bluuebunny/crossref_metadata_2025 huggingface dataset:
P-P19 Incidentally detected Double Duct Sign (InDDuS): a study on the long-term outcomes
Authors: Yao Lu , Aroori Somaiah
Published: December 2021

Background

The long-term outcomes of patients with biliary and pancreatic ductal dilatation (double duct sign-DDS), without a detectable underlying cause, is unclear in the current literature. This study aims to review the five-year outcomes of patients with incidentally detected double duct sign.

Methods

This is a retrospective study of patients that were found to have DDS between January 2010 to December 2015 at a tertiary referral Hepato-Pancreatico-Biliary unit. Patients were identified from the departmental performance team and cross-checked with the Radiology department. Patients who had malignancy and benign causes of DDS (such as pancreatitis and gallstones) were excluded. Five-year patient outcomes were collected from subsequent MDT outcomes and clinic letters.

Results

Initial screen identified 108 patients with DDS. Of these, 37 patients (81% female, median age 69 years, range 26-94 years) had no identifiable cause and were analysed. Main presenting complaints were abdominal pain (n = 22), weight loss (n = 9), and asymptomatic (n = 3). Twelve had anaemia, 14 had derange LFTs and 2 patients had elevated serum CA19-9. A median of two (range 0-9) further investigations were performed to determine the underlying cause of DDS (US = 6, CT = 24, MRCP=17, endoscopy=16). Median follow up of 7.2 (range 5-11) years detected no pancreatic or ampullary cancer amongst all patients.

Conclusions

Results from this study suggests DDS without evidence of malignancy on Magnetic resonance cholangiopancreatography (MRCP) and endoscopic ultrasound (EUS) have minimal risk of developing pancreatic or ampullary cancer in the next five years. Thus, they can be safely discharged from follow up.
P-P20 ‘Fast Recovery’ A multidisciplinary approach to improving recovery after pancreatic resection and ultimately increasing uptake of adjuvant chemotherapy
Authors: Powell-Brett Sarah , Pande Rupaly , Hodson James , Mann Samantha , Freer alice , Wyrko Zoe , Hughes Clare , Isaac John , Sutcliffe Robert , Roberts Keith
Published: December 2021

Background

Pancreatic cancer surgery has a multi-system impact on a potentially vulnerable population. Current rates of adjuvant chemotherapy uptake are low. Our group developed a multidisciplinary bundle of care with the aim of improving recovery after surgery. The primary aim was to improve uptake of adjuvant chemotherapy and the secondary aim was to prevent nutritional decline.

Methods

This prospective, observational, cohort study evaluated the effect of the ‘Fast Recovery’ programme. This programme, developed with input from dieticians, physiotherapists, surgeons, and geriatricians and comprising pre- and post-operative frailty assessments, nutritional support and physiotherapy was implemented for all within our unit undergoing pancreatic resection for cancer. (See Fig. 1)

Results

Over 1 year, patients enrolled in the Fast Recovery programme (N = 44) were compared to those treated prior to the pathway change (N = 409). The Fast Recovery programme was not associated with a significant increase of adjuvant chemotherapy uptake (80.5 vs. 74.3%, p = 0.452), but did lead to a significantly lower average weight loss (4.3 vs. 6.9kg, p = 0.013). Patients that did not receive adjuvant chemotherapy performed significantly worse on a pre-operative six minute walk test (mean distance: 277 vs. 454 metres, p = 0.001).

Conclusions

Feasibility of a multimodal package to improve patient care following pancreatic resection has been shown by this pilot study. No significant improvement in the chemotherapy uptake was observed, however, this was potentially a result of the study being underpowered. Pre-operative physical assessments were found to be predictive of adjuvant chemotherapy uptake and could potentially be used to identify those in need of additional support. Further work is needed to evaluate the routine use of such a programme.
P-P27 Long term follow-up after pancreatico-duodenectomy: A UK wide survey
Authors: Phillips Mary , Robertson Denise , Hart Kathryn , Kumar Rajesh , Karanjia Nariman
Published: December 2021

Background

Pancreatico-duodenectomy (PD)  results in major anatomical changes that have an impact on nutritional status and quality of life. Issues such as pancreatic exocrine insufficiency (PEI), diabetes mellitus (DM), malnutrition, micronutrient deficiency, osteoporosis and other gastrointestinal diseases are common in the post-operative setting (1, 2). Appropriate treatment of these surgical consequences is associated with improved survival (3, 4), and should improve quality of life.

The aim of this survey was to assess current practice and identify which disciplines were reviewing patients following PD, what format that review takes and the duration of follow up.

Methods

A UK wide electronic survey was developed using Qualtrics® software (SAP America Inc. USA) to capture all the nutritional aspects of follow up thought to be relevant in the long term. Markers of endocrine failure and malnutrition (weight, nutritional assessment and biochemical vitamin and mineral screens), smoking and alcohol cessation advice and the use of dual energy x-ray absorptiometry (DEXA) scans were included.

The survey was piloted on 5 staff locally prior to being circulated through a professional network – the Pancreatic Society of Great Britain and Ireland (PSGBI). Data were analysed using Chi-Square tests in SPSS (Version 26).

Results

One hundred and one (23% response rate) clinicians completed the survey, with 83 useable data sets.  Surgeons and dietitians were most likely to reply to the questionnaire, 88% of respondents worked in tertiary centres, half (55%) had more than 10 years’ experience.

