bluuebunny/crossref_metadata_2025 huggingface dataset:
Global Prevalence of Chronic Pain in Women with HIV: A Systematic Review and Meta-analysis
Authors: Povshedna Tetiana , Swann Shayda A , Levy Sofia L A , Campbell Amber R , Choinière Manon , Durand Madeleine , Price Colleen , Gill Prubjot , Murray Melanie C M , Côté Hélène C F
Published: July 2023

Chronic pain is common among people with human immunodeficiency virus (HIV) and detrimental to quality of life and overall health. It is often underdiagnosed, undertreated, and frankly dismissed in women with HIV, despite growing evidence that it is highly prevalent in this population. Thus, we conducted a systematic review and meta-analysis to estimate the global prevalence of chronic pain in women with HIV. The full protocol can be found on PROSPERO (identifier CRD42022301145). Of the 2984 references identified in our search, 36 were included in the systematic review and 35 in the meta-analysis. The prevalence of chronic pain was 31.2% (95% confidence interval [CI], 24.6%–38.7%; I2 = 98% [95% CI, 97%–99%]; P < .0001). In this global assessment, we found a high prevalence of chronic pain among women with HIV, underscoring the importance of understanding the etiology of chronic pain, identifying effective treatments, and conducting regular assessments in clinical practice.
Neural Signatures of Predictive Strategies Track Individuals Along the Autism-Schizophrenia Continuum
Authors: Tarasi Luca , Martelli Maria Eugenia , Bortoletto Marta , di Pellegrino Giuseppe , Romei Vincenzo
Published: July 2023

Background and Hypothesis

Humans develop a constellation of different representations of the external environment, even in the face of the same sensory exposure. According to the Bayesian framework, these differentiations could be grounded in a different weight assigned to prior knowledge vs. new external inputs in predictive inference. Since recent advances in computational psychiatry suggest that autism (ASD) and schizophrenia (SSD) lie on the two diametric poles of the same predictive continuum, the adoption of a specific inferential style could be routed by dispositional factors related to autistic and schizotypal traits. However, no studies have directly investigated the role of ASD–SSD dimension in shaping the neuro-behavioral markers underlying perceptual inference.

Study Design

We used a probabilistic detection task while simultaneously recording EEG to investigate whether neurobehavioral signatures related to prior processing were diametrically shaped by ASD and SSD traits in the general population (n = 80).

Results

We found that the position along the ASD–SSD continuum directed the predictive strategies adopted by the individuals in decision-making. While proximity to the positive schizotypy pole was associated with the adoption of the predictive approach associated to the hyper-weighting of prior knowledge, proximity to ASD pole was related to strategies that favored sensory evidence in decision-making.

Conclusions

These findings revealed that the weight assigned to prior knowledge is a marker of the ASD–SSD continuum, potentially useful for identifying individuals at-risk of developing mental disorders and for understanding the mechanisms contributing to the onset of symptoms observed in ASD and SSD clinical forms.
Low androgen levels induce ferroptosis of rat penile cavernous endothelial cells
Authors: Shi Hong-Xing , Zhao Xin , Yang Haifan , Cheng Yong , Jiang Jun , Jiang Rui
Published: July 2023

Background

Endothelial dysfunction caused by low androgen levels in penile tissue can lead to erectile dysfunction. The exact mechanism of endothelial dysfunction has not been thoroughly studied.

Objective

The study sought to verify whether low androgen levels induce ferroptosis of endothelial cells in rat penile tissue.

Methods

Rat penile cavernous endothelial cells (CP-R133) were divided into a no-androgen group (Dihydrotestosterone (DHT): 0 nmol/L), very low-androgen group (DHT: 0.1 nmol/L), low-androgen group (DHT: 1 nmol/L), DHT = 10 nmol/L group, DHT (0 nmol/L) + ferrostatin-1 (Fer-1) group, DHT (0.1 nmol/L) + Fer-1 group, DHT (1 nmol/L) + Fer-1 group, DHT (10 nmol/L) + Fer-1 group. Cell viability, intracellular ferrous ion (Fe2+), malondialdehyde (MDA), GSH into oxidized glutathione (GSSG), reactive oxygen species (ROS), nitric oxide (NO), transferrin receptor 1 protein (TfR1), solute carrier family 7 member 11 (SLC7A11), glutathione peroxidase 4 (GPX4), acyl-CoA synthetase long-chain family member 4 (ACSL4), endothelial nitric oxide synthase (eNOS), and phospho-eNOS (p-eNOS) were detected.

