bluuebunny/crossref_metadata_2025 huggingface dataset:
Development and validation of a clinical model for predicting the severity of carpal tunnel syndrome
Authors: Aalaie Behnaz , Sadeghi Javad , Mohammadi Tanya , Mohammadi Babak
Published: July 2023

Objectives

To develop a clinical instrument to assess carpal tunnel syndrome (CTS) severity before electrodiagnostic testing.

Methods

Data from 1037 patients with CTS (39.1% male) were included. The mean (SD) age was 58.0 (10.8) years. The severity of CTS was based on electrodiagnostic findings.

Results

We devised a composite index incorporating a pain numeric rating scale (NRS) rated from 0 (no pain at all) to 10 (the worst pain ever possible), thenar muscle weakness or atrophy (TW), cross-sectional area (CSA) of the median nerve (mm2), and nocturnal pain (NP). The index was calculated as [scale(NRS)+scale(CSA)+NP+TW]/4, where NP and TW are binary features (0 or 1). The accuracy and area under the curve of the index were 0.85 and 0.71, respectively (Cohen’s Kappa = 0.51, McNemar’s test P = 0.249). The index increased pretest probabilities by 1.6, 1.8, and 3.3 times with positive likelihood ratios of 3.3, 2.5, and 13.5, and false-positive rates of 26.6, 17.6, and 4.8% for mild, moderate, and severe CTS, respectively. The index thresholds for mild, moderate, and severe CTS were <0.8, ≥0.8 to <1.1, and ≥1.1, respectively.

Conclusion

Using a composite index, patients with CTS can be categorized for the severity of the syndrome.
Survey of Premium Versus Large Manufactured Cigars Use in U.S. Consumers
Authors: Smith Carson , Hiteman Kristin , Triplett Cheryl , Pickworth Wallace B
Published: July 2023

Introduction

An Internet questionnaire was used to determine smoking behavior, purchasing behavior, and risk perceptions among exclusive or nearly exclusive current users of either large manufactured (LMC) or premium cigars (PC).

Aims and Methods

Respondents (n = 250) were recruited from a nationally representative market research panel. An a priori designation of PC users was adapted from criteria in published literature and the recent National Academy of Science report.

Results

Examination of responses revealed a (n = 19) disagreement between cigar users’ self-classifications and the a priori classification. After eliminating ineligible respondents 188 participants were classified as PC (n = 92; 55 male) or LMC (n = 96; 49 male) users. There were no significant differences in age or gender between groups. Respondents were all over 21 years old. The largest age groups were 30–39 years and 60–69 years. PC users were significantly more likely to have higher annual incomes and to buy cigars online or through tobacco specialty shops, whereas LMC users purchased from convenience stores. Most participants had used other combustible tobacco products (88%) but few had used ENDS (24%) or oral tobacco (7.5%). There was no significant difference in the frequency of smoke inhalation or perceptions of risk for health. There was marked uncertainty in self-characterization of cigar type; our sample had higher female representation than expected (n = 84, 45%), and inhalation was frequently endorsed in both groups (52%, overall).

Conclusions

The results support the need for standardized classifications and suggest current trends may indicate shifts in gender and use behavior but provide no evidence supporting less restrictive regulation of PC.

Implications

An Internet questionnaire was used to determine smoking behavior, purchasing behavior, and risk perceptions among current users of LMC or PC. There was uncertainty about cigar classification even in this sample of regular users. Our results demonstrated more than expected inhalation of cigar smoke, considerable use by females, and under appreciation of health risks. No results supported less restrictive regulations for premium cigars.
Patterns of Premium and Nonpremium Cigar Use in the United States: Findings from Wave 6 (2021) of the Population Assessment of Tobacco and Health Study
Authors: Edwards Kathryn C , Halenar Michael J , Delnevo Cristine D , Villanti Andrea C , Bansal-Travers Maansi , O’Connor Richard , Del Valle-Pinero Arseima Y , Creamer MeLisa R , Donaldson Elisabeth A , Hammad Hoda T , Lagasse Lisa , Anesetti-Rothermel Andrew , Taylor Kristie A , Kimmel Heather L , Compton Wilson , Cheng Yu-Ching , Ambrose Bridget K , Hyland Andrew
Published: July 2023

Introduction

Understanding the characteristics of premium cigar use patterns is essential for minimizing public health harms. Typically, premium cigars are handmade, larger, more expensive, and without the characterizing flavors that are present in other cigar types: Nonpremium traditional cigars, cigarillos, and filtered cigars.

Aims and Methods

Self-reported brand and price data were used from Wave 6 of the Population Assessment of Tobacco and Health (PATH) Study to define and estimate premium versus nonpremium cigar use among U.S. adults, as well as to explore cigar smoking patterns, purchasing behavior, and reasons for use by cigar type.

Results

In 2021, 0.9% (95% CI = 0.7–1.0) of adults were premium cigar users, compared to 0.4% of nonpremium traditional cigar users (95% CI = 0.3–0.5), 1.1% of cigarillo users (95% CI = 1.0–1.2), and 0.6% filtered cigar users (95% CI = 0.5–0.7). Premium cigar users were overwhelmingly male (97.7%), and 35.8% were aged ≥55 years. The average premium cigar price/stick was $8.67, $5.50–7.00 more than other cigar types. Compared to other cigar types, significantly fewer premium cigar users had a regular brand with a flavor other than tobacco (~15% vs. 38%–53%). Though flavors remained the top reason for premium cigar use, they were less likely to endorse flavors as a reason for use than other cigar users (~40% vs. 68–74%). Premium cigar users had a lower prevalence (aRR: 0.37, 95% CI = 0.25–0.55) of dual use of cigars and cigarettes.

