bluuebunny/crossref_metadata_2025 huggingface dataset:
On the BBM-Phenomenon in Fractional Poincaré–Sobolev Inequalities with Weights
Authors: Hurri-Syrjänen Ritva , Martínez-Perales Javier C , Pérez Carlos , Vähäkangas Antti V
Published: September 2022

In this paper, we unify and improve some of the results of Bourgain, Brezis, and Mironescu and the weighted Poincaré–Sobolev estimate by Fabes, Kenig, and Serapioni. More precisely, we get weighted counterparts of the Poincaré–Sobolev-type inequality and also of the Hardy type inequality in the fractional case under some mild natural restrictions. A main feature of the results we obtain is the fact that we keep track of the behavior of the constants involved when the fractional parameter approaches to $1$. Our main method is based on techniques coming from harmonic analysis related to the self-improving property of generalized Poincaré inequalities.
Multimodal attention-based deep learning for Alzheimer’s disease diagnosis
Authors: Golovanevsky Michal , Eickhoff Carsten , Singh Ritambhara
Published: September 2022

Objective

Alzheimer’s disease (AD) is the most common neurodegenerative disorder with one of the most complex pathogeneses, making effective and clinically actionable decision support difficult. The objective of this study was to develop a novel multimodal deep learning framework to aid medical professionals in AD diagnosis.

Materials and Methods

We present a Multimodal Alzheimer’s Disease Diagnosis framework (MADDi) to accurately detect the presence of AD and mild cognitive impairment (MCI) from imaging, genetic, and clinical data. MADDi is novel in that we use cross-modal attention, which captures interactions between modalities—a method not previously explored in this domain. We perform multi-class classification, a challenging task considering the strong similarities between MCI and AD. We compare with previous state-of-the-art models, evaluate the importance of attention, and examine the contribution of each modality to the model’s performance.

Results

MADDi classifies MCI, AD, and controls with 96.88% accuracy on a held-out test set. When examining the contribution of different attention schemes, we found that the combination of cross-modal attention with self-attention performed the best, and no attention layers in the model performed the worst, with a 7.9% difference in F1-scores.

Discussion

Our experiments underlined the importance of structured clinical data to help machine learning models contextualize and interpret the remaining modalities. Extensive ablation studies showed that any multimodal mixture of input features without access to structured clinical information suffered marked performance losses.

Conclusion

This study demonstrates the merit of combining multiple input modalities via cross-modal attention to deliver highly accurate AD diagnostic decision support.
Human Nature and Aspiring the Divine: On Antiquity and Transhumanism
Authors: Malanowski Sarah , Baima Nicholas R
Published: September 2022

Many transhumanists see their respective movement as being rooted in ancient ethical thought. However, this alleged connection between the contemporary transhumanist doctrine and the ethical theory of antiquity has come under attack. In this paper, we defend this connection by pointing out a key similarity between the two intellectual traditions. Both traditions are committed to the “radical transformation thesis”: ancient ethical theory holds that we should assimilate ourselves to the gods as far as possible, and transhumanists hold that we should enhance ourselves beyond the physical and intellectual parameters of being human so as to become posthuman. By considering the two views in tandem, we develop an account of the assimilation directive that is palatable to contemporary readers and provide a view of posthumanism worth wanting.
Assessing Oncologists’ Adoption of Biomarker Testing in Metastatic Colorectal Cancer Using Real-World Data
Authors: Iyer Pritish , Deng Mengying , Handorf Elizabeth A , Nakhoda Shazia , Dotan Efrat
Published: September 2022

Background

Despite national guideline recommendations for universal biomarker testing (KRAS, NRAS, BRAF, and mismatch repair and microsatellite instability [MMR/MSI]) in all patients with metastatic colorectal cancer (mCRC), little is known regarding adherence to these recommendations in routine practice.

Methods

We retrospectively reviewed patients with mCRC diagnosed between January 1, 2013, and December 27, 2018, from a de-identified electronic health record–derived database. We analyzed disparities in KRAS, NRAS, BRAF, and MMR/MSI testing by race, age, sex, and insurance status using χ2 tests and t tests. We evaluated changes in biomarker testing over time with attention to changes around dates of landmark publications and guideline updates using χ2 tests and Cochran-Armitage tests.

Results

A total of 20 333 patients were identified of which 66.6% had test results for any biomarker. Rates of test results for all 4 biomarkers statistically significantly increased over time (P < .001). However, as of June 30, 2018, the rate of test results was only 46% for NRAS, 56% for KRAS, and 46% for BRAF. As of December 31, 2017, the rate of MMR/MSI testing was 59%. Higher documented testing rates were associated with younger age, lower Eastern Cooperative Oncology Group performance status, and commercial insurance. There were no clinically meaningful and/or statistically significant differences in documented testing rates by tumor sidedness, race, sex, or initial stage.

