bluuebunny/crossref_metadata_2025_split huggingface dataset:
State of the Art: Pouch Surgery in the 21st Century
Authors: Maspero Marianna , Hull Tracy L. 
Published: March 2024

BACKGROUND:
An ileoanal pouch with ileal pouch-anal anastomosis is the preferred method to restore intestinal continuity in patients who require a total proctocolectomy. Pouch surgery has evolved during the past decades thanks to increased experience and research, changes in the medical management of patients who require an ileal pouch, and technological innovations.

OBJECTIVE:
To review the main changes in pouch surgery during the last two decades, with focus on staging, minimally invasive and transanal approaches, pouch design, and anastomotic configuration.

RESULTS:
The decision on the number of stages depends on the patient’s conditions, their indication for surgery, and the risk of anastomotic leak. A minimally invasive approach should be performed whenever feasible, but open surgery still has a role in this technically demanding operation. Transanal IPAA may be performed in experienced centers and may reduce conversion to open in the hostile pelvis. The J pouch is the easiest, fastest, and most commonly performed design, but other designs may be used when a J-pouch is not feasible. A stapled anastomosis without mucosectomy can be safely performed in the majority of cases, with low incidence of rectal cuff neoplasia and better functional outcomes than handsewn. Finally, Crohn’s disease is not an absolute contraindication to an ileoanal pouch, but pouch failure may be higher compared to other indications.

CONCLUSIONS:
Many technical nuances contribute to the success of an ileoanal pouch. The current standard of care is a laparoscopic J pouch with double-stapled anastomosis, but this should not be seen as a dogma, and the optimal approach and design should be tailored to each individual patient. See video from symposium.
Navigating menopause at work: a preliminary study about challenges and support systems
Authors: Alzueta Elisabet , Menghini Luca , Volpe Laila , Baker Fiona C. , Garnier Ann , Sarrel Philip M. , de Zambotti Massimiliano 
Published: March 2024

Abstract

Objective
Women's increasing workforce participation necessitates understanding unique life phases like menopause for enhanced workplace inclusivity. This research investigates the challenges and needs of peri-menopausal women in work settings, using the Job Demands–Resources model as a foundation.

Methods
A cross-sectional survey was administered to 351 working women aged 40 to 65 years in the United States. Hierarchical multiple regression models were employed to assess the relationship between the severity of menopausal symptoms, emotional exhaustion, work engagement, and turnover intentions.

Results
Most of the respondents reported moderate (38.46%) to severe (35.9%) menopausal symptoms. Notably, 54% of the women were caregivers for children or adults. About 77.7% of participants reported work-related challenges due to menopause, with a perceived reduction in productivity (56.8%) being the most common issue. The severity of menopausal symptoms was found to significantly predict more emotional exhaustion (P < 0.001), less work engagement (P < 0.001), and greater turnover intentions (P = 0.03). Concerns about being perceived as less capable in the workplace due to menopausal symptoms were reported by 51.2% of respondents. A striking gap exists between the workplace measures desired by women, such as formal menopause policies and managerial training (65.4%-68%), and their actual implementation (2%-6.3%).

Conclusions
This study reveals an exigent need for increased awareness and structural changes to support working women going through menopause. The findings have far-reaching implications for not just promoting gender equity and well-being but are also pivotal for maintaining a diversified, engaged, and effective workforce.
Tranexamic acid in upper gastrointestinal bleed in patients with cirrhosis: A randomized controlled trial
Authors: Kumar Manoj , Venishetty Shantan , Jindal Ankur , Bihari Chhagan , Maiwall Rakhi , Vijayaraghavan Rajan , Saggere Muralikrishna Shasthry , Arora Vinod , Kumar Guresh , Sarin Shiv K. 
Published: March 2024

Background and Aims:
Patients with Child-Turcotte-Pugh class B and C cirrhosis with upper gastrointestinal bleeding (UGIB) have systemic as well as localized (in the mucosa of the esophagus and stomach) fibrinolysis. The aim of this study was to evaluate the efficacy and safety of tranexamic acid in the treatment of acute UGIB in patients with cirrhosis.