There were highly significant variations in practice according to clinician experience, underlying pathology, and institution (p < 0.001 in all cases). Diabetes screening did not occur in 30% of cases.

Lifelong follow up was offered by 24% of clinicians (17 surgeons, 3 dietitians, 1 nurse), in pre-malignant (n = 15), benign (n = 11) and malignant disease (n = 10) (P < 0.001).

Conclusions

Whilst this study may be biased towards those with an interest in follow up, we still demonstrated a need to improve the provision of long-term follow up for patients who have undergone PD, especially since provision of a comprehensive assessment appeared to be associated with clinician experience, and varies between institutions.

More evidence for the benefits of long-term follow up and the optimal content is required to inform the development of clinical guidance. Early detection of clinical consequences may improve quality of life and reduce complications associated with poorly managed endocrine and exocrine failure.
P-P37 Robot assisted pancreaticojejunostomy may be associated with lower risk of post-operative pancreatic fistula in high-risk cases: Initial experience
Authors: Farrugia Alexia , Muhammad Qazi Rahim , Jalil Omar , Ali Majid , Marangoni Gabriele , Ahmad Jawad
Published: December 2021

Background

Robot assisted pancreaticoduodenectomy has increased in popularity over recent years. There is evidence from high volume centers which suggests that it is associated with lower risk of post-operative pancreatic fistula than open surgery. The aims of this study were to evaluate our initial experience after robotic assisted pancreaticoduodenectomy and compare if a low volume center can produce similar positive outcomes.

Methods

The initial 12 patients who were listed for a robot assisted pancreaticoduodenectomy were included in the study in a consecutive manner. A standardised method of anastomosis was used in all surgeries, this being a duct-to-mucosa two-layer modified Blumgart pancreato-jejunostomy. Data was collected prospectively and stored in an encrypted database. Surgical outcomes were then analysed.

Results

The study included first 12 consecutive patients who underwent robotic pancreaticoduodenectomy between August 2019 and January 2020. None of the patients had clinically relevant postoperative pancreatic fistula despite 75% of the patients falling into moderate to high-risk group for fistula development. Median operative time and length of stay was 547 minutes and 8 days respectively with three  Clavien Dindo grade III complications and three Clavien-Dindo grade II complications.

Conclusions

Robotic assisted pancreaticoduodenectomy maybe associated with lower risk of post-operative pancreatic fistula in high-risk cases.
P-P42 Neo-adjuvant Chemoradiation for Borderline Resectable Pancreatic Adenocarcinoma: A UK Tertiary Surgical Oncology Centre Series
Authors: Likos-Corbett Marina , Patel Pranav , Goburdhun Rachna , Mudan Satvinder , Khan Amir , Kumar Sacheen , Bhogal Ricky
Published: December 2021

Background

Pancreatic ductal adenocarcinoma (PDAC) is associated with a historically poor long-term survival of 5-10%, despite surgical resection. Borderline resectable pancreatic ductal adenocarcinoma (BR-PDAC) is reported as potentially resectable disease with a degree of vascular involvement, increasing the risk of a positive surgical margin. This cohort of patients have the worst survival despite curative resection and adjuvant chemotherapy. Emerging evidence suggests that neo-adjuvant chemoradiation (NCR) improves R0 resection rates in BR-PDAC patients. We evaluated the R0 resection rate, disease free survival (DFS) and overall survival (OS) in our patients, who had undergone NCR for BR-PDAC at our institution.

Methods

Data was collected retrospectively for all patients undergoing NCR for BR-PDAC between Jan 2010 to Mar 2020 for this study. Surgical management was ratified by clinical assessment and cross-sectional imaging in a pancreatic multidisciplinary team meeting (MDM). Patients underwent NCR by a number of standardised regimens. Patients with proven regressive or stable disease on imaging underwent a pancreatic resection. All BR-PDAC patients underwent resection in the form of classical Whipple’s or pylorus preserving pancreaticoduodenectomy (PPPD) depending on intra-operative findings. Patient morbidity, R0 resection rate, histological parameters, DFS and OS were evaluated.

Results

29 patients were included in the study (16 men and 13 women), with a median age of 65 years (range, 46-74 years). 17 patients received FOLFIRINOX and 12 patients received gemcitabine (GEM) based NCR regimens. All patients received chemoradiation at the end of chemotherapy (range 45-56Gy). 75% had an R0 resection, with a greater proportion in the FOLFIRINOX group. Whole cohort median DFS was 35 months, survival was superior in the FOLFIRINOX group (42 months). Median OS was 30 months for the whole group, with a greater median OS in the FOLFIRINOX versus the GEM cohort (42 versus 29 months).

Conclusions

We present a single centre retrospective study utilising NCR for BR-PDAC, we reiterate the strong association of an R0 resection with superior patient overall survival following surgery in this cohort. We show that in patients with BR-PDAC, NCR results in superior R0 resection rates with an associated increase in patient survival. Our results show that survival advantage is greatest in BR-PDAC patients who received neo-adjuvant FOLFIRINOX. 

