bluuebunny/crossref_metadata_2025 huggingface dataset:
Current Practices in Anticoagulation Management for Patients Undergoing Percutaneous Image-guided Breast Procedures
Authors: Brown Theodore , Schafer Leah , Qureshi Muhammad Mustafa , Freer Phoebe , Niell Bethany L , Yeh Eren D , Moy Linda , Fishman Michael D C , Slanetz Priscilla J
Published: June 2023

Objective

Given variability in how practices manage patients on antithrombotic medications, we undertook this study to understand the current practice of antithrombotic management for patients undergoing percutaneous breast and axillary procedures.

Methods

A 20-item survey with multiple-choice and write-in options was emailed to 2094 active North American members of the Society of Breast Imaging (SBI) in March 2021. Data were collected anonymously and analyzed quantitatively, with free-text responses categorized by themes.

Results

Three-hundred twenty-six of 2094 members (15.6%) completed the survey. Eighty-seven percent (274/313) reported having a policy for managing antithrombotic medications. Fifty-nine percent (185/312) reported routinely withholding medications before biopsy, more commonly in the Northeast and South (P = 0.08). Withholding of medications did not vary by lesion location (182/308, 59%, breast vs 181/308, 58.7%, axillary; P = 0.81). Respondents were statistically more likely to withhold medications if using a vacuum-assisted device for all classes of antithrombotic medications (P < 0.001). Up to 50.2% (100/199) on warfarin and 33.6% (66/196) on direct oral anticoagulants had medications withheld more stringently than guidelines suggest.

Conclusion

Based on a survey of SBI members, breast imaging practices vary widely in antithrombotic management for image-guided breast and axillary procedures. Of the 60% who withhold antithrombotic medications, a minority comply with recommended withhold guidelines, placing at least some patients at potential risk for thrombotic events. Breast imaging radiologists should weigh the risks and benefits of withholding these medications, and if they elect to withhold should closely follow evidence-based guidelines to minimize the risks of this practice.
Developing a Program for Advanced Physical Therapist Practice in Amputation Care
Authors: Crunkhorn Andrea E , Campbell Stuart M , Lutz Laurie L
Published: June 2023

Introduction

Over the past 20 years, military medicine made great strides in the medical management of traumatically injured patients. Significant advancements were made in the treatment and rehabilitation after limb loss. These advancements can be attributed to the large number of complex patients presenting to military treatment facilities and the demand for medical professionals to provide care to patients with complex injuries and multiple traumatic amputations. The concern now is to maintain the skills needed to be prepared for the next conflict. To meet this demand, the Extremity Trauma and Amputation Center of Excellence (EACE) initiated the documentation of knowledge, skills, and abilities (KSAs) to ensure that the skill sets needed to treat this unique population are not lost. The EACE developed KSAs to sustain advanced clinical practice for physical therapists, occupational therapists, and prosthetists and is in the process of developing KSAs for orthotists and physical medicine physicians. The learning objectives [terminal and enabling learning objectives (TLOs and ELOs)] derived from each set of KSAs will drive curricula development for enduring education, residencies, and fellowships. This article describes the KSAs and learning objectives for advanced physical therapist competencies in amputation care.

Methods

Clinical subject matter experts (SMEs) convened from the Department of Defense (DoD) Advanced Rehabilitation Centers (ARCs) to draft the initial KSAs. All experts had specific expertise in treating individuals with highly complex lower and upper limb amputation. In a quasi-Delphi methodology, the initial draft KSAs underwent five cycles of review and comment by an additional 15 DoD, Veterans Affairs, and civilian institution experts from clinical practice, education, and research. The consensus KSAs were then transcribed into learning objectives with collaboration between clinical subject matter experts and doctoral-level educators.

Results

The final program document has 21 instructional modules with 30 TLOs and 157 ELOs.

Conclusion

The KSAs and the learning objectives describe the skills expected of an advanced practice physical therapist treating patients with traumatic limb loss. Weaknesses of this document include the focus on traumatic amputation and military specific needs. However, many of the central advanced practices are universal to all physical therapists working in amputation. Thus, this document should serve as a starting point and can evolve to include dysvascular, oncology, and other etiologies. To our knowledge, this is the first paper to describe the KSAs for the advanced practice physical therapist working with traumatic limb loss population. This work will form the framework for physical therapist advanced practice training programs.
Aberration of gravitational waveforms by peculiar velocity
Authors: Bonvin Camille , Cusin Giulia , Pitrou Cyril , Mastrogiovanni Simone , Congedo Giuseppe , Gair Jonathan
Published: June 2023