Approach and Results:
A total of 600 patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB were randomly allocated to either the tranexamic acid (n=300) or the placebo group (n=300). The primary outcome measure was the proportion of patients developing 5-day treatment failure. Failure to control bleeding by day 5 was seen in 19/300 (6.3%) patients in the tranexamic acid group and 40/300 (13.3%) patients in the placebo group (p=0.006). Esophageal endoscopic variceal ligation (EVL) site as a source of failure to control bleeding by day 5 among patients undergoing first-time esophageal EVL (excluding patients with a previous post-EVL ulcer as a source of bleed) was seen in 11/222 (4.9%) patients in the tranexamic acid group and 27/225 (1212.0%) patients in the placebo group (p=0.005). However, 5-day and 6-week mortality was similar in the tranexamic acid and placebo groups.

Conclusions:
Tranexamic acid significantly reduces the failure to control bleeding by day 5 and failure to prevent rebleeding after day 5 to 6 weeks in patients with advanced liver cirrhosis (Child-Turcotte-Pugh class B or C) presenting with UGIB, by preventing bleeding from the EVL site.
Tympanic Perforations in Children: When to Propose Surgical Closure?
Authors: Del Puppo Marine , Farinetti Anne , Roman Stéphane , Rossi Marie-Eva , Le Treut Claire , Nicollas Richard , Moreddu Eric 
Published: March 2024

Objective
This study aims to analyze the impact of age and other prognostic factors on the success of myringoplasty.

Study design
A retrospective case series.

Settings
Pediatric ENT department of a tertiary academic center.

Patients
Two hundred forty-one children (318 ears) aged 3 to 17 years with tympanic perforation.

Intervention
Myringoplasty performed between 2009 and 2019.

Main outcomes measures
The rate of tympanic closure, perforation recurrence, revision surgery, and audiometric gain were collected. The impact of age and anatomical and surgical factors was analyzed for each procedure.

Results
With a mean follow-up time of 1 year, the tympanic closure rate was 87.7%, the perforation recurrence rate was 18.6%, and 16.7% of ears required reoperation. The mean air–bone gap decreased from 21 dB preoperatively to 12 dB postoperatively (p < 0.0001). We did not find different anatomical and audiometric results for our three groups of patients classified according to age. Audiometric results were associated with the location of the perforation, intraoperative inflammation of the middle ear mucosa, and the surgical technique performed.

Conclusion
Myringoplasty in children is associated with excellent anatomical and functional results, even in the youngest patients. It can be proposed whatever the child's age if the patients are well selected before giving the indication.
Autoimmune and inflammatory neurological disorders in the intensive care unit
Authors: Legouy Camille , Cervantes Anna , Sonneville Romain , Thakur Kiran T. 
Published: March 2024

Purpose of review
The present review summarizes the diagnostic approach to autoimmune encephalitis (AE) in the intensive care unit (ICU) and provides practical guidance on therapeutic management.

Recent findings
Autoimmune encephalitis represents a group of immune-mediated brain diseases associated with antibodies that are pathogenic against central nervous system proteins. Recent findings suggests that the diagnosis of AE requires a multidisciplinary approach including appropriate recognition of common clinical syndromes, brain imaging and electroencephalography to confirm focal pathology, and cerebrospinal fluid and serum tests to rule out common brain infections, and to detect autoantibodies. ICU admission may be necessary at AE onset because of altered mental status, refractory seizures, and/or dysautonomia. Early management in ICU includes prompt initiation of immunotherapy, detection and treatment of seizures, and supportive care with neuromonitoring. In parallel, screening for neoplasm should be systematically performed. Despite severe presentation, epidemiological studies suggest that functional recovery is likely under appropriate therapy, even after prolonged ICU stays.

Conclusion
AE and related disorders are increasingly recognized in the ICU population. Critical care physicians should be aware of these conditions and consider them early in the differential diagnosis of patients presenting with unexplained encephalopathy. A multidisciplinary approach is mandatory for diagnosis, ICU management, specific therapy, and prognostication.
An Illustrated Review of the Recent 2019 World Health Organization Classification of Neuroendocrine Neoplasms: A Radiologic and Pathologic Correlation
Authors: Ursprung Stephan , Zhang M. Lisa , Asmundo Luigi , Hesami Mina , Najmi Zahra , Cañamaque Lina Garcia , Shenoy-Bhangle Anuradha S. , Pierce Theodore T. , Mojtahed Amirkasra , Blake Michael A. , Cochran Rory , Nikolau Konstantin , Harisinghani Mukesh G. , Catalano Onofrio A. 
Published: March 2024

