bluuebunny/crossref_metadata_2025 huggingface dataset:
The Search for the Optimal cut-off Value of p53-Immunohistochemistry to Predict Prognosis of Invasive Bladder Cancer: A Multi-Center, Multi-Laboratory Analysis
Authors: Mertens Laura S. , Claps Francesco , Mayr Roman , Hodgson Anjelica , Shariat Shahrokh F. , Hippe Katrin , Neuzillet Yann , Sanders Joyce , Burger Maximilian , Pouessel Damien , Otto Wolfgang , van der Kwast Theo H. , Lotan Yair , Allory Yves , Downes Michelle R. , van Rhijn Bas W.G.
Published: April 2022

Introduction: Mutations in the TP53 gene are indicative of worse outcome in bladder cancer and are usually assessed by immunohistochemistry. To define p53-overexpression, a threshold of >10% is most commonly used (cut-off1). Recently, a novel cut-off (aberrant = 0% or ≥50%) (cut-off2) showed better correlation to clinical outcome. In this study, we evaluate the association between p53-immunohistochemistry cut-offs, clinico-pathological variables and disease-specific survival (DSS). Methods: Seven-hundred-fifty chemotherapy-naïve patients who underwent radical cystectomy were included (92% muscle-invasive bladder cancer. In addition to cut-off1 and cut-off2, a third cut-off (cut-off3) was determined based on the highest Youden-index value. Cut-off values were associated with clinico-pathological variables and FGFR3 mutation status. The Kaplan-Meier method was used to estimate DSS. Results: Aberrant p53-expression was found in 489 (65%) (cut-off1) and 466 (62%) (cut-off2) tumors. Cut-off3 was determined at 25% and aberrant p53-expression in 410 cases (55%) (cutoff3). p53-expression levels were significantly associated with higher pT-stage (cut-off1/2/3: P = 0.047, P = 0.006 and P = 0.0002, respectively), higher grade (all, P < 0.0001), and FGFR3 wild-type (cut-off1: P = 0.02, cut-offs2&3: P = 0.001). Median follow-up was 5.3 years (interquartile range, 4.0-6.0 years). p53-expression was not associated with DSS for any of the three cut-offs (cut-off1/2/3: P-log-rank = 0.566, 0.77 and 0.50, respectively). If we only considered locally advanced bladder cancer, results on DSS remained non-significant. Conclusion: This multi-center, multi-laboratory study showed that, regardless of the cut-off used, p53-immunohistochemistry did not enable selection of patients with worse outcome. Our results suggest that p53-immunohistochemistry alone is not suitable to guide clinical decision making after radical cystectomy.
The Overexpression of Programmed Death-Ligand 2 in Uterine Adenosarcoma: Correlation with High-Grade Morphology, Mutant Type TP53 Expression and Clinical Outcomes
Authors: Ok Atılgan Alev , Yılmaz Akçay Eda , Özen Özlem , Haberal Reyhan A. Nihan , Ayhan Ali
Published: April 2022

Immunotherapy involving the programmed death-1 (PD-1)/the programmed death-ligand (PD-1/PD-L) blockade is an understudied tumor therapy approach in cases of adenosarcoma. PD-L1 and PD-L2, and tumor protein p53 (p53) were examined in 20 uterine adenosarcoma cases, and tumor-infiltrating lymphocytes and tumor-associated macrophages were counted in tumor tissue using immunohistochemistry. While CPS PD-L1 positivity with 1% and 10% cut-off values was observed in 40% and 10% of tumors, respectively, CPS PD-L2 positivity with 1%, 10% and 50% cut-off values was observed in 100%, 85% and 50% of the tumors, respectively. The CPS PD-L2 positivity with a 50% cut-off value was positively correlated with tumor grade and the presence of sarcomatous overgrowth and lymphovascular invasion (LVI) (p = 0.025, p = 0.025, and p = 0.025, respectively). Nine of 11 high-grade adenosarcomas and none of the low-grade adenosarcomas showed mutant type p53 expression (p = 0.000). However, PD-L1 expression and tumor-infiltrating immune cells did not correlate with clinicopathological parameters. The CPS PD-L2 positivity with a 50% cut-off value was also positively correlated with mutant type p53 expression (p = 0.024) and tumor-associated macrophages density (p = 0.024). The CPS PD-L2 positivity with a 50% cut-off value and mutant type p53 expression were associated with shorter disease-free survival and shorter overall survival. The high density of tumor-associated macrophages and low density of tumor-infiltrating lymphocytes were also associated with shorter disease-free survival and overall survival (p < 0.05).These results suggested that the CPS PD-L2 positivity with a 50% cut-off value, p53 mutation and tumor microenvironment played an essential role in the progression of uterine adenosarcomas.
SMARCA4-deficient Undifferentiated Uterine Sarcoma: Clinicopathological Features of an Emerging Entity
Authors: Nakra Tripti , Kakkar Aanchal , Mathur Sandeep R. , Jain Deepali , Kumar Sunesh
Published: April 2022