One key prediction of General Relativity is that gravitational waves are emitted with two independent polarizations. Any observation of extra polarization mode, spin-1 or spin-0, is consequently considered a smoking gun for deviations from General Relativity. In this paper, we show that the velocity of merging binaries with respect to the observer gives rise to spin-1 polarization in the observer frame even in the context of General Relativity. These are pure projection effects, proportional to the plus and cross polarizations in the source frame, hence they do not correspond to new degrees of freedom. We demonstrate that the spin-1 modes can always be rewritten as pure spin-2 modes coming from an aberrated direction. Since gravitational waves are not isotropically emitted around binary systems, this aberration modifies the apparent orientation of the binary system with respect to the observer: the system appears slightly rotated due to the source velocity. Fortunately, this bias does not propagate to other parameters of the system (and therefore does not spoil tests of General Relativity), since the impact of the velocity can be fully reabsorbed into new orientation angles.
Long-term cryopreservation of potassium bromate positive assay controls for measurement of oxidatively damaged DNA by the Fpg-modified comet assay: results from the hCOMET ring trial
Authors: Møller Peter , Azqueta Amaya , Rodriguez-Garraus Adriana , Bakuradze Tamara , Richling Elke , Bankoglu Ezgi Eyluel , Stopper Helga , Claudino Bastos Victoria , Langie Sabine A S , Jensen Annie , Ristori Sara , Scavone Francesca , Giovannelli Lisa , Wojewódzka Maria , Kruszewski Marcin , Valdiglesias Vanessa , Laffon Blanca , Costa Carla , Costa Solange , Paulo Teixeira João , Marino Mirko , Del Bo’ Cristian , Riso Patrizia , Zheng Congying , Shaposhnikov Sergey , Collins Andrew
Published: June 2023

The formamidopyrimidine DNA glycosylase (Fpg)-modified comet assay is widely used for the measurement of oxidatively generated damage to DNA. However, there has not been a recommended long-term positive control for this version of the comet assay. We have investigated potassium bromate as a positive control for the Fpg-modified comet assay because it generates many Fpg-sensitive sites with a little concurrent generation of DNA strand breaks. Eight laboratories used the same procedure for the treatment of monocytic THP-1 cells with potassium bromate (0, 0.5, 1.5, and 4.5 mM) and subsequent cryopreservation in a freezing medium consisting of 50% foetal bovine serum, 40% RPMI-1640 medium, and 10% dimethyl sulphoxide. The samples were analysed by the Fpg-modified comet assay three times over a 3-year period. All laboratories obtained a positive concentration–response relationship in cryopreserved samples (linear regression coefficients ranging from 0.79 to 0.99). However, there was a wide difference in the levels of Fpg-sensitive sites between the laboratory with the lowest (4.2% Tail DNA) and highest (74% Tail DNA) values in THP-1 cells after exposure to 4.5 mM KBrO3. In an attempt to assess sources of inter-laboratory variation in Fpg-sensitive sites, comet images from one experiment in each laboratory were forwarded to a central laboratory for visual scoring. There was high consistency between measurements of %Tail DNA values in each laboratory and the visual score of the same comets done in the central laboratory (r = 0.98, P < 0.001, linear regression). In conclusion, the results show that potassium bromate is a suitable positive comet assay control.
Laparoscopic resection for pedunculated focal nodular hyperplasia of the liver during pregnancy
Authors: Akaguma Ai , Ishii Takamichi , Uchida Yoichiro , Chigusa Yoshitsugu , Ueda Yusuke , Mandai Masaki , Mogami Haruta
Published: June 2023

Focal nodular hyperplasia (FNH) is the second most common intrahepatic benign mass lesion; however, extremely rarely, FNH grows in an exophytic manner. It is unclear whether pedunculated FNH can be managed in the same way as intrahepatic FNH. A 35-year-old female presented with right upper quadrant pain, and dynamic enhanced computed tomography revealed an exophytic hyperdense mass lesion originating from the liver, suggesting a pedunculated FNH. Shortly thereafter, she conceived. Since there was a history of acute abdomen, as well as the possibility of torsion of the mass or sudden massive bleeding during pregnancy, laparoscopic resection was performed at 17 weeks of gestation. Her postoperative and pregnancy course was uneventful, and she delivered a baby by cesarean section at 41 weeks of gestation. Our case suggests that pedunculated FNH, unlike typical intrahepatic FNH, may be better managed by laparoscopic surgery during pregnancy, resulting in favorable maternal and fetal outcomes.
Fecal incontinence as the sole presentation of focal epilepsy; a case report
Authors: Al-Ameri Laith T , Hameed Ekhlas K , Maroof Bilal S , Al-Momen Hayder
Published: June 2023

Focal epilepsy is a surge in brain activity arising from a localised area of the cerebral cortex; it can be sub-classified in different categories including motor, sensory, autonomic and cognitive subtypes. A clinical case report of a 11-year-old girl was diagnosed with frequent fecal incontinence four or more times daily for more than two months. An electroencephalogram (EEG) study suggested a prominent interictal spike and sharp wave discharge on the left hemisphere, mainly at the frontotemporal region without loss of consciousness or even speech disruption. This could be due to the normal EEG study of the dominant hemisphere. A magnetic resonance imaging study was done to exclude space-occupying lesions or focal lesions of the left hemisphere of the brain. An impression was made with abnormal EEG showing focal epileptiform activity as a final diagnosis. The patient was treated with Leviteracetam anti-epileptic drug 250 mg twice daily with significant clinical improvement at a 3-month follow-up.
MOYAMOYA disease in an adolescent with HIV-1
Authors: Pereira Noella Maria Delia , Gabhale Yashwant R , Lala Mamatha M , Dere Harshad , Ghildiyal Radha
Published: June 2023

