bluuebunny/crossref_metadata_2025_split huggingface dataset:
Spatial Positioning of Immune Hotspots Reflects the Interplay between B and T Cells in Lung Squamous Cell Carcinoma
Authors: Zhang Hanyun , AbdulJabbar Khalid , Moore David A. , Akarca Ayse , Enfield Katey S.S. , Jamal-Hanjani Mariam , Raza Shan E. Ahmed , Veeriah Selvaraju , Salgado Roberto , McGranahan Nicholas , Le Quesne John , Swanton Charles , Marafioti Teresa , Yuan Yinyin 
Published: February 2023

Abstract

Beyond tertiary lymphoid structures, a significant number of immune-rich areas without germinal center-like structures are observed in non–small cell lung cancer. Here, we integrated transcriptomic data and digital pathology images to study the prognostic implications, spatial locations, and constitution of immune rich areas (immune hotspots) in a cohort of 935 patients with lung cancer from The Cancer Genome Atlas. A high intratumoral immune hotspot score, which measures the proportion of immune hotspots interfacing with tumor islands, was correlated with poor overall survival in lung squamous cell carcinoma but not in lung adenocarcinoma. Lung squamous cell carcinomas with high intratumoral immune hotspot scores were characterized by consistent upregulation of B-cell signatures. Spatial statistical analyses conducted on serial multiplex IHC slides further revealed that only 4.87% of peritumoral immune hotspots and 0.26% of intratumoral immune hotspots were tertiary lymphoid structures. Significantly lower densities of CD20+CXCR5+ and CD79b+ B cells and less diverse immune cell interactions were found in intratumoral immune hotspots compared with peritumoral immune hotspots. Furthermore, there was a negative correlation between the percentages of CD8+ T cells and T regulatory cells in intratumoral but not in peritumoral immune hotspots, with tertiary lymphoid structures excluded. These findings suggest that the intratumoral immune hotspots reflect an immunosuppressive niche compared with peritumoral immune hotspots, independent of the distribution of tertiary lymphoid structures. A balance toward increased intratumoral immune hotspots is indicative of a compromised antitumor immune response and poor outcome in lung squamous cell carcinoma.

Significance:
Intratumoral immune hotspots beyond tertiary lymphoid structures reflect an immunosuppressive microenvironment, different from peritumoral immune hotspots, warranting further study in the context of immunotherapies.
Ocean Mesoscale and Frontal-Scale Ocean–Atmosphere Interactions and Influence on Large-Scale Climate: A Review
Authors: Seo Hyodae , O’Neill Larry W. , Bourassa Mark A. , Czaja Arnaud , Drushka Kyla , Edson James B. , Fox-Kemper Baylor , Frenger Ivy , Gille Sarah T. , Kirtman Benjamin P. , Minobe Shoshiro , Pendergrass Angeline G. , Renault Lionel , Roberts Malcolm J. , Schneider Niklas , Small R. Justin , Stoffelen Ad , Wang Qing 
Published: February 2023

Abstract
Two decades of high-resolution satellite observations and climate modeling studies have indicated strong ocean–atmosphere coupled feedback mediated by ocean mesoscale processes, including semipermanent and meandrous SST fronts, mesoscale eddies, and filaments. The air–sea exchanges in latent heat, sensible heat, momentum, and carbon dioxide associated with this so-called mesoscale air–sea interaction are robust near the major western boundary currents, Southern Ocean fronts, and equatorial and coastal upwelling zones, but they are also ubiquitous over the global oceans wherever ocean mesoscale processes are active. Current theories, informed by rapidly advancing observational and modeling capabilities, have established the importance of mesoscale and frontal-scale air–sea interaction processes for understanding large-scale ocean circulation, biogeochemistry, and weather and climate variability. However, numerous challenges remain to accurately diagnose, observe, and simulate mesoscale air–sea interaction to quantify its impacts on large-scale processes. This article provides a comprehensive review of key aspects pertinent to mesoscale air–sea interaction, synthesizes current understanding with remaining gaps and uncertainties, and provides recommendations on theoretical, observational, and modeling strategies for future air–sea interaction research.