Conclusions

Increased rates of documented testing for NRAS, BRAF, and MMR/MSI in mCRC was seen between 2013 and 2018 reflecting adoption of guideline recommendations. However, the rate of documented testing remains lower than expected and warrants additional research to understand the extent to which this may represent a clinical practice quality concern.
Recurrence patterns and progression-free survival after chemoradiotherapy with or without consolidation durvalumab for stage III non-small cell lung cancer
Authors: Kishi Noriko , Matsuo Yukinori , Shintani Takashi , Ogura Masakazu , Mitsuyoshi Takamasa , Araki Norio , Fujii Kota , Okumura Setsuko , Nakamatsu Kiyoshi , Kishi Takahiro , Atsuta Tomoko , Sakamoto Takashi , Ohtsu Shuji , Katagiri Tomohiro , Narabayashi Masaru , Fujishiro Satsuki , Iizuka Yusuke , Ozasa Hiroaki , Hirai Toyohiro , Mizowaki Takashi ,   Kyoto Radiation Oncology Study Group (KROSG)
Published: September 2022

Chemoradiotherapy followed by consolidation durvalumab (CCRT+D) improves survival in patients with stage III non-small-cell lung cancer (NSCLC). We compared recurrence patterns and survival in the CCRT+D and CCRT cohorts. We conducted a multicenter, retrospective study in Japan. Patients who received CCRT for stage III NSCLC were included in this study. Of 178 eligible patients, 136 were in the CCRT+D and 42 were in the CCRT cohorts. Locoregional recurrence (LR), LR plus distant metastases (DM), and DM were observed in 20.6%, 8.8%, 27.9% of the CCRT+D, and 26.2%, 16.7% and 33.3% of the CCRT cohorts, respectively. In-field recurrence was the most common LR pattern in both cohorts. Squamous cell carcinoma and PD-L1 expression < 1%, and female sex and EGFR mutations were significantly associated with an increased risk of LR and DM. In patients with any risk factors for LR, the incidence of LR was similar in the CCRT+D and CCRT (39.5% vs 45.5%). The 24 month progression-free survival (PFS) and overall survival (OS) were 40.3% and 69.4% in the CCRT+D and 24.7% and 61.0% in the CCRT cohorts, respectively. Poor performance status and no consolidation durvalumab were significantly associated with shorter PFS. There was a significant difference in PFS between the CCRT+D and CCRT in the propensity score-matched cohort (HR = 0.51, P = 0.005). In conclusion, consolidation durvalumab decreased both LR and DM, and significantly improved PFS. However, in-field recurrence was still a major problem, as well as DM.
The Second Canonization of the Qur’ān: A Review Article
Authors: Moqbel Tareq
Published: September 2022

Shady Nasser's monograph The Second Canonization of the Qur’ān is a significant intervention in the field of qirā’āt. The present article provides an analysis of the book. The main themes of the book are surveyed, and some of its arguments are presented, though not always free from criticism. The review also includes a discussion of various technical points which require amendment, others that invite investigation, as well as issues on which the present author has his doubts.
Resurgence of influenza A infections in children after the relaxation of COVID-19-related social distancing measures and normalization of international travel in Qatar
Authors: Pérez-López Andrés , Al Mana Hassan , Iqbal Muhammad , Suleiman Mohammed , Hasan Mohammad Rubayet , Tang Patrick
Published: September 2022

We report an off-season surge of influenza A infections among children in Qatar coinciding with the relaxation of COVID-19 related social restrictions and the normalization of international travel. The unusual surge may be related to population waning immunity after a prolonged reduced influenza A activity in Qatar.
A Pleiotropic Flowering Time QTL Exhibits Gene-by-Environment Interaction for Fitness in a Perennial Grass
Authors: Weng Xiaoyu , Haque Taslima , Zhang Li , Razzaque Samsad , Lovell John T , Palacio-Mejía Juan Diego , Duberney Perla , Lloyd-Reilley John , Bonnette Jason , Juenger Thomas E
Published: September 2022

Appropriate flowering time is a crucial adaptation impacting fitness in natural plant populations. Although the genetic basis of flowering variation has been extensively studied, its mechanisms in nonmodel organisms and its adaptive value in the field are still poorly understood. Here, we report new insights into the genetic basis of flowering time and its effect on fitness in Panicum hallii, a native perennial grass. Genetic mapping in populations derived from inland and coastal ecotypes identified flowering time quantitative trait loci (QTL) and many exhibited extensive QTL-by-environment interactions. Patterns of segregation within recombinant hybrids provide strong support for directional selection driving ecotypic divergence in flowering time. A major QTL on chromosome 5 (q-FT5) was detected in all experiments. Fine-mapping and expression studies identified a gene with orthology to a rice FLOWERING LOCUS T-like 9 (PhFTL9) as the candidate underlying q-FT5. We used a reciprocal transplant experiment to test for local adaptation and the specific impact of q-FT5 on performance. We did not observe local adaptation in terms of fitness tradeoffs when contrasting ecotypes in home versus away habitats. However, we observed that the coastal allele of q-FT5 conferred a fitness advantage only in its local habitat but not at the inland site. Sequence analyses identified an excess of low-frequency polymorphisms at the PhFTL9 promoter in the inland lineage, suggesting a role for either selection or population expansion on promoter evolution. Together, our findings demonstrate the genetic basis of flowering variation in a perennial grass and provide evidence for conditional neutrality underlying flowering time divergence.
Disability History and Greco-Roman Antiquity
Authors: Goodey C. F. , Rose M. Lynn
Published: September 2022

To obtain a historical perspective on disability, we need to know what questions people of the past asked about each other and thus how they grouped human types. This effort involves removing the carapace of modern forms of classification and avoiding their imposition on the primary sources of an era so distant from our own (“retrospective diagnosis”). At least three major forms are identifiable: (1) the post-Cartesian divide between mind and body; (2) the tightening of forms of human categorization in general since the late Middle Ages; and (3) the thoroughly modern divide between the scientific/medical and the social. Human disparities and putative disabilities, ranging widely from the ancient era to the start of the Middle Ages and including the body, the senses, cognition, speech, social behavior, and sexual make-up, are discussed. These may or may not correspond with modern categorizations.
Intellectual Disability in the European Middle Ages
Authors: Metzler Irina
Published: September 2022

