bluuebunny/crossref_metadata_2025_split huggingface dataset:
On the stability of stalled RNA polymerase and its removal by RapA
Authors: Portman James R , Qayyum M Zuhaib , Murakami Katsuhiko S , Strick Terence R 
Published: July 2022

Abstract
Stalling of the transcription elongation complex formed by DNA, RNA polymerase (RNAP) and RNA presents a serious obstacle to concurrent processes due to the extremely high stability of the DNA-bound polymerase. RapA, known to remove RNAP from DNA in an ATP-dependent fashion, was identified over 50 years ago as an abundant binding partner of RNAP; however, its mechanism of action remains unknown. Here, we use single-molecule magnetic trapping assays to characterize RapA activity and begin to specify its mechanism of action. We first show that stalled RNAP resides on DNA for times on the order of 106 seconds and that increasing positive torque on the DNA reduces this lifetime. Using stalled RNAP as a substrate we show that the RapA protein stimulates dissociation of stalled RNAP from positively supercoiled DNA but not negatively supercoiled DNA. We observe that RapA-dependent RNAP dissociation is torque-sensitive, is inhibited by GreB and depends on RNA length. We propose that stalled RNAP is dislodged from DNA by RapA via backtracking in a supercoiling- and torque-dependent manner, suggesting that RapA’s activity on transcribing RNAP in vivo is responsible for resolving conflicts between converging polymerase molecular motors.
Unsaintly Composure? The Old English Saint Eustace and Models of Holiness in Early Medieval England
Authors: Kehoe Niamh 
Published: July 2022

Abstract
This article discusses literary models of holiness from early medieval England. It focuses on the behaviours associated with both the iconic and fallible modes of sainthood, using the anonymous Old English Passion of St Eustace as a case study. It outlines how scholarship on early medieval vernacular hagiography has shaped our understanding of sainthood to align ‘saintly’ behaviour with iconic models of holiness, and then argues that the translator of the Old English Eustace recognized the importance of Eustace’s fallibility. A comparison with the Latin source reveals how the translator intentionally cast Eustace as a human, sinful, and fallible saint for rhetorical effect: to model how to cope with everyday hardship and despair, to demonstrate the importance of penance for redemption, and to show the real-life working of God’s grace. In doing so, this article questions modern scholarly parameters of acceptable medieval models of holy behaviour.
Adding Dexamethasone to Adductor Canal Block Combined With iPACK Block Improve Postoperative Analgesia of Total Knee Arthroplasty
Authors: Zeng Yan , Wang Qiuru , Hu Jian , Yang Jing 
Published: July 2022

Objective:
Both adductor canal block (ACB) and infiltration between the popliteal artery and capsule of the knee (iPACK) block are mainly sensory blocks, preserving muscle strength and the ability to ambulate. This study was designed to evaluate whether adding dexamethasone to ropivacaine could improve postoperative analgesia after total knee arthroplasty (TKA).

Materials and Methods:
This prospective double-blind randomized controlled trial included 60 patients who underwent unilateral TKA under general anesthesia. All patients who received ACB and iPACK block were randomly divided into a dexamethasone group (Group D, ropivacaine combined with dexamethasone) and a control group (Group C, ropivacaine only). The primary outcome was the time to first administration of rescue analgesic drugs. The secondary outcomes included the total amount of rescue analgesic drugs and the pain scores at different time points within 72 hours postoperatively; the time to first getting out of bed; the quality of recovery scale (QOR-15 score); and the levels of plasma inflammatory markers (interleukin-6 and C-reactive protein) on postoperative day 1.

Results:
Compared with Group C, the time to first administration of rescue analgesic drugs in Group D was significantly extended by ∼10.5 hours. Patients in Group D had significantly lower pain scores at different postoperative time points and consumed significantly less total morphine within 72 hours postoperatively. In addition, patients in group D reported significantly higher QoR-15 scores on postoperative days 1 and 3, earlier first time of getting out of bed, and significantly lower levels of C-reactive protein and interleukin-6 on postoperative day 1.