Conclusions

Although <1% of U.S. adults use premium cigars, their use and purchasing characteristics continue to differ from other cigar types, highlighting the importance of capturing data specific to premium cigar use.

Implications

This manuscript extends previous research from the National Academies of Science, Engineering, and Medicine report, “Premium cigars: Patterns of use, marketing, and health effects” by utilizing the most recent PATH Study data (Wave 6) to examine patterns of cigar use, including purchasing behavior and reasons for use, by cigar type (eg, premium traditional cigars, nonpremium traditional cigars, cigarillos, and filtered cigars). The findings support continued research on patterns of premium cigar use, which differ from use patterns of other cigar types.
Political Transactions, the Social Contract, and Administrative Power
Authors: Eckerd Adam
Published: July 2023

Although power has frequently been noted as a key to understanding administration, the concept of administrative power has remained ill-defined. In this essay I offer a definition of administrative power based on the social contract, arguing that administrative power is the transactional granting of power by the people in exchange for services and a reduction in uncertainty that agencies provide. I elaborate on the role of communication and persuasion in garnering administrative power and conclude by offering arguments, based on both risk communication and political spin, for how agencies acquire and maintain administrative power in the 21st Century.
A population-based study of caesarean section in women with juvenile idiopathic arthritis
Authors: Götestam Skorpen Carina , Lydersen Stian , Salvesen Kjell Å , Wallenius Marianne
Published: July 2023

Objectives

The literature on delivery methods in women with JIA is limited. Active inflammation is a risk factor for caesarean section (CS) in other arthritic diseases. A CS entails a higher risk for complications than vaginal delivery and restricted physical activity in the first weeks after birth. Our objective was to explore a possible association of inflammatory active disease and the proportion of CS in women with JIA.

Methods

Data from the Norwegian nationwide observational register RevNatus were linked with data from the Medical Birth Registry of Norway (MBRN). Cases comprised singleton births in women with JIA (n = 196) included in RevNatus from 2010 to 2019. Singleton births registered in the MBRN during the same period of time, excluding births in mothers with rheumatic inflammatory diseases, served as population controls (n = 575 798).

Results

CS was more frequent in women with JIA (20.4%) and in the subgroup of women with inflammatory active JIA (30.0%) than in population controls (15.6%). Women with active JIA had a risk for elective CS similar to population controls [risk difference 2.3% (95% CI −2.5, 12.9)] and a higher risk for emergency CS [risk difference 14.0% (95% CI 4.3, 27.4)] compared with population controls.

Conclusion

Women with active JIA had a higher risk for emergency CS, but not elective CS, compared with population controls.
Who Mismanages Student Loans, and Why?
Authors: Cornaggia Kimberly , Xia Han
Published: July 2023

Many financially distressed students who qualify for federal assistance plans with interest moratorium and principal forgiveness instead accrue interest over long periods of nonpayment. This loan mismanagement is associated with higher delinquency. Mismanagement varies significantly across student gender and race: it is more prominent among male and non-white students. Mismanagement also varies across loan servicers, depending on proxies for student-adverse servicer policies. We consider explanations based on student selection and servicer treatment for loan mismanagement. Student financial literacy plays an important role but variation in treatment on the part of loan servicers appears more important.

Authors have furnished an Internet Appendix, which is available on the Oxford University Press Web site next to the link to the final published paper online
Evaluation of saturated and unsaturated fat with vitamin A or beta-carotene supplementation in nursery pigs
Authors: Elefson Sarah , Greiner Laura
Published: July 2023

One hundred and fifty-two nursery pigs (PIC, Hendersonville, TN) were randomly assigned to mix sex pens and one of six dietary treatments in a 3 × 2 factorial. Diets included no added fat, 3% added choice white grease, or 3% added soy oil with either a supplemented vitamin A (for a total of 11,640 IU vitamin A/kg, Rovimix A 1000, DSM, Parsippany, NJ, US) or beta-carotene (for a total of 8,708 IU vitamin A/kg equivalent, Rovimix β-Carotene 10%, DSM). Pigs were given a 3-d adaptation period upon arrival. Pigs were weighed at the start of the study and at the end of each phase. A blood sample was taken from one pig per pen at the start and end of the study. Tissues were collected from eight pigs at the start of the study and six pigs per treatment at the end of the study. Data were analyzed via the GLIMMIX procedure in SAS 9.4 (SAS Inst., Cary, NC). Pen was the experimental unit, and repeated measures were used for growth performance and blood parameters. There was no fat by supplement interaction (P > 0.05) on body weight (BW), but there was a tendency (P = 0.054) for heavier BWs when soy oil was added to diets. There was no difference (P > 0.05) in average daily feed intake or average daily gain (ADG). There was an improved gain:feed (P = 0.02) when pigs were fed choice white grease over no added fat. There were time differences (P < 0.05) for plasma vitamins A (retinol), D (25 hydroxy vitamin D3), and E (alpha-tocopherol). Vitamin A and D values were higher at the end of the study, whereas vitamin E values were lower at the end of the study. The choice white grease diets had the highest (P < 0.05) plasma vitamins D and E (6.74 ng/mL and 2.87 ppm, respectively). Pigs supplemented with vitamin A had higher (P < 0.05) hepatic vitamin A than pigs supplemented with beta-carotene (19.9 vs. 15.6 ppm, respectively). There were no differences (P < 0.05) between immunoglobulins G and M or mRNA abundance of select genes (retinol binding protein 2, alcohol dehydrogenase class 1, lecithin retinol acyltransferase phosphatidylcholine-retinol O-acyltransferase, and beta-carotene oxygenase 1). In conclusion, fat inclusion level and type, with either vitamin A or beta-carotene supplementation, did not affect the overall nursery pig growth performance. The addition of fat resulted in an increase in ADG and BW. Diets with choice white grease had the highest plasma vitamins D and E, and supplemental vitamin A increased hepatic vitamin A.
Antiepileptic drugs are endocrine disruptors for the human fetal testisex vivo
Authors: Lesné Laurianne , Desdoits-Lethimonier Christèle , Hug Elisa , Costet Nathalie , Raffenne Léo , Toupin Maryne , Evrard Bertrand , Kugathas Indusha , Lavoué Vincent , Chalmel Frédéric , Jégou Bernard , Mazaud-Guittot Séverine
Published: July 2023