Moyamoya disease has been reported in both children and adults with HIV-1. Most cases reported in children were found to have unsuppressed viral loads and low CD4 counts. Although the aetiology of the disease is largely unknown, a few studies have postulated cytokine imbalance and immune activation as possible causes. Intimal staining of the involved cerebral arteries have revealed transmembrane glycoprotein of HIV-gp 41. We present the case of an 18-year-old boy with congenitally acquired HIV-1 who presented with right hemiparesis at the age of 12 years and was found to have Moyamoya disease on neuroimaging. His CD4 count has always been low (<100 cells/cumm) in spite of being virally suppressed. He was started on anti-retroviral therapy at 5 and half years of age and he was continued on the same. He was treated conservatively and he continues to have residual right hemiparesis.
The acute care burden of asthma in children was profoundly reduced during the COVID-19 pandemic: A multi-centre Canadian retrospective study
Authors: McConnery Jason R , Bone Jeffrey N , Goldman Ran D , Hicks Anne , Seaton Claire , Subbarao Padmaja , Moraes Theo J
Published: June 2023

Objectives

Asthma is a chronic lung condition that can be exacerbated when triggered by viruses. Pandemic public health restrictions aimed to reduce COVID-19 transmission indirectly effected other circulating viruses. This study assessed the impact of the pandemic and associated public health measures on acute paediatric asthma across four tertiary sites in three Canadian provinces. We queried whether pandemic-related changes would impair preventive care and delay presentation to care, increasing asthma exacerbation severity.

Methods

This retrospective study compared the frequency of acute care access and severity of presentation to emergency departments (ED) for acute asthma to four tertiary care children’s hospitals during the COVID-19 pandemic (from March 17, 2020 to June 30, 2021) to a pre-lockdown control period (July 1, 2018 to March 16, 2020). Data was subjected to interrupted time series and Chi-square analysis.

Results

Our study included 26,316 acute asthma visits to ED. Sites experienced a 63% to 89% reduction in acute asthma visits during the pandemic, compared with pre-lockdown controls, and a 17% to 85% reduction in asthma, that is out of proportion as a fraction of all-cause ED visits. For asthma, there was no difference in severity measured by rate of ward admission or rate of Paediatric Intensive Care Unit (PICU) admission.

Conclusions

Public health measures appear to have resulted in a specific protective association on acute asthma with reduced acute care utilization over and above the reduction in all-cause presentations, without an increase in severity upon presentation. Our study indicates an importance to antiviral public health and engineering strategies to reduce viral transmission and thereby asthma morbidity.
Transcription factor RcNAC091 enhances rose drought tolerance through the abscisic acid–dependent pathway
Authors: Geng Lifang , Yu Shuang , Zhang Yichang , Su Lin , Lu Wanpei , Zhu Hong , Jiang Xinqiang
Published: June 2023

NAC (NAM, ATAF1,2, and CUC2) transcription factors (TFs) play critical roles in controlling plant growth, development, and abiotic stress responses. However, few studies have examined NAC proteins related to drought stress tolerance in rose (Rosa chinensis). Here, we identified a drought- and abscisic acid (ABA)–induced NAC TF, RcNAC091, that localizes to the nucleus and has transcriptional activation activity. Virus-induced silencing of RcNAC091 resulted in decreased drought stress tolerance, and RcNAC091 overexpression had the opposite effect. Specifically, ABA mediated RcNAC091-regulated drought tolerance. A transcriptomic comparison showed altered expression of genes involved in ABA signaling and oxidase metabolism in RcNAC091-silenced plants. We further confirmed that RcNAC091 directly targets the promoter of RcWRKY71 in vivo and in vitro. Moreover, RcWRKY71-slienced rose plants were not sensitive to both ABA and drought stress, whereas RcWRKY71-overexpressing plants were hypersensitive to ABA, which resulted in drought-tolerant phenotypes. The expression of ABA biosynthesis– and signaling–related genes was impaired in RcWRKY71-slienced plants, suggesting that RcWRKY71 might facilitate the ABA-dependent pathway. Therefore, our results show that RcWRKY71 is transcriptionally activated by RcNAC091, which positively modulates ABA signaling and drought responses. The results of this study provide insights into the roles of TFs as functional links between RcNAC091 and RcWRKY71 in priming resistance; our findings also have implications for the approaches to enhance the drought resistance of roses.
Swift’s War and Peace
Authors: Sperrin Dan
Published: June 2023

This article considers some of the military and diplomatic contexts which have been neglected in the study of eighteenth-century mock-heroic literature, with a particular focus on the early satires of Swift. Typically, mock-heroic literature is seen as a skilful exercise in a particular kind of literary style, and individual mock-heroic satires are usually contextualized by setting them alongside the military epics (e.g., the Iliad or Aeneid) which they seem to parody. This article takes a slightly different approach by setting Swift’s mock-heroic satires against the background of the Grand Alliance wars against Louis XIV (1688–1714), and by taking another look at his relationship with the retired diplomat and ambassador Sir William Temple. As will be discussed, Temple’s essay ‘Of Heroic Virtue’ offered Swift a model of civil heroism which could be defended or advocated in satire, and it is the influence on Swift of the period’s diplomatic, political, and legal writings which will occupy the core of this discussion.
The immune escape mechanism of nasopharyngeal carcinoma
Authors: Li Xiaoxu , Guo Yinlin , Xiao Minmin , Zhang Wenling
Published: June 2023