Conclusions:
Compared with using ropivacaine alone, ultrasonic-guided ACB combined with iPACK using ropivacaine and dexamethasone could prolong the duration of postoperative analgesia and strength analgesic intensity and promote the early rehabilitation exercise of patients undergoing TKA.
Mid-term to Long-term Follow-up Results of Reconstruction for Thumb Radial Polydactyly
Authors: Lee Hyun-Joo , Lee Kang-San , Chung Seung-Ho , Kim Hee-June , Park Kyeong-Hyeon , Kim Poong-Taek , Park Sook-Hyun 
Published: July 2022

Background:
Preaxial or radial polydactyly is one of the most common hand congenital anomalies in newborns. Contemporary reconstruction methods include ligament reconstruction, excision of the polydactylous thumb, osteotomy, and other surgical techniques according to the type of polydactyly. The purpose of this study was to report mid-term to long-term reconstruction results for thumb (radial) polydactyly.

Methods:
We retrospectively reviewed the medical records of patients who underwent reconstruction surgery for preaxial polydactyly. Clinical outcomes, including the range of motion (ROM), pain, and complications, were evaluated. We assessed the final radiographs of the reconstructed thumb to identify the potential development of arthritis or other remaining deformities. After excluding cases without a simple radiograph and cases with a short follow-up period of fewer than 5 years, 26 thumbs were included. The surgical technique followed including excision of polydactylout thumb was tailored to the type of polydactyly. If the nail size of the thumbs was similar, the Bilhaut-Cloquet method was preferred.

Results:
The mean age of the patients at the surgery and final follow-up was 14.9 months (range: 8 to 30 mo) and 11.9 years (range: 5.8 to 19.3 y), respectively. The mean follow-up was 128.8 months years (range: 60 to 219 mo), and the mean ROM of the thumb was 32.7 and 57.5 degrees in the distal interphalangeal joint (DIP) and metacarpophalangeal (MP) joint, respectively. Ulnar or radial side instability was prominent in 7 patients in the involved joints (26.9%). One patient underwent interphalangeal (IP) fusion for extension lag with pain. The radiologic evaluation revealed that 2 patients developed radiographic evidence of IP joint arthritis (7.7%). Radial deviation of the MP or IP joint existed in 13 cases (range: 5 to 40 degrees) (50.0%), and ulnar deviation of the MP or IP joint existed in 2 cases (range: 19 to 20 degrees) (7.7%).

Conclusions:
In mid-term to long-term experience, sequelae such as joint instability, joint stiffness, and remaining deformity cannot be neglected. An unstable MP joint may result if the DIP joint remains stiff or has a lower ROM.

Level of Evidence:
Level IV—therapeutic studies.
Minimizing the Risk of Vascular Injury: Anatomy of the Popliteal Artery in the Pediatric Knee
Authors: Mun Frederick , Suresh Sukrit J. , Marrache Majd , Suresh Krishna V. , Ikwuezunma Ijezie , Lee Rushyuan Jay 
Published: July 2022

Background:
Displaced pediatric tibial tubercle fractures are commonly stabilized with screws directed posteriorly toward neurovascular structures. Here, we (1) characterize the variation of the popliteal artery among pediatric patients; and (2) recommend a safe screw trajectory for fixation of tibial tubercle fractures.

Methods:
We retrospectively identified 42 patients (42 knees; 29 female) aged 12–17 years with lower-extremity magnetic resonance imaging (MRI) at a tertiary academic center. The mean patient age was 14.5 (range: 12–17) years, and the mean body mass index value was 19.1 (range: 14.9–25.1). We included patients with open physes or visible physeal scars and excluded those with prior instrumentation or lower-extremity injury. Using sagittal MRI, we measured the distances from 5 levels each on the anterior and posterior tibial cortex to the popliteal artery (level 1, midpoint of proximal tibial epiphysis; level 2, the proximal extent of the tubercle; level 3, tubercle prominence; level 4, 2 cm distal to the proximal extent of the tubercle; level 5, 4 cm distal to the proximal extent of the tubercle). Using coronal MRI, we measured the width of the tibia at each level and the distance from the lateral-most and medial-most cortex to the artery.

Results:
The popliteal artery was laterally positioned in all knees. The mean distance between the artery and lateral-most aspect of the tibia at each level ranged from 1.9 to 2.4 cm, and from 2.3 to 3.9 cm from the medial-most aspect of the tibia. The mean distance that a screw can advance before vascular injury was 5.1 cm at level 1. The shortest mean distance to the popliteal artery was 1.7 cm, at level 5. There is minimal distance between the posterior tibial cortex and the artery at all levels.

Conclusions:
Understanding the position of the popliteal artery in pediatric patients can help when stabilizing tibial tubercle fractures. Because the artery is close to the posterior cortex, a drill exiting in line with the popliteal artery risks vascular injury. Therefore, we recommend that screws exit within the medial 60% of the tibia.

