bluuebunny/crossref_metadata_2025 huggingface dataset:
Sexual Health in Women Affected by Gynecologic or Breast Cancer
Authors: Robison Katina , Kulkarni Amita , Dizon Don S.
Published: January 2024

Sexual health problems are prevalent among women affected by gynecologic or breast cancer. It is important to understand the effects cancer treatment can have on sexual health and to have the tools necessary to identify and treat sexual health problems. This Clinical Expert Series discusses practical methods for routinely screening for sexual dysfunction and reviews sexual health treatment options for women affected by cancer. We review the limitations of the current literature in addressing sexual health problems among sexually and gender minoritized communities. Finally, we discuss appropriate timing of referrals to sexual health experts, physical therapists, and sex therapists. Multiple resources available for both patients and clinicians are included.
Sodium and Its Impact on Outcome After Aneurysmal Subarachnoid Hemorrhage in Patients With and Without Delayed Cerebral Ischemia
Authors: Labib Homeyra , Tjerkstra Maud A. , Coert Bert A. , Post René , Vandertop W. Peter , Verbaan Dagmar , Müller Marcella C.A.
Published: January 2024

OBJECTIVES:

To perform a detailed examination of sodium levels, hyponatremia and sodium fluctuations, and their association with delayed cerebral ischemia (DCI) and poor outcome after aneurysmal subarachnoid hemorrhage (aSAH).

DESIGN:

An observational cohort study from a prospective SAH Registry.

SETTING:

Tertiary referral center focused on SAH treatment in the Amsterdam metropolitan area.

PATIENTS:

A total of 964 adult patients with confirmed aSAH were included between 2011 and 2021.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A total of 277 (29%) developed DCI. Hyponatremia occurred significantly more often in DCI patients compared with no-DCI patients (77% vs. 48%). Sodium levels, hyponatremia, hypernatremia, and sodium fluctuations did not predict DCI. However, higher sodium levels were significantly associated with poor outcome in DCI patients (DCI onset –7, DCI +0, +1, +2, +4, +5, +8, +9 d), and in no-DCI patients (postbleed day 6–10 and 12–14). Also, hypernatremia and greater sodium fluctuations were significantly associated with poor outcome in both DCI and no-DCI patients.

CONCLUSIONS:

Sodium levels, hyponatremia, and sodium fluctuations were not associated with the occurrence of DCI. However, higher sodium levels, hypernatremia, and greater sodium fluctuations were associated with poor outcome after aSAH irrespective of the presence of DCI. Therefore, sodium levels, even with mild changes in levels, warrant close attention.
Pivoting Continuing Professional Development During the COVID-19 Pandemic: A Narrative Scoping Review of Adaptations and Innovations
Authors: Soklaridis Sophie , Chowdhury Mushfika , Turco Mary G. , Tremblay Martin , Mazmanian Paul , Williams Betsy , Besa Reena , Sockalingam Sanjeev
Published: January 2024

Introduction:

Most formal continuing professional development (CPD) opportunities were offered in person until March 2020 when the COVID-19 pandemic disrupted traditional structures of CPD offerings. The authors explored the adaptations and innovations in CPD that were strengthened or newly created during the first 16 months of the pandemic.

Methods:

The objectives of the narrative review were to answer the following questions: (1) what types of adaptations to CPD innovations are described? and (2) what may shape future innovations in CPD? The following databases were searched: Medline, Embase, CINAHL, and ERIC to identify the literature published between March 2020 to July 2021. The authors conducted a comprehensive search by including all study types that described adaptations and/or innovations in CPD during the stated pandemic period.

Results:

Of the 8295 citations retrieved from databases, 191 satisfied the inclusion criteria. The authors found three categories to describe adaptations to CPD innovations: (1) creation of new online resources, (2) increased use of the existing online platforms/software to deliver CPD, and (3) use of simulation for teaching and learning. Reported advantages and disadvantages associated with these adaptations included logistical, interactional, and capacity building elements. The review identified five potential future CPD innovations: (1) empirical research on the effectiveness of virtual learning; (2) novel roles and ways of thinking; (3) learning from other disciplines beyond medicine; (4) formation of a global perspective; and (5) emerging wellness initiatives.

Discussion:

This review provided an overview of the adaptations and innovations that may shape the future of CPD beyond the pandemic.
Current role of radiomics and radiogenomics in predicting oncological outcomes in bladder cancer
Authors: O’Sullivan Niall J. , Temperley Hugo C. , Corr Alison , Meaney James F.M. , Lonergan Peter E. , Kelly Michael E.
Published: January 2024

Background

Radiomics refers to the conversion of medical images into high-throughput, quantifiable data to analyze disease patterns, aid decision-making, and predict prognosis. Radiogenomics is an extension of radiomics and involves a combination of conventional radiomics techniques with molecular analysis in the form of genomic and transcriptomic data. In the field of bladder cancer, studies have investigated the development, implementation, and efficacy of radiomic and radiogenomic nomograms in predicting tumor grade, gene expression, and oncological outcomes, with variable results. We aimed to perform a systematic review of the current literature to investigate the development of a radiomics-based nomogram to predict oncological outcomes in bladder cancer.

Materials and methods

The Medline, EMBASE, and Web of Science databases were searched up to February 17, 2023. Gray literature was also searched to further identify other suitable publications. Quality assessment of the included studies was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 and Radiomics Quality Score.