SMARCA4-deficient undifferentiated uterine sarcoma is a recently described molecularly defined entity among the subset of aggressive undifferentiated uterine tumors. Mutation in the SMARCA4 gene is a key driver alteration, as also seen in small cell carcinoma of ovary, hypercalcemic type (SCCOHT) and thoracic undifferentiated carcinoma. Limited number of cases of SMARCA4-deficient undifferentiated uterine sarcoma has been reported in literature. We hereby describe a case of this distinct entity in a 52-year-old woman. Histomorphological examination showed sheets of monomorphic epithelioid cells with a variable proportion of cells displaying rhabdoid features, brisk mitotic activity, and lymphovascular invasion. A panel of immunohistochemical markers was required to exclude the differential diagnoses. The tumor was microsatellite stable. Loss of SMARCA4 expression and intact expression of INI1 in tumor cells by immunohistochemistry (IHC) confirmed the diagnosis of SMARCA4- deficient undifferentiated uterine sarcoma. The patient had a rapidly progressive clinical course.
Primary Pulmonary Myxoid Sarcoma with EWSR1::ATF1 Fusion: A Case Report
Authors: Nishimura Tomoki , Ii Tsunehiro , Inamori Osamu , Konishi Eiichi , Yoshida Akihiko
Published: April 2022

Primary pulmonary myxoid sarcoma is a rare lung sarcoma, mostly involving the central lung and harboring the EWSR1::CREB1 fusion. We report an exceptional case of primary pulmonary myxoid sarcoma arising in the peripheral lung and harboring an EWSR1::ATF1 gene fusion. A 67-year-old man presented with a solid nodule in the right lower lobe, and wedge resection was performed. Microscopically, the tumor consisted of reticular proliferation of uniform mildly atypical spindle cells within abundant myxoid stroma. Immunohistochemically, smooth muscle actin was positive but desmin was negative. Fluorescence in situ hybridization confirmed EWSR1 and ATF1 gene rearrangements. No recurrence was seen for 12 months. Pathological findings and gene rearrangements are important for the diagnosis of primary pulmonary myxoid sarcoma. Complete resection and careful observation are required.
Cadaveric Gait Simulation of the Effect of Subtalar Arthrodesis on Total Ankle Replacement Kinematics
Authors: Henry Jensen K. , Sturnick Daniel , Rosenbaum Andrew , Saito Guilherme Honda , Deland Johnathan , Steineman Brett , Demetracopoulos Constantine
Published: April 2022

Background:

Patients undergoing total ankle replacement (TAR) often have symptomatic adjacent joint arthritis and deformity. Subtalar arthrodesis can effectively address a degenerative and/or malaligned hindfoot, but there is concern that it places abnormal stresses on the TAR and adjacent joints of the foot, potentially leading to early TAR failure. This study hypothesized that ankle and talonavicular joint kinematics would be altered after subtalar arthrodesis in the setting of TAR.

Methods:

Thirteen mid-tibia cadaveric specimens with neutral alignment were tested in a robotic gait simulator. To simulate gait, each specimen was secured to a static mounting fixture about a 6-degree of freedom robotic platform, and a force plate moves relative to the stationary specimen based on standardized gait parameters. Specimens were tested sequentially in TAR and TAR with subtalar arthrodesis (TAR-STfuse). Kinematics and range of motion of the ankle and talonavicular joint were compared between TAR and TAR-STfuse.

Results:

There were significant differences in kinematics and range of motion between TAR and TAR-STfuse groups. At the ankle joint, TAR-STfuse had less internal rotation in early-mid stance ( P < .05), with decreased range of motion in the sagittal (–2.7 degrees, P = .008) and axial (–1.8 degrees, P = .002) planes in early stance, and increased range of motion in the coronal plane in middle (+1.2 degrees, P < .001) and late (+2.5 degrees, P = .012) stance. At the talonavicular joint, there were significant differences in axial and coronal kinematics in early and late stance ( P < .05). Subtalar arthrodesis resulted in significantly decreased talonavicular range of motion in all planes in early and late stance ( P < .003).

Conclusion:

In ankles implanted with the TAR design used in this study, kinematics of the ankle and talonavicular joint were found to be altered after subtalar arthrodesis. Aberrant motion may reflect altered contact mechanics at the prosthesis and increased stress at the bone-implant interface, and affect the progression of adjacent joint arthritis in the talonavicular joint.

Clinical Relevance:

These findings may provide a correlate to clinical studies that have cited hindfoot arthrodesis as a risk factor for TAR failure.
Linkages Between Childhood Maltreatment, Intimate Partner Violence, and Posttraumatic Stress Disorder Symptoms in Pregnant Hispanic Women: A Network Analysis
Authors: Diestel Annabel J. , Price Matthew , Hidalgo Johanna E. , Contractor Ateka A. , Grasso Damion J.
Published: April 2022

Pregnant Hispanic women are at increased risk for posttraumatic stress disorder (PTSD) in part due to greater risk of childhood maltreatment, intimate partner violence (IPV), and pregnancy-related vulnerabilities. However, PTSD, is a highly heterogenous diagnosis with numerous presentations. Individual PTSD symptoms may be differentially associated with specific types of maltreatment, IPV. Determining how IPV exposure across the lifespan is associated with specific symptoms of PTSD in pregnant Hispanic women is necessary to develop group-relevant models of this disorder and targeted interventions. The present study examined a network model of PTSD symptoms, childhood maltreatment, and adulthood IPV in a sample of pregnant Hispanic women ( N = 198). Childhood emotional abuse and adulthood psychological distress had the highest bridge centrality. These types of exposures were most strongly associated with social isolation. Childhood emotional abuse was associated with more individual PTSD symptoms than any IPV type. These findings suggest that associations between PTSD symptoms and different types of IPV exposure vary. In addition, robust associations between childhood emotional abuse and PTSD symptoms suggest that this domain may be particularly important for the clinical assessment and intervention for pregnant women.
The transformation of HIV therapy: One pill once a day
Authors: Choudhary Madhu C , Mellors John W
Published: April 2022