Significance Statement
Recent high-resolution satellite observations and climate models have shown a significant impact of coupled ocean–atmosphere interactions mediated by small-scale (mesoscale) ocean processes, including ocean eddies and fronts, on Earth’s climate. Ocean mesoscale-induced spatial temperature and current variability modulate the air–sea exchanges in heat, momentum, and mass (e.g., gases such as water vapor and carbon dioxide), altering coupled boundary layer processes. Studies suggest that skillful simulations and predictions of ocean circulation, biogeochemistry, and weather events and climate variability depend on accurate representation of the eddy-mediated air–sea interaction. However, numerous challenges remain in accurately diagnosing, observing, and simulating mesoscale air–sea interaction to quantify its large-scale impacts. This article synthesizes the latest understanding of mesoscale air–sea interaction, identifies remaining gaps and uncertainties, and provides recommendations on strategies for future ocean–weather–climate research.
Pancreatic Cancer with Vascular Involvement: Adherence to Current Standard-of-Care Associated with Improved Survival
Authors: Mohamed Abdimajid , Nicolais Laura , Fitzgerald Timothy L. 
Published: February 2023

Multiagent chemotherapy regimens have revolutionized the treatment of patients with localized pancreatic cancer. Therefore, current guidelines recommend neoadjuvant multiagent chemotherapy (N-MAC) for patients with borderline resectable or locally advanced pancreatic cancer. Methods This study is a retrospective cohort study of National Cancer Data Base (NCDB) data for pancreatic cancer with vascular involvement. Results A total of 23 903 patients with vascular involvement were included and divided into 3 groups; no treatment (40.6%), medical treatment (36.6%), and resection (22.8%). Of the patients undergoing resection, 31.3% received neoadjuvant multiagent chemotherapy (N-MAC). The remainder were treated with postoperative adjuvant treatment (33.8%), surgery alone (24.9%), preoperative radiotherapy (8.3%), or single-agent preoperative chemotherapy (1.7%). Median survival for N-MAC was superior (28.42 months) when compared to neoadjuvant radiotherapy (20.73 months), neoadjuvant single-agent chemotherapy (20.8 months), postoperative adjuvant therapy (17.87 months), and surgery alone (10.12 months). N-MAC was associated with improved survival compared to postoperative multiagent chemotherapy (P-MAC) (28.4 vs 16.95, HR 1.82; CI 1.64-2.02, P < .0010) (Figure 1). The addition of radiation therapy to N-MAC did not improve survival (27.4 vs 29.8, HR .93; CI .83-1.05, P = .3). Clinical downstaging occurred in 40% of patients treated with N-MAC, and downstaging was associated with improved survival (HR .74; CI .64-.85, P < .001). N-MAC patients were more likely to undergo an R0 resection than P-MAC (74% v. 48, P < .001). Conclusions Most resected pancreatic cancer patients in this study with vascular involvement receive either postoperative or no adjuvant therapy. N-MAC increases downstaging, R0 resection rates, and survival.
Comparing Payments to Surgeons From Drug and Medical Device Corporations Reveals Inequalities Between Genders and Specialties
Authors: Spector Chelsea L. , Hernandez Jennifer , Shatawi Zaineb , Quintero Luis A. , Rosenthal Andrew , Parreco Joshua P. , Buicko Jessica L. 
Published: February 2023

