bluuebunny/crossref_metadata_2025 huggingface dataset:
1032 Mixed sleep apnea management in a pediatric patient with Arnold Chiari type 1 and septo-optic dysplasia leading to hypopituitarism
Authors: Ghildiyal Naomi , Pant Alok , Rosales William , Chernyshev Oleg , Fahmy Omar
Published: May 2023

Introduction

Mixed Sleep apnea and Central sleep apnea are commonly noted in a patient with Arnold Chiari Malformation and definitive treatment of Arnold Chiari Malformation is surgical decompression.

Report of case(s)

The patient at the time of diagnosis of Mixed sleep apnea was 7 years old. She had already undergone tonsillectomy and adenoidectomy at the age of 4 years. Due to continued Sleep-disordered breathing, PSG was done in 2016 which showed predominantly mixed and central events. MRI was done which revealed Chiari 1 malformation with cerebellar tonsils extending 6 mm below the foramen magnum. The patient also due to septo-optic dysplasia and hypopituitarism followed with pediatric endocrinology and was on supplementation of Desmopressin, Hydrocortisone, Levothyroxine, and Somatropin. The mother at the time of pregnancy was a substance abuser, was incarcerated and the primary care was assumed by the patient’s legal guardian. The legal guardian was not interested in surgery for Arnold Chiari Malformation as she feared long-term outcomes and requested alternate treatment options. The patient underwent another split study and started on CPAP. The patient did not tolerate the CPAP and was transitioned to BiPAP. During her last clinic visit, the patient’s compliance had improved and she had achieved therapeutic AHI. The patient was also counseled on the effects of GH supplementation and untreated sleep apnea and is regularly followed by Sleep Medicine and Pediatric Endocrinology. The patient after transitioning to BiPAP has responded well to treatment for Mixed sleep apnea. Despite being on GH supplementation, with careful monitoring of hormone levels by Pediatric Endocrinology and symptom control by Sleep Medicine, the patient has shown remarkable improvement.

Conclusion

Mixed and central sleep apnea secondary to Arnold Chiari Malformation responds well to surgical decompression with improvement in sleep-disordered breathing. In a pediatric patient with complicated medical history with needing stress dose steroids, not a candidate for surgery, and intolerant to CPAP, BiPAP as a treatment modality showed good control of Sleep Apnea.

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1034 A Rare Case of ROHHAD Syndrome
Authors: Saha Anand , Bashir Ahsan , Francis Natalie , Stanton Crystal , Coughlin Kevin
Published: May 2023

Introduction

Early diagnosis of pediatric syndromes that are rare and involve multiple systems can be challenging. Rapid onset obesity, hypoventilation, hypothalamic dysfunction, and autonomic dysregulation characterizes ROHHAD syndrome which, if undiagnosed, can lead to potentially harmful outcomes including deferring radiological workup for a neural crest tumor (which has an over 50% association) and cardiopulmonary arrest.

Report of case(s)

A 10-year-old female with a history of obesity, precocious puberty, recurrent hypothermia, recurrent sodium derangements, bilateral ptosis, seizure disorder, and GERD initially presented to sleep clinic as a 4-year-old in 2017 when she recently began snoring with excessive daytime sleepiness as a result of rapid onset of weight gain. BMI at that time was 99th percentile and Epworth was 11. An in-lab polysomnography revealed severe OSA with AHI 26.4 events/hour; nocturnal hypoxemia with TS90 27% and O2 nadir 70%; and sleep related hypoventilation based on elevated pCO2 on end-tidal capnometry. Patient underwent adenotonsillectomy, revision adenoidectomy, and was started on CPAP before transitioning to BiPAP over the span of the next several years with serial polysomnographies ultimately showing significant improvement of sleep apnea with AHI 5.4 events/hour. Sleep-related hypoventilation, however, remained persistent with blood gases showing pCO2 as high as 89. PHOX2B gene testing was negative and secondary causes of hypoventilation were ruled out. During this time, she was also followed by Endocrinology for suspected hypothalamic dysfunction resulting in precocious puberty, deceleration of growth rate, sodium derangements. Autonomic dysfunction was also suspected due to recurrent hypothermia including a recent admission for Temperature < 95F and ophthalmologic abnormalities including bilateral ptosis. At a multidisciplinary care conference, a working diagnosis of ROHHAD syndrome was made based on the rapid onset of obesity, hypoventilation on sleep studies and CBGs, hypothalamic dysfunction, and autonomic degeneration. Workup for neural crest tumor with MRI chest and abdomen unremarkable. Outside academic consultation was sought for management which recommended shared decision-making regarding steroids, immunosuppressive therapy (eg rituximab, cyclophosphamide), and IVIG.

Conclusion

For ROHHAD syndrome, there are very few documented cases in the United States and there is no known laboratory marker; diagnosis remains clinical and takes multidisciplinary collaboration, education, and a high degree of suspicion.

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1038 Treating Obstructive Sleep Apnea Without Batting an Eye: A Case of Lacrimal Duct Air Regurgitation Complicating CPAP Therapy
Authors: Taich Zachary , Rodríguez Astrid Carrión , Hsieh Caleb
Published: May 2023

Introduction

Dacryocystorhinostomy (DCR) is a surgical procedure that re-opens the nasolacrimal duct in patients with nasolacrimal duct obstruction and relieves symptoms of epiphora (watery eyes) by allowing tear drainage back to nasal mucosa. This procedure, however, can present a unique challenge for patients with obstructive sleep apnea (OSA) on continuous positive airway pressure (CPAP).