Valproic acid (VPA) has long been the most widely used antiepileptic drug (AED) for the treatment of epilepsy, bipolar psychiatric disorders, and migraine. However, long-term VPA treatment has several adverse effects on the male reproductive system notably on endocrine functions and/or spermatic parameters. In utero exposure of the fetus to VPA is well known to be associated with a higher risk of several congenital malformations including those of male reproductive organs. Subsequent generations of AEDs, such as carbamazepine (CARB) and lamotrigine (LAM), are considered safer and are currently recommended for women of child-bearing age with epilepsy. Because anomalies of the male genital tract mostly result from endocrine imbalance during fetal life, we hypothesized that AEDs could directly impair testis differentiation. We thus aimed at identifying and characterizing the effects of VPA, CARB, and LAM on the differentiation and function of the different testicular cell types, and at understanding the mechanisms underlying these effects. By using ex vivo culture of first-trimester human fetal testes, we show that VPA induces multiple endocrine disruptive effects, compared with the milder ones caused by CARB and LAM. AED also subtly altered the germ cell lineage in distinct manners. Transcriptomic analysis of VPA-induced alterations highlighted a very broad range of effects on the fetal testis. Overall, our results show that AEDs can behave as endocrine disruptors for the human fetal testis ex vivo. This is consistent with, and likely underlies, the VPA-induced male genital tract masculinization abnormalities observed in patients.
Continuous presence of genetically diverse rustrela virus lineages in yellow-necked field mouse reservoir populations in northeastern Germany
Authors: Nippert Sina , Rubbenstroth Dennis , Geers Jessica Anna , Ebinger Arnt , Hoffmann Donata , Breithaupt Angele , Wylezich Claudia , Wang Xuejing , Haring Viola C , Starcky Philip , Fruci Paola , Langner Christoph , Trapp Christin , Schulz Heiko , Stubbe Wilko , Imholt Christian , Heckel Gerald , Beer Martin , Pfaff Florian , Ulrich Rainer G
Published: July 2023

Rustrela virus (RusV; species Rubivirus strelense, family Matonaviridae) was discovered in different zoo animal species affected by fatal encephalitis. Simultaneous RusV RNA detection in multiple yellow-necked field mice (Apodemus flavicollis) suggested this rodent as a reservoir of RusV. Here, we investigated 1,264 yellow-necked field mice and sympatric other small mammals from different regions in Germany for RusV RNA using an optimized reverse transcription-quantitative polymerase chain reaction (RT-qPCR) protocol and high-throughput sequencing. The investigation resulted in the detection of RusV RNA exclusively in 50 of 396 (12.6 per cent) yellow-necked field mice but absence in other sympatric species. RT-qPCR-determined tissue distribution of RusV RNA revealed the highest viral loads in the central nervous system, with other tissues being only very rarely affected. The histopathological evaluation did not reveal any hints of encephalitis in the brains of infected animals despite the detection of viral RNA in neurons by in situ hybridization (ISH). The positive association between the body mass of yellow-necked field mice and RusV RNA detection suggests a persistent infection. Phylogenetic analysis of partial E1 and full-genome sequences showed a high diversification with at least four RusV lineages (1A–1D) in northeastern Germany. Moreover, phylogenetic and isolation-by-distance analyses indicated evolutionary processes of RusV mostly in local reservoir populations. A comparison of complete genome sequences from all detected RusV lineages demonstrated a high level of amino acid and nucleotide sequence variability within a part of the p150 peptide of the non-structural polyprotein and its coding sequence, respectively. The location of this region within the RusV genome and its genetic properties were comparable to the hypervariable region of the rubella virus. The broad range of detected RusV spillover hosts in combination with its geographical distribution in northeastern Germany requires the assessment of its zoonotic potential and further analysis of encephalitis cases in mammals. Future studies have to prove a putative co-evolution scenario for RusV in the yellow-necked field mouse reservoir.
First Report of Alfalfa Mosaic Virus on Cowpea in the United States
Authors: Harveson Robert M. , Porter Lyndon D.
Published: July 2023

Cowpea ( Vigna unguiculata) is grown on approximately 5,220 ha across California and several Midwestern and southern states. In August of 2020, a viral disease was observed infecting cowpea in commercial fields and research trials in Nebraska, United States. Based on RNA sequencing and serology, the virus species was identified as Alfalfa mosaic virus. To our knowledge, this is the first report of this virus on cowpea in the United States.
Hemp Abnormal Growth Is Attributed to Mono-, Di-, or Tri-Infections of Spiroplasma citri, ‘Candidatus Phytoplasma trifolii’, and Beet Curly Top Virus
Authors: Schoener Jennifer L. , Wang Shouhua
Published: July 2023