Results

Radiogenomic nomograms generally had good performance in predicting the primary outcome across the included studies. The median area under the curve, sensitivity, and specificity across the included studies were 0.83 (0.63–0.973), 0.813, and 0.815, respectively, in the training set and 0.75 (0.702–0.838), 0.723, and 0.652, respectively, in the validation set.

Conclusions

Several studies have demonstrated the predictive potential of radiomic and radiogenomic models in advanced pelvic oncology. Further large-scale studies in a prospective setting are required to further validate results and allow generalized use in modern medicine.
Sodium Hydrosulfide Reverts Chronic Stress–Induced Cardiovascular Alterations by Reducing Oxidative Stress
Authors: Beltran-Ornelas Jesus H. , Silva-Velasco Diana L. , Tapia-Martínez Jorge A. , Sánchez-López Araceli , Cano-Europa Edgar , Huerta de la Cruz Saúl , Centurión David
Published: January 2024

Chronic stress induces a group of unrecognized cardiovascular impairments, including elevated hemodynamic variables and vascular dysfunction. Moreover, hydrogen sulfide (H2S), a gasotransmitter that regulates the cardiovascular system decreases under chronic stress. Thus, this study assessed the impact of sodium hydrosulfide (NaHS) (H2S donor) on chronic restraint stress (CRS)–induced cardiovascular changes. For that purpose, male Wistar rats were restrained for 2 hours a day in a transparent acrylic tube over 8 weeks. Then, body weight, relative adrenal gland weight, serum corticosterone, H2S-synthesizing enzymes, endothelial nitric oxide synthetize expression, reactive oxygen species levels, lipid peroxidation, and reduced glutathione-to-oxidized glutathione (GSH2:GSSG) ratio were determined in the thoracic aorta. The hemodynamic variables were measured in vivo by the plethysmograph method. The vascular function was evaluated in vitro as vasorelaxant responses induced by carbachol or sodium nitroprusside, and norepinephrine (NE)-mediated vasocontractile responses in the thoracic aorta. CRS increased (1) relative adrenal gland weight; (2) hemodynamic variables; (3) vasoconstrictor responses induced by NE, (4) reactive oxygen species levels, and (5) lipid peroxidation in the thoracic aorta. In addition, CRS decreased (1) body weight; (2) vasorelaxant responses induced by carbachol; (3) GSH content, and (4) GSH2:GSSG ratio. Notably, NaHS administration (5.6 mg/kg) restored hemodynamic variables and lipid peroxidation and attenuated the vasoconstrictor responses induced by NE in the thoracic aorta. In addition, NaHS treatment increased relative adrenal gland weight and the GSH2:GSSG ratio. Taken together, our results demonstrate that NaHS alleviates CRS-induced hypertension by reducing oxidative stress and restoring vascular function in the thoracic aorta.
Analgesic effects of ibuprofen soft and flexible absorbent foam dressing after colorectal surgery: A single-center comparative study
Authors: Cheng Tzu-Yen , Kiu Kee-Thai , Yen Min-Hsuan , Tam Ka-Wai , Chang Tung-Cheng
Published: January 2024

Background

Postoperative wound care and pain management are crucial components of the postoperative recovery process. This study aims to evaluate whether the analgesic effects of the ibuprofen soft and flexible absorbent foam dressing are superior to those of traditional gauze after colorectal surgery.

Materials and Methods

Data pertaining to patients who underwent colorectal surgery between May 2021 and January 2022 were extracted from the electronic medical records database archive of a single institution. The ibuprofen soft and flexible absorbent foam dressing was applied to 62 patients for postoperative wound care, whereas gauze was used for 78 patients. Primary outcome measurements included the count of dressings, visual analog scale pain scores, analgesic dosage, complications, and length of hospitalization.

Results

The mean pain score on the 5th day postoperation was significantly lower for the ibuprofen group (2.03 ± 1.55) than for the control group (2.63 ± 1.72, p = 0.035). The mean dosage (mg) of parecoxib on the 3rd day postoperation was significantly lower for the ibuprofen group (2.58 ± 12.27) than for the control group (10.26 ± 21.80, p = 0.01). The cumulative number of dressing changes during the 1st week postoperation was significantly lower for the ibuprofen group (mean ± standard deviation, 3.00 ± 0.98) than for the control group (7.55 ± 2.68, p < 0.001). No significant differences were observed in the complication rate or length of hospitalization between the groups.

Conclusions

The ibuprofen soft and flexible absorbent foam dressing can either enhance the analgesic effect during postoperative recovery or reduce the cost and dressing time associated with postoperative wound care.
Immunologic landscape of human hepatic hemangiomas and epithelioid hemangioendotheliomas
Authors: Thomann Stefan , Metzler Thomas , Tóth Marcell , Schirmacher Peter , Mogler Carolin
Published: January 2024

Background:

The missing requirement for resection for the majority of hepatic hemangiomas (HH) and tissue scarcity for rare diseases such as hepatic epithelioid hemangioendotheliomas (HEHE) complicate the characterization of the spatial immunovascular niche of these benign and malignant vascular neoplastic diseases.

Methods:

Two tissue cohorts containing 98 HHs and 13 HEHEs were used to study entity-specific and disease stage–specific endothelial cell (EC) phenotype and immune cell abundance. Using semiquantitative assessment, annotation-based cell classifiers, digital cell detection on whole slides, and tissue microarrays, we quantified 23 immunologic and vascular niche-associated markers and correlated this with clinicopathologic data.