Report of case(s)

We present a 65 year-old man with a history of nasolacrimal duct obstruction status-post DCR who initially presented with daytime hypersomnolence and multiple nighttime awakenings. He underwent polysomnography (PSG) demonstrating moderate OSA with Apnea-hypopnea index (AHI) 18.5 events per hour. After initiation of CPAP, he reported eye pain, dryness and a sensation of air blowing into his eye. Both mandibular advancement device and BPAP (bilevel positive airway pressure) were attempted, unfortunately neither was found to be sufficiently effective.

Conclusion

This patient experienced a potential complication of DCR called lacrimal duct air regurgitation (LADR), which occurs due to the potential for reflux of air through the relatively dilated anastomosis from nasopharynx to puncta of the eye. By reducing end expiratory pressure, BPAP may in theory relieve expiratory LADR. A total-face mask was then employed as, covering the eyes allows for pressure equalization across the duct with resultant LADR improvement. This improved eye discomfort, but adherence was limited due to bulkiness of the mask. Lacrimal duct plugging may also be explored to reduce air reflux. This is an example of an uncommon complication of PAP therapy and highlights the unique challenges in maintaining adherence in this setting.

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Water- and feed-based arginine impacts on gut integrity in weanling pigs
Authors: Greiner Laura , Humphrey Dalton , Kerr Brian , Becker Spenser , Breuer Sophie , Hagen Chloe , Elefson Sarah , Haydon Keith
Published: May 2023

Two hundred and forty newly weaned pigs (PIC, Hendersonville, TN) were used to determine if supplementing additional arginine (Arg) either in the water or in the feed, and the combinations thereof, improved intestinal integrity and growth performance in nursery pigs. Each of the 80 pens contained three pigs (21 ± 2 d of age) which were randomly allotted to treatments in 4 × 3 factorial arrangement consisting of four water treatments (0%, 4%, 8%, and 12% Arg stock delivered through a 1:128 medication delivery system) in combination with three dietary Arg treatments (1.35%, 1.55%, and 1.75% standardized ileal digestible Arg; SID). Pigs and feeders were weighed at the d0, d6 (water and diet change), d20 (diet change), and d41 for the calculation of average daily gain (ADG), average daily feed intake (ADFI), and feed efficiency (G:F). Eighty pigs, 1 pig/pen, were euthanized at d6 for ileum evaluation of villus height and crypt depth. The remaining pigs were taken off the Arg-water treatment and fed phase-2 diets formulated to contain 1.35%, 1.55%, and 1.75% SID Arg. All pigs received a common diet from d20 to d41. Data were analyzed by pen as repeated measures (SAS 9.4). No interaction between water- and dietary-Arg was detected on nursery pig growth performance. There was a significant quadratic effect of SID Arg in the feed on pig final body weight (BW), ADG, ADFI, and G:F (P ≤ 0.037), where feeding 1.55% dietary Arg tended to improve growth performance compared to the 1.35% level for the 41 d of the trial (P ≤ 0.088). The use of the stock 8% Arg in the water resulted in a reduction in crypt depth (0:132.5, 4:140.7, 8:117.3, 12:132.0; P ≤ 0.01) and an improvement in intestinal permeability. The 4% oral Arg significantly reduced villous height:crypt depth ratio (0:2.50, 4:2.09, 8:2.56, 12:2.43; P ≤ 0.02). In conclusion, the feeding of 1.55% Arg resulted in an improvement in nursery pig ADG, ADFI, G:F, and final BW but did not alter intestinal villi morphology; however, the use of Arg in the water resulted in an improvement in intestinal villi, but no phenotypical change in piglet growth in the nursery.
Bacteroides fragilis expresses three proteins similar to Porphyromonas gingivalisHmuY: Hemophore‐like proteins differentially evolved to participate in heme acquisition in oral and gut microbiomes
Authors: Antonyuk Svetlana V. , Siemińska Klaudia , Śmiga Michał , Strange Richard W. , Wagner Mateusz , Barnett Katie J. , Olczak Teresa
Published: May 2023

Oral and gut microbiomes are important for the maintenance of homeostasis in the human body. Altered or disturbed mutualism between their members results in dysbiosis with local injury and subsequent systemic diseases. The high bacterial density causes intense competition among microbiome residents to acquire nutrients, including iron and heme, the latter of high importance for heme auxotrophic members of the Bacteroidetes phylum. Our main hypothesis is that the heme acquisition mechanism, with the leading role played by a novel HmuY family of hemophore‐like proteins, can be used to fulfill nutritional requirements and increase virulence. We characterized HmuY homologs expressed by Bacteroides fragilis and compared their properties with the first representative of this family, the HmuY protein of Porphyromonas gingivalis. In contrast to other Bacteroidetes members, B. fragilis produces three HmuY homologs (Bfr proteins). All bfr transcripts were produced at higher levels in bacteria starved of iron and heme (fold change increase ~60, ~90, and ~70 for bfrA, bfrB, and bfrC, respectively). X‐ray protein crystallography showed that B. fragilis Bfr proteins are structurally similar to P. gingivalis HmuY and to other homologs, except for differences in the potential heme‐binding pockets. BfrA binds heme, mesoheme, and deuteroheme, but preferentially under reducing conditions, using Met175 and Met146 to coordinate heme iron. BfrB binds iron‐free protoporphyrin IX and coproporphyrin III, whereas BfrC does not bind porphyrins. HmuY is capable of heme sequestration from BfrA, which might increase the ability of P. gingivalis to cause dysbiosis also in the gut microbiome.
“Uncrossed Central Facial Paralysis” Caused by Pontine Infarction
Authors: Zhao Liwen , Ren Bingcheng
Published: May 2023

Introduction:

We report a patient with extraordinary pontine infarction-induced contralateral central facial palsy and weakened limb strength.

