bluuebunny/crossref_metadata_2025_split huggingface dataset:
Triadic percolation induces dynamical topological patterns in higher-order networks
Authors: Millán Ana P , Sun Hanlin , Torres Joaquín J , Bianconi Ginestra 
Published: July 2024

Abstract
Triadic interactions are higher-order interactions which occur when a set of nodes affects the interaction between two other nodes. Examples of triadic interactions are present in the brain when glia modulate the synaptic signals among neuron pairs or when interneuron axo-axonic synapses enable presynaptic inhibition and facilitation, and in ecosystems when one or more species can affect the interaction among two other species. On random graphs, triadic percolation has been recently shown to turn percolation into a fully fledged dynamical process in which the size of the giant component undergoes a route to chaos. However, in many real cases, triadic interactions are local and occur on spatially embedded networks. Here, we show that triadic interactions in spatial networks induce a very complex spatio-temporal modulation of the giant component which gives rise to triadic percolation patterns with significantly different topology. We classify the observed patterns (stripes, octopus, and small clusters) with topological data analysis and we assess their information content (entropy and complexity). Moreover, we illustrate the multistability of the dynamics of the triadic percolation patterns, and we provide a comprehensive phase diagram of the model. These results open new perspectives in percolation as they demonstrate that in presence of spatial triadic interactions, the giant component can acquire a time-varying topology. Hence, this work provides a theoretical framework that can be applied to model realistic scenarios in which the giant component is time dependent as in neuroscience.
High alert in the low countries: State-sponsored threat awareness in policing the Dutch port and knowledge sectors
Authors: Eski Yarin , Boelens Mauro , Kok Bibi 
Published: July 2024

Abstract
The war in Ukraine has made clear that we live in a multipolar world where global powers, being the West, Russia, and China, are in continuous geopolitical conflict with one another. It has brought about old and new state-sponsored threats (SSTs), in particular (online) espionage and spreading disinformation, which are instrumentalized by each of these global powers against one another. It altogether puts the national security and economic interests of many more countries at risk. Being heavily dependent on global powers for trade and knowledge building and sharing, small countries seem to be confronted with their powerlessness in the wake of the increasingly threatening multipolar geopolitics. Simultaneously, some of these small countries accommodate important nodes through which international transport and knowledge flow on which global powers, in turn, depend on. In the Netherlands, the port sector (consisting in this study of the Rotterdam and Amsterdam seaports) and the knowledge sector (consisting of several universities, applied universities, and research institutes) form important international nodes for the global transport and knowledge economy. How does the Netherlands position and secure itself through raising awareness of SSTs coming from the global powers it depends on? Based on a study of SST awareness in Dutch ports and higher education, this contribution delivers a possible answer to that question.
Machine learning: implications and applications for ambulatory anesthesia
Authors: Anand Karisa , Hong Suk , Anand Kapil , Hendrix Joseph 
Published: July 2024

Purpose of review
This review explores the timely and relevant applications of machine learning in ambulatory anesthesia, focusing on its potential to optimize operational efficiency, personalize risk assessment, and enhance patient care.

Recent findings
Machine learning models have demonstrated the ability to accurately forecast case durations, Post-Anesthesia Care Unit (PACU) lengths of stay, and risk of hospital transfers based on preoperative patient and procedural factors. These models can inform case scheduling, resource allocation, and preoperative evaluation. Additionally, machine learning can standardize assessments, predict outcomes, improve handoff communication, and enrich patient education.

Summary
Machine learning has the potential to revolutionize ambulatory anesthesia practice by optimizing efficiency, personalizing care, and improving quality and safety. However, limitations such as algorithmic opacity, data biases, reproducibility issues, and adoption barriers must be addressed through transparent, participatory design principles and ongoing validation to ensure responsible innovation and incremental adoption.
Spinal anesthesia in ambulatory patients
Authors: Ledesma Ignacio , Stieger Andrea , Luedi Markus M. , Romero Carolina S. 
Published: July 2024

Purpose of review
To assess current practice in the use of spinal anesthesia in major ambulatory surgery, highlighting its advantages over general anesthesia and identifying potential areas for improvement to facilitate a transition to a sustainable healthcare system.