Results:

Both HH and HEHE ECs were characterized by a CD31high, CD34high, FVIII-related antigenhigh expression phenotype with entity-specific expression differences of sinusoidal EC markers Stabilin1, Stabilin2, CD32, and Lymphatic Vessel Endothelial Hyaluronan Receptor 1 (LYVE-1). Cell detection identified an HH margin-prevailing immunologic response dominated by Myeloperoxidase+
(MPO+) macrophages, CD3+ and CD8+ T cell subsets, and B cells (CD20+, CD79A+). In HEHE, increased CD68+ and CD20+ cell demarcation of lesion margins was observed, while CD3+ and CD8+ T cells were equally detectable both marginally and intralesionally. Stage-specific pairwise correlation analysis of HH and HEHE revealed disease entity–specific immunologic infiltration patterns as seen by high CD117+ cell numbers in HH, while HEHE samples showed increased CD3+ T cell infiltration.

Conclusions:

ECs in HH and HEHE share a continuous EC expression phenotype, while the expression of sinusoidal EC markers is more highly retained in HEHE. These phenotypic differences are associated with a unique and disease-specific immunovascular landscape.
Feasibility of Treatment Agents in Radioactive Iodine Separation from Waste Liquids
Authors: Hirota Masahiro , Higaki Shogo , Ishida Yoshiyuki , Nakata Daisuke , Terao Keiji , Ito Shigeki
Published: January 2024

To discharge waste liquid containing radioactive iodine into sewage systems, long-term storage or dilution with a large amount of water may be required until the radioactivity concentration reduces below the standard value. Processing the waste liquid could be easier if radioactive iodine could be separated from the water. This study verified the effectiveness of superabsorbent polymer and α-cyclodextrin as treatment agents to separate radioactive iodine from waste liquids. Sodium iodide (Na125I) was added to purified water and artificial urine to prepare simulated waste liquids containing iodine equivalent to the urine of patients treated with radioactive iodine. The as-prepared simulated waste liquid was poured into a container with superabsorbent polymer and left for 90 d. The residual iodine rate in the simulated waste liquid was estimated by measuring 125I radioactivity. When the water was sufficiently dried, residual iodine rates on day 15 were 0.102 and 0.884 in the simulated waste liquids comprising purified water and artificial urine, respectively. The simulated waste liquid comprising purified water with 5% α-cyclodextrin absorbed by 1 g of superabsorbent polymer had a residual rate of 0.980. Moreover, the residual rate of simulated waste liquid comprising artificial urine with 2% α-cyclodextrin absorbed by 1 g of SAP was 0.949. Superabsorbent polymer combined with α-cyclodextrin was an effective treatment agent for separating radioactive iodine from waste liquids.
Significant Experiences Caring for Vascular Anomalies: A Survey of Caregivers and Adult Patients
Authors: Kerr Anna M. , Bereitschaft Christine , Goldberg Jessica , Sisk Bryan
Published: January 2024

Objectives:

The goal of the current study was to gain a deeper understanding of the significant experiences that characterize care for vascular anomalies (VAs).

Materials and methods:

A total of 166 adult patients and 88 caregivers (N = 254) completed an anonymous online cross-sectional survey about their experiences seeking care for their (or their child’s) vascular anomaly. We used thematic analysis to analyze participants’ responses to 3 open-ended questions asking about the biggest challenges, most memorable positive experiences, and any other significant experiences.

Results:

Participants reported significant healthcare experiences representing 5 primary areas: diagnosis and treatment, healthcare system and logistics, psychosocial consequences, physical consequences, and clinical relationships. The availability of clinical knowledge and information was identified as an overarching theme affecting all 5 categories. The most common negative experiences related to healthcare system and logistics (n = 100). Clinical relationships were commonly identified in both positive (n = 100) and negative (n = 86) experiences.

Conclusion:

Their responses highlighted the value of a well-organized system of care that promotes productive interactions with expert clinicians and connects patients with support organizations. Unfortunately, VA patients and caregivers often experience long diagnostic journeys, fragmented care, and nonproductive interactions with clinicians due to the pervasive lack of information about VAs. The results indicate the need for systemic changes to address these barriers to care for patients with rare diseases.
Medical aid in dying: The role of the nurse practitioner
Authors: Harrawood Kathryn A.
Published: January 2024

Medical aid in dying (MAID) is a practice that has been expanding in the United States over the past few decades. As it becomes a viable option for a growing portion of the American population, nurse practitioners (NPs) need to be prepared to engage in conversation with patients about the practice. Although historically only physicians were able to participate in MAID, the role has recently expanded to include additional advanced practice providers, including NPs. Reviewing the history of MAID and examining how current legislation affects clinical practice can support the NP's ability to educate and counsel patients about the option. Identifying specific areas in which MAID providers report needing additional training and support can help providers work toward delivering the highest quality patient care possible. As MAID becomes accessible to greater numbers of people, NPs need to be prepared to talk to patients who are navigating serious, life-limiting illnesses about the possibility of MAID.
Pathophysiology of Facial Nerve Stimulation and Its Implications for Electrical Stimulation in Cochlear Implants
Authors: Saoji Aniket A. , DeJong Melissa D. , Bertsch Natasha J. , Graham Madison K. , Goulson Kayla R. , Wernsman Pease Megan L. , Gruenwald Jill M. , Bross Abigail E. , Dornhoffer James R. , Neff Brian A. , Driscoll Colin L. W. , Carlson Matthew L. , Lane John I. , Pesch Joerg , Vanpoucke Filiep J.
Published: January 2024

Objectives

A small number of cochlear implant (CI) users experience facial nerve stimulation (FNS), which can manifest as facial twitching. In some patients, this can be resolved by adjusting the electrical stimulation parameters. However, for others, facial stimulation can significantly impair CI outcomes or even prevent its use. The exact mechanisms underlying FNS are unclear and may vary among patients.