As hemp ( Cannabis sativa) emerges as a commercial crop in Nevada, mild to severe abnormal growth has been observed from many plants in commercial fields throughout the growing season. Affected plants exhibited a group of symptoms typically including stunting, leaf yellowing, excessive apical branching, clusters of witches’ broom, leaf rolling upwards, and leaf mottling and mosaic. These symptoms mostly showed up together in a plant or a crop and are defined here as abnormal growth syndrome (AGS). Between 2017 and 2019, the Nevada State Plant Pathology and Molecular Diagnostic Lab received 67 symptomatic hemp samples from Nevada for diagnosis, and ‘ Candidatus Phytoplasma trifolii’ was detected in 14 samples (21%). To investigate additional biotic agents associated with AGS, PCR products generated by primers P1/P7 were cloned into a pGEM-T vector and sequenced, and Spiroplasma citri DNA was found in two samples (3%). All 67 DNA samples were further tested for beet curly top virus (BCTV), and 57 samples (85%) were found to be infected by BCTV. Twelve samples (18%) were coinfected by both ‘ Ca. Phytoplasma trifolii’ and BCTV, and two (3%) were coinfected by S. citri, ‘ Ca. Phytoplasma trifolii’, and BCTV. The findings suggest that BCTV is the most prevalent pathogen causing the hemp abnormal growth in Nevada, but ‘ Ca. Phytoplasma trifolii’ and S. citri may also contribute to the severity and complexity of symptoms. Thus, hemp abnormal growth can be attributed to single, dual, or triple infections of these three leafhopper-vectored mollicutes and virus.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
ASAM Clinical Considerations: Buprenorphine Treatment of Opioid Use Disorder for Individuals Using High-potency Synthetic Opioids
Authors: Weimer Melissa B. , Herring Andrew A. , Kawasaki Sarah S. , Meyer Marjorie , Kleykamp Bethea A. , Ramsey Kelly S.
Published: July 2023

Treatment of opioid use disorder (OUD) with buprenorphine has evolved considerably in the last decade as the scale of the OUD epidemic has increased along with the emergence of high-potency synthetic opioids (HPSOs) and stimulants in the drug supply. These changes have outpaced the development of prospective research, so a clinical consideration document based on expert consensus is needed to address pressing clinical questions. This clinical considerations document is based on a narrative literature review and expert consensus and will specifically address considerations for changes to the clinical practice of treatment of OUD with buprenorphine for individuals using HPSO. An expert panel developed 6 key questions addressing buprenorphine initiation, stabilization, and long-term treatment for individuals with OUD exposed to HPSO in various treatment settings. Broadly, the clinical considerations suggest that individualized strategies for buprenorphine initiation may be needed. The experience of opioid withdrawal negatively impacts the success of buprenorphine treatment, and attention to its management before and during buprenorphine initiation should be proactively addressed. Buprenorphine dose and dosing frequency should be individualized based on patients’ treatment needs, the possibility of novel components in the drug supply should be considered during OUD treatment, and all forms of opioid agonist treatment should be offered and considered for patients. Together, these clinical considerations attempt to be responsive to the challenges and opportunities experienced by frontline clinicians using buprenorphine for the treatment of OUD in patients using HPSOs and highlight areas where prospective research is urgently needed.
The Effect of Oral Nimodipine on Cerebral Metabolism and Hemodynamic Parameters in Patients Suffering Aneurysmal Subarachnoid Hemorrhage
Authors: Moser Miriam , Schwarz Yannik , Herta Johannes , Plöchl Walter , Reinprecht Andrea , Zeitlinger Markus , Brugger Jonas , Ramazanova Dariga , Rössler Karl , Hosmann Arthur
Published: July 2023

Introduction:

Nimodipine is routinely administered to aneurysmal subarachnoid hemorrhage patients to improve functional outcomes. Nimodipine can induce marked systemic hypotension, which might impair cerebral perfusion and brain metabolism.

Methods:

Twenty-seven aneurysmal subarachnoid hemorrhage patients having multimodality neuromonitoring and oral nimodipine treatment as standard of care were included in this retrospective study. Alterations in mean arterial blood pressure (MAP), cerebral perfusion pressure (CPP), brain tissue oxygen tension (pbtO2), and brain metabolism (cerebral microdialysis), were investigated up to 120 minutes after oral administration of nimodipine (60 mg or 30 mg), using mixed linear models.

Results:

Three thousand four hundred twenty-five oral nimodipine administrations were investigated (126±59 administrations/patient). After 60 mg of oral nimodipine, there was an immediate statistically significant (but clinically irrelevant) drop in MAP (relative change, 0.97; P<0.001) and CPP (relative change: 0.97; P<0.001) compared with baseline, which lasted for the whole 120 minutes observation period (P<0.001). Subsequently, pbtO2 significantly decreased 50 minutes after administration (P=0.04) for the rest of the observation period; the maximum decrease was −0.6 mmHg after 100 minutes (P<0.001). None of the investigated cerebral metabolites (glucose, lactate, pyruvate, lactate/pyruvate ratio, glutamate, glycerol) changed after 60 mg nimodipine. Compared with 60 mg nimodipine, 30 mg induced a lower reduction in MAP (relative change, 1.01; P=0.02) and CPP (relative change, 1.01; P=0.03) but had similar effects on pbtO2 and cerebral metabolism (P>0.05).