Our findings affirm the advantage of NCR prior to surgery, particularly FOLFIRINOX based treatment, in this cohort of patients.
P-P48 Clinical Benefit of Surveillance after Resection of Pancreatic Ductal Adenocarcinoma: A Systematic Review and Meta-Analysis
Authors: Halle-Smith James , Hall Lewis , Daamen Lois , Hodson James , Pande Rupaly , Young Alastair , Jamieson Nigel , Lamarca Angela , van Santvoort Hjalmar , Molenaar Izaak Quintus , Valle Juan , Roberts Keith
Published: December 2021

Background

The clinical benefit and acceptability to patients of routine surveillance after resection of pancreatic ductal adenocarcinoma (PDAC) remains unclear. Furthermore, expert guidelines around the world offer conflicting recommendations. This study is a systematic review of evidence for surveillance programs.

Methods

A systematic review of studies evaluating different surveillance methods was undertaken. Meta-analyses were performed for those studies reporting rates of asymptomatic recurrence, treatment of recurrence and overall survival, according to different surveillance methods.

Results

There were ten studies included in the literature review. Five studies were appropriate for meta-analysis (1,596 patients). If enrolled in an active surveillance program, patients were more likely to have recurrence detected at an asymptomatic stage (Pooled Rate: 49.3% vs. 19.1%, p = 0.043). In terms of clinical outcomes, patients with asymptomatic recurrence were more likely to receive treatment for recurrence (Odds Ratio 3.49; 95% CI: 1.73-7.07; p < 0.001) and had longer overall survival (Mean Difference: 9.5 months; 95% CI: 4.1-14.8; p < 0.001) than those with symptoms at time of recurrence.

Conclusions

From this systematic review and meta-analysis of early data it appears that routine surveillance after surgery for PDAC detects more patients at the asymptomatic stage. Data from these non-randomised trials also suggest that treatment rates and survival may be superior in patients were recurrence is detected when asymptomatic. As such, these data suggest that routine surveillance may improve patient outcomes, however an appropriately conducted trial would be required to address concerns that various sources of bias may be affecting these results.
P-P49 Predicting Future Pathological and Operative Complexity in Pancreatoduodenectomy: 30 Years of Experience
Authors: Halle-Smith James , Hodson James , Coldham Christopher , Dasari Bobby , Chatzizacharias Nikolaos , Marudanayagam Ravi , Sutcliffe Robert , Isaac John , Mirza Darius , Roberts Keith
Published: December 2021

Background

Patient selection for pancreatoduodenectomy (PD) is largely based upon local experience and established practice. This study sought to observe changes in complexity and patient cohort over time with the aim of predicting future cohort characteristic of patients undergoing PD.

Methods

All PDs at our institution between 1988 and 2020 were reviewed (n = 1,878) to observe changing trends in patient demographic, pathological diagnosis, operative factors and postoperative outcomes. Coefficients from regression models were reported as gradients per decade, to quantify the rate of change over time. The resulting models were then plotted to illustrate the trend across the study period, as well as forecasts for subsequent years.

Results

The annual volume (7 to 128) and proportion of pancreatic ductal adenocarcinoma (PDAC) (28 to 53%) increased at a linear rate. The proportion of associated vein resection (3 to 25%) and technical difficulty (type 2-4; 5 to 28%) increased in a nonlinear way, increasing more rapidly in later times. The average age (48 to 67) increased in a log linear trend. Length of stay reduced by 9.3%, whilst mortality reduced with an odds ratio of 0.69, per decade. Furthermore, When performance at our institution was compared to recently established benchmarks, it was shown that our institution regularly performed within these standards with few exceptions. By 2030 our predictions indicate that the average age will increase to 69, PDAC will comprise 62% of pathology, 40% will have an associated venous resection and 43% will be graded 2-4 in technical difficulty. Length of stay will have reduced to 9.6 days and mortality to 2%. 

Conclusions

Despite increasing complexity of surgery and patient age, length of stay and mortality after PD are reducing. Understanding changes over time permits an estimation of a future surgical cohort where complexity will increase. It is important that surgeons continue to push boundaries. Patient selection, based upon prior experience may inhibit progression and development of services.
Jean Talairach: the man behind the cerebral stereotactic space
Authors: Zanello Marc , Roux Alexandre , Duriez Philibert , Savoureux Anne-Sophie , Vinckier Fabien , Chrétien Fabrice , Gavaret Martine , Gorwood Philip , Gaillard Raphaël , Pallud Johan
Published: December 2021

Jean Talairach is world-renowned for his development of stereo-electroencephalography, and remains the most cited French neurosurgeon to date with his stereotactic atlas of the human brain. Zanello et al. explore the life of Jean Talairach, including his training as a psychiatrist and his military service during WW2.
Cortical oscillatory dysrhythmias in visual snow syndrome: a magnetoencephalography study
Authors: Hepschke Jenny L. , Seymour Robert A. , He Wei , Etchell Andrew , Sowman Paul F. , Fraser Clare L.
Published: December 2021

