bluuebunny/crossref_metadata_2025 huggingface dataset:
Assessment of the effect of cannabis use before partnered sex on women with and without orgasm difficulty
Authors: Mulvehill Suzanne , Tishler Jordan
Published: May 2024

Background

Up to 41% of women face challenges achieving orgasm, a statistic unchanged for 50 years.

Aim

To evaluate the effect of cannabis use before partnered sex on women with and without difficulty achieving orgasm.

Methods

This observational study evaluated responses from female study participants relating to their demographics, sexual activities, mental well-being, cannabis usage, and orgasm-related questions from the Female Sexual Function Index (FSFI).

Outcomes

Outcomes included orgasm frequency, difficulty, and satisfaction related to cannabis use or lack of use before partnered sex, largely based on the FSFI orgasm subscale.

Results

Of the 1037 survey responses, 410 were valid and complete. Twenty-three surveys (5.6% returned) were excluded due to failure to meet the study’s criteria. Of the valid surveys, most women (52%, n = 202) reported difficulty achieving orgasm during sexual activity with a partner. These women were primarily between 25 and 34 years of age (45%, n = 91); 75% identified their race as White (n = 152/202); 52% (n = 105) identified as LGBTQI+ (lesbian, gay, bisexual, transgender, queer/questioning, intersex, or other); and 82% (n = 165) were married or in a relationship. Among participants who experienced challenges in achieving orgasm, 72.8% (n = 147, P < .001) reported that cannabis use before partnered sex increased orgasm frequency, 67% stated that it improved orgasm satisfaction (n = 136, P < .001), and 71% indicated that cannabis use made orgasm easier (n = 143, P < .001). The frequency of cannabis use before partnered sex correlated with increased orgasm frequency for women who experienced difficulties achieving orgasm (n = 202, P < .001). The reasons for cannabis use before partnered sex resulted in a more positive orgasm response (n = 202, P = .22).

Clinical Implications

Cannabis may be a treatment for women with difficulty achieving orgasm during partnered sex.

Strengths and Limitations

The researchers examined the challenge of achieving orgasm and considered the covariates reported in the literature, including the FSFI orgasm subscale. The findings may not be generalizable to women who rarely or never use cannabis before sex, women who have never experienced an orgasm, or women who do not have female genitalia. Additionally, the specific type of cannabis used, its chemical composition, the quantity used, and whether or not the partner used cannabis were not assessed in this study.

Conclusion

Cannabis-related treatment appears to provide benefit to women who have female orgasm difficulties or dysfunction.
Resisting and Reclaiming: Squatting as Contentious Urban Politics in the U.S.
Authors: Herbert Claire W , Ricketts Amanda V
Published: May 2024

Squatting as contentious politics has been well studied globally, expanding knowledge of how everyday people resist injustices, strive to remake cities, and respond to local/regional conditions. These histories and contemporary struggles have largely been overlooked in the U.S. This article uses qualitative data to compare three recent cases of organized housing occupations in Detroit (2011), Oakland (2019), and Philadelphia (2020) by mothers of color with their children, to better understand how this form of global urban politics manifests in the U.S. Using this comparison, we identify important dimensions that have shaped these three cases of contentious politics and their outcomes, including differences in goals, tactics, and socio-spatial context.  We also uncover the diagnostic and prognostic frames reflected in each case: despite common legal violations, each case purposefully diagnoses locally-rooted housing problems and suggests different property-relations as solutions. We find that each case varies in terms of what kind of property squatters target, how these spaces reflect broader structural problems in the U.S. housing market, and what kind of property-relations they envision with these occupations. In turn, our findings also advance understanding of this global urban politics by showing how squatting efforts may dovetail with place-based legacies, such as racial segregation and settler colonialism in the U.S.  Researchers have long attended to organized housing struggles in their varied manifestations, but by foregrounding resistance to and reclaiming of property by squatters, we draw out understudied problems and possibilities related to land and housing occupations that are subverted within broader housing studies.
Engagement and online mathematics enrichment for secondary students
Authors: Lyakhova Sofya , Neate Andrew
Published: May 2024

Online may not be the ideal format for a mathematics enrichment event, but in some circumstances, it may be the only option available. This article considers a mathematics enrichment programme consisting of a series of masterclasses which were held live online for secondary students in the UK during the Covid-19 pandemic. The series of masterclasses were part of the Royal Institution of Great Britain’s Mathematics Masterclass Programme which runs annually across the UK. In this study, we investigate how and to what extent students were able to engage with this series of online masterclasses. Learner engagement is researched through in-session observations, student work, attendance data, participant feedback and interviews. While the online masterclass series lost some of its traditional in person features, such as hands-on live social interaction and a university environment, it appeared that the participants perceived the online sessions as interactive enabling them to both enjoy the sessions and enjoy learning mathematics in the sessions. The evidence found suggests that the participating students could engage behaviourally, emotionally and cognitively in online mathematics enrichment. However, constructing mathematical knowledge in online sessions can be difficult for some students and social interaction may need to rely on existing social groups among school friends.
Long-term evolution of human seasonal influenza virus A(H3N2) is associated with an increase in polymerase complex activity
Authors: Vigeveno René M , Han Alvin X , de Vries Robert P , Parker Edyth , de Haan Karen , van Leeuwen Sarah , Hulme Katina D , Lauring Adam S , te Velthuis Aartjan J W , Boons Geert-Jan , Fouchier Ron A M , Russell Colin A , de Jong Menno D , Eggink Dirk
Published: May 2024

Since the influenza pandemic in 1968, influenza A(H3N2) viruses have become endemic. In this state, H3N2 viruses continuously evolve to overcome immune pressure as a result of prior infection or vaccination, as is evident from the accumulation of mutations in the surface glycoproteins hemagglutinin (HA) and neuraminidase (NA). However, phylogenetic studies have also demonstrated ongoing evolution in the influenza A(H3N2) virus RNA polymerase complex genes. The RNA polymerase complex of seasonal influenza A(H3N2) viruses produces mRNA for viral protein synthesis and replicates the negative sense viral RNA genome (vRNA) through a positive sense complementary RNA intermediate (cRNA). Presently, the consequences and selection pressures driving the evolution of the polymerase complex remain largely unknown. Here, we characterize the RNA polymerase complex of seasonal influenza A(H3N2) viruses representative of nearly 50 years of influenza A(H3N2) virus evolution. The H3N2 polymerase complex is a reassortment of human and avian influenza virus genes. We show that since 1968, influenza A(H3N2) viruses have increased the transcriptional activity of the polymerase complex while retaining a close balance between mRNA, vRNA, and cRNA levels. Interestingly, the increased polymerase complex activity did not result in increased replicative ability on differentiated human airway epithelial (HAE) cells. We hypothesize that the evolutionary increase in polymerase complex activity of influenza A(H3N2) viruses may compensate for the reduced HA receptor binding and avidity that is the result of the antigenic evolution of influenza A(H3N2) viruses.
Changing Nurse Education Meaningfully
Authors: Wilson Deborah H. , Hemmer Brigit , Werk Alicia , Han Hae-Ra
Published: May 2024

Nurse educators are called to increase diversity in the clinical and faculty workforce; promote safe, inclusive learning environments; develop curricula that provide an anti-biased view of patients and health conditions; and provide students with educational opportunities to learn from individuals with diverse backgrounds. An innovative curriculum design inclusive of Indigenous worldviews was implemented at a tribal college. It provides an exemplar that supports diverse student learning, retention, and graduation. A curriculum inclusive of experiences that promote reflective practices and cultural safety can contribute toward a diverse, inclusive nursing workforce that provides equitable care while addressing social determinants of health.
Patient and Hospital Characteristics Associated with Admission Among Patients With Minor Isolated Extremity Firearm Injuries: A Propensity-Matched Analysis
Authors: Thomas Arielle C. , Royan Regina , Nathens Avery B. , Campbell Brendan T. , Reddy Susheel , Spitzer Sarabeth , Hamad Doulia , Jang Angie , Stey Anne M.
Published: May 2024

Objective:

To quantify the association between insurance and hospital admission following minor isolated extremity firearm injury.

Background:

The association between insurance and injury admission has not been examined.

Methods:

This was an observational retrospective cohort study of minor isolated extremity firearm injury captured in the Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases in 6 states (New York, Arkansas, Wisconsin, Massachusetts, Florida, and Maryland) from 2016 to 2017 among patients aged 16 years or older. The primary exposure was insurance. Admitted patients were propensity score matched to nonadmitted patients on age, extremity Abbreviated Injury Score, and Elixhauser Comorbidity Index with exact matching within hospital to adjust for selection bias. A general estimating equation logistic regression estimated the association between insurance and odds of admission in the matched cohort while controlling for sex, race, injury intent, injury type, hospital profit type, and trauma center designation with observations clustered by propensity score-matched pairs within hospital.

Results:

A total of 8151 patients presented to hospital with a minor isolated extremity firearm injury between 2016 and 2017 in 6 states. Patients were 88.0% male, 56.6% Black, and 71.7% aged 16 to 36 years old, and 22.1% were admitted. A total of 2090 patients were matched on propensity for admission. Privately insured matched patients had 1.70 higher adjusted odds of admission and 95% confidence interval of 1.30 to 2.22, compared with uninsured after adjusting for patient and hospital characteristics.

Conclusions:

Insurance was associated with hospital admission for minor isolated extremity firearm injury.
Temporal Trends of Improvement After Minimally Invasive Transforaminal Lumbar Interbody Fusion
Authors: Shahi Pratyush , Subramanian Tejas , Tuma Olivia , Singh Sumedha , Araghi Kasra , Asada Tomoyuki , Korsun Maximilian , Singh Nishtha , Simon Chad , Vaishnav Avani , Mai Eric , Zhang Joshua , Kwas Cole , Allen Myles , Kim Eric , Heuer Annika , Sheha Evan , Dowdell James , Qureshi Sheeraz , Iyer Sravisht
Published: May 2024

Study Design.

Retrospective review of prospectively collected data.

Objective.

To analyze temporal trends in improvement after minimally invasive transforaminal lumbar interbody fusion (MIS TLIF).

Summary of Background Data.

Although several studies have shown that patients improve significantly after MIS TLIF, evidence regarding the temporal trends in improvement is still largely lacking.

Methods.

Patients who underwent primary single-level MIS TLIF for degenerative conditions of the lumbar spine and had a minimum of 2-year follow-up were included. Outcome measures were: 1) patient reported outcome measures (PROMs) (Oswestry Disability Index, ODI; Visual Analog Scale, VAS back and leg; 12-Item Short Form Survey Physical Component Score, SF-12 PCS); 2) global rating change (GRC); 3) minimal clinically important difference (MCID); and 4) return to activities. Timepoints analyzed were preoperative, 2 weeks, 6 weeks, 3 months, 6 months, 1 year, and 2 years. Trends across these timepoints were plotted on graphs.

Results.

236 patients were included. VAS back and VAS leg were found to have statistically significant improvement compared to the previous timepoint up to 3 months after surgery. ODI and SF-12 PCS were found to have statistically significant improvement compared to the previous timepoint up to 6 months after surgery. Beyond these timepoints, there was no significant improvement in PROMs. 80% of patients reported feeling better compared to preoperative by 3 months. >50% of patients achieved MCID in all PROMs by 3 months. Most patients returned to driving, returned to work, and discontinued narcotics at an average of 21, 20, and 10 days, respectively.

Conclusions.

Patients are expected to improve up to 6 months after MIS TLIF. Back pain and leg pain improve up to 3 months and disability and physical function improve up to 6 months. Beyond these timepoints, the trends in improvement tend to reach a plateau. 80% of patients feel better compared to preoperative by 3 months after surgery.
MRI Vertebral Bone Quality Correlates With Interbody Cage Subsidence After Anterior Cervical Discectomy and Fusion
Authors: Bernatz James T. , Pumford Andrew , Goh Brian C. , Pinter Zachariah W. , Mikula Anthony L. , Michalopoulos Giorgos D. , Bydon Mohamad , Huddleston Paul , Nassr Ahmad N. , Freedman Brett A. , Sebastian Arjun S.
Published: May 2024

Study Design:

Retrospective observational study of consecutive patients

Objective:

The purpose of the study was to evaluate VBQ as a predictor of interbody subsidence and to determine threshold values that portend increased risk of subsidence.

Summary of Background Data:

Many risk factors have been reported for the subsidence of interbody cages in anterior cervical discectomy and fusion (ACDF). MRI Vertebral Bone Quality (VQB) is a relatively new radiographic parameter that can be easily obtained from preoperative MRI and has been shown to correlate with measurements of bone density such as DXA and CT Hounsfield Units.

Methods:

All patients who underwent 1- to 3-level ACDF using titanium interbodies with anterior plating between the years 2018 and 2020 at our tertiary referral center were included. Subsidence measurements were performed by 2 independent reviewers on CT scans obtained 6 months postoperatively. VBQ was measured on pre-operative sagittal T1 MRI by 2 independent reviewers, and values were averaged.

Results:

Eight-five fusion levels in 44 patients were included in the study. There were 32 levels (38%) with moderate subsidence and 12 levels with severe subsidence (14%). The average VBQ score in those patients with severe subsidence was significantly higher than those without subsidence (3.80 vs. 2.40, P<0.01). A threshold value of 3.2 was determined to be optimal for predicting subsidence (AUC=0.99) and had a sensitivity of 100% and a specificity of 94.1% in predicting subsidence.

Conclusions:

VBQ strongly correlates with the subsidence of interbody grafts after ACDF. A threshold VBQ score value of 3.2 has excellent sensitivity and specificity for predicting subsidence. Spine surgeons can use VBQ as a readily available screening tool to identify patients at higher risk for subsidence.

Level of Evidence:

Level—IV
Preexisting Diabetes Mellitus and All-Cause Mortality in Adult Patients With Sepsis: A Population-Based Cohort Study
Authors: Angriman Federico , Saoraya Jutamas , Lawler Patrick R. , Shah Baiju R. , Martin Claudio M. , Scales Damon C. ,   on behalf of the Sepsis Canada Network
Published: May 2024

OBJECTIVES:

We assessed the association of preexisting diabetes mellitus with all-cause mortality and organ support receipt in adult patients with sepsis.

DESIGN:

Population-based cohort study.

SETTING:

Ontario, Canada (2008–2019).

POPULATION:

Adult patients (18 yr old or older) with a first sepsis-related hospitalization episode.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

The main exposure of interest was preexisting diabetes (either type 1 or 2). The primary outcome was all-cause mortality by 90 days; secondary outcomes included receipt of invasive mechanical ventilation and new renal replacement therapy. We report adjusted (for baseline characteristics using standardization) risk ratios (RRs) alongside 95% CIs. A main secondary analysis evaluated the potential mediation by prior metformin use of the association between preexisting diabetes and all-cause mortality following sepsis. Overall, 503,455 adults with a first sepsis-related hospitalization episode were included; 36% had preexisting diabetes. Mean age was 73 years, and 54% of the cohort were females. Preexisting diabetes was associated with a lower adjusted risk of all-cause mortality at 90 days (RR, 0.81; 95% CI, 0.80–0.82). Preexisting diabetes was associated with an increased risk of new renal replacement therapy (RR, 1.53; 95% CI, 1.46–1.60) but not invasive mechanical ventilation (RR, 1.03; 95% CI, 1.00–1.05). Overall, 21% (95% CI, 19–28) of the association between preexisting diabetes and reduced risk of all-cause mortality was mediated by prior metformin use.

CONCLUSIONS:

Preexisting diabetes is associated with a lower risk of all-cause mortality and higher risk of new renal replacement therapy among adult patients with sepsis. Future studies should evaluate the underlying mechanisms of these associations.
Can Machine Learning Personalize Cardiovascular Therapy in Sepsis?
Authors: Catling Finneas J. R. , Nagendran Myura , Festor Paul , Bien Zuzanna , Harris Steve , Faisal A. Aldo , Gordon Anthony C. , Komorowski Matthieu
Published: May 2024

Large randomized trials in sepsis have generally failed to find effective novel treatments. This is increasingly attributed to patient heterogeneity, including heterogeneous cardiovascular changes in septic shock. We discuss the potential for machine learning systems to personalize cardiovascular resuscitation in sepsis. While the literature is replete with proofs of concept, the technological readiness of current systems is low, with a paucity of clinical trials and proven patient benefit. Systems may be vulnerable to confounding and poor generalization to new patient populations or contemporary patterns of care. Typical electronic health records do not capture rich enough data, at sufficient temporal resolution, to produce systems that make actionable treatment suggestions. To resolve these issues, we recommend a simultaneous focus on technical challenges and removing barriers to translation. This will involve improving data quality, adopting causally grounded models, prioritizing safety assessment and integration into healthcare workflows, conducting randomized clinical trials and aligning with regulatory requirements.
Revolutionizing Cardiovascular Frontiers: A Dive Into Cutting-Edge Innovations in Coronary Stent Technology
Authors: Wiyono Alice Valeria , Ardinal Azizah Puspitasari
Published: May 2024

Plain balloon angioplasty was the initial method used to enlarge the intracoronary lumen size. However, it was linked to acute coronary closure due to early vessel recoil. This led to the invention of coronary stents, which offer mechanical support to open and maintain the vascular lumen. Nevertheless, the metallic scaffold introduced other issues, such as thrombosis and restenosis caused by neointimal proliferation. To address these concerns, polymers were employed to cover the scaffold, acting as drug reservoirs and regulators for controlled drug release. The use of polymers prevents direct contact between blood and metallic scaffolds. Drugs within the stent were incorporated to inhibit proliferation and expedite endothelialization in the healing process. Despite these advancements, adverse effects still arise due to the inflammatory reaction caused by the polymer material. Consequently, resorbable polymers and scaffolds were later discovered, but they have limitations and are not universally applicable. Various scaffold designs, thicknesses, materials, polymer components, and drugs have their own advantages and complications. Each stent generation has been designed to address the shortcomings of the preceding generation, yet new challenges continue to emerge. Conflicting data regarding the long-term safety and efficacy of coronary stents, especially in the extended follow-up, further complicates the assessment.
Independent and Added Value of Cardiopulmonary Exercise Testing to New York Heart Association Classification in Patients With Heart Failure
Authors: de Souza Isabela Pilar Moraes Alves , Ramos João Victor Santos Pereira , da Silveira Anderson Donelli , Stein Ricardo , Ribeiro Rebeca Sadigursky , Pazelli Alexandre Meira , de Oliveira Queila Borges , Darzé Eduardo Sahade , Ritt Luiz Eduardo Fonteles
Published: May 2024

Purpose:

The objective of this study was to evaluate the independent and added value of a cardiopulmonary exercise test (CPX) to New York Heart Association (NYHA) functional analysis in patients with heart failure (HF) and ejection fraction (EF) <50%.

Methods:

Patients (n = 613) with HF and EF < 50% underwent CPX and were followed for 28 ± 17 mo with respect to primary outcomes (death or heart transplantation).

Results:

Mean patient age was 56 ± 12 yr, and 64% were male. Most patients were classified as NYHA class II (41%). The composite rate of primary outcomes was 12%; death occurred in 9%, and heart transplant in 4%. Independent predictors of primary outcomes were: EF (HR = 0.95: 95% CI, 0.92-0.98; P = .001) and NYHA (HR = 2.06: 95% CI, 1.54-2.75; P < .0001). When added to the model, peak oxygen uptake (V˙O
2peak) was an independent predictor (HR = 0.90: 95% CI, 0.84-0.96; P = .001), as was the percentage of predicted V˙O
2peak (HR = 0.03: 95% CI, 0.007-0.147; P < .001), minute ventilation/carbon dioxide production slope (HR = 1.02: 95% CI, 1.01-1.04; P = .012), and CPX score (HR = 1.16: 95% CI, 1.06-1.27; P = .001).

Conclusions:

CPX variables were independent predictors of HF prognosis, even when controlled by NYHA functional class. Despite being independent predictors, the value added to NYHA classification was modest and lacked statistical significance.
Characteristics and Treatment Outcomes of Hypotony Maculopathy Postglaucoma Filtering Surgery: An Optical Coherence Tomography-Based Study
Authors: Strzalkowska Alicja , Braegelmann Lisa , Strzalkowski Piotr , Stingl Julia V. , Hoffmann Esther M. , Pfeiffer Norbert , Schuster Alexander K.
Published: May 2024

Précis:

Bleb revision procedures for hypotony maculopathy (HM) following glaucoma filtering surgery show promising outcomes, including notable improvements in visual acuity and IOP.

Purpose:

This study assesses morphologic characteristics using SD-OCT in patients with HM following glaucoma filtering surgery and evaluates the results of its treatment.

Materials and Methods:

A retrospective analysis of all HM patients between January 2019 and March 2023. Inclusion criteria consisted of both preoperative and postrevision SD-OCT images of the macula and the presence of HM as observed on OCT images preoperatively. HM was graded according to its appearance in OCT both prerevision and postrevision surgery. Changes in visual acuity and IOP were assessed.

Results:

A total of 45 eyes of 45 patients were included. In all, 21 eyes had HM limited to retinal pigment epithelium (RPE), 18 eyes had involvement of RPE and photoreceptor layers, and 6 eyes had additional intraretinal or subretinal edema. After revision surgery with IOP elevation, 64% of eyes had complete HM regression with no HM signs in OCT imaging. Overall, 80% of patients achieved at least 1 grade improvement in HM. Preoperative visual acuity increased from 0.7±0.4 (logMAR) to 0.4±0.4 at 2 weeks postoperatively, over the course of an increase of IOP from 3.5±1.8 to 17.1±10.6 mm Hg at day 1. Eyes with complete HM regression had higher IOP at day 1 compared with those without improvement (P=0.04). The median time between HM onset and revision was 10.0 days for those with complete regression and 27 days for those without improvement (P=0.04).