Recent findings
Spinal anesthesia might be preferred in selected populations when compared to general anesthesia providing the highest standards of healthcare quality.
The use of local anesthetics with short half-life has proven to be efficient in achieving high anesthesia success rates. Spinal anesthesia does not increase perioperative complications; instead, it has shown a reduction in postoperative nausea and vomiting, an improvement in patient comfort, and a favorable economic impact when compared to general anesthesia.

Summary
Spinal anesthesia is an appropriate method for anesthesia in ambulatory patients, offering advantages over general anesthesia in selected populations.
The use of spinal anesthesia is expanding to meet surgical needs. Therefore, it is crucial to plan ahead and anticipate organizational failures in the ambulatory setting to maintain safety and efficiency during outpatient procedures and surgeries.
Balancing Expectations: Navigating Medically Necessary Torso Procedures with Cosmetic Components in the Military Healthcare System
Authors: Zbar Ross I.S. , Richards Carly R.N. , Durbin Ronald R. , Wellington Jennifer M. 
Published: July 2024

Background:
Surgeons performing federal insurance–financed procedures involving medically necessary and cosmetic components must navigate patient expectations to avoid postoperative disappointment. This challenge is amplified in military healthcare, where different surgical specialties concurrently address the same diagnosis, while the Department of Defense policy on cosmetic fees and TRICARE’s definition of excluded services adds further complexity. With the increasing prevalence of elevated body mass index, focus is directed toward diagnoses involving the torso, specifically gynecomastia in male individuals, and diastasis of the rectus abdominis muscles (DRAM) in female individuals.

Methods:
The study involves a team of experienced board-certified surgeons conducting a narrative review of surgical procedures addressing gynecomastia and DRAM. Relevant literature from 2000 to 2023 is reviewed, focusing on patient satisfaction regarding outcome of medically necessary and cosmetic aspects.

Results:
For gynecomastia, distinguishing between true and pseudogynecomastia is critical. A protocol is presented based on the Simon classification, offering evidence-based guidelines for surgical interventions. Similarly, for DRAM, a minimally invasive approach balances deployment readiness and surgical recovery. The presence of a symptomatic panniculus, however, requires more invasive intervention. The downstream ramification of limited Current Procedural Terminology codes for these interventions is discussed.

Conclusions:
In medically necessary procedures funded through federal health plans such as TRICARE, the primary goal is functional improvement, not the final torso contour. Clear communication and preoperative counseling are crucial to managing patient expectations. Providers in military healthcare must navigate the complex landscape of patient expectations, policy guidelines, and duty readiness while maintaining the standard of care.
New Applications of the Anterior Intercostal Artery Perforator Flap for Prosthetic Breast Reconstruction in the Setting of Postoperative Radiotherapy
Authors: Marruzzo Giovanni , Patanè Luca , Lo Torto Federico , Ribuffo Diego 
Published: July 2024

Background:
Several studies have reported preliminary experiences with the anterior intercostal artery perforator (AICAP) flap for treating partial breast defects or breast implant exposure following reconstruction. As radiotherapy is commonly administered for breast cancer, some patients may present with heavily damaged skin flaps and chronic radiodermatitis. We describe new applications of a de-epithelialized AICAP flap, used in combination with an implant, for breast reconstruction when other treatment options are unavailable.

Methods:
A retrospective study was conducted, including all patients who underwent implant-based breast reconstruction with the aid of an AICAP flap. A literature review was also performed.

Results:
Between November 2022 and August 2023, four pedicled AICAP flaps were harvested in four patients. The indications were breast implant coverage in cases of chronic dermatitis of the mastectomy skin flaps (two unilateral flaps) and inferolateral coverage of partially submuscular expanders for immediate breast reconstruction (two unilateral flaps). All four flaps were based on one perforator. The mean harvesting time was 40 minutes. Complete flap survival was achieved, with no complications at the donor site.

