bluuebunny/crossref_metadata_2025_split huggingface dataset:
The evening complex component ELF3 recruits H3K4me3 demethylases to repress PHYTOCHROME INTERACTING FACTOR4 and 5 in Arabidopsis
Authors: Tian Shiyu , Zhang Shen , Xu Fan , Sun Qingbin , Xu Gang , Ni Min 
Published: January 2025

Abstract
In Arabidopsis (Arabidopsis thaliana), light and circadian clock signaling converge on PHYTOCHROME-INTERACTING FACTORS (PIFs) 4 and 5 to produce a daily rhythm of hypocotyl elongation. PIF4 and PIF5 expression is repressed at dusk by the evening complex (EC), consisting of EARLY FLOWERING3 (ELF3), ELF4, and LUX ARRHYTHMO (LUX). Here, we report that ELF3 recruits the JUMONJI (JMJ) H3K4me3 demethylases JMJ17 and JMJ18 to the PIF4 and PIF5 loci in the evening to remove their H3K4me3 marks. The association of JMJ17 and JMJ18 with the 2 genomic loci depends on the EC, and the H3K4me3 marks are enriched in the elf3 and jmj17 jmj18 mutants. Half of the globally differentially expressed genes are overlapping in elf3 and jmj17 jmj18. Cleavage Under Targets and Tagmentation sequencing analysis identified 976 H3K4me3-enriched loci in elf3. Aligning the H3K4me3-enriched loci in elf3 to genes with increased expression in elf3 and jmj17 jmj18 identified 179 and 176 target loci, respectively. Half of the loci are targeted by both ELF3 and JMJ17/JMJ18. This suggests a strong connection between the 2 JMJ proteins and EC function. Our studies reveal that an array of key genes in addition to PIF4 and PIF5 are repressed by the EC through the H3K4me3 demethylation pathway.
What Rose and Fell in Imperial China? State Strength, the Civil Service Examination and Inventiveness
Authors: Hui Victoria Tin-bor 
Published: January 2025

Abstract
Yuhua Wang's The Rise and Fall of Imperial China and Yasheng Huang's The Rise and Fall of the EAST (Exams, Autocracy, Stability, and Technology) take on grand history with big social science data. While both analyze China's rise and decline, they fundamentally disagree on what rose and fell, whether the imperial state was weak or strong, and whether the driving forces were social terrains or the emperor's designs. Wang's central puzzle is the “sovereign's dilemma” that presents a negative correlation between the emperor's duration and state strength. He uses elite social networks to explain why the Tang-Song transition brought about longer imperial reigns but weaker state strength. A closer look at Wang's data, however, suggests that state strength as fiscal capacity went up alongside the emperor's longevity in the Song. Huang offers a different “emperor's dilemma”: how the rational autocrat could ensure a competent yet loyal staff. Huang features “trailblazing emperors” who crafted the civil service examinations, called keju, to assert “end-to-end controls over the entire pipeline—nomination, evaluation, and final selections.” Keju also dissolves Wang's “sovereign's dilemma” by simultaneously enhancing ruler survival and state strength. For Huang, what rose and rose were keju and state strength; what rose and fell were societal diversity and inventiveness. Imperial China collapsed when the Qing abandoned keju. Both books inform today's China: if the autocrat's relentless pursuit of power through fragmenting the elites was “the final culprit” for imperial China's fall, readers should be deeply concerned about Xi Jinping's China.
Ultrasound-guided synovial tissue biopsy for people with rheumatoid arthritis: a micro-costing study
Authors: Chang Sainan , Rivellese Felice , Payne Katherine , Ide Zoë , Barton Anne , Pitzalis Costantino , Gavan Sean P 
Published: January 2025

Abstract

Objective
Identify and quantify the resource use and cost per patient of performing a US-guided synovial tissue biopsy for people with RA within a routine healthcare setting.

Method
A micro-costing study was performed from a healthcare system perspective (National Health Service England). A service pathway conceptual model described how the procedure will be embedded within routine care to inform management decisions. Consumables were estimated from existing standard operating procedures for synovial biopsies. Staff time was estimated by expert input (clinical rheumatologist and patient). The time for tissue sample acquisition was obtained from data within the biopsy-driven R4RA trial. Unit costs were sourced from historic purchase prices, published salary scales and public-facing list prices. One-way sensitivity analysis identified key drivers of total cost per patient. Scenario analyses explored the cost impact if less senior healthcare staff performed the biopsy or if an additional outpatient appointment was required to identify joint suitability.

