Early Interval Research Articles

Comparative Study between Endoscopic Lumbar Discectomy and Lumbar Fixation in Management of Recurrent Lumbar Disc Prolapse

Abstract Background There is a great controversy in operative methods which can be used for recurrent lumbar disc herniation such as repeated endoscopic discectomy or repeated open discectomy either using fusion or not Endoscopic revision surgery can be conducted using the endoscopic interlaminar discectomy. Open surgery can be used for recurrent discectomy and lumbar fixation can be used in addition. Interbody fusion might be used as well. Patients and Methods The current study is a prospective, comparative study that included 90 patients with recurrent lumbar disc prolapse, who were scheduled for reoperation in Neurosurgical departments in Ain Shams University Hospitals and Other Affiliated Hospitals during time period from November 2016 to February 2022. Using spine endoscopy in 45 patients with recurrent disc prolapse (group 1) and fixation in another 45 patients (group 2). Results Operative time, wound length in centimeters, intraoperative bleeding, and the presence of a drain were compared between Group 1 and Group 2. All these variables showed statistically significant differences between the two groups showing better results in endoscopic group. Preoperatively, there was no statistically significant difference in JOA scores between Group 1 and Group 2. Immediately postoperative and at 1 week interval, endoscopic group had significantly higher JOA scores, indicating better outcomes. Preoperatively, there was no statistically significant difference in disability scores between Group 1 and Group 2. Immediately postoperative and at early time intervals, endoscopic group had significantly lower disability scores compared to fixation group. There were no statistically significant differences between Group 1 and Group 2 in terms of recurrence and stability rates. There was no statistically significant difference between Group 1 and Group 2 in terms of motor power outcome index. Conclusion Endoscopic lumbar discectomy is superior to open lumbar discectomy using fixation with or without fusion in the management of recurrent lumbar disc herniation, as for short-term results, however both techniques are equal in long-term results

Comparison of reactivation between ranibizumab and bevacizumab in aggressive retinopathy of prematurity: A retrospective case series.

To compare the incidence, type, interval for reactivation, and structural outcomes in infants with aggressive retinopathy of prematurity (A-ROP) treated with ranibizumab or bevacizumab. It is a single-center, retrospective, consecutive, case series. We included infants with A-ROP which were initially treated with either intravitreal ranibizumab (IVR, 0.25 mg) or intravitreal bevacizumab (IVB, 0.625 mg) between January 2017 and December 2023. The infants were followed up for reactivation. The demographic and clinical data were collected. The time, zone, type of reactivation, its treatment, type of final structural outcome, and factors associated with reactivation were analyzed. One hundred eight among the 322 infants with A-ROP were included in the study. Fifty-five received IVR, while 53 received IVB. Infants treated with IVR had higher incidence of reactivation (92.7% vs 52.8%, P < 0.001) at an earlier interval than IVB (7.7 weeks vs 12.8 weeks, P < 0.001). Infants treated with IVR had approximately 3.3 times higher possibility of reactivation than those treated with IVB. Three infants (5.9%) in the IVR group and five (9.4%) in the IVB group attained complete vascularization of the retina (P = 0.72). More infants treated with IVB had regression with a persistent avascular retina (PAR) than IVR (52.8% vs 15.7%, P < 0.001). Infants in the IVB group had 10 times higher possibility of regression with PAR. Infants of A-ROP treated with IVR have a higher incidence and earlier reactivation, while those treated with IVB have less incidence and delayed reactivation, albeit with a higher possibility of regression with a PAR.

The effect of performance contingent reward prospects flexibly adapts to more versus less specific task goals.

In some situations, for example, when we expect to gain a reward in case of good performance, goal-driven top-down attention is particularly strong. Little is known about the task specificity of such increases of top-down attention due to environmental factors. To understand to what extent performance-contingent reward prospects can result in specific and unspecific changes in cognitive processing, we here investigate reward effects under different levels of task specification. Thirty-two participants performed a visual or an auditory discrimination task cued by two consecutive visual stimuli: First, a reward cue indicated if good performance was rewarded. Second, a task cue announced either which of the two tasks would follow (precise cue) or that both tasks would follow equally likely (imprecise cue). Reward and task cue preciseness both significantly improved performance. Moreover, the response time difference between precisely and imprecisely cued trials was significantly stronger in rewarded than in unrewarded trials. These effects were reflected in event-related potential (ERP) slow wave amplitudes: Reward and preciseness both significantly enhanced the contingent negative variation (CNV) prior to the task stimulus. In an early CNV time interval, both factors also showed an interaction. A negative slow wave prior to the task cue was also significantly enhanced for rewarded trials. This effect correlated with the reward difference in response times. These results indicate that reward prospects trigger task-specific changes in preparatory top-down attention which can flexibly adapt over time and across different task requirements. This highlights that a reward-induced increase of cognitive control can occur on different specificity levels.