Conclusions:
The AICAP flap is a safe and reliable technique for difficult cases of breast reconstruction when no other options are available. Moreover, this technique can easily provide additional coverage for the breast implant when needed.
A Supraorbital V-Y Myocutaneous Perforator Flap for Forehead Reconstruction
Authors: Feinendegen Dominik L. , Feinendegen Sandra Y. , Keller Martin 
Published: July 2024

Summary:
V-Y flaps vascularized by perforators have gained great popularity in the last years. The advantages over randomized local flaps are the significantly greater arc of rotation and transfer length as well as less lymphatic congestion. We introduce a supraorbital V-Y myocutaneous perforator flap for forehead reconstruction. The vascular basis of this flap are the perforators from the ophthalmic artery passing through the supraorbital foramen and incisura frontalis.
Adolescents With a High Burden of New-Onset Mood Symptoms After Sport-Related Concussion Benefit From Prescribed Aerobic Exercise, a Secondary Analysis of 2 Randomized Controlled Trials
Authors: Castellana Matthew C. , Burnett George J. , Gasper Andrew , Nazir Muhammad S. Z. , Leddy John J. , Master Christina L. , Mannix Rebekah C. , Meehan William P. , Willer Barry S. , Haider Mohammad N. 
Published: July 2024

Objective:
Approximately 20% of students with sport-related concussion (SRC) report new symptoms of anxiety and depression which may be associated with delayed recovery and increased risk for developing a mood disorder. Early prescribed aerobic exercise facilitates recovery in athletes with concussion-related exercise intolerance. We studied the effect of aerobic exercise treatment on new mood symptoms early after SRC.

Design:
Exploratory secondary analysis of 2 randomized controlled trials (RCT).

Setting:
Sports medicine clinics associated with UB (Buffalo, NY), CHOP (Philadelphia, PA), and Boston Children’s Hospital (Boston, MA).

Participants:
Male and female adolescents (aged 13-18 years) diagnosed with SRC (2-10 days since injury).

Interventions:
Participants were randomized to individualized targeted heart rate aerobic exercise (n = 102) or to a placebo intervention designed to mimic relative rest (n = 96).

Main Outcome Measures:
Incidence of Persisting Post-Concussive Symptoms (PPCS, symptoms ≥28 days).

Results:
First RCT recruited from 2016 to 2018 and the second from 2018 to 2020. Of 198 adolescents, 156 (79%) reported a low burden (mean 1.2 ± 1.65/24) while 42 (21%) reported a high burden (mean 9.74 ± 3.70/24) of emotional symptoms before randomization. Intervention hazard ratio for developing PPCS for low burden was 0.767 (95% CI, 0.546-1.079; P = 0.128; β = 0.085) and for high burden was 0.290 (95% CI, 0.123-0.683; P = 0.005; β = 0.732).

Conclusions:
High burden of mood symptoms early after injury increases risk for PPCS, but the sports medicine model of providing early targeted aerobic exercise treatment reduces it. Nonsports medicine clinicians who treat patients with a high burden of new mood symptoms after concussion should consider prescribing aerobic exercise treatment to reduce the risk of PPCS and a mood disorder.
Technical Pearls and Pitfalls of Facial Feminization Surgery
Authors: Chaya Bachar F. , Laspro Matteo , Trilles Jorge , Brydges Hilliard , Tran David , Rochlin Danielle H. , Cassidy Michael F. , Colon Ricardo Rodriguez , Rodriguez Eduardo D. 
Published: July 2024

Background
Facial feminization surgery (FFS) is an emerging practice that falls under the broader umbrella of gender-affirming surgery. Various approaches exist to feminize the face, yet few published articles describe in detail the techniques of each component procedure. Considering the diversity of interventions employed, the objective of this manuscript is to highlight FFS techniques utilized by the senior author and create a corresponding media gallery.