Case Report:

This is a 66-year-old man with left arm movement difficulty for 10 days and worsening over the last 1 day. His left nasolabial fold flattening and left arm strength and sensory were decreased. He could not complete the finger-nose test well with his right hand. Magnetic resonance and magnetic resonance angiography tests confirmed his right pontine acute infarction but without large vessel stenosis or occlusion.

Conclusion:

“Uncrossed paralysis” patients may present with contralateral face and body weakness with pontine infarcts, if the infarct occurs above the level of the facial nucleus head, and may be simmilar with the higher level pontine lesions or cerebrum semisphere infarction, which need particular attention during clinical practice.
Use of Subcutaneous Injection of Epinephrine and Triamcinolone with Tranexamic Acid Reduces Blood Loss, Transfusion Rates, and Length of Stay in Open Sagittal Craniosynostosis Repair
Authors: Ackerman Laurie L. , Snider Anna A. , Ye Jian
Published: May 2023

Objective:

In 2017, we adopted the use of triamcinolone/epinephrine (TAC/Epi) scalp injection and later added tranexamic acid (TXA) in open sagittal synostosis surgery. We believe that this reduced blood loss and transfusion rates.

Methods:

A total of 107 consecutive patients operated for sagittal synostosis aged <4 months from 2007 to 2019 were retrospectively reviewed. We collected demographics [age, sex, weight at surgery, and length of stay (LOS)], intraoperative information [estimated blood loss (EBL)], administration of packed red blood cell, transfusion of plasmalyte/albumen, operating time, baseline hemoglobin (Hb) and hematocrit (Hct), type of local anesthetic (1/4% bupivacaine vs. TAC/Epi), and use/volume of TXA. Hb, Hct, coagulation studies, and platelets at 2 hours postoperatively and postoperative day (POD) 1 were recorded.

Results:

There were 3 groups: 1/4% bupivacaine/epinephrine (N=64), TAC/Epi (N=13), and TAC/Epi with TXA bolus/infusion intraoperatively (N=30). Groups receiving TAC/Epi or TAC/Epi with TXA had lower mean EBL (P<0.0001), lower rate/amount of packed red blood cell transfusion (P<0.0001), lower prothrombin time/international normalized ratio on POD 1 (P<0.0001), higher platelets (P<0.001), and shorter operative time (P<0.0001). LOS was shortest for TAC/Epi with TXA (P<0.0001). No significant differences between groups were noted on POD 1 Hb, Hct, or partial prothrombin time. Post hoc testing revealed an advantage of TAC/Epi with TXA over TAC/Epi alone for 2-hour postoperative international normalized ratio (P=0.0249), Operating Room time (P=0.0179), and LOS (P=0.0049).

Conclusions:

Use of TAC/Epi alone reduced EBL, LOS, Operating Room time, and improved laboratory values postoperatively in open sagittal synostosis surgery. Addition of TXA further improved operative time and LOS. It is likely that lower rates of transfusion could be tolerated.
TMJ Ankylosis Following Mandibular Distraction Osteogenesis: Management With Simultaneous Midface External Distraction and Bilateral Temporomandibular Joint Replacement
Authors: Arnold Sydney H. , Harmon Kelly A. , Jazayeri Hossein E. , Figueroa Alvaro A. , Tragos Christina
Published: May 2023

Early mandibular distraction osteogenesis (MDO) can decrease upper airway and feeding complications in pediatric patients with micrognathia; however, temporomandibular joint (TMJ) complications like TMJ ankylosis (TMJA) may occur. TMJA can disturb pediatric patients’ function and craniofacial growth, resulting in significant physical and psychosocial consequences. Additional surgical procedures may also be required, increasing the burden of care on patients and their families. CMF surgeons must discuss the potential complications of early MDO surgery with families as well as potential solutions should these problems occur. This report presents the case of a 17-year-old male with a severe craniofacial anomaly with features of Treacher-Collins syndrome (TCS) and a surgical history of tracheostomy, cleft palate repair, mandibular reconstruction with harvested costochondral grafts, and MDO with resultant bilateral TMJA and limited mouth opening. The patient Was treated with bilateral custom alloplastic TMJ replacements and simultaneous maxillary DO using a Rigid External Distraction (RED) device.
Quantifying and estimating ecological network diversity based on incomplete sampling data
Authors: Chiu Chun-Huo , Chao Anne , Vogel Sebastian , Kriegel Peter , Thorn Simon
Published: May 2023

An ecological network refers to the ecological interactions among sets of species. Quantification of ecological network diversity and related sampling/estimation challenges have explicit analogues in species diversity research. A unified framework based on Hill numbers and their generalizations was developed to quantify taxonomic, phylogenetic and functional diversity. Drawing on this unified framework, we propose three dimensions of network diversity that incorporate the frequency (or strength) of interactions, species phylogenies and traits. As with surveys in species inventories, nearly all network studies are based on sampling data and thus also suffer from under-sampling effects. Adapting the sampling/estimation theory and the iNEXT (interpolation/extrapolation) standardization developed for species diversity research, we propose the iNEXT.link method to analyse network sampling data. The proposed method integrates the following four inference procedures: (i) assessment of sample completeness of networks; (ii) asymptotic analysis via estimating the true network diversity; (iii) non-asymptotic analysis based on standardizing sample completeness via rarefaction and extrapolation with network diversity; and (iv) estimation of the degree of unevenness or specialization in networks based on standardized diversity. Interaction data between European trees and saproxylic beetles are used to illustrate the proposed procedures. The software iNEXT.link has been developed to facilitate all computations and graphics.