This investigation of intellectual disability in the Middle Ages uncovers narratives of this perceived condition in the historical sources. Authors of normative texts, for instance, medical, legal, and natural-philosophical authorities, were the medieval equivalent of modern scientific experts with regard to defining, assessing, and controlling notions of intellectual disability. This new and specific discussion seeks to reframe the paradigm of what constituted intellectual disability at different periods in both medieval and modern times. Philosophically, and subsequently judicially, medieval intellectual disability was considered the absence of reason, representing the irrational, which contrasted the mentally disabled with the Aristotelian concept of the human being as the rational animal. Medieval terminology employed a fluidity of definitions, which highlights the constructedness of terms revolving around intellectual disability. Analyses of the culturally specific constructions of intellectual disability enhance our knowledge of the intellectual heritage underpinning current concepts of cognitive and mental pathologies.
Disability and the History of Eugenics
Authors: Rembis Michael
Published: September 2022

Eugenics is central to the history of disability in the nineteenth and twentieth centuries. Recently, scholars in a number of disciplines have debated whether the biopolitical regime that emerged in the waning decades of the twentieth century can be called “eugenic.” Some scholars claim that although distinctions can be made between an “old” eugenics (1860s–1950s) and a “new” eugenics (1960s–present), the basic tenets of eugenics have endured. Other scholars, Nikolas Rose being the most prominent among them, assert that the biopolitics at the turn of the twenty-first century is significantly different from the “old” eugenics and must be analyzed on its own terms. The question of whether one can write a “long” history of eugenics has animated a lively debate among historians. When viewed through the lens of disability, important continuities emerge between the history of eugenics and the current biopolitical regime.
Material Culture, Technology, and the Body in Disability History
Authors: Ott Katherine
Published: September 2022

Disability is created, measured, and supported through material culture. Technology, a kind of material culture, has an especially close relationship with disability in that it both supports daily activities and is often a primary element in defining who is of worth or qualifies as human. Some of the unique and complicated ways in which disability and material culture interact and intersect are presented here, highlighting such things as sensory and nonverbal information, material expression of inclusion and accessibility, definitions of technology, the prevalence of do-it-yourself solutions, and ideologies of assistance and independence. Also discussed is the use of two broad functions of technology, objects of activity and objects of worth, as an entry point into critical disability studies analysis.
Picturing Disability in Eighteenth-Century England
Authors: Turner David M.
Published: September 2022

The eighteenth century is often seen as a time when disability became increasingly marginalized in visual culture. However, a glimpse beyond the classical tastes of “high” art reveals not a disappearance but a flourishing of representations of physical and sensory difference. Eighteenth-century popular art and satirical prints examined the disabled body not just as a symbol of misfortune or target for medical intervention, but also as a source of pleasure or an object of satire that conveyed wider messages about the times. A rich and varied range of pictorial representations of disability in the long eighteenth century (ca. 1680–ca. 1830) contributed to social, cultural, and medical understandings of bodily difference in English culture. People with disabilities played important roles as artists, models, and critics in an era before modern “disability arts.”
Devices of future excellence: Detaching excellence recognition from ‘eminent men’
Authors: Bloch Roland , Mitterle Alexander
Published: September 2022

The global diffusion of the graduate school organizational model has shifted the way future academic excellence is identified from a paternalistic master–disciple relationship to a collective organizational decision. ‘Eminent men’ used to recruit PhD students on the firm belief that they could identify excellence and integrate it in their own scientific endeavor. Graduate schools formalize such judgments and transform them into an organizational decision. They establish admission devices to assure criteria-based collective decisions. To understand this shift, the article draws on the example of two German graduate schools that proclaim to search for outstanding doctoral candidates. As a latecomer in the transformation to graduate schools, the German case allows to observe the shift in statu nascendi. The article highlights the distinct role multi-site admission devices play. In both cases, they redistribute agency and excellence through the construction of competitive social fields. Documents, grades, committee deliberations, interviews, and excel files mobilize a social space in which applicants are qualified as acting holistically and competitively against each other in order to identify those most likely of future excellence. Admission is not predefined but the result of a cascade of socio-material fielding practices that purify a comparative social space, qualify applicants competitively, and infuse them with site-specific agency that increasingly authenticates them as field actors. Building on the work of Michel Callon and colleagues, we understand such formatting of future excellence as field agencements.
EURADOS REM-COUNTER INTERCOMPARISON AT MAASTRO PROTON THERAPY CENTRE: COMPARISON WITH LITERATURE DATA
Authors: Zorloni Gabriele , Bosmans Geert , Brall Thomas , Caresana Marco , De Saint-Hubert Marijke , Domingo Carles , Ferrante Christian , Ferrulli Francesca , Kopec Renata , Leidner Johannes , Mares Vladimir , Nabha Racell , Olko Pawel , Caballero-Pacheco Miguel Angel , Rühm Werner , Silari Marco , Stolarczyk Liliana , Swakon Jan , Tisi Marco , Trinkl Sebastian , Van Hoey Olivier , Vilches-Freixas Gloria
Published: September 2022