A co-formulated, one pill once a day antiretroviral regimen (single-tablet regimen), containing efavirenz, emtricitabine, and tenofovir disoproxyl fumarate ( Atripla), revolutionized the antiretroviral therapy landscape. Single-tablet regimens provide not only dosing convenience but help optimize adherence and persistence with antiretroviral therapy to achieve durably suppressed viremia with both individual and societal benefits. Given the many excellent options available now, single-tablet regimens are the preferred choice for initiating antiretroviral therapy in almost all patients with rare exceptions for drug interactions and pregnancy, and for simplification of more complex antiretroviral therapy to a single-tablet regimen. In this special commemorative article, we celebrate this astounding advancement in antiretroviral therapy, championed by John C. Martin while CEO of Gilead Sciences, and its transformative impact on HIV care nationally and globally.
The role of tenofovir disoproxil fumarate for preventing vertical transmission of hepatitis B
Authors: Pan Calvin Q
Published: April 2022

Background

Since immunoprophylaxis failure can occur if maternal serum hepatitis B virus (HBV) DNA levels are >200,000 IU/ml, tenofovir disoproxil fumarate (TDF) therapy has been investigated for preventing mother to child transmission (PMTCT).

Methods

A literature search for maternal TDF therapy for PMTCT between 1/1/2015 and 7/1/21 on PUBMED, EMBASE, Cochrane, CNKI, and Wanfang databases was performed. Data from RCTs in English or Chinese were extracted and reviewed. The outcomes of interest included the efficacy and safety of TDF versus placebo for PMTCT.

Results

Among 11 RCTs identified from the databases, the risk-of-bias was low. All studies demonstrated that maternal TDF therapy initiated from the second or third trimester for highly viremic chronic hepatitis B mothers is highly effective and safe in the PMTCT of HBV, except one RCT performed in Thailand which showed no therapeutic advantage on TDF treatment versus placebo for PMTCT (0% vs 3% transmission). Recent emerging data suggest that maternal TDF therapy initiated at the 2nd or early 3rd trimester in mothers with HBV DNA >200,000 IU/ml achieved viremic control before delivery. In the 4-year long follow-up study for maternal TDF therapy, there were no impacts on infants’ physical growth, psychological or mental development, and bone mineral density after fetal exposure to TDF. In the light of updated efficacy and safety data from RCTs, an algorithm was proposed. The approaches in resource-limit areas were discussed.

Conclusions

TDF is safe for both mothers and infants as the preferred therapy for PMTCT in highly viremic mothers. TDF should be initiated at the second or early third trimester in the combination of the appropriate infants’ immunoprophylaxis.
Cautious communicators: Strategic communication of European Union commissioners in regulatory decision-making
Authors: Müller Moritz , Braun Caelesta , Fraussen Bert
Published: April 2022

The bureaucratic reputation literature stipulates that bureaucracies strategically aim to maximize reputational benefits and minimize reputational damages through targeted communication strategies. Departing from this assumption and using an extensive dataset on the media coverage of 54 legislative acts, we examine the conditions under which commissioners appear in the news and which communication strategies they pursue. Our analyses show that commissioners are more likely to appear in news coverage in the context of technically complex issues. We find that if a regulation is less politically conflictual, they are more likely to promote the commission's policy preferences, whereas they adopt a more passive style of communication in the face of political conflict. The findings further our understanding of regulatory policymaking by explaining bureaucratic behaviour through a communicational lens.
Visualizing multiracial identity development
Authors: Jackson Kelly Faye , Mumma Sarah Yang
Published: April 2022

Despite astonishing growth in the multiracial population since 2010 and increased empirical scholarship on the experiences of persons from two or more racial groups, little progress has been made to extend multiracial identity development theory. Drawing from constructivist grounded theory and multiple visual grounded theory (VGT) frameworks, our secondary qualitative study analyzed 26 participatory diagrams from two previous qualitative studies examining multiracial identity development. In alignment with our novel VGT analytic approach, we co-constructed a visual theoretical model that more accurately represents the dynamism between complex developmental and ecological processes that interactively influence multiracial identity development over time. Our findings suggest that multiracial identity development is a dynamic process influenced by critical events and experiences, including trauma and abuse, movement of place, and turning points and milestones that mutually shape a multiracial person’s social environments, interpersonal relationships, and sense of self. Reflecting on our innovative study, we advocate for more critical, emancipatory methods like VGT that have the potential to overcome epistemological barriers in research that restrict the more accurate and complete storytelling of the multiracial experience.
Theoretical Feasibility of Using Arch Branched Endograft Devices for Repair of Post Type A Aortic Dissection in Patients With Prior Ascending Aortic Replacement
Authors: Ni Leng , Wong Alfred C. C. , Hui Victor , Chan Yiu Che , Cheng Stephen W. K.
Published: April 2022

Purpose:

Ascending aortic replacement is a common emergency procedure for treating acute type A aortic dissection. Secondary open or endovascular interventions for residual arch pathologies is difficult because of adhesions, short prosthetic grafts, and distorted anatomies. Aortic arch branched stent grafts have emerged as a potential solution for these patients if they have suitable anatomical conditions. This study aimed to evaluate the theoretical anatomical and technical feasibility of 2 currently used aortic arch branch endografts in patients who had prior replacement of the ascending aorta.