Results
The total cost of US-guided synovial tissue biopsy was £356.24/patient (best-case estimate: £185.30; worst-case estimate: £812.46). The key driver of total cost was the time taken to perform tissue sample acquisition. The total cost was lower if a registrar performed the biopsy (£294.24) and higher if an additional outpatient appointment was required for joint selection (£438.98).

Conclusion
Interventions requiring synovial tissue samples to inform treatment selection or prognosis are emerging. The findings can inform cost parameters for future cost-effectiveness analyses. These results will help resource allocation and clinical decisions to improve the value of treatments for RA.
Foot peripheral sensory neuropathy: a frequent disabling manifestation in systemic sclerosis
Authors: Alcacer-Pitarch Begonya , Di Battista Marco , Redmond Anthony C , Keenan Anne-Maree , Di Donato Stefano , Buch Maya H , Del Galdo Francesco 
Published: January 2025

Abstract

Objectives
Peripheral sensory neuropathy (PSN) is an under-recognized feature in SSc. Moreover, SSc foot involvement is frequent but poorly investigated. We aimed to provide a detailed characterization of foot PSN in a large cohort of SSc patients, describing its associations with disease-specific features, physical disability and quality of life (QoL).

Methods
SSc patients and healthy controls (HCs) comparable for age and gender were enrolled in a cross-sectional observational case-control study. All subjects underwent a detailed quantitative sensory testing of feet evaluating touch, vibratory, thermal and pain sensitivity, ultimately investigating the presence of large and small fiber neuropathy. Patient-reported outcomes (Scleroderma Health Assessment Questionnaire, Manchester Foot Pain and Disability Index and Systemic Sclerosis Quality of Life Questionnaire) were administered to assess neuropathic symptoms, foot disability and QoL.

Results
A total of 109 SSc patients (88.1% female, median age 59.0 years) and 51 HC were enrolled. SSc patients presented with a significant impairment in each sensory parameter assessed (P ≤ 0.01 for all). Foot PSN was present in 85.3% of the patients, with 80% having small fiber and 57% large fiber neuropathy, co-existing in 51.4% of the cases. PSN was associated with age, smoking, foot ulceration, disease duration and corticosteroids use. Precisely, 80.6% subjects with PSN reported at least one neuropathic symptom. Patients with neuropathic symptoms reported worse physical function, worse foot disability and more impaired QoL.

Conclusion
Foot PSN presents as a common and disabling manifestation in SSc patients, involving small and large fibres. Hence, foot PSN assessment should be included as a part of the SSc workup.
The Association of Race, Rurality, and Neighborhood Disadvantage with Disease Severity at Initial Presentation in Cervical Spondylotic Myelopathy
Authors: Laskay Nicholas M.B. , Sun Yifei , Gross Evan G. , Hamo Mohammad A. , Howell Sasha , Mooney James , Godzik Jakub 
Published: January 2025

Study Design.
Retrospective Cohort Study

Objectives.
To examine the impact of neighborhood-level socioeconomic factors on the delay of care and severity of disease among DCM patients at initial presentation.

Summary of Background Data.
Degenerative Cervical Myelopathy (DCM) is the most common etiology for spinal cord dysfunction among adults worldwide. Previous literature has suggested that social determinants of health including neighborhood-level socioeconomic status such as Area of Deprivation Index (ADI) may impact spine surgery outcomes in DCM.

Methods.
We performed a single-institution retrospective analysis of all patients undergoing spine surgery for the treatment of DCM from 2010 to 2022. Patients were identified using CPT and ICD9/10 codes. Data was collected via review of the electronic medical record. ADI was extracted from patients addresses. Multivariate and univariate analysis was used to assess the relationship between socioeconomic variables and myelopathy characteristics.