Conclusions:

Oral nimodipine reduced MAP, which translated into a reduction in cerebral perfusion and oxygenation. However, these changes are unlikely to be clinically relevant, as the absolute changes were minimal and did not impact cerebral metabolism.
Integrin β5 subunit regulates hyperglycemia-induced vascular endothelial cell apoptosis through FoxO1-mediated macroautophagy
Authors: Lin Xuze , Huang Sizhuang , Gao Side , Liu Jinxing , Tang Jiong , Yu Mengyue
Published: July 2023

Background:

Hyperglycemia frequently induces apoptosis in endothelial cells and ultimately contributes to microvascular dysfunction in patients with diabetes mellitus (DM). Previous research reported that the expression of integrins as well as their ligands was elevated in the diseased vessels of DM patients. However, the association between integrins and hyperglycemia-induced cell death is still unclear. This research was designed to investigate the role played by integrin subunit β5 (ITGB5) in hyperglycemia-induced endothelial cell apoptosis.

Methods:

We used leptin receptor knockout (Lepr-KO) (db/db) mice as spontaneous diabetes animal model. Selective deletion of ITGB5 in endothelial cell was achieved by injecting vascular targeted adeno-associated virus via tail vein. Besides, we also applied small interfering RNA in vitro to study the mechanism of ITGB5 in regulating high glucose-induced cell apoptosis.

Results:

ITGB5 and its ligand, fibronectin, were both upregulated after exposure to high glucose in vivo and in vitro. ITGB5 knockdown alleviated hyperglycemia-induced vascular endothelial cell apoptosis and microvascular rarefaction in vivo.
In vitro analysis revealed that knockdown of either ITGB5 or fibronectin ameliorated high glucose-induced apoptosis in human umbilical vascular endothelial cells (HUVECs). In addition, knockdown of ITGB5 inhibited fibronectin-induced HUVEC apoptosis, which indicated that the fibronectin-ITGB5 interaction participated in high glucose-induced endothelial cell apoptosis. By using RNA-sequencing technology and bioinformatic analysis, we identified Forkhead Box Protein O1 (FoxO1) as an important downstream target regulated by ITGB5. Moreover, we demonstrated that the excessive macroautophagy induced by high glucose can contribute to HUVEC apoptosis, which was regulated by the ITGB5–FoxO1 axis.

Conclusion:

The study revealed that high glucose-induced endothelial cell apoptosis was positively regulated by ITGB5, which suggested that ITGB5 could potentially be used to predict and treat DM-related vascular complications.
Signet-Ring Cell/Histiocytoid Carcinoma: Report of Two Cases and Systematic Review of the Literature on the Epidemiology, Clinical Characteristics, and Pathological and Molecular Findings
Authors: Michalek Irmina Maria , Caetano dos Santos Florentino Luciano , Zwolinski Jakub , Olszewski Wojciech , Gałazka Adam , Prochorec-Sobieszek Monika , Durzynska Monika
Published: July 2023

Signet-ring cell/histiocytoid carcinoma (SRCHC) is a rare appendageal tumor, mainly considering eyelids, more rarely axillae. This article describes 2 novel SRCHC cases of 71- and 66-year-old men and systematically reviews the literature on SRCHC. Of all cases reported in the literature, 73 (91.2%) were men and 7 (8.8%) were women. The median age at diagnosis was 71 years. Skin changes were located in the eyelids (68%) and axillae (32%). In all tested cases, SRCHC cells expressed CK7, CKAE1/AE3, EMA, CAM5.2, and AR and PIK3CA mutations. Future research should determine whether AR/PIK3CA-targeted therapies influence patients' survival.
Perianal Cutaneous Spindle Cell Squamous Cell Carcinoma With Myxoid Stroma: Case Report and Literature Review
Authors: Zhurauliou Aliaksandr , Vasyukova Olesya
Published: July 2023

Spindle cell squamous cell carcinoma with myxoid stroma is a rare variant of squamous cell carcinoma with sarcomatoid morphology. We report a case of a 75-year-old woman with an ulcerated polypoid cutaneous mass in the perianal area. The patient had a history of clear cell renal cell carcinoma. Microscopy revealed an invasive myxoid spindle cell carcinoma without the classic squamous cell carcinoma component. The immunohistochemical study demonstrated diffuse positive reactions for p63, AE1/3, and CK5/6. The tumor cells were negative for desmin, smooth muscle actin, S100, and CD34. Fluorescent in situ hybridization was negative for EWSR1 gene rearrangement. Follow-up was remarkable for recurrence of tumor in 2 months after complete resection with negative surgical margin. This is the first case report of perianal spindle cell squamous cell carcinoma with myxoid stroma with a literature review of previous case reports from different locations.
Comparison of Ticagrelor Monotherapy and Ticagrelor Plus Aspirin Among Patients With Acute Coronary Syndrome Combined With High-Risk of Gastrointestinal Bleeding After Percutaneous Coronary Intervention: A Retrospective Cohort Study
Authors: Tian Ming-Yu , Wang Xiao-Yan , Chen Feng , Guo Yun-Feng
Published: July 2023