Tumor cells are known for being able to evade immune system surveillance, a hallmark of malignancy. Complicated immune escape mechanisms in the tumor microenvironment (TME) provide favorable conditions for tumor invasion, metastasis, treatment resistance, and recurrence. Epstein–Barr virus (EBV) infection is closely related to the pathogenesis of nasopharyngeal carcinoma (NPC), and the co‐existence of EBV‐infected NPC cells and tumor‐infiltrating lymphocytes represents a distinctive, highly heterogeneous, and suppressive TME that supports immune escape and promotes tumorigenesis. Understanding the complex interaction between EBV and NPC host cells and focusing on the immune escape mechanism of TME may help to identify specific immunotherapy targets and to develop effective immunotherapy drugs.
Infection promotes Ser‐214 phosphorylation important for generation of cytotoxic tau variants
Authors: Balczon Ron , Choi Chung‐Sik , deWeever Althea , Zhou Chun , Gwin Meredith S. , Kolb Claire , Francis C. Michael , Lin Mike T. , Stevens Troy
Published: June 2023

Patients who recover from hospital‐acquired pneumonia exhibit a high incidence of end‐organ dysfunction following hospital discharge, including cognitive deficits. We have previously demonstrated that pneumonia induces the production and release of cytotoxic oligomeric tau from pulmonary endothelial cells, and these tau oligomers can enter the circulation and may be a cause of long‐term morbidities. Endothelial‐derived oligomeric tau is hyperphosphorylated during infection. The purpose of these studies was to determine whether Ser‐214 phosphorylation of tau is a necessary stimulus for generation of cytotoxic tau variants. The results of these studies demonstrate that Ser‐214 phosphorylation is critical for the cytotoxic properties of infection‐induced oligomeric tau. In the lung, Ser‐214 phosphorylated tau contributes to disruption of the alveolar–capillary barrier, resulting in increased permeability. However, in the brain, both the Ser‐214 phosphorylated tau and the mutant Ser‐214‐Ala tau, which cannot be phosphorylated, disrupted hippocampal long‐term potentiation suggesting that inhibition of long‐term potentiation was relatively insensitive to the phosphorylation status of Ser‐214. Nonetheless, phosphorylation of tau is essential to its cytotoxicity since global dephosphorylation of the infection‐induced cytotoxic tau variants rescued long‐term potentiation. Collectively, these data demonstrate that multiple forms of oligomeric tau are generated during infectious pneumonia, with different forms of oligomeric tau being responsible for dysfunction of distinct end‐organs during pneumonia.
Serum tryptase and drug hypersensitivity: why, how and what? A systematic review
Authors: Klingebiel Caroline , Belhocine Wahib , Vitte Joana
Published: June 2023

Purpose of review

Serum tryptase, a mast cell marker, provides clues for the mechanism, severity, and management of drug hypersensitivity induced by immunoglobulin E dependent or independent mast cell activation.

Recent findings

The interpretation of serum tryptase levels has been challenged during the last 2 years by major advances in tryptase genetics and their rapid incorporation into clinical practice. On the contrary, new pathophysiological insight into nonmast cell-dependent immediate hypersensitivity has been gained.

This review provides up-to-date information on the pathophysiology and recommended use and interpretation of tryptase in the context of drug hypersensitivity reactions as a function of their endotype.
New approaches in childhood asthma treatment
Authors: Castagnoli Riccardo , Brambilla Ilaria , Giovannini Mattia , Marseglia Gian Luigi , Licari Amelia
Published: June 2023

Purpose of review

This review aims to summarize the most recent advances in asthma management, focusing on novel approaches to pediatric asthma.

Recent findings

In recent years, the therapeutic tools for pediatric asthma have expanded significantly for both the nonsevere and severe forms. The use of anti-inflammatory treatment, even for the mildest cases, and the withdrawal of symptomatic bronchodilation as monotherapy have been included in the most recent guidelines. Also, different biological therapies have revolutionized the therapeutical approach for severe uncontrolled asthma in children and adolescents.

With the expanding landscape of novel therapeutic approaches for pediatric asthma, further evidence is needed to help clinicians choose the best option for patients, particularly those with severe asthma. The identification of novel predictive biomarkers may also help pediatricians in selecting children and adolescents for innovative therapies.
The Diagnostic Process of Spinal Post-traumatic Deformity
Authors: De Gendt Erin E.A. , Benneker Lorin M. , Joaquim Andrei F. , El-Sharkawi Mohammad , Dhakal Gaurav R. , Kandziora Frank , Tee Jin , Bransford Richard J. , Vialle Emiliano N. , Vaccaro Alex R. , Popescu Eugen C. , Kanna Rishi M. , Polly David W. , Schnake Klaus J. , Berjano Pedro , Ryabykh Sergey , Neva Marko , Lamartina Claudio , Rothenfluh Dominique A. , Lewis Stephan J. , Muijs Sander P.J. , Oner F. Cumhur
Published: June 2023

Study Design:

Survey of cases.

Objective:

To evaluate the opinion of experts in the diagnostic process of clinically relevant Spinal Post-traumatic Deformity (SPTD).

Summary of Background Data:

SPTD is a potential complication of spine trauma that can cause decreased function and quality of life impairment. The question of when SPTD becomes clinically relevant is yet to be resolved.

Methods:

The survey of 7 cases was sent to 31 experts. The case presentation was medical history, diagnostic assessment, evaluation of diagnostic assessment, diagnosis, and treatment options. Means, ranges, percentages of participants, and descriptive statistics were calculated.