Abstract
Recent advances in molecular pathology and an improved understanding of the etiology of neuroendocrine neoplasms (NENs) have given rise to an updated World Health Organization classification. Since gastroenteropancreatic NENs (GEP-NENs) are the most common forms of NENs and their incidence has been increasing constantly, they will be the focus of our attention. Here, we review the findings at the foundation of the new classification system, discuss how it impacts imaging research and radiological practice, and illustrate typical and atypical imaging and pathological findings. Gastroenteropancreatic NENs have a highly variable clinical course, which existing classification schemes based on proliferation rate were unable to fully capture. While well- and poorly differentiated NENs both express neuroendocrine markers, they are fundamentally different diseases, which may show similar proliferation rates. Genetic alterations specific to well-differentiated neuroendocrine tumors graded 1 to 3 and poorly differentiated neuroendocrine cancers of small cell and large-cell subtype have been identified. The new tumor classification places new demands and creates opportunities for radiologists to continue providing the clinically most relevant report and on researchers to design projects, which continue to be clinically applicable.
Comparison of ultrasound-guided erector spinal muscle plane block and quadratus block for laparoscopic renal cancer resection:A single-center,double-blind, randomized controlled trial
Authors: Zhang Meng , Zhao Shuchuan , Li Mingfang , Liu Yue , Li Hu , Su Peng , Xu Guangmin 
Published: March 2024

AbstractObjectiveThis study investigated the effects of ultrasound-guided erector spinal muscle plane block (ESPB) and quadratus muscle block (QLB) on the quality of analgesia and recovery after laparoscopic nephrectomy.Designrandomized, controlled, double-blind study.SettingA single tertiary care academic medical center,include anesthesia preparation room, operating room, anesthesia recovery room and ward.PatientsAged 18-70years,ASA grades I-III,elective laparoscopic partial nephrectomy or radical nephrectomy and 54 patients were included in the statistical analysis.InterventionsAll included patients were randomassigned to the erector spinal muscle plane block or the quadratus block,and all patients underwent morphine pump controlled analgesia.ResultsThe study found that ultrasound-guided ESPB had a higher incidence of hypotension than QLB at the T1 time point, but it did not significantly increase the intraoperative dose of the vasoactive drug used. Patients in the ESPB group showed significant improvement in resting NRS pain scores at 0.5h,number of morphine pumps at 6h and 24h, cumulative morphine equivalent consumed 6h after surgery, and QOR-15 score at 24 h after surgery, and shortened hospital stay.ConclusionsCompared with QLB,ESPB has certain advantages in analgesia and recovery quality after laparoscopic nephrectomy, and shows opioid frugality effect at individual postoperative time points.Trial registrationThe trial was registered prior to patient enrollment at the Chinese Clinical Trial Registry on 15/08/2023 (ChiCTR2300074743).Key pointAlthough regional anaesthsia is beneficial for laparoscopic renal cancer resection, it is still controversial which type of regional anaesthsia is most appropriate.A good regional anaesthsia not only has a long postoperative analgesia time, but also has better anesthesia recovery quality.The primary outcome measure was the cumulative consumption of morphine equivalent within 6h after surgery.ESPB is a good regional anaesthsia that can be used for laparoscopic renal cancer resection.In this randomised controlled trial of patients undergoing laparoscopic renal cancer resection, compared with QLB, ESPB has certain advantages in analgesia and recovery quality after laparoscopic nephrectomy.
Real-time control of a hearing instrument with EEG-based attention decoding
Authors: Hjortkjær Jens , Wong Daniel D.E. , Catania Alessandro , Märcher-Rørsted Jonatan , Ceolini Enea , Fuglsang Søren A. , Kiselev Ilya , Di Liberto Giovanni , Liu Shih-Chii , Dau Torsten , Slaney Malcolm , de Cheveigné Alain 
Published: March 2024