The Maastro Proton Therapy Centre is the first European facility housing the Mevion S250i Hyperscan synchrocyclotron. The proximity of the accelerator to the patient, the presence of an active pencil beam delivery system downstream of a passive energy degrader and the pulsed structure of the beam make the Mevion stray neutron field unique amongst proton therapy facilities. This paper reviews the results of a rem-counter intercomparison experiment promoted by the European Radiation Dosimetry Group at Maastro and compares them with those at other proton therapy facilities. The Maastro neutron H*(10) in the room (100–200 μSv/Gy at about 2 m from the isocentre) is in line with accelerators using purely passive or wobbling beam delivery modalities, even though Maastro shows a dose gradient peaked near the accelerator. Unlike synchrotron- and cyclotron-based facilities, the pulsed beam at Maastro requires the employment of rem-counters specifically designed to withstand pulsed neutron fields.
Reduced brain activity and functional connectivity during creative idea generation in individuals with smartphone addiction
Authors: Li Xinyi , Li Yadan , Wang Xuewei , Hu Weiping
Published: September 2022

Since the coronavirus disease 2019 outbreak, the frequency of smartphone use has surged, which has caused an increase in smartphone addiction among individuals. Smartphone addiction can impair various cognitive abilities. However, to date, the impact of smartphone addiction on creative cognition remains unclear. The current functional near-infrared spectroscopy study compared neural differences between smartphone addiction tendency (SAT) and healthy control (HC) individuals during creative idea generation. In particular, by manipulating a key component of creative cognition, that is, overcoming semantic constraints, we explored whether SAT individuals could overcome semantic constraints. Both the SAT and HC groups completed the alternate uses task (AUT) in semantic constraint and unconstraint conditions. The results indicated that the prefrontal cortex (PFC) and temporal regions were less active during AUT in the SAT group than in the HC group. In the SAT group, the PFC was less active under constraint than unconstraint conditions. Moreover, both task-related and resting-state functional connectivity analyses indicated weaker coupling between the PFC and temporal regions in the SAT than in the HC group. Furthermore, the left dorsolateral PFC mediated the effect of smartphone addiction on creative performance. These findings provide unprecedented neuroimaging evidence on the negative impact of smartphone addiction on creative cognition.
Relapse to cotinine seeking in rats: differential effects of sex
Authors: Tan Xiaoying , Neslund Elizabeth , Ding Zheng-Ming
Published: September 2022

Relapse is a defining feature of smoking and a significant challenge in cessation management. Elucidation of novel factors underlying relapse may inform future treatments. Cotinine, the major metabolite of nicotine, has been shown to support intravenous self-administration in rats, implicating it as one potential factor contributing to nicotine reinforcement. However, it remains unknown whether cotinine would induce relapse-like behaviors. The current study investigated relapse to cotinine seeking in two relapse models, the reinstatement of drug seeking and incubation of drug craving models. In the reinstatement model, rats were trained to self-administer cotinine, underwent extinction of cotinine-associated responses, and were tested for cue-, drug-, or stress-induced reinstatement. Conditioned cues associated with cotinine self-administration, cotinine (1–2 mg/kg), or the pharmacological stressor yohimbine (1.25–2.5 mg/kg) induced reinstatement of cotinine seeking. Female rats displayed more pronounced cue-induced, but not drug- or stress-induced reinstatement than male rats. In the incubation of the craving model, rats were trained to self-administer cotinine and underwent forced withdrawal in home cages. Rats were tested for cue-induced cotinine-seeking on both withdrawal day 1 and withdrawal day 18. Rats exhibited greater cue-induced cotinine-seeking on withdrawal day 18 compared to withdrawal day 1, with no difference between male and female rats. These findings indicate that cotinine induces sex-specific relapse to drug seeking in rats, suggesting that cotinine may contribute to relapse.
The modulatory role of dopamine receptors within the hippocampal cornu ammonis area 1 in stress-induced analgesia in an animal model of persistent inflammatory pain
Authors: Abdi Dezfouli Ramin , Ghanbari Merdasi Pooriya , Rashvand Mina , Mousavi Zahra , Haghparast Abbas
Published: September 2022

The intrinsic pain inhibitory mechanisms can be activated by fear, anxiety, and stress. Stressful experiences produce analgesia, referred to as stress-induced analgesia (SIA). Major components of the limbic system, including the ventral tegmental area, nucleus accumbens, amygdala, and hippocampus, are involved in the SIA. In this study, we tried to understand the role of dopamine receptors in the cornu ammonis area 1 (CA1) of the hippocampus in the forced swim stress (FSS)-induced analgesia. Stereotaxic surgery was unilaterally performed on 129 adult male Wistar rats weighing 220–280 g. SCH23390 (0.25, 1, and 4 μg/0.5 μl saline) or sulpiride (0.25, 1, and 4 μg/0.5 μl DMSO), as D1- and D2-like dopamine receptor antagonists, respectively, were microinjected into the CA1 area, 5 min before exposure to FSS for a 6-min period. The vehicle groups received saline or DMSO instead of SCH23390 or sulpiride, respectively. The formalin test was done using formalin injection (50 μl; 2.5%) into the plantar surface of the rat’s hind paw immediately after exposure to FSS. The results demonstrated that FSS produces analgesia during the early and late phases of the formalin test. However, intra-CA1 microinjection of SCH23390 or sulpiride attenuated the FSS-induced analgesia in both phases of the formalin test. This study provides new insight into the role of D1- and D2-like dopamine receptors in the CA1 area in the FSS-induced analgesia during persistent inflammatory pain.
Outcomes of Margin Reexcision after Oncoplastic Breast Reduction
Authors: Martin Tasha A. , Choudhry Salman , Holton Luther H. , Mylander W. Charles , Tafra Lorraine , Liang Wen , Jackson Rubie Sue
Published: September 2022

Introduction:

Tissue rearrangement after an oncoplastic breast reduction may complicate identification of margins during reexcision. Little is known about outcomes of reoperation in this setting.

