bluuebunny/crossref_metadata_2025 huggingface dataset:
Sex- and body mass index-specific reference intervals for serum leptin: a population based study in China
Authors: Cheng Jiayu , Luo Yingying , Li Yufeng , Zhang Fang , Zhang Xiuying , Zhou Xianghai , Ji Linong
Published: August 2022

Background

Leptin is a peptide hormone secreted by adipose tissue and is an important determinant of obesity and its complications. The purpose of this study was to establish sex- and body mass index (BMI)-specific reference intervals for serum leptin in a Chinese population and investigate the factors influencing leptin concentrations.

Methods

Fasting serum leptin levels were assayed in 469 men and 773 women from randomly sampled Chinese residents. Blood glucose, insulin, hemoglobin A1c (HbA1c), liver enzymes, blood lipid profiles, creatinine, and uric acid (UA) levels were measured. Pearson’s correlation coefficient and multiple linear regression analyses were used to estimate the relationship between serum leptin level and other variables. The reference intervals were determined by the 2.5th and 97.5th percentiles.

Results

The mean ± standard deviation serum leptin level was much higher in women (20.92 ± 12.96 ng/mL) than in men (6.45 ± 5.53 ng/mL). The reference interval of serum leptin was 0.33–19.85 ng/mL in men and 3.60–54.86 ng/mL in women. The specific reference intervals of serum leptin in men with BMI of 20 to < 25 and 25 to < 27.5 kg/m2 were 0.42–12.32 and 2.17–20.22 ng/ml, respectively. The specific reference intervals of serum leptin in women with BMI of 20 to < 25 and 25 to < 27.5 kg/m2 were 4.11–38.09 and 8.27–48.66 ng/ml, respectively. BMI was significantly correlated with Ln (leptin) both in men (r = 0.698, P < 0.001) and women (r = 0.626, P < 0.001). In multivariate linear regression analysis, serum leptin was correlated with BMI, homeostasis model assessment of insulin resistance (HOMA-IR), UA in women, and plus triglyceride (TG) in men. The variance in serum leptin levels could be partially explained by these variables in both women (adjusted R2 = 0.447) and men (adjusted R2 = 0.552). In participants with leptin levels higher than the reference intervals, significantly higher levels of HOMA-IR, low-density lipoprotein cholesterol (LDL-C), UA, a higher proportion of central obesity (waist circumference [WC] > 90 cm), and metabolic syndrome were found in men, and significantly higher levels of HOMA-IR, UA and a higher proportion of central obesity (WC > 85 cm) were found in women.

Conclusion

This is the first study to establish sex- and BMI-specific reference intervals of leptin for both sexes in a large Chinese population. Serum concentration of leptin was predicted by BMI, HOMA-IR, UA in women, and TG in men.
Follicular dendritic cell sarcoma of gastrointestinal tract with two emerging distinct subtypes: a case report and systemic review
Authors: Gui Hongxing , Chaudhari Jigisha , Mannan Rifat
Published: August 2022

Background

Follicular dendritic cell sarcoma (FDCS) is a rare neoplasm of mesenchymal origin. FDCS of gastrointestinal tract (GI) are exceedingly uncommon.

Case presentation

We report the first case of classic type FDCS in a 34-year-old male with Birt-Hogg-Dubé syndrome, which presented as a mass at the ileo-cecal junction. He received no further treatment after resection and remained disease free for 3.5 years. We further analyze and review the clinical and pathologic findings of 33 cases of GI tract FDCS reported in the literature.

Conclusions

There are two distinct subtypes of FDCS in the GI tract: the classic type occurs in relatively younger patients (mean = 45.3 years) without Epstein-Barr virus (EBV) association, and behaves more aggressively; the inflammatory subtype presents as colonic polypoid tumor in older patients (mean = 60.7 years) and is EBV positive. The clinical outcome in the latter group appears favorable although mortality rate is not necessarily low.
The role of neoadjuvant radiochemotherapy in the management of localized high-grade soft tissue sarcoma
Authors: Kobus Marta , Roohani Siyer , Ehret Felix , Flörcken Anne , Striefler Jana Käthe , Brandes Franziska , Märdian Sven , Rau Daniel , Wittenberg Silvan , Öllinger Robert , Kaul David
Published: August 2022

Background

Standard treatment of soft tissue sarcoma (STS) of the extremities includes limb-sparing surgery combined with pre- or postoperative radiotherapy (RT). The role of perioperative chemotherapy (CTX) remains uncertain. STS patients with high-risk features for local recurrence, distant metastases, and increased mortality may require additional systemic therapy. The objective of this study was to evaluate predictors of outcome regarding local control (LC), overall survival (OS), and freedom from distant metastases (FFDM) in a large single-center cohort of patients suffering from localized high-grade STS (grade 2/3, G2/G3). Special emphasis was put on a subgroup of patients who received combined neoadjuvant radiochemotherapy (RCT).

Methods

Overall, 115 adult STS patients were included in this retrospective study. The median follow-up was 34 months. Twenty-three patients (20.0%) were treated with neoadjuvant RCT, 92 (80.0%) received other therapies (adjuvant RT alone (n = 58); neoadjuvant CTX + adjuvant RT (n = 17); adjuvant RCT (n = 10), neoadjuvant RT alone (n = 7)). To assess potential prognostic factors on LC, OS, and FFDM, univariate (UVA) and multivariable (MVA) Cox proportional hazards models were applied.