AbstractEnhancing speech perception in everyday noisy acoustic environments remains an outstanding challenge for hearing aids. Speech separation technology is improving rapidly, but hearing devices cannot fully exploit this advance without knowing which sound sources the user wants to hear. Even with high-quality source separation, the hearing aid must know which speech streams to enhance and which to suppress. Advances in EEG-based decoding of auditory attention raise the potential of neurosteering, in which a hearing instrument selectively enhances the sound sources that a hearing-impaired listener is focusing their attention on. Here, we present and discuss a real-time brain-computer interface (BCI) system that combines a stimulus-response model based on canonical correlation analysis (CCA) for real-time EEG attention decoding, coupled with a multi-microphone hardware platform enabling low-latency real-time speech separation through spatial beamforming. We provide an overview of the system and its various components, discuss prospects and limitations of the technology, and illustrate its application with case studies of listeners steering acoustic feedback of competing speech streams via real-time attention decoding. A software implementation code of the system is publicly available for further research and explorations.
The TCRs of pathogenic Th17 cells in arthritogenic mice are shifted toward a Treg-like repertoire
Authors: Llamas-Covarrubias Mara A. , Tanaka Atsushi , Loza Martin , Diez Diego , Xu Zichang , Lim Ee Lyn , Teraguchi Shunsuke , Sakaguchi Shimon , Standley Daron M. 
Published: March 2024

SummaryMutations in the ZAP-70 gene that cause moderate attenuation of T cell receptor (TCR) signaling in mice can result in autoimmune manifestations. One explanation for this pathology is a shift in the regulatory-conventional (Treg-Tconv) T cell repertoire composition. To test this hypothesis, we characterized the single-cell gene expression profiles and TCR repertoires of Tconv and Treg CD4+ T cells of arthritic (ZAC), poised (SKG) ZAP-70 mutant, and wild-type (WT) mice. We identified a group of Th17 cells which exhibited a pathogenic signature and occurred exclusively in inflamed joints of ZAC mice. Such pathogenic signature was uniquely detected in CD4+ T cells obtained from inflamed joints of RA patients. Overall, the Tconv repertoires of ZAP-70 mutant mice were increasingly similar to the repertoires of WT Tregs, and this effect was most notable in the subset of pathogenic Th17 cells. Our results support a model where, upon moderate ZAP-70-mediated signal weakening, T cells that would normally develop into Tregs, instead develop into self-reactive Tconvs, resulting in a breakdown in self-tolerance and susceptibility to autoimmune arthritis.
Something old, something new: the origins of an unusual renal cell underpinning a beetle water-conserving mechanism
Authors: Beaven Robin , Koyama Takashi , Naseem Muhammad T. , Halberg Kenneth V. , Denholm Barry 
Published: March 2024

AbstractTenebrionid beetles have been highly successful in colonising environments where water is scarce, underpinned by their unique osmoregulatory adaptations. These include a cryptonephridial arrangement of their organs, in which part of their renal/Malpighian tubules are bound to the surface of the rectum. This allows them to generate a steep osmotic gradient to draw water from within the rectum and return it to the body. Within the cryptonephridial tubules a seemingly novel cell type, the leptophragmata, is considered to play a key role in transporting potassium chloride to generate this osmotic gradient. Nothing was known about the developmental mechanisms or evolution of these unusual renal cells. Here we investigate the mechanisms underpinning development of the leptophragmata in the red flour beetle,Tribolium castaneum. We find that leptophragmata express and require ateashirt/tiptoptranscription factor gene, as do the secondary renal cells ofDrosophila melanogasterwhich lack a cryptonephridial arrangement. We also find an additional transcription factor, Dachshund, is required to establish leptophragmata identity and to distinguish them from the secondary cells inTribolium’snon-cryptonephridial region of renal tubule. Dachshund is also expressed in a sub-population of secondary cells inDrosophila. So leptophragmata, which are unique to the beetle lineage, appear to have originated from a specific renal cell type present ancestrally, and specified by a conserved repertoire of transcription factors.SignificanceBeetles are a highly successful insect group and represent a quarter of all known animal species. Their digestive/renal systems have undergone major evolutionary change compared to other insects, likely contributing to their success. A dramatic example is the cryptonephridial complex, an evolutionary innovation of the gut and renal system which integrate as a powerful water-conservation system; an adaptation for survival in arid conditions. An unusual renal cell type—the leptophragmata—underpin the functions of the complex, but their developmental and evolutionary origins are unknown. Here we reveal the developmental mechanism that establish leptophragmata identity and, by studying a species lacking a cryptonephridial complex, shed light on their evolutionary origin. More broadly, the work illuminates the evolution of novel cell types.
Astrocytic thrombospondins 1 and 2 are required for cortical synapse development controlling instrumental performance
Authors: Lawal Oluwadamilola O. , Ulloa Severino Francesco Paolo , Wang Shiyi , Bindu Dhanesh Sivadasan , Sakers Kristina , Johnson Sarah Anne , Yin Henry H. , Eroglu Cagla 
Published: March 2024