Results.
A total of 490 patients (Mean age: 60.3±11.3 y) were identified. Residence in rural areas was associated with higher Nurick score (OR 2.48,P=0.011), and lower mJOA score (OR 2.51, P=0.014) at presentation, and longer times to presentation (HR 0.48, P=0.003). Having high ADI was independently associated with shorter times to presentation (HR 1.46,P<0.001), but predicted higher Nurick score (OR 1.6, P=0.021) and lower mJOA score (OR 1.86,P=0.002). Unemployment was associated with longer times to presentation (HR 0.66,P<0.001), higher Nurick score (OR 4.5,P<0.001), and lower mJOA score (OR 4.51, P<0.001), while race was not.

Conclusions.
This is the first single institution study investigating the influence of neighborhood-level measures such as ADI on presentation status and disease burden in patients with DCM. High ADI predicts shorter disease duration but more severe DCM symptoms. Rural residence, unemployment, and non-private insurance were independently associated with prolonged and more severe DCM symptoms while race was not.

Level of Evidence.
3
Establishment of Scoring to Predict Severe Complication After Pyogenic Spondylodiscitis Surgery
Authors: Ukon Yuichiro , Takenaka Shota , Hirai Hiromasa , Sugiura Tsuyoshi , Sakai Yusuke , Fujimori Takahito , Furuya Masayuki , Kanie Yuya , Okada Seiji , Kaito Takashi 
Published: January 2025

Study Design:
Retrospective cohort study using prospective database.

Objective:
This study aimed to establish a risk-scoring system for predicting severe complications after pyogenic spondylodiscitis surgery.

Summary of Background data:
Pyogenic spondylodiscitis surgery can cause severe complications.

Methods:
Grades III, IV, and V complications in the CD classification were defined as severe complications. A predictive scoring system for severe complications was developed using 7 risk factors identified from a cohort of 143 PS surgery patients from January 2013 to December 2017 described in a previous study. External validation used a separate cohort of 70 patients from 9 institutions identified from January 2018 to December 2021.

Results:
This first study proposed a risk predictive scoring system for severe complications [updated Charlson comorbidity index (≥3), 2; chronic pulmonary disease, 3; diabetes, 1; Gram-negative bacteria, 3; pyogenic osteoarthritis, 3; preoperative white blood count (≥1.0×104/μL), 2; preoperative platelet count (≤2.4×105/μL), 2]. The scoring system could well predict severe complications [area under the receiver operating curve (AUROC) value of 0.851]. There was classification into 3 risk groups: low–moderate risk (≤4), high risk (5 or 6), and very high risk (≥7), further simplified by the scoring system. Complication rates were 5.2% (low–moderate), 40.1% (high), and 84.2% (very high). In addition, external validation showed a very good AUROC value of 0.820.

Conclusions:
We developed a simple, externally validated scoring system for predicting severe complications after pyogenic spondylodiscitis surgery that will be helpful for clinicians involved in informed consent and intensive care unit management of high-risk patients.
Introduction to the Wellness Mini-series. Burnout, Disengagement, and Other Psychological Quagmires: It’s Not All in Your Head
Authors: Khansa Ibrahim 
Published: January 2025

Summary:
Surgery is a state of mind. The brain controls the hands. As a result, “technical skills” are more mental than technical. In fact, physician burnout and poor well-being are independent predictors of major medical errors. Part of becoming a better surgeon is caring for one’s mind, and making sure one’s brain is healthy and happy. Therefore, the reader of this mini-series should read every article with the perspective that it can (and will) make them a better physician and surgeon. In this mini-series, 45 unique authors and 2 expert discussants compiled a comprehensive, evidence-based resource on physician wellness, including topics such as wellness during residency, oral board examination and every other career stage, the interface between work life and home life, physical well-being, self-awareness, mindfulness, mentorship, and dealing with aging parents and microaggressions. This mini-series truly covers the entire spectrum of physician wellness. In this article, I will provide a brief introduction to some important concepts, and the subsequent articles in the mini-series will go into much more practical detail.
The Intersection of a Life Partner and Professional Wellness for the Plastic Surgeon
Authors: Guest Rachel , Kapadia Kailash , Ledbetter Kelly , Martinez Carlos , Lin Ines C. 
Published: January 2025