Results

UVA showed significantly better LC rates in the neoadjuvant RCT group (p = 0.025), with trends in MVA (p = 0.057). The 3-year LC rate was 89.7% in the neoadjuvant RCT group vs. 75.6% in the "other therapies" group. UVA also showed significantly better OS rates in the neoadjuvant RCT group (p = 0.049), however, this was not confirmed in MVA (p = 0.205), the 3-year OS rate was 85.8% for patients treated with neoadjuvant RCT compared to 73.5% in the "other therapies" group. UVA showed significantly better FFDM rates in (p = 0.018) and a trend towards better FFDM rates in MVA (p = 0.059). The 3-year FFDM rate was 89.7% for patients treated with neoadjuvant RCT compared to 65.9% in the "other therapies" group. In the subgroup of patients with G3 STS, neoadjuvant RCT was a significant positive predictor of LC and FFDM in MVA (p = 0.047, p = 0.027) but not for OS. Overall grade 3 and 4 toxicities were significantly higher (p = 0.019) in the neoadjuvant RCT group and occurred in 73.9% vs. 38.0% in patients receiving other therapies.

Conclusions

The results suggest that neoadjuvant RCT might improve LC and FFDM in patients with localized G3 STS while also being associated with increased acute complication rates. Further prospective research is warranted to confirm these findings.
Uptake of cervical cancer screening and its predictors among women of reproductive age in Gomma district, South West Ethiopia: a community-based cross-sectional study
Authors: Gizaw Abraham Tamirat , El-Khatib Ziad , Wolancho Wadu , Amdissa Demuma , Bamboro Shemsedin , Boltena Minyahil Tadesse , Appiah Seth Christopher Yaw , Asamoah Benedict Oppong , Wasihun Yitbarek , Tareke Kasahun Girma
Published: August 2022

Background

Cervical cancer is a public health challenge despite the available free screening service in Ethiopia. Early screening for cervical cancer significantly improves the chances of successful treatment of pre-cancers and cancers among women of reproductive age. Therefore, this study aimed to assess the uptake of screening and identify the factors among women of reproductive age.

Methods

A community-based cross-sectional study was conducted in Gomma Woreda, Jimma Zone, Ethiopia, from 1st to the 30th of August, 2019. The total sample size was 422. A systematic random sampling technique was employed. Data were collected using a structured questionnaire, entered in epidata, and exported and analyzed using SPSS version 20.0 software packages. Descriptive, bivariate and multivariable logistic regression analyses with 95% CI for odds ratio (OR) were performed to declare a significant predictors.

Result

A total of 382 study participants were involved with a response rate of 90.5%. The mean age of the study participants was 26.45 ± 4.76 SD. One hundred forty-eight (38.7%) of participants had been screened for CC. Marital status (AOR = 10.74, 95%, CI = 5.02–22.96), residence (AOR = 4.45, 95%, CI = 2.85–6.96), educational status (AOR = 1.95, 95% CI = 1.12–3.49), government employee (AOR = 2.61, 95%, CI = 1.33–5.15), birth experience (AOR = 8.92, 95% CI = 4.28–19.19), giving birth at health center and government hospitals (AOR = 10.31, 95% CI = 4.99–21.62; AOR = 5.54, 95% CI = 2.25–13.61); distance from health facility (AOR = 4.41, 95% CI = 2.53–9.41), health workers encouragement (AOR = 3.23, 95% CI = 1.57–6.63), awareness on cervical cancer (AOR = 0.37, 95% CI = 0.19–0.72), awareness about CC screening (AOR = 4.52, 95%, CI = 2.71–7.55) and number of health facility visit per year (AOR = 3.63, 95%, CI = 1.86–6.93) were the predictors for the uptake of cervical cancer screening.

Conclusion

The uptake of cervical cancer screening was low. Marital status, residence, occupation, perceived distance from screening health facility, health workers encouragement, number of health facility visits, birth experience, place of birth, and knowledge about cervical cancer screening were the predictors. There is a need to conduct further studies on continuous social and behavioral change communication.
Foot pain and inflammatory markers: a cross sectional study in older adults
Authors: Siefkas Anna C. , Dufour Alyssa B. , Golightly Yvonne M. , Menz Hylton B. , Hillstrom Howard J. , Hannan Marian T.
Published: August 2022

Background

Foot disorders may limit independence and reduce quality of life for older adults. Obesity is a risk factor for foot conditions; both mechanical load and metabolic effects may contribute to these conditions. This study determined cross‐sectional associations between inflammatory markers and foot disorders.

Methods

Participants were drawn from the Framingham Foot Study (2002–2008). C‐reactive protein (CRP), interleukin‐6 (IL‐6), and tumor necrosis factor alpha (TNF‐α) were each examined for associations with foot pain, forefoot pain, hindfoot pain, hallux valgus, hallux rigidus, and toe deformities (claw, hammer, or overlapping toes). Unadjusted and adjusted (age, body mass index, physical activity, smoking status) sex‐specific logistic regression was performed.

Results

Of 909 participants, 54% were women (mean age 65 9 years), 20% had foot pain, 29% had hallux valgus, 3% had hallux rigidus, and 27% had toe deformities. In unadjusted models, higher CRP (OR [95% CI] = 1.5 [1.1, 2.0]) and IL‐6 (OR [95% CI] = 1.8 [1.2, 2.6]) were associated with foot pain among men; higher CRP was associated with foot pain (OR [95% CI] = 1.3 [1.0, 1.5]) among women. Higher CRP (OR [95% CI] = 1.9 [1.1, 3.2]) and IL‐6 (OR [95% CI] = 2.4 [1.2, 4.7]) were associated with forefoot pain in men. Higher CRP was associated with hindfoot pain ([95% CI] = 1.8 [1.2, 2.6]) in women. After adjustment, CRP ([95% CI] = 1.5 [1.1, 2.0]) and IL‐6 ([95% CI] = 1.8 [1.2, 2.6]) remained associated with foot pain in men, and IL‐6 with forefoot pain ([95% CI] = 2.9 [1.4, 6.1]) in men. No associations with structural foot disorders were observed.