Design

Transimpedance measurements were used to assess lateral and longitudinal spread of current within 15 cochlea of nucleus CI recipients with FNS (13 unilateral recipients and 1 bilateral recipient). We compared the transimpedance measurements with programming parameters from clinical visits and pre- and postoperative temporal bone computed tomography (CT) scans to identify factors that may contribute to FNS in each CI ear.

Results

In nine ears, transimpedance curves showed inflection, which suggests a localized current sink within the cochlea. This indicates a low-impedance pathway through which current exits the cochlea and stimulates the labyrinthine segment of the facial nerve canal. Electrodes near this current sink were disabled or underfit to minimize facial stimulation. In the other seven ears, current flow peaked toward the basal end of the cochlea, suggesting that current exits through the round window or other structures near the basal end of the cochlea, stimulating the tympanic segment of the facial nerve.

Conclusions

Objective transimpedance measurements can be used to elucidate the mechanisms of FNS and to develop strategies for optimizing electrical stimulation parameters and speech coding to minimize or eliminate FNS in a small subset of CI users.
Assessment of Central Auditory Processing in Children Using a Novel Tablet-Based Platform: Application for Low- and Middle-Income Countries
Authors: Lee Torri , Rieke Catherine , Niemczak Christopher , Kobrina Anastasiya , Clavier Odile , Gonzalez Julian , Fuente Adrian , Alvarez Karen Mojica , Gonzalez-Quiroz Marvin , Buckey Jay , Saunders James
Published: January 2024

Objective

Evaluate whether a portable, tablet-based central auditory processing (CAP) test system using native language training videos and administered by minimally trained community health workers can produce CAP results comparable to previously published norms. Our secondary aim was to determine subject parameters that influence test results.

Study Design

Cross-sectional study.

Setting

Community-based settings in Chontales, Nicaragua, New Hampshire, and Florida.

Patients

English- and/or Spanish-speaking children and adolescents (n = 245; average age, 12.20 yr; range, 6–18 yr)

Main Outcome Measures

Completion of the following tests with responses comparable to published norms: Pure-tone average (PTA), gap detection threshold (GDT), fixed-level frequency threshold, masking level difference (MLD), Hearing in Noise Test (HINT), Dichotic Digits Test (DDT), and Frequency Pattern Recognition (FPR) test.

Results

GDT, HINT, and DDT had comparable results to previously published normative values. MLD and FPR results differed compared with previously published normative values. Most CAP tests (MLD, GDT, HINT) results were independent of age and PTA (p = 0.1–0.9). However, DDT was associated with age and PTA (p < 0.0001)

Conclusions

Pediatric CAP testing can be successfully completed in remote low- and middle- income country environments using a tablet-based platform without the presence of an audiologist. Performance on DDT improved with age but deteriorated with hearing loss. Further investigation is warranted to assess the variability of FPR.
Speech Understanding and Subjective Listening Effort in Noise With Different OTEs and Sound Processing Technologies
Authors: Wesarg Thomas , Wiebe Konstantin , Galindo Guerreros Julio Cesar , Arndt Susan , Aschendorff Antje , Voß Bettina
Published: January 2024

Objective

To determine speech reception thresholds (SRTs) in noise and subjective listening effort (LE) in cochlear implant (CI) recipients for application of three sound processing (SP) technologies with two off-the-ear (OTE) CI sound processors, a fixed moderately directional microphone (Standard), an adaptive directional microphone (Beam), and the spatial noise-reduction setting ForwardFocus, with the Kanso 2 (OTE2), and Beam with the Kanso (OTE1).

Study Design

Prospective repeated measures, within-subject design.

Setting

Single tertiary-referral center.

Patients

Twenty CI recipients with bilateral severe-to-profound sensorineural hearing loss.

Main Outcome Measures

SRTs were assessed in two spatial configurations with frontal speech and noise from 90–180–270 degrees (S0N90–180–270) or from the CI side (S0NCI). SRTs were obtained for sentences of the Oldenburg sentence test presented in International Collegium of Rehabilitative Audiology (ICRA) noise ICRA5-250. LE for speech understanding in noise was evaluated in S0N90–180–270 and assessed in effort scale categorical units (ESCUs) by using Adaptive Categorical Listening Effort Scaling (ACALES). LEs at 5-dB signal-to-noise ratio (SNR) were calculated from fitted psychometric curves.

Results

With OTE2 in S0N90–180–270, SRT with ForwardFocus (−4.28 dB SNR) was better than with Beam (−3.13 dB SNR) and Standard (0.43 dB SNR). ForwardFocus showed lower LE5dB (2.61 ESCU) compared with Beam (4.60 ESCU) and Standard (5.32 ESCU). In a comparison of both OTEs in S0N90–180–270 regarding best-performing SP technology, ForwardFocus with OTE2 yielded a better SRT and better LE5dB than Beam with OTE1 (SRT: −1.70 dB SNR; LE5dB: 4.00 ESCU). With OTE2 in S0NCI, SRT was improved with ForwardFocus (−2.78 dB SNR) compared with Beam (−1.23 dB SNR) and Standard (1.83 dB SNR).