Materials and Methods:

All patients who had a prosthetic ascending aortic or hemiarch replacement for acute type A dissection in a single institution between January 2013 and December 2018 were included. Contrast computed tomography images on the most recent follow-up were analyzed on a 3-dimensional workstation. Morphological parameters were measured individually for the ascending aorta, aortic arch, supra-aortic branches, and access iliac arteries. The computed tomography scan of each patient was individually evaluated for anatomical suitability for the arch branched and double-branch devices according to set selection criteria.

Results:

Computed tomography images of 56 patients (median age of 57 years, 45 males) were reviewed. Based on our evaluation, 26 patients (46.4%) were good candidates for an endovascular arch branched device. It would be feasible for 13 patients (23.2%), but prudent preoperative planning was required due to complicated anatomy. The other 17 patients (30.4%) were unsuitable because they met at least 1 exclusion criterion. Short prosthetic grafts, extreme graft angulations, and extensive dissections in the supra-aortic branches were the main reasons for exclusion.

Conclusion:

Endovascular repair using arch branched endografts is feasible in patients with prior ascending aortic arch or hemiarch replacement for acute type A aortic dissection. The most common anatomical conditions that may influence the feasibility of the arch branched endograft procedure include insufficient proximal seal length, severe angulation of the graft, and extensive aortic dissection within the supra-aortic vessels.
Mid-term Outcomes of Endovascular and Hybrid Procedures to Treat Complex Aortic Arch Pathologies
Authors: Li Peng , Bi Jiaxue , Niu Fang , Chen Junhang , Dai Xiangchen , Zhu Jiechang , Hu Fanguo
Published: April 2022

Purpose:

To compare the mid-term outcomes of endovascular and hybrid procedures in treating aortic arch pathologies with an unfavorable proximal landing zone, and analyze the different indications of the 2 methods.

Methods:

We collected the clinical data from 59 patients with complex aortic arch pathologies who underwent endovascular or hybrid surgery from March 2018 to April 2020 at a single center. Among the patients, 45 were treated by branched or fenestrated surgery and 14 by hybrid surgery. The clinical data of preoperative, perioperative, and postoperative results were retrospectively analyzed and compared. The main study indexes were the branch patency rate and endoleakage rate during the follow-up period. The secondary study indexes included the operation success rate, operative time, hospital expenses, complication incidence, freedom from reintervention rate, mortality, etc.

Results:

The operation success rate of all the groups was 100%. The hospital expenses of the hybrid group were lower than those of the endovascular group (p<0.05). The operative time of the hybrid group was longer than that of the endovascular group (p<0.05). The incidence of anatomic variants in the hybrid group was 28.6%, which was significantly higher than that in the endovascular group (2.2%, p=0.011). However, there were no significant differences in operative bleeding, ventilator use duration, and treatment time in intensive care units between the 2 groups (p>0.05). Follow-up was conducted for a period of 12 to 34 months. Four patients of the hybrid group experienced numbness of the upper limb (28.57%); the proportion was higher than the endovascular group (0%, p=0.002). There were no significant differences in the occurrence of endoleaks, retrograde aortic dissection, target lesion, secondary operation, branch patency rate, paraplegia, cerebral apoplexy, renal failure, or other complications in either group (p>0.05). The mortality of the endovascular group was 6.67% (3/45). Overall cumulative survival at 1 year was 100% in the hybrid group and 93.3% in the endovascular group. There was no statistical difference in the increase of the true lumen between the 2 groups for vascular remodeling (p>0.05).

Conclusion:

The hybrid surgery costs less and proves more suitable for treating variants of the aortic arch. The endovascular treatment still has limitations due to anatomical conditions.
Comparison of Three Methods for Preparation of Autologous Cells for Use in Cell Therapy of Chronic Limb-Threatening Ischemia in People with Diabetes
Authors: Husakova Jitka , Bem Robert , Jirkovska Alexandra , Nemcova Andrea , Fejfarova Vladimira , Sutoris Karol , Kahle Michal , Jude Edward B. , Dubsky Michal
Published: April 2022

Autologous cell therapy (ACT) is a new therapeutic approach for diabetic patients with no-option chronic limb-threatening ischemia (NO-CLTI). The aim of our study was to quantify cell populations of cell therapy products (CTPs) obtained by three different isolation methods and to correlate their numbers with changes in transcutaneous oxygen pressure (TcPO2). CTPs were separated either from stimulated peripheral blood (PB) (n = 11) or harvested from bone marrow (BM) processed either by Harvest SmartPReP2 (n = 50) or sedimented with succinate gelatin (n = 29). The clinical effect was evaluated by the change in TcPO2 after 1, 3 and 6 months. TcPO2 increased significantly in all three methods at each time point in comparison with baseline values ( p < .01) with no significant difference among them. There was no correlation between the change in TcPO2 and the size of injected cell populations. We only observed a weak correlation between the number of injected white blood cells (WBC) and an increase in TcPO2 at 1 and 3 months. Our study showed that all three isolation methods of ACT were similarly relatively efficient in the treatment of NO-CLTI. We observed no correlation of TcPO2 increase with the number of injected monocytes, lymphocytes or CD34+. We observed a weak correlation between TcPO2 increase and the number of injected WBCs.
Linking Supervisor Role Identity Saliences to Supervisor Work-Family Support
Authors: Wang Peng , Rode Joseph , Wang Zhen
Published: April 2022