Conclusions

Inflammation may impact foot pain. Future work assessing whether inflammation is part of the mechanism linking obesity to foot pain may identify areas for intervention and prevention.
Low-dose intravenous plus inhaled versus intravenous polymyxin B for the treatment of extensive drug-resistant Gram-negative ventilator-associated pneumonia in the critical illnesses: a multi-center matched case–control study
Authors: Liu Jiao , Shao Min , Xu Qianghong , Liu Fen , Pan Xiaojun , Wu Jianfeng , Xiong Lihong , Wu Yueming , Tian Mi , Yao Jianying , Huang Sisi , Zhang Lidi , Chen Yizhu , Zhang Sheng , Wen Zhenliang , Du Hangxiang , TaoWang  , Liu Yongan , Li Wenzhe , Xu Yan , Teboul Jean-louis , Chen Dechang
Published: August 2022

Background

The mortality of extensively drug-resistant Gram-negative (XDR GN) bacilli-induced ventilator-associated pneumonia (VAP) is extremely high. The purpose of this study was to compare the efficacy and safety of inhaled (IH) plus intravenous (IV) polymyxin B versus IV polymyxin B in XDR GN bacilli VAP patients.

Methods

A retrospective multi-center observational cohort study was performed at eight ICUs between January 1st 2018, and January 1st 2020 in China. Data from all patients treated with polymyxin B for a microbiologically confirmed VAP were analyzed. The primary endpoint was the clinical cure of VAP. The favorable clinical outcome, microbiological outcome, VAP-related mortality and all-cause mortality during hospitalization, and side effects related with polymyxin B were secondary endpoints. Favorable clinical outcome included clinical cure or clinical improvement.

Results

151 patients and 46 patients were treated with IV polymyxin B and IH plus IV polymyxin B, respectively. XDR Klebsiella pneumoniae was the main isolated pathogen (n = 83, 42.1%). After matching on age (± 5 years), gender, septic shock, and Apache II score (± 4 points) when polymyxin B was started, 132 patients were included. 44 patients received simultaneous IH plus IV polymyxin B and 88 patients received IV polymyxin B. The rates of clinical cure (43.2% vs 27.3%, p = 0.066), bacterial eradication (36.4% vs 23.9%, p = 0.132) as well as VAP-related mortality (27.3% vs 34.1%, p = 0.428), all-cause mortality (34.1% vs 42.0%, p = 0.378) did not show any significant difference between the two groups. However, IH plus IV polymyxin B therapy was associated with improved favorable clinical outcome (77.3% vs 58.0%, p = 0.029). Patients in the different subgroups (admitted with medical etiology, infected with XDR K. pneumoniae, without bacteremia, with immunosuppressive status) were with odd ratios (ORs) in favor of the combined therapy. No patient required polymyxin B discontinuation due to adverse events. Additional use of IH polymyxin B (aOR 2.63, 95% CI 1.06, 6.66, p = 0.037) was an independent factor associated with favorable clinical outcome.

Conclusions

The addition of low-dose IH polymyxin B to low-dose IV polymyxin B did not provide efficient clinical cure and bacterial eradication in VAP caused by XDR GN bacilli.

Keypoints

Additional use of IH polymyxin B was the sole independent risk factor of favorable clinical outcome. Patients in the different subgroups were with HRs substantially favoring additional use of IH polymyxin B. No patients required polymyxin B discontinuation due to adverse events.
Effect of the Cement-to-Water Ratio and Fractal Granular Model on the Prediction of Concretes Compressive Strength
Authors: Abdeldjalil Mhammed , Chouicha Kaddour
Published: August 2022

The main objective of this work was to highlight the contribution of cement-to-water $$\mathrm{C}/\mathrm{W}$$

C
/
W

ratio and the fractal dimension $$\mathrm{FD}$$
FD
model to the prediction of the compressive strength of concrete. In particular, the fractal dimension $$\mathrm{FD}$$
FD
concept relative to the size distribution of the granular mixtures provided an insight into the fineness and compactness of the granular mixtures. The unconventional fractal granular model $${\mathrm{FGM}}_{\mathrm{g}}$$

FGM
g

also effectively contributed to highlight the correlation between cement-to-water ratio and compressive strength $${\mathrm{R}}_{\mathrm{C}28}$$

R

C
28

of concretes. Initially, 99 granular mixtures of concretes composition available in literature were investigated and for which the granular distributions by means of the fractal dimension $$\mathrm{FD}$$
FD
model and the granular range $$\mathrm{D}/\mathrm{d}$$

D
/
d

were we determined. Then, 36 concrete mixtures endowed with different granular mixtures were elaborated and analysed. These enabled to validate and evaluate the reliability of the basic granular fractal model $${\mathrm{FGM}}_{\mathrm{g}}$$

FGM
g

and the influence of cement–water $$\mathrm{C}/\mathrm{W}$$

C
/
W

ratio of concretes mixtures when predicting the concretes compressive strength $${\mathrm{R}}_{\mathrm{C}28}.$$

R

C
28

.