Summary:
Our literature review describes the complicated intersection of the physician/surgeon’s professional practice and their spouse/domestic partner, acknowledging that the existing literature specific to plastic surgeons is limited. Nevertheless, the broader research of physicians and other surgical fields identifies many risk factors for work-home conflicts, which can negatively impact the surgeon and the spouse. Furthermore, certain studied groups have other unique challenges and considerations, such as women surgeons, residents, and dual-physician couples. Fortunately, the presence of a domestic partner has been shown to benefit the surgeon in multiple ways. Finally, we summarize some strategies to support and maintain this important relationship.
Importance of Exercise for Career Longevity: Maintaining Fitness, Strength, and Flexibility as a Plastic Surgeon
Authors: Rogoff Hunter M. , Byrnes Yasmeen M. , Kauffman Christian A. 
Published: January 2025

Summary:
The benefits of exercise for the general population are well established, although there is limited information focusing on its importance for plastic surgeons. Plastic surgery is arguably one of the most physically taxing fields within medicine due to lengthy operations that often require putting oneself in uncomfortable positions for the majority of the case, all while maintaining mental focus and discipline. It is essential to incorporate regular routines that can optimize a plastic surgeon’s mental and physical capacity both short- and long-term. Exercise provides multiple physical benefits and simultaneously contributes to better mental and emotional health. Unfortunately, it is rather uncommon for those within our profession to exercise on a regular basis, with lack of available time being a major contributor. Considering the physical nature of our specialty, plastic surgeons are susceptible to and frequently have debilitating musculoskeletal pain and injuries. In this article, we discuss the benefits of exercise on mental health and physician burnout, its potential for injury prevention, and strategies for implementing physical activity on a regular basis to sustain long and fulfilling careers as plastic surgeons.
Practicing Emotional Self-awareness to Build Surgeon Resilience
Authors: Tandon Damini , Taylor Ruby L. , Bialowas Christie , Johnson Anna Rose , Orr Jonah , Said Abdullah , Currie Kelly , Feinmann Marcie , Ridley Clare H. , Mackinnon Susan E. 
Published: January 2025

Summary:
As surgeons, we work in a high-stress, high-stakes environment to take care of our patients. In this setting, it is not uncommon for us to experience microaggressions—subtle or indirect actions or statements that communicate a demeaning or exclusionary message, often unintentionally. Microaggressions can bring us down, taking away from the fulfillment that attracted many of us to this profession. In this article, we introduce the Institute for Professional Excellence in Coaching energy leadership framework as a tool to understand and address microaggressions. We then apply it to real-life scenarios surgeons may encounter, demonstrating how this framework can help us to build resilience and recover our joy for our profession.
Internal Breast Lift: A New Method for Performing Internal Mastopexy
Authors: Duarte Getulio , Coelho Duarte Fabio , Federerigh Baisi Chagas Eduardo , Cervantes André 
Published: January 2025

Background:
Mastopexy combined with implant placement is a complex cosmetic surgery due to the dual nature of the procedure. Various mammoplasty techniques and implant types add to its intricacy. This study aimed to evaluate the effectiveness of an internal breast lift in correcting pseudoptosis, grade 1 breast ptosis, and asymmetries, thereby offering a safer alternative with reduced morbidity and avoiding the creation of an inverted T scar.

Methods:
From January 2020 to January 2022, 20 female patients with pseudoptosis, grade I breast ptosis as per the Regnault classification, and a subareolar-to-mammary groove distance less than 7 cm were selected. For those with breast tissue hypertrophy, internal tissue resection maintained a minimum thickness of 3 cm. Patients with areolar asymmetries but without breast ptosis were also included. Surgical access was achieved via the mammary fold or periareolar approach. The procedure involved internal mastopexy between the mammary gland and the pectoralis major muscle’s superomedial portion, coupled with polyurethane implant insertion.

Results:
Significant elevations in the areola and breast tissue were noted in patients with pseudoptosis and grade I breast ptosis, with a notable pre- and postoperative difference (Student t test, P ≤ 0.050). Additionally, there was an improvement in areolar and breast tissue positioning in asymmetrical cases. Patient satisfaction and a 1-year follow-up were also part of the assessment.

Conclusions:
The internal breast lift emerges as a safe and aesthetically pleasing alternative for patients with pseudoptosis and grade I breast ptosis. It effectively enhances areolar symmetry without the need for an inverted T scar.
Prevalence and predictors of cirrhosis and portal hypertension in the United States
Authors: Younossi Zobair M. , de Avila Leyla , Racila Andrei , Nader Fatema , Paik James , Henry Linda , Stepanova Maria 
Published: January 2025

Background and Aims:
There is a paucity of data about the prevalence of cirrhosis and portal hypertension in the US general population.