To date, no studies have specifically examined the efficacy of P2Y12 inhibitor monotherapy in patients with acute coronary syndrome (ACS) exhibiting a high risk of gastrointestinal (GI) bleeding following percutaneous coronary intervention (PCI). This was a retrospective cohort study of ACS exhibiting a high GI bleeding risk after PCI admitted to the Affiliated Hospital of the Jiangnan University from August 2016 to December 2019. Of the 308 enrolled patients, 269 were found eligible and were assigned to the ticagrelor monotherapy (TIC) arm (n = 128) and to ticagrelor plus aspirin (TIC + ASP) arm (n = 141) treatment for a 1-year period. The primary study outcome was a composite end point, including bleeding academic research consortium (BARC) type 2, 3, or 5 bleeding and adverse cardiac or cerebrovascular events; 8 (6.3%) in the TIC group and 14 (9.9%) in the combination treatment group reached the primary ischemic end point within 1 year with no significant difference between these groups. BARC type 2, 3, and 5 bleeding events affected significantly more patients in the combination group relative to the TIC group (38 [27.0%] vs. 11 [8.6%], P < 0.001). As the follow-up interval was prolonged, the cumulative BARC type 2, 3, and 5 bleeding incidence in the TIC group remained significantly below than that in the combination treatment group (P < 0.05). These results indicate that TIC is associated with a lower risk of clinically relevant bleeding events among ACS with a high risk of GI bleeding after PCI relative to combination TIC + ASP treatment, although ischemic outcomes in these 2 groups were similar.
Severe acute respiratory syndrome coronavirus 2 infection does not worsen the course of inflammatory bowel disease in the long term
Authors: Neri Benedetto , D’Agostini Giorgia , Salvatori Silvia , Mossa Michelangela , Bettin Federica , Mancone Roberto , Marafini Irene , Lolli Elisabetta , Calabrese Emma , Monteleone Giovanni , Biancone Livia
Published: July 2023

Background

The long-term outcome of inflammatory bowel disease (IBD) patients after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is under investigation.

Aim

To assess, in a prospective study, whether a recent SARS-CoV-2 infection increases the risk of IBD relapse within 12 months.

Methods

From March to April 2021, all IBD patients with recent (<2 months) SARS-CoV-2 infection (Cases) were enrolled. For each enrolled Case, four IBD Controls with no history of infection were considered. Clinical course of IBD was recorded for 12 months. Inclusion criteria: well defined diagnosis of IBD; age ≥18 and ≤85 years; 12-month follow-up; consent. Exclusion criteria: incomplete data; SARS-CoV-2 infection after enrollment. Additional inclusion criteria: recent SARS-CoV-2 infection for Cases; no history of SARS-CoV-2 infection for Controls. Data expressed as median [range]. Statistical analysis: Student-t-Test, Mann–Whitney U-test, χ
2 test, multivariate logistic regression model [odds ratio (95% confidence interval)], Kaplan–Meier curves.

Results

One hundred forty-three IBD patients were enrolled. The analysis included 118 patients (22 met the exclusion criteria, three lost at follow-up): 29 (24.6%) Cases and 89 (75.4%) Controls. Demographic and clinical characteristics were comparable between groups. During the 12-month study, the frequency of IBD relapse was comparable between Cases and Controls [8 (27%) vs 19 (21%); P = 0.65]. At univariate analysis, SARS-CoV-2 infection was not a risk factor for IBD relapse within 12 months [1.5 (0.6–3.9); P = 0.34]. At multivariate analysis, IBD activity at baseline was the only risk factor for relapse [3.2 (1.1–9.1); P = 0.03]. Kaplan–Meier curves showed that survival from IBD relapse was comparable between Cases and Controls (P = 0.33).

Conclusion

In a prospective 12-month study, a recent SARS-CoV-2 infection did not increase the risk of clinical relapse of IBD in the long term.
The impact of race and gender on the outcomes of patients with acetaminophen-induced acute liver failure: propensity score-matched analysis of the NIS database
Authors: Lee David Uihwan , Choi Dabin , Shaik Mohammed Rifat , Schuster Kimmy , Schellhammer Sophie , Ponder Reid , Lee Ki Jung , Chou Hannah , Ding Samuel , Bahadur Aneesh , Fan Gregory , Lominadze Zurabi
Published: July 2023

Background

Acetaminophen overdose is one of the leading causes of acute liver failure in the USA. In this study, we investigated the impact of race and gender on the hospital outcomes of patients admitted with acetaminophen-induced acute liver failure.

Methods

From the National Inpatient Sample between the years 2016 and 2019, patients with acetaminophen-induced acute liver failure were selected and stratified based on gender (Male and Female) and race (White, Black and Hispanic). The cases were propensity score-matched to controls (male and Whites) and were compared along the following endpoints: mortality, length of stay, hospitalization costs, and hepatic complications.

Results

Among patients with acetaminophen-induced acute liver failure, females experienced higher rates of mortality (16.60% vs. 11.70%, P = 0.004) and clinical illness, including hypotension (11.80% vs. 7.15%, P = 0.002) and ventilator use (40.80% vs. 30.00%, P < 0.001). When stratified by race, Black patients had longer hospital stays (Black vs. White, 8.76 days vs. 7.46 days, P = 0.03). There were no significant differences in outcomes between Hispanic and White patients. No significant differences in mortality were shown between races.