The analytical model provided a close correlation with the experimental values of the compressive strength $${\mathrm{R}}_{\mathrm{C}28}$$

R

C
28

of all the concretes. The correlation highlighted the relevance of including fractal granular model $${\mathrm{FGM}}_{\mathrm{g}}$$

FGM
g

that denoted the skeleton of the concretes and the cement–water $$\mathrm{C}/\mathrm{W}$$

C
/
W

ratio that referred to the binders into concretes mixtures when predicting $${\mathrm{R}}_{\mathrm{C}28}$$

R

C
28

. The theoretical approach whose effectiveness was highlighted using a "limited" number of real case studies may pave the way for further studies, when selecting the two key-factors for the prediction of concretes compressive strength $${\mathrm{R}}_{\mathrm{C}28}$$

R

C
28

.
Weight gain and parental self-efficacy in a family-based partial hospitalization program
Authors: Van Huysse Jessica L. , Lock James , Le Grange Daniel , Rienecke Renee D.
Published: August 2022

Background

Family-based treatment (FBT) is an outpatient therapy, though FBT principles have been incorporated in higher levels of care (e.g., partial hospitalization programs, PHPs). It is unknown how participation in a family-based PHP impacts weight restoration and parental self-efficacy.

Methods

Weight gain and parental self-efficacy were examined in 98 participants with anorexia nervosa or atypical anorexia nervosa during the first five weeks of participation in a family-based PHP. Maternal self-efficacy was assessed using the Parent versus Anorexia Scale.

Results

Significant increases in weight, percent expected body weight (EBW), and maternal self-efficacy were observed, with large effect sizes. During the first five weeks of treatment, patients in the PHP gained an average of 4.5 kg, or 8.3% EBW. Maternal self-efficacy improved within two weeks of treatment.

Conclusions

Findings suggest that family-based PHPs may facilitate rapid weight restoration without decreasing parental self-efficacy. Randomized trials are needed to directly compare family-based PHPs to outpatient FBT and PHPs with alternate treatment approaches, including longer-term follow-up and cost-effectiveness modeling.
Study on digital protection and innovative design of Qin opera costumes
Authors: Liu Kaixuan , Gao Yuanyuan , Zhang Jiaqi , Zhu Chun
Published: August 2022

Qin opera culture has a long history in China for thousands of years. It is the ancestor of Chinese opera. However, with the development of modern technology and the rise of new media, the protection and inheritance of traditional Qin opera culture is facing a new challenge and opportunity, its costume culture is the same. This paper analyzes the style and structure of Qin opera costumes, extracts the colors of the costumes, summarizes the costume patterns, and then uses the three-dimensional (3D) virtual visualization technology to virtually restore the Qin opera costume, and innovates the Qin opera costume. In this paper, twelve sets of traditional Qin opera costumes are virtually restored, and on this basis, the digital protection and innovative design of Qin opera series costumes are carried out, and all the restored costumes are displayed digitally in an all-round way. The combination of Qin opera costume and digital protection extends the application scope of virtual visualization technology and enriches the transmission mode of Qin opera costume. This study inherits and protects the traditional Qin opera costume culture better.
Stereolithography (STL) measurement rubric for the evaluation of craniomaxillofacial STLs
Authors: Muller Henra , Fossey Annabel
Published: August 2022

Background

Facial deformities often demand reconstructive surgery and the placement of three-dimensional (3D) printed craniomaxillofacial prostheses. Prostheses manufacturing requires patients’ computed tomography (CT) images. Poor quality images result in incorrectly sized prostheses, necessitating repeat imaging and refitting. The Centre for Rapid Prototyping and Manufacturing (CRPM) produces most facial prostheses in South Africa but does not have a prescribed optimised CT protocol. Therefore, this study was undertaken.

Methods

A collection of CRPM STLs used in the design and manufacturing of craniomaxillofacial prostheses is available. The image quality of stereolithography (STL) files of CRPM CT scans was evaluated to determine what constitutes good image quality. This collection was scrutinised for inclusion in the image quality evaluation. After scrutiny, 35 STLs of individuals ≥15 years of age were selected and included metadata attached to the DICOM file. Furthermore, only STLs created without manipulation by the same designer were included in the collection. Before the qualitative evaluation of the STLs, eight different critical anatomical reference points (CARPs) were identified with the assistance of an expert team. A visual acuity rating scale of three categories was devised for each CARP, where 1 was allocated to poor visual acuity, 2 to partial, and 3 to good visual acuity. Similarly, rating scales were devised for the presence of concentric rings and the overall impression score awarded by the two designers involved in the design and manufacturing of the prostheses. This stereolithography measurement rubric (SMR) was then applied to the 35 STLs by a team of three experts, including the two designers, during a structured evaluation session. The scores were used to calculate summary and inferential statistics.

Results

Scores grouped around the central rating of partial visual acuity. The three evaluators’ mean total CARP scores ranged from 13.1 to 14.4 (maximum possible score 24), while the mean total CARP + ring scores ranged from 15.8 to 17.1 (maximum possible score 27). No significant differences were detected between the evaluators’ scores.

Conclusion

This SMR appears to be the first of its kind. This image quality assessment of STLs provides the groundwork for finer CT image quality evaluation to formulate a CT imaging protocol for the CRPM to design and manufacture accurate internal cranial prostheses.
Neuroinflammation in autism spectrum disorders: potential target for mesenchymal stem cell-based therapy
Authors: Wong Rebecca S. Y.
Published: August 2022

Background

Autism spectrum disorders (ASD) include a group of neurodevelopmental disorders characterised by repetitive behaviours and impairments in communication, emotional and social skills. This review gives an overview of ASD, focusing on the aetiological and clinical aspects. It also discusses the role of neuroinflammation in ASD, critically examines the current evidence on the therapeutic effects of MSCs in ASD and consolidates key findings in this area of research.