AbstractDuring development, controlled synaptogenesis is required to form functioning neural circuits that underlie cognition and behavior. Astrocytes, a major glial-cell type in the central nervous system (CNS), promote synapse formation by secreting synaptogenic proteins. Thrombospondins 1 and 2 (TSP1/2), which act through their neuronal receptor α2δ-1, are required for proper intracortical excitatory synaptogenesis. In the adult brain, the loss of α2δ-1 impairs training-induced excitatory synaptogenesis in the anterior cingulate cortex (ACC), and this impairment leads to increased effort-exertion during high-effort tasks. Here, we tested whether TSP1 and TSP2 are required for controlling effort during operant conditioning by using a lever press for food reward training in mice. Surprisingly, we found that constitutive loss of TSP1/2 significantly reduced lever pressing performance when the effort required for a food reward was increased, a phenotype opposite of α2δ-1 loss. Loss of TSP1/2 reduced excitatory synapse number significantly in adult brains. However, in the ACC of TSP1/2 knockout mice, there was still training-induced excitatory synaptogenesis, likely through the upregulation of TSP4, a TSP isoform that is also synaptogenic. Unexpectedly, we also found a significant increase in inhibitory synapse number and function in the ACC of TSP1/2 knockout mice, which was eliminated after training. Finally, we found that astrocyte-specific ablation of TSP1/2 in developing but not adult astrocytes is sufficient to reduce performance during high-effort tasks. Taken together, our study highlights the importance of developmental astrocyte-derived synaptogenic cues TSP1 and 2 in establishing excitatory and inhibitory circuits that control effort during operant conditioning in adults.
Last-century vegetation dynamics in a highland Pyrenean national park and implications for conservation
Authors: Rull V. , Blasco A. , Sigró J. , Vegas-Vilarrúbia T. 
Published: March 2024

AbstractEcological records from before and after the creation of natural parks are valuable for informing conservation and restoration actions. Such records are often unavailable, but high-resolution paleoecological studies may provide useful information. This paper presents a sub-decadal paleoecological reconstruction of vegetation and landscape in a national park in the Pyrenean highlands, established in the 1950s. The park lands were traditionally been used for small-scale cultivation, extensive grazing, forest exploitation and, since 1910, hydroelectricity generation following the damming of numerous glacial lakes. A significant finding is that present-like forests, with negligible changes in composition, have dominated the landscape during the study period. Major vegetation changes involved shifts in forest cover, influenced by both climatic and anthropic factors. Interestingly, the creation of the park in 1955 and the initial restrictions on forest exploitation in 1975 did not significantly affect vegetation cover or composition. Forest expansion did not occur significantly until the 1980s when the park was enlarged, and forest exploitation was further restricted. This expansion peaked in the mid-1990s coinciding with a warming trend and a decrease in fire incidence, before declining due to warmer and drier climates. This decline in forest cover occurred concurrently with the ongoing global forest dieback phenomenon and may be exacerbated by the predicted global warming in this century, which could also increase fire incidence due to the accumulation of dead wood. Under current conservation measures, the main threats are global warming, fire and, on a more local scale, the massification of tourism. Expanding the park and implementing forest restoration actions on degraded terrains surrounding the park could only be beneficial.
Dorsal CA1 silencing degrades tactile short-term memory
Authors: Someck Shirly , Katz Netta , Levi Amir , Stark Eran 
Published: March 2024

AbstractPrevious studies in rodents showed that the hippocampus is involved in spatial short-term memory (STM), but hippocampal necessity for maintaining short-term sensory memories is unknown. Here, we develop tactile discrimination and STM tasks for freely-moving mice. Subjects learn to discriminate between textures after four shaping sessions and a single post-shaping session, and learn the STM task within a dozen sessions. Transient closed-loop silencing of dorsal hippocampal region CA1 during memory maintenance degrades task performance, compared to interleaved control blocks. Thus, uninterrupted hippocampal activity is required for acting upon tactile information maintained in STM. The findings suggest that the role of the hippocampus extends beyond spatial navigation, encoding memories, and long-term consolidation of experiences.