Conclusion

With respect to SP technology and OTE, CI recipients experience best SRT and lowest LE in S0N90–180–270 when using ForwardFocus with OTE2. ACALES is feasible for assessing subjective LE in CI recipients.
Long-Term Neurobehavioral and Functional Outcomes of Pediatric Extracorporeal Membrane Oxygenation Survivors
Authors: Turner Ashley D. , Streb Madison M. , Ouyang Amy , Leonard Skyler S. , Hall Trevor A. , Bosworth Christopher C. , Williams Cydni N. , Guerriero Réjean M. , Hartman Mary E. , Said Ahmed S. , Guilliams Kristin P.
Published: January 2024

There are limited reports of neurobehavioral outcomes of children supported on extracorporeal membrane oxygenation (ECMO). This observational study aims to characterize the long-term (≥1 year) neurobehavioral outcomes, identify risk factors associated with neurobehavioral impairment, and evaluate the trajectory of functional status in pediatric ECMO survivors. Pediatric ECMO survivors ≥1-year postdecannulation and ≥3 years of age at follow-up were prospectively enrolled and completed assessments of adaptive behavior (Vineland Adaptive Behavior Scales, Third Edition [Vineland-3]) and functional status (Functional Status Scale [FSS]). Patient characteristics were retrospectively collected. Forty-one ECMO survivors cannulated at 0.0–19.8 years (median: 2.4 [IQR: 0.0, 13.1]) were enrolled at 1.3–12.8 years (median: 5.5 [IQR: 3.3, 6.5]) postdecannulation. ECMO survivors scored significantly lower than the normative population in the Vineland-3 Adaptive Behavior Composite (85 [IQR: 70, 99], P < 0.001) and all domains (Communication, Daily Living, Socialization, Motor). Independent risk factors for lower Vineland-3 composite scores included extracorporeal cardiopulmonary resuscitation, electrographic seizures during ECMO, congenital heart disease, and premorbid developmental delay. Of the 21 patients with impaired function at discharge (FSS ≥8), 86% reported an improved FSS at follow-up. Pediatric ECMO survivors have, on average, mild neurobehavioral impairment related to adaptive functioning years after decannulation. Continued functional recovery after hospital discharge is likely.
Clearing the air: a review of the effects of air pollution on dialysis outcomes
Authors: Spencer Annika , Lavenburg Linda-Marie , Sanders Alison P. , Shah Ankur D.
Published: January 2024

Purpose of review

An evolving body of literature indicates exposure to air pollutants is associated with adverse health outcomes in dialysis patients. As the prevalence of kidney disease increases, understanding the role of environmental agents on the health of dialysis patients is critical to reducing global morbidity and mortality.

Recent findings

We identified 16 publications that investigated associations between pollutants including particulate matter (PM2.5 and PM10), carbon monoxide (CO), nitrogen dioxide (NO2), sulfur dioxide (SO2), and ozone (O3) and health outcomes among dialysis patients. Eight studies examined the effects of particulate matter (PM) and four studies examined the effects CO exposure on dialysis patients. Exposure to PM was consistently associated with outcomes including all-cause mortality and a smaller body of literature suggested relationships with subclinical outcomes. Exposure to CO was associated with all-cause mortality, generalized inflammation, and uremic pruritus. An additional four studies examined multiple pollutant exposures including NO2, SO2, and O3 and reported associations with all-cause mortality in dialysis patients.

This review emphasized the nascent literature that demonstrates consistent relationships between air pollutant exposure and adverse outcomes among dialysis patients. Further research is needed to assess the impact of air pollutants, including how co-exposures will impact dialysis patient health.
Implementing a Clinical Decision Support Tool to Improve Physical Activity
Authors: McCarthy Margaret M. , Szerencsy Adam , Taza-Rocano Leslie , Hopkins Stephanie , Mann Devin , D’Eramo Melkus Gail , Vorderstrasse Allison , Katz Stuart D.
Published: January 2024

Background

Currently, only about half of U.S. adults achieve current physical activity guidelines. Routine physical activity is not regularly assessed, nor are patients routinely counseled by their healthcare provider on achieving recommended levels. The three-question physical activity vital sign (PAVS) was developed to assess physical activity duration and intensity and identify adults not meeting physical activity guidelines. Clinical decision support provided via a best practice advisory in an electronic health record (EHR) system can be triggered as a prompt, reminding healthcare providers to implement the best practice intervention when appropriate. Remote patient monitoring of physical activity can provide objective data in the EHR.

Objectives

This study aimed to evaluate the feasibility and clinical utility of embedding the PAVS and a triggered best practice advisor into the EHR in an ambulatory preventive cardiology practice setting to alert providers to patients reporting low physical activity and prompt healthcare providers to counsel these patients as needed.

Methods

Three components based in the EHR were integrated for the purpose of this study: Patients completed the PAVS through their electronic patient portal prior to an office visit, a best practice advisory was created to prompt providers to counsel patients who reported low levels of physical activity, and remote patient monitoring via Fitbit synced to the EHR provided objective physical activity data. The intervention was pilot-tested in the Epic EHR for 1 year (July 1, 2021 to June 30, 2022). Qualitative feedback on the intervention from both providers and patients was obtained at the completion of the study.

Results

Monthly assessments of the use of the PAVS and best practice advisory and remote patient monitoring were completed. Patients’ completion of the PAVS varied from 35% to 48% per month. The best practice advisory was signed by providers between 2% and 65% and was acknowledged by 2%–22% per month. The majority (58%) of patients were able to sync a Fitbit device to their EHR for remote monitoring.