Results

Many environmental and genetic factors have been linked to the aetiology of ASD. It has become increasingly evident that neuroinflammation plays a role in ASD. Conventional treatment of ASD revolves around psychosocial approaches whereas recent studies have turned to alternative approaches such as mesenchymal stem cell (MSC)-based therapy, owing to the well-recognised immunomodulatory characteristics of MSCs. Preclinical and clinical studies have shown that MSCs were able to exert anti-inflammatory effects and alleviate ASD symptoms.

Conclusions

There are many preclinical studies that support the use of MSCs in ASD. However, there are relatively fewer clinical studies concerning the safety and efficacy of MSCs in ASD, which warrants more large-scale clinical studies for future research.
New concepts in neurology education: successful implementation of flipped classroom lectures
Authors: Mosene Katharina , Heitmann Henrik , Pötter Dennis , Schmidt-Graf Friederike
Published: August 2022

In order to inspire and attract young people to Neurology, we must offer high-quality and attractive teaching! To improve neurological education at our Medical School (Technical University of Munich), we converted the main lecture into an e-learning concept using a flipped classroom model. Students had to prepare with a video and a text as well as answering multiple choice questions before each lecture. As a further incentive, students with ≥ 80% right answers in multiple choice questions received a bonus for the final exam. During the lectures, predominantely patient cases were discussed to apply, improve and enhance the previously acquired knowledge. The realignment of the main lecture in Neurology into a flipped classroom model was very successful and was further optimized in the following semesters based on the evaluations obtained for the new concept. Moreover, this enabled us to quickly switch to remote teaching during the COVID-19 pandemic, while still offering lectures of high quality. In addition, this new teaching concept attracts students for Neurology. Furthermore, the exemplary conversion of the Neurology main lecture to a flipped classroom concept also serves as best practice and motivation to adapt other courses in our faculty and far beyond.
Multiomic approaches reveal novel lineage-specific effectors in the potato and tomato early blight pathogen Alternaria solani
Authors: Wang Jinhui , Xiao Siyu , Zheng Lijia , Pan Yang , Zhao Dongmei , Zhang Dai , Li Qian , Zhu Jiehua , Yang Zhihui
Published: August 2022

The effectome of the necrotrophic fungal pathogen, Alternaria solani, was determined using multiomics. In total, 238 effector candidates were predicted from the A. solani genome, and apoplastic effectors constitute most of the total candidate effector proteins (AsCEPs). Comparative genomics revealed two main groups of AsCEPs: lineage-specific and conserved effectors. RNA-Seq analysis revealed that the most highly expressed genes encoding AsCEPs were enriched with lineage-specific forms. Two lineage-specific effector genes, AsCEP19 and AsCEP20, were found to form a ‘head-to-head’ gene pair located near an AT-rich region on the chromosome. To date, AsCEP19 and AsCEP20 have been found only in a few fungal species. Phylogenetic inference revealed that AsCEP19 and AsCEP20 were likely acquired by the common ancestor of A. solani and A. tomatophila via horizontal gene transfer, probably mediated by long terminal repeat retrotransposon. RT-qPCR analysis showed that AsCEP19 and AsCEP20 are tightly coexpressed in a host-specific manner and that they are upregulated at advanced stages of A. solani infection only in solanaceous hosts. Transient expression of AsCEP19 and AsCEP20 in Nicotiana benthamiana plants showed that these effectors could promote Phytophthora infestans infection. AsCEP19 and AsCEP20 were required for the full virulence of A. solani on host potato, because deletion of this gene pair significantly reduced the size of necrotic lesions on potato leaves. Transient expression of AsCEP20 could elicit plant cell death depending on the presence of its signal peptide, indicating that AsCEP20 is a necrosis-inducing apoplastic effector with the mature form localized specifically in chloroplasts. Our work provides a better understanding of the function and evolution of necrotrophic fungal effectors, and helps explain the high aggressiveness of A. solani against solanaceous crops.
Treatment and Survival Outcomes of Waldenstrom Macroglobulinemia in Latin American Patients: A Multinational Retrospective Cohort Study
Authors: Riva Eloísa , Duarte Patricio José , Valcárcel Bryan , Remaggi Guillermina , Murrieta Ivan , Corzo Ariel , del Carpio Daniel , Peña Camila , Vásquez Jule , Bove Virginia , Teixeira Larissa , Fleury-Perini Guilherme , Yantorno Sebastian , Samánez César , Lopresti Sergio , Altamirano Milagros , Villela Luis , Ruiz-Arguelles Guillermo J. , Ruiz-Delgado Guillermo J. , Montaño Efreen , Verri Verónica , Zamora Pérez Elia , Pérez Jacobo Fernando , Idrobo Henry , Martínez-Cordero Humberto , Beltran Brady E. , Ramírez Jhoanna , Castillo Jorge J. , Malpica Castillo Luis E.
Published: August 2022

PURPOSE

Waldenstrom Macroglobulinemia (WM) is a rare lymphoma with distinct clinical features, and data from Latin American patients are lacking. Therefore, we aim to investigate the clinical, therapy, and outcome patterns of WM in Latin America.

METHODS

We retrospectively analyzed patients with WM diagnosed between 1991 and 2019 from 24 centers in seven Latin American countries. The study outcomes were overall survival (OS) and progression-free survival (PFS).