Conclusion

We found that females had a higher rate of mortality and incidence of hepatic encephalopathy compared to males. When stratified by race, Blacks were shown to have longer hospital stay. Females and racial minorities were also affected by special healthcare needs after discharge compared to their male and White cohorts, respectively.
Clostridioides difficile and colorectal cancer: a dangerous liaison
Authors: Bassotti Gabrio , Stracci Fabrizio , Marconi Pierfrancesco , Fettucciari Katia
Published: July 2023

Many colorectal diseases depend on complex interactions between several pathophysiological factors, including the intestinal microbiota. In recent years, the widespread use of antibiotics has been recognized as a main cause of intestinal dysbiosis and a favouring factor for Clostridioides difficile infection. The latter, in addition, causes infectious diarrhoea, pseudomembranous colitis, and toxic megacolon by means of its toxins (A and, especially, B), is characterized by frequent relapses; thus, its persistence in a host may be long-lasting. Based on recent experimental evidence, here we analyse the possibility that, similarly to other bacteria, Clostridioides difficile may be considered a potential carcinogen for colorectal cancer.
Relationship Between Pericallosal Lipoma and Neuropsychiatric Symptoms
Authors: Abbas Zargham , Mahmood Tayyibah , Bellman Val , Koirala Prashar , Myers Trenton
Published: July 2023

Intracranial lipomas are extremely rare fat-containing lesions that occur due to the abnormal differentiation of embryonic meninges. Interhemispheric lipomas that are closely related to the corpus callosum are also referred to as pericallosal lipomas and are the most common subtype. Pericallosal lipomas are associated with varying degrees of dysgenesis of the corpus callosum and therefore have a broad clinical presentation. Herein, we describe a case of a 15-year-old man who presented with a history of developmental delay and psychiatric symptoms and was incidentally found to have a pericallosal lipoma on magnetic resonance imaging, prompting clinical correlation.
Palliating in Avoidable Death: Reconciling Psychiatrists' Roles as Treaters on Death Row With Participation in a System of Overt Harm
Authors: Shah Arya
Published: July 2023

Although nations across the globe have eliminated capital punishment, the United States remains one of the few countries in the Americas and Europe that still uses execution. There has been little discussion around the implications of psychiatry's involvement in providing care to incarcerated individuals awaiting death. The following perspective examines the United States as an example of a democratic and highly developed country where the death penalty remains an undeniable reality; the piece provides a brief discussion on psychiatry's relationship with end-of-life care to provide context for subsequent discussion on the role of the psychiatrist on death row in the United States. Medicolegal and ethical considerations are further outlined to identify specific concessions that might be made by the US criminal justice system to truly allow death row psychiatrists to practice to the highest standard of compassionate care.
Reactive Psychosis
Authors: Castagnini Augusto C. , Berrios German E.
Published: July 2023

Reactive psychosis (RP) is a trauma-induced category whose meaning has varied in relation to the role attributed to lived experiences or vulnerable personality. It has long been described in different countries, but seldom investigated under the influence of symptom-based psychiatric classifications. This article aims to examine the development of RP since the early 20th century, outline how it has been incorporated in modern diagnostic classifications, and set out empirical findings. It is likely that variations in terminology and diagnostic practice have affected estimates of the frequency and hampered the validity of RP in earlier studies. To enhance reliability, RP underwent several changes in successive Diagnostic and Statistical Manual of Mental Disorders and ICD versions and was eventually replaced with descriptive categories for short-lived psychotic disorders. Clinical observations during the COVID-19 pandemic attest the durability of RP, but the current categories prove unhelpful in identifying it and have failed to encourage research.
Transumbilical Silicone Implant Breast Augmentation
Authors: Huang Wen-Chi , Tsai Ming-Feng , Yang San-Tsun , Chen Shu-Hsien , Ou Kuang-Wen , Tung Kwang-Yi , Huang Wen-Chen , Yu Chia-Meng
Published: July 2023

In transumbilical breast augmentation (TUBA) with prefilled silicone implants, technical challenges remain to accommodate more implant options and dissection planes. The authors aimed to demonstrate the feasibility of TUBA using various types of prefilled silicone implants (TUSBA) and its applicability for subglandular, subfascial, dual-plane implantation. In the early stage, TUSBA was primarily performed using endoscope-assisted blunt dissection, and later converted to full endoscopy dissection to achieve better results. An endoscope was used to confirm the pocket and check bleeding for both groups. For the endoscope-assisted group, surgical techniques were modified from conventional TUBA. In full endoscopy TUSBA, the entire dissection process was performed under endoscopic monitoring. Preliminary data of patients undergoing TUSBA from June of 2016 to April of 2021 were retrospectively reviewed. Breast implants with smooth, textured, or nanotextured surface properties and round or anatomic shapes were used, with sizes up to 500 mL. Seventy-four patients with a mean age of 36.4 years (range, 21 to 55 years) were enrolled in this study. Follow-up ranged from 1 month to 4.5 years (mean, 15.6 months). No excessive postoperative pain in breast or abdomen was reported. Surgery outcomes were aesthetically pleasing in both groups. In the endoscope-assisted group, 3 patients (4.6%) required major revisional procedures. No revision was required in the full-endoscopy group. TUSBA with various types of silicone implants is feasible and accommodable to all dissection planes. The full-endoscopy technique is helpful in reducing the higher complication rate.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Venous Thromboembolism after DIEP Flap Breast Reconstruction: Review of Outcomes after a Postoperative Prophylaxis Protocol
Authors: Tuaño Krystle R. , Yang Jerry H. , Fisher Marlie H. , Le Elliot , Khatter Neil J. , Kalia Nargis , Colakoglu Salih , Cohen Justin B. , Kaoutzanis Christodoulos , Chong Tae W. , Mathes David W.
Published: July 2023

Background:

Deep inferior epigastric perforator (DIEP) flap breast reconstruction is among the higher-risk patient groups for venous thromboembolism (VTE) in plastic surgery. Surgeons often opt for a patient-specific approach to postoperative anticoagulation, and the field has yet to come to a consensus on VTE chemoprophylaxis regimens.