Methods:

This is a single-institution, retrospective analysis of outcomes of margin reexcisions after lumpectomy with concurrent oncoplastic Wise-pattern reduction from 2015 to 2020. Outcomes assessed were the rate of successful breast conservation, in-breast recurrence, wound issues or complications, effect on cosmesis, and delay to onset of adjuvant therapy.

Results:

From 2015 to 2020, 649 patients underwent lumpectomy with oncoplastic Wise-pattern reduction. Forty-seven patients (7.2%) had greater than or equal to one positive margin(s); of these, 28 went directly to mastectomy, and 19 underwent margin reexcision. Residual disease was found in seven of 19 patients (37%) at reexcision. The rate of successful breast-conserving therapy was 95% with a mean follow-up of 31 months. There was one (5%) in-breast recurrence (invasive ductal carcinoma [IDC] occurring 30 months after the original operation); this patient had a mastectomy for treatment of her recurrence. The overall complication rate was 37%. Radiation was administered to 18 patients (95%), and two patients (11%) had delay of radiation past 6 weeks due to wound complications. Of the 14 patients with photographs available, 12 of 14 patients (86%) were blindly assessed to have equivalent or better cosmesis after margin reexcision (versus initial lumpectomy).

Conclusion:

Margin reexcision after oncoplastic breast reduction with Wise-pattern is feasible and effective, and can be done without compromising the initial cosmetic results.
Erector Spinae Plane Block is Equivalent to Tumescent Local Anesthesia for Perioperative Pain Control with Abdominal Harvest for Fat Grafting
Authors: Shahriari Shawhin , Laarakker Avra , Luna Donald , Merchant Kanwal , Baker Elizabeth , Billstrand Mary , Wu Jeffrey
Published: September 2022

Background:

There is increasing evidence that lidocaine is toxic to adipocytes and their precursors, which can contribute to the variability in fat graft resorption. Erector spinae plane (ESP) block is a new technique to provide analgesia of the trunk and would avoid lidocaine at the fat graft donor site. The aim of this study was to compare the efficacy of ESP block versus tumescent local anesthesia (TLA).

Methods:

A retrospective review was performed for all patients who underwent autologous fat grafting from the abdomen at the University of New Mexico Hospital between February 2016 and March 2019. These patients received either ESP block or TLA during abdominal fat harvest. The primary endpoints were intraoperative, postoperative, and total morphine equivalents.

Results:

There was no difference in the mean intraoperative, postoperative, and total morphine equivalents administered between the ESP and TLA groups.

Conclusions:

ESP block is equivalent to TLA for analgesia when using an abdominal donor site for fat harvest. ESP block should be considered in fat-grafting cases to avoid the potential toxicity of lidocaine to the viability of adipocytes and preadipocytes.
Saphenous Vein Interposition Grafts in Lower Extremity Reconstruction: Appraisal of Technique and Case Series
Authors: Dekker Paige K. , Abdou Salma A. , Youn Richard , Bekeny Jenna C. , Kim Kevin G. , Zolper Elizabeth G. , Fan Kenneth L. , Evans Karen K.
Published: September 2022

Vascular microanastomosis is technically challenging in patients with calcified recipient and donor vessels. Inside-to-outside suturing can prevent plaque rupture and ensure full-thickness intimal approximation. Although this is the preferred technique for anastomosis of atherosclerotic vessels, direct connection of calcified arteries necessitates outside-to-inside suturing on one side of the anastomosis. Furthermore, it is difficult to achieve optimal vessel wall approximation in the setting of luminal size mismatch and rigid vasculature. We previously reported on the use of a saphenous vein interposition graft as a novel technique to achieve a flow-sparing anastomosis in patients with diffuse atherosclerosis who are undergoing free tissue transfer. This study further assesses outcomes of this technique in a series of patients and demonstrates a flap success rate of over 93% in patients with calcified recipient and donor microvasculature.
The treatment effect of Levofloxacin, Moxifloxacin, and Gatifloxacin contained in the conventional therapy regimen for pulmonary tuberculosis: Systematic review and network meta-analysis
Authors: He Yiyue , Li Xiaofei
Published: September 2022

Background:

Tuberculosis (TB) is one of the serious epidemics that highly threaten the global public health. To explore the treatment effect of Levofloxacin, Moxifloxacin, and Gatifloxacin contained in the conventional therapy regimen for pulmonary tuberculosis.

Methods:

Medline, PubMed, Embase, and Cochrane Library were searched with the keyword such as “Levofloxacin,” “Moxifloxacin,” “Gatifloxacin,” and “tuberculosis”, through June 1992 to 2017. According to the inclusion and exclusion criteria, 2 researchers independently screened the literature, extracted the data, and evaluated the quality of the included studies. The Cochrane system was evaluated by RevMan5.2 and the network meta-analysis was performed by Stata 15.