Discussion

Although uptake of each component needs improvement, this pilot demonstrated the feasibility of incorporating a physical activity promotion intervention into the EHR. Qualitative feedback provided guidance for future implementation.
Safety and real-world dosing of onabotulinumtoxinA for the treatment of adult spasticity: post hoc analysis of the Adult Spasticity International Registry study
Authors: Bavikatte Ganesh , Esquenazi Alberto , Dimyan Michael A. , Dashtipour Khashayar , Feng Wuwei , Mayadev Angeli , Fanning Kristina , Musacchio Tiziana , Zuzek Aleksej , Francisco Gerard E.
Published: January 2024

Objective

To evaluate the safety of onabotulinumtoxinA treatment for spasticity across dose ranges in real-world practice.

Design

Adult Spasticity International Registry (ASPIRE) was a multicenter, prospective, observational study (NCT01930786) of onabotulinumtoxinA treatment for adult spasticity over 2 years. Adverse events (AEs), serious AEs (SAEs), treatment-related AEs (TRAEs), and TRSAEs were sorted into 5 categories (≤200 U, 201-400 U, 401-600 U, 601-800 U, ≥801 U) based on cumulative dose per session.

Results

In 3103 treatment sessions (T), 730 patients received ≥1 dose of onabotulinumtoxinA. Dose categories included: ≤200 U (n = 312; t = 811), 201-400 U (n = 446, t = 1366), 401-600 U (n = 244, t = 716), 601-800 U (n = 69, t = 149), ≥801 U (n = 29, t = 61). Of these patients, 261 reported 827 AEs, 94 reported 195 SAEs, 20 reported 23 TRAEs, and 2 patients treated with 201-400 U onabotulinumtoxinA reported 3 TRSAEs. TRAEs reported: ≤200 U (8 TRAEs/811, 0.9%); 201-400 U (7/1366, 0.5%); 401-600 U (6/716, 0.8%); 601-800 U (1/149, 0.7%); ≥801 U (1/61, 1.6%).

Conclusions

In this post hoc analysis, most treatment sessions were performed with 201-400 U onabotulinumtoxinA. Patients treated with 201-400 U onabotulinumtoxinA had an AE profile consistent with onabotulinumtoxinA package inserts globally (eg, United States, European Union, United Kingdom, Canada). No new safety signals were identified.
Influence of verbal instruction on gait training in Parkinson’s disease: a randomized controlled trial
Authors: Li Ming-Hao , Tai Chun-Hwei , Luh Jer-Junn , Chen Yu-Jen , Hsu Wei-Li , Lee Ya-Yun
Published: January 2024

Objective

Verbal instruction is one of the most commonly used methods that therapists use to correct walking pattern for people with Parkinson’s disease (PD). This study aimed to compare the long-term training effects of two different verbal instructions that either asked the participants to ‘take big steps’ or ‘strike the ground with the heel’ on walking ability in individuals with PD.

Design

Forty-five participants with PD were randomized into the big-step (BIG) or heel strike (HS) group. The participants underwent 12 sessions of treadmill and overground gait training. Throughout the interventions, the BIG group received an instruction to ‘take big steps,’ while the HS group received an instruction to ‘strike the ground with your heel.’ The primary outcome was gait performance, including velocity, stride length, cadence, and heel strike angle. The participants were assessed before, immediately after, and 1-month after training.

Results

Both groups showed significant improvements in gait performance after training. The HS group showed continuous improvements in velocity and stride length during the follow-up period; however, the BIG group showed slightly decreased performance.

Conclusion

A verbal instruction emphasizing heel strike can facilitate long-term retention of walking performance in people with PD.
Transition From Pediatric to Adult Rheumatology Care
Authors: Borgia R. Ezequiel , De Cunto Carmen L. , Terreri Maria Teresa , Guerini L. Lorena , Espada Graciela
Published: January 2024

Background/Purpose

Adequate transition from pediatric to adult care is associated with better adherence to treatment and better outcomes in pediatric patients with chronic diseases. There are little data on transition programs, outcomes, use of transition guidelines, and available tools in pediatric rheumatology centers from Latin America (LATAM). In this study, we described the characteristics of transition programs from 3 pediatric rheumatology centers. We also introduced results of the first survey examining the transition experience in countries from LATAM.

Methods

The experience and implementation process of transition programs from 3 pediatric rheumatology centers are described. A survey based on a questionnaire created by Chira et al (J Rheumatol. 2014;41:768–779) from the Childhood Arthritis and Rheumatology Research Alliance was also administrated to pediatric rheumatology centers from LATAM.

Results

A total of 49 (68%) pediatric rheumatologists answered the survey. Most centers do not have an official and written transition program and reported a need for more tools and resources in their services to facilitate the transition experience.

Conclusions

Transition guidelines culturally tailored to developing countries are needed in LATAM.
Frail Patients Undergoing Optimization Before Surgery: Preliminary Results
Authors: Hui Lauren T , St Pierre Diane , Miller Richard S
Published: January 2024

BACKGROUND:

It is estimated that 10% or more of patients older than 65 years are affected by frailty, a mental and physical state of vulnerability to adverse surgical outcomes. Frailty can be assessed using the Edmonton Frailty Scale: a reliable and convenient multidimensional assessment before surgery. The correlation between frailty score, presurgical optimization, and surgical outcomes was investigated in this preliminary pilot study.

STUDY DESIGN:

A retrospective study was performed on patients referred to the surgical optimization clinic and assessed for frailty from September 2020 to May 2023. Patients received presurgical optimization for reasons including diabetes, smoking cessation, prehabilitation and nutrition, and/or cardiopulmonary issues. Outcomes were evaluated whether they proceeded to surgery, were referred to the High-Risk Surgical Committee, surgical case canceled, or not scheduled. For those who proceeded to surgery, infection rates, complications, and 30-day emergency department (ED) and readmission rates were evaluated.