Outcomes

Low androgen levels could induce ferroptosis of rat penile cavernous endothelial cells in vivo by upregulating the expressions of TfR1 and ACSL4 and downregulating the expressions of SLC7A11 and GPX4.

Results

Cell viability, the levels of glutathione (GSH), NO, SLC7A11, GPX4, and p-eNOS/eNOS in the DHT = 0 nmol/L group were lower than those in the other groups (P < .05). The levels of Fe2+, ROS, MDA, GSSG, TfR1, and ACSL4 in the DHT = 0 nmol/L group were higher than those in the other groups (P < .05). Cell viability and the levels of GSH, NO, SLC7A11, GPX4, and p-eNOS/eNOS in the DHT = 1 nmol/L group were lower than those in the DHT (1 nmol/L) + Fer-1 group, DHT = 10 nmol/L group, and DHT (10 nmol/L) + Fer-1 group (P < .05). The levels of Fe2+, ROS, MDA, GSSG, TfR1, and ACSL4 in the DHT = 1 nmol/L group were higher than those in the DHT (1 nmol/L) + Fer-1 group, DHT = 10 nmol/L group, and DHT (10 nmol/L) + Fer-1 group (P < .05).

Clinical Implications

A ferroptosis inhibitor might be a novel drug for treating erectile dysfunction caused by low androgen level.

Strengths and Limitations

The results of this study need to be further confirmed in in vitro and in human studies. Meanwhile, further investigation is needed to clarify whether low androgen levels affect ferroptosis of rat penile cavernous smooth muscle and nerve cells.

Conclusion

Low androgen levels can induce ferroptosis of endothelial cells in rat penile tissue. Inhibition of ferroptosis can reverse endothelial dysfunction caused by low androgen levels.
Demonstrating the Value of Routine Anesthesiologist Involvement in Acute Stroke Care: A Retrospective Chart Review
Authors: McCusker Robert J. , Chinchilli Vernon M. , Fritch Chanju D. , Kochar Puneet S. , Sharma Sonal
Published: July 2023

Introduction:

The value of routine involvement of anesthesiologists during endovascular thrombectomy (EVT) for acute ischemic stroke has not been clearly demonstrated. At some institutions, anesthesiologists are involved only as needed, while at other institutions, anesthesiologists are involved from the beginning for every EVT.

Methods:

We retrospectively analyzed the workflow, intraprocedural variables and complications, and outcomes in acute ischemic stroke patients undergoing EVT at a comprehensive stroke center after implementation of routine involvement of an anesthesia team and compared this cohort with patients who received care from sedation-trained nurses working under the supervision of neurointerventionalists with the involvement of anesthesiologists on an as-needed basis.

Results:

Routine involvement of anesthesiologists was associated with improved workflow performance measures, including decreased median door-to-arterial puncture time (68 min; interquartile range (IQR), 15.5–94.5 min vs. 81 min; IQR, 53–104 min; P=0.001), in-room to arterial puncture time (11 min; IQR, 8–14 min vs. 15 min; IQR, 9–21 min; P<0.0001), and procedure time (51 min; IQR, 40–64 min vs. 60 min; IQR, 40–88.5 min; P=0.007). It was also associated with a nonsignificant trend towards lower rates of desaturation events (8.2% vs. 3.4%; P=0.082) and lower rates of conversion to general anesthesia (1.7% vs. 0%; P=0.160). Ninety-day modified Rankin scores were similar regardless of provider type.