Approach and Results:
We used National Health and Nutrition Examination Surveys (NHANES 2017–2020) to estimate the prevalence of cirrhosis and clinically significant (CS)-portal hypertension in alcohol-associated liver disease (ALD), MetALD, viral hepatitis to include chronic hepatitis B (CHB) and chronic hepatitis C (CHC), and metabolic dysfunction–associated steatotic liver disease (MASLD). Cirrhosis was evaluated using liver stiffness measurement by transient elastography or FIB-4 score; CS-portal hypertension was defined through liver stiffness measurement and platelet count or the use of nonselective beta-blockers in the presence of cirrhosis.
The prevalence of chronic liver disease etiologies was ALD 0.85%, MetALD 3.38%, CHB 0.23%, CHC 0.73%, ALD + viral hepatitis 0.16%, and MASLD 33.05%. In the general population, the prevalence of ALD-cirrhosis was 0.08%, MetALD-cirrhosis 0.19%, CHB-cirrhosis 0.01%, CHC-cirrhosis 0.10%, MASLD-cirrhosis 1.27%, ALD + viral hepatitis-cirrhosis 0.08%, and other cirrhosis 0.87%. The prevalence of CS-portal hypertension in chronic liver disease was 1.31% in MetALD, 1.60% in CHB, 4.73% in CHC, 2.00% in MASLD, and 0.35% in controls, to yield a population prevalence of 0.98%. In multivariate analysis, excessive alcohol use, CHC, male sex, obesity, type 2 diabetes, and hypertension were independently associated with an increased risk of cirrhosis (all p<0.05). Predictors of having CS-portal hypertension in chronic liver disease included CHC, obesity, and type 2 diabetes (all p<0.05).

Conclusions:
The prevalence of cirrhosis in the United States is 2.6% while the prevalence of CS-portal hypertension is 0.98%. Individuals with MASLD comprise the majority of US residents with cirrhosis.
Femtosecond Laser–Assisted Pterygium Surgery Using a Customized Algorithm for Trapezoidal Conjunctival Grafts
Authors: Tan Shayne S. , Liu Yu-Chi , Han Evelina J. Y. , Ong Hon Shing , Ang Marcus , Riau Andri K. , Mehta Jodhbir S. 
Published: January 2025

Purpose:
Conjunctival autografts (CAGs) are the gold standard treatment after pterygium resection, but it is challenging to achieve consistently thin Tenon-free CAGs with manual dissection. We herein report the reproducibility and clinical outcomes of a novel algorithm to produce customizable trapezoidal CAGs using femtosecond laser (femtosecond lasers)-assisted pterygium surgery.

Methods:
We first tested this algorithm in 4 pig eyes to show reproducibility. We then treated 15 pterygia of 14 patients using this algorithm. After manual pterygium excision, 7-mm x 10-mm preset trapezoidal CAGs were dissected with the Ziemer FEMTO LDV Z8 laser set at a 60 μm depth. The achieved thickness was measured with intraoperative optical coherence tomography, and the achieved area was calculated.

Results:
For the pig eyes, the average CAG length and width were 9.8 ± 0.1 mm and 7.3 ± 0.04 mm, respectively, with a mean deviation of 7.3% ± 3.2% and 7.5% ± 4.1%, respectively. The mean age of the patients was 56.8 ± 7.3 years. The programmed and achieved CAG areas were 70 mm2 and 72.5 ± 3.9 mm2, respectively, with a mean deviation of 4.7% ± 4.6%. The eventual CAG thickness was 59.5 ± 3.9 μm, with a minimal deviation of 4.4% ± 4.6%. The average time to remove the FSL-prepared CAG to unfold it onto the cornea was 19.9 ± 14.9 seconds. At the postoperative month 3 follow-up, no postoperative complications or recurrences occurred, and all donor CAG sites had completely healed.

Conclusions:
This novel algorithm using the FEMTO LDV Z8 in Femtosecond Laser–Assisted Pterygium Surgery provides consistent and customizable trapezoid ultrathin CAGs. Longer follow-up and larger cohorts will need to be studied for recurrence and complication rates.