Results:

Seventeen spinal surgeons reviewed the presented cases. The items’ fracture type and complaints were rated by the participants as more important, but no agreement existed on the items of medical history. In patients with possible SPTD in the cervical spine (C) area, participants requested a conventional radiograph (CR) (76%–83%), a flexion/extension CR (61%–71%), a computed tomography (CT)-scan (76%–89%), and a magnetic resonance (MR)-scan (89%–94%). In thoracolumbar spine (ThL) cases, full spine CR (89%–100%), CT scan (72%–94%), and MR scan (65%–94%) were requested most often. There was a consensus on 5 out of 7 cases with clinically relevant SPTD (82%–100%). When consensus existed on the diagnosis of SPTD, there was a consensus on the case being compensated or decompensated and being symptomatic or asymptomatic.

Conclusions:

There was strong agreement in 5 out of 7 cases on the presence of the diagnosis of clinically relevant SPTD. Among spine experts, there is a strong consensus to use CT scan and MR scan, a cervical CR for C-cases, and a full spine CR for ThL-cases. The lack of agreement on items of the medical history suggests that a Delphi study can help us reach a consensus on the essential items of clinically relevant SPTD.

Level of Evidence:

Level V
Clinical development of chimeric antigen receptor-T cell therapy for hematological malignancies
Authors: Yang Zhihuan , Wang Ying
Published: June 2023

Cellular therapies have revolutionized the treatment of hematological malignancies since their conception and rapid development. Chimeric antigen receptor (CAR)-T cell therapy is the most widely applied cellular therapy. Since the Food and Drug Administration approved two CD19-CAR-T products for clinical treatment of relapsed/refractory acute lymphoblastic leukemia and diffuse large B cell lymphoma in 2017, five more chimeric antigen receptor-T (CAR-T) cell products were subsequently approved for treating multiple myeloma or B cell malignancies. Moreover, clinical trials of CAR-T cell therapy for treating other hematological malignancies are ongoing. Both China and the United States have contributed significantly to the development of clinical trials. However, CAR-T cell therapy has many limitations such as a high relapse rate, adverse side effects, and restricted availability. Various methods are being implemented in clinical trials to address these issues, some of which have demonstrated promising breakthroughs. This review summarizes developments in CAR-T cell trials and advances in CAR-T cell therapy.
Red Meat Consumption and its Relationship With Cardiovascular Health: A Review of Pathophysiology and Literature
Authors: Singh Bhupinder , Khan Abdul Allam , Anamika FNU , Munjal Ripudaman , Munjal Jaskaran , Jain Rohit
Published: June 2023

Red meat is the muscle meat of mammals like beef, lamb, and pork that is red due to the abundance of myoglobin pigment and becomes even darker when cooked. The global average per capita consumption of meat and the total amount of meat consumed is rising, and there has been a particularly marked increase in the global consumption of chicken and pork. The consumption of red meat has always been a contentious issue, with data suggesting benefits in terms of nutritional value and at the same time linking its consumption to major health disorders such as endocrine abnormalities, gastrointestinal issues, cancers, and cardiovascular diseases (CVDs). Despite being normalized by major food franchises, red meat consumption may lead to adverse cardiovascular outcomes such as atherosclerosis, ischemic heart disease, stroke, and cardiac failure. Given the evidence that indicates the consumption of red and processed meat as a risk factor for cardiovascular diseases and all-cause mortality, it is important to review the effects of red meat on the risk of cardiovascular diseases.
Breast cancer in young women: a rising threat: A 5-year follow-up comparative study
Authors: Fernandes Urânia , Guidi Gonçalo , Martins Daniela , Vieira Bruno , Leal Clara , Marques Carolina , Freitas Francisca , Dupont Margarida , Ribeiro Juliana , Gomes Carina , Marques Rita , Avelar Paulo , Esteves Ana Sofia , Pinto-de-Sousa João
Published: June 2023

Introduction:

Breast cancer in young women is usually considered as breast cancer occurring in women younger than 40 years and is the most frequent cancer-related cause of death in these patients. In the past few years, there seems to be an increasing trend in the prevalence of breast cancer in young women, which, associated with poorer prognosis, more aggressive histologic features, and more frequent recurrence rates, makes it a rising threat to young women. This study aimed to evaluate the biological behavior of breast cancer in young women in our institution.

Material and methods:

A retrospective, unicentric, cohort study was conducted between 2012 and 2016. All consecutive patients with breast cancer were enrolled in the study. Cases were divided into two groups: case group, those younger than 40 years, and control group, those 40 years or older. The exclusion criterion was nonoperative treatment. Several clinical and pathologic parameters were evaluated, as well as were overall survival time and disease-free survival time.

Results:

The incidence of breast cancer in young women presented a rising tendency over the study period. Significant differences were observed in the comparison of the groups according to body mass index, age at menarche, age at birth of the first child, and proliferation rate. There were no differences in overall survival and disease-free survival rates between the groups.

Conclusions:

Young women had a more symptomatic presentation, a greater tumor proliferation rate, but similar outcomes compared with older patients. Greater multicentric studies are needed to confirm or refute these results.
Self-care Level of Adults With Arterial Hypertension in Outpatient Follow-up in Brazil
Authors: de Lima Nathália Xavier , da Silva Ricardo Costa , Vieira Flaviana Vely Mendonça , Guimarães Janaína Valadares , de Matos Marcos André , Cavalcante Agueda Maria Ruiz Zimmer
Published: June 2023

Background

Self-care is essential for minimizing the long-term progression of hypertension (HTN) and improving global health outcomes. However, little is known about the predictors of HTN self-care among adults with HTN in Brazil.