Conclusion:

Implementation of routine involvement of an anesthesia team during EVT was not associated with improved outcomes but was associated with improved efficiency and greater adherence to guidelines-based physiological parameters, supporting the routine involvement of anesthesiologists during EVT.
Monitored Anesthesia Care and Soft Tissue Infiltration with Local Anesthesia: An Anesthetic Option for High-Risk Patients with Hip Fractures
Authors: Konda Sanjit R. , Solasz Sara , Ganta Abhishek , Egol Kenneth A.
Published: July 2023

This review demonstrates the technique for monitored anesthesia care and soft tissue infiltration with local anesthesia as the only form of anesthesia for short cephalomedullary nailing in medically complex patients. Monitored anesthesia care is defined as providing sedation and analgesia that is titrated to a level that preserves spontaneous breathing and airway reflexes. Soft tissue infiltration refers to soft tissue infiltration with local anesthesia directly into the surgical site and is performed by the surgeon before the start of the procedure.
Stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture: a systemic review with meta-analysis
Authors: Cao Shengxuan , Wang Chen , Chen Yungu , Zhang Chao , Huang Jiazhang , Ma Xin , Wang Xu
Published: July 2023

Objectives:

To determine the diagnostic accuracy of various stress tests for deltoid ligament and syndesmosis injury in patients with ankle fracture.

Data Sources:

A systemic literature search was conducted in the Medline, Embase, and Cochrane Library databases to identify studies published from January 1990 to August 2022.

Study selection:

Studies that evaluated external rotation or gravity stress tests, or hook or tap tests for the diagnosis of deltoid ligament or syndesmosis injury were included.

Data Extraction:

Authors, publication years, study design, index tests, reference standards, demographic features of participants, reliability and the numbers of true positive, true negative, false positive, and false negative subjects were extracted from 14 included studies. Article quality was assessed through the revised Quality Assessment of Diagnostic Accuracy Studies tool.

Data synthesis:

The pooled sensitivity and specificity of each index test for each structure were calculated with a random-effects model using the extracted data of true positive, true negative, false positive, and false negative outcomes in all relevant studies. The overall diagnostic performance of the different index tests for different structures was determined with the estimation of the area under the curve using the summary receiver operating characteristics curve.

Conclusions:

The gravity stress test and the tap test exhibited high sensitivity and specificity in diagnosing deltoid ligament injury. The hook test has relatively high accuracy in diagnosing syndesmosis injury. Further studies with large sample sizes are warranted to confirm the results of this review.

Levels of Evidence:

Diagnostic Level III. See Instructions for Authors for a complete description of levels of evidence.
Study on sustentaculum tali fragment constancy in intraarticular calcaneus fracture
Authors: Yan Hongfei , Na Ho Dong , Park Jeong Jin , Park Chul Hyun
Published: July 2023

OBJECTIVES:

To establish reproducible measurements of the sustentaculum tali (ST) fragment regarding fracture classification and patient-related factors.

DESIGN:

Retrospective.

SETTING:

Trauma center, University Hospital.

PATIENTS:

A retrospective analysis of the 142 fractured calcanei of 122 patients (101 men and 21 women) treated at our institution between 2012 to 2020 was performed. As control, 62 unaffected calcanei were used.

INTERVENTION:

Radiographic images were evaluated twice within 2 weeks by two orthopedic surgeons and one postgraduate student. Angulation and diastasis were used to distinguish ST fragment constancy based on computed tomography. Using these parameters, the prevalence of inconstant ST fragments was assessed. We also analyzed factors related to ST fragment inconstancy. Patient factors included age, body mass index, smoking, and diabetes. Radiographic factors included the Sanders’ classification, location of the outermost fracture line of the posterior facet, presence of an intraarticular fracture of the ST, and ST fragment width.

MAIN OUTCOME MEASUREMENTS:

Angulation and diastasis were used to confirm the ST fragment constancy. Potential risks for inconstant ST fragment subsequently defined.

RESULTS:

According to the criteria, ST fragment inconstancy was observed in 34.5%. ST fragment width was significantly smaller in the inconstant group (p < 0.001). Severe comminution of the posterior facet (p < 0.05), intraarticular fracture of the ST (p < 0.001), and diabetes (p < 0.05) were significantly higher in the inconstant group. The cut-off value of the ST fragment width was 20.5 mm.

CONCLUSIONS:

In intraarticular calcaneus fractures, small ST fragment width, comminuted fracture, intraarticular fracture of the ST, and diabetes were associated with the inconstant group. The ST fragment was expected to be inconstant when the width was less than 20.5 mm.