Methods:

A new chemoprophylaxis protocol was introduced starting in March of 2019 that involved 2 weeks of treatment with enoxaparin, regardless of patient risk factors. A retrospective chart review was conducted on all patients who underwent DIEP flap breast reconstruction at the authors’ institution between January of 2014 and March of 2020. Patients were grouped based on whether they enrolled in the new VTE protocol in the postoperative period or not. Patient demographics, prophylaxis type, and outcomes data were recorded, retrospectively. The primary outcome measure was postoperative VTE incidence.

Results:

Risk of VTE was significantly higher in patients discharged without VTE prophylaxis compared with patients discharged with prophylaxis (3.7% versus 0%; P = 0.03). Notably, zero patients in the VTE prophylaxis group developed a deep venous thrombosis or pulmonary embolism. In addition, the risk of a VTE event was 25 times greater in patients with a Caprini score greater than or equal to 6 (P = 0.0002).

Conclusion:

The authors demonstrate the successful implementation of a 2-week VTE chemoprophylaxis protocol in DIEP flap breast reconstruction patients that significantly reduces the rate of VTE while not affecting the rate of hematoma complications.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, III.
Topical Tranexamic Acid Does Not Reduce Hematoma in Reduction Mammaplasty: A Double-Blind Randomized Controlled Trial
Authors: Yao Amy , Wang Fei , Benacquista Teresa , Draper Lawrence B. , Garfein Evan S. , Monaco Casian , Tepper Oren M. , Weichman Katie E. , Ricci Joseph A.
Published: July 2023

Background:

Breast reduction mammaplasty is among the most common procedures in plastic surgery, with a 1% to 7% postoperative hematoma incidence reported. Tranexamic acid (TXA) has been shown to reduce perioperative bleeding and need for transfusion when administered intravenously or topically, but it remains underused in plastic surgery. This study aims to investigate whether topical administration of topical TXA reduces postoperative hematoma following breast reduction mammaplasty.

Methods:

A double-blind randomized controlled trial of 98 patients (196 breasts) undergoing bilateral primary reduction mammaplasty at a single academic institution was performed. Patients were used as internal matched controls, with one breast randomized to receive 1000 mg of topical TXA before closure, and the other receiving saline. All members of the surgical team and the patient were blinded as to which breast received the study drug. Postoperative complications, including hematoma within 30 days of surgery, drain outputs, and duration of drain use, were compared between treatment and placebo breasts.

Results:

The overall hematoma rate was 1.5%. There was no significant association between application of TXA and development of a hematoma (P = 0.56) or other complications. The hematoma rate of patients enrolled in the trial was similar to the overall rate of hematoma during the study period (1.5% versus 2.4%; P = 0.511). In a multivariate model, TXA was not significantly associated with differences in drain output after controlling for resection weight, age, and duration of drain use (P = 0.799). No adverse effects or thromboembolic events from TXA were observed.

Conclusion:

Topical application of TXA does not decrease the incidence of hematoma following reduction mammaplasty.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, I.
Hepatic steatosis and NAFLD are common and associated with cardiometabolic risk in a primary prevention cohort of people with HIV
Authors: Lake Jordan E. , Taron Jana , Ribaudo Heather J. , Leon-Cruz Jorge , Utay Netanya S. , Swaminathan Shobha , Fitch Kathleen V. , Kileel Emma M. , Paradis Kayla , Fulda Evelynne S. , Ho Ken S. , Luetkemeyer Anne F. , Johnston Carrie D. , Zanni Markella V. , Douglas Pamela S. , Grinspoon Steven K. , Lu Michael T. , Fichtenbaum Carl J.
Published: July 2023

Background:

Hepatic steatosis, including non-alcoholic fatty liver disease (NAFLD), is common among people with HIV (PWH). We present baseline steatosis prevalence and cardiometabolic characteristics among REPRIEVE substudy participants.

Methods:

REPRIEVE is an international, primary cardiovascular disease prevention, randomized, controlled trial of pitavastatin calcium vs. placebo among 7,769 PWH ages 40–75 years on antiretroviral therapy (ART) and with low-to-moderate cardiovascular risk. A subset of participants underwent non-contrast computed tomography, with hepatic steatosis defined as mean hepatic attenuation <40 HU or liver/spleen ratio <1.0, and NAFLD defined as steatosis in the absence of frequent alcohol use or viral hepatitis.

Results:

Of 687 evaluable persons, median age was 51 years, BMI 27 kg/m2, CD4+ T cell count 607 cells/mm3; 17% natal female sex, 36% Black, 24% Hispanic, and 98% HIV-1 RNA <400 copies/mL. Hepatic steatosis prevalence was 22% (149/687), and NAFLD 21% (96/466). Steatosis/NAFLD prevalence was higher in males and with older age, non-Black race, and higher BMI and waist circumference. Both were associated with BMI >30 kg/m2, Metabolic Syndrome components, higher ASCVD risk score, HOMA-IR, LpPLA-2 and hs-CRP, and lower high-density lipoprotein cholesterol. Of HIV-/ART-specific characteristics, only history of an AIDS-defining illness was more common among persons with steatosis/NAFLD. After adjusting for age, sex and race/ethnicity, BMI >30 kg/m2, HOMA-IR >2.0, Metabolic Syndrome and each of its components were associated with NAFLD prevalence.

Conclusions:

In this cohort with controlled HIV and low-to-moderate cardiovascular risk, hepatic steatosis and NAFLD were common and associated with clinically relevant metabolic and inflammatory disturbances, but not current HIV- or ART-related factors.