Visual snow refers to the persistent visual experience of static in the whole visual field of both eyes. It is often reported by patients with migraine and co-occurs with conditions such as tinnitus and tremor. The underlying pathophysiology of the condition is poorly understood. Previously, we hypothesized that visual snow syndrome may be characterized by disruptions to rhythmical activity within the visual system. To test this, data from 18 patients diagnosed with visual snow syndrome, and 16 matched controls, were acquired using magnetoencephalography. Participants were presented with visual grating stimuli, known to elicit decreases in alpha-band (8–13 Hz) power and increases in gamma-band power (40–70 Hz). Data were mapped to source-space using a beamformer. Across both groups, decreased alpha power and increased gamma power localized to early visual cortex. Data from the primary visual cortex were compared between groups. No differences were found in either alpha or gamma peak frequency or the magnitude of alpha power, p > 0.05. However, compared with controls, our visual snow syndrome cohort displayed significantly increased primary visual cortex gamma power, p = 0.035. This new electromagnetic finding concurs with previous functional MRI and PET findings, suggesting that in visual snow syndrome, the visual cortex is hyperexcitable. The coupling of alpha-phase to gamma amplitude within the primary visual cortex was also quantified. Compared with controls, the visual snow syndrome group had significantly reduced alpha–gamma phase–amplitude coupling, p < 0.05, indicating a potential excitation–inhibition imbalance in visual snow syndrome, as well as a potential disruption to top-down ‘noise-cancellation’ mechanisms. Overall, these results suggest that rhythmical brain activity in the primary visual cortex is both hyperexcitable and disorganized in visual snow syndrome, consistent with this being a condition of thalamocortical dysrhythmia.
De novo and relapsing necrotizing vasculitis after COVID-19 vaccination
Authors: Fillon Alexandre , Sautenet Benedicte , Barbet Christelle , Moret Léa , Thillard Eve Marie , Jonville-Béra Annie Pierre , Halimi Jean Michel
Published: December 2021

We describe five cases of severe necrotizing vasculitis following the RNA-based vaccine for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including four relapsing anti neutrophil cytoplasmic antibodies (ANCA) vasculitis, 27 days (1–60) after vaccination and one patient with quiescent chronic hepatitis B and de novo polyarteritis nodosa (PAN) 21 days after vaccination. Ten other cases were reported to the French national pharmacovigilance database: six patients with ANCA-associated vasculitis and four patients with PAN (first symptoms 19 days on average after vaccination). Five of these 10 patients developed kidney dysfunction. In conclusion, coronavirus disease 2019 (COVID-19) vaccines can be associated with de novo or recurrent ANCA vasculitis or PAN. Attention should be paid to patients with known ANCA vasculitis or patients with a history of hepatitis B infection.
The validation of orthodontic artificial intelligence systems that perform orthodontic diagnoses and treatment planning
Authors: Shimizu Yuujin , Tanikawa Chihiro , Kajiwara Tomoyuki , Nagahara Hajime , Yamashiro Takashi
Published: December 2021

Aim

This study was aimed to evaluate two artificial intelligence (AI) systems that created a prioritized problem list and treatment plan, and examine whether the performance of the aforementioned systems was equivalent to orthodontists.

Materials and methods

A total of 967 consecutive cases [800: training; 67: validation; 100: evaluation (40: randomly selected for the clinical evaluation)] were used. We used a stored document that describes (1) the patient’s clinical information, (2) the prioritized list, and (3) a treatment strategy without digital tooth movement. Sentences of (1) were vectorized according to the bag of words method (V); sentences of (2) and (3) were relabelled with 423 and 330 labels, respectively. AI systems that output labels for the prioritized list (subtask 1) and treatment planning (subtask 2) based on the vectors V were developed using a support vector machine and self-attention network, respectively, while the system was trained to improve precision and recall. Clinical evaluations were conducted by four orthodontists (no faculty or residents; peer group) in two sessions: in the first session, peer group and the developed AI systems created problem lists and treatment plans; in the second session, two of the peer group (not AI) evaluated these lists and plans, including the lists and plans of the AIs, by scoring them using 4-point scales [unacceptable (1) to ideal (4)]. Scores were compared among the system and peer group (Wilcoxon signed-rank test, P < 0.05).

Results

The precision after system training was 65% and 48% for subtasks 1 and 2 respectively, with recall of 55% and 48%, respectively. The clinical evaluation of the AI system for subtask 1 showed a mid-rank. For subtask 2, the AI system had a significantly lower score than the three panels but the same rank with one panel.

Conclusions

Two AI systems that output a prioritized problem list and create a treatment plan were developed. The clinical system ability of the former system showed a mid-rank in the peer group, and the latter system was almost equivalent to the worst orthodontist.
Factors associated with patient decision time in ST-segment elevation myocardial infarction, in early and late responders—an observational cross-sectional survey study
Authors: Ericsson Maria , Thylén Ingela , Strömberg Anna , Ängerud Karin H , Moser Debra K , Sederholm Lawesson Sofia
Published: December 2021

Aims

A short time span from symptom onset to reperfusion is imperative in ST-segment elevation myocardial infarction (STEMI). The aim of this study was to determine factors associated with patient decision time for seeking care in STEMI, particularly how symptoms were experienced and affected patient response.

Methods and results

A multicentre cross-sectional self-report survey study was completed at five Swedish hospitals representing geographic diversity. The 521 patients were divided into three groups based on their time to respond to symptoms: early (<20 min), intermediate (20–90 min), and late responders (>90 min). Only one out of five patients both responded early and called an ambulance within 20 min. Believing symptoms were cardiac in origin [odds ratio (OR) 2.60], male sex (OR 2.40), left anterior descending artery as culprit artery (OR 1.77), and bystanders calling an ambulance (OR 4.32) were factors associated with early response and correct action. Associated symptoms such as dyspnoea (OR 1.67) and weakness (OR 1.65) were associated with an early action (<20 min), while chest pain was not independently associated with response time. Cold sweat (OR 0.61) prevented late care-seeking behaviour as did a high symptom burden (OR 0.86).