LEVEL OF EVIDENCE:

Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
Costs and Consequences of a Novel Emergency Department Sepsis Diagnostic Test: The IntelliSep Index
Authors: Hollenbeak Christopher S. , Henning Daniel J. , Geeting Glenn K. , Ledeboer Nathan A. , Faruqi Imran A. , Pierce Christi G. , Thomas Christopher B. , O’Neal Hollis R.
Published: July 2023

OBJECTIVES:

Sepsis causes 270,000 deaths and costs $38 billion annually in the United States. Most cases of sepsis present in the emergency department (ED), where rapid diagnosis remains challenging. The IntelliSep Index (ISI) is a novel diagnostic test that analyzes characteristics of WBC structure and provides a reliable early signal for sepsis. This study performs a cost-consequence analysis of the ISI relative to procalcitonin for early sepsis diagnosis in the ED.

PERSPECTIVE:

U.S. healthcare system.

SETTING:

Community hospital ED.

METHODS:

A decision tree analysis was performed comparing ISI with procalcitonin. Model parameters included prevalence of sepsis, sensitivity and specificity of diagnostic tests (both ISI and procalcitonin), costs of hospitalization, and mortality rate stratified by diagnostic test result. Mortality and prevalence of sepsis were estimated from best available literature. Costs were estimated based on an analysis of a large, national discharge dataset, and adjusted to 2018 U.S. dollars. Outcomes included expected costs and survival.

RESULTS:

Assuming a confirmed sepsis prevalence of 16.9% (adjudicated to Sepsis-3), the ISI strategy had an expected cost per patient of $3,849 and expected survival rate of 95.08%, whereas the procalcitonin strategy had an expected cost of $4,656 per patient and an expected survival of 94.98%. ISI was both less costly and more effective than procalcitonin, primarily because of fewer false-negative results. These results were robust in sensitivity analyses.

CONCLUSIONS:

ISI was both less costly and more effective in preventing mortality than procalcitonin, primarily because of fewer false-negative results. The ISI may provide health systems with a higher-value diagnostic test in ED sepsis evaluation. Additional work is needed to validate these results in clinical practice.
Definition and Clinical Evaluation for Trimethoprim-Sulfamethoxazole Severe Acute Respiratory Failure
Authors: Miller Jenna , Khan Hason , Mino-Kenudson Mari , Taylor Martin , Shih Angela , Goldman Jennifer
Published: July 2023

OBJECTIVES:

Trimethoprim-sulfamethoxazole (TMP-SMX)-associated severe acute respiratory distress syndrome (ARDS) has gone underrecognized. We propose the first disease definition and clinical evaluation for a novel adverse drug reaction (ADR) based on a series of recently identified rare cases of life-threatening ADRs.

DESIGN:

A retrospective study was conducted. All medical records were evaluated. Available pathology samples were sent to Massachusetts General for clinical consultation. Blood samples from surviving patients were obtained and human leukocyte antigen (HLA) analysis was performed by the Children’s Mercy Hospital Genomic Center and Vanderbilt University Medical Center.

SETTING:

U.S. ICUs, 1996–2021.

PATIENTS:

Nineteen young patients (10–37) were identified. Patients were previously healthy, with no preexisting pulmonary disease, no other cause for respiratory failure, and no chronic history of smoking/vaping.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Through our retrospective analysis, we analyzed clinical characteristics associated with TMP-SMX. Pathology samples were reviewed, and HLA analysis was performed on available samples by the study team or as standard of care at treatment hospitals in some cases. In 19 critically ill patients, we identified a pattern of severe respiratory failure requiring ICU admission, mechanical ventilation, and frequent extracorporeal membrane oxygenation use. We describe the first three-part clinical diagnosis and evaluation strategy: 1) Clinical definition: Unexplained severe respiratory failure in a patient receiving greater than or equal to 6 days of TMP-SMX at treatment dose (not prophylaxis). TMP-SMX ARDS is a diagnosis of exclusion. 2) Genetic association: One hundred percent of currently available TMP-SMX respiratory failure patient genomic data, (n = 11) have been carriers of both HLA-B*07:02 and HLA-C*07:02 alleles. HLA allele evaluation could be considered in patients with suspected TMP-SMX respiratory failure. 3) Lung pathology: A unique pulmonary pathologic pattern of lung injury termed diffuse alveolar injury with delayed epithelialization has been observed in these cases. In suspected cases, surgical lung biopsy early in the clinical course could be considered.