Drawing upon role identity theory and the dual judgment model of perspective-taking, we investigated a model describing the relationship between supervisor family identity salience (SFIS) and supervisor work-family support, with supervisor work identity salience (SWIS) as a moderator and supervisor work-family perspective taking as a mediator. We tested the model using two data sets. Results from supervisor-reported data indicated that SFIS was related to supervisor work-family perspective-taking, which was, in turn, related to supervisor work-family support. Results from leader-follower dyadic data found that SFIS was related to work-family support. In both samples, the effects of SFIS were stronger when SWIS was high. We discuss the theoretical and practical implications of these findings.
Effect of variability when estimating throwing arm stress for fastball in youth baseball pitchers
Authors: Hulburt Tessa , Kimura Brianne , Nicholson Kristen
Published: April 2022

Intra-player movement pattern variability in baseball pitching has been demonstrated to affect metrics of performance and injury risk. It is currently unknown how many pitches are necessary to properly accommodate for intra-player variability for an appropriately representative analysis of a pitcher’s throwing mechanics. The purpose of this study was to establish a standard for how many fastball pitches are necessary to account for within and between-individual pitching variability for fastballs thrown by youth athletes. Motion capture data were collected for seven fastballs thrown by 17 male youth pitchers (age = 13.5 ± 1.07 years) using a 3D motion analysis system, incorporating 10-cameras. Maximum shoulder distraction force (MSDF) and maximum elbow valgus torque (MEVT) were compiled from pitching reports previously generated using Visual 3D and the Qualisys baseball module. Spearman-Brown prophecy formula was used to calculate how many pitches were required to account for within and between subject variability for throwing arm metrics analyzed. Results showed that 2, 4, and 19 fastballs are needed to accurately report MSDF and MEVT metrics with 90%, 95%, and 99% reliability, respectively. The results of this study provide the first methodological guidelines for how to account for the factor of fastball pitch variability in youth baseball biomechanics studies.
“We’re Human Too”: Media Coverage of Simone Biles's Mental Health Disclosure during the 2020 Tokyo Olympics
Authors: Thompson Kevin G. , Carter Gilbert , Lee Edwin S. , Alshamrani Talal , Billings Andrew C.
Published: April 2022

When gymnast Simone Biles withdrew from several events at the 2020 Tokyo Olympics due to concern for her mental health, media organizations discussed both her departure and return to competition. Utilizing framing theory, 192 domestic and international news sources published from July to August 2021 were thematically analyzed to examine how media covered Biles's exit and ultimate return to competition. Results show media covered Biles overwhelmingly positively while focusing on her mental health, productivity as an individual and team athlete, heroism, and gender. More specifically, themes of Biles's gender and race were commonly paired with the theme of heroism. Results also indicate domestic news sources were much more likely to mention Biles's race than international news sources. This work adds to growing scholarship about media coverage of high-profile athletes’ mental health disclosures.
Strengths and Challenges of Closed-Loop Insulin Delivery During Exercise in People With Type 1 Diabetes: Potential Future Directions
Authors: Paldus Barbora , Morrison Dale , Lee Melissa , Zaharieva Dessi P. , Riddell Michael C. , O’Neal David N.
Published: April 2022

Exercise has many physical and psychological benefits and is recommended for people with type 1 diabetes; however, there are many barriers to exercise, including glycemic instability and fear of hypoglycemia. Closed-loop (CL) systems have shown benefit in the overall glycemic management of type 1 diabetes, including improving HbA1c levels and reducing the incidence of nocturnal hypoglycemia; however, these systems are challenged by the rapidly changing insulin needs with exercise. This commentary focuses on the principles, strengths, and challenges of CL in the management of exercise, and discusses potential approaches, including the use of additional physiological signals, to address their shortcomings in the pursuit of fully automated CL systems.
Discordance Between Glycated Hemoglobin A1c and the Glucose Management Indicator in People With Diabetes and Chronic Kidney Disease
Authors: Oriot Philippe , Viry Claire , Vandelaer Antoine , Grigioni Sébastien , Roy Malanie , Philips Jean Christophe , Prévost Gaëtan
Published: April 2022

Introduction:

Assessment of glucose exposure via glycated hemoglobin A1c (HbA1c) has limitations for interpretation in individuals with diabetes and chronic kidney disease (CKD). The glucose management indicator (GMI) derived from continuous glucose monitoring (CGM) data could be an alternative. However, the concordance between HbA1c measured in laboratory and GMI (HbA1c-GMI) is uncertain in individuals with CKD. The purpose of this study is to analyze this discrepancy.

Material and method:

We performed a multicentric, retrospective, observational study. A group of individuals with diabetes and CKD (n = 170) was compared with a group of individuals with diabetes without CKD (n = 185). All individuals used an intermittently scanned continuous glucose monitoring (isCGM). A comparison of 14-day and 90-day glucose data recorded by the isCGM was performed to calculate GMI and the discordance between lab HbA1c and GMI was analyzed by a Bland-Altman method and linear regression.

Results:

HbA1c-GMI discordance was significantly higher in the CKD group versus without CKD group (0.78 ± 0.57 [0.66-0.90] vs 0.59 ± 0.44 [0.50-0.66]%, P < .005). An absolute difference >0.5% was found in 68.2% of individuals with CKD versus 42.2% of individuals without CKD. We suggest a new specific formula to estimate HbA1c from the linear regression between HbA1c and mean glucose CGM, namely CKD-GMI = 0.0261 × 90-day mean glucose (mg/L) + 3.5579 ( r2 = 0.59).