This article is part of the theme issue ‘Detecting and attributing the causes of biodiversity change: needs, gaps and solutions’.
Biodiversity–ecosystem function relationships change in sign and magnitude across the Hill diversity spectrum
Authors: Roswell Michael , Harrison Tina , Genung Mark A.
Published: May 2023

Motivated by accelerating anthropogenic extinctions, decades of biodiversity–ecosystem function (BEF) experiments show that ecosystem function declines with species loss from local communities. Yet, at the local scale, changes in species' total and relative abundances are more common than species loss. The consensus best biodiversity measures are Hill numbers, which use a scaling parameter,ℓ, to emphasize rarer versus more common species. Shifting that emphasis captures distinct, function-relevant biodiversity gradients beyond species richness. Here, we hypothesized that Hill numbers that emphasize rare species more than richness does may distinguish large, complex and presumably higher-functioning assemblages from smaller and simpler ones. In this study, we tested which values ofℓproduce the strongest BEF relationships in community datasets of ecosystem functions provided by wild, free-living organisms. We found thatℓvalues that emphasized rare species more than richness does most often correlated most strongly with ecosystem functions. As emphasis shifted to more common species, BEF correlations were often weak and/or negative. We argue that unconventional Hill diversities that shift emphasis towards rarer species may be useful for describing biodiversity change, and that employing a wide spectrum of Hill numbers can clarify mechanisms underlying BEF relationships.

This article is part of the theme issue ‘Detecting and attributing the causes of biodiversity change: needs, gaps and solutions’.
Groundfish biodiversity change in northeastern Pacific waters under projected warming and deoxygenation
Authors: Thompson Patrick L. , Nephin Jessica , Davies Sarah C. , Park Ashley E. , Lyons Devin A. , Rooper Christopher N. , Angelica Peña M. , Christian James R. , Hunter Karen L. , Rubidge Emily , Holdsworth Amber M.
Published: May 2023

In the coming decades, warming and deoxygenation of marine waters are anticipated to result in shifts in the distribution and abundance of fishes, with consequences for the diversity and composition of fish communities. Here, we combine fisheries-independent trawl survey data spanning the west coast of the USA and Canada with high-resolution regional ocean models to make projections of how 34 groundfish species will be impacted by changes in temperature and oxygen in British Columbia (BC) and Washington. In this region, species that are projected to decrease in occurrence are roughly balanced by those that are projected to increase, resulting in considerable compositional turnover. Many, but not all, species are projected to shift to deeper depths as conditions warm, but low oxygen will limit how deep they can go. Thus, biodiversity will likely decrease in the shallowest waters (less than 100 m), where warming will be greatest, increase at mid-depths (100–600 m) as shallow species shift deeper, and decrease at depths where oxygen is limited (greater than 600 m). These results highlight the critical importance of accounting for the joint role of temperature, oxygen and depth when projecting the impacts of climate change on marine biodiversity.

This article is part of the theme issue ‘Detecting and attributing the causes of biodiversity change: needs, gaps and solutions’.
Neighbourhood built environments, socioeconomic position, and hospital admissions for cardiovascular disease: a prospective study using UK Biobank
Authors: Mason Kate , Pearce Neil , Cummins Steven
Published: May 2023

Background

Neighbourhood environments may influence cardiovascular disease (CVD) risk, e.g. by influencing diet and physical activity (PA) behaviours. We explored whether associations between characteristics of neighbourhood environments and CVD are modified by area deprivation and household income. If effects of neighbourhood risk exposures vary by socioeconomic position, efforts to improve population health by improving neighbourhood built environments could widen health inequalities.

Methods

In the UK Biobank cohort we used linked records of hospital admissions to assess the relative hazard of being admitted to hospital with a primary diagnosis of CVD according to three characteristics of the neighbourhood built environment: availability of formal PA facilities, proximity of a takeaway/fast-food store, and neighbourhood greenspace. We then examined potential effect modification of the main associations by household income and area deprivation. We used Cox proportional hazards models, adjusted for likely confounding, and calculated relative excess risks due to interaction (RERI) to assess effect modification on the additive scale. We also examined the combined modifying role of income and deprivation.

Results

There were 13,809 incident CVD admissions in the sample (mean follow-up=6.8 years). Overall associations between neighbourhood exposures and CVD-related hospital admissions were weak to null. However, there was evidence of effect modification by both area deprivation and household income. Greater availability of PA facilities near home was associated with lower risk of CVD-related admission in more deprived areas, but only among people in higher-income households. Area deprivation and household income both modified the association with fast-food proximity. More greenspace was not associated with lower risk of CVD-related admission for any group. Some results differed between women and men. Findings were largely robust to alternative model specifications.