Level of Evidence:
IV
Endoscopic transcanal transtympanic myringoplasty vs. endoscopic transcanal tympanoplasty: 1-year follow-up study
Authors: Chen Chin-Kuo , Kuo Chin-Lung , Weng Yu-Ting , Hsieh Li-Chun 
Published: July 2022

Background:
Endoscopic transcanal transtympanic myringoplasty (ETTM) is a relatively easier technique than endoscopic transcanal tympanoplasty (ETT) for repairing tympanic membrane perforations. No studies have compared the outcomes of these two procedures with tragal perichondrium after 1-year. Furthermore, there is no evidence-based stratification according to variations in perforation size in endoscopic ear surgery. Therefore, we compared the 1-year outcomes of ETTM and ETT stratified according to perforation size.

Methods:
Patients who underwent ETT and ETTM to repair eardrum perforations with a tragal perichondrium graft were identified. Pure-tone audiometric tests and otoscopic examination were performed to assess hearing outcomes and perforation sizes both preoperatively and at least 1 year postoperatively.

Results:
In total, 158 patients (159 ears) were included. ETT was performed on 83 ears, and ETTM was performed on 76 ears. The ETTM procedure time was 10-minutes shorter than that for ETT (p < 0.001). Perforation size was significantly correlated with graft take-rate. For large perforations, the ETT success rate was significantly higher than that of ETTM (91.7% vs. 78.9%). Success rates for small-medium perforations were comparable for both methods (p > 0.05). However, for medium perforations, the graft take-rate of ETT reached a plateau after 6 months, while that of ETTM gradually declined during the 12-month follow-up. Both groups had a comparable mean postoperative air-bone gap gain (p = 0.666).

Conclusion:
ETTM is suitable for repairing small perforations, whereas ETT is preferred for large perforations. Both methods, and particularly ETTM, should be employed cautiously for medium perforations.
Designing a Plastic and Reconstructive Surgery Virtual Curriculum (PRSVC): Assessment of Medical Student Knowledge, Surgical Skill, and Community Building
Authors: Shen Abra H. , Alfonso Allyson R. , Cuccolo Nicholas G. , Johnson Anna Rose , Lee Bernard T. , Lin Samuel J. 
Published: July 2022

Background:
The COVID-19 pandemic displaced medical students from their rotations and into virtual classrooms. We aimed to develop a virtual curriculum with the goals for students to gain knowledge in plastic surgery, to acquire technical skills, and to be able to promote community.

Methods:
We developed a four-week educational curriculum of topics in plastic surgery using the American Society of Plastic Surgeons Resident Education Curriculum and an online plastic surgery curriculum. Virtual flipped classroom case discussions and weekly surgical skills workshops were offered. Pre- and post-course surveys were administered, and results analyzed using IBM SPSS Statistics version 25.0.

Results:
303 medical students and recent graduates enrolled in the course in June 2020. 182 students completed the pre-course survey (60% response rate), and of those, 50.0% (n=91) completed the post-course survey for paired comparison. Students reported significant improvement in confidence discussing the relevant anatomy, work-up and surgical approaches to clinical cases, as well as confidence in knowledge of all topic areas (p<0.001). Confidence in suturing and knot-tying techniques significantly improved among workshop participants (p<0.001). Students applying to residency programs this cycle felt significantly more prepared for sub-internships (p<0.001) and significantly more connected to the community of applicants (p<0.001).

Conclusions:
The Plastic and Reconstructive Surgery Virtual Curriculum (PRSVC) improved knowledge, surgical skills, and community in the field among medical student participants. This course may serve to provide a framework for structured virtual learning activities for students interested in plastic surgery and may have significant long-lasting utility for students interested in the field.
Five-year Survival after McKeown Compared to Ivor-Lewis Esophagectomy for Esophageal Cancer
Authors: Junttila Anna , Helminen Olli , Helmiö Mika , Huhta Heikki , Kallio Raija , Koivukangas Vesa , Kokkola Arto , Laine Simo , Lietzen Elina , Meriläinen Sanna , Pohjanen Vesa-Matti , Rantanen Tuomo , Ristimäki Ari , Räsänen Jari V. , Saarnio Juha , Sihvo Eero , Toikkanen Vesa , Tyrväinen Tuula , Valtola Antti , Kauppila Joonas H. ,   on behalf of the FINEGO group
Published: July 2022

Objective:
The aim of study was to compare overall 5-year survival of esophageal cancer patients undergoing transthoracic esophagectomy with either neck or intrathoracic anastomosis, that is, McKeown and Ivor-Lewis esophagectomy.