Conclusions:

Bleb revision procedures for HM following glaucoma filtering surgery show promising outcomes, including notable improvements in visual acuity and IOP. The timing of revision surgery appears to influence the outcome. In our study, earlier intervention was associated with better results. Even delayed surgeries can lead to an improvement, although complete morphologic restoration may not be achieved in advanced grades of HM.
One-Year Outcomes of Preserflo Microshunt for Primary Open Angle Glaucoma: A Systematic Review and Meta-Analysis
Authors: Pietris James , Casson Robert
Published: May 2024

Précis:

This systematic review and meta-analysis concludes that the PreserFlo Microshunt glaucoma drainage device significantly reduces intraocular pressure in primary open angle glaucoma patients at 12 months postinsertion.

Purpose:

A systematic review and meta-analysis on the effect of the PRESERFLO MicroShunt (PF-MS) on intraocular pressure (IOP) at 12 months has been conducted.

Method:

The PubMed/MEDLINE, Embase, CENTRAL, Google Scholar, Scopus, and Web of Science databases were searched. Inclusion criteria required a diagnosis of open angle glaucoma, PF-MS insertion, and examination of IOP over time. Meta-analyses were conducted on the primary outcome of IOP and the secondary outcome of glaucoma medication regime. Adverse events were also noted.

Results:

Fourteen studies were identified for inclusion in the meta-analyses, of which none had a high risk of bias. The meta-analyses found a significant mean reduction in IOP of 9.07 mm Hg (95% CI: 7.88–10.25; P<0.0001) and a significant mean reduction in mean glaucoma medication requirement of 2.37 medications (95% CI: 2.15–2.60; P<0.0001). Hypotony and hyphaema are common early complications.

Conclusions:

The PF-MS device significantly reduced both IOP and glaucoma medication requirement at 12 months postinsertion in individuals with open angle glaucoma without a significant adverse event burden. Further research is required to determine the economic and environmental effects of widely implementing the PF-MS device into clinical practice.
Epidemiologic and Clinical Characteristics and Risk Factors for Severe Community-acquired Clostridium difficile Infection in Children
Authors: Stemberger Marić Lorna , Nikčević Andrea , Bodulić Kristian , Tešović Goran
Published: May 2024

Although children most frequently suffer from milder forms of community-acquired Clostridium difficile infection, severe cases and fatal outcomes have been recorded. In this study we identified older children (>12 years of age) and patients who had surgery up to 6 months before Clostridium difficile infection onset as a subgroup at somewhat higher risk for severe community-acquired Clostridium difficile infection.
The downside to choice: instrumental control increases conditioned nocebo hyperalgesia
Authors: Tang Biya , Livesey Evan , Colagiuri Ben
Published: May 2024

Nocebo hyperalgesia is a pervasive problem in which the treatment context triggers negative expectations that exacerbate pain. Thus, developing ethical strategies to mitigate nocebo hyperalgesia is crucial. Emerging research suggests that choice has the capacity to reduce nocebo side effects, but choice effects on nocebo hyperalgesia have not been explored. This study investigated the impact of choice on conditioned nocebo hyperalgesia using a well-established electrocutaneous pain paradigm where increases in noxious stimulation were surreptitiously paired with the activation of a sham device. In study 1, healthy volunteers (N = 104) were randomised to choice over (nocebo) treatment administration, nocebo administration without choice, or a natural history control group. Nocebo hyperalgesia was greater for those with choice than no choice, suggesting that choice increased rather than diminished nocebo hyperalgesia. Study 2 tested whether providing positive information about the benefits of choice in coping with pain could counteract heightened nocebo hyperalgesia caused by choice. A different sample of healthy adults (N = 137) were randomised to receive nocebo treatment with choice and positive choice information, choice only, or no choice. The positive choice information failed to attenuate the effect of choice on nocebo hyperalgesia. The current results suggest that, rather than decreasing nocebo hyperalgesia, treatment choice may exacerbate pain outcomes when a painful procedure is repeatedly administered. As such, using choice as a strategy to mitigate nocebo outcomes should be treated with caution.
Outcome Measures in Adult Vulvar Lichen Sclerosus: A Case Series of Women Diagnosed as Juveniles
Authors: Morrel Beth , ten Kate-Booij Marianne J. , van Dijk Charlotte , van Hees Colette L.M. , Wigny Kiki M.G.J. , Burger Curt W. , Pasmans Suzanne G.M.A. , van der Avoort Irene A.M.
Published: May 2024

Objectives

Studies on the consequences of juvenile vulvar lichen sclerosus (JVLS) in adulthood are limited. A number of measuring tools are available for analyzing adult vulvar lichen sclerosus (VLS), but these have not been applied in studies on JVLS. The aim is to study physical findings, quality of life, sexual well-being, and self-image in adult women with a history of juvenile VLS.

Materials and Methods

Adult women with a biopsy proven history of JVLS were recruited to be examined and surveyed using available standardized measurement tools. This took place in an outpatient setting by physicians who were not involved in the treatment of participants.

Results

Twenty-seven women (median age 29 years) with a history of JVLS and median time since biopsy of 19.5 years were recruited. Of these women, 59% currently had symptoms, 63% had signs of active disease, and 85% had moderate to severe architectural changes. Despite these residual signs, vulvar specific-quality of life and vulvar self-image scored favorably while generic health-related quality of life was somewhat effected.