Results:

A total of 891 studies were included, with a total of 6565 patients. The results of network meta-analysis showed that Moxifloxacin + conventional therapy (CT) regimen was superior to CT regimen only on the spectrum culture negative. Both Levofloxacin + CT and Moxifloxacin + CT were superior to the CT regimen in treatment success rate. For the adverse events, the Levofloxacin + CT showed much safer results than CT group, while Moxifloxacin + CT had more adverse events than CT group.

Conclusion:

Levofloxacin, Moxifloxacin, and Gatifloxacin have different superiority, comparing to CT regimen in spectrum culture negative, treatment success rate, and adverse events. Hence, combined utilization of these quinolone is important on the clinical treatment for tuberculosis.
Influence of subsidence after stand-alone anterior cervical discectomy and fusion in patients with degenerative cervical disease: A long-term follow-up study
Authors: Ryu Han-Seung , Han Moon-Soo , Lee Shin-Seok , Moon Bong Ju , Lee Jung-Kil
Published: September 2022

This study aimed to evaluate the influence of subsidence in patients who performed stand-alone anterior cervical discectomy and fusion (ACDF) by analyzing the long-term clinical and radiological outcomes. This retrospective study enrolled 53 patients with 79 segments with degenerative cervical disease treated with stand-alone ACDF with ≥5 years of follow-up. Segmental angle (SA), cervical sagittal alignment (CSA), subsidence, and fusion were analyzed. Visual analog scale (VAS) scores and neck disability index (NDI) were also evaluated. Subsidence occurred in 24 (45.2%) patients and 38 segments (48.1%) at the last follow-up. The mean VAS score and NDI had improved in both the subsidence and non- subsidence groups. The mean SA at the last follow-up had increased to 1.3° ± 8.5° in the subsidence group and to 1.5° ± 5.2° in the non-subsidence group compared with the post-operative SA (P < .001). The overall mean CSA at the last follow-up increased over time in both the groups compared with the post-operative CSA (P = .003). The fusion rate at 1 year after surgery was 86.8% and 82.9% in the subsidence and non-subsidence groups, respectively. However, the differences in the SA, CSA, and fusion rates between the groups were not statistically significant (P = .117, .98, and .682, respectively). Subsidence after stand-alone ACDF occurs to a certain capacity; however, it does not appear to significantly influence the radiological and clinical outcomes if foramen decompression is adequately and sufficiently provided in a long-term follow-up study. In contrast, subsidence appears to positively affect the fusion rate in the short-term follow-up.
Digital Point Solutions for Extending Contact Tracing Capacity
Authors: Santos Anicia , Nuñez Gloria , La Stacy , Dorsey Jammal H. , Patel Swati Shah , Luk Karen G. , Brillantes Kristen , Birnbaum Rebecca , Boyette Melissa , Bergquist Eleanor Peters , McClelland Amanda
Published: September 2022

Background

Initial COVID-19 surges in the United States created a need for technology to supplement human resources to increase efficiency and efficacy.

Methods

Resolve to Save Lives worked with jurisdictions to co-design four technology solutions—Epi Viaduct data pipeline, Epi Contacts contact elicitation webform, Epi Locator contact information search plugin, and Epi Viewpoint case management system (CMS)—to expand the capacity of case investigation and contact tracing (CI/CT) teams. We assessed impact on reducing CI/CT time intervals for COVID-19 using product data and user feedback.

Results

Epi Viaduct accelerated the transfer of approximately 7,400,000 records from an electronic laboratory reporting system in a single jurisdiction to the respective CMS from more than 2.5 hours to less than 1 minute and reduced time to remove duplicate laboratory results from multiple days to less than 6 hours. Epi Contacts focused on increasing the efficacy of contact elicitation, and during a single period, 10% of index cases (9,440 of 96,319) completed Epi Contacts for a total of approximately 18,700 contacts elicited. User interviews indicated the tool increased speed of CI/CT workflows. In total, 134,410 searches were run in Epi Locator by 7320 distinct users—75% of which returned 1 or more person matches. A simple CMS, Epi Viewpoint, was developed and completed, but not deployed.

Conclusions

Systems to mount large-scale population-based contact tracing programs were developed and implemented during the COVID-19 pandemic and can be adapted for CI/CT programs aiming to control the spread of other communicable diseases such as sexually transmitted diseases.
Previous Syphilis Not Associated With Neurocognitive Outcomes in People Living With Human Immunodeficiency Virus in Ontario, Canada
Authors: Christensen Brandon L. , Tavangar Farideh , Kroch Abigail E. , Burchell Ann N. , Rourke Sean B. , Rousseau Rodney K. , Raboud Janet M. , Light Lucia , Bekele Tsegaye , Tan Darrell H.S. ,   OHTN Cohort Study Team
Published: September 2022

Background

About 40% to 60% of people living with human immunodeficiency virus (HIV) experience neurocognitive impairments, irrespective of antiretroviral status. We hypothesized that a history of syphilis or neurosyphilis would be associated with worse neurocognitive outcomes in this population.