Background:
No national studies comparing long-term survival after McKeown and ivor-Lewis esophagectomies in the West exist.

Methods:
This population-based nationwide study included all curatively intended transthoracic esophagectomies for esophageal adenocarcinoma or squamous cell carcinoma in Finland in 1987 to 2016, with follow-up until December 31, 2019. Cox proportional hazard models provided hazard ratios (HR) with 95% confidence intervals (ci) of all-cause 5-year mortality. The results were adjusted for age, sex, year of the operation, comorbidities, histology, stage, and neoadjuvant treatment. Adjusted model 2 included also tumor location and lymph node yield.

Results:
A total of 990 patients underwent McKeown (n = 278) or Ivor-Lewis (n = 712) esophagectomy The observed overall 5-year survival was 43.1% after McKeown, and 45.9% after Ivor-Lewis esophagectomy. McKeown esophagectomy was not associated with the overall 5-year mortality (adjusted HR 1.11, 95% CI: 0.89-1.38), compared to Ivor-Lewis esophagectomy. Additional adjustment for tumor location and lymphadenectomy further attenuated the point estimate (HR 1.06, 95% CI: 0.85–1.33). Surgical approach was not associated with 90-day mortality rate (adjusted HR 1.15, 95% CI: 0.67–1.97).

Conclusions:
This population-based nationwide study suggests that overall 5-year survival or 90-day survival with McKeown and Ivor-Lewis esopha-gectomy for esophageal cancer are comparable.
Homeostatic responses to hypoxia by the carotid body and adrenal medulla are based on mutual antagonism between HIF-1α and HIF-2α
Authors: Yuan Guoxiang , Peng Ying-Jie , Reddy Vaddi Damodar , Makarenko Vladislav , Nanduri Jayasri , Khan Shakil A. , Garcia Joseph A. , Kumar Ganesh K. , Semenza Gregg L. , Prabhakar Nanduri R. 
Published: July 2022

AbstractRespiration and blood pressure (BP) are regulated to maintain optimal delivery of O2 to every cell in the body. Arterial hypoxemia is sensed by the carotid body (CB), which initiates sympathetic reflex arcs to the diaphragm to increase ventilation, and to the adrenal medulla (AM) to increase catecholamine secretion and thereby increase BP. However, the underlying molecular mechanisms have not been fully delineated. Here, we report that the relative activities of hypoxia-inducible factor-1 (HIF-1) and HIF-2 determine the set point for the CB and AM, with respect to their maintenance of BP and respiration. In Hif2a+/- mice, which are heterozygous for a knockout allele at the locus encoding HIF-2α, expression of HIF-1α and NADPH oxidase 2 was increased in the CB and AM, resulting in an oxidized intracellular redox state with augmented sensitivity to hypoxia, increased BP, and respiratory abnormalities, which were all normalized by treatment with a HIF-1α inhibitor or a superoxide anion scavenger. By contrast, in Hif1a+/- mice, which are heterozygous for a knockout allele at the locus encoding HIF-1α, the expression of HIF-2α and superoxide dismutase 2 was increased in the CB and AM, resulting in a reduced intracellular redox state with impaired CB and ventilatory responses to chronic hypoxia, which were normalized by treatment with a HIF-2α inhibitor. None of the abnormalities that were observed in Hif1a+/- or Hif2a+/- mice were observed in Hif1a+/-; Hif2a+/- double- heterozygous mice. Our results demonstrate that redox balance in the CB and AM, which is determined by mutual antagonism between HIF-α isoforms, establishes the set point for responses of the CB and AM to hypoxia, and is required for the maintenance of normal BP and respiration.
Delayed generation of functional virus-specific circulating T follicular helper cells correlates with severe COVID-19
Authors: Yu Meng , Charles Afandi , Cagigi Alberto , Christ Wanda , Österberg Björn , Falck-Jones Sara , Azizmohammadi Lida , Åhlberg Eric , Falck-Jones Ryan , Svensson Julia , Nie Mu , Warnqvist Anna , Hellgren Fredrika , Lenart Klara , Cerveira Rodrigo Arcoverde , Ols Sebastian , Lindgren Gustaf , Lin Ang , Maecker Holden , Bell Max , Johansson Niclas , Albert Jan , Sundling Christopher , Czarnewski Paulo , Klingström Jonas , Färnert Anna , Loré Karin , Smed-Sörensen Anna 
Published: July 2022

