariate analysis, factors significantly related to lower overall survival were PLR > 150 (adjusted HR: 2.33; 95% confidence interval (CI): 1.22, 4.44) and stage III (adjusted HR: 4.15; 95% CI: 1.35, 12.83). Conclusions The Elevated Platelet-Lymphocyte Index and advanced clinical stage were associated with lower overall survival in breast cancer patients. Furthermore, PLR >150 proved to be an independent prognostic factor for mortality.
For Debate: Concomitant Critical Coronary Arterial Disease and Abdominal Aortic Aneurysm — Timing of Corrective Procedures
Authors: Onwudike M. , Barnard M. , Singh-Ranger R. , Raphael M. , Adiseshiah M. 
Published: September 2024

Background.The high prevalence of coronary artery disease (CAD) in patients with abdominal aortic aneurysm (AAA) is responsible for most < 30-day mortality and morbidity in elective repair of AAA. The continuing debate regarding staged or combined surgery for AAA and CAD (coronary artery bypass grafting — CABG) in the small number of patients with critical degrees of both co-morbidities has not had a significant impact on the greater mortality and morbidity when the AAA repair is undertaken using the standard open operation.Patients.We report four cases with these combined pathologies which we have managed over the last 30 months during which time we have developed techniques of endolumenal repair of AAA.Conclusions.Whilst it is not possible to make firm recommendations regarding management strategy owing mainly to a lack of large series reporting this unusual combination of co-morbidities, the options are debated on the basis of published anecdotal evidence as well as our own case reports. We suggest that if the AAA is non-tender and/or 5.5–8.0 cm, the staged approach is appropriate. If the AAA is tender and/or > 8.0 cm, a combined approach may be a better option in order to avoid the risk of AAA rupture during the interval between the operations. Endolumenal repair of AAA offers a further option for the staged and combined approach, and may be less invasive than the standard open surgery for AAA repair.
Pericapillary Fibrin Deposits and Skin Hypoxia Precede the Changes of Lipodermatosclerosis in Limbs at Increased Risk of Developing a Venous Ulcer
Authors: Stacey M.C. , Burnand K.G. , Bhogal B.S. , Black M.M. 
Published: September 2024

This study investigated the possibility that pericapillary fibrin deposition, found in the calf skin of patients with venous ulceration and lipodermatosclerosis, might already be present in the dermis of the gaiter area of apparently healthy limbs before any skin changes were visible. The apparently healthy limbs of 19 consecutive patients with a healed venous ulcer on one leg and no history of ulceration or clinical evidence of lipodermatosclerosis in the opposite calf, were studied. Bipedal ascending phlebography and foot volume plethysmography were performed, and systemic fibrinolytic activity and fibrinogen levels were calculated. Transcutaneous oxygen measurements were expressed as a ratio of levels from a fixed position in the gaiter skin over a control site on the arm. Biopsies of a standard site in the gaiter skin and the thigh were assessed for the presence of laminin, fibrinogen and fibronectin using immunofluorescent microscopy. The extent of pericapillary fluorescence was expressed as a ratio of the number of capillaries with deposits divided by the total number of capillaries staining with laminin (fibrin and fibronectin scores). Pericapillary fibrin deposits were observed in the dermis in 16 of the biopsies of the gaiter region (median score 0.20), and in eight of the biopsies from the thigh (median score 0.0). This difference was highly significant ( P < 0.01, Wilcoxon signed rank test). The transcutaneous oxygen ratio correlated negatively with the fibrin score (Spearman rank correlation coefficient − 0.62, P < 0.01), and there was a weak negative correlation between the half volume refilling time on foot volume plethysmography (an indicator of venous reflux) and the fibrin score (Speraman rank correlation coefficient − 0.47, P < 0.05). No such correlation could be shown between the fibrin score and the indicators of calf pump function, the euglobulin clot lysis time or the plasma fibrinogen. The presence of significant numbers of pericapillary fibrin deposits within the dermis of the gaiter skin has been demonstrated in 84% of this cohort of ‘at risk’ limbs before there is any evidence of clinical lipodermatosclerosis.
Lower Levels of PAI-2 May Contribute to Impaired Healing in Venous Ulcers — A Preliminary Study
Authors: Stacey Michael C. , Mata Sandy D. 
Published: September 2024