Methods

Among health care–engaged people living with HIV in Ontario older than 16 years enrolled in the OHTN Cohort Study, neurocognitive outcomes were as follows: (1) self-reported Medical Outcome Study–HIV Health Survey 4-item cognitive scale; (2) average T score summary scores based on objective neuropsychological testing of complex attention, speed of processing, and learning/memory; and (3) global deficit score dichotomized into impaired/unimpaired neurocognitive status. Syphilis history was determined by laboratory data or chart review. Univariable and multivariable generalized linear mixed models assessed the association between each of: syphilis, number of episodes of syphilis, and years since syphilis diagnosis with these neurocognitive outcomes controlling for age, sex, race, education, income, years of HIV, nadir and most recent CD4 count, most recent HIV viral load, substance use, depression, and number of prior neurocognitive tests.

Results

Of 1288 eligible participants, 218 (16.9%) had a history of syphilis at baseline and an additional 53 were diagnosed during follow up for a total of 271 (21.0%) at the most recent visit. Of those with past infection at baseline, 179 (82.1%) had 1 and 39 (17.9%) had 2 or more episodes of syphilis. In longitudinal multivariable models, we observed no relationship between syphilis diagnosis or years since syphilis diagnosis and any of the neurocognitive outcomes.

Conclusions

In this sample, prior syphilis was not associated with worse neurocognitive outcomes over time according to self-reported scales or objective neuropsychological testing.
Depression and Sexual Stigma Are Associated With Cardiometabolic Risk Among Sexual and Gender Minorities Living With HIV in Nigeria
Authors: Adebajo Sylvia B. , Adebiyi Ruxton , Chama John , Bello Segun , Ononaku Uche , Aka Abayomi , Lai Shenghan , Baral Stefan D. , Dyer Typhanye V. , Crowell Trevor A. , Nowak Rebecca G. , Charurat Man ,   for the TRUST/RV368 Study Group
Published: September 2022

Background:

People living with HIV are vulnerable to cardiometabolic diseases. We assessed the prevalence of cardiometabolic risk factors (CMRF) and associations with sexual stigma and depression among sexual and gender minorities (SGM) in Abuja and Lagos, Nigeria.

Methods:

The TRUST/RV368 study enrolled SGM between March 2013 and February 2020. Participants were assessed for depression, sexual stigma, and CMRF. Robust multinomial logistic regression was used to estimate adjusted odds ratio (aORs) and 95% confidence intervals (CIs) for associations of depression, sexual stigma, and other factors with increasing numbers of CMRF.

Results:

Among 761 SGM, the mean age was 25.0 ± 6.0 years; 580 (76%) identified as cisgender men, 641 (84%) had ≥1 CMRF, 355 (47%) had mild–severe depression, and 405 (53%) reported moderate–high sexual stigma. Compared with individuals without depression, those with mild (aOR 8.28; 95% CI: 4.18 to 16.40) or moderate–severe depression (aOR 41.69; 95% CI: 9.60 to 181.04) were more likely to have 3–5 CMRF. Individuals with medium (aOR 3.17; 95% CI: 1.79 to 5.61) and high sexual stigma (aOR 14.42; 95% CI: 2.88 to 72.29) compared with those with low sexual stigma were more likely to have 3–5 CMRF. Participants age 25–34 years were less likely to have 3–5 CMRF (aOR 0.41; 95% CI: 0.23 to 0.73) compared with participants age younger than 25 years.

Conclusion:

CMRF increased with severity of depression and sexual stigma, potentially predisposing SGM living with HIV to cardiometabolic diseases. Integrating interventions that address depression and sexual stigma in HIV care programs for SGM may improve cardiometabolic outcomes.
Weight Gain and Metabolic Effects in Persons With HIV Who Switch to ART Regimens Containing Integrase Inhibitors or Tenofovir Alafenamide
Authors: Palella Frank J. , Hou Qingjiang , Li Jun , Mahnken Jonathan , Carlson Kimberly J. , Durham Marcus , Ward Douglas , Fuhrer Jack , Tedaldi Ellen , Novak Richard , Buchacz Kate
Published: September 2022

Background:

The timing and magnitude of antiretroviral therapy–associated weight change attributions are unclear.

Setting:

HIV Outpatient Study participants.

Methods:

We analyzed 2007–2018 records of virally suppressed (VS) persons without integrase inhibitor (INSTI) experience who switched to either INSTI-based or another non–INSTI-based ART, and remained VS. We analyzed BMI changes using linear mixed models, INSTI- and tenofovir alafenamide (TAF) contributions to BMI change by linear mixed models–estimated slopes, and BMI inflection points.

Results:

Among 736 participants (5316 person-years), 441 (60%) switched to INSTI-based ART; the remainder to non–INSTI-based ART. The mean follow-up was 7.15 years for INSTI recipients and 7.35 years for non-INSTI. Preswitch, INSTI and non-INSTI groups had similar median BMI (26.3 versus 25.9 kg/m2, P = 0.41). INSTI regimens included raltegravir (178), elvitegravir (112), and dolutegravir (143). Monthly BMI increases postswitch were greater with INSTI than non-INSTI (0.0525 versus 0.006, P < 0.001). A BMI inflection point occurred 8 months after switch among INSTI users; slopes were similar regardless of TAF use immediately postswitch. Among INSTI + TAF users, during 8 months postswitch, 87% of BMI slope change was associated with INSTI use, 13% with TAF use; after 8 months, estimated contributions were 27% and 73%, respectively. For non-INSTI+TAF, 84% of BMI gain was TAF-associated consistently postswitch. Persons switching from TDF to TAF had greater BMI increases than others (P < 0.001).