Conclusions:

HbA1c-GMI discordance is frequent and usually in favor of an HbA1c level higher than the GMI value, which can lead to errors in changes in glucose-lowering therapy, especially for individuals with CKD. This latter population should benefit from the CGM to measure their glucose exposure more precisely.
In Vitro Continuous 3 Months Operation of Direct Electron Transfer Type Open Circuit Potential Based Glucose Sensor: Heralding the Next CGM Sensor
Authors: Lee Inyoung , Wakako Tsugawa , Ikebukuro Kazunori , Sode Koji
Published: April 2022

Background:

While continuous glucose monitoring (CGM) systems allow precise and real-time blood glucose control, current electrochemicalbased CGM technologies inherently harbor enzyme instability issues. The direct electron transfer (DET) type open circuit potential (OCP) based enzyme sensing principle can minimize the catalytic turnover of the enzyme reaction, thereby providing longer-term operational stability in future CGM glucose sensors.

Method:

DET-type OCP based glucose sensors were constructed using gold disk electrodes with glucose dehydrogenase capable of DET which was immobilized using a self-assembled monolayer (SAM). The single enzyme layer prepared on the gold electrode was operated in the presence of glucose, using in vitro buffer solution, continuously for over 3 months with the OCP sensor signal monitored every 10 seconds at 25°C.

Results:

The DET-type OCP glucose sensor was continuously operated for more than 3 months without a significant decrease of the sensor signal and sensitivity (slope). These results suggest that the DET-type OCP glucose sensor is far more stable than the sensor constructed based on the amperometric principle. The long-term stability of DET-type OCP glucose sensor is attributed to the enzyme’s minimized catalytic reaction during the operation, thereby extending the lifetime of enzyme.

Conclusion:

The DET-type OCP glucose sensor can be continuously operated for more than 3 months at 25 °C, in vitro without significant decreases in sensor signal and sensitivity. While the further investigation will be required for in vivo validation, the DET-type OCP glucose sensor is ideal for next generation CGM’s, especially in long duration implantable use cases.
Case Report of Spinal Cord Involvement in Susac Syndrome Masquerading as a Multiple Sclerosis Mimic
Authors: Song Kun-Wei , Manzano Giovanna S. , Kharal G. Abbas , Venna Nagagopal
Published: April 2022

We present a unique case of a 59-year-old woman with atypical Susac syndrome and prominent involvement of the spinal cord. She initially presented with progressive headaches, lower extremity weakness and hearing loss. Her MRI brain showed multiple enhancing lesions and her MRI spine showed a T8 enhancing lesion as well as a C2 cord infarct. She was treated with IV methylprednisolone with initial stabilization. However, she developed worsening encephalopathy and lower extremity weakness. Her repeat MRI brain showed new bilateral enhancing lesions and subacute infarcts. Given the increased burden of new lesions, she underwent a brain biopsy, which showed perivascular chronic inflammation within a small vessel distribution. Additionally, fluorescein angiography revealed bilateral branch retinal arterial occlusion (BRAO) and an audiogram demonstrated bilateral sensorineural hearing loss. She was diagnosed with Susac syndrome and treated with IV cyclophosphamide with improvement in her clinical exam. Spinal cord involvement is extremely rare for Susac syndrome, which commonly manifests as the classic triad of encephalopathy, BRAO and hearing loss. Her presentation with myelopathy highlights the importance of considering atypical presentations of well-established syndromes for optimal diagnosis and management.
Experiences with benzodiazepine use, tapering, and discontinuation: an Internet survey
Authors: Reid Finlayson Alistair J. , Macoubrie Jane , Huff Christy , Foster D.E. , Martin Peter R.
Published: April 2022

Background:

Over 92 million prescriptions for benzodiazepines are dispensed in the United States annually, yet little is known about the experiences of those taking and discontinuing them.

Objective:

The aim of this study is to assess the experiences of those taking, tapering, or having discontinued benzodiazepines.

Methods:

An online survey ( n = 1207) elicited information about benzodiazepine use, including long-term use, tapering, discontinuation, and withdrawal symptoms.

Results:

Symptoms associated with benzodiazepine use, tapering, and discontinuation were numerous and ranged from symptoms such as anxiety, insomnia, and nervousness to digestive problems, irregular heart rhythms, uncontrollable anger, photosensitivity, balance problems, and others. When asked how benzodiazepine symptoms affected their lives, 82.9% reported work problems, 86.3% had problems with social interactions and friendships, and 88.8% had problems with fun, recreation, and hobbies. Suicidal thoughts or attempted suicide was reported by 54.4%, and 46.8% said benzodiazepines caused lost employment. Most of the respondents for whom benzodiazepines were prescribed (76.2%) stated they had not been informed that benzodiazepines were indicated for short-term use only and that discontinuation might be difficult. About a third (31.5%) reported food allergies and/or seasonal allergies that occurred only after benzodiazepine use.