A new late-diverging non-hadrosaurid hadrosauroid (Dinosauria: Ornithopoda) from southwest China: Support for interchange of dinosaur faunas across East Asia during the Late Cretaceous

A non-hadrosaurid hadrosauroid, Qianjiangsaurus changshengi gen. et sp. nov., is named and described here based on an incomplete, partially articulated skeleton from the top of the Upper Cretaceous Zhengyang Formation in Qianjiang District, Chongqing Municipality, southwest China. The skeleton displays a transitional morphology between non-hadrosaurid hadrosauroids and hadrosaurids. The diagnosis of the taxon is therefore defined as a unique combination of characters, including a series of plesiomorphic features typical of non-hadrosaurid hadrosauroids, some apomorphic features common among hadrosaurids but rarely reported in non-hadrosaurid hadrosauroids, and a probable autopomorphy, namely the fan-shaped prepubic process of the pubis strongly anteroposteriorly constricted and dorsoventrally expanded, with the length/height ratio of ∼0.79. Phylogenetic analysis recovers a sister-taxon relationship between Qianjiangsaurus and Plesiohadros outside of Hadrosauridae, and the clade consisting of the two taxa is positioned higher on the tree than Gobihadros and Gilmoreosaurus, but below the clade of Telmatosaurus + Tethyshadros, Eotrachodon and Zhanghenglong. Combining the morphological data with the phylogenetic topology identifies Q. changshengi as a late-branching non-hadrosaurid hadrosauroid. Given that the age assemblage of the eight hadrosauroids closely related to Qianjiangsaurus in phylogeny spans the Santonian–early Maastrichtian time interval, the top of the Zhengyang Formation, from which Qianjiangsaurus is recovered, is possibly restricted to the late Late Cretaceous in age. Hierarchical clustering of twelve hadrosauroid-bearing dinosaur assemblages from the Late Cretaceous deposits of Asia shows a strong correlation between the Zhengyang Formation and the Djadokhta and Baruungoyot formations in Mongolia that supports coeval interchange of dinosaur faunas across East Asia.

New insights on Late Pliensbachian-Early Toarcian seawater chemistry based on belemnite rostra element content

Belemnites were a type of cephalopod abundant in the Jurassic and Cretaceous, whose fossils have been extensively used for paleo-oceanographic studies. For this study, we analyzed 69 elements by Inductively Coupled Plasma-Sector Field Mass Spectrometry (ICP-SFMS) in 15 belemnite rostra from the West Rodiles section in the Asturian Basin, Northern Spain. We aim to determine if belemnite rostra carbonate chemistry reflects changes in seawater chemistry during the Late Pliensbachian–Early Toarcian time interval and examine how belemnites can be used to trace known drivers of the Early Toarcian Oceanic Anoxic Event (T-OAE) and associated oceanographic processes.Discarding drastic intra-species effects and assuming a similar influence of growth rates, diet, and other physiological processes for all analyzed belemnite specimens and taking into consideration the sizeable analytical uncertainty, we assess if determined belemnite rostra element chemistry reflects broad and relative changes in paleo-seawater chemistry. Many determined elements are present in only ppb amounts, and their interpretation is uncertain. We found that Mg, Mn, and P increase in the interval chronocorrelative to the T-OAE. This is interpreted to have resulted from an increase in these elements' inventory in seawater due to an increase in continental weathering and fluvial runoff associated with this global event. Iron, K, and Na contents decrease upwards in the section, potentially indicating that these elements became limited and likely hampered oceanic productivity. Our study also found a correspondence between a change in the behaviour of several elements, warming, the T-OAE negative CIE, and a reduction in the diversity and size of both calcareous nannofossils and belemnites in the study area.