Conclusions

Improving deprived neighbourhoods by increasing the number of PA facilities, while also ensuring access to these is free or affordable, may improve population health. Examining effect modification by multiple socioeconomic indicators in parallel can yield deeper insight into how different aspects of the people’s socioeconomic conditions influence their relationship with the built environment and its effects on their health. Improved understanding may help to avoid generating or perpetuating health inequalities when neighbourhood-based built environment interventions are designed.
Analysing the psychosocial and health impacts of Long COVID in Pakistan: A cross sectional study
Authors: Khan Madeeha , Majeed Sadaf , Ain Qura Tul , Nawaz Amjad , Sumra Khadija Awais , Lammi Vilma , Nihal Faizan , Afrah Aleena , Khan Ejaz Ahmed , Khan Mohammad Iqbal , Sadiq Fouzia
Published: May 2023

Long COVID corresponds to the occurrence of symptoms beyond twelve weeks after the onset of acute COVID-19 illness. The study aimed to analyze impacts of long COVID on the general health and psychosocial well-being of the Pakistani population. This cross-sectional study aimed to analyse the impacts of long COVID on general health and psychosocial well-being. For this study, the participants were interviewed, and their responses were recorded on a questionnaire capturing information on demographics, COVID-19 status, duration of symptoms and long COVID symptoms. The psychological impacts of the pandemic were assessed using scales like Short Mood and feeling questionnaire (sMFQ), Warwick-Edinburgh Mental Well-being Scale (WEMWBS), Generalized Anxiety Disorder Assessment (GAD-7) and Perceived Stress Scale (PSS). Regression analysis was conducted to analyse the predictors of long COVID. A total of 300 participants were interviewed, of which 155 (52%) had COVID-19 illness. Of these 54 (35%) had persistent symptoms for a period of more than 12 weeks classified as long COVID. Muscle problems and fatigue were the most frequent (14.7%) symptoms encountered, followed by breathing problems (12.6%) and cognitive issues (12.6%). Symptoms such as decrease in appetite and confusion or disorientation during the initial phase of the infection were associated with long COVID. Majority of the participants (83.3%) had moderate level of perceived stress while moderate to severe levels of stress was observed in 17.3% of the individuals. Moreover, a high level positive mental wellbeing was also observed.
Long COVID and financial outcomes: Evidence from four longitudinal population surveys
Authors: Rhead Rebecca , Wels Jacques , Moltrecht Bettina , Shaw Richard J. , Silverwood Richard J. , Zhu Jingmin , Hughes Alun , Chaturvedi Nishi , Demou Evangelia , Katikireddi Srinivasa Vittal , Ploubidis George B.
Published: May 2023

Background

Long-term sequelae of COVID-19 (long COVID) include muscle weakness, fatigue, breathing difficulties and sleep disturbance over weeks or months. Using UK longitudinal data, we assessed the relationship between long COVID and financial disruption.

Methods

We estimated associations between long COVID (derived using self-reported length of COVID-19 symptoms) and measures of financial disruption (subjective financial well-being, new benefit claims, changes in household income) by analysing data from four longitudinal population studies, gathered during the first year of the pandemic. We employed modified Poisson regression in a pooled analysis of the four cohorts adjusting for a range of potential confounders, including pre-pandemic (pre-long COVID) factors.

Results

Among 20,112 observations across four population surveys, 13% reported having COVID-19 with symptoms that impeded their ability to function normally - 10.7% had such symptoms for <4 weeks (acute COVID-19), 1.2% had such symptoms for 4-12 weeks (ongoing symptomatic COVID-19) and 0.6% had such symptoms for >12 weeks (post-COVID-19 syndrome). We found that post-COVID-19 syndrome was associated with worse subjective financial well-being (adjusted relative risk ratios (aRRR)=1.57, 95% confidence interval (CI)=1.25, 1.96) and new benefit claims (aRRR=1.79, CI=1.27, 2.53). Associations were broadly similar across sexes and education levels. These results were not meaningfully altered when scaled to represent the population by age.

Conclusions

Long COVID was associated with financial disruption in the UK. If our findings reflect causal effects, extending employment protection and financial support to people with long COVID may be warranted.
Barriers and Perceived Facilitators for PrEP Use Among Women of Color in South Florida: Findings from theEmpowering Women to Take Control of Their Sexual Health Summit
Authors: Cyrus Elena , Villalba Karina , Jean-Gilles Michele , Rosenberg Rhonda , Ichite Amanda , Ullah Evelyn , Lovera Evelyn , Lester Aryah , Neptune Sandra , Wilson Hannah , Exantus Maude , Lerner Brenda , Cook Robert , Dévieux Jessy G.
Published: May 2023

This paper aims to summarize conference proceedings and testimonies from the “Empowering Women to Take Control of Their Sexual Health Summit” convened in South Florida. In the present study, the phrase “women of color” refers to 279 cisgender and transgender African American, Latina, and Haitian women. Data were collected through three 90-minute group discussions conducted at the conference Individual-, social-, and structural-level PrEP barriers and facilitators were identified. Individual level barriers included: medical distrust, limited knowledge about PrEP, and economic dependence on sexual partners. Participants discussed cultural gender norms and roles as overarching social barriers, with religiosity reinforcing these norms. Structural barriers included: health literacy, health insurance coverage, immigration status, and structural racism. Community attributes that acted as facilitators of PrEP use were resilience and adaptability. Increasing PrEP utilization among women of color requires a multi-tiered approach to comprehensively address structural and community level barriers.
Recovery from Amblyopia in Adulthood: A Meta-Analysis
Authors: Echavarri-Leet Madison P. , Resnick Hannah H. , Bowen Daniel A. , Goss Deborah , Bear Mark F. , Gaier Eric D.
Published: May 2023

Purpose

The effectiveness of traditional amblyopia therapies is largely restricted to childhood. However, recovery in adulthood is possible following removal or vision-limiting disease of the fellow eye. Study of this phenomenon is currently limited to isolated case reports and a few case series, with reported incidence ranging from 19-77%1–5. We set out to accomplish two distinct goals: (1) define the incidence of clinically meaningful recovery and (2) elucidate the clinical features associated with greater amblyopic eye gains.