Conclusion

Misinterpretation of symptoms delays correct care-seeking behaviour because patient expectations may not be aligned with the experience when stricken by Myocardial infarction. Therefore, it is imperative to continuously enhance public awareness in correct symptom recognition and appropriate care-seeking behaviour and to make efforts to educate individuals at risk for STEMI as well as their next of kin.
Group- plus home-based Tai Chi program improves functional health among patients with coronary heart disease: a randomized controlled trial
Authors: Liu Ting , Chan Aileen Wai Kiu , Chair Sek Ying
Published: December 2021

Aims

Tai Chi is a promising exercise option in cardiac rehabilitation to manage coronary heart disease (CHD). Increasing attention was paid on home-based cardiac rehabilitation to improve participation rate, but no study has yet emphasized the effect of home-based Tai Chi. A single-blinded randomized controlled trial is used to examine the effects of a group- plus home-based Tai Chi program on functional health.

Methods and results

Ninety-eight community-dwelling patients with CHD were randomly assigned to the Tai Chi and control groups. Participants in the Tai Chi group attended 6-week group- plus 6-week home-based Tai Chi program. Outcome measures included physical functions, cardiovascular risk factors, and exercise self-efficacy. Data were collected at baseline, 6-week, 12-week, and 24-week. Intervention effects were analysed using the generalized estimating equation model. Compared with changes in the control group, the intervention group achieved significant improvements in aerobic endurance, lower-body strength, agility and dynamic balance, diastolic blood pressure, and exercise self-efficacy over the 24-week study period (all Ps < 0.05). Intervention adherence was high (79.6% of participants attending >75% of all Tai Chi sessions).

Conclusions

This Tai Chi program significantly improved the functional health of patients with CHD, indicating that Tai Chi could be taught in group sessions and then continued independently as a home exercise routine for health promotion.
Change in Episodic Memory With Spousal Loss: The Role of Social Relationships
Authors: Hülür Gizem , Elayoubi Joanne , Nelson Monica E , Haley William E
Published: December 2021

Objectives

The spousal relationship is one of the most important social contexts in old age, and the loss of a spouse/partner is associated with stress and cognitive decline. In the present study, we examined whether social relationships can buffer potential negative effects of spousal loss on cognition. We examined the role of social network, social activities, and perceived deficiencies in social relationships (loneliness).

Method

We used longitudinal data between 1998 and 2012 from 2,074 participants of the Health and Retirement Study, who had experienced spousal loss during the study period. Multilevel modeling was used to examine how time-varying indicators of social network, social activities, and loneliness were related to age-related trajectories of episodic memory prior to and after spousal loss. Analyses controlled for gender, race/ethnicity, education, time-varying functional health, and being repartnered/remarried.

Results

Having children living within 10 miles and providing help to others buffered negative effects of widowhood on episodic memory. In addition, within-person increase in providing help to others buffered against decline in episodic memory after spousal loss. Having friends in the neighborhood, more frequent social visits, providing help to others, volunteering, and lack of loneliness were related to higher episodic memory, while having relatives in the neighborhood was related to lower episodic memory.

Discussion

Our findings suggest that social networks, social activities, and loneliness are related to levels of cognitive function at the time of spousal loss and that social relationships can buffer negative effects of spousal loss on cognitive function. Implications for future research are discussed.
Examining Racial Disparities in Historical Change of Mental and Physical Health Across Midlife and Old Age in the United States
Authors: Staben Omar E , Infurna Frank J , Lachman Margie E , Gerstorf Denis
Published: December 2021

Objectives

To examine whether racial disparities are narrowing or widening with historical time among U.S. middle-aged and older adults, and test the extent to which educational attainment moderates racial disparities over historical time.

Methods

Multilevel models were applied to longitudinal data on middle-aged (ages 40–65) and older adults (ages 66 and older) from the Health and Retirement Study. Historical change was indexed as cohort or birth year. The outcomes of focus were depressive symptoms, episodic memory, health conditions, functional limitations, and self-rated health.

Results

Results revealed a differential pattern of racial disparities in historical change between midlife and old age. Across midlife and old age, on average, Blacks and Hispanics reported poorer levels of mental and physical health, compared with Whites. In midlife, racial disparities narrowed with historical time; later-born cohorts of Hispanics but not Whites reported fewer depressive symptoms than their earlier-born peers. Likewise, historical improvements in health were stronger among Hispanics and Blacks than Whites. Conversely, in old age, later-born cohorts across race consistently showed historical improvements in each of the outcomes examined. Regarding educational attainment, we observed little consistent evidence that health-promoting effects of educational attainment differ across race and cohort. Examining questions about heterogeneity, results revealed that in midlife and old age there was greater heterogeneity between race across each of the outcomes.