RESULTS

We identified 159 cases (median age 67 years, male 62%). Most patients (95%) were symptomatic at diagnosis. The International Prognostic Scoring System for WM (IPSSWM) at diagnosis was available in 141 (89%) patients (high-risk 40%, intermediate-risk 37%, and low-risk 23%). Twenty-seven (17%) patients were tested for MYD88L265P, with 89% (n = 24 of 27) carrying the mutation. First-line and second-line therapies were administered to 142 (89%) and 53 (33%) patients, respectively. Chemoimmunotherapy was the most commonly used first-line (66%) and second-line (45%) approach; only 18 (11%) patients received ibrutinib. With a median follow-up of 69 months, the 5-year OS rate was 81%. In treated patients, the 5-year OS and PFS rates were 78% and 59%, respectively. High-risk IPSSWM at treatment initiation was an independent risk factor for OS (adjusted hazard ratio: 4.73, 95% CI, 1.67 to 13.41, P = .003) and PFS (adjusted hazard ratio: 2.43, 95% CI, 1.31 to 4.50, P = .005).

CONCLUSION

In Latin America, the management of WM is heterogeneous, with limited access to molecular testing and novel agents. However, outcomes were similar to those reported internationally. We validated the IPSSWM score as a prognostic factor for OS and PFS. There is an unmet need to improve access to recommended diagnostic approaches and therapies in Latin America.
Disparities in Psychosocial Distress Screening and Management of Lung and Ovarian Cancer Survivors
Authors: Rohan Elizabeth A. , Gallaway M. Shayne , Huang Grace C. , Ng Diane , Boehm Jennifer E. , Samarasinha Ruvini , Stachon Karen
Published: August 2022

PURPOSE:

Since 2016, the American College of Surgeons' Commission on Cancer (CoC) has required routine distress screening (DS) of cancer survivors treated in their accredited facilities to facilitate early identification of survivors with psychosocial concerns. Lung and ovarian cancer survivors have relatively low 5-year survival rates and may experience high levels of distress. We examined the extent to which ovarian and lung cancer survivors received CoC-mandated DS and whether DS disparities exist on the basis of diagnosis, sociodemographic factors, or facility geography (urban/rural).

METHODS:

This study included a quantitative review of DS documentation and follow-up services provided using existing electronic health records (EHRs). We worked with 21 CoC-accredited facilities across the United States and examined EHRs of 2,258 survivors from these facilities (1,618 lung cancer survivors and 640 ovarian cancer survivors) diagnosed in 2016 or 2017.

RESULTS:

Documentation of DS was found in half (54.8%) of the EHRs reviewed. Disparities existed across race/ethnicity, cancer type and stage, and facility characteristics. Hispanic/Latino and Asian/Pacific Islander survivors were screened at lower percentages than other survivors. Patients with ovarian cancer, those diagnosed at earlier stages, and survivors in urban facilities had relatively low percentages of DS. Non-Hispanic Black survivors were more likely than non-Hispanic White survivors to decline further psychosocial services.

CONCLUSION:

Despite the mandate for routine DS in CoC-accredited oncology programs, gaps remain in how many and which survivors are screened for distress. Improvements in DS processes to enhance access to DS and appropriate psychosocial care could benefit cancer survivors. Collaboration with CoC during this study led to improvement of their processes for collecting DS data for measuring standard adherence.
Virtual Tumor Board Increases Provider Attendance and Case Presentations
Authors: Davis Catherine H. , Ho Jason , Stephenson Ryan , August David A. , Gee Heather , Weiner Joseph , Alexander H. Richard , Pitt Henry A. , Berger Adam C.
Published: August 2022

PURPOSE:

Many cancer centers engage in multidisciplinary tumor board meetings to determine the optimal approach to complex cancer care. With the onset of the COVID-19 pandemic, many institutions changed the format of these meetings from in-person to virtual. The aim of this study was to determine if the change to a virtual meeting format had an impact on attendance and cases presented.

METHODS:

Tumor board records were analyzed to obtain attendance and case presentation information at a National Cancer Institute–designated Comprehensive Cancer Center. Twelve-month in-person tumor board data were compared with 12-month virtual tumor board data to assess for difference in attendance and case presentation patterns.

RESULTS:

Seven separate weekly tumor board meetings at the beginning of the study (breast, GI, gynecology, liver, lung, melanoma, and urology) were expanded to nine meetings on the virtual platform (+endocrine and pancreas). Overall attendance increased by 46% on the virtual platform compared with in-person meetings (4,030 virtual attendances v 2,753 in-person, P < .001). Increased attendance was present across all specialties on the virtual platform. In addition, the number of patient cases discussed increased from 2,127 in in-person meeting to 2,656 on the virtual platform (a 20% increase, P < .001).

CONCLUSION:

A significant increase was observed in overall tumor board attendance and in case presentations per meeting, requiring the expansion of additional weekly meetings. Furthermore, in a major cancer center with multiple community affiliates, virtual tumor boards may encourage increased participation from remote sites with the benefit of obtaining expert specialist advice as compared with geographically challenging in-person meetings.
An Approach to Solving the Complex Clinicogenomic Data Landscape in Precision Oncology: Learnings From the Design of WAYFIND-R, a Global Precision Oncology Registry
Authors: Le Tourneau Christophe , Perret Camille , Hackshaw Allan , Blay Jean-Yves , Nabholz Christoph , Geissler Jan , Do Thy , von Meyenn Martina , Dienstmann Rodrigo
Published: August 2022