Conclusion:

Among VS persons who switched ART, INSTI and TAF use were independently associated with BMI increases. During 8 months postswitch, BMI changes were greatest and most associated with INSTI use; afterward, gradual BMI gain was largely TAF-associated.
The State of Breast Cancer Reconstruction in Virginia
Authors: Liston Jared M. , Samuel Ankhita , Camacho T. Fabian , Anderson Roger T. , Campbell Chris A. , Stranix John T.
Published: September 2022

Background

Age, race, socioeconomic status, and proximity to plastic surgeons have been shown to impact receipt of reconstruction after mastectomy in several national studies. Given that targeted outreach efforts and programs to address these discrepancies would occur locoregionally, investigation of these reconstructive trends on a state level is warranted.

Study Design

Patients diagnosed with breast cancer in Virginia between 2000 and 2018 were identified in the Virginia Department of Health Cancer Registry. Patients who underwent mastectomy breast conservation surgery, and/or breast reconstruction at the time of oncologic surgery were identified. Patient demographics were analyzed, and logistic regression analyses were used to determine the likelihood of receipt of mastectomy, receipt of mastectomy versus breast conservation surgery, receipt of mastectomy with reconstruction versus mastectomy alone, and receipt of mastectomy with reconstruction versus breast conservation surgery with respect to the demographic variables. Geographically weighted regression analyses were also performed to determine impact of geographic location on receipt of mastectomy and reconstruction after mastectomy.

Results

A total of 78,682 patients in Virginia underwent surgical treatment for breast cancer between 2000 and 2018. Living outside a metropolitan area, increased age, lower socioeconomic status, non-White race, and lower number of plastic surgeons within 50 miles were associated with decreased rates of postmastectomy reconstruction. Rural setting, lower socioeconomic status, and lower plastic surgeon supply were also associated with decreased rates of breast conservation surgery. Reconstruction after mastectomy was lowest in the northwest, central, and southwest regions of Virginia.

Conclusions

Within the state of Virginia, programs to improve access to breast reconstruction for patients residing in rural regions, as well as non-White patients, older patients, and those in lower socioeconomic groups should be implemented. Future studies would implement and study the efficacy of such outreach programs, which could then be applied and tailored to other states or regions to address sociodemographic disparities in access to breast reconstruction.
Reconstruction of Quadriceps Function Using a Single Functional Gracilis Muscle Transfer With an Adductor Longus Nerve to Femoral Nerve Branch of the Rectus Femoris Nerve Transfer
Authors: Donaldson Elsa K. , Chandler Rowan M. , Clark Tod A. , Hayakawa Thomas E.J. , Giuffre Jennifer L.
Published: September 2022

Background

A femoral nerve injury may result in cutaneous sensory disturbances of the anteromedial thigh and complete paralysis of the quadriceps femoris muscles resulting in an inability to extend the knee. The traditional mainstay of treatment for femoral neuropathy is early physiotherapy, knee support devices, and pain control. Case reports have used the anterior division of the obturator nerve as a donor nerve to innervate the quadriceps femoris muscles; however, a second nerve transfer or nerve grafting is often required for improved outcomes. We suggest a novel technique of combining an innervated, pedicled gracilis transfer with an adductor longus to rectus femoris nerve transfer to restore the strength and stability of the quadriceps muscles.

Methods

This is a case series describing the use of a pedicled gracilis muscle transposed into the rectus femoris position with a concomitant nerve transfer from the adductor longus nerve branch into the rectus femoris nerve branch to restore quadriceps function after iatrogenic injury (hip arthroplasty) and trauma (gunshot wound).

Results

With electrodiagnostic confirmation of severe denervation of the quadriceps muscles and no evidence of elicitable motor units, 2 patients (average age, 47 years) underwent a quadriceps muscle reconstruction with a pedicled, innervated gracilis muscle and an adductor longus to recuts femoris nerve transfer. At 1 year follow-up, the patients achieved 4.5/5 British Medical Research Council full knee extension, a stable knee, and the ability to ambulate without an assistive aid.

Conclusions

The required amount of quadriceps strength necessary to maintain quality of life has not been accurately established. In the case of femoral neuropathy, we assumed that a nerve transfer alone and a gracilis muscle transfer alone would not provide enough stability and strength to restore quadriceps function. We believe that the restoration of the quadriceps function after femoral nerve injury can be achieved by combining an innervated, pedicled gracilis transfer with an adductor longus to rectus femoris nerve transfer with low morbidity and no donor defects.
Hyperosmolar Hyperglycemic Crisis After Burn Injury in a Patient With Advanced Amyotrophic Lateral Sclerosis
Authors: Lin Meng-Wei , Chang Yu-Tzu , Hsueh Yuan-Yu
Published: September 2022

Metabolic disturbance in patients of amyotrophic lateral sclerosis is a rare presentation that might be related to disease progression and outcomes. Hypermetabolic status after major burn injury remains a critical issue in the modern medical care. Here, we present a rare case of a patient sporadic amyotrophic lateral sclerosis who suffered from minor burn injury (8% total body surface area), developing critical hyperosmolar hyperglycemic state during early hospitalization. Newly diagnosed diabetes is established and found related to the underlying disease of this patient. The accumulative metabolic alteration among vulnerable patients of amyotrophic lateral sclerosis and burn injury is noteworthy. Judicious monitoring of fluid and metabolic status helps to prevent the occurrence of acute hyperosmolar hyperglycemic state.