Methods
All patients with the diagnosis of gender dysphoria that were referred to the senior author for FFS consultation between June 2017 and August 2022 were reviewed. Data were retrospectively collected from electronic medical records according to the institutional review board (IRB)–approved study protocol. Data collected and analyzed included demographics, operative documentation, and postoperative follow-up. Multimedia material was collected intraoperatively and postoperatively.

Results
A total of 231 patients underwent 262 operations with a total of 1224 FFS procedures. The average follow-up time was 7.7 ± 11 months. Out of the 262 operations, 24 (9.2%) patients experienced minor complications, including 3 (1.1%) with wound dehiscence, 13 (5.0%) with hematomas, and 14 (5.3%) with postoperative infection requiring antibiotics. Of those, 3 (1.1%) required a return to the operating room for washout or removal of malar implants.

Conclusion
Although there is a consensus on the fundamental surgical principles to achieve adequate feminization of the facial architecture, the specific techniques to do so differ according to individual practices. As techniques diverge, so do their risk profiles and outcomes; techniques must, thus, align with patients' interventional goals. The material presented here is one of many that can support trainees and junior surgeons as they build a gender-affirming practice.
Oncoplastic Surgery Outcomes in the Older Breast Cancer Population
Authors: Gaffney Kerry A. , Karamchandani Manish M. , De La Cruz Ku Gabriel , Wareham Carly , Homsy Christopher , Nardello Salvatore , Chatterjee Abhishek , Persing Sarah M. 
Published: July 2024

Background
Oncoplastic breast surgery (OBS) is a form of breast conservation surgery (BCS) that involves a partial mastectomy followed by immediate volume displacement or volume replacement surgical techniques. To date, there are few studies evaluating OBS in older patients. Therefore, we sought to determine if outcomes differed between patients 65 years and older versus younger patients who underwent oncoplastic surgical procedures.

Methods
A retrospective chart review was performed for all oncoplastic breast operations within a single health system from 2015 to 2021. Patients were stratified by age, with patients 65 years and older (OBS65+) identified and then matched with younger patients (OBS <65) based on BMI. Primary outcomes were positive margin rates and overall complication rates; secondary outcomes were locoregional recurrence (LR), distant recurrence (DR), disease-free survival (DFS), overall survival (OS), and long-term breast asymmetry.

Results
A total of 217 patients underwent OBS over the 6-year period, with 22% being OBS65+. Preoperatively, older patients experienced higher American Anesthesia (ASA) scores, Charlson Co-morbidity index (CCI) scores, and higher rates of diabetes mellitus, hypertension, and grade 3 breast ptosis. Despite this, no significant differences were found between primary or secondary outcomes compared to younger patients undergoing the same procedures.

Conclusions
Oncoplastic breast reconstruction is a safe option in patients 65 years and older, with overall similar recurrence rates, positive margin rates, and survival when compared to younger patients. Although the older cohort of patients had greater preoperative risk, there was no difference in overall surgical complication rates or outcomes. Supporting the argument that all oncoplastic breast reconstruction techniques should be offered to eligible patients, irrespective of age.
Frontal Theta Oscillations and Cognitive Flexibility: Age-Related Modulations in EEG Activity
Authors: Darna Margarita , Stolz Christopher , Jauch Hannah-Sophia , Strumpf Hendrik , Hopf Jens-Max , Seidenbecher Constanze I. , Schott Björn H. , Richter Anni 
Published: July 2024

AbstractCognitive flexibility, the ability to adapt one’s behaviour in changing environments, declines during aging. Electroencephalography (EEG) studies have implicated midfrontal theta oscillations in attentional set-shifting, a measure of cognitive flexibility. Little is known about the electrocortical underpinnings of set-shifting in aging. Here, we investigated aging effects on set-shifting performance by analysing theta power in 20 young (mean age: 22.5 ± 2.9 years) and 19 older (mean age: 69.4 ± 6.1 years) adults. While increasing shift difficulty (i.e., intra- vs. extra-dimensional shifts) elicited increased reaction times (RTs) and higher error rates in both age groups, older adults additionally showed an increase in RT variability. Young adults exhibited amplified theta power increases with higher shift difficulty whereas older adults showed overall lower theta power and no task-related power modulation. Our results suggest that set-shifting in older adults occurs without midfrontal theta modulation, indicating potentially distinct underlying neural mechanisms compared to young adults.
Pharmacological rescue of motor circuit dysfunction in aDrosophilamodel of paroxysmal dyskinesia
Authors: Wilson Abigail D. , Jiang Yuyao , Desai Nidhika , Simon-Batsford Nell , Sanderson Angelina , Tolley Isaac , Gao Hao , Jepson James E.C. 
Published: July 2024