CONCLUSIONS:

TMP-SMX is a commonly prescribed antibiotic. However, we find it imperative to share this relatively rare but life-threatening condition with clinicians as the mortality rate approaches 40%.
Long-term exposure to low-concentration PM2.5 and heart disease in older men in Perth, Australia: The Health in Men Study
Authors: Jones Joshua S. , Nedkoff Lee , Heyworth Jane S. , Almeida Osvaldo P. , Flicker Leon , Golledge Jonathan , Hankey Graeme J. , Lim Elizabeth H. , Nieuwenhuijsen Mark , Yeap Bu B. , Trevenen Michelle L.
Published: July 2023

Background:

Exposure to particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5) is associated with increased risk of heart disease, but less is known about the relationship at low concentrations. This study aimed to determine the dose-response relationship between long-term PM2.5 exposure and risk of incident ischemic heart disease (IHD), incident heart failure (HF), and incident atrial fibrillation (AF) in older men living in a region with relatively low ambient air pollution.

Methods:

PM2.5 exposure was estimated for 11,249 older adult males who resided in Perth, Western Australia and were recruited from 1996 to 1999. Participants were followed until 2018 for the HF and AF outcomes, and until 2017 for IHD. Cox-proportional hazards models, using age as the analysis time, and adjusting for demographic and lifestyle factors were used. PM2.5 was entered as a restricted cubic spline to model nonlinearity.

Results:

We observed a mean PM2.5 concentration of 4.95 μg/m3 (SD 1.68 μg/m3) in the first year of recruitment. After excluding participants with preexisting disease and adjusting for demographic and lifestyle factors, PM2.5 exposure was associated with a trend toward increased incidence of IHD, HF, and AF, but none were statistically significant. At a PM2.5 concentration of 7 μg/m3 the hazard ratio for incident IHD was 1.04 (95% confidence interval [CI] = 0.86, 1.25) compared with the reference category of 1 μg/m3.

Conclusions:

We did not observe a significant association between long-term exposure to low-concentration PM2.5 air pollution and IHD, HF, or AF.
Comparative safety of conjugated estrogens/bazedoxifene versus estrogen/progestin combination hormone therapy among women in the United States: a multidatabase cohort study
Authors: Hoffman Sarah R. , Governor Samuel , Daniels Kimberly , Seals Ryan M. , Ziyadeh Najat J. , Wang Florence T. , Dai Dingwei , Mcmahill-Walraven Cheryl N. , Shuminski Patty , Frajzyngier Vera , Zhou Xiaofeng , Shen Rongjun , Garg Renu K. , Fournakis Nicole , Lanes Stephan , Beachler Daniel C.
Published: July 2023

Objective

To assess the risk of select safety outcomes including endometrial cancer, endometrial hyperplasia, and breast cancer among women using conjugated estrogens/bazedoxifene (CE/BZA) as compared with estrogen/progestin combination hormone therapy (EP).

Methods

We conducted a new-user cohort study in five US healthcare claims databases representing more than 92 million women. We included CE/BZA or EP new users from May 1, 2014, to August 30, 2019. EP users were propensity score (PS) matched to users of CE/BZA. Incidence of endometrial cancer, endometrial hyperplasia, breast cancer, and eight additional cancer and cardiovascular outcomes were ascertained using claims-based algorithms. Rate ratios (RR) and differences pooled across databases were estimated using random-effects models.

Results

The study population included 10,596 CE/BZA and 33,818 PS-matched EP new users. Rates of endometrial cancer and endometrial hyperplasia were slightly higher among CE/BZA users (1.6 and 0.4 additional cases per 10,000 person-years), although precision was limited because of small numbers of cases (endometrial cancer: RR, 1.50 [95% confidence interval {CI}, 0.79-2.88]; endometrial hyperplasia: RR, 1.69 [95% CI, 0.51-5.61]). Breast cancer incidence was lower in CE/BZA users (9.1 fewer cases per 10,000 person-years; RR, 0.79; 95% CI, 0.58-1.05). Rates of other outcomes were slightly higher among CE/BZA users, but with confidence intervals compatible with a wider range of possible associations.

Conclusions

CE/BZA users might experience slightly higher rates of endometrial cancer and endometrial hyperplasia, and a lower rate of breast cancer, than EP users in the first years of use.
Prevalence and Predictors of Unmet Need for Upper-Limb Prostheses: