bluuebunny/crossref_metadata_2025 huggingface dataset:
Racial–Ethnic Disparities in Dual-Function Life Expectancy
Authors: Bauldry Shawn , Thomas Patricia A , Sauerteig-Rolston Madison R , Ferraro Kenneth F
Published: February 2023

Background

This study develops a new concept, dual functionality, that integrates physical and cognitive function. We use the concept to define a measure of dual-function life expectancy (2FLE) and assess racial–ethnic inequalities in aging.

Methods

Drawing on data from the National Health Interview Survey Linked Mortality Files and the Health and Retirement Study, we define dual functionality as having no limitations in activities of daily living and being free of dementia. We use this measure and Sullivan life tables to estimate age-50 total life expectancy and age-50 2FLE for women and men across 4 racial–ethnic and nativity groups.

Results

At ages 50–54, between 79.0% (95% CI: 73.5, 84.5) and 87.6% (95% CI: 84.0, 91.2) of (non-Hispanic) Black, foreign-born Hispanic, and U.S.-born Hispanic women and men remain dual functional as compared with 90.4% (95% CI: 89.3, 91.4) and 91.4% (95% CI: 90.2, 92.5) of (non-Hispanic) White women and men, respectively. These and corresponding racial–ethnic disparities in dual functionality through ages 85 and older translate into substantial inequalities in 2FLE. For instance, the Black–White gap in age-50 2FLE is 6.9 years (95% CI: −7.5, −6.4) for women and 6.0 years (95% CI: −6.6, −5.4) for men.

Conclusions

Black, foreign-born Hispanic, and U.S.-born Hispanic older adults are estimated to live a smaller percentage of their remaining years with dual functionality than White older adults. These results reveal stark racial–ethnic inequalities in aging that have significant implications for quality of life, caregiving, and health needs.
Efficacy and Tolerance of Thalidomide in Patients With Very Early Onset Inflammatory Bowel Disease
Authors: Bramuzzo Matteo , Giudici Fabiola , Arrigo Serena , Lionetti Paolo , Zuin Giovanna , Romano Claudio , Graziano Francesco , Faraci Simona , Alvisi Patrizia , Signa Sara , Scarallo Luca , Martelossi Stefano , Di Leo Grazia
Published: February 2023

Background

Few drugs have been studied for patients with very early onset inflammatory bowel disease (VEOIBD). This study aimed to evaluate the efficacy and tolerance of thalidomide in children with VEOIBD compared with children with pediatric-onset IBD (pIBD).

Methods

A retrospective cohort study with a control group was conducted. Propensity score 1:1 matching was used to identify control subjects. The treatment persistence; the causes of drug withdrawal; the rate of clinical remission and mucosal healing at 1, 2, and 3 years; and adverse events (AEs) were evaluated in children with VEOIBD treated with thalidomide and compared with children with pIBD.

Results

Thirty-nine courses of treatment with thalidomide in VEOIBD and pIBD patients were compared. The treatment persistence at 1, 2, and 3 years was 68.2% (95% confidence interval [CI], 50.8%-80.6%), 57.0% (95% CI, 39.6%-71.1%), and 50.9% (95% CI, 33.7%-65.8%) for VEOIBD patients and 81.7% (95% CI, 65.3%-90.9%), 60.0% (95% CI, 41.7%-74.3%) and 33.0% (95% CI, 17.4%-49.5%) for pIBD patients, respectively (P = .12). A significantly higher proportion of VEOIBD patients discontinued therapy due to lack of efficacy (48.2% vs 17.2%; P = .03), while AEs were the main reason for discontinuation in pIBD patients. Clinical remission and mucosal healing rates did not significantly differ between VEOIBD and pIBD patients. A significatively lower number of VEOIBD patients experienced AEs compared with pIBD patients (14 [35.9%] vs 30 [76.9%]; P = .0005).

Conclusions

Thalidomide is an effective and tolerated treatment in children with VEOIBD. Discontinuation due to lack of efficacy is more frequent, but AEs are less common than in children with pIBD.
Climate change and growth
Authors: Stern Nicholas , Stiglitz Joseph E
Published: February 2023

Contrary to much of the conventional wisdom, taking stronger actions on climate change may enhance economic growth, even as conventionally measured, but even more so, in terms of societal well-being. We identify the flaws in the models and analyses which contend that there must be a trade-off and explain the mechanisms and dynamic forces which have the potential to enhance growth. Critically, there are numerous market failures that result in suboptimal economic performance. We explain how addressing climate change reduces the bite of these failures and enhances the incentives and political will to address them. We identify packages of policies that alleviate market failures, enhance growth, and reduce carbon emissions. Finally, we argue that the green transition is coming at a time when, both because of persistent deficiencies of aggregate demand and advances in technology, including artificial intelligence and robotization, the macroeconomic opportunity costs of strong climate actions may be especially low and the benefits particularly high.
Effects of dietary zinc oxide levels on the metabolism of zinc and copper in weaned pigs
Authors: Dalto Danyel Bueno , Audet Isabelle , Roy Caroline , Novais Aliny Kétilim , Deschêne Karine , Goulet Katherine , Matte J Jacques , Lapointe Jérôme
Published: February 2023

This study compared different dietary zinc oxide (ZnO) levels on zinc (Zn) and copper (Cu) metabolism in weaned pigs. One hundred twenty weaned piglets (7.96 ± 1.17 kg; 21 d of age) were used in a completely randomized 3 × 4 factorial design composed with three levels of dietary ZnO at 100 (100Zn), 1,000 (1,000Zn), or 3,000 mg/kg (3,000Zn) and four ages at slaughter at 21 (day 21), 23 (day 23), 35 (day 35), and 42 d (day 42). Dietary Cu levels were constant at 130 mg/kg. Serum, jejunum, liver, and kidney levels of Zn and Cu as well as mRNA abundance of genes related to Zn and Cu metabolism were analyzed. Zinc levels were greatest in 3,000Zn piglets from day 35 in all tissues (P ≤ 0.01). In 3,000Zn piglets, mRNA expression of ZIP4 was reduced in jejunum whereas ZnT1 and MT3 were stimulated in jejunum and liver and MT1 in kidney (P ≤ 0.04) from day 35. Copper levels were greatest in jejunum (P = 0.06) and kidney (P ≤ 0.01; days 35 and 42 only) and lowest in liver and serum (P ≤ 0.01) of 3,000Zn piglets. In conclusion, the treatment containing 3,000 mg ZnO/kg triggered Zn homeostatic mechanisms in weaned pigs and impaired Cu metabolism through high enterocyte and kidney Cu sequestration.
Astrology, plague, and prognostication in early modern England: A forgotten chapter in the history of public health
Authors: Pfeffer Michelle
Published: February 2023

The ability to foresee the outbreak of epidemic disease, and to predict its course, is a highly coveted skill. Most often associated with statistical techniques, such efforts to improve the health of communities are thought to be exclusively modern. Public health more generally is often said to be categorically distinct from pre-modern medicine, which was interested above all in individual patients and rarely considered the broader health of a population. This article challenges these long-entrenched views by showcasing early modern astrologers at work on disease at the population level. Located at the intersection of medicine and mathematics, astrology was once a promising methodology for monitoring the health of the people. Astrologers made annual predictions about the diseases that would predominate in particular regions, disseminating their forecasts widely alongside advice on what should be done in response. Their ability to think in terms of relatively standardized ‘populations’ — alongside their attempts to correlate the incidence of disease with external factors — made astrologers prime candidates for developing novel approaches to epidemics. Before the epidemiologist there was the astrologer, who looked to the stars to find patterns between celestial configurations and major health events, using their findings to model the rise and fall of epidemics.
Distribution-free model for community detection
Authors: Qing Huan
Published: February 2023

Community detection for unweighted networks has been widely studied in network analysis, but the case of weighted networks remains a challenge. This paper proposes a general distribution-free model (DFM) for weighted networks in which nodes are partitioned into different communities. DFM can be seen as a generalization of the famous stochastic block models from unweighted networks to weighted networks. DFM does not require prior knowledge of a specific distribution for elements of the adjacency matrix but only the expected value. In particular, signed networks with latent community structures can be modeled by DFM. We build a theoretical guarantee to show that a simple spectral clustering algorithm stably yields consistent community detection under DFM. We also propose a four-step data generation process to generate adjacency matrices with missing edges by combining DFM, noise matrix, and a model for unweighted networks. Using experiments with simulated and real datasets, we show that some benchmark algorithms can successfully recover community membership for weighted networks generated by the proposed data generation process.
Automatic hermiticity for mixed states
Authors: Nagao Keiichi , Nielsen Holger Bech
Published: February 2023

We previously proposed a mechanism to effectively obtain, after a long time development, a Hamiltonian being Hermitian with regard to a modified inner product IQ that makes a given non-normal Hamiltonian normal by using an appropriately chosen Hermitian operator Q. We studied it for pure states. In this letter we show that a similar mechanism also works for mixed states by introducing density matrices to describe them and investigating their properties explicitly both in the future-not-included and future-included theories. In particular, in the latter, where not only a past state at the initial time TA but also a future state at the final time TB is given, we study a couple of candidates for it, and introduce a “skew density matrix” composed of both ensembles of the future and past states such that the trace of the product of it and an operator ${\cal O}$ matches a normalized matrix element of ${\cal O}$. We argue that the skew density matrix defined with IQ at the present time t for large TB − t and large t − TA approximately corresponds to another density matrix composed of only an ensemble of past states and defined with another inner product $I_{Q_J}$ for large t − TA.
Opportunity or responsibility? Tracing co-creation in the European policy discourse
Authors: Ruess Anja K , Müller Ruth , Pfotenhauer Sebastian M
Published: February 2023

Co-creation seems to be flourishing across innovation policy discourses: The concept suggests that engaging diverse actors throughout innovation processes will unlock new sources of innovation and conduce robust outcomes. While co-creation seems to embrace new and diverse participation opportunities, it is necessary to interrogate how it affects existing notions of public engagement. In this paper, we explore the discursive uptake of co-creation in European innovation policy. Drawing on a qualitative discourse analysis of European Union (EU) publications, we scrutinize the value propositions of co-creation and discuss them in light of the existing public engagement literature. We find that the EU tends to foreground alleged economic benefits of co-creation over questions of social justice. To that effect, it consistently conflates citizens, consumers, and users and blurs the line between self-motivated opportunity and democratic legitimacy. Countering the prevalent co-creation optimism, we propose a more nuanced outlook on co-creation that should prompt further scholarly inquiry.
Live and (Let) Die – Shifting Legitimacies and Organizational Mortality in American Higher Education, 1944–2018
Authors: Zapp Mike , Dahmen Clarissa
Published: February 2023

Sociologists of U.S. higher education have emphasized the sector’s historical expansion, which has limited the attention given to the dynamics of organizational closure. Drawing on an original dataset comprising colleges and universities across all sectors and tiers, we show how general expansion is tempered by 354 organizational closures between 1944 and 2018. Closures cluster in time between 1964 and 1974 and after 2008 reflecting shifting causes of and responses to legitimacy loss. Analyses provide support for hypotheses drawn from institutional theory, and, while controlling for a number of variables, identify two main causes of college mortality. These are demographic exclusivity, i.e., women’s and (historically) Black college status, and accreditation. Mortality of exclusionary institutions is further associated with social activism and the system-wide diffusion of related group-differentiated study programs, particularly in the period 1944–1979. By contrast, accreditation becomes more important in the post-1980 period.
Insulin Infusion Dosing in Pediatric Diabetic Ketoacidosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials
Authors: Forestell Ben , Battaglia Frank , Sharif Sameer , Eltorki Mohamed , Samaan M. Constantine , Choong Karen , Rochwerg Bram
Published: February 2023

OBJECTIVES:

In children with diabetic ketoacidosis (DKA), insulin infusions are the mainstay of treatment; however, optimal dosing remains unclear. Our objective was to compare the efficacy and safety of different insulin infusion doses for the treatment of pediatric DKA.

DATA SOURCES:

We searched MEDLINE, EMBASE, PubMed, and Cochrane from inception to April 1, 2022.

STUDY SELECTION:

We included randomized controlled trials (RCTs) of children with DKA comparing intravenous insulin infusion administered at 0.05 units/kg/hr (low dose) versus 0.1 units/kg/hr (standard dose).

DATA EXTRACTION:

We extracted data independently and in duplicate and pooled using a random effects model. We assessed the overall certainty of evidence for each outcome using the Grading Recommendations Assessment, Development and Evaluation approach.

DATA SYNTHESIS:

We included four RCTs (n = 190 participants). In children with DKA, low-dose compared with standard-dose insulin infusion probably has no effect on time to resolution of hyperglycemia (mean difference [MD], 0.22 hr fewer; 95% CI, 1.19 hr fewer to 0.75 hr more; moderate certainty), or time to resolution of acidosis (MD, 0.61 hr more; 95% CI, 1.81 hr fewer to 3.02 hr more; moderate certainty). Low-dose insulin infusion probably decreases the incidence of hypokalemia (relative risk [RR], 0.65; 95% CI, 0.47–0.89; moderate certainty) and hypoglycemia (RR, 0.37; 95% CI, 0.15–0.80; moderate certainty), but may have no effect on rate of change of blood glucose (MD, 0.42 mmol/L/hr slower; 95% CI, 1 mmol/L/hr slower to 0.18 mmol/L/hr faster; low certainty).

CONCLUSIONS:

In children with DKA, the use of low-dose insulin infusion is probably as efficacious as standard-dose insulin, and probably reduces treatment-related adverse events. Imprecision limited the certainty in the outcomes of interest, and the generalizability of the results is limited by all studies being performed in a single country.
COVID-19: Attacks Immune Cells and Interferences With Antigen Presentation Through MHC-Like Decoy System
Authors: Liu Wenzhong , Li Hualan
Published: February 2023

The high mortality of coronavirus disease 2019 is related to poor antigen presentation and lymphopenia. Cytomegalovirus and the herpes family encode a series of major histocompatibility complex (MHC)-like molecules required for targeted immune responses to achieve immune escape. In this present study, domain search results showed that many proteins of the severe acute respiratory syndrome coronavirus 2 virus had MHC-like domains, which were similar to decoys for the human immune system. MHC-like structures could bind to MHC receptors of immune cells (such as CD4+ T-cell, CD8+ T-cell, and natural killer-cell), interfering with antigen presentation. Then the oxygen free radicals generated by E protein destroyed immune cells after MHC-like of S protein could bind to them. Mutations in the MHC-like region of the viral proteins such as S promoted weaker immune resistance and more robust transmission. S 127–194 were the primary reason for the robust transmission of delta variants. The S 144–162 regulated the formation of S trimer. The mutations of RdRP: G671S and N: D63G of delta variant caused high viral load. S 62–80 of alpha, beta, lambda variants were the important factor for fast-spreading. S 616–676 and 1014–1114 were causes of high mortality for gamma variants infections. These sites were in the MHC-like structure regions.
Food Insecurity and COVID-19 Vaccination Status and Vaccination Hesitancy in the United States
Authors: Testa Alexander , Sharma Bonita B.
Published: February 2023

During the COVID-19 pandemic, vaccination hesitancy emerged as a factor that impacted vaccine uptake. In addition, during this period, there was a substantial increase in food insecurity in the United States (US). However, there is a lack of research on the potential connection between food insecurity and COVID-19 vaccine intentions. This study assesses whether experiencing food insecurity during the COVID-19 pandemic is associated with COVID-19 vaccination uptake and vaccination hesitancy. Data were from the 2021 Crime, Health, and Politics Survey, a national probability sample of community-dwelling adults 18 years and older living in the US (N = 1741) conducted from May 10, 2021, to June 1, 2021. Results from multinomial logistic regression analyses found that mild food insecurity and moderate-to-severe food insecurity were associated with an increased relative risk of not planning to get the COVID-19 vaccination compared with having been vaccinated or planning to get vaccinated. Moderate-to-severe food insecurity was associated with an increased risk of being unsure about getting the COVID-19 vaccine. The results suggest that efforts to expand vaccination and health literacy outreach to food-insecure populations are essential steps to promote greater health equity.
Perspectives of Primary Care Clinicians on the Diagnosis and Treatment of Pediatric Hypertension
Authors: Carroll Allison J. , Mohanty Nivedita , Wallace Andrea S. , Langman Craig B. , Smith Justin D.
Published: February 2023

The purpose of this study was to contextualize the challenges of diagnosing and managing pediatric hypertension (pHTN) in federally qualified health centers. We conducted a survey among primary care clinicians (N = 72) who treat children (3-17 years old) in a national network of health centers. Clinicians reported practices of blood pressure (BP) measurement, barriers to diagnosis and management of pHTN, and use of population health tools. Most clinicians (83%) used electronic devices to measure BP, only 49% used manual BP readings for follow-up measurements, and more than half measured BP at each encounter. The highest-rated barrier to pHTN management was lack of comfort with antihypertensive medications (71% of respondents). Few clinicians (10%) had used population health tools, but most (78%) indicated they would like to use them for pHTN. These results offer clinician-level insights regarding implementation of the pHTN guideline in pediatric primary care settings.
Improving Relational Functioning in Mother-Daughter Dyads With Obesity
Authors: Marquez Becky , Lebensohn-Chialvo Florencia , Huang Xinyi , Zhang Xinlian , Allison Matthew
Published: February 2023

Family-level interventions have the potential to address intergenerational obesity among Mexican American women. Given that poor family functioning is associated with worse weight loss outcomes, this study tested a weight management program aimed at improving relational functioning in mothers and daughters with obesity. Mexican American mothers and their adult daughters were randomly assigned to participate in a 16-week group-based standard behavioral (SB) weight loss program without or with relationship skills training (SRT). Relational functioning was assessed via observational behavioral coding using the Global Structural Family Rating Scale. General relational functioning and specifically positive alliance patterns and conflict avoidance improved significantly more in the SRT group than in the SB group. Average weight changes included percent weight loss of −5.6% in the SRT group versus −3.9% in the SB group and body mass index reduction of −2.2 kg/m2 in the SRT group versus −1.2 kg/m2 in the SB group. More participants in the SRT group (75%) than in the SB group (40%) tended to achieve at least 3% weight loss. Greater changes in positive alliance patterns increased the likelihood of losing 3% of body weight. Improving relational functioning in mother-daughter dyads may promote favorable outcomes in a behavioral weight loss intervention.
Evolution of a Plastic Surgery Summer Research Program: Lessons Learned from Programmatic Evaluation and Quality Enhancement
Authors: Alfonso Allyson R. , Berman Zoe P. , Diep Gustave K. , Lee Jasmine , Ramly Elie P. , Diaz-Siso J. Rodrigo , Rodriguez Eduardo D. , Rabbani Piul S.
Published: February 2023

Background:

Early surgical exposure and research fellowships can influence medical students’ specialty choice, increase academic productivity, and impact residency match. However, to our knowledge, there is no published guidance on the programmatic evaluation and quality enhancement necessary for the sustainability of formal plastic surgery summer research programs for first year medical students. We present seven years (2013–2020) of institutional experience in an effort to inform program development at other institutions.

Methods:

From 2013 to 2016, a sole basic science research arm existed. In 2017, a clinical research arm was introduced, with several supplemental activities, including surgical skills curriculum. A formalized selection process was instituted in 2014. Participant feedback was analyzed annually. Long-term outcomes included continued research commitment, productivity, and residency match.

Results:

The applicant pool reached 96 applicants in 2019, with 85% from outside institutions. Acceptance rate reached 7% in 2020. With adherence to a scoring rubric for applicant evaluation, good to excellent interrater reliability was achieved (intraclass correlation coefficient = 0.75). Long-term outcomes showed that on average per year, 28% of participants continued involvement in departmental research and 29% returned for dedicated research. Upon finishing medical school, participants had a mean of 7 ± 4 peer-reviewed publications. In total, 62% of participants matched into a surgical residency program, with 54% in integrated plastic surgery.

Conclusions:

A research program designed for first year medical students interested in plastic surgery can achieve academic goals. Students are provided with mentorship, networking opportunities, and tools for self-guided learning and career development.
Breast Reconstruction Trends in the Setting of Postmastectomy Radiation Therapy: Analysis of Practices among Plastic Surgeons in the United States
Authors: Khavanin Nima , Yang Jerry H. , Colakoglu Salih , Tuano Krystle R. , Wong Jeffrey O. , Cohen Justin B. , Chong Tae W. , Reddy Sashank , Mathes David W. , Kaoutzanis Christodoulos
Published: February 2023

Background:

Radiation is an integral part of breast cancer therapy. The ideal type and timing of breast reconstruction with relation to radiation delivery are not well established. The study aimed to identify reconstructive practices among American plastic surgeons in the setting of pre- and postmastectomy radiation.

Methods:

A cross-sectional survey of members of the American Society of Plastic Surgery was performed. Practice/demographic information and breast reconstruction protocols were queried. Univariate descriptive statistics were calculated, and outcomes were compared across cohorts with χ2 and Fischer exact tests.

Results:

Overall, 477 plastic surgeons averaging 16.3 years in practice were surveyed. With respect to types of reconstruction, all options were well represented, although nearly 60% preferred autologous reconstruction with prior radiation and 55% preferred tissue expansion followed by implant/autologous reconstruction in the setting of unknown postoperative radiation. There was little consensus on the optimal timing of reconstruction in the setting of possible postoperative radiation. Most respondents wait 4–6 or 7–12 months between the end of radiation and stage 2 implant-based or autologous reconstruction. Common concerns regarding the effect of radiation on reconstructive outcomes included mastectomy flap necrosis, wound dehiscence, capsular contracture, tissue fibrosis, and donor vessel complications.

Conclusions:

Despite considerable research, there is little consensus on the ideal type and timing of reconstruction in the setting of pre- and postoperative radiation. Understanding how the current body of knowledge is translated into clinical practice by different populations of surgeons allows us to forge a path forward toward more robust, evidence-based guidelines for patient care.
Healthcare Providers and Parents Highlight Challenges of Pediatric Hand Fracture Care
Authors: Lafreniere Ann-Sophie , Baykan Altay , Hartley Rebecca , Ronksley Paul , Love Shannan , Harrop Alan Robertson , Fraulin Frankie O.G. , Campbell Dave J.T. , Donald Maoliosa
Published: February 2023

Background:

Pediatric hand fractures are common, and many are referred to hand surgeons despite less than 10% of referrals requiring surgical intervention. We explored healthcare provider and parent perspectives to inform a new care pathway.

Methods:

We conducted a qualitative descriptive study using virtual focus groups. Emergency physicians, hand therapists, plastic surgeons, and parents of children treated for hand fractures were asked to discuss their experiences with existing care for pediatric hand fractures, and perceptions surrounding the implementation of a new care pathway. Data were analyzed using directed content analysis with an inductive approach.

Results:

Four focus groups included 24 participants: 18 healthcare providers and six parents. Four themes were identified: educating parents throughout the hand fracture journey, streamlining the referral process for simple hand fractures, identifying the most appropriate care provider for simple hand fractures, and maintaining strong multidisciplinary connections to facilitate care. Participants described gaps in the current care, including a need to better inform parents, and elucidated the motivations behind emergency medicine physicians’ existing referral practices. Participants also generally agreed on the need for more efficient management of simple hand fractures that do not require surgical care. Healthcare providers believed the strong preexisting relationship between surgeons and hand therapists would facilitate the changes brought forward by the new care pathway.

Conclusion:

These findings highlighted shortcomings of existing care for pediatric hand fractures and will inform the co-development and implementation of a new care pathway to enable more efficient management while preserving good patient outcomes.
A Simple Surgical Solution for Functional Improvement of Deforming Vascular Malformations with Lip Involvement
Authors: King Brody W. , Anderson Eric W. , Sudduth Jack D. , Marquez Jessica L. , Dunklebarger Mitch , Collar-Yagas Lucia , Gociman Barbu
Published: February 2023

The management of large, deforming facial arteriovenous malformations (AVMs) can be a daunting clinical challenge for patients and surgeons. Many patients delay treatment due to fear of surgical intervention and concern for unfavorable cosmetic outcomes. Delaying treatment can lead to soft-tissue hypertrophy. Occasionally, facial AVMs can also present with lip involvement, necessitating surgical intervention. A major potential issue regarding AVMs managed with surgical excision is excessive bleeding due to the enlarged dermal vascular plexus. Here, we present a simple surgical technique used to manage deforming AVMs involving the lips. A 32-year-old man with Sturge-Weber syndrome and a 72-year-old man with AVMs of the left face presented to clinic for management. The malformations involved the lips in both patients. Both patients had constant drooling and difficulty eating and talking, in addition to aesthetic concerns. They both underwent surgical excision of the redundant tissue with minimal undermining, advancement flaps, and layered closure. Minimal undermining allowed successful removal of the AVMs and redundant tissue without excessive blood loss and allowed healing without complications. Both patients had significant improvement in eating and talking without drooling. Aesthetically, satisfactory outcomes were maintained at 1-year follow-up appointments. Removal of AVMs while minimizing blood loss can be a challenging endeavor. Here, we have presented a successful, effective technique for restoring both form and function in patients with AVMs involving the lips, with good long-term results.
The Insurance Landscape for Implant- and Autologous-based Breast Reconstruction in the United States
Authors: Boyd Louisa C. , Greenfield Jason A. , Ainapurapu Sravya S. , Skladman Rachel , Skolnick Gary , Sundaramoorthi Durai , Sacks Justin M.
Published: February 2023

Background:

Insurance coverage of postmastectomy breast reconstruction is mandated in America, regardless of reconstructive modality. Despite enhanced patient-reported outcomes, autologous reconstruction is utilized less than nonautologous reconstruction nationally. Lower reimbursement from Medicare and Medicaid may disincentivize autologous-based reconstruction. This study examines the impact of insurance and sociodemographic factors on breast reconstruction.

Methods:

A retrospective analysis of the Healthcare Cost and Utilization Project National Inpatient Sample Database from 2014 to 2017 was performed. International Classification of Diseases Clinical Modification and Procedure Coding System codes were used to identify patients for inclusion. De-identified sociodemographic and insurance data were analyzed using χ
2, least absolute shrinkage and selection operator regression analysis, and classification trees.

Results:

In total, 31,468 patients were identified for analysis and stratified by reconstructive modality, sociodemographics, insurance, and hospital characteristics. Most patients underwent nonautologous reconstruction (63.2%). Deep inferior epigastric perforator flaps were the most common autologous modality (46.7%). Least absolute shrinkage and selection operator regression identified Black race, urban-teaching hospitals, nonsmoking status, and obesity to be associated with autologous reconstruction. Publicly-insured patients were less likely to undergo autologous reconstruction than privately-insured patients. Within autologous reconstruction, publicly-insured patients were 1.97 (P < 0.001) times as likely to obtain pedicled flaps than free flaps. Black patients were 33% (P < 0.001) less likely to obtain free flaps than White patients.

Conclusions:

Breast reconstruction is influenced by insurance, hospital demographics, and sociodemographic factors. Action to mitigate this health disparity should be undertaken so that surgical decision-making is solely dependent upon medical and anatomic factors.
p16 INK4A drives nonalcoholic fatty liver disease phenotypes in high fat diet fed mice through biliary E2F1/FOXO1/IGF-1 signaling
Authors: Kundu Debjyoti , Kennedy Lindsey , Zhou Tianhao , Ekser Burcin , Meadows Vik , Sybenga Amelia , Kyritsi Konstantina , Chen Lixian , Ceci Ludovica , Wu Nan , Wu Chaodong , Glaser Shannon , Carpino Guido , Onori Paolo , Gaudio Eugenio , Alpini Gianfranco , Francis Heather
Published: February 2023

Background and Aims:

NAFLD is characterized by steatosis, hepatic inflammation, and fibrosis, which can develop into NASH. Patients with NAFLD/NASH have increased ductular reaction (DR) and biliary senescence. High fat/high cholesterol diet feeding increases biliary senescence, DR, and biliary insulin-like growth factor-1 (IGF-1) expression in mice. p16/IGF-1 converges with fork-head box transcription factor O1 (FOXO1) through E2F1. We evaluated p16 inhibition on NAFLD phenotypes and biliary E2F1/FOXO1/IGF-1 signaling.

Approach and Results:

4-week wild-type (C57BL/6J) male mice were fed a control diet (CD) or high fat/high cholesterol diet and received either p16 or control Vivo Morpholino (VM) by tail vein injection 2× during the 16th week of feeding. We confirmed p16 knockdown and examined: (i) NAFLD phenotypes; (ii) DR and biliary senescence; (iii) serum metabolites; and (iv) biliary E2F1/FOXO1/IGF-1 signaling. Human normal, NAFLD, and NASH liver samples and isolated cholangiocytes treated with control or p16 VM were evaluated for p16/E2F1/FOXO1/IGF-1 signaling. p16 VM treatment reduced cholangiocyte and hepatocyte p16. In wild-type high fat/high cholesterol diet mice with control VM, there were increased (i) NAFLD phenotypes; (ii) DR and biliary senescence; (iii) serum metabolites; and (iv) biliary E2F1/FOXO1/IGF-1 signaling; however, p16 VM treatment reduced these parameters. Biliary E2F1/FOX-O1/IGF-1 signaling increased in human NAFLD/NASH but was blocked by p16 VM. In vitro, p16 VM reduced biliary E2f1 and Foxo1 transcription by inhibiting RNA pol II binding and E2F1 binding at the Foxo1 locus, respectively. Inhibition of E2F1 reduced biliary FOXO1 in vitro.

Conclusion:

Attenuating hepatic p16 expression may be a therapeutic approach for improving NAFLD/NASH phenotypes.
Treatment of chronic hepatitis D with peginterferon lambda—the phase 2 LIMT-1 clinical trial
Authors: Etzion Ohad , Hamid Saeed , Lurie Yoav , Gane Edward J. , Yardeni David , Duehren Sarah , Bader Nimrah , Nevo-Shor Anat , Channa Saleh Muhammad , Cotler Scott J. , Mawani Minaz , Parkash Om , Dahari Harel , Choong Ingrid , Glenn Jeffrey S.
Published: February 2023

Background and Aims:

HDV infection leads to the most aggressive form of human viral hepatitis for which there is no FDA-approved therapy. PEG IFN-lambda-1a (Lambda) has previously demonstrated a good tolerability profile in HBV and HCV patients compared to PEG IFN-alfa. The goal of Phase 2 LIMT-1 trial was to evaluate the safety and efficacy of Lambda monotherapy in patients with HDV.

Approach and Results:

An open-label study of Lambda 120 or 180 mcg, administered once weekly by subcutaneous injections for 48 weeks, followed by 24 weeks of posttreatment follow-up. Thirty-three patients were allocated to Lambda 180 mcg (n=14) or 120 mcg (n=19). Baseline mean values: HDV RNA 4.1 log10 IU/mL (SD±1.4); ALT 106 IU/L (35–364); and bilirubin 0.5 mg/dL (0.2–1.2). Intention-to-treat rates of virologic response to Lambda 180 mcg and 120 mcg, 24 weeks following treatment cessation were 5 of 14(36%) and 3 of 19 (16%), respectively. The posttreatment response rate of 50% was seen in low BL viral load (≤4 log10) on 180 mcg. Common on-treatment adverse events included flu-like symptoms and elevated transaminase levels. Eight (24%) cases of hyperbilirubinemia with or without liver enzyme elevation, leading to drug discontinuation, were mainly observed in the Pakistani cohort. The clinical course was uneventful, and all responded favorably to dose reduction or discontinuation.

Conclusions:

Treatment with Lambda in patients with chronic HDV may result in virologic response during and following treatment cessation. Clinical phase 3 development of Lambda for this rare and serious disease is ongoing.
P4HA2 induces hepatic ductular reaction and biliary fibrosis in chronic cholestatic liver diseases
Authors: Zhang Jun , Lyu Zhuwan , Li Bo , You Zhengrui , Cui Nana , Li You , Li Yikang , Huang Bingyuan , Chen Ruiling , Chen Yong , Peng Yanshen , Fang Jingyuan , Wang Qixia , Miao Qi , Tang Ruqi , Gershwin M. Eric , Lian Min , Xiao Xiao , Ma Xiong
Published: February 2023

Backgrounds:

Prolyl-4-hydroxylases (P4Hs) are key enzymes in collagen synthesis. The P4HA subunit (P4HA1, P4HA2, and P4HA3) contains a substrate binding and catalyzation domain. We postulated that P4HA2 would play a key role in the cholangiocyte pathology of cholestatic liver diseases.

Methods:

We studied humans with primary biliary cholangitis (PBC) and Primary sclerosing cholangitis (PSC), P4HA2-/- mice injured by DDC, and P4HA2-/-/MDR2-/- double knockout mice. A parallel study was performed in patients with PBC, PSC, and controls using immunohistochemistry and immunofluorescence. In the murine model, the level of ductular reaction and biliary fibrosis were monitored by histology, qPCR, immunohistochemistry, and Western blotting. Expression of Yes1 Associated Transcriptional Regulator (YAP) phosphorylation was measured in isolated mouse cholangiocytes. The mechanism of P4HA2 was explored in RBE and 293T cell lines by using qPCR, Western blot, immunofluorescence, and co-immunoprecipitation.

Results:

The hepatic expression level of P4HA2 was highly elevated in patients with PBC or PSC. Ductular reactive cholangiocytes predominantly expressed P4HA2. Cholestatic patients with more severe liver injury correlated with levels of P4HA2 in the liver. In P4HA2-/- mice, there was a significantly reduced level of ductular reaction and fibrosis compared with controls in the DDC-induced chronic cholestasis. Decreased liver fibrosis and ductular reaction were observed in P4HA2-/-/MDR2-/- mice compared with MDR2-/- mice. Cholangiocytes isolated from P4HA2-/-/MDR2-/- mice displayed a higher level of YAP phosphorylation, resulting in cholangiocytes proliferation inhibition. In vitro studies showed that P4HA2 promotes RBE cell proliferation by inducing SAV1 degradation, eventually resulting in the activation of YAP.

Conclusions:

P4HA2 promotes hepatic ductular reaction and biliary fibrosis by regulating the SAV1-mediated Hippo signaling pathway. P4HA2 is a potential therapeutic target for PBC and PSC.
Portable sensing devices for smart healthcare and prevention of lead poisoning
Authors: Lai Wei-Qun , Huang Ta-Chou , Liang Kung-Hao , Chang Yu-Fen , Yang De-Ming
Published: February 2023

Lead (Pb) poisoning can damage human bodies silently, without specific symptoms or conspicuous warning signs. To provide safe and user-friendly tools for detecting heavy metals at low concentrations, scientists have developed and optimized versatile biosensors. To practically employ the developed biosensors specific for Pb (eg, the optimized Met-lead 1.44 M1), smartphone applications designed for user convenience and are easily operable for the on-site detection of Pb in environmental water, drinking water, food, and blood/urine are urgently needed. To establish a monitoring system for home health maintenance, a portable device and useful apps installed on a smartphone can be integrated, and the data acquired can be sent to and stored in the cloud for further analysis and evidence preservation. With the high transmissions speeds for 4G and 4G wireless Internet, such a system can be applied for health protection; water-quality data can be provided by anyone and publicly shared for display on smartphone interfaces, alerting individuals of heavy metal contamination. In this review, we describe recent developments in heavy metal–sensing devices, including home health maintenance systems, which have been successfully and practically applied to prevent heavy metal Pb poisoning.
Effect of respiratory training on respiratory failure secondary to unilateral phrenic nerve injury: A case report
Authors: Li Dawei , Li Zhendong , Zhang Zhiyou , Liu Yueyang , Wang Congcong , Cheng Aixia
Published: February 2023

Introduction:

Diaphragm is one of the most important respiratory muscles dominated by the phrenic nerve. Phrenic nerve injury would induce a series of clinical symptoms, including respiratory failure. Respiratory training could assist in regular treatment in improving the respiratory function and daily ability of respiratory failure patients.

Case presentation:

A 71-years-old female was enrolled for the disorders of consciousness of 4.5 hours observed by her family and was diagnosed with respiratory failure secondary to unilateral phrenic nerve injury. The patient received basic therapy combined with rehabilitation training, including the training of aspirate muscle, limb resistance, thoracic loosening, aerobic training, electrical stimulation on respiratory nerves, and airway clearance. The combining therapeutic strategy significantly improved the daily ability and respiratory of the patient. The ultrasound showed that after therapy, the diaphragmatic muscles were thickened and the range of diaphragmatic movement was also enhanced. The pulmonary function was also improved after therapy.

Conclusion:

The combination of rehabilitation is suitable for the treatment of respiratory failure patients with clear causes of phrenic nerve injury. For patients with unexplained causes, rehabilitation could also be performed before the diagnosis. Patients with irreversible injury need long-term and family rehabilitation prescriptions.
Adverse reactions and efficacy of camrelizumab in patients with lung adenocarcinoma with high PD-L1 expression: A case report
Authors: Wei Tingting , Wang Zhisheng , Liu Xinlan
Published: February 2023

Rationale:

Immune checkpoint inhibitors have been rapidly developed for lung cancer therapy and major clinical guidelines have recommended them as the optimal first-line treatment for PD-L1-positive advanced lung cancer. Unfortunately, there is a lack of efficient prediction tools for the occurrence of immune-related adverse events (irAEs) caused by immunotherapy, and there is a lack of real-world data on the processing of irAEs, particularly those occurring in multiple systems simultaneously.

Patient concerns:

We report a 62-year-old male with expectoration who was diagnosed with lung adenocarcinoma with brain and bone metastases.

Diagnoses:

The results of the lung cancer tissue biopsy showed lung adenocarcinoma. Gene detection results of lung cancer tissue biopsy showed that the KRAS gene G12D was mutated and PD-L1 was positive, with a tumor proportion score of 95% (Dako 22C3 IHC platform).

Interventions:

The patient initially received 1 cycle of pemetrexed in combination with cisplatin-based chemotherapy. After the results of PD-L1 testing were reported, he received 1 cycle of camrelizumab immunotherapy in combination with pemetrexed plus cisplatin based chemotherapy.

Outcomes:

Seventeen days after treatment, the patient presented with symptoms such as yellow staining of the sclera and skin, itching throughout the body, dry mouth, and ecchymosis of the skin of the right lower extremity, which continued to worsen. Following treatment with 2 mg/kg methylprednisolone, the patient’s condition continued to deteriorate. IrAEs were controlled after dose escalation to 8 mg/kg in combination with plasma exchange therapy and treatment with multiple doses of mycophenolate ester. The patient then received no treatment for almost 2 months, but examination revealed that the tumor still had a persistent shrinkage reaction.

Lessons:

Camrelizumab has been well tolerated in several studies, but in patients with high PD-L1 expression and a G12D mutation in KRAS, one should be alert to the development of serious or even multisystem immune-related adverse effects. Timely and individualized selection of the hormone dosage is essential for the treatment of immunotherapy-induced multisystem irAEs.
Screening and identification of hub-gene associated with brain metastasis in breast cancer
Authors: Li Xiao-Gang , Niu Chao , Lu Ping , Wan Hong-Wei , Jin Wen-Di , Wang Chun-Xiao , Mao Wen-Yuan , Zhang Zhi-Ping , Zhang Wan-Fu , Li Bo
Published: February 2023

Background:

The presence of breast cancer in the brain, also known as brain metastasis (BMS), is the primary reason for a bad prognosis in cases of breast cancer. Breast cancer is the most prevalent malignant tumor seen in women in developing nations. At present, there is no effective method to inhibit brain metastasis of breast cancer. Therefore, it is necessary to conduct a systematic study on BMS of breast cancer, which will not provide ideas and sites for follow-up studies on the treatment and inhibition of BMS.

Methods:

In this study, data set GSE43837 was screened from gene expression omnibus database, and then R language tool was used for differential analysis of its expression spectrum, The gene ontology functional enrichment and Kyoto encyclopedia of genes and genomes signal pathway enrichment analyses, as well as the interactive gene retrieval tool for hub-gene analysis, were performed.

Results:

According to the findings, the primary genes linked to breast cancer brain metastases are those that involve interactions between cytokines and their respective receptors and between neuroactive ligands and their respective receptors. The majority of the gene ontology enrichment took place in the extracellular structural tissues, the extracellular matrix tissues, and the second message-mediated signaling. We were able to identify 8 genes that are linked to breast cancer spreading to the brain. The gene score for matrix metallopeptidase1 (MMP-1) was the highest among them, and the genes MMP10, tumor necrosis factor alpha-inducible protein 8, collagen type I alpha 2 chain, vascular cell adhesion molecule 1, and TNF superfamily member 11 were all connected to 1 another in an interaction way.

Conclusions:

There is a possibility that the 8 key genes that were identified in this research are connected to the progression of BMS in breast cancer. Among them, MMP1 is 1 that has the potential to have a role in the diagnosis and treatment of BMS in breast cancer.
Effects of late evening snacks on glucose homeostasis in cirrhotic patients: A meta-analysis
Authors: Chen Ni , Qiu Xinze , Ruan Huaqiang , Huang Jiean , Liu Shiquan
Published: February 2023

Background:

Insulin resistance and hepatogenic diabetes are common complications in patients with liver cirrhosis. Previous studies have shown that reducing the fasting phase by supplying a late evening snack (LES) is a potential intervention to improve substrate utilization and liver function. However, the underlying mechanisms need to be further elucidated. The purpose of current meta-analysis is to evaluate effects of LES on glucose homeostasis in cirrhotic patients.

Methods:

Electronic databases including PubMed, Web of Science, and major scientific conference sessions were searched without language restriction and carried out on March 1, 2022 with an additional manual search of bibliographies of relevant articles. A total of 4145 studies were identified, and 10 studies were eligible for the meta-analysis, comprising 631 patients (319 in the LES group and 312 in the non-LES group). Subgroup analyses were performed to investigate the effect of LES on cirrhotic patients with or without diabetes.

Results:

Analysis showed that LES intervention had significant effects in cirrhotic patients for glycemic parameters on fasting plasma glucose, fasting insulin, and glycosylated hemoglobin respective effect sizes of −8.7, −0.86, and −0.76. Subgroup result revealed that the effect of LES on fasting plasma glucose is higher in cirrhotic patients with diabetes group than cirrhotic patients without diabetes group, and long-term LES supplementation (>2 months) was more beneficial to maintain glucose homeostasis in cirrhotic patients than that of short-term supplementation (<2 months). LES also had significant effect on nutritional metabolic parameters like including albumin and non-protein respiratory quotient.

Conclusion:

Meta-analysis indicated that LES not only improved malnutrition in cirrhotic patients with or without diabetes but also maintain glucose homeostasis in cirrhotic patients with diabetes. LES is a promising and simple intervention that beneficial to maintain glucose homeostasis in cirrhotic patients.