Conclusions

JVLS has consequences in adulthood involving physical findings and vulvar quality of life. The use of standardized outcome measures for clinical practice and research purposes facilitates a better understanding of the sequelae to JVLS.
Modulation of Nuclear Receptor 4A1 Expression Improves Insulin Secretion in a Mouse Model of Chronic Pancreatitis
Authors: Sheethal Galande , Verma Archana , Mall Raghvendra , Parsa Kishore VL , Tokala Ranjeet K. , Bynigeri Ratnakar , Pondugala Pavan Kumar , Vemula Krishna , Sai Latha S , Sowpati Divya Tej , Singh Surya S. , Rao GV , Talukdar Rupjyoti , Kanneganti Thirumala-Devi , Reddy D Nageshwar , Sasikala Mitnala
Published: May 2024

Objectives

Diabetes secondary to chronic pancreatitis (CP) presents clinical challenges due to lack of understanding on factor(s) triggering insulin secretory defects. Therefore, we aimed to delineate the molecular mechanism of β-cell dysfunction in CP.

Materials and Methods

Transcriptomic analysis was conducted to identify endocrine-specific receptor expression in mice and human CP on microarray. The identified receptor (NR4A1) was overexpressed in MIN6 cells using PEI linear transfection. RNA-Seq analysis of NR4A1-overexpressed (OE) MIN6 cells on NovaSeq6000 identified aberrant metabolic pathways. Upstream trigger for NR4A1OE was studied by InBio Discover and cytokine exposure, whereas downstream effect was examined by Fura2 AM-based fluorimetric and imaging studies. Mice with CP were treated with IFN-γ-neutralizing monoclonal antibodies to assess NR4A1 expression and insulin secretion.

Results

Increased expression of NR4A1 associated with decreased insulin secretion in islets (humans: controls 9 ± 0.2, CP 3.7 ± 0.2, mice: controls 8.5 ± 0.2, CP 2.1 ± 0.1 μg/L). NR4A1OE in MIN6 cells (13.2 ± 0.1) showed reduction in insulin secretion (13 ± 5 to 0.2 ± 0.1 μg/mg protein per minute, P = 0.001) and downregulation of calcium and cAMP signaling pathways. IFN-γ was identified as upstream signal for NR4A1OE in MIN6. Mice treated with IFN-γ–neutralizing antibodies showed decreased NR4A1 expression 3.4 ± 0.11-fold (P = 0.03), showed improved insulin secretion (4.4 ± 0.2-fold, P = 0.01), and associated with increased Ca2+ levels (2.39 ± 0.06-fold, P = 0.009).

Conclusions

Modulating NR4A1 expression can be a promising therapeutic strategy to improve insulin secretion in CP.
Multiple Myeloma
Authors: Vrtis Mary C.
Published: May 2024

Multiple myeloma (MM) is a cancer that arises from plasma cells in bone marrow. Approximately 35,730 Americans received a new diagnosis and MM will claim the lives of an estimated 12,590 people in 2023. Complications of the disease process include anemia, leukopenia, thrombocytopenia, renal failure, severe pain, bone loss, and hypercalcemia. Patients with MM have a high risk for pathological fractures. For most forms of MM there are effective treatments that may result in long-term remission using multi-drug regimens. Although the medications approved in the United States to treat MM generally produce good outcomes, they have serious, and potentially life-threatening adverse effects. In addition, patients with specific genetic variations are at high risk for relapse. Communication with the oncology team and early intervention in the event of adverse effects of medications, complications of the disease process, or evidence of relapse are important to obtain the best possible outcome. Patients are easily overwhelmed with a three- to four-drug treatment regimen with some drugs given intravenously and/or subcutaneously at the clinic, and others taken orally at home on specific days of each 28-day cycle. Home care nursing is needed to assess for tolerance, adverse effects, and to address patient concerns. Medication management and teaching are very important in guiding patients to safely manage a schedule that changes daily. In addition, the high risk of pathological fractures and serious injury if the patient should fall supports the need for physical and occupational therapy fall prevention and safety education and exercise programs to help avert decline in functional status and combat cancer-related fatigue.
Neural Mechanisms Associated With Postural Control in Collegiate Soccer and Non-Soccer Athletes
Authors: Jain Divya , Porfido Tara , de Souza Nicola L. , Brown Allison M. , Caccese Jaclyn B. , Czykier Anna , Dennis Emily L. , Tosto-Mancuso Jenna , Wilde Elisabeth A. , Esopenko Carrie
Published: May 2024

Background and Purpose:

Sport-specific training may improve postural control, while repetitive head acceleration events (RHAEs) may compromise it. Understanding the neural mechanisms underlying postural control may contextualize changes due to training and RHAE. The goal of this study was to determine whether postural sway during the Balance Error Scoring System (BESS) is related to white matter organization (WMO) in collegiate athletes.

Methods:

Collegiate soccer (N = 33) and non-soccer athletes (N = 44) completed BESS and diffusion tensor imaging. Postural sway during each BESS stance, fractional anisotropy (FA), and mean diffusivity (MD) were extracted for each participant. Partial least squares analyses determined group differences in postural sway and WMO and the relationship between postural sway and WMO in soccer and non-soccer athletes separately.

Results:

Soccer athletes displayed better performance during BESS 6, with lower FA and higher MD in the medial lemniscus (ML) and inferior cerebellar peduncle (ICP), compared to non-soccer athletes. In soccer athletes, lower sway during BESS 2, 5, and 6 was associated with higher FA and lower MD in the corticospinal tract, ML, and ICP. In non-soccer athletes, lower sway during BESS 2 and 4 was associated with higher FA and lower MD in the ML and ICP. BESS 1 was associated with higher FA, and BESS 3 was associated with lower MD in the same tracts in non-soccer athletes.

Discussion and Conclusions:

Soccer and non-soccer athletes showed unique relationships between sway and WMO, suggesting that sport-specific exposures are partly responsible for changes in neurological structure and accompanying postural control performance and should be considered when evaluating postural control after injury.

Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content, available at: http://links.lww.com/JNPT/A472).
Examination of Pain Comorbid Diagnoses in the Inpatient Rehabilitation Population Across All Impairment Groups
Authors: Curry Zachary A. , Andrew Michael N. , Chiang Michael C. , Goldstein Richard , Zafonte Ross , Ryan Colleen M. , Coleman Brian C. , Schneider Jeffrey C.
Published: May 2024

Objective

Pain is common in inpatient rehabilitation patients; however, the prevalence of pain diagnoses in this population is not well-defined. This study examines comorbid pain diagnoses in inpatient rehabilitation patients across impairment groups.

Design

Adult inpatient rehabilitation patients discharged from January 2016 through December 2019 were identified in the Uniform Data System for Medical Rehabilitation database using a literature-established framework containing International Classification of Diseases, Tenth Revision, Clinical (ICD-10-CM) pain diagnoses. Demographic data, clinical data, and pain diagnoses were compared across the 17 rehabilitation impairment groups.

Results

Of 1,925,002 patients identified, 1,347,239 (70.0%) had at least one International Classification of Diseases, Tenth Revision (ICD-10) pain diagnosis. Over half of all patients in each impairment group had at least one pain diagnosis. The most common pain diagnoses were limb/extremity and joint pain, with variation between impairment groups. Female sex and being in the arthritis, major multiple trauma, and pain syndrome impairment groups were associated with a greater odds of a pain diagnosis.

Conclusions

Over half of all patients in each rehabilitation impairment group have a pain diagnosis, which varies between impairment groups. Because of the high prevalence of pain diagnoses, a new focus on pain management in inpatient rehabilitation patients is needed. Rehabilitation outcomes may also be affected by pain.
Diagnostic Ultrasound in the Evaluation of Stiff Shoulder
Authors: Yao Buwen , Yang Yanyan , Roll Shawn C. , Lin Zhuohua , Zhang Yuanmingfei , Jiang Jie , Zhou Mouwang
Published: May 2024

Objectives

Stiff shoulder, including primary and secondary types, poses diagnostic challenges due to vague definitions and criteria. This study evaluates the diagnostic potential of ultrasound-measured axillary recess thickness in shoulder stiffness.

Designs

In this cross-sectional study, 35 patients with unilateral shoulder stiffness were assessed. Axillary recess thickness was measured using high-resolution ultrasound. Parameters like passive range of motion, Numerical Rating Scale, and Constant-Murley score were evaluated to find correlations with axillary recess thickness.

Results

The average age was 50.7 yrs, and mean body mass index was 22.7. Axillary recess thickness in stiff shoulders (average 3.19 mm) was significantly higher than in unaffected shoulders (average 1.93 mm, P < 0.001). A cutoff of 3.0 mm for axillary recess thickness yielded 73.3% sensitivity and 84.6% specificity for primary stiffness; 2.6 mm cutoff resulted in 57.9% sensitivity and 88.2% specificity for secondary stiffness. Significant correlations were found between axillary recess thickness and passive range of motion, especially in shoulder external rotation and extension.

Conclusions

Axillary recess thickness measured by ultrasound might serve as a valuable diagnostic and evaluation parameter in shoulder stiffness.
Safety and Immunogenicity of a DNA Vaccine With Subtype C gp120 Protein Adjuvanted With MF59 or AS01B: A Phase 1/2a HIV-1 Vaccine Trial
Authors: Garrett Nigel , Dintwe One , Monaco Cynthia L. , Jones Megan , Seaton Kelly E. , Church E. Chandler , Grunenberg Nicole , Hutter Julia , deCamp Allan , Huang Yunda , Lu Huiyin , Mann Philipp , Robinson Samuel T. , Heptinstall Jack , Jensen Ryan L. , Pantaleo Giuseppe , Ding Song , Koutsoukos Marguerite , Hosseinipour Mina C. , Van Der Meeren Olivier , Gilbert Peter B. , Ferrari Guido , Andersen-Nissen Erica , McElrath M. Juliana , Tomaras Georgia D. , Gray Glenda E. , Corey Lawrence , Kublin James G. ,   on behalf of the HVTN 108 and HVTN 111 Study Teams
Published: May 2024

Background:

An effective vaccine is required to end the HIV pandemic. We evaluated the safety and immunogenicity of a DNA (DNA-HIV-PT123) vaccine with low- or high-dose bivalent (TV1.C and 1086.C glycoprotein 120) subtype C envelope protein combinations, adjuvanted with MF59 or AS01B.

Methods:

HIV Vaccine Trials Network (HVTN)108 was a randomized, placebo-controlled, double-blind, phase 1/2a trial conducted in the United States and South Africa. HIV-negative adults were randomly assigned to 1 of 7 intervention arms or placebo to assess DNA prime with DNA/protein/adjuvant boosts, DNA/protein/adjuvant co-administration, and low-dose protein/adjuvant regimens. HVTN111 trial participants who received an identical regimen were also included. Outcomes included safety and immunogenicity 2 weeks and 6 months after final vaccination.

Results:

From June 2016 to July 2018, 400 participants were enrolled (N = 334 HVTN108, N = 66 HVTN111); 370 received vaccine and 30 received placebo. There were 48 grade 3 and 3 grade 4 reactogenicity events among 39/400 (9.8%) participants, and 32 mild/moderate-related adverse events in 23/400 (5.8%) participants. All intervention groups demonstrated high IgG response rates (>89%) and high magnitudes to HIV-1 Env gp120 and gp140 proteins; response rates for AS01B-adjuvanted groups approached 100%. V1V2 IgG magnitude, Fc-mediated functions, IgG3 Env response rates, and CD4+ T-cell response magnitudes and rates were higher in the AS01B-adjuvanted groups. The AS01B-adjuvanted low-dose protein elicited greater IgG responses than the higher protein dose.

Conclusions:

The vaccine regimens were generally well tolerated. Co-administration of DNA with AS01B-adjuvanted bivalent Env gp120 elicited the strongest humoral responses; AS01B-adjuvanted regimens elicited stronger CD4+ T-cell responses, justifying further evaluation.

ClinicalTrials.gov registration: NCT02915016, registered 26 September 2016.
Postoperative Extremity Tomosynthesis—A Superimposition-Free Alternative to Standard Radiography?
Authors: Grunz Jan-Peter , Kunz Andreas Steven , Paul Mila Marie , Luetkens Karsten Sebastian , Huflage Henner , Conrads Nora , Ergün Süleyman , Weber Thomas , Herbst Magdalena , Herold Sophia , Bley Thorsten Alexander , Patzer Theresa Sophie
Published: May 2024

Rationale and Objectives

This study investigates the performance of tomosynthesis in the presence of osteosynthetic implants, aiming to overcome superimposition-induced limitations in conventional radiograms.

Materials and Methods

After surgical fracture induction and subsequent osteosynthesis, 8 cadaveric fracture models (wrist, metacarpus, ankle, metatarsus) were scanned with the prototypical tomosynthesis mode of a multiuse x-ray system. Tomosynthesis protocols at 60, 80, and 116 kV (sweep angle 10°, 13 FPS) were compared with standard radiograms. Five radiologists independently rated diagnostic assessability based on an equidistant 7-point scale focusing on fracture delineation, intra-articular screw placement, and implant positioning. The intraclass correlation coefficient (ICC) was calculated to analyze interrater agreement.

Results

Radiation dose in radiography was 0.48 ± 0.26 dGy·cm2 versus 0.12 ± 0.01, 0.36 ± 0.02, and 1.95 ± 0.11 dGy·cm2 for tomosynthesis scans at 60, 80, and 116 kV. Delineation of fracture lines was superior for 80/116 kV tomosynthesis compared with radiograms (P ≤ 0.003). Assessability of intra-articular screw placement was deemed favorable for all tomosynthesis protocols (P ≤ 0.004), whereas superiority for evaluation of implant positioning could not be ascertained (all P's ≥ 0.599). Diagnostic confidence was higher for 80/116 kV tomosynthesis versus radiograms and 60 kV tomosynthesis (P ≤ 0.002). Interrater agreement was good for fracture delineation (ICC, 0.803; 95% confidence interval [CI], 0.598–0.904), intra-articular screw placement (ICC, 0.802; 95% CI, 0.599–0.903), implant positioning (ICC, 0.855; 95% CI, 0.729–0.926), and diagnostic confidence (ICC, 0.842; 95% CI, 0.556–0.934).

Conclusions

In the postoperative workup of extremity fractures, tomosynthesis allows for superior assessment of fracture lines and intra-articular screw positioning with greater diagnostic confidence at radiation doses comparable to conventional radiograms.
Microtia, Branchial Cleft Fistula, and Tetralogy of Fallot: A Possible Association
Authors: Mou Li , Wei Qingqian , Zhang Zu-Xin , Chen Yue-Yin , He Mei-Yang , Mai Yue-Xue , Hu Jintian , Wang Tong
Published: May 2024

When searching over associations between congenital ear abnormalities, especially microtia and affiliated deformities like cleft lip or palate and congenital heart diseases, some clinical analysis and genetic theories are found. A 10-year-old boy sent to the plastic surgery hospital was puzzled by a congenital anterior auricular fistula with fluid trace for more than 9 years. The preoperative diagnoses were branchial cleft fistula and congenital left ear deformity with postoperation of TOF. By browsing over studies on genetic concerns and clinical performance, it may be attributed to a possible association between microtia, branchial cleft fistula, and tetralogy of Fallot, though whose fundamental mechanisms remain concerned.
Evaluation of Clinical Success of the 3D-Printed Custom-Made Subperiosteal Implants
Authors: Ayhan Mustafa , Ozturk Muhtar Merve , Kundakcioglu Abdulsamet , Kucukcakir Osman , Cansiz Erol
Published: May 2024

Objective:

The authors aim to share their experiences in subperiosteal implant applications in atrophic jaws, which have been practiced in their clinic for about 2 years, and evaluate the complications and clinical success of the implants.

Material and method:

Clinical and radiologic data of 32 patients who underwent subperiosteal implantation for advanced alveolar bone loss were evaluated, but 1 patient was excluded as they smoked. Of the 31 patients included in the study, 27 were operated with the diagnosis of total tooth loss, 3 for maxillectomy and 1 for partial tooth loss. A total of 60 subperiosteal implants were placed in them. The mean follow-up period was 15 months.

Results:

During the operation, implant-bone adaptation problems were encountered in 11 patients, implant skeletal fracture in 1 patient, and loss of primary stabilization during mini-screw fixation in 2. Although there were no complications in the early postoperative period, biological and prosthetic complications occurred in the late postoperative period. Soft tissue retraction at various levels in 12 patients (only keratinized tissue retraction in 6 and mucosal retraction exceeding keratinized tissue in 6), soft tissue infection in 5 and oroantral fistula development in 1, mini-screw loosening in 3 were the biological complications that occurred.

Conclusions:

Various complications may occur during or after the application of custom-made subperiosteal implants. However, these are manageable and can be reapplied in case of a possible implant loss, making it an important alternative, especially in atrophic jaws where endosseous dental implants cannot be applied.