ABSTRACTBackgroundParoxysmal dyskinesias (PxDs) are characterised by bouts of involuntary dystonic and choreiform movements. The patho-mechanisms underlying these debilitating disorders remain poorly understood, and drug treatments are often limited. We recently generated aDrosophilamodel of a PxD-linked mutation causing BK potassium channel gain- of-function (BK GOF), and showed that BK GOF perturbs movement inDrosophilaby disrupting neurodevelopment. However, whether locomotor capacity in BK GOF flies can be pharmacologically restored following neurodevelopmental insults has remained unclear.ObjectiveTo identify pharmacological suppressors of motor defects caused by BK GOF.MethodsUsing adult BK GOF flies, we performed an unbiased, in vivo, locomotion-based screen of 370 FDA-approved drugs. To test the impact of positive hits from this screen on motor circuit activity, we used optical imaging to record the intrinsic rhythmic activity ofDrosophilalarval motor circuits driving peristalsis and turning behaviors.ResultsWe found that inhibitors of acetylcholinesterase – a protein that degrades acetylcholine in cholinergic synapses – partially rescued movement defects caused by BK GOF. Inhibition of acetylcholinesterase also partially restored intrinsic activity of motor circuits controlling forward movement and turning in BK GOF larvae.ConclusionsOur findings indicate that elevating cholinergic tone can reverse motor circuit dysfunction in an animal model of PxD caused by BK GOF. Furthermore, our study provides proof-of-principle thatDrosophilacan be utilised for screens to uncover putative drug treatments for involuntary movement disorders.
In-silico studies on structural and thermodynamics basis of interaction of lac repressor protein binding to different DNA operators
Authors: Das Soumi , Roy Siddhartha , Bhattacharyya Dhananjay 
Published: July 2024

AbstractTranscription factors, which bind to a large number of sequences in the sea of genome non-specifically, affect the final outcome in a sequence-dependent manner and intrigued us to explore whether there exists any conformational preference of the DNA. Lac-repressor, binds to major groove of DNA with strong sequence specificity, also interacts with the minor groove of its operator by partially intercalating two symmetry related Leucine side-chains between two CG base pairs. We attempt to elucidate mechanisms of the structural and dynamic alterations of two different Lac operator DNA sequences upon Lac repressor recognition using molecular modelling and all-atom molecular dynamics simulations. The difference of hydrogen bonding network and deformation of DNA base pair step produce the asymmetric dynamics of the two subunits of Lac repressor protein. Variation of minor groove widths can direct overall shape complementarily between the DNA and protein surfaces indicating DNA is significantly deformed to accommodate the protein fold. Bending flexibility indirectly modulates the Lac binding activity that controls transcription efficiency. Thus we suggest that Lac operator is unique as it uses both Lock & Key mechanism for DNA recognition, where protein induced structural alteration of the receptor DNA is not required, and also Induced Fit/Conformational Selection model of recognition.Graphical AbstractHighlightsRecognition of two different DNA Sequences by prokaryotic transcription factor lac repressor is modulated through asymmetric protein dynamics that have emerged in terms of conformational entropy and essential dynamics.The difference of the hydrogen bonding network and the deformation of the DNA base pair step produces the asymmetric dynamics of the two subunits of the lac repressor protein.The difference in overall protein dynamics upon interaction with DNAs of different sequences is the key feature in stabilizing the gene regulatory networks differently.