Discussion

Our discussion elaborates on reasons behind the documented racial differences in historical changes among U.S. middle-aged and older adults, and how the protective role of education is changing over time.
Elevated plasma complement components in facioscapulohumeral dystrophy
Authors: Wong Chao-Jen , Wang Leo , Holers V Michael , Frazer-Abel Ashley , van der Maarel Silvère M , Tawil Rabi , Statland Jeffrey M , Tapscott Stephen J ,   ReSolve Network
Published: December 2021

Advances in understanding the pathophysiology of facioscapulohumeral dystrophy (FSHD) have led to several therapeutic approaches entering clinical trials and an increased need to develop biomarkers of disease activity and progression. Multiple prior studies have shown early elevation of RNAs encoding components of the complement pathways and relatively widespread activated complement complexes by immunodetection in FSHD muscle. The current study tested plasma from two independent cohorts of FSHD and control subjects and found elevated complement components in both FSHD cohorts. Combining subjects from both cohorts identified complement factors that best distinguished FSHD and controls. Within the FSHD group, a subset of subjects showed elevation in multiple complement components. Together these findings suggest the need for future studies to determine whether measurements of complement activation can be used as a non-invasive measurement of FSHD disease activity, progression and/or response to therapies. In addition, with the ongoing expansion of complement therapeutic approaches, consideration for precision-based targeting of this pathway is appropriate.
Impact of counterclockwise rotation of the right middle lobe following right upper lobectomy
Authors: Koike Sachie , Eguchi Takashi , Matsuoka Shunichiro , Takeda Tetsu , Miura Kentaro , Shimizu Kimihiro , Hamanaka Kazutoshi
Published: December 2021

OBJECTIVES

Following right upper lobectomy, the right middle lobe may shift towards the apex and rotate in a counterclockwise direction with respect to the hilum. This study aimed to investigate the incidence and clinical impact of middle lobe rotation in patients undergoing right upper lobectomy.

METHODS

From January 2014 to November 2018, 82 patients underwent right upper lobectomy at our institution for lung cancer using a surgical stapler to divide the minor fissure. Postoperative computed tomography scans evaluated the counterclockwise rotation of the middle lobe, in which the staple lines placed on the minor fissure were in contact with the major fissure of the right lower lobe (120° counterclockwise rotation). Clinicoradiological factors were evaluated and compared between patients with and without middle lobe rotation. We also reviewed surgical videos in patients with middle lobe rotation to evaluate the position of the middle lobe at the end of surgery.

RESULTS

Nine patients had a middle lobe rotation (11%), where 1 patient required surgical derotation. Patients with middle lobe rotation were significantly associated with more frequent right middle lobe atelectasis and severe postoperative complications compared with those without rotation. A surgical video review detected potential middle lobe rotation at the end of the surgery.

CONCLUSIONS

Middle lobe rotation without torsion following right upper lobectomy is not rare, and it is associated with adverse postoperative courses. Careful positioning of the right middle lobe at the end of surgery is warranted to improve postoperative outcomes.
The Private Is Political: Partisan Persuasion through Mobile Instant Messaging Services
Authors: Lobera Josep , Portos Martín
Published: December 2021

The use of mobile instant messaging services (MIMS) for the dissemination of electoral information has been increasing in recent years. Drawing on a novel dataset from a 2015 post-electoral survey in Spain, we focus on individuals’ digital political behavior, both public and private. Our results show that, in a context of high electoral volatility and polarization, right-wing supporters are willing to engage in political persuasion activities using tools such as MIMS in the private digital arena but not publicly (e.g., on social media). In contrast, left-wing milieus develop mobilization efforts in both public and private settings. We argue that distinct political styles are key in accounting for the difference in channels of partisan persuasion, in which preference falsification mechanisms are involved in the public sphere. These results bear important implications for the understanding of false information exchanges in the private sphere, social media activism, and political participation. Additionally, they help us shed light on the recurring failure of polls in capturing electoral behavior among right-wing voters in polarized elections and referenda.
Mycobacterium tuberculosis-Specific T-Cell Responses Are Impaired During Late Pregnancy With Elevated Biomarkers of Tuberculosis Risk Postpartum
Authors: Saha Aparajita , Escuduero Jaclyn , Layouni Troy , Richardson Barbra , Hou Sharon , Mugo Nelly , Mujugira Andrew , Celum Connie , Baeten Jared M , Lingappa Jairam , John-Stewart Grace C , LaCourse Sylvia M , Shah Javeed A
Published: December 2021

Background

Pregnancy is a risk factor for progression from latent tuberculosis infection to symptomatic tuberculosis. However, how pregnancy influences T-cell responses to Mycobacterium tuberculosis is unknown.

Methods

We measured M. tuberculosis-specific cytokines, T-cell memory markers, and overall CD4+ and CD8+ T-cell activation by flow cytometry from 49 women (18 with and 31 without HIV) who became pregnant while enrolled in a randomized controlled trial of preexposure prophylaxis for HIV. We analyzed data using COMPASS, an established statistical method for evaluating overall antigen-specific T-cell responses.

Results

Pregnant women with latent tuberculosis infection demonstrated significantly diminished M. tuberculosis-specific CD4+ cytokine responses in the third trimester (COMPASS polyfunctional score [PFS], 0.07) compared before (PFS, 0.15), during (PFS, 0.13 and 0.16), and after pregnancy (PFS, 0.14; P = .0084, Kruskal-Wallis test). Paradoxically, M. tuberculosis-specific CD8+ cytokines and nonspecifically activated T-cells increased during late pregnancy. Nonspecific T-cell activation, a validated biomarker for progression from latent tuberculosis infection to tuberculosis disease, increased in latent tuberculosis infection-positive women postpartum, compared with latent tuberculosis infection-negative women.