Precision oncology, where patients are given therapies based on their genomic profile and disease trajectory, is rapidly evolving to become a pivotal part of cancer management, supported by regulatory approvals of biomarker-matched targeted therapies and cancer immunotherapies. However, next-generation sequencing (NGS)–based technologies have revealed an increasing number of molecular-based cancer subtypes with rare patient populations, leading to difficulties in executing/recruiting for traditional clinical trials. Therefore, approval of novel therapeutics based on traditional interventional studies may be difficult and time consuming, with delayed access to innovative therapies. Real-world data (RWD) that describe the patient journey in routine clinical practice can help elucidate the clinical utility of NGS-based genomic profiling, multidisciplinary case discussions, and targeted therapies. We describe key learnings from the setup of WAYFIND-R (NCT04529122), a first-of-its-kind global cancer registry collecting RWD from patients with solid tumors who have undergone NGS-based genomic profiling. The meaning of ‘generalizability’ and ‘high quality’ for RWD across different geographic areas was revisited, together with patient recruitment processes, and data sharing and privacy. Inspired by these learnings, WAYFIND-R’s design will help physicians discuss patient treatment plans with their colleagues, improve understanding of the impact of treatment decisions/cancer care processes on patient outcomes, and provide a platform to support the design and conduct of further clinical/epidemiologic research. WAYFIND-R demonstrates user-friendly, electronic case report forms, standardized collection of molecular tumor board-based decisions, and a dashboard providing investigators with access to local cohort-level data and the ability to interact with colleagues or search the entire registry to find rare populations. Overall, WAYFIND-R will inform on best practice for NGS-based treatment decisions by clinicians, foster global collaborations between cancer centers and enable robust conclusions regarding outcome data to be drawn, improve understanding of disparities in patients’ access to advanced diagnostics and therapies, and ultimately drive advances in precision oncology.
Epidemiology and Pathophysiology of Multiple Sclerosis
Authors: Ward Melanie , Goldman Myla D.
Published: August 2022

PURPOSE OF REVIEW

This article provides an overview of genetic, environmental, and lifestyle risk factors affecting the disease course of multiple sclerosis (MS) and reviews the pathophysiologic characteristics of both relapsing and progressive MS.

RECENT FINDINGS

The prevalence of MS has increased in recent decades, and costs of care for patients with MS have risen dramatically. Black, Asian, and Hispanic individuals may be at risk for more severe MS-related disability. Multiple genetic MS risk factors have been identified. Factors such as low vitamin D levels and a history of Epstein-Barr virus, smoking, and obesity, especially during childhood, also influence MS risk. Traditionally thought to be a T-cell–mediated disease, recent research has highlighted the additional roles of B cells and microglia in both relapsing and progressive MS.

Complex interactions between genetic, environmental, and lifestyle factors affect the risk for MS as well as the disease course. People of color have historically been underrepresented in both MS clinical trials and literature, but current research is attempting to better clarify unique considerations in these groups. MS pathology consists of the focal inflammatory lesions that have been well characterized in relapsing MS, as well as a more widespread neurodegenerative component that is posited to drive progressive disease. Recent advances in characterization of both the inflammatory and neurodegenerative aspects of MS pathophysiology have yielded potential targets for future therapeutic options.
Approach to Symptom Management in Multiple Sclerosis With a Focus on Wellness
Authors: Spain Rebecca
Published: August 2022

PURPOSE OF REVIEW

This article describes an approach to symptom management in people with multiple sclerosis (MS), emphasizing healthy lifestyles and evidence-based treatments.

RECENT FINDINGS

Growing evidence supports healthy nutrition, exercise, and emotional well-being (wellness) as foundational for MS symptom management. A stepped approach starts with healthy lifestyle practices and adds nonpharmacologic, pharmacologic, and procedural-based therapies balancing levels of evidence, risks, and potential benefits. The growing availability of cannabis and widespread use of dietary supplements in self-management of MS symptoms raise both therapeutic promises and challenges.

Wellness approaches for MS symptom management foster self-reliance and should be reinforced early and often. Recognition of symptom clusters and medical comorbidities helps limit polypharmacy.
Treatment of Multiple Sclerosis
Authors: Cross Anne , Riley Claire
Published: August 2022

PURPOSE OF REVIEW

Given the expansion of options for the treatment of relapsing multiple sclerosis, this review outlines the framework for developing a treatment strategy, with consideration of when to switch or discontinue therapies, and a comprehensive elaboration of the mechanisms of action, efficacy, and safety considerations for each of the therapeutic classes.

RECENT FINDINGS

The armamentarium of immunotherapies has grown rapidly, to encompass 19 US Food and Drug Administration (FDA)-approved immunotherapies available in 2021, which are addressed in the review. The coronavirus pandemic that began in 2020 underscored existing concerns regarding vaccine efficacy in those treated with immune-suppressing immunotherapies, which are also addressed here.

By choosing a treatment strategy before exploring the individual medications, patients and providers can focus their efforts on a subset of the therapeutic options. Although the mechanisms of action, routes of administration, efficacy, safety, and tolerability of the described agents and classes differ, all are effective in reducing relapse frequency in multiple sclerosis (MS), with most also showing a reduction in the accumulation of neurologic disability. These powerful effects are improving the lives of people with MS. Pharmacovigilance is critical for the safe use of these immune-modulating and -suppressing agents, and vaccine efficacy may be reduced by those with immune-suppressing effects.
Pharmacy practitioners’ attitudes and practice towards herbal products in Jordan: Exploring their knowledge about herbal products potential interactions with cardiovascular medications
Authors: Abudalo Rawan , Abudalo Razan , Alqudah Abdelrahim , Abuqamar Ayman , Abdelaziz Amr , Alshawabkeh Maram , Taha Luma
Published: August 2022

Background:Herbal medicine use is widespread among patients, as community pharmacies may provide such products. Therefore, pharmacy practitioners should be aware of potential herbal products’ adverse effects and herb-drug interactions, particularly with medications for comorbid diseases, such as cardiovascular drugs, in which pharmacy practitioners need to have good knowledge to provide patients with relevant advice to get optimal and safe therapeutic outcomes. Accordingly, the study is designed to assess the knowledge and awareness of pharmacy practitioners regarding herbal product dispensing and cardiovascular drug interaction in Jordan and view their role in patients’ counselling to set up safe and effective drug use.