RESULTS:

Of 143 unique patients, 138 (men = 61, women = 77) were evaluated for this study. The average Edmonton frailty score for patients who proceeded to surgery was 7.013 (n = 78) vs 9.389 with cancelation and 9.600 for not scheduled or not optimized for surgery. Postoperative infection rates were <3%. However, 30-day ED and readmission rate was 21% (16 of 78).

CONCLUSIONS:

Patients with lower average Edmonton frailty scores were more likely to proceed to surgery, whereas those with higher average Edmonton frailty scores were more likely to have surgery canceled or delayed. Frail patients cleared for surgery were found to have a high 30-day ED and readmission rate.
Pilot study of a high-intensity interval training program in older adults: Safety, feasibility, functional fitness and cognitive effects
Authors: Anderson Vanessa R. , Kakuske Katherine , Thompson Christian , Ivanova Maria V.
Published: January 2024

Exercise can boost physical and cognitive health in older adults. However, there are a lack of accessible exercise programs that foster adherence among older adults. In this study, we aimed to establish the safety and feasibility of APEX, a new exercise program designed to optimize fitness and cognitive gains for older adults, in addition to evaluating its acute physiological effects, and assessing its possible effects on functional fitness and cognition among healthy older adults. APEX utilizes a multimodal progressive high-intensity interval training (HIIT) design, with high-intensity intervals focused on enhancing cardiovascular fitness and muscle strength, and recovery intervals that incorporate balance and mobility exercises. The APEX training was tested in healthy older adults (n=4) over the course of four weeks. Ultimately, APEX was found to be safe and feasible, with no adverse events and high adherence. Participants met heart rate targets for all of the high-intensity exercises, and all intervals had a significant difference in heart rates between high-intensity and recovery periods in linear effects models (p<0.001). Improvements in functional fitness were observed in aerobic endurance, lower body strength, and balance. The intervention was also associated with positive trends in the cognitive domains of information processing, working memory, executive control, and attention. APEX offers a promising alternative to traditional cardiovascular exercise modalities for older adults with additional benefits for functional fitness and cognition. These results encourage further testing of the APEX program in older adults and different clinical populations.
Efficacy of Different Treatment Approaches (Insulin and Metformin) in Women with Gestational Diabetes Mellitus (GDM).
Authors: Asatiani Natalia G. , Kurashvili Ramaz B. , Shelestova Elena
Published: January 2024

Background and Purpose: The pharmacotherapy options in patients with GDM, are insulin or oral antihyperglycemic agents. Insulin is the preferred medication for treating hyperglycemia, but in recent years, metformin has been increasingly used in the treatment of GDM. The aim to assess the efficacy of different treatment (insulin and metformin) in women with GDM. Methods: Screening for GDM was performed in 2422 pregnant women and reveal GDM in 119 women (75 g OGTT was performed at 24-28 weeks of gestation). All patients started treated at 24-29 weeks of gestations. The patients were divided into 2 groups (Gr.): Gr.1 - 68 patients, who treated with diet and insulin therapy Gr.2 - 51patients, who treated with diet and metformin. Results: At the 2nd trimester HbA1c (%) levels vas for Gr.1 and 2: 6.7 (0.05), 6.4 (0.6) respectively; By term HbA1c levels statistically decreased in both groups, but we did not found statistical difference between groups. Women from Gr.2 gained less weight compared to women from Gr.1 (1.89±3.88 vs 4.53±3.67 kg; P=0.003). In Gr.1 percent of pre-eclampsia was (2,9%) and in Gr.2(3,9%) (P= 0,7773, OR 1,33), we did not find statistical difference between groups. The incidence of preterm delivery before 37 weeks of gestation in Gr1 was lower, than in Gr.2 (P=0.7311, OR 1,33) and we also did not find a statistical difference between groups. Perinatal mortality was observed in Gr.1 - 1.4% and in Gr.2 - 1,9% (P =0.8402, OR 1,33). In both groups we observed high percent Cesarean section (Gr.1 - 32.3% and Gr.2 - 29.4% (P =0.7651, OR 1,0909), but we did not find a statistical difference between the groups. In both groups, percent of macrosomia was high, despite good glycemic control maintained through pregnancies: 20.0% and 23.0%, for Gr.1 and Gr.2, respectively (P =0.9236, OR 1,0256), and again no statistical difference was found between the groups. Percent of neonatal hypoglycemia was lower in Gr.2 (1.9%), than in Gr.1 (4.41%) (P=0.9236, OR 1,0256). Percent of respiratory distress syndrome was 2.94% and in 3.92% for Gr.1 and Gr.2, respectively (P= 0.9694, OR 0.9893), with no statistical difference between the groups. Conclusions: We did not find differences between patients who treated with diet and insulin therapy and with diet and metformin. Percent of preeclampsia, preterm delivery, macrosomia and perinatal death was similar in both groups, only maternal weight gain was lower in the metformin group
Oral Baricitinib in the Treatment of Cutaneous Lichen Planus
Authors: Hwang Angelina , Kechter Jacob , Do Tran , Hughes Alysia , Zhang Nan , Li Xing , Wasikowski Rachael , Brumfiel Caitlin , Patel Meera , Boudreaux Blake , Bhullar Puneet , Nassir Shams , Yousif Miranda , DiCaudo David J , Fox Jennifer , Gharaee-Kermani Mehrnaz , Xing Xianying , Zunich Samantha , Branch Emily , Kahlenberg J. Michelle , Billi Allison C. , Plazyo Olesya , Tsoi Lam C. , Pittelkow Mark R , Gudjonsson Johann E. , Mangold Aaron R
Published: January 2024

Background

Cutaneous lichen planus (LP) is a recalcitrant, difficult-to-treat, inflammatory skin disease characterized by pruritic, flat-topped, violaceous papules on the skin. Baricitinib is an oral Janus kinase (JAK) 1/2 inhibitor that interrupts the signaling pathway of interferon (IFN)-γ, a cytokine implicated in the pathogenesis of LP.