Conclusion:

The trajectory of those who taper or discontinue benzodiazepines is unpredictable, and many patients experience a range of protracted and severe symptoms, even years after benzodiazepines were completely discontinued. Greater awareness is needed for both prescribers and patients about the potential for a difficult withdrawal from benzodiazepines.
Situating questions of data, power, and racial formation
Authors: Shelby Renee , Henne Kathryn
Published: April 2022

This special theme of Big Data & Society explores connections, relationships, and tensions that coalesce around data, power, and racial formation. This collection of articles and commentaries builds upon scholarly observations of data substantiating and transforming racial hierarchies. Contributors consider how racial projects intersect with interlocking systems of oppression across concerns of class, coloniality, dis/ability, gendered difference, and sexuality across contexts and jurisdictions. In doing so, this special issue illuminates how data can both reinforce and challenge colorblind ideologies as well as how data might be mobilized in support of anti-racist movements.
COVAN Leading to ESKD Despite Minimal COVID Symptoms
Authors: Maldonado Dawn , Ray Justina , Lin XiongBin , Salem Fadi , Brown Maritza , Bansal Ishita
Published: April 2022

We report a case of dialysis dependence in a patient with COVID-19-associated nephropathy (COVAN) who had minimal respiratory manifestations. A 25-year-old man with a history of multiple sclerosis in remission presented with mild dyspnea due to COVID-19 pneumonia and was found to have rapidly worsening kidney function. He only required nasal cannula and was able to be weaned off within a few days. Despite having only mild respiratory disease, his kidney function worsened and urgent hemodialysis was started for hyperkalemia and uremic encephalopathy. Kidney biopsy demonstrated collapsing glomerulopathy due to COVID-19 with moderate interstitial fibrosis and tubular atrophy. His kidney function did not recover, and he unfortunately now has been dependent on hemodialysis for over 3 months. Multiple case reports have described COVAN causing dialysis dependence, but to our knowledge this is the first reported case of COVAN causing dialysis dependence in a patient with such mild respiratory disease. Currently the indications for intensive COVID-19 therapies are based on oxygen requirements. This case demonstrates that the oxygen requirement may not fully reflect the severity of COVID-19 and raises the question of whether these therapies should be considered in patients with COVAN.
Low Incidence and Brief Duration of Gastrointestinal Adverse Events with Darunavir/Cobicistat/Emtricitabine/Tenofovir Alafenamide (D/C/F/TAF) Over 96 Weeks: Post hoc Analyses of AMBER and EMERALD
Authors: Dunn Keith , Baugh Bryan , Bejou Nika , Luo Donghan , Campbell Jennifer , Seyedkazemi Sareh , Anderson David
Published: April 2022

Gastrointestinal intolerance has been associated with ritonavir-boosted protease inhibitors. This post hoc analysis evaluated gastrointestinal adverse events of interest (AEOIs; diarrhea, nausea, abdominal discomfort, flatulence [MedDRAv21]) through Wk96 among patients enrolled in the phase 3 AMBER (treatment-naïve) and EMERALD (virologically suppressed) studies of darunavir/cobicistat/emtricitabine/tenofovir alafenamide (D/C/F/TAF) 800/150/200/10 mg. 362 and 763 patients initiated D/C/F/TAF in AMBER and EMERALD, respectively. All D/C/F/TAF-related gastrointestinal AEOIs were grade 1/2 in severity; none were serious. Across studies, incidence of D/C/F/TAF-related diarrhea and nausea were each ≤5% in Wk1 (≤1% post-Wk2); prevalence of each decreased to <5% post-Wk2. In each study, there was 1 case of D/C/F/TAF-related abdominal discomfort during Wk1 and none thereafter. Incidence of D/C/F/TAF-related flatulence was <1% throughout. Median duration of D/C/F/TAF-related gastrointestinal AEOIs was 16.5 (AMBER) and 8.5 (EMERALD) days. In conclusion, in treatment-naïve and virologically suppressed patients, incidences and prevalences of D/C/F/TAF-related gastrointestinal AEOIs were low and tended to present early.
Efficacy and Safety of Anti–Nerve Growth Factor Antibody Therapy for Hip and Knee Osteoarthritis: A Meta-analysis
Authors: Gao Yijie , Hu Zhengxu , Huang Yi , Liu Weijian , Ren Changle
Published: April 2022

Background:

The efficacy and safety of anti–nerve growth factor (NGF) antibody therapy used for osteoarthritis (OA) pain are controversial.

Purpose:

To evaluate the efficacy and safety of anti-NGF antibody therapy via a meta-analysis of randomized controlled trials (RCTs).

Study Design:

Systematic review; Level of evidence, 1.

Methods:

PubMed, the Cochrane Central Register of Controlled Trials, Embase, and the Web of Science databases were searched for RCTs assessing anti-NGF antibody treatments for hip and knee OA. A total of 623 records were retrieved from the databases. A random-effects model was used to assess primary and secondary outcomes. Bias was assessed using the Cochrane Collaboration tool, funnel plots, and the Egger test. Subgroup analyses were used to assess the efficacy and safety of the independent variables. Sensitivity analysis was conducted to evaluate the effectiveness of tanezumab and the effectiveness of anti-NGF antibodies compared to active comparator drugs. We present the effects of dose, administration mode, and treatment duration on the efficacy and safety of anti-NGF antibody therapy.