Conclusions

Pregnancy-related functional T-cell changes were most pronounced during late pregnancy. Both M. tuberculosis-specific T-cell changes during pregnancy and increases in immune activation postpartum may contribute to increased risk for tuberculosis progression.

Clinical Trials Registration

NCT0557245.
Similar Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Infection and Similar Nucleocapsid Antibody Levels in People With Well-Controlled Human Immunodeficiency Virus (HIV) and a Comparable Cohort of People Without HIV
Authors: Verburgh Myrthe L , Boyd Anders , Wit Ferdinand W N M , Schim van der Loeff Maarten F , van der Valk Marc , Bakker Margreet , Kootstra Neeltje A , van der Hoek Lia , Reiss Peter
Published: December 2021

Background

Within the ongoing AGEhIV Cohort Study in Amsterdam, we prospectively compared the incidence of and risk factors for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection between human immunodeficiency virus (HIV)–positive and HIV-negative participants. Moreover, we compared SARS-CoV-2 nucleocapsid antibody levels between participants with incident infection from both groups.

Methods

Starting in September 2020, consenting HIV-positive and HIV-negative participants were assessed every 6 months for incident SARS-CoV-2 infection, using combined immunoglobulin (Ig) A/IgM/IgG SARS-CoV-2 nucleocapsid antibody assay. Cumulative incidence of SARS-CoV-2 infection and associated risk factors were assessed from 27 February 2020 through 30 April 2021, using complementary log-log regression. In those with incident SARS-CoV-2 infection, nucleocapsid (N) antibody levels were compared between groups using linear regression.

Results

The study included 241 HIV-positive (99.2% virally suppressed) and 326 HIV-negative AGEhIV participants. The cumulative SARS-CoV-2 incidence by April 2021 was 13.4% and 11.6% in HIV-positive and HIV-negative participants, respectively (P = .61). Younger age and African origin were independently associated with incident infection. In those with incident infection, only self-reported fever, but not HIV status, was associated with higher N antibody levels.

Conclusions

HIV-positive individuals with suppressed viremia and adequate CD4 cell counts had similar risk of SARS-CoV-2 acquisition and similar SARS-CoV-2 N antibody levels after infection compared with a comparable HIV-negative cohort.

Clinical Trial Registration

NCT01466582.
Cruel Intentions: Liberal Logics and Processes of International Criminalization
Authors: Han Yuna , Nantermoz Olivia
Published: December 2021

The prohibition and prosecution of core international crimes are understood as a liberal response to particularly cruel acts that shock the conscience of humanity. But what is the nature of this cruelty and how does it relate to liberalism? Rather than seeing liberalism as monolithic, we examine the different relationships between liberal logics and cruelty and how they manifest in processes of international criminalization. We develop a three-pronged typology of liberalism(s) based on their constitutive relationship to cruelty. The first logic expands upon Judith Shklar's theory of “Liberalism of Fear” that sees cruelty as detrimental to liberal society, foregrounding particularly acute forms of physical and affective cruelty in liberal politics and law; the second logic, “Racial Liberalism,” understands cruelty as a condition of possibility for the liberal order built on the exploitation of racialized others; and the third conceives of cruelty as produced by the market logic of trade-offs, referred to as “Sacrificial Liberalism.” Based on this framework, we examine two processes of international criminalization: the crime of genocide (widely considered to be the “crime of crimes” and thus an emblematic case of criminalized cruelty directed against collective identities) and the crime of aggression (which followed a more complicated criminalization trajectory). By tracing how different liberal logics interrelate, come into tension, and thus shape the processes of international criminalization, we not only illuminate the shifting legitimations and normative priorities of the liberal international order but also confront the normative value of criminalizing cruelty.
Prediction of the Values of CRP, eGFR, and Hemoglobin in the Follow-Up of Renal Cell Carcinoma Patients after (Cryo)Surgery Using Machine Learning Algorithms
Authors: Bosma Madeleen , Jansen Swetta A , Gawel Job H , van Dullemen Coen E M , Priems Margrite M , Westerhof Alisa , Meijer Aswin R , Ruven Henk J T
Published: December 2021

Background

Artificial intelligence can support clinical decisions by predictive modeling. Using patient-specific characteristics, models may predict the course of clinical parameters, thus guiding monitoring approaches for the individual patient. Here, we present prediction models for inflammation and for the course of renal function and hemoglobin (Hb) in renal cell carcinoma patients after (cryo)surgery.

Methods

Using random forest machine learning in a longitudinal value-based healthcare data set (n = 86) of renal cell carcinoma patients, prediction models were established and optimized using random and grid searches. Data were split into a training and test set in a 70:30 ratio. Inflammation was predicted for a single timepoint, whereas for renal function estimated glomerular filtration rate (eGFR) and Hb time course prediction was performed.

Results

Whereas the last Hb and eGFR values before (cryo)surgery were the main basis for the course of Hb and renal function, age and several time frame features also contributed significantly. For eGFR, the type of (cryo)surgery was also a main predicting feature, and for Hb, tumor location, and body mass index were important predictors. With regard to prediction of inflammation no feature was markedly prominent. Inflammation prediction was based on a combination of patient characteristics, physiological parameters, and time frame features.