Attentional resource consumption of verbal-humor processing: An ERP study

As a high-demanding mental activity with both cognitive and emotional factors, verbal-humor processing consumes more attentional resources than non-humor processing, which has been demonstrated by behavioral studies, but little has been examined at a real-time scale. Based on the three-stage model (incongruity detection, incongruity resolution, and mirth), the current study used event-related potential (ERP) and event-related oscillation (ERO) to explore the attentional resource consumption of verbal-humor processing by employing a dual-task paradigm in which sentence comprehension (humorous, positive, neutral) was the primary task and arithmetical calculation (simple, difficult) was the secondary task.Participants’ (N=38) behavioral performance and ERP/ERO measures in two tasks were analyzed. ERP results of verbal-humor processing revealed significantly larger LAN, LLAN, and LPP activation, which indexed three stages. ERO results showed significant beta power changes in the detection stage and theta changes in the resolution and mirth stages. The behavioral data indicated that the Reaction Times (RTs) of the arithmetical task following verbal-humor processing were longer than those following non-humorous positive and neutral ones. The ERP results of arithmetical calculation found that the calculations following verbal-humor processing elicited significantly greater P2, P3b, and positive slow wave amplitudes than those following the other two processings, which reflected more resource allocation in the calculation to compensate for the resource preemption of verbal-humor processing. In addition, the calculation following positive sentence exhibited a greater ERP amplitude in the relatively early P2 time intervals than that following the neutral sentences. Collectively, the behavioral, ERP, and ERO results concurrently confirmed that verbal-humor processing consumed more attentional resources compared with non-humorous counterparts, and moreover, the comparison of ERP following humorous and positive sentences suggested that the processing of the cognitive factor consumes more attentional resources than the emotional factor although both factors play a role in the process.

Depositional facies and evolution of sponge-microbial-constructed carbonate platforms in the lower Cambrian (Stage 3), Tarim basin, China: Understanding from anatomy

The early Cambrian was generally considered the earliest time interval while the archaeocyaths could act as the constructors in building reef framework although commonly coexisting with the microbial constructors (Epiphyton and Renalcis) in the course of the “Cambrian explosion”; however, this kind of metazoan-microbial buildups has not yet been reported in Tarim Basin. To delineate facies (associations), spatiotemporal variations, reef-building processes of metazoan-microbial constructed ramps/shelves and evolution, detailed anatomy was carried out upon the lower Cambrian Xiaoerbulak Formation (or Stage 3) exposed continuously along a marginal transect (∼2 km wide) in Aksu area, northwestern Tarim Basin. Three platform types with distinctive facies associations are distinguished: (1) sponge-microbial biostrome/mound-colonized homoclinal and distally-steepened ramps recorded respectively in the Lower Member and basal Middle Member, (2) Archaeocyath-Epiphyton reef- and microbial reef-rimmed platforms (or shelves) in the mid-upper Middle Member, and (3) microbial biostrome-colonized ramp in the Upper Member, thus illustrating the evolution from the ramp to reef-rimmed platform and final reversion to the ramp system. Four and a half third-order depositional sequences are further identified: one in the Lower Member, two in the Middle Member and one and half (TST) in the Upper Member, although, at least, one sequence was absent in the platform/ramp interior. All these can be well correlated with those in equivalent successions identified elsewhere around the world, implying a basic control of eustatic changes on platform development and evolution. Moreover, syndepositional faulting/sliding that occurred off the ramp margin, as demonstrated by slope failure/collapse, may have enhanced the relief difference between the inner and mid-outer ramps, promoting metazoan-microbes to colonize and build up wave-resistant architecture on the uplifting margin, forming the reef-rimmed platform (or shelf) system as typified in the Middle Member. Meanwhile, the development of wave-resistant, metazoan-microbial reef complexes also benefited from their concurrently-gained calcifying ability, which likely resulted from the instinctive biotic responses to the changes in climate and oceanic chemistry (i.e., pCO2, seawater Mg/Ca ratio) in the early Cambrian. The new datasets of this study fill previous information gap on the early Cambrian metazoan-involved buildups that had controlled the platform configuration and evolution in Tarim Basin, which thus are critically important for better understanding of climatic/environmental controls on their occurrence and evolution of the time-specific reef complexes in the course of “Cambrian Explosion”. Additionally, these datasets would provide a useful analogue for perceiving the facies-constrained porosity and heterogeneity in the deeply buried counterparts in the basin, helpful for making exploration strategy for the deeply-buried hydrocarbon resources.