Objective

The aim of this study was to evaluate the self-care practices and the association of sociodemographic and clinical factors of adults with HTN in Brazil.

Methods

This was a cross-sectional study conducted by telephone with 120 adults with HTN monitored in a specialized outpatient clinic of a teaching hospital. Sociodemographic and clinical information was collected by a questionnaire survey. Self-care was assessed by the Self-care of Hypertension Inventory version 2. Multiple regression and Kendall's correlation analyses were performed to determine possible predictors.

Results

Low levels of self-care were observed across maintenance, management, and confidence measures. A weak correlation was observed between self-care maintenance and education (−0.13), the time of diagnosis (0.16), and the number of medications (0.15); self-care management and family income (0.13) and cognitive function (0.17); and self-care confidence and systolic (−0.15) and diastolic (−0.18) blood pressure values and time of diagnosis (0.16). In multiple regression analysis, self-care confidence was a predictor of self-care maintenance (β = 0.30; 95% confidence interval, 0.10–0.36) and management (β = 0.20; 95% confidence interval, 0.03–0.46).

Conclusion

Confidence was essential in the maintenance and management of self-care and is central to the control of HTN. Self-care interventions must consider the different aspects that may affect self-care, highlighting improving self-care confidence as a main goal.
Backheel Pass During Forward Running as a Mechanism of Severe Acute Hamstring Injury in Football: A Case Report
Authors: Markovic Goran , Karuc Ivan
Published: June 2023

Proximal hamstring tendon avulsions represent the most severe hamstring injury in sports and are typically sustained during stretch-related movements in closed kinetic chain: forced hip hyperflexion combined with knee extension. Here, we present the case study of the right-foot dominant professional football player with a severe proximal hamstring tendon avulsion injury and concomitant lower-grade injuries of hamstring muscle–tendon complex caused by a potentially new football-specific injury mechanism: right-foot backheel pass during forward running (ie, a kick directly backward). This mechanism involves a specific stretch-shortening cycle action of hamstring muscles in open-kinetic chain movement that has not yet been described in the scientific literature. Although further studies related to this football-specific hamstring injury mechanism are needed, clinicians and coaches working in football should be aware of it and potentially introduce additional injury mechanism-specific exercises and strategies for prevention of severe hamstring injuries which often require surgical intervention.
Gender Disparities Among Professional Team Sports Medicine Physicians
Authors: Schick Sam , Chandler Kelly , Kasprow Sarah , Sisk Morgan , Elphingstone Joseph , Wing Judson , Evely Thomas , Casp Aaron , Ponce Brent , Brabston Eugene , Momaya Amit M.
Published: June 2023

Objective:

Although recent trends from the Accreditation Council for Graduate Medical Education (ACGME) present encouraging growth of female representation in sports medicine, the field is still lagging behind other specialties. This study investigates gender disparities among physicians providing care for professional sports teams in male and female sports leagues.

Design:

Information regarding physicians providing sports medicine care to professional teams obtained by database queries (May 2021). Chi-square analysis compared gender data of orthopaedic team physicians with American Orthopaedic Society for Sports Medicine (AOSSM) and American Academy of Orthopaedic Surgeons (AAOS) membership, residency, and fellowship census data. Primary care sports medicine physicians were compared with American Medical Society for Sports Medicine (AMSSM) and primary-care sports medicine fellowship census data.

Setting:

Professional sports health care.

Study Population:

Professional league physicians.

Interventions:

None.

Main Outcome Measures:

Gender, residency, and fellowship training of professional league physicians.

Results:

Among a total of 608 team physicians, 572 (93.5%) were male and 40 (6.5%) were female. Orthopedic surgeons comprised 64.7% of the physicians. Fourteen (3.6%) team orthopedic surgeons were female. Thirty-five percent of team physicians were primary care sports medicine physicians. Twenty-six primary care sports medicine physicians (11.6%) were female. Orthopaedic female team physician representation overall was comparable with AOSSM and AAOS membership but significantly less than orthopaedic surgery residents and sports medicine fellows (P < 0.01). Women's National Basketball Association orthopaedic team physicians were more represented than female membership among AOSSM, AAOS, and orthopaedic sports medicine fellows (P < 0.01). Except for the WNBA, Premiere Hockey Federation, National Women's Soccer League, and United States Football League, female primary care sports medicine physicians were underrepresented in professional sports compared with AMSSM membership and primary care sports fellows (P < 0.01).

Conclusion:

Overall, female representation is poor among orthopaedic surgeons and primary care physicians providing sports medicine care to professional teams. Leagues encompassing female athletes tend to have better representation of female physicians.

Level of Evidence:

IV.
Percutaneous Electrical Nerve Field Stimulation for Drug-Refractory Pediatric Cyclic Vomiting Syndrome
Authors: Karrento Katja , Venkatesan Thangam , Zhang Liyun , Pawela Louis , Simpson Pippa , Li B U.K.
Published: June 2023

Background:

Cyclic vomiting syndrome (CVS) is a disabling condition frequently refractory to pharmacologic therapy. The aim of this study was to evaluate the effects of noninvasive, auricular percutaneous electrical nerve field stimulation (PENFS) as prophylactic therapy for pediatric CVS.