Results:

There were 19 RCTs included in our meta-analysis. Anti-NGF antibody treatment showed significant improvements on the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain, physical function, and stiffness as well as on a patient global assessment (PGA). The overall standardized mean differences were as follows: WOMAC pain (–0.31 [95% CI, –0.36 to –0.26]; Z = 11.75; P < .001; I 2 = 38%), WOMAC physical function (−0.36 [95% CI, –0.41 to –0.30]; Z = 12.67; P < .001; I 2 = 44%), WOMAC stiffness (–3.59 [95% CI, –4.87 to –2.30]; Z = 5.47; P < .001; I 2 = 98%), and PGA (−0.28 [95% CI, –0.34 to –0.22]; Z = 9.39; P < .001; I 2 = 50%). Anti-NGF antibody treatment resulted in a greater incidence of adverse events (risk ratio, 1.09 [95% CI, 1.06 to 1.12]; Z = 5.60; P < .001; I 2 = 0%). The incidence of serious adverse events was similar between the treatment and control groups (risk ratio, 1.15 [95% CI, 0.98 to 1.34]; Z = 1.71; P = .09; I 2 = 0%).

Conclusion:

Anti-NGF antibody treatment significantly relieved pain and improved function in patients with hip and knee OA. However, no conclusion could be drawn regarding the optimal treatment plan for anti-NGF antibodies when all 3 variables (dose, administration mode, and treatment duration) were combined in the analyses.
Traversing webs: Reflections on relational theory and international relations
Authors: Kurki Milja
Published: April 2022

Relational theories challenge, in a multitude of ways, how we understand and work with relations in International Relations (IR) scholarship. It invites engagement with thought and practice of relationality from different parts of the world and invites a rethinking of the boundaries between states and individuals but also between humans and non-humans. This essay considers the role of relational theory in and around IR by way of a series of short inter-related reflections, drawing on ‘IR’ but also author’s experiences of relational shifts in everyday life. The experiences of ‘traversing the webs’ of relationality at home and at work, with humans and non-humans, in IR scholarship and beyond it, demonstrate the ways in which relational thought and practice is much more than ‘theory’, travels well beyond ‘IR’, and yet also poses important questions to how we think and do IR.
Visualizing Young Men’s Fertility Desires: A View from Balaka, Malawi
Authors: Trinitapoli Jenny , Chilungo Abdallah , Zhao Huimeng , adams jimi , Yeatman Sara
Published: April 2022

Fertility desires may not indicate precise plans; nonetheless, they contain important clues for understanding future fertility. On the basis of the dual assertion that fertility desires are (1) meaningful and (2) subject to revision with changing circumstances, this visualization provides a snapshot of young men’s fertility desires using data from the Tsogolo La Thanzi study set in Balaka, Malawi. Scholars typically measure desires by summarizing how many children respondents would like to have (numeric) and when (timing). This visualization adds a third dimension, flexibility, asking how changing circumstances would alter fertility desires, as typically measured. HIV-related concerns reduce most young men’s numeric desires while also accelerating family formation; the only scenario that increases desired fertility for many men is an imbalanced gender ratio in the family. Visualizing flexibility as a dimension of fertility desires clarifies that young men’s stated fertility desires are often tentative and subject to revision.
Doing time online: Prison TikTok as social reclamation
Authors: Schlosser Jennifer A , Feldman Lindsey Raisa
Published: April 2022

In recent years, the United States government along with prison authorities have worked to pass laws preventing incarcerated people from accessing cellular technology and using social media behind bars. Yet through the acquisition of contraband cell phones, some incarcerated people have subverted these laws to create a presence on social media, particularly on the popular social media app TikTok. We introduce the term social reclamation to describe the use of social media by imprisoned people to achieve three primary goals: (1) to remain connected to society through engagement with current social and cultural trends, (2) to reclaim self-narratives of everyday life by sharing lived experiences behind bars, and (3) to expose the unseen dehumanizing reality of prison industrial complex. Through the analysis of select prison TikTok videos we situate these acts of social reclamation on Rubin’s continuum of friction-resistance, and we conclude by juxtaposing our findings to state-centered narratives that claim cell phone use in prison poses a threat to public safety.
Solid Pseudopapillary Neoplasm of the Pancreas: A Case Report of a Rare Tumor Detected by Sonography
Authors: Zulfiqar Amina M. , Bertsch Ruth Ann
Published: April 2022

This case presentation describes a solid pseudopapillary neoplasm found in a young 41-year-old female. This mass was initially detected with sonography and later confirmed with an ultrasound-guided biopsy. The neoplasm was scheduled to be surgically resected, as a cure, which has a favorable long-term prognosis. This case provides information on the imaging characteristics and natural history of this benign neoplasm.
The Impact of Virtual Site Visits on Programmatic Accreditation Through the Commission on Accreditation of Allied Health Education Programs (CAAHEP)
Authors: Rienzo Catherine E.
Published: April 2022

Objective:

This research was designed to investigate the effectiveness of programmatic accreditation, when performing a virtual site visit, compared with a traditional on-site visit.

Materials and Methods:

This study used a quasi-experimental, mixed-methods design with the virtual site visits as the independent variable and the site visit outcomes (number of citations, level of the citation, and recommendation for continuing accreditation) as the dependent variable. For this study, there were 28 diagnostic medical sonography programs throughout the United States, applying to the Commission on Accreditation of Allied Health Education Programs (CAAHEP), for reaccreditation status. Those programs that experienced a virtual site visit were compared with their counterpart programs (N = 109), which had a traditional on-site visit.

Results:

Based on these comparisons, there was no significant difference in diagnostic medical sonography programmatic accreditation effectiveness in the United States when performing a virtual site visit.

Conclusion:

These study results would highly suggest that there was no significant difference in the level of the citations or the accreditation outcomes, based on a virtual site visit compared with those programs having an on-site visit. This research points to the effectiveness of the accreditation process, when is it conducted through a virtual site visit.