Impact of Traffic Flow Rate on the Accuracy of Short-Term Prediction of Origin-Destination Matrix in Urban Transportation Networks

Information about spatial distribution (OD flows) is a key element in traffic management systems in urban transport networks that enables efficient traffic control and decisions to redirect traffic to less congested sections of the network in emergencies. With the development of modern techniques of remote sensing, more and more advanced methods are used to measure traffic and determine OD flows. However, they may produce results with different levels of errors caused by various factors. The article examines the impact of traffic volume and its variability on the error values of short-term prediction of the OD matrix in the urban network. The OD flows were determined using a deep learning network based on data obtained from video remote sensing devices. These data were recorded at earlier intervals concerning the forecasting time. The extent to which there is a correlation between the size of OD flows and the prediction error was examined. The most frequently used measure of prediction accuracy, i.e., MAPE (mean absolute percentage error), was considered. The analysis carried out made it possible to determine the ranges of traffic flow rate for which the MAPE stabilizes at the level of approximately 6%. A set of video remote sensing devices was used to collect spatiotemporal data. They were located at the entrances and exits from the study area on important roads of a medium-sized city in Poland. The conclusions obtained may be helpful in further research on improving methods to determine OD matrices and estimate their reliability. This, in turn, involves the development of more precise methods that allow for reliable traffic forecasting and improve the efficiency of traffic management in urban areas.

Exploring the neurofunctional impairments and cognitive biases concerning food and body related stimuli in anorexia nervosa: An integrated EEG and eye-tracking study protocol.

Patients with Anorexia Nervosa (AN) exhibit significant cognitive and neural disturbances compared to healthy individuals when processing food and body-related stimuli. These disturbances not only contribute to the manifestation and chronification of their pathological eating behaviour but also underscore the complex interplay of cognitive, emotional, and neurobiological factors in AN. However, the precise underlying cognitive and neural mechanisms of these disturbances remain a compelling area of investigation. This study presents a protocol developed for conducting a cross-sectional quasi-experimental study using a mixed model ANOVA approach with a crossover design. Our participants will consist of 20 patients with an active diagnosis of AN, 20 Overweight/obese individuals, and 20 Healthy Controls (HCs) with a normal BMI. An integrated eye-tracking and EEG methodology will be used in conjunction, with the primary aim of assessing participants' cognitive and neural processing towards high and low-calorie food stimuli. On an exploratory level, by utilizing the same methods, the present study will also investigate AN patients' responses towards high weight, normal weight, low weight, and self-body pictures, as well as towards images from the International Affective Picture System (IAPS) characterized by elevated valence and arousal levels. Additionally, behavioural methods such as yes or no questions, and self-reported questionnaires will be administered. The EEG and eye-tracking data will be analysed at early (50-300 ms) and late (350-500 ms) time intervals. The investigation of the underlying cognitive and neural processes employed by patients with AN during the processing of food and body-related stimuli can help us develop a better understanding of the cognitive and neural mechanisms that contribute to the manifestation and maintenance of the disorder and assist in the development of more effective screening methods. Ethical approval for the study has been obtained by the Cyprus National Bioethics Committee on 27.04.2023 (ΕΕΒΚ/ΕΠ/2023/19), and by the University of Cyprus (20.02.2023). Written informed consent will be obtained from all participants.

Maximum a posteriori Bayesian methods out-perform non-compartmental analysis for busulfan precision dosing

Dose personalization improves patient outcomes for many drugs with a narrow therapeutic index and high inter-individuality variability, including busulfan. Non-compartmental analysis (NCA) and model-based methods like maximum a posteriori Bayesian (MAP) approaches are two methods routinely used for dose optimization. These approaches vary in how they estimate patient-specific pharmacokinetic parameters to inform a dose and the impact of these differences is not well-understood. Using busulfan as an example application and area under the concentration–time curve (AUC) as a target exposure metric, these estimation methods were compared using retrospective patient data (N = 246) and simulated precision dosing treatment courses. NCA was performed with or without peak extension, and MAP Bayesian estimation was performed using either the one-compartment Shukla model or the two-compartment McCune model. All methods showed good agreement on real-world data (correlation coefficients of 0.945–0.998) as assessed by Bland–Altman plots, although agreement between NCA and MAP methods was higher during the first dosing interval (0.982–0.994) compared to subsequent dosing intervals (0.918–0.938). In dose adjustment simulations, both NCA and MAP estimated high target attainment (> 98%) although true simulated target attainment was lower for NCA (63–66%) versus MAP (91–93%). The largest differences in AUC estimation were due to different assumptions for the shape of the concentration curve during the infusion phase, followed by how the methods considered time-dependent clearance and concentration–time points collected in earlier intervals. In conclusion, although AUC estimates between the two methods showed good correlation, in a simulated study, MAP lead to higher target attainment. When changing from one method to another, or changing infusion duration and other factors, optimum estimated exposure targets may require adjusting to maintain a consistent exposure.