Plasminogen activators may potentially influence the wound healing processes of cell migration matrix degradation and cellular adhesion in venous ulcers by their regulation of protease activity The aim of this study was to assess the levels of plasminogen activators in venous ulcers and to gain preliminary data from healing wounds. The concentrations of u-PA, t-PA, PAI-1 and PAI-2 antigen as well as functional u-PA were assessed in tissue homogenates from 20 chronic venous ulcers, six actively healing venous ulcers and five traumatic wounds. The concentrations of functional u-PA. u-PA antigen and PAI-1 were significantly greater and PAI-2 was siqnificantly lower in the edge and base of chronic venous ulcers compared to adjacent intact skin ( P < 0.01). Healing wounds had significantly higher functional u-PA at the ulcer edge and higher u-PA antigen concentration in intact skin ( P < 0.05). PAI-2 levels were significantly higher in the ulcer edge and base in the healing wounds than in chronic These findings suggest that regulation of protease activity by u-PA and PAI-2 may play a role in the impaired healing of chronic venous ulcers.
Posterior Transverse Plication Technique for Treatment of Redundant Internal Carotid Artery during Endarterectomy
Authors: Ascher Enrico , Hingorani Anil , Gunduz Yilmaz , Mazzariol Fernanda , Yorkovich William , Salles-Cunha Sergio 
Published: September 2024

Purpose: Posterior transverse plication (PTP) has gained popularity as a technique to correct redundancy of the internal carotid artery during endarterectomy. The safety of this technique in large series of patients has not been extensively studied. We investigated 876 primary carotid endarterectomies (CEAs) performed at our institution over the last six years to determine the safety of this technique. Methods: Indication for surgery was carotid stenosis ≥ 70% in 341 (39%) symptomatic and 535 (61%) asymptomatic cases. Preoperative imaging consisted of duplex ultrasound alone or combined with magnetic resonance angiography. Patients were divided into four groups related to surgical technique: CEA + PTP + 8 mm patch (group la), CEA + PTP + 10 mm patch (group lb), CEA + patch (group II) and CEA + primary closure (group III). There were 43, 39, 581 and 213 patients in groups la, lb, II and III, respectively. No statistical differences in age, sex or risk factors for atherosclerotic disease were noted among the groups. Postoperative duplex ultrasonography was used at 2 weeks and every 6 months thereafter to evaluate the adequacy of the repair and presence of complications such as pseudoaneurysm formation and extrinsic compression by the excluded carotid segment. Results: The 30-day mortality was 1.2%, 0.6% and 0.3% for groups I, II and III, respectively. Stroke rates for the same period were 0%, 0.6% and 0.8% for groups I. II and III, respectively. Duplex ultrasonography demonstrated significant stenosis (≥ 50%) in two (5%) patients in group la at 12 months. No restenosis was observed in group lb. For groups II and III the rates of restenosis were 1.5% and 0.8%. One patient in group II developed a pseudoaneurysm after 7 months. Conclusion: Posterior transverse plication safely corrects redundancy of the internal carotid artery during endarterectomy without causing early significant restenosis. Continued follow-up in a larger group of patients to determine long-term efficacy and correlation between patch size and restenosis rate is warranted.
Comparison of the Flow Capacity of Free Arterial Grafts and Saphenous Vein Grafts for Coronary Bypass Surgery
Authors: Hall Timothy S. , Ferguson John , Sines Jean , Spotnitz Alan J. 
Published: September 2024