Introduction Maintaining trust in the patient-doctor relationship requires transparency in the details of the financial relationships between physicians and drug and medical device corporations. These details are publicly available through the Open Payments database, and patients are encouraged to ask surgeons to interpret their implications. The purpose of this study was to better equip surgeons in responding to these inquiries and to compare the distribution of these payments by gender and specialty. Methods The 2021 Open Payments dataset was searched for all payments to surgeons from the 14 different specialties recognized by the American College of Surgeons. The total payments per surgeon were compared by calculating the mean and median payments. The Gini index, a measure of income inequality, was also calculated for each specialty. Results There were 96 724 surgeons who received over $755 million in payments from drug and medical device companies. There were 72 245 (74.7%) men and 24 479 (25.3%) women. The total amount of payments to men was $712 million (94.2%) and for women it was $44 million (5.8%). The overall Gini index was .9508. The specialty with the highest Gini index was pediatric surgery (.9844) and the lowest was cardiothoracic surgery (.8656). Discussion Male surgeons received disproportionately higher payments from drug and device corporations than female surgeons. Surgeons should be aware of their own standing within the Open Payments database in order to respond appropriately to patient inquiries.
The Larry Tube: Customized 3D Printed Laryngectomy Tubes Following Total Laryngectomy
Authors: Daoud Georges E. , von Windheim Natalia , Alfayez Yazen , Michaels Ross E. , Nyirjesy Sarah , Chinn Steven B. , Spector Matthew E. , VanKoevering Kyle K. 
Published: February 2023

Objective: To determine whether a custom laryngectomy tube can improve airway symptoms in total laryngectomy patients with atypical anatomy who are unable to use commercial laryngectomy tubes. Furthermore, to exemplify the power of customizable 3D printed medical devices when combined with the expanded access pathway through the FDA. Methods: A custom-fabricated laryngectomy tube, manufactured at in-house clinical engineering labs, was utilized for each patient following typical laryngectomy tube protocols. All participants had previously undergone a total laryngectomy. Patients were selected based on critical airway obstruction posing potentially life-threatening scenarios while using commercially available laryngectomy tubes. Results: For all patients involved, there were no further airway obstruction complications or events, and they reported a subjective, significant improvement in comfort after placement of the custom laryngectomy tube. Conclusion: Custom laryngectomy tubes can provide patients with atypical anatomy relief from airway obstructions and improve comfort when commercial options fail to address the anatomic restriction. The process used to develop custom laryngectomy tubes may be relevant for other diseases and patients with atypical anatomies through the expanded access pathway.
An image recognition measurement approach and uncertainty for overspeed governors employed in elevator safety
Authors: Zhang Yongming , Zhao Yicheng , Yan Zhe , Feng Shuangchang , Chen Jie 
Published: February 2023

Elevator safety is closely related to public safety. Overspeed governor is a crucial part of the elevator safety system. Its inspection and calibration involve the measurement of tripping velocity. The frequently-used contact-type measurement method has risks. This paper proposes a non-contact image-recognizing measurement method by the camera, which includes the processes of rotor centre recognition, feature points matching, and tripping switches recognition. The velocity curve can be obtained by feature points displacement based on the rotor centre. Tripping switches recognition can determine the electrical and mechanical tripping velocities in the speed curve. The experimental results demonstrate that the proposed method has no significant difference from the common contact-type measurement method, while it significantly eliminates the risks of physical damage and improves measurement safety. Moreover, this paper proposes the deduction and calculation of measurement uncertainty decided by camera performance. Due to the enhancement of measuring safety, the proposed method will have further application in the field of elevator inspection. Practical application: The research on tripping velocity measurement for overspeed governor in this paper is principally based on image recognition with the help of a camera. The experiment result indicates that the proposed method is capable of completing the speed measurement for the overspeed governor without contact. The proposed method significantly mitigates the risks of physical damage and improves measurement safety rather than the contact-type measurement method. The proposed non-contact image-recognizing method can substitute for the existing contact-type method and contributes to the inspection, maintenance, and management of elevators, which will have further application prospects.
Theorising the Politics of Tourism: Global Travel and the Nation-State
Authors: Fayard Gregory 
Published: February 2023

Despite tourism being one of the largest industries in the world and key to the economies of many countries, there has been little effort to systematically connect the nation-state to global circuits of tourism. Most theoretical work centres around international flows of capital and issues of policy choice, sidelining how states as sovereign, territorial institutions are constructed through global travel. Using a constructivist approach to the state, the present paper redresses these gaps by building a theory of the state-tourism nexus that synthesises multiple historic and contemporary examples, demonstrating the major mechanisms connecting tourism to the global institutionalisation and positioning of states. Including both domestic and foreign travel, this theoretic illustrates how travel flows are useful for state leaders in constituting, imagining, legitimising and territorialising the nation-state. Théoriser la politique du tourisme : le tourisme international et l’État-nation
Hidden Meniscus Problems: Ramp Lesion and Posterior Meniscus Medial Root Tear
Authors: Butar Butar John C. P. 
Published: February 2023