Conclusions

This study provided interesting insights into factors influencing complications and recovery in individual renal cell carcinoma patients. The established prediction models provide the basis for development of clinical decision support tools for selection and timing of laboratory analyses after (cryo)surgery, thus contributing to quality and efficiency of care.
Transesterification of Indazole-3-carboxamide Synthetic Cannabinoids: Identification of Metabolite Biomarkers for Diagnosing Co-abuse of 5F-MDMB-PINACA and Alcohol
Authors: Wang Ziteng , Fong Ching Yee , Goh Evelyn Mei Ling , Moy Hooi Yan , Chan Eric Chun Yong
Published: December 2021

Concurrent use of alcohol with synthetic cannabinoids (SCs) has been widely recorded among drug abusers. The susceptibilities of three indazole-3-carboxamide type SCs with methyl ester moiety, 5F-MDMB-PINACA, 5F-MMB-PINACA, and MMB-FUBINACA, to transesterification in the presence of ethanol warranted further investigation in view of probable augmented toxicity. In vitro metabolite identification experiments were first performed using human liver microsomes (HLMs) to characterize the novel metabolites of the three parent SCs in the presence of ethanol. Formation of transesterified metabolite, hydrolyzed metabolite, and several oxidative metabolites in HLM in the presence of alcohol was further determined for each parent SC and the respective ethyl ester analog, 5F-EDMB-PINACA, 5F-EMB-PINACA, and EMB-FUBINACA, to quantitatively elucidate transesterification and hydrolysis activities. Our results suggested that all three SCs undergo carboxylesterase-mediated transesterification to their respective ethyl ester analog in the presence of ethanol, which was incubation time- and ethanol concentration-dependent. Each ethyl ester metabolite was sequentially and readily metabolized to novel oxidative metabolites with the intact ethyl ester moiety and the same hydrolyzed metabolite as derived from its parent SC. A smaller extent of transesterification was non-enzymatically driven. Notably, we proposed 5F-EDMB-PINACA oxidative defluorination metabolite as the biomarker for diagnosing the potential co-abuse of 5F-MDMB-PINACA and alcohol. Due to the comparable pharmacological activities between each SC and its ethyl ester metabolite, augmented toxicity associated with co-abuse of SCs and alcohol is probable and deserves further investigation.
Computational co-design framework for coreless wound fibre–polymer composite structures
Authors: Gil Pérez M , Zechmeister C , Kannenberg F , Mindermann P , Balangé L , Guo Y , Hügle S , Gienger A , Forster D , Bischoff M , Tarín C , Middendorf P , Schwieger V , Gresser G T , Menges A , Knippers J
Published: December 2021

In coreless filament winding, resin-impregnated fibre filaments are wound around anchor points without an additional mould. The final geometry of the produced part results from the interaction of fibres in space and is initially undetermined. Therefore, the success of large-scale coreless wound fibre composite structures for architectural applications relies on the reciprocal collaboration of simulation, fabrication, quality evaluation, and data integration domains. The correlation of data from those domains enables the optimization of the design towards ideal performance and material efficiency. This paper elaborates on a computational co-design framework to enable new modes of collaboration for coreless wound fibre–polymer composite structures. It introduces the use of a shared object model acting as a central data repository that facilitates interdisciplinary data exchange and the investigation of correlations between domains. The application of the developed computational co-design framework is demonstrated in a case study in which the data are successfully mapped, linked, and analysed across the different fields of expertise. The results showcase the framework’s potential to gain a deeper understanding of large-scale coreless wound filament structures and their fabrication and geometrical implications for design optimization.
Nutritional and Physiological Regulation of Glassy-Winged Sharpshooter Oogenesis
Authors: Sisterson Mark S , Brent Colin S
Published: December 2021

The glassy-winged sharpshooter (Homalodisca vitripennis (Germar); Hemiptera: Cicadellidae: Cicadellinae) is an invasive insect that transmits the plant pathogenic bacterium Xylella fastidiosa Wells et al. (Xanthomonadales: Xanthomonadacae). While adult glassy-winged sharpshooter must feed to produce eggs, the role of nutritional status on initiating oogenesis is poorly understood. To determine the effects of glassy-winged sharpshooter nutrition on nymphal development, oogenesis, and fecundity, glassy-winged sharpshooter were reared on cowpea, sunflower, sorghum, and a mixture of the three plant species. Adults emerging from cowpea, sunflower, or plant mixture treatments had shorter development times, attained larger size, and had greater estimated lipid reserves than females reared on sorghum. In choice tests, nymphs avoided sorghum and preferentially fed on cowpea and sunflower. Adult females provisioned with a single plant species during the nymphal stage were provided with either the same host plant species or a mixture of host plant species (cowpea, sunflower, sorghum) for a 9-wk oviposition period, with 37% of females initiating oogenesis. Ovipositing females had greater juvenile hormone and octopamine levels than reproductively inactive females, although topical application of the juvenile hormone analog Methoprene did not promote oogenesis. Across nymphal diets, reproductively active females produced more eggs when held on plant mixtures than on single plant species. In choice tests, adult females were observed most frequently on cowpea, although most eggs were deposited on sorghum, the host least preferred by nymphs. Results suggest that fecundity is largely determined by the quality of the adult diet, although the stimulus that initiates oogenesis does not appear to be related to nutrition.