Methods:

Children 8–18 years with drug-refractory CVS were prospectively enrolled from a tertiary care CVS clinic. Subjects received 6 consecutive weeks of PENFS. CVS severity was quantified by episode frequency and duration score (range 0–25) at baseline and at extended follow-up (4–6 months after end of therapy). Response was classified as ≥50% improvement in either frequency or duration of attacks at extended follow-up. Subjects also completed validated surveys of nausea, disability, and global response.

Results:

Thirty subjects completed the study. Median (interquartile range, IQR) age was 10.5 (8.5–15.5) years; 60% were female. At follow-up, 80% met criteria for treatment response with a median (IQR) response duration of 113 (61–182) days. The frequency-duration score improved from baseline median (IQR) 12.0 (9.0–16.0) to 3.0 (1.0–6.0) at follow-up, P < 0.0001. Median (IQR) nausea and disability scores decreased from baseline to week 6: 2.1 (1.3–2.7) to 0.9 (0–1.6), P = 0.003 and 47.5 (41.0–53.0) to 38.0 (16.0–51.0), P = 0.001, respectively. At end of therapy, 66% and 55% patients reported global response of at least “moderately better” and “a good deal better,” respectively. There were no serious side effects.

Conclusions:

This study suggests long-term benefits of PENFS for children with CVS. PENFS improves several disabling aspects of CVS, including episode frequency, duration, and functional disability.
Management of aseptic nonunions and severe bone defects: let us get this thing healed!
Authors: Nauth Aaron , Crist Brett D. , Morshed Saam , Watson J. Tracy , Pape Hans-Christoph
Published: June 2023

Effective nonunion and bone defect management requires consideration of multiple potential contributing factors including biomechanics, biology, metabolic, and patient factors. This article reviews these factors as well as several potential nonunion or bone defect treatments including bone grafts, bone graft substitutes, the induced membrane technique, and distraction osteogenesis. A summary of these concepts and guidelines for an overall approach to management are also provided.
Millennials, the Most Afflicted Generation
Authors: Holden Brittany A. , Dwyer Jessica B.
Published: June 2023

In the wake of the SARS-CoV-2 (COVID-19) pandemic, mental health has become a pivotal topic of discussion nationwide.
1,2
Recognition of mental health disorders, mitigation of psychological distress during times of uncertainty, and abating negative stigma have become a focus of many groups, both internal and external to the medical field. Still, one of the most devastating sequelae of mental health afflictions is suicide.

A retrospective review of all cases classified as suicide from January 2019 through December 2021 was conducted using the laboratory information system database within the Southwestern Institute of Forensic Sciences, the county division that performs postmortem examinations of cases under the jurisdiction of Dallas County and some surrounding North Texas counties. A total of 846 cases were retrieved that occurred within Dallas County. This cohort consisted of 659 men and 187 women with an average age of 42.9 years (median, 40 years). This study highlights compelling trends of suicides within a localized portion of North Texas during a 3-year period in which the population endured momentous and unprecedented worldwide events.
Heterogeneity of the Tumor Microenvironment Across Molecular Subtypes of Breast Cancer
Authors: Kashyap Dharambir , Bal Amanjit , Irinike Santosh , Khare Siddhant , Bhattacharya Shalmoli , Das Ashim , Singh Gurpreet
Published: June 2023

Breast cancer is a heterogenous disease at the molecular level thus, it can be hypothesized that different molecular subtypes differ in their tumor microenvironment (TME) also. Understanding the TME heterogeneity may provide new prognostic biomarkers and new targets for cancer therapy. For deciphering heterogeneity in the TME, immunohistochemistry for immune markers (CD3, CD4, CD8, CD68, CD163, and programmed death-ligand 1), Cancer-associated fibroblast markers [anti-fibroblast activating protein α (FAP-α), platelet-derived growth factor receptor α (PDGFR-α), S100A4, Neuron-glial antigen 2, and Caveolin-1], and angiogenesis (CD31) was performed on tissue microarrays of different molecular subtypes of breast cancer. High CD3+ T cells were noted in the Luminal B subtype (P=0.002) of which the majority were CD8+ cytotoxic T cells. Programmed death-ligand 1 expression in immune cells was highest in the human epidermal growth factor receptor 2 (Her-2)-positive and Luminal B subtypes compared with the triple-negative breast cancer (TNBC) subtype (P=0.003). Her-2 subtype is rich in M2 tumor-associated macrophages (P=0.000) compared with TNBC and Luminal B subtypes. M2 immune microenvironment correlated with high tumor grade and high Ki-67. Her-2 and TNBC subtypes are rich in extracellular matrix remodeling (FAP-α, P=0.003), angiogenesis-promoting (PDGFR-α; P=0.000) and invasion markers (Neuron-glial antigen 2, P=0.000; S100A4, P=0.07) compared with Luminal subtypes. Mean Microvessel density showed an increasing trend: Luminal A>Luminal B>Her-2 positive>TNBC; however, this difference was not statistically significant. The cancer-associated fibroblasts (FAP-α, PDGFR-α, and Neuron-glial antigen 2) showed a positive correlation with lymph node metastasis in specific subtypes. Immune cells, tumor-associated macrophage, and cancer-associated fibroblast–related stromal markers showed higher expression in Luminal B, Her-2 positive, and TNBC respectively. This differential expression of different components of TME indicates heterogeneity of the TME across molecular subtypes of breast cancer.
POU2F3
Authors: Wang Yue , Jin Yan , Shen Xuxia , Zheng Qiang , Xue Qianqian , Chen Lijun , Lin Yicong , Li Yuan
Published: June 2023