Methods

A systematic review of 3 literature databases yielded 23 reports containing 109 cases of patients ≥18 years old with unilateral amblyopia and vision-limiting fellow eye pathology.

Results

Study 1 revealed 25/42 (59.5%) of adult patients gained ≥2 logMAR lines in the amblyopia eye after FE vision loss. The overall degree of improvement is clinically meaningful (median 2.6 logMAR lines). Study 2 showed that for cases with amblyopic eye visual acuity improvement, recovery occurs within 12 months of initial loss of fellow eye vision. Regression analysis revealed that younger age, worse baseline acuity in the amblyopic eye, and worse vision in the fellow eye independently conferred greater gains in amblyopic eye visual acuity. Recovery occurs across amblyopia types and fellow eye pathologies, although disease entities affecting fellow eye retinal ganglion cells demonstrate shorter latencies to recovery.

Conclusions

Amblyopia recovery after fellow eye injury demonstrates that the adult brain harbors the neuroplastic capacity for clinically meaningful recovery, which could potentially be harnessed by novel approaches to treat adults with amblyopia.
Risk of perinatal deaths for fetuses and early newborns with congenital heart defects
Authors: Zhou Xu , Jiang Yurong , Fang Junqun , Xie Donghua
Published: May 2023

Background

Few studies assessed the perinatal death (PD) risk for congenital heart defects (CHDs).

Methods

Data were obtained from the Birth Defects Surveillance System in Hunan Province, China, 2016–2020. Perinatal mortality (stillbirths and early neonatal deaths per 1000 fetuses (>=28 weeks)) and 95% confidence intervals (CI) were calculated. Crude odds ratios (ORs) and 95%CI were calculated to estimate the PD risk for CHDs and to examine the association of each maternal characteristic with PD risk for CHDs.

Results

847755 fetuses were registered, including 14459 (1.71%) birth defects (4161 CHDs, 0.49%) and 833296 (98.29%) cases without birth defects. 7445 PDs (6874 stillbirths and 571 early neonatal deaths) were identified, including 976 (13.11%) CHD-related deaths, and 4396 PDs for fetuses without birth defects. 97.50% (936/960) of CHD-related stillbirths were selective termination of pregnancy. The overall perinatal mortality was 0.88% (95%CI: 0.86-0.90). CHDs increased the PD risk (23.46% vs. 0.53%, OR=57.78, 95%CI: 53.47-62.44). Any specific CHD increased the PD risk (OR>1, P<0.05). Perinatal mortality for CHDs was higher in rural than urban areas (OR= 3.40, 95%CI: 2.92-3.95). And perinatal mortalities for CHDs were higher in low maternal age (<25 years old), low per-capita annual income (<4000¥), low maternal education, no birth, and premature birth compared to the reference group. (OR>1, P<0.05).

Conclusions

CHDs significantly increase the PD risk. Several maternal characteristics were associated with CHD-related PDs. And several mechanisms have been proposed to explain these phenomena. Our results are of immediate value for clinical care and consultation.
Individual Deviations from Normative Electroencephalographic Connectivity Predict Antidepressant Response
Authors: Tong Xiaoyu , Xie Hua , Wu Wei , Keller Corey , Fonzo Gregory , Chidharom Matthieu , Carlisle Nancy , Etkin Amit , Zhang Yu
Published: May 2023

Antidepressant medications yield unsatisfactory treatment outcomes in patients with major depressive disorder (MDD) with modest advantages over the placebo. This modest efficacy is partly due to the elusive mechanisms of antidepressant responses and unexplained heterogeneity in patient’s response to treatment — the approved antidepressants only benefit a portion of patients, calling for personalized psychiatry based on individual-level prediction of treatment responses. Normative modeling, a framework that quantifies individual deviations in psychopathological dimensions, offers a promising avenue for the personalized treatment for psychiatric disorders. In this study, we built a normative model with resting-state electroencephalography (EEG) connectivity data from healthy controls of three independent cohorts. We characterized the individual deviation of MDD patients from the healthy norms, based on which we trained sparse predictive models for treatment responses of MDD patients. We successfully predicted treatment outcomes for patients receiving sertraline (r = 0.43, p < 0.001) and placebo (r = 0.33, p < 0.001). We also showed that the normative modeling framework successfully distinguished subclinical and diagnostic variabilities among subjects. From the predictive models, we identified key connectivity signatures in resting-state EEG for antidepressant treatment, suggesting differences in neural circuit involvement between treatment responses. Our findings and highly generalizable framework advance the neurobiological understanding in the potential pathways of antidepressant responses, enabling more targeted and effective MDD treatment.