HIV incidence before and during the COVID-19 pandemic in Japan.

At the end of 2022, a total of 20,003 diagnoses of human immunodeficiency virus (HIV) infection and 8,983 cases of acquired immunodeficiency syndrome (AIDS) among Japanese nationals, and 3,860 HIV diagnoses and 1,575 AIDS cases among foreign residents, had been notified to the government in Japan. This study updates the estimate of HIV incidence, including during the COVID-19 pandemic. It aimed to reconstruct the incidence of HIV and understand how the disruption caused by COVID-19 affected the epidemiology of HIV. Using a median incubation period of 10.0 years, the number of undiagnosed HIV infections was estimated to be 3,209 (95% confidence interval (CI): 2,642, 3,710) at the end of 2022. This figure has declined steadily over the past 10 years. Assuming that the median incubation period was 10.0 years, the proportion of diagnosed HIV infections, including surviving AIDS cases, was 89.3% (95% CI: 87.8%, 91.0%). When AIDS cases were excluded, the proportion was 86.2% (95% CI: 84.3%, 88.3%). During the COVID-19 pandemic, the estimated annual diagnosis rate was slightly lower than during earlier time intervals, at around 16.5% (95% CI: 14.9%, 18.1%). Japan may already have achieved diagnostic coverage of 90%, given its 9% increment in the diagnosed proportion during the past 5 years. The incidence of HIV infection continued to decrease even during the COVID-19 pandemic from 2020 to 2022, and the annual rate of diagnosis decreased slightly to 16.5%. Monitoring the recovery of diagnosis along with the effective reproduction number is vital in the future.

The Father of Wisdom: "The Influence of Surgical Experience on Overall Survival in Patients with Malignant Gliomas".

The role of surgery in the management of malignant gliomas has been feverishly deliberated after the publication of the first expansive case series, the last two decades reinvigorating the discussion regarding the value of total removal in improving survivability. Despite numerous technologies being implemented to increase the resection rates of malignant gliomas, the role of surgical experience has been largely overlooked. This article aims to discuss the importance of a single surgeon's experience in treating high-grade gliomas over a period of 20years. In order to demonstrate the role of surgical experience, we divided the patients operated by a single neurosurgeon into two distinct intervals: between 2000 and 2009 and between 2012 and 2020, respectively. Only cases with subsequent adjuvant radio-chemotherapy were included. For objective reasons, no technologies that could assist the extent of resection (EOR) such as intraoperative MRI (iMRI) or 5-ALA could be used in the country of our study. Gross total resection was the main goal whenever possible, whereas subtotal removal was defined as a clear remnant on contrasted MRI or CT performed 24-48h postoperatively. Using the Kaplan-Meier method, we analyzed the survival and disease-free interval of our patients according to age, pathology, and degree of resection. In the 20-year interval of our retrospective study, the main author (ISF) operated 1591 cases of gliomas in a total of 1878 surgeries, including recurrences. The number of high-grade glioma (HGG) patients was 909 (57.10%), 495 of which were male (54.5%) and 414 (45.5%) female. The mean age of the HGG population was 51.9years. The most common type of HGG subtype were glioblastomas with a total number 620 cases (68.2%). Regarding overall survival (OS), average survival at 12months was better by 1.6%, and 12.1% improved at 18months and 17.8% longer at 24months in the 2012-2020 interval. The mean OS in the earlier interval was 11.00months compared to the second when it reached 13.441months (CI, 12.642-14.24). Surgical treatment represents a critical step in the multimodal treatment of malignant gliomas. According to our results, surgical experience improves not only overall survival in a manner equivalent to adjuvant chemotherapy but also the quality of life. As such, a special qualification in neurooncology may prove necessary in offering these patients a second chance at life.