There is controversy regarding the flow reserve and capacity of arterial conduits to meet the needs of the myocardium. This study compared flow in 22 free arterial bypasses to 15 saphenous vein grafts in procedures involving twenty patients. To assess the maximal flow possible, (flow capacity) graft flow was measured using a calibrated pump while perfusing blood cardioplegia through the conduit and distal anastomosis during cardiac arrest (no competitive flow). This assessment was subsequently confirmed with whole blood during myocardial contraction while on cardiopulmonary bypass. Twenty-two free arterial grafts were used; 15 right internal mammary artery grafts. 4 right gastroepiploic grafts. 3 inferior epigastric artery grafts, and 3 sequential bypasses. Free arterial conduit flow ranged from 50 to 180 cc/ml, with an average flow of 102.5 ± 28.5 ml/min as compared to saphenous vein graft flow. 102 ± 28 ml/min. No correlation of flow with the conduit size was found. Arterial graft flow demonstrated a mild correlation with the size of the native coronary artery bypassed ( R = 0.47, P ≤ 0.02). Conclusions: Basal flow through free arterial grafts is equivalent to saphenous vein grafts and is primarily determined by the native coronary vessels. The flow reserve for free arterial conduits is more than adequate for coronary bypass surgery.
Effects of a New Cardiomyoplasty Technique on Cardiac Function
Authors: El Oakley Reida M. , Jarvist Jonathan C. 
Published: September 2024

Objective: The current cardiomyoplasty technique was modified to maintain the resting tension of the latissimus dorsi muscle and to prevent lateral movement of the heart during muscle stimulation. The aim of this study is to compare the short term hemodynamic effects of the new cardiomyoplasty wrap (W1) with those of the clinically applied cardiomyoplasty wrap (W2). Preliminary indications of the long-term hemodynamic effects of W1 are presented. Methods: In three acute experiments in sheep mean central venous pressure (MCVP), mean arterial pressure (MAP), mean cardiac output (MCOP), mean left ventricular systolic pressure (MLVSP). and mean left ventricular diastolic pressure (MLVDP) were measured for 30 s before and five minutes after applying each procedure with and without stimulation of the muscle graft. The same parameters were also recorded 5 min after removing each muscle wrap. Hemodynamic changes associated with unstimulated muscle wraps were compared to the baseline data. Hemodynamic effects of muscle stimulation were determined by comparing the assisted to the preceding unassisted cardiac cycle. The long-term effects of W1 on the hemodynamics of another three sheep were studied at 6–12 months after the operation. The viability of the muscles used in the chronic experiments were evaluated by morphometric analysis. Results: Unstimulated W2 significantly increased mean central venous pressure and reduced mean cardiac output. It also increased mean left ventricular diastolic pressure and reduced peak negative dP/dt. Unstimulated W1 had no deleterious effect on mean central venous pressure, mean left ventricular diastolic pressure or peak — dP/dt, but it also reduced mean cardiac output and increased mean left atrial pressure (MLAP). Synchronised muscle stimulation, in both techniques, augmented the mean arterial pressure, mean cardiac output and mean left ventricular systolic pressure. In W2, however, myostimulation was also associated with a significant increase of the mean left ventricular diastolic pressure. In two long-term experiments significant hemodynamic assistance was observed at 6 months and at 1 yr after W1. In those sheep 68% of the cross-sectional area of the muscle was well preserved. Conclusions: Unstimulated cardiomyoplasty wraps acutely impair left ventricular function in sheep. The new technique, however, may offer significant long-term hemodynamic assistance and adequate preservation of the structural and functional integrity of the muscle flap for up to 1 yr.
Familial Abdominal Aortic Aneurysms in the Otago Region of New Zealand
Authors: Rossaak J.I. , Hill T.M. , Jones G.T. , Phillips L.V. , Harris E.L. , van Rij A.M. 
Published: September 2024

Purpose: To investigate the familial incidence and phenotypic characteristics of patients with abdominal aortic aneurysms (AAA) in the Otago region of New Zealand. Methodology: A retrospective audit based pilot study and a prospective study of patients having abdominal aortic aneurysm repair from September 1988 to September 1999 was performed. Results: 248 probands were enrolled, of which 19.4% had one or more first degree relative affected. The age at diagnosis of the familial (70.2) and non-familial (70.5) patients was similar. The proportion of females was increased in the familial subgroup. Hypercholesterolaemia was the only phenotypic feature to differentiate familial from non-familial patients and was associated with an earlier age of presentation. In the familial families, brothers were the most common relative affected and 77% of the families had two patients with AAA. Conclusion: 19.4% of patients operated on in the Otago area for AAA had a familial component to their aneurysm.