POU2F3 (POU class 2 homeobox 3) is a novel transcription factor used to define the special molecular subtype of small cell lung cancer (SCLC) known as SCLC-P. Nevertheless, the sensitivity and specificity of POU2F3 immunohistochemical (IHC) staining have not been fully investigated. In this study, we explored the expression of POU2F3 by IHC in a large cohort of SCLC clinical samples (n=246), other common lung cancer types (n=2207), and various other cancer types (n=194). The results showed that POU2F3 was strongly nuclear stained in 13.41% (33/246) of SCLC cases, with negative or minimal labeling for thyroid transcription factor-1 and neuroendocrine (NE) markers. Compared with POU2F3-negative SCLC, SCLC-P harbored fewer TP53 and RB1 mutations. POU2F3 was also expressed in 3.13% (8/256) of squamous cell carcinomas (SCCs) and 20% (2/10) of large cell NE carcinomas (LCNECs), whereas other lung cancer types were negative. In addition to lung cancer, POU2F3 was positive in 22.2% (4/18) of thymic tumors. All other tumors were POU2F3-negative except for thymic carcinoma, although sparsely distributed weak nuclear staining was observed in lung adenocarcinoma, cervical SCC, and colorectal carcinoma. The sensitivity and specificity of POU2F3 in NE-low/negative SCLC were 82.1% and 99.4%, respectively. Notably, some rare unique patterns of POU2F3 expression were observed. One case of thymic SCC was characterized by diffuse and uniform cytomembrane staining. One case of esophageal NE tumor was nuclear-positive, while the normal proliferating squamous epithelium was strongly membrane-stained. This is the largest cohort of clinical samples to confirm that POU2F3 is a highly sensitive and specific diagnostic marker for NE-low/negative SCLC.
Crohn’s Disease in a Patient With Bardet-Biedl Syndrome: Random Anomaly or Rare Phenotypic Trait?
Authors: Zuidhof Margot L. , de Meij Tim G.J. , Nagelkerke Sietse Q. , Smets Anne M. , Koppen Ilan J.N.
Published: June 2023

Bardet-Biedl syndrome (BBS) is an autosomal recessive multisystem nonmotile ciliopathy. There are anecdotal reports of the co-occurrence of BBS and autoimmune diseases, including inflammatory bowel disease (IBD). We present the first case report of a child with BBS7 who developed Crohn disease, adding to the evidence on the association between BBS and IBD. A 13-year-old girl with BBS7 presented with abdominal pain and significant weight loss (−13%), but without other classical symptoms of IBD, such as diarrhea and blood loss. Fecal calprotectin was elevated, but on gastroscopy and colonoscopy, no macroscopic abnormalities were found. Ultrasound and MRI revealed an intestinal stenosis which was treated surgically. Histopathological examination confirmed the diagnosis Crohn disease. In conclusion, the reported co-occurrence of BSS and autoimmune diseases and the atypical presentation of IBD in this patient warrant a low threshold to perform diagnostic tests for IBD in patients with BBS and gastrointestinal symptoms.
Evaluation of Peripapillary and Macular Optical Coherence Tomography Angiography Characteristics in Different Stages of Papilledema
Authors: Pahuja Akshra , Dhiman Rebika , Aggarwal Vasudha , Aalok Swati P. , Saxena Rohit
Published: June 2023

Background:

Prospective evaluation of optical coherence tomography (OCT) and OCT angiography (OCT-A) characteristics in different stages of papilledema in idiopathic intracranial hypertension (IIH).

Methods:

In this prospective, observational study patients of IIH with papilledema were recruited and divided into 3 groups—early/established (Group 1), chronic (Group 2), and atrophic papilledema (Group 3). Peripapillary retinal nerve fiber layer (RNFL) and macular ganglion cell inner plexiform layer (GC-IPL) were recorded on OCT. Peripapillary and macular perfusion was documented at superficial retinal, deep retinal, and choriocapillary level using OCT-A. The investigations were repeated at 3 months.

Results:

RNFL showed significant thinning in all groups on follow-up with the atrophic group showing maximum thinning (P = 0.01—Group 3). GC-IPL was significantly reduced in all stages of papilledema at baseline compared with the controls. Thinnest GC-IPL was noted in the atrophic group (52.75 ± 7.44 μm; P = 0.00 in Group 3 vs controls) that showed further deterioration on follow-up. On Image J analysis, significant decrease was noted at various levels in the peripapillary and macular perfusion at baseline especially in the atrophic group which showed further deterioration noted on follow-up. The final visual acuity showed a statistically significant weak negative correlation with baseline RNFL (r = −0.306) and GC-IPL (r = −0.384) and moderately negative correlation with baseline superficial peripapillary retinal perfusion (r = −0.553). A significant negative correlation was seen between increasing grade of papilledema and superficial peripapillary retinal perfusion with both Image J and automated indices (r = −0.46; r = −0.61), respectively.

Conclusions:

GC-IPL may help identify early damage in papilledema even in the presence of thicker RNFL. Significant vascular changes can be observed on OCT-A that may help predict the final visual outcome in papilledema due to IIH.