Obtaining cumin (Cuminum Cymminum) essential oils by steam distillation. Part I: investigation of operation parameters on essential oil yield and distribution of oil composition

AbstractBACKGROUNDThe effect of pretreatment (grinding), packing material (raschig rings) and vacuum on the yield and the component distribution of the essential oil of cumin during steam distillation was investigated. Concurrently, kinetic studies were conducted to examine the essential oil yield.RESULTSAt the end of 120 min, the yield under normal conditions was 0.79, 1.26, 1.90 and 2.36 for nonground and 20‐, 40‐ and 80‐s ground cumin seeds, respectively. Equivalent figures in a vacuum were 0.64, 1.56 and 1.95 for nonground, 40‐ and 80‐s ground cumin seeds, respectively. When raschig rings were used, the yield value was 1.99 and 2.06 under normal and vacuum conditions, respectively, for cumin seeds ground for 80 s. Under normal conditions, the cumin aldehyde percentages of the nonground sample, and the 40‐ and 80‐s ground samples was 51.31, 33.59 and 32.54, respectively, and under vacuum, 70.00, 49.02 and 40.59, respectively. Six kinetic models were applied with sufficient R2 values. Drug release models were first applied to kinetic data successfully.ConclusionGrinding cumin seeds in a blender increased the essential oil yield up to three‐fold and Raschig rings as a packing material also contributed to this increase. The effect of complex mechanisms such as sample positioning and flow regime on the essential oil yield during the washing stage was observed. Although there was minimal difference (3.8%) in the yield values for the experiments with nonground cumin samples, the slight variation in essential oil yield observed in the experiments with each ground cumin sample may be attributed to the particle distribution, positioning and flow regime. So, five cases were determined depending on positioning. Cumin aldehyde has the highest composition in all time intervals after 10 min at the fractional distillation under vacuum. However sabinene was relatively higher only in the early time interval at 0‐10 min. © 2023 The Authors. Journal of Chemical Technology and Biotechnology published by John Wiley &amp; Sons Ltd on behalf of Society of Chemical Industry (SCI).

Quantifying the potential benefits of early detection for pancreatic cancer through a counterfactual simulation modeling analysis

The benefits of cancer early detection depend on various factors, including cancer type, screening method performance, stage at diagnosis, and subsequent treatment. Although numerous studies have evaluated the effectiveness of screening interventions for identifying cancer at earlier stages, there is no quantitative analysis that studies the optimal early detection time interval that results in the greatest mortality benefit; such data could serve as a target and benchmark for cancer early detection strategies. In this study, we focus on pancreatic ductal adenocarcinoma (PDAC), a cancer known for its lack of early symptoms. Consequently, it is most often detected at late stages when the 5-year survival rate is only 3%. We developed a PDAC population model that simulates an individual patient's age and stage at diagnosis, while replicating overall US cancer incidence and mortality rates. The model includes “cancer sojourn time,” serving as a proxy for the speed of cancer progression, with shorter times indicating rapid progression and longer times indicating slower progression. In our PDAC model, our hypothesis was that earlier cancer detection, potentially through a hypothetical screening intervention in the counterfactual analysis, would yield reduced mortality as compared to a no-screening group. We found that the benefits of early detection, such as increased life-years gained, are greater when the sojourn time is shorter, reaching their maximum when identification is made 4–6 years prior to clinical diagnosis (e.g., when a symptomatic diagnosis is made). However, when early detection occurs even earlier, for example 6–10 years prior to clinical diagnosis, the benefits significantly diminish for shorter sojourn time cancers, and level off for longer sojourn time cancers. Our study clarifies the potential benefits of PDAC early detection that explicitly incorporates individual patient heterogeneity in cancer progression and identifies quantitative benchmarks for future interventions.

TiME OUT: Time-specific machine-learning evaluation to optimize ultramassive transfusion.

Ultramassive transfusion (UMT) is a resource-demanding intervention for trauma patients in hemorrhagic shock, and associated mortality rates remains high. Current research has been unable to identify a transfusion ceiling or point where UMT transitions from lifesaving to futility. Furthermore, little consideration has been given to how time-specific patient data points impact decisions with ongoing high-volume resuscitation. Therefore, this study sought to use time-specific machine learning modeling to predict mortality and identify parameters associated with survivability in trauma patients undergoing UMT. A retrospective review was conducted at a Level I trauma (2018-2021) and included trauma patients meeting criteria for UMT, defined as ≥20 red blood cell products within 24 hours of admission. Cross-sectional data were obtained from the blood bank and trauma registries, and time-specific data were obtained from the electronic medical record. Time-specific decision-tree models predicating mortality were generated and evaluated using area under the curve. In the 180 patients included, mortality rate was 40.5% at 48 hours and 52.2% overall. The deceased received significantly more blood products with a median of 71.5 total units compared with 55.5 in the survivors ( p < 0.001) and significantly greater rates of packed red blood cells and fresh frozen plasma at each time interval. Time-specific decision-tree models predicted mortality with an accuracy as high as 81%. In the early time intervals, hemodynamic stability, undergoing an emergency department thoracotomy, and injury severity were most predictive of survival, while, in the later intervals, markers of adequate resuscitation such as arterial pH and lactate level became more prominent. This study supports that the decision of "when to stop" in UMT resuscitation is not based exclusively on the number of units transfused but rather the complex integration of patient and time-specific data. Machine learning is an effective tool to investigate this concept, and further research is needed to refine and validate these time-specific decision-tree models. Prognostic and Epidemiological; Level IV.