Trial Registration:Establishing Moderators and Biosignatures of Antidepressant Response for Clinical Care for Depression (EMBARC), NCT#01407094
DNA repair biomarkers to guide usage of combined PARP inhibitors and chemotherapy: a meta-analysis and systematic review
Authors: Phan Zoe , Ford Caroline E. , Caldon C. Elizabeth
Published: May 2023

Purpose

The addition of PARP inhibitors to chemotherapy has been assessed in ∼80 clinical trials across multiple malignancies, on the premise that PARP inhibitors will increase chemotherapy effectiveness regardless of whether cancers have underlying disruption of DNA repair pathways. Consequently, the majority of combination therapy trials have been performed on patients without biomarker selection, despite the use of homologous recombination deficiency to dictate use of PARP inhibitors in the maintenance setting. An unresolved question is whether biomarkers are needed to identify patients who respond to combination PARP inhibitors and chemotherapy.

Methods

A systematic literature review identified studies using PARP inhibitors in combination with chemotherapy versus chemotherapy alone, where the study included a biomarker of DNA repair function (BRCA1,BRCA2, BRCAPRO, ATM, ERCC1, SFLN11). Hazard ratios (HR) were pooled in a meta-analysis using generic inverse-variance and fixed or random effects modelling. Subgroup analyses were conducted on biomarker selection and type of malignancy.

Results

Nine studies comprising 2,084 patients met the inclusion criteria. Progression-free survival (PFS) was significantly better in patients with a DNA repair biomarker (HR 0.52, 95% confidence interval (CI) 0.43-0.63; p < 0.00001), but there was no benefit in patients who lacked a biomarker (HR 0.94, 95% CI 0.82–1.08; p = 0.38). Subgroup analysis showed thatBRCAmutation and SFLN11 biomarkers could predict benefit, and biomarker-driven benefit occurred in ovarian, breast and small cell lung cancers. The addition of PARP inhibitors was associated with increased grade 3/4 side effects, and particularly neutropenia.

Conclusions

Combination therapy only increases PFS in patients with identifiable DNA repair biomarkers. This indicates that PARP inhibitors do not sensitise patients to chemotherapy treatment, except where their cancer has a homologous recombination defect, or an alternative biomarker of altered DNA repair. While effective in patients with DNA repair biomarkers, there is a risk of high-grade haematological side-effects with the use of combination therapy. Thus, the benefit in PFS from combination therapy must be weighed against potential adverse effects, as individual arms of treatment can also confer benefit.

GRAPHICAL ABSTRACT
Retrospective Observational Study on an AI-Powered Symptom Checker for Pre-Diagnosis of Anxiety Disorders
Authors: Orelogio Abel Andrés , Garcia-Esquirol Oscar , Rodriguez María Eugenia , Malet Gausa Andrea , Sarrias Ramis Ernest
Published: May 2023

Objective

To describe the data obtained about diagnoses of anxiety disorders from the Mediktor database to reveal the relationship with the current scientific evidence.

Methods

This retrospective observational study uses secondary data obtained from the Mediktor database and evaluated age, sex, and the most frequent reason for consultation. Descriptive statistics were used to analyze the variables of the sample and their association with pre-diagnosis anxiety disorders. A significance level of p < 0.05 was set for all statistical tests, and all analyses were conducted using Power BI and Google Sheets.

Results

Young adults (18-35 years old) were more likely to be pre-diagnosed with anxiety disorders compared to individuals in other life stages and the proportion of anxiety disorders was found to be higher in females compared to males, both with a statistically significant p-value of less than 0.01.

Conclusions

The data observed in Mediktor relates to current scientific evidence and it has the potential as a technological tool for early detection of anxiety disorders.
Effects of visual arts on persistent pain: A systematic review
Authors: Matthew Lee Wen Hao , Gholamrezaei Ali , Pourkazemi Fereshteh
Published: May 2023

Background

Persistent pain impacts 30% of people worldwide. Evidence on the effectiveness of visual arts in treating persistent pain seems to be emerging. Thus, the aim of this systematic review was to investigate the impact of visual arts on patients with persistent pain.

Methods

Studies were identified by searching seven databases from perception until Jan-2019, then screened by two independent reviewers. Studies were included if they were published controlled trials investigating the impact of visual arts on participants with persistent pain. Studies were excluded if they were abstracts, sampled participants who could not express pain, did not report relevant outcome measures, or did not have a comparator group. The study qualities were assessed by the PEDro scale.

Results

After removing duplicates, 2,732 titles and abstracts were screened. Of 125 full-texts, four satisfied the eligibility criteria; all published within the last decade. Three of four controlled studies were randomised-controlled trials. Studies were conducted in inpatient settings (n=2) and outpatient clinics (n=2). Three studies included elderly participants (>60y/o), while one included patients with HIV (>18y/o). Visual arts interventions included painting, drawing, crafting, and others. Two studies utilised visual arts as the sole treatment, while two studies used visual arts as part of a multimodal treatment. Comparators received usual care in two studies, a music intervention in one, and an art-therapy video in another. The common outcome measure in all studies was pain level (0-to-10 scale). All studies also included psychosocial outcome measures. Quality of studies ranged from grade four to eight on PEDro scale; two had “high” quality, and two had “fair” quality. All studies reported statistically significant improvements in pain within intervention groups.