Ramp lesion (RL) is a peripheral tear affecting the posterior horn of the medial meniscus in the setting of ACL tears. Posterior meniscus medial root tear (PMMRT) is defined as an avulsion of the attachment, or a complete radial tear within 1 cm of the posterior tibial attachments of the meniscus. Both are not uncommonly found. The prevalence of RL existing in conjunction with ACL tears ranges from 9 to 42%. On the other hand, PMMRT contributes up to 10 to 21% of all meniscus tears. Both RL and PMMRT have significant consequences. RT increases anterior tibia translation and internal rotation after ACL reconstruction which may increase graft failure. PMMRT may accelerate the progress of medial knee osteoarthritis. Unfortunately, both conditions are frequently overlooked from physical examination, MRI reading, and arthroscopy procedures, due to the low sensitivity, unfamiliarity, and hidden location of the lesions. Posteromedial tibia edema finding on MRI images in a complete ACL tear in young patients increases the risks of RL. Ghost sign and medial femorotibial edema found on MRI may indicate PMMRT. RL and PMMRT may not be identifiable from the standard arthroscopic view. The trochlear view may be needed for RL and MCL trephination is almost always needed for PMMRT. The stability of both lesions should be assessed by meniscus probing, and repair is the gold standard for unstable lesions. RL can be repaired with sutures from the anterior or posterior. PMMRT is usually repaired using the transtibial pull-out suture technique.
POL Reconstruction: a Necessity or an Accessory
Authors: Nelwan Bobby N 
Published: February 2023

The MCL is the knee ligament that is most commonly injured but is quite often neglected in terms of in-depth research and understanding. This is due to the belief in good healing abilities that there is a belief that MCL injuries are almost certain to be cured conservatively. Commonly, recurrent rupture after ACL reconstruction is due to neglect of MCL rupture. This prompted researchers and orthopedic sports surgeons to think about the importance of the MCL, initiate in-depth research on the MCL, and initiate repair of the ligament. Surgical indications include high-grade MCL injuries, valgus instability that persists on conservative therapy, and low-grade MCL injuries with other ligamentous injuries. The MCL consists of the superficial MCL (sMCL), deep MCL (dMCL) and the Posterior Oblique Ligament (POL).It stabilizes the medial of the knee against the valgus and rotation. The sMCL attachment to the femur covers the EM (Epicondyle Medial) and has a long attachment proximal to the tibia distally. The course of the dMCL has a sloping path from its attachment at the posterior distal of EM to the anterior distal of the proximal tibia. The posterior oblique ligament consists of three arms: the superficial, central (tibial), and capsular. The central arm is the largest and thickest part of the POL. The POL attachment to the medial condyle of the femur is somewhat more posterior and proximal than the EM or posterior and distal to the adductor tubercle, extending to the distal aspect of the semimembranosus tendon and is a thickening of the posterior medial capsule, with a distinct attachment to the medial meniscus. It is fused anteriorly with the sMCL but can be identified by the orientation of the fibers. The sMCL biomechanics found tension in the anterior aspect of the ligament when flexed about 90 degrees and externally rotated. In the posterior part of the sMCL, tension during full extension and internal rotation. The anterior part of the dMCL relaxes at 0-30 degrees and tension at an angle of 60 degrees to full flexion, while the posterior part of the dMCL relaxes more when flexed at 0-100 degrees. The POL is the posterior part of the MCL complex, which will be tensioned during Full Extension and internal rotation. The MCL complex is different in its response to changes in length to the extension, flexion, and knee rotation. The MCL is not isometric. The role of POL, which is quite prominent in the medial corner of the posterior knee, holds the movement of internal rotation, so this ligament is not accessory. Rupture of POL requires reconstruction to maintain the internal rotation stability of the knee joint. Furthermore, in performing reconstruction, the POL must be tightened and fixed in full knee extension and neutral rotation to reproduce its anatomical length and prevent over-tightening.
Management of Cartilage Lesions Based on Etiology : OCD versus Acute Traumatic Lesions
Authors: Sulistiani Athiyah 
Published: February 2023