Methods

In this phase II trial, twelve patients with cutaneous LP received baricitinib 2 mg daily for 16 weeks, accompanied by in-depth spatial, single-cell, and bulk transcriptomic profiling of pre-and post-treatment samples.

Results

An early and sustained clinical response was seen with 83.3% of patients responsive at week 16. Our molecular data identified a unique, oligoclonal IFN-γ, CD8+, CXCL13+ cytotoxic T-cell population in LP skin and demonstrate a rapid decrease in interferon signature within 2 weeks of treatment, most prominent in the basal layer of the epidermis.

Conclusion

This study demonstrates the efficacy and molecular mechanisms of JAK inhibition in LP.

Trial Registration Number:NCT05188521
A temporal map of division, chromatin modification, and identity specification in the regenerating root
Authors: Rahni Ramin , Guillotin Bruno , Lee Laura R. , Birnbaum Kenneth D.
Published: January 2024

Plants have a remarkable capacity for regeneration. InArabidopsis thaliana(Arabidopsis), the entire root tip—housing stem cells and specialized cells like the gravity-sensing columella—can be cut off and the remnant tissue will rapidly divide and differentiate to replace these missing identities. Despite some knowledge of the molecular mechanisms driving this process, the necessity of cell division in this context is not fully understood. Here, we define a timeline of the major steps in regeneration and investigate the role of division and chromatin remodeling in that time. We show that while cell cycle inhibition blocks regeneration, some partial reprogramming can still occur. We outline three broad processes during regeneration—ectopic stem cell niche gene expression, loss of remnant identities, and gain of new identities—and show that some reprogramming events like ectopic stem cell niche gene expression are division-independent. We find that the cell cycle is also accelerated during root regeneration, speeding up to nearly three times faster than in uncut roots. Moreover, we show that histone deacetylase (HDAC) activity is critical at the very early stages of regeneration, potentially preceding the role of cell division. Intriguingly, a one-hour treatment with the HDAC inhibitor Trichostatin A (TSA) immediately upon root tip removal is sufficient to significantly perturb regeneration, whereas a one-hour cell cycle inhibition is not. We propose that Class I HDACs are the prime mediators of this HDAC inhibition and implicateHDA19as a potential regulator of early reprogramming in root tip regeneration.
An inappropriate decline in ribosome levels drives a diverse set of neurodevelopmental disorders
Authors: Ni Chunyang , Yu Leqian , Vona Barbara , Park Dayea , Wei Yulei , Schmitz Daniel A , Wei Yudong , Ding Yi , Sakurai Masahiro , Ballard Emily , Liu Yan , Kumar Ashwani , Xing Chao , Kim Hyung-Goo , Ekmekci Cumhur , Karimiani Ehsan Ghayoor , Imannezhad Shima , Eghbal Fatemeh , Badv Reza Shervin , Schwaibold Eva Maria Christina , Dehghani Mohammadreza , Mehrjardi Mohammad Yahya Vahidi , Metanat Zahra , Eslamiyeh Hosein , Khouj Ebtissal , Alhajj Saleh Mohammed Nasser , Chedrawi Aziza , Alves César Augusto Pinheiro Ferreira , Houlden Henry , Kruer Michael , Alkuraya Fowzan S. , Cenik Can , Maroofian Reza , Wu Jun , Buszczak Michael
Published: January 2024

Many neurodevelopmental defects are linked to perturbations in genes involved in housekeeping functions, such as those encoding ribosome biogenesis factors. However, how reductions in ribosome biogenesis can result in tissue and developmental specific defects remains a mystery. Here we describe new allelic variants in the ribosome biogenesis factorAIRIMprimarily associated with neurodevelopmental disorders. Using human cerebral organoids in combination with proteomic analysis, single-cell transcriptome analysis across multiple developmental stages, and single organoid translatome analysis, we identify a previously unappreciated mechanism linking changes in ribosome levels and the timing of cell fate specification during early brain development. We find ribosome levels decrease during neuroepithelial differentiation, making differentiating cells particularly vulnerable to perturbations in ribosome biogenesis during this time. Reduced ribosome availability more profoundly impacts the translation of specific transcripts, disrupting both survival and cell fate commitment of transitioning neuroepithelia. Enhancing mTOR activity by both genetic and pharmacologic approaches ameliorates the growth and developmental defects associated with intellectual disability linked variants, identifying potential treatment options for specific brain ribosomopathies. This work reveals the cellular and molecular origins of protein synthesis defect-related disorders of human brain development.

Highlights

AIRIMvariants reduce ribosome levels specifically in neural progenitor cells.

Inappropriately low ribosome levels cause a transient delay in radial glia fate commitment.

Reduced ribosome levels impair translation of a selected subset of mRNAs.

Genetic and pharmacologic activation of mTORC1 suppresses AIRIM-linked phenotypes.