Conclusions

Visual arts seem to benefit patients with persistent pain. Further investigation on the clinical significance of these positive findings on pain and other biopsychosocial factors are required.
Spatiotemporal variability in transmission risk of human schistosomes and animal trematodes in a seasonally desiccating East African landscape
Authors: Starkloff Naima C. , Angelo Teckla , Mahalila Moses P. , Charles Jenitha , Kinung’hi Safari , Civitello David J
Published: May 2023

Different populations of hosts and parasites experience distinct seasonality in environmental factors, depending on local-scale biotic and abiotic factors. This can lead to highly heterogenous disease outcomes across host ranges. Variable seasonality characterizes urogenital schistosomiasis, a neglected tropical disease caused by parasitic trematodes (Schistosoma haematobium). Their intermediate hosts are aquaticBulinussnails that are highly adapted to extreme rainfall seasonality, undergoing dormancy for up to seven months yearly. WhileBulinussnails have a remarkable capacity for rebounding following dormancy, parasite survival within snails is greatly diminished. We conducted a year-round investigation of seasonal snail-schistosome dynamics in 109 ponds of variable ephemerality in Tanzania. First, we found that ponds have two synchronized peaks of schistosome infection prevalence and cercariae release, though of lower magnitude in the fully desiccating ponds than non-desiccating ponds. Second, we evaluated total yearly prevalence across a gradient of an ephemerality, finding ponds with intermediate ephemerality to have the highest infection rates. We also investigated dynamics of non-schistosome trematodes, which lacked synonymity with schistosome patterns. We found peak schistosome transmission risk at intermediate pond ephemerality, thus the impacts of anticipated increases in landscape desiccation could result in increases or decreases in transmission risk with global change.
Soluble CTLA-4 mainly produced by Treg cells inhibits type 1 inflammation without hindering type 2 immunity to allow for inflammation resolution
Authors: Osaki Motonao , Sakaguchi Shimon
Published: May 2023

CTLA-4 exists as membrane (mCTLA-4) and soluble (sCTLA-4) forms. Here, we show that effector-type regulatory T cells (Tregs) are main sCTLA-4 producers in basal and inflammatory states with distinct kinetics upon TCR stimulation. Mice specifically deficient in sCTLA-4 production exhibited spontaneous activation of Th1, Th17, Tfh, and Tc1 cells, autoantibody and IgE production, M1-like macrophage polarization, and impaired wound healing. In contrast, sCTLA-4-intact mCTLA-4-deficient mice, when compared with double-deficient mice, developed milder systemic inflammation and showed predominant activation/differentiation of Th2, M2-like macrophages, and eosinophils. Consistently, recombinant sCTLA-4 inhibitedin vitrodifferentiation of naïve T cells towards Th1 through CD80/CD86 blockade on antigen-presenting cells, but did not affect Th2 differentiation. Moreover, sCTLA-4-intact mCTLA-4-deficient Tregs effectively suppressed Th1-mediated experimental colitis whereas double-deficient Tregs did not. Thus, sCTLA-4 production by Tregs during chronic inflammation is instrumental in controlling type 1 immunity while allowing type 2 immunity to dominate and facilitate inflammation resolution.
Use of Artificial Intelligence for Automated Detection and Surveillance of Red Imported Fire Ants Nests
Authors: Su Xin , Shi Guijie , Zhong Jiamei , Li Yuling , Dai Wennan , Xu Guohua , Fox Eduardo G. P. , Qiu Hualong , Yan Zheng
Published: May 2023

The red imported fire ant,Solenopsis invictaBuren is a destructive invasive species that has spread around the world. Early detection ofS. invictanests is critical for effective monitoring and control in invaded regions. This study presents a novel surveillance system forS. invictanests combining artificial intelligence and robotic dogs. The system was designed with intelligent recognition algorithms to accurately identifyS. invictanests. With a precision rate of 95%, the system yielded efficient detection ofS. invictanests with increased sensitivity and low missing and false discovery rates, which can aid or even replace humans in locating and delivering pesticides to fire ant nests in open fields to effective control of this invasive pest.
The RNA-binding protein, Imp specifies olfactory navigation circuitry and behavior inDrosophila
Authors: Hamid Aisha , Gattuso Hannah , Caglar Aysu Nora , Pillai Midhula , Steele Theresa , Gonzalez Alexa , Nagel Katherine , Syed Mubarak Hussain
Published: May 2023

Complex behaviors depend on the precise developmental specification of neuronal circuits, but the relationship between genetic programs for neural development, circuit structure, and behavioral output is often unclear. The central complex (CX) is a conserved sensory-motor integration center in insects that governs many higher order behaviors and largely derives from a small number of Type II neural stem cells. Here, we show that Imp, a conserved IGF-II mRNA-binding protein expressed in Type II neural stem cells, specifies components of CX olfactory navigation circuitry. We show: (1) that multiple components of olfactory navigation circuitry arise from Type II neural stem cells and manipulating Imp expression in Type II neural stem cells alters the number and morphology of many of these circuit elements, with the most potent effects on neurons targeting the ventral layers of the fan-shaped body. (2) Imp regulates the specification of Tachykinin expressing ventral fan-shaped body input neurons. (3) Imp in Type II neural stem cells alters the morphology of the CX neuropil structures. (4) Loss of Imp in Type II neural stem cells abolishes upwind orientation to attractive odor while leaving locomotion and odor-evoked regulation of movement intact. Taken together, our work establishes that a single temporally expressed gene can regulate the expression of a complex behavior through the developmental specification of multiple circuit components and provides a first step towards a developmental dissection of the CX and its roles in behavior.