Treatment of articular cartilage lesions in the knee remains a challenge. A wide range of options is available nowadays, including conservative measures, simple arthroscopic interventions, marrow tapping techniques, osteochondral auto/allografting, cell-based techniques, growth factors and emerging gene therapy techniques. Osteochondritis dissecans (OCD) is first described by Konig in 1888. Its prevalence is estimated at 15 to 30 cases per 100.000. The lateral aspect of the medial femoral condyle is the classic site, repetitive trauma with microscopic fractures below the surface of the joint of clogging of the tiny blood vessels inside the bone associated with a number of differing medical conditions. OCD is commonly found in older children and adolescents who actively participate in sports. It is different from acute traumatic cartilage lession, as they happen due to a direct compaction injuries, such as occur in the patellofemoral joint. The more common mechanism is a rotational injury to the knee or shearing force across the articular cartilage. Patellar dislocation may lead to osteochondral fracture through this mechanism and is responsible for 40-50% of osteochondral lesions around the femoral condyles. It is most common in young active patients aged 20-40 years. Treatment options are variable and dependent on many factors, including patient age and activity level, location and size of the defect, meniscal status, limb alignment, concomitant knee pathologies, chronicity, and comorbidities. Treatment of cartilage lesions is differentiated not based on its etiology but based on the severity of the cartilage lesions such as size, depth, shape and description of the walls (contained, partially contained or opened), and the resource capabilities of each centre. What needs to be understood is that OCD lesions are disease-related, whereas acute traumatic lesions may occur in otherwise healthy cartilage due to mechanical trauma.
When and What to Consider Knee Arthroscopy Surgery in Post-COVID 19 Infected Patients
Authors: Yudhadibrata Permana 
Published: February 2023

Coronavirus disease 19 (COVID-19) is the worst pandemic ever recorded in history, as of this day more than 545 million people infected and more than 6 million cumulative deaths. COVID 19 is primarily respiratory disease, however non-respiratory presentations that could be manifested are venous and arterial thromboembolic events. Both pulmonary embolism (PE) and deep vein thrombosis (DVT) are the most frequently thrombotic events in COVID-19. Knee arthroscopy surgery is the one of the most common orthopedic surgical procedures nowadays, with the most common procedures are meniscectomy, meniscal repair and cruciate ligament reconstruction. Although knee arthroscopy is known to be a safe procedure, several complications could be found with the 3 most common complications are DVT, effusion and synovitis, and PE. We reported a case series of four patients with DVT post knee arthroscopy anterior cruciate ligament reconstruction during 2021. The DVT diagnosis was retained on clinical presentation and elevated of D-dimer testing. The patient’s mean age was 35,25 years, and all of the patients had no risk factors of DVT, although they had COVID-19 infection within 3 months before surgery. The most common clinical presentation was swelling on the lower leg (around the ankle) with slightly pain and numbness. Only one patient had severe pain around the thigh. All of the patients had elevated D-dimer testing result with mean of D-dimer 1250 (normal value < 500). Only one patient had sonography testing and found proximal DVT. One of the patients had DVT at post operative day (POD) 3, one at POD 4 and the other two at POD 5. Three of the patients improved with oral anticoagulant therapy using rivaroxaban (XARELTO). In one patient the symptom was not improved after two days oral anticoagulant therapy and underwent thrombectomy by vascular surgeon. DVT is the most common complication of knee arthroscopy and also the most common non-respiratory events of COVID-19 infection. Routinely administration of thromboprophylaxis agent was not recommended, pre-operative risk assessment of DVT should be used, especially in post-COVID 19 patients.