Methods: A cross-sectional study was conducted in Jordan using an online formatted questionnaire distributed to pharmacy practitioners working in community pharmacies. Descriptive and analytical statistics were performed for the responses using the Statistical Package for the Social Sciences (SPSS) software, version 26.

Results:Out of 508 participants, 41.7% had medium knowledge of herbal products pertaining mainly to university education (68.1%); 55.1% of participants dispensed herbal products without prescriptions for obesity and weight reduction (72.8%) and gastrointestinal problems (70.9%); this is because respondents agreed that herbal remedies are safe (28.5%) and effective (38.4%). Whilst the knowledge level of respondents about herbal medicine interaction with cardiovascular medication was medium, with a mean of 1.94, as this interaction may result in potentially serious consequences, 40.7% of respondents strongly agreed to gain more knowledge about the side effects of herbal products and medicine interactions through educational courses.

Conclusions:The pharmacy practitioners had medium knowledge of herbal products; however, more attention should be paid to herb-drug interactions in the pharmacy educational curriculum. Additionally, pharmacy practitioners need to refresh their knowledge by attending periodic educational courses and by using reliable resources for information about herbal products in order to provide effective and competent pharmaceutical care.
Managerial Duties and Managerial Biases
Authors: Malmendier Ulrike , Pezone Vincenzo , Zheng Hui
Published: August 2022

Much of the evidence on managerial biases in corporate finance focuses on the CEO and, in particular, CEO overconfidence. This singular focus can lead to misattribution as it ignores the roles of other managers who are responsible for a given corporate outcome. We evaluate the influence of the CFO and other C-suite executives as compared with the CEO. Mirroring the widely used Longholder CEO measure of CEO overconfidence, we construct Longholder CFO and Longholder Other measures. For financing decisions, we find that CEO overconfidence becomes an insignificant predictor of most decisions when included jointly with the CFO proxy, whereas CFO overconfidence has strong predictive power. The reverse holds for nonfinancing decisions: CEO beliefs predict the risk and return of investment projects and, thus, their cost of financing as well as acquisitions. Other C-suite managers’ overconfidence is not significant in either of these two realms. CEO overconfidence does remain significant even for financing decisions in the subsample of firms with “powerful” (entrenched) CEOs. We also show that overconfident CEOs tend to hire overconfident CFOs, which generates a multiplier effect and explains the misattribution to the CEO in analyses that do not account for the roles of other managers. Our results imply that analyses of managerial biases need to identify the dominant decision makers and account for their respective influence.

This paper was accepted by Victoria Ivashina, finance.

Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2022.4467 .
Does Terrorism Affect Acquisitions?
Authors: Nguyen Tung , Petmezas Dimitris , Karampatsas Nikolaos
Published: August 2022

Using terrorist attacks as an exogenous shock to uncertainty, we provide evidence that firms located near terrorism-stricken areas are less likely takeover targets for two years after the attack and receive lower acquisition premiums. The latter finding is reflected in lower target firm abnormal returns and synergy gains. Additionally, in terrorism-stricken areas, target firms are associated with a lower share of synergies, withdrawn deals rise, and acquirers are more likely to get involved in acquisitions of target firms located in different metropolitan statistical areas than their own or acquire faraway target firms. We attribute our results to the real options theory, which predicts that high uncertainty increases the value of the option to delay investments. Additionally, we show that the impact on target firm human capital and acquirer CEO uncertainty and fear are potential sources of terrorism-induced uncertainty with the former source prevailing over the latter.

This paper was accepted by Gustavo Manso, finance.

Supplemental Material: The online appendix and data are available at https://doi.org/10.1287/mnsc.2022.4506 .
Headache service management: a new approach to providing more robust and equitable care across the UK
Authors: Gordon Alexander , Lashley Daniel , Weatherby Stuart
Published: August 2022

Headaches are common conditions, but can represent a significant burden to patients, healthcare services and the wider economy. Gordon et al outline how headache services could be made more effective and equally accessible in the UK.
Asthma reviews: an essential part of good care
Authors: Henry Heather
Published: August 2022

Asthma reviews are essential in asthma management. Heather Henry provides a reminder of the essential topics to cover when conducting an asthma review

Asthma reviews are an essential part of long-term conditions management in general practice. An assessment of asthma control will help practice nurses to prioritise frequency and effort, but caution must be taken to not overlook those with poor control who do not seek help and/or do not adhere to treatment. Asthma reviews are an opportunity to assess, review and collaborate on clinical and self-management. Empathic communication and shared decision-making are key to relationship building.
Prescribing the resolution of conflict in general practice
Authors: Harris Victoria
Published: August 2022

Local community mediation organisations can provide support for individuals experiencing conflict. Victoria Harris explains how they can help
Research Roundup
Authors: Winter George
Published: August 2022

George Winter provides an overview of recently published articles that are of interest to practice nurses. Should you wish to look at any of the papers in more detail, a full reference is provided.
Birefringence Compensation from Polarization Maintaining Fiber Pairs
Authors: Godin Paul J. , Wu Wilson , Tannous Ramy , Moffat Brian , Jennewein Thomas
Published: August 2022

Theoretical modeling and experimental verification demonstrate that pair of identical polarization maintaining fibers (PMF), with a relative rotation angle of 90°, will preserve any linear polarization state entering the fiber pair.