bluuebunny/crossref_metadata_2025 huggingface dataset:
(323) SEXUAL FUNCTION AND ASSOCIATIONS WITH ANDROGEN LEVELS IN WOMEN WITH POLYCYSTIC OVARY SYNDROME
Authors: Hester Pastoor , Dr. Stephanie Both , Prof. Ellen Laan , Prof. Joop Laven
Published: July 2023

Objectives

To investigate sexual function in women with and without polycystic ovary syndrome (PCOS) and the relationship with androgen levels.

Methods

Heterosexual women with clinically diagnosed PCOS (n=68), aged 18-40 years, in a committed relationship and healthy controls (n=67) were included. All women went through a medical and endocrine screening using liquid chromatography – tandem mass spectrometry and completed the Female Sexual Function Index (FSFI) and the Female Sexual Distress Scale Revised (FSDS-R).

Results

All endocrine and medical measures were as expected, with higher androgen levels, biochemical hyperandrogenism, hirsutism, acne, polycystic ovaries and irregular menstrual cycles in the PCOS group. The PCOS group was slightly older, had a significantly longer relationship, and used less often oral contraceptive pills.

The PCOS group scored significantly lower on all FSFI scales, except for pain and showed lower sexual function (FSFI total P<0.001, partial η2 = 0.104), and higher sexual distress (FSDS-R total P<0.001, partial η2 = 0.090). Also, more women with PCOS than controls complied with the definition of sexual dysfunction (41.2% vs 11.9%, p<0.001) and reported clinically sexual distress (51.5% vs 19.4%, p<0.001).

Regression analysis adjusted for confounders showed only few and weak associations between androgen levels and sexual function, with each model explaining less than 15%.

Analyses for both groups separately showed no significant associations in the PCOS group. The control group showed associations between testosterone and FSFI pain (β=-6.022, P=0.044, Adj R2=0.050), FAI and FSFI orgasm (β=-3.360, P=0.023, Adj R2=0.049) and androstenedione and clinical sexual distress (β=-7.293, P=0.036, exp(β)=0.001).

Conclusions

Sexual function is impaired in women with PCOS. Contrary to general belief, endocrine perturbations seem to have minimal impact on sexual dysfunction. Addressing sexuality and offering psychosexual counseling is important in the clinical care for women with PCOS.

Conflicts of Interest

HP, SB, EL: no conflicts to report

JL: received unrestricted research grants from the following companies (in alphabetical order): Ansh Labs, Ferring, Merck Serono and Roche Diagnostics. He also received consultancy fees from Ansh Labs, Ferring, Gedeon Richter, Titus Healthcare, Roche Diagnostics.
(159) PROPERLY DEALING WITH SEXUALITY/INTIMACY IN HIGH-RISK PREGNANCIES
Authors: Gabrijela Simetinger
Published: July 2023

Objectives

In complicated and high-risk pregnancies, health care professionals (HCPs) must carefully balance between sexual restrictions (avoiding damage to pregnancy, mother or baby) and recommendations to continue sexuality and intimacy (aiming at the sexual health of the couple).

Methods

In the scarce literature on this area geared to non-sexual medicine professionals, we investigated how much proactive attention is paid to sexuality and intimacy in complicated and high-risk pregnancies. We then developed detailed recommendations related to specific pregnancy pathologies. That process also yielded valuable general recommendations.

Results

Regarding complicated and high-risk pregnancies, there is minimal information for midwifery and obstetric HCPs that deals with sexuality and intimacy. The little available literature mainly addresses the dangerous aspects without paying attention to the variety of sexual behaviour. Besides, it focuses on restrictions without recommending what is allowed.

We then tried to separate the various elements of sexuality with their potential beneficial and adverse effects on pregnancy, baby or mother and apply that knowledge to each of the common pregnancy pathologies: threatening miscarriage, early bleeding, hyperemesis, short cervix, painful contractions, premature rupture of membranes, preterm labour, placenta previa, uterine scars, urinary tract infection, vaginal infection, hypertension, poor fetal growth, and twin pregnancy.

Conclusions

When dealing with threatening pregnancy complications, it is vital to proactively address the not-asked questions on sexuality and intimacy, be very explicit and clear about what is better to renounce, and always add what is sexually allowed or recommended to consider.

Ref: Simetinger G, Gianotten WL. Sexual aspects of high-risk and complicated pregnancy. In Geuens S, Mivšek AP, Gianotten WL (eds). Springer Nature OA 2023.

Conflicts of Interest

No conflict of interest.
(209) SELECTED PERSONALITY TRAITS OF PEOPLE EXPERIENCING DISCRIMINATION ON THE GROUNDS OF SEXUAL ORIENTATION AND GENDER IDENTITY
Authors: Katarzyna Zborowska , Bożena Chrapkiewicz , Daria Jorg
Published: July 2023

Objectives

The conducted research touches on a very important topic in the field of selected personality traits of people experiencing discrimination and homophobia on the basis of sexual orientation and gender identity. This work is innovative in the empirical dimension, so far the literature on the subject has not analyzed the personality traits of non-heteronormative people in the dimension of conformism-nonconformism, narcissism or disposition to forgive. Self-esteem and the phenomenon of discrimination in the LGBTQIA + community is described quite widely.

Methods

Features such as (non) conformism, narcissism, self-esteem and forgiveness were analyzed in detail. 104 homosexuals and 100 transgender people were surveyed using the following questionnaires: KANH III Creative Behavior Questionnaire, NPI (Narccistic Personality Inventory), and Rosenberg Self-Esteem Scale (SES); Heartland Forgiveness Scale (HFS) and an original survey on experienced discrimination and homophobia.

Results

The obtained results indicate that the respondents did not differ from each other in the dimension of conformism-nonconformity. For the narcissism level variable, there was a difference in the self-sufficiency scale. This study confirmed that non-heteronormative persons are characterized by low self-esteem and that transgender persons are characterized by a higher tendency to positive self-forgiveness than the homosexual respondents. Moreover, homosexual and transgender people differ in terms of experienced discrimination and homophobia. The results of the research indicate that transgender persons experienced a greater intensity of discrimination than homosexual persons.

Conclusions

The pervasive stigma and discrimination against LGBTQIA + people affect the health of non-heteronormative people throughout their lives, especially when it comes to mental health and well-being.

Conflicts of Interest

No Conflicts of Interest.
Mapping the Galactic magnetic field orientation and strength in three dimensions
Authors: Hu Yue , Lazarian A
Published: July 2023

The mapping of the Galactic magnetic field (GMF) in three dimensions is essential to comprehend various astrophysical processes that occur within the Milky Way. This study endeavours to map the GMF by utilizing the latest MM2 technique, the velocity gradient technique (VGT), the column density variance approach, and the Galactic Arecibo L-band Feed Array HI survey of neutral hydrogen (H i) emission. The MM2 and VGT methods rely on an advanced understanding of magnetohydrodynamics turbulence to determine the plane-of-the-sky magnetic field strength and orientation, respectively. The H i emission data, combined with the Galactic rotational curve, give us the distribution of H i gas throughout the Milky Way. By combining these two techniques, we map the GMF orientation and strength, as well as the Alfvén Mach number MA in 3D for a low-galactic latitude (b < 30o) region close to the Perseus Arm. The analysis of column density variance gives the sonic Mach number Ms distribution. The results of this study reveal the sub-Alfvénic and subsonic (or trans-sonic) nature of the H i gas. The variation of mean MA along the line of sight approximately ranges from 0.6 to 0.9, while that of mean Ms is from 0.2 to 1.5. The mean magnetic field strength varies from 0.5 to 2.5 µG exhibiting a decreasing trend towards the Galaxy’s outskirt. This work provides a new avenue for mapping the GMF, especially the magnetic field strength, in 3D. We discuss potential synergetic applications with other approaches.
The Gaia alerted fading of the FUor-type star Gaia21elv
Authors: Nagy Zsófia , Park Sunkyung , Ábrahám Péter , Kóspál Ágnes , Cruz-Sáenz de Miera Fernando , Kun Mária , Siwak Michał , Szabó Zsófia Marianna , Szilágyi Máté , Fiorellino Eleonora , Giannini Teresa , Lee Jae-Joon , Lee Jeong-Eun , Marton Gábor , Szabados László , Vitali Fabrizio , Andrzejewski Jan , Gromadzki Mariusz , Hodgkin Simon , Jabłońska Maja , Mendez Rene A , Merc Jaroslav , Michniewicz Olga , Mikołajczyk Przemysław J , Pylypenko Uliana , Ratajczak Milena , Wyrzykowski Łukasz , Zejmo Michal , Zieliński Paweł
Published: July 2023

FU Orionis objects (FUors) are eruptive young stars, which exhibit outbursts that last from decades to a century. Due to the duration of their outbursts, and to the fact that only about two dozens of such sources are known, information on the end of their outbursts is limited. Here we analyse follow-up photometry and spectroscopy of Gaia21elv, a young stellar object, which had a several decades long outburst. It was reported as a Gaia science alert due to its recent fading by more than a magnitude. To study the fading of the source and look for signatures characteristic of FUors, we have obtained follow-up near-infrared (NIR) spectra using Gemini South/IGRINS, and both optical and NIR spectra using VLT/X-SHOOTER. The spectra at both epochs show typical FUor signatures, such as a triangular shaped H-band continuum, absorption-line dominated spectrum, and P Cygni profiles. In addition to the typical FUor signatures, [O i], [Fe ii], and [S ii] were detected, suggesting the presence of a jet or disc wind. Fitting the spectral energy distributions with an accretion disc model suggests a decrease of the accretion rate between the brightest and faintest states. The rapid fading of the source in 2021 was most likely dominated by an increase of circumstellar extinction. The spectroscopy presented here confirms that Gaia21elv is a classical FUor, the third such object discovered among the Gaia science alerts.
Optical spectral observations of three binary millisecond pulsars
Authors: Bobakov A V , Karpova A V , Zharikov S V , Kirichenko A Yu , Shibanov Yu A , Zyuzin D A
Published: July 2023

We present the results of optical spectroscopy of stellar companions to three binary millisecond pulsars, PSRs J0621+2514, J2317+1439, and J2302+4442, obtained with the Gran Telescopio Canarias. The spectrum of the J0621+2514 companion shows a blue continuum and prominent Balmer absorption lines. The latter are also resolved in the spectrum of the J2317+1439 companion, showing that both are DA-type white dwarfs. No spectral features are detected for the J2302+4442 companion; however, its broad-band magnitudes and the spectral shape of the continuum emission imply that this is also a DA-type white dwarf. Based on the spectral analyses, we conclude that the companions of J0621+2514 and J2317+1439 are relatively hot, with effective temperatures Teff = 8600 ± 200 and 9600 ± 2000 K, respectively, while the J2302+4442 companion is significantly cooler, Teff<6000 K. We also estimated the distance to J0621+2514 of 1.1 ± 0.3 kpc and argue that its companion and the companion of J2317+1439 are He-core white dwarfs providing constraints on their cooling ages of $\lesssim$2 Gyr.
Explanation Good, Grounding Bad
Authors: Daly Chris
Published: July 2023

Grounding is not required for explanation in metaphysics, and, more generally, in philosophy. An account independent of grounding is available. Grounding claims do not provide the explanations that they are alleged to. The case for displacing supervenience in favour of grounding is mistaken. Grounding is a zombie idea: it staggers on in philosophical culture despite being thoroughly discredited.
An Epistemic Approach to Ground
Authors: Hall Ned
Published: July 2023

Recent enthusiasm for grounding often begins by observing that inquiry in metaphysics (and other areas) features a distinctive species of noncausal explanation. Having labeled this species “grounding explanation,” it’s a short step to the conclusion that we need a philosophical theory of grounding itself: an allegedly fundamental relation of metaphysical dependency between facts, such that a “grounding explanation” of some fact succeeds by providing information about what “grounds” that fact. This short step is hasty. For another live option is to accept that grounding explanation is a legitimate form of explanation, but to give it a thoroughly epistemic treatment, one that does not see it as involving any sort of special metaphysical relationship or structure at all. This paper sketches such a treatment, drawing inspiration from reflections on explanatory structure in mathematics.
Time, Grounding, and Esoteric Metaphysics
Authors: Deng Natalja
Published: July 2023

I examine the relation between naturalistically motivated and other critiques of grounding and similar critiques of the contrast between A- and B-theoretic views of time. I argue that even the combined dialectical upshot of nonunity objections in the latter case is not what it is in the former. I sympathetically discuss the objection that the notion of grounding is not intelligible and part of ‘esoteric’ metaphysics; this objection turns out to be just as serious in the case of the A/B contrast. I then consider whether grounding is needed to draw the A/B contrast in the first place and answer this question in the negative. Finally, I comment on the costs of esotericism in both cases.
How does less public spending affect the motivation of citizens to contribute to nature conservation?
Authors: Richter Andries , Reinhard Stijn
Published: July 2023

Contributions to public goods, such as nature areas, are often made by private actors, as well as governmental agencies. Typically, the motivation of citizens to voluntarily contribute depends on how the distribution of such tasks has evolved between public and private actors, and wider contextual factors. Therefore, it is unclear whether decreased public spending on nature areas affects private funding. We conduct an economic experiment in The Hague Forest in the Netherlands and ask citizens to perform a task that generates funding for the forest. In the treatment condition, we describe the ongoing policy changes, which implies less state funding and greater dependency on private actors. We find that highlighting a greater need for private funding reduces individual contributions significantly, which is mostly due to a drop in motivation of frequent visitors. Overall, our study suggests that decreasing public spending may have unexpected repercussions on citizens’ motivation to contribute.
Feeding in mixoplankton enhances phototrophy increasing bloom-induced pH changes with ocean acidification
Authors: Flynn Kevin J , Mitra Aditee
Published: July 2023

Plankton phototrophy consumes CO2, increasing seawater pH, while heterotrophy does the converse. Elevation of pH (>8.5) during coastal blooms becomes increasingly deleterious for plankton. Mixoplankton, which can be important bloom-formers, engage in both photoautotrophy and phagoheterotrophy; in theory, this activity could create a relatively stable pH environment for plankton growth. Using a systems biology modelling approach, we explored whether different mixoplankton functional groups could modulate the environmental pH compared to the extreme activities of phototrophic phytoplankton and heterotrophic zooplankton. Activities by most mixoplankton groups do not stabilize seawater pH. Through access to additional nutrient streams from internal recycling with phagotrophy, mixoplankton phototrophy is enhanced, elevating pH; this is especially so for constitutive and plastidic specialist non-constitutive mixoplankton. Mixoplankton blooms can exceed the size of phytoplankton blooms; the synergisms of mixoplankton physiology, accessing nutrition via phagotrophy as well as from inorganic sources, enhance or augment primary production rather than depressing it. Ocean acidification will thus enable larger coastal mixoplankton blooms to form before basification becomes detrimental. The dynamics of such bloom developments will depend on whether the mixoplankton are consuming heterotrophs and/or phototrophs and how the plankton community succession evolves.
Uncovering hidden structures: previously undescribed pseudopodia and ectoplasmic structures in planktonic foraminifera
Authors: Greco Mattia , Westgård Adele , Sykes Freya E , Ezat Mohamed M , Meilland Julie
Published: July 2023

The trophic strategies of cold-water planktonic foraminifera are not well understood due to the challenge of culturing them in polar conditions. Here, we identify previously unknown ectoplasmic and cytoplasmic projections in three species of planktonic foraminifera thriving in polar and subpolar marine environments: Globigerina bulloides, Neogloboquadrina incompta and Neogloboquadrina pachyderma. These structures were observed during routine monitoring of cultured specimens sampled from the Norwegian coast, Greenland Sea and Baffin Bay. Two types of projections were discovered, including permanent and non-permanent structures such as ectoplasmic roots, twigs and twig-like projections, similar to those observed in benthic taxa Cibicides and Cibicidoides. Additionally, a previously undescribed filopodia-like projection was observed in N. pachyderma. We discuss the function, the ecological significance and the potential impact on pelagic processes of the presence of these structures in foraminifera species that occupy diverse niches in the water column. Our findings suggest that these structures may play an important role in the trophic strategies of cold-water planktonic foraminifera, and further research and observations are necessary to fully comprehend their significance in the carbon cycle.
FUSCA3-induced AINTEGUMENTA-like 6 manages seed dormancy and lipid metabolism
Authors: Liu Xiangling , Li Na , Chen Aoyu , Saleem Noor , Jia Qingli , Zhao Cuizhu , Li Wenqiang , Zhang Meng
Published: July 2023

FUSCA 3 (FUS3), a seed master regulator, plays critical role in seed dormancy and oil accumulation. However, its downstream regulation mechanisms remain poorly understood. Here, we explored the roles of AINTEGUMENTA-like 6 (AIL6), a seed transcription factor, in these processes. The activation of AIL6 by FUS3 was demonstrated by dual-LUC assay. Seeds of ail6 mutants showed alterations in fatty acid compositions, and both AtAIL6 (AIL6 from Arabidopsis thaliana) and BnaAIL6 (AIL6 from Brassica napus) rescued the phenotype. Over-expression (OE) of AIL6s reversed changes in seed fatty acid composition. Notably, OE lines showed low seed germination rates down to 12% compared to 100% of wild-type Col-0. Transcriptome analysis of the mutant and an OE line indicated widespread expression changes of genes involved in lipid metabolism and phytohormone pathways. In OE mature seeds, GA4 content decreased more than 15-fold, while abscisic acid and indole-3-acetic acid (IAA) contents clearly increased. Exogenous GA3 treatments did not effectively rescue the low germination rate. Nicking seed coats increased germination rates from 25% to nearly 80% while the wild-type rdr6-11 is 100% and 98% respectively, and elongation of storage time also improved seed germination. Furthermore, dormancy imposed by AIL6 was fully released in the della quintuple mutant. Together, our results indicate AIL6 acts as a manager downstream of FUS3 in seed dormancy and lipid metabolism.
Neuropsychiatric lupus in late- and early-onset systemic lupus erythematosus patients: a systematic review and meta-analysis
Authors: Pamuk Omer Nuri , Raza Ali Abbas , Hasni Sarfaraz
Published: July 2023

Objectives

Late-onset SLE is usually milder and associated with lower frequency of LN and neuropsychiatric manifestations. The diagnosis of NPSLE is especially challenging in older patients because of increased incidence of neurological comorbidities. We performed a systematic review and meta-analysis to evaluate the differences in NPSLE manifestations in early-onset (<50-year-old) vs late-onset (≥50-year-old) SLE patients.

Methods

A literature search was performed using the PubMed, Web of Science and Cochrane Library databases. Studies available in English (1959–2022) including a late-onset SLE comparison group and evaluating the frequency of NPSLE were eligible. A forest plot was used to compare odds ratios (95% CI) of incidence and manifestations of NPSLE by age groups. Study heterogeneity was assessed using I2 statistics.

Results

A total of 44 studies, including 17 865 early-onset and 2970 late-onset SLE patients, fulfilled our eligibility criteria. CNS involvement was reported in 3326 patients. Cumulative NPSLE frequency was higher in the early-onset group than in the late-onset group (OR: 1.41, 95% CI: 1.24, 1.59, P < 0.0001). In early-onset SLE patients, seizures (OR: 1.68, 95% CI: 1.27, 2.22) and psychosis (OR: 1.72, 95% CI: 1.23, 2.41) were more common than in late-onset SLE patients (P values, 0.0003 and 0.0014, respectively). Peripheral neuropathy was more commonly reported in the late-onset SLE group than in the early-onset SLE group (OR: 0.64, 95% CI: 0.47, 0.86, P = 0.004).

Conclusion

Our meta-analysis revealed that the frequencies of overall NPSLE, seizures, and psychosis were less common in late-onset SLE patients than in early-onset SLE patients. In contrast, peripheral neuropathy was more common in the late-onset SLE group.
Refugee migration, labor demand and local employment
Authors: Auer Daniel , Götz Lilia
Published: July 2023

Whether or not immigration negatively affects the labor market outcomes of natives is an ongoing debate. One challenge for empirical evidence is the simultaneity of supply- and demand-side effects. To isolate the demand side, we focus on refugees in Germany who are exogenously allocated to districts and excluded from the labor market. We leverage quasi-random variation in the local refugee share as an instrument to show that an influx of 1000 asylum-seekers creates almost 300 jobs in a district, on average. This effect is mainly driven by a demand for additional (female) labor in service, public administration and social work. The results are robust to various sensitivity checks and an alternative difference-in-differences identification strategy. Moreover, we show that employment effects largely offset the financial burden on the public. Quantifying the demand side of immigration adds to our understanding of local labor market dynamics in an increasingly mobile world.
A real-time, personalized sleep intervention using mathematical modeling and wearable devices
Authors: Song Yun Min , Choi Su Jung , Park Se Ho , Lee Soo Jin , Joo Eun Yeon , Kim Jae Kyoung
Published: July 2023

The prevalence of artificial light exposure has enabled us to be active any time of the day or night, leading to the need for high alertness outside of traditional daytime hours. To address this need, we developed a personalized sleep intervention framework that analyzes real-world sleep–wake patterns obtained from wearable devices to maximize alertness during specific target periods. Our framework utilizes a mathematical model that tracks the dynamic sleep pressure and circadian rhythm based on the user’s sleep history. In this way, the model accurately predicts real-time alertness, even for shift workers with complex sleep and work schedules (N = 71, t = 13~21 days). This allowed us to discover a new sleep–wake pattern called the adaptive circadian split sleep, which incorporates a main sleep period and a late nap to enable high alertness during both work and non-work periods of shift workers. We further developed a mobile application that integrates this framework to recommend practical, personalized sleep schedules for individual users to maximize their alertness during a targeted activity time based on their desired sleep onset and available sleep duration. This can reduce the risk of errors for those who require high alertness during nontraditional activity times and improve the health and quality of life for those leading shift work-like lifestyles.
Integrative taxonomy reveals hidden diversity in theCatharus fuscater(Passeriformes: Turdidae) complex in Central and South America
Authors: Halley Matthew R , Catanach Therese A , Klicka John , Weckstein Jason D
Published: July 2023

We assembled datasets of genetic ﻿(genomic ultraconserved elements ﻿[UCEs﻿], mtDNA﻿) and phenotypic (morphology, voice) characters to address species limits and taxonomy in the slaty-backed nightingale-thrush Catharus fuscater (Passeriformes: Turdidae), a polytypic complex of songbirds with a broad montane distribution in Central and South America. We identified 10 allopatric populations that have been evolving independently for multiple glacial cycles. Genetic structure is broadly correlated with divergence in phenotypic characters, including plumage colour, iris colour, maxilla (bill) colour, and the acoustic structure of vocalizations (calls and songs). We propose an integrative taxonomic revision that recognizes seven species in the complex, including a newly described species from eastern Panama, and four subspecies, of which two are newly described.
Evaluation of Seed Transmission Rates of Wheat Streak Mosaic Virus in Mechanically Inoculated Winter and Spring Wheat Cultivars in Montana
Authors: McKelvy Uta , Brelsford Monica , Burrows Mary
Published: July 2023

Wheat streak mosaic disease is caused by wheat streak mosaic virus (WSMV) and two other viruses and persistently limits wheat yields in the Great Plains region of the United States. Seed transmission of viruses is an important consideration in international movement and is important epidemiologically. Seed transmission of WSMV in wheat was first reported from Australia in 2005, but there is little data from United States cultivars on the rate of seed transmission. In 2018, mechanically inoculated winter and spring wheat cultivars were evaluated in Montana. We found differences in WSMV seed transmission rates between winter and spring wheat, with average transmission rates in spring wheat (3.1%) being five times higher compared to winter wheat (0.6%). Seed transmission rates in spring wheat were twice as high as the highest previously reported transmission rate for individual genotypes, 1.5%. The results from this study provide a strong argument for increasing the current testing of seed for breeding purposes prior to international movement when WSMV has been observed and caution against using grain from WSMV-infected fields as seed source because it can heighten the risk of wheat streak mosaic outbreaks.
Evaluation of Efficacy and Adverse Events After Second Immunotherapy Exposure in Endometrial and Cervical Carcinoma
Authors: Morton Molly , Marcu Ioana , Levine Monica , Cosgrove Casey , Backes Floor , O'Malley David , Chambers Laura
Published: July 2023

Immunotherapy has changed the treatment paradigm for gynecologic malignancies. The RUBY (NCT03981796) and NRG-GY018 (NCT03914612) studies have shown significant improvements in survival for immunotherapy in combination with chemotherapy in advanced and recurrent endometrial cancer, and immunotherapy likely will become the first-line standard-of-care therapy. However, the efficacy of repeated exposure to immunotherapy for gynecologic cancers is unknown. In this retrospective series, 11 patients with endometrial cancer and four patients with cervical cancer were identified who received subsequent immunotherapy after first immunotherapy. With subsequent immunotherapy, three patients (20.0%) had complete response, three (20.0%) had partial response, three (20.0%) had stable disease, and six (40.0%) had disease progression; progression-free survival was similar to first-line immunotherapy. These data provide proof of concept for subsequent treatment with immunotherapy in gynecologic cancers, specifically endometrial cancer.
Imiquimod for Cervical and Vaginal Intraepithelial Neoplasia
Authors: Inayama Yoshihide , Takamatsu Shiro , Hamanishi Junzo , Mizuno Kayoko , Horinouchi Noboru , Yamanoi Koji , Taki Mana , Murakami Ryusuke , Yamaguchi Ken , Kosaka Kenzo , Efthimiou Orestis , Kawakami Koji , Furukawa Toshiaki A. , Mandai Masaki
Published: July 2023

OBJECTIVE:

To evaluate the treatment efficacy and the risk of adverse events of imiquimod for cervical intraepithelial neoplasia (CIN) and vaginal intraepithelial neoplasia (VAIN), compared with placebo or no intervention.

DATA SOURCES:

We searched Cochrane, PubMed, ISRCTN registry, ClinicalTrials.gov, and the World Health Organization International Clinical Trials Registry Platform up to November 23, 2022.

METHODS OF STUDY SELECTION:

We included randomized controlled trials and prospective nonrandomized studies with control arms that investigated the efficacy of imiquimod for histologically confirmed CIN or VAIN. The primary outcomes were histologic regression of the disease (primary efficacy outcome) and treatment discontinuation due to side effects (primary safety outcome). We estimated pooled odds ratios (ORs) of imiquimod, compared with placebo or no intervention. We also conducted a meta-analysis of the proportions of patients with adverse events in the imiquimod arms.

TABULATION, INTEGRATION, AND RESULTS:

Four studies contributed to the pooled OR for the primary efficacy outcome. An additional four studies were available for meta-analyses of proportions in the imiquimod arm. Imiquimod was associated with increased probability of regression (pooled OR 4.05, 95% CI 2.08–7.89). Pooled OR for CIN in the three studies was 4.27 (95% CI 2.11–8.66); results of one study were available for VAIN (OR, 2.67, 95% CI 0.36–19.71). Pooled probability for primary safety outcome in the imiquimod arm was 0.07 (95% CI 0.03–0.14). The pooled probabilities (95% CI) of secondary outcomes were 0.51 (0.20–0.81) for fever, 0.53 (0.31–0.73) for arthralgia or myalgia, 0.31 (0.18–0.47) for abdominal pain, 0.28 (0.09–0.61) for abnormal vaginal discharge or genital bleeding, 0.48 (0.16–0.82) for vulvovaginal pain, and 0.02 (0.01–0.06) for vaginal ulceration.

CONCLUSION:

Imiquimod was found to be effective for CIN, whereas data on VAIN were limited. Although local and systemic complications are common, treatment discontinuation is infrequent. Thus, imiquimod is potentially an alternative therapy to surgery for CIN.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022377982.
Longitudinal Analysis of Early Hearing Detection and Intervention Program Performance
Authors: Mahal Rajwant , Bluher Andrew , Kallogjeri Dorina , Seeser James , Piccirillo Jay , Buchman Craig A.
Published: July 2023

Objectives:

Early hearing detection and intervention (EHDI) is a newborn hearing screening system created to detect infants with hearing loss (HL) and intervene to reduce language and communication impairment. Early hearing detection (EHD) consists of three sequential stages: identification, screening, and diagnostic testing. This study longitudinally reviews each stage of EHD in each state and proposes a framework to improve utilization of EHD data.

Design:

A retrospective public database review was conducted, accessing publicly available data from the Centers for Disease Control and Prevention. Summary descriptive statistics were utilized to generate a descriptive study of EHDI programs in each U.S. state from 2007 to 2016.

Results:

Data over 10 years from 50 states as well as Washington, DC were included in this analysis, creating up to 510 data points per analysis. Hundred percent (85 to 105) (median [min to max]) of newborns were identified by and entered EHDI programs. Ninety-eight percent (51 to 100) of identified infants completed screening. Of the infants who screened positive for HL, the proportion that received diagnostic testing was 55% (1 to 100). The overall proportion of infants who failed to complete EHD was 3% (1 to 51). Of the infants who fail to complete EHD 70% (0 to 100) are from missed screenings, 24% (0 to 95) are from missed diagnostic testing, and 0% (0 to 93) are from missed identification. Although there are more infants missed at screening, it was estimated, with limitations, that there is an order of magnitude more infants with HL among those who did not complete diagnostic testing compared with those who did not complete screening.

Conclusions:

Analysis demonstrates high completion rates at both identification and screening stages, whereas the diagnostic testing stage demonstrates low and highly variable completion rates. The low completion rates at diagnostic testing create a bottleneck in the EHD process and the large variability impedes the comparison of HL outcomes across states. Analysis also demonstrates that among all stages of EHD, whereas the largest number of infants are missed at screening, the largest number of children with HL are likely missed at diagnostic testing. Therefore, a focus by individual EHDI programs on addressing causes of low diagnostic testing completion rates would yield the greatest increase in the identification of children with HL. Potential causes of low diagnostic testing completion rates are further discussed. Finally, a new vocabulary framework is proposed to facilitate further study of EHD outcomes.
Cannabis Use is Associated With Higher Rates of Pseudarthrosis Following TLIF
Authors: Tao Xu , Matur Abhijith V. , Khalid Syed , Shukla Geet , Vorster Phillip , Childress Kelly , Garner Rebecca , Gibson Justin , Cass Daryn , Mejia Munne Juan C. , McGrath Kyle , Ivey Natalie , Garcia-Vargas Julia , Wu Andrew , Street Seth , Mehta Jay , Onyewadume Louisa , Duah Henry O. , Motley Benjamin , Cheng Joseph S. , Adogwa Owoicho
Published: July 2023

Study Design.

This was a retrospective cohort study.

Objective.

To compare the rates of pseudarthrosis in patients undergoing 1 to 3 level transforaminal lumbar interbody fusion (TLIF) procedures between cannabis users and noncannabis users.

Summary of Background Data.

Recreational use of cannabis is common, though it remains poorly studied and legally ambiguous in the United States. Patients with back pain may turn to adjunctive use of cannabis to manage their pain. However, the implications of cannabis use on the achievement of bony fusion are not well-characterized.

Methods.

Patients who underwent 1 to 3 level TLIF for degenerative disc disease or degenerative spondylolisthesis between 2010 and 2022 were identified using the PearlDiver Mariner all-claims insurance database. Cannabis users were identified with ICD 10 code F12.90. Patients undergoing surgery for nondegenerative pathologies such as tumors, trauma, or infection were excluded. 1:1 exact matching was performed using demographic factors, medical comorbidities, and surgical factors which were significantly associated with pseudarthrosis in a linear regression model. The primary outcome measure was development of pseudarthrosis within 24 months after 1 to 3 level TLIF. The secondary outcomes were the development of all-cause surgical complications as well as all-cause medical complications.

Results.

A 1:1 exact matching resulted in two equal groups of 1593 patients who did or did not use cannabis and underwent 1 to 3 level TLIF. Patients who used cannabis were 80% more likely to experience pseudarthrosis compared with patients who do not [relative risk (RR): 1.816, 95% CI: 1.291–2.556, P<0.001]. Similarly, cannabis use was associated with significantly higher rates of all-cause surgical complications (RR: 2.350, 95% CI: 1.399–3.947, P=0.001) and all-cause medical complications (RR: 1.934, 95% CI: 1.516–2.467, P<0.001).

Conclusion.

After 1:1 exact matching to control for confounding variables, the findings of this study suggest that cannabis use is associated with higher rates of pseudarthrosis, as well as higher rates of all-cause surgical and all-cause medical complications. Further studies are needed to corroborate our findings.
Prevalence of Elevated Pulse Pressure and Hypertension in Adults Participating in Outpatient Physical Therapy
Authors: O'Connell Dennis G. , Jumper Jill D. , Hicks Brad , Klostermann Bubba , Carl Christopher , Bell Carmen
Published: July 2023

Purpose:

To examine pulse pressure (PP), systolic (SBP), and diastolic (DBP) pressure in outpatient physical therapy or maintenance fitness subjects by age (5 age groups) and in those younger than versus those who were 65 years and older. To test for differences in SBP, DBP, and PP in those with and without a hypertension (HTN) diagnosis.

Methods:

Ninety-eight physical therapy and maintenance fitness subjects in 1 urban outpatient clinic had PP and SBP/DBP measured and classified (ACC/AHA 2017 guidelines) using two different age classifications: (1) 20 to 44, 45 to 54, 55 to 64, 65 to 74, or ≥75 and (2) ≤64 or ≥65. Comparisons were also made in SBP, DBP, and PP based on a known hypertension diagnosis.

Results:

Forty male and 58 female subjects (height: 65.98 inches [SD = 4.19]; weight: 180.91 pounds [SD = 39.62]; body mass index: 29.11 [SD = 5.86]; age: 64.34 years [SD = 15.92]) participated in this investigation. Systolic blood pressure, DBP, and PP were significantly higher in those older than 65 years. Systolic blood pressure significantly increases across 5 age groups. Systolic blood pressure, DBP, and PP were significantly higher in those older than 65 years. Pulse pressure was significantly greater in those with hypertension. Pulse pressure was abnormal in 36.2% of the sample.

Conclusions:

Thirty-six percent of subjects receiving physical therapy treatment or participating in maintenance fitness had elevated PP while 78.9% and 47.3% had abnormal SBP and DBP, respectively. Both PP and blood pressure were significantly influenced by age. Therapists should measure resting BP and PP before treatment and refer as needed to achieve improved control.
Impact of Preoperative Factors in Patients with Inflammatory Bowel Disease on Postoperative Length of Stay: A National Surgical Quality Improvement Program-Inflammatory Bowel Disease Collaborative Analysis
Authors: Hill Susanna S. , Ottaviano Kathryn E. , Palange David C. , Chismark A. David , Valerian Brian T. , Canete Jonathan J. , Lee Edward C.
Published: July 2023

BACKGROUND:

Inflammatory bowel disease patients are challenging to manage peri-operatively due to disease complexity and multiple comorbidities.

OBJECTIVE:

This study aimed to identify if preoperative factors and operation type were associated with extended postoperative length of stay after inflammatory bowel disease-related surgery, defined by 75 th percentile or greater (n = 926, 30.8%).

DESIGN:

This was a cross-sectional study based on a retrospective multicenter database.

SETTING:

The National Surgery Quality Improvement Program-Inflammatory Bowel Disease collaborative captured data from 15 high-volume sites.

PATIENTS:

A total of 3,008 patients with inflammatory bowel disease (1,710 with Crohn’s disease and 1,291 with ulcerative colitis) with a median postoperative length of stay of 4 days (IQR 3-7) from March 2017 to February 2020.

MAIN OUTCOME MEASURES:

The primary outcome was extended postoperative length of stay.

RESULTS:

On multivariable logistic regression, increased odds of extended postoperative length of stay were associated with multiple demographic and clinical factors (model p < 0.001, area under ROC curve - 0.85). Clinically significant contributors that increased post-operative length of stay were rectal surgery (vs colon) (OR 2.13, 95% CI: 1.52-2.98), new ileostomy (vs no ileostomy) (OR 1. 50, 95% CI: 1.15-1.97), preoperative hospitalization (OR 13.45, 95% CI: 10.15-17.84), non-home discharge (OR 4.78, 95% CI: 2.27-10.08), hypoalbuminemia (OR 1.66, 95% CI: 1.27-2.18), and bleeding disorder (OR 2.42, 95% CI: 1.22-4.82).

LIMITATIONS:

Retrospective review of only high-volume centers.

CONCLUSIONS:

Patients with inflammatory bowel disease who were preoperatively hospitalized, who had non-home discharge, and who underwent rectal surgery had the highest odds of extended postoperative length of stay. Associated patient characteristics included bleeding disorder, hypoalbuminemia and ASA classes 3-5. Chronic corticosteroid, immunologic, small molecule and biologic agent use were not significant on multivariable analysis.
Performance and Quality Measure Selection by Mohs Surgeons in the 2020 Merit-Based Incentive Payment System
Authors: Gronbeck Christian , Feng Hao
Published: July 2023

BACKGROUND

The Merit-Based Incentive Payment System (MIPS) seeks to promote value-based care through quality-adjusted Medicare payments.

OBJECTIVE

To assess 2020 MIPS performance and quality measure selection by Mohs surgeons.

METHODS

Retrospective, cross-sectional review of Medicare Quality Payment Program and Part B billing data sets.

RESULTS

In 2020, 8,778 dermatologists and 2,148 Mohs surgeons received a MIPS score. Mohs surgeons primarily participated through groups (51.6%) or individuals (36.4%). Most of them (77.4%) received a final score enabling a positive payment adjustment in 2022, with a notable proportion (22.3%) being eligible for a neutral payment adjustment in the setting of COVID-19 exemptions. The members of the American College of Mohs Surgery were more likely to meet the exceptional performance threshold (71.5% vs 59.0%, p < .0001), as were Mohs surgeons with <15 years of experience (73.3% vs 54.8%, p < .0001). Measures related to dermatology or Mohs surgery were reported by most individuals (92.0%) and dermatology groups (90.4%), yet less frequently by multispecialty groups (5.9%).

CONCLUSION

Many Mohs surgeons exceeded the performance threshold and used dermatology- or Mohs-related quality measures in 2020. Further assessments correlating quality measures with patient outcomes are needed to better understand the utility and appropriateness of the current value-based payment system and guide further policies.
Retinitis pigmentosa associated with the EYS C2139Y variant: an important cause of blindness in East Asian populations.
Authors: Chan Choi Mun , Tan Tien-En , Jain Kanika , Bylstra Yasmin , Mathur Ranjana S. , Tang GDN Rachael W.C. , Lee Brian J.H. , Jamuar Saumya S. , Kam Sylvia , Vithana Eranga N. , Lim Weng Khong , Fenner Beau J.
Published: July 2023

Purpose:

The study aimed to describe the phenotypic features of retinitis pigmentosa (RP) associated with the previously described EYS C2139Y variant in Singaporeans and establish the importance of this variant as a prevalent cause of RP among East Asians.

Methods:

A clinical phenotyping and exome sequencing study was conducted on consecutive patients with non-syndromic RP. Epidemiological analysis was performed using Singaporean and global population-based genetic data.

Results:

A study of 150 consecutive unrelated individuals with non-syndromic RP found that 87 (58%) of cases had plausible genotypes. A previously described missense variant in the EYS gene, 6416G>A (C2139Y), occurred heterozygously or homozygously in 17 of 150 families (11.3%), all with autosomal recessive RP. Symptom onset in EYS C2139Y-related RP ranged from 6 to 45 years, with visual acuity (VA) ranging from 20/20 at 21 years to no light perception by 48 years. C2139Y-related RP had typical findings, including sectoral RP in cases with EYS E2703X in trans. The median age at presentation was 45 and visual fields declined to less than 20° (Goldmann V4e isopter) by age 65. Inter-eye correlation for VA, fields, and ellipsoid band width was high (r-squared 0.77 to 0.95). Carrier prevalence was 0.66% (allele frequency of 0.33%) in Singaporean Chinese and 0.34% in East Asians, suggesting a global disease burden exceeding ten thousand individuals.

Conclusions:

The EYS C2139Y variant is common in Singaporean RP patients and other ethnic Chinese populations. Targeted molecular therapy for this single variant could potentially treat a significant proportion of RP cases worldwide.
Evaluation of Schlemm Canal Parameters Using Swept-Source Optical Coherence Tomography in Eyes That Underwent Keratoplasty
Authors: Bolac Ruveyde , Ozcelik-Kose Alev , Imamoglu Serhat , Yildiz Elvin , Ozturk Yucel , Mangan Mehmet Serhat
Published: July 2023

Objectives:

In this study, we aimed to evaluate Schlemm canal parameters using anterior segment swept-source optical coherence tomography in eyes that underwent keratoplasty and compare them with keratoconus and healthy control groups.

Methods:

The study included 32 patients who underwent penetrating keratoplasty or deep anterior lamellar keratoplasty once due to keratoconus and age-matched and sex-matched 20 keratoconus patients and 30 healthy controls. In all the patients, a single horizontal image centered on the central cornea was obtained from the nasal and temporal quadrants with low-intensity scanning to visualize Schlemm canal.

Results:

There was no statistically significant difference between the groups for age and gender (P˃0.05). In the keratoplasty group, the area and diameter of Schlemm canal were 2.266±1.141μm2 and 160.77±65.08 μm, respectively, in the nasal quadrant and 2.623±1.277 μm2 and 158.81±68.05 μm, respectively in the temporal quadrant, which were statistically significantly lower compared with other groups (P<0.001 for all). There was no significant difference between the penetrating and deep anterior lamellar keratoplasty subgroups for Schlemm canal parameters.

Conclusion:

This is the first study to report anterior segment optical coherence tomography after surgery shows SC parameters that are, on average, less than age-matched and keratoconus controls.
Effect of Scleral Contact Lens Size and Duration of Wear on Intraocular Pressure Effect of Scleral Lenses on Intraocular Pressure
Authors: Litvin Taras V , Tse Vivien , Chung Lisa , Zhou Yixiu , Tan Bo , Han Ying , Lin Meng C
Published: July 2023

Objective:

To evaluate the effects of scleral lens size and the duration of wear on intraocular pressure (IOP) during lens wear.

Methods:

Healthy adults were recruited for this prospective and randomized study. Intraocular pressure measurements were performed using a pneumotonometer. A block randomization was used to assign the order of scleral lens diameter of either 15.6 mm or 18.0 mm for 5-hr bilateral wear over a course of two visits. Scleral IOP (sIOP) was measured during the predetermined intervals, 1.25 hr apart, during the 5-hr scleral lens wear. Corneal IOP (cIOP) was measured before and after the scleral lens wear. The primary outcome measure was the mean change in sIOP from prelens insertion baseline.

Results:

Corneal IOP unchanged after scleral lens removal compared with the baseline measurements (P=0.878). Smaller and larger lenses introduced significantly higher sIOP at 2.5 hr after lens insertion with the mean (95% CI) increase of 1.16 (0.54, 1.78) mm Hg and 1.37 (0.76, 1.99) mm Hg, respectively. There was no difference in IOP change between the smaller and larger diameter lenses (P=0.590).

Conclusions:

Well-fitted scleral lenses do not result in clinically significant changes in intraocular pressure during 5-hr lens wear in young and healthy individuals.
Orbital Involvement in Acute Adult Leukemias: Case Series and Review of Literature
Authors: Chen Teresa H. , Roelofs Kelsey A. , Goh Tracie , Pullarkat Sheeja , Goldberg Robert A. , Rootman Daniel B.
Published: July 2023

Orbital involvement in acute myeloid leukemia (AML) and acute lymphoblastic leukemia (ALL) is well-described in children but is uncommon in adults. This series reports 2 adult patients with orbital leukemic involvement and summarizes the existing literature. A 37-year-old male with recently diagnosed AML underwent induction therapy and subsequently developed a tan-pink colored sub-conjunctival lesion in the left eye. Incisional biopsy confirmed AML. A 35-year-old male with history of ALL presented with left-sided orbital mass. Fine needle aspiration biopsy confirmed ALL. Literature review of adult-onset orbital leukemia yielded 29 cases of AML and 3 cases of ALL. Orbital involvement of acute adult-onset leukemia tends to be unilateral, presents in the extraconal space and can occur at any point during systemic leukemic disease. Chemotherapy is the mainstay of treatment, often in combination with radiation and/or hematopoietic stem cell transplant.