AbstractEffective humoral immune responses require well-orchestrated cellular interactions between B and T follicular helper (Tfh) cells. Whether this interaction is impaired and associated with COVID-19 disease severity is unknown. Here, longitudinal acute and convalescent blood samples from 49 COVID-19 patients across mild to severe disease were analysed. We found that during acute infection activated and SARS-CoV-2-specific circulating Tfh (cTfh) cell frequencies expanded with increasing disease severity. The frequency of activated and SARS-CoV-2-specific cTfh cells correlated with plasmablast frequencies and SARS-CoV-2 antibody titers, avidity and neutralization. Furthermore, cTfh cells but not other memory CD4 T cells, isolated from severe patients induced more pronounced differentiation of autologous plasmablast and antibody production in vitro compared to cTfh cells isolated from mild patients. However, the development of virus-specific cTfh cells was delayed in patients that displayed or later developed severe disease compared to those that maintained a mild or moderate disease. This correlated with a delayed induction of high-avidity and neutralizing virus-specific antibodies. Our study therefore suggests that impaired generation of functional virus-specific cTfh cells delays the production of high-quality antibodies to combat the infection at an early stage and thereby enabling progression to more severe COVID-19 disease.
Experimental and theoretical evidence for effective corrosion mitigation in mild steel using novel Garcinia gummi-gutta leaf extract
Authors: G.K. Shamnamol , John Sam , Jacob Jaya Mary 
Published: July 2022

Purpose
Surface pretreatment of iron and its alloys to remove stains and inorganic contaminants on the metal surface undergoes dissolution by virtue of the strong acidic media thereby increasing its susceptibility to corrosion. The purpose of this study is to explore the corrosion mitigation prospects of green corrosion inhibitors on mild steel surface.

Design/methodology/approach
Corrosion inhibition performance of Garcinia gummi-gutta leaf extract (GGLE) was explored against mild steel in 1 M HCl solution using the weight-loss method, electrochemical impedance spectroscopy (EIS) and potentiodynamic polarization (PDP) techniques. Surface characterization was carried out to study the mechanism of inhibitor action.

Findings
The concentration of GGLE varied from 100 to 6,000 ppm and the result indicates that corrosion inhibition efficiency was amplified by raising the inhibitor concentration. The maximum inhibition efficiency was 82.2% at 6,000 ppm concentration. EIS results show the development of a protective layer of inhibitor molecule over the metal surface and PDP demonstrates that the inhibitor operates as a mixed-type inhibitor. Scanning electron microscopy and atomic force microscopy were executed to assess the surface morphology and roughness, respectively.

Originality/value
To the best of the authors’ knowledge, so far, no studies have been reported on the corrosion inhibition performance of GGLE which is rich in many bioactive components especially hydroxyl citric acid. This work encompasses the corrosion inhibition capability of GGLE against mild steel in an acidic medium.
Organizational hierarchical position, perception of unfair pay, and job satisfaction: evidence from large nation-wide surveys in Poland
Authors: Adamchik Vera A. , Hyclak Thomas J. , Sedlak Piotr 
Published: July 2022

PurposeThe study examines the relationship between perceived unfair pay and job satisfaction and how this relationship is contingent on organizational hierarchical rank.Design/methodology/approachThe proprietary data are from ongoing surveys of individual workers conducted by a major Polish human resource consulting firm. The pooled cross-section dataset is comprised of nearly 330,000 individuals working in the Polish labor market during 2015–2017. Drawing upon various theories, the authors formalize and test three hypotheses. The estimations are performed using the ordered probit method.FindingsCeteris paribus, job satisfaction is increasing with organizational hierarchical rank; perceived unfairness of pay is negatively associated with job satisfaction, and organizational hierarchical rank exacerbates this negative relationship by making it stronger for employees holding higher organizational positions.Originality/valueFirst, prior research is mainly confined to studying pay satisfaction as a contributing factor to job satisfaction, and perceived fairness of pay was rarely considered. Second, very few studies examine the role of hierarchical level as a moderator in the relationship between organizational justice and workplace outcomes. Third, the authors add to the scarce empirical literature on job satisfaction for post-Communist Central and East European countries as only a limited number of such studies exist for Poland.