Evolution from Carbonate Platform to Pelagic Environments in the South Iberian Paleomargin (Pliensbachian–Early Toarcian, Early Jurassic): Carbonate Features and Isotope Geochemistry

This paper studies ten Subbetic (Betic External Zones) stratigraphic sections spanning the Pliensbachian–early Toarcian time interval. Eight lithofacies were distinguished: crinoidal limestones, peloidal limestones, breccias, cherty limestones, nodular limestones, hardground surfaces and condensed levels, marls and marly limestone alternance, and dark marls. The biostratigraphy matches data from ammonite and calcareous nannofossil zonations. In addition, we analyzed C and O isotopes from bulk samples from three of the studied sections in which the lower Toarcian sedimentation crops out. The demise of the Lower Jurassic shallow platform developed in the South Iberian Paleomargin was a complex process driven by rifting, which led to tilted blocks giving way to different sedimentary environments. The tectonic stages occurred in the Sinemurian–Pliensbachian transition (R1), toward the lower part of the Ibex Zone (FO of the Biscutum grande, R2), in the Ibex–Davoei zones boundary (FO of Lotharingius barozii, R3), in the lower–upper Pliensbachian (R4), and in the lower boundary of the NJT4d nannofossil Subzone (R5) (Lavinianum Zone, upper Pliensbachian). After this last phase, sedimentation became pelagic in origin throughout the basin, represented by the sections studied. However, the isotope data show no clear record of the different C-isotopic events, though the Davoei–Margaritatus Event, the late Pliensbachian Event, and the Pliensbachian–Toarcian Boundary Event (PTBE) could be cautiously identified. These geochemical features are explained by the convergence of marine currents from Panthalassa (through the Hispanic Corridor) and Tethys.

Higher-order comparative reward processing is affected by noninvasive stimulation of the ventromedial prefrontal cortex.

A crucial skill, especially in rapidly changing environments, is to be able to learn efficiently from prior rewards or losses and apply this acquired knowledge in upcoming situations. Often, we must weigh the risks of different options and decide whether an option is worth the risk or whether we should choose a safer option. The ventromedial prefrontal cortex (vmPFC) is suggested as a major hub for basic but also higher-order reward processing. Dysfunction in this region has been linked to cognitive risk factors for depression and behavioral addictions, including reduced optimism and feedback learning. Here, we test whether modulations of vmPFC excitability via noninvasive transcranial direct current stimulation (tDCS) can alter reward anticipation and reward processing. In a financial gambling task, participants chose between a higher and a lower monetary risk option and eventually received feedback whether they won or lost. Simultaneously feedback on the unchosen option was presented as well. Behavioral and magnetoencephalographic correlates of reward processing were evaluated in direct succession of either excitatory or inhibitory tDCS of the vmPFC. We were able to show modulated reward approach behavior (expectancy of greater reward magnitudes) as well as altered reevaluation of received feedback by vmPFC tDCS as indicated by modified choice behavior following the feedback. Thereby, tDCS not only influenced early, rather basic reward processing, but it also modulated higher-order comparative feedback evaluation of gains and losses relative to alternative outcomes. The neural results underline this idea, as stimulation-driven modulations of the basic reward-related effect occurred at rather early time intervals and were followed by stimulation effects related to comparative reward processing. Importantly, behavioral ratings were correlated with neural activity in left frontal areas. Our results imply a dual function of the vmPFC consisting of approaching reward (as indicated by more risky choices) and elaborately evaluating outcomes. In addition, our data suggest that vmPFC activity is associated with adaptive decision-making in the future via modulated behavioral adaptation or reinforcement learning.

Do advances in technology translate to improved outcomes? Comparing robotic bariatric surgery outcomes over two-time intervals utilizing the MBSAQIP database.

This study aims to compare outcomes and utilization of robotics in bariatric procedures across two-time intervals, chosen because they correspond to drastic changes in technology utilization-namely, a new platform and a new stapling device. Outcomes of robotic Roux-en-Y gastric bypass (rRYGB) and robotic sleeve gastrectomy (rSG) across this changing landscape have not been well studied, despite increasing popularity. The MBSAQIP database was analyzed over early (2015-2016) and late (2019-2020) time intervals. Patients who underwent rSG and rRYGB were identified, and the cohorts were matched for 26 preoperative characteristics using Propensity Score Matching Analysis. We then compared 30-day outcomes and bariatric-specific complications between the early and late time frames for rSG and rRYGB. 49,442 rSG were identified: 13,526 cases in the early time frame and 35,916 in the late time frame. The matched cohorts were 13,526 for the two groups. 30-day outcomes showed that in the late time frame, rSG was associated with lower rates of pulmonary complications (0.1% vs 0.3%, p < 0.001), readmissions (2.5% vs 3.6%, p < 0.001), interventions (0.6% vs 1.4%, p < 0.001), reoperations (0.7% vs 1.0%, p = 0.024), length of stay (1.36 ± 1.01days vs 1.76 ± 1.79days, p < 0.001), operative time (92.47 ± 41.70min vs102.76 ± 45.67min p < 0.001), staple line leaks (0.2% vs 0.4%, p = 0.001) and strictures (0.0% vs 0.2%, p < 0.001). Similarly, 21,933 rRYGB were found: 6,514 cases were identified in the early time frame and 15,419 in the late time frame. The matched cohorts were 6,513 for the two groups. 30-day outcomes revealed that the late time fame rRYGB was associated with lower rates of pulmonary complications (0.1% vs 0.3%, p = 0.012), readmissions (6.3% vs 7.2%, p = 0.050), interventions (2.0% vs 3.1%, p < 0.001), length of stay (1.69 ± 1.46days vs 2.13 ± 2.12days p < 0.001), postoperative bleeding (0.4% vs 0.7%, p = 0.001), stricture (0.4% vs 0.8%, p < 0.001) and anastomotic ulcer (0.2% vs 0.4%, p = 0.013). Compared to early robotic bariatric surgery outcomes, a significant reduction in pulmonary complications, readmissions, reoperations, interventions and length of stay were seen in 2019-20 after rSG and rRYGB. Potential contributing factors include increased surgical experience and advances in the robotic platform. A significant recent reduction in staple line leaks with faster operative times associated with rSG suggests that stapling technology has had a positive impact on patient outcomes.

Spatiotemporal connectivity maps abnormal communication pathways in major depressive disorder underlying gamma oscillations.

Auditory steady-state response underlying gamma oscillations (gamma-ASSR) have been explored in patients with major depressive disorder (MDD), while ignoring the spatiotemporal dynamic characteristics. This study aims to construct dynamic directed brain networks to explore the disruption of spatiotemporal dynamics underlying gamma-ASSR in MDD. This study recruited 29 MDD patients and 30 healthy controls for a 40Hz auditory steady-state evoked experiment. The propagation of gamma-ASSR was divided into early, middle, and late time interval. Partial directed coherence was applied to construct dynamic directed brain networks based on graph theory. The results showed that MDD patients had lower global efficiency and out-strength in temporal, parietal, and occipital regions over three time intervals. Additionally, distinct disrupted connectivity patterns occurred in different time intervals with abnormalities in the early and middle gamma-ASSR in left parietal regions cascading forward to produce dysfunction of frontal brain regions necessary to support gamma oscillations. Furthermore, the early and middle local efficiency of frontal regions were negatively correlated with symptom severity. These findings highlight patterns of hypofunction in the generation and maintenance of gamma-band oscillations across parietal-to-frontal regions in MDD patients, which provides novel insights into the neuropathological mechanism underlying gamma oscillations associated with aberrant brain network dynamics of MDD.

Unveiling the time course of visual stabilization through human electrophysiology

Object positions are coded relative to their surroundings, presumably providing visual stability during eye movements. But when does this perceived stability arise? Here we used a visual illusion, the frame-induced position shift, and measured electrophysiological activity elicited by an object whose perceived position was either shifted because of a surrounding frame or not, thus dissociating perceived and physical locations. We found that visually evoked responses were sensitive to only physical location earlier in time (∼70ms), but both physical and illusory location information was present at a later time point (∼140ms). Furthermore, location information could be reliably decoded across physical and illusory locations during the later time interval but not during the earlier time interval, demonstrating that neural activity patterns are shared between the two processes at a later stage. These results suggest that visual stability of objects emerges relatively late and is thus dependent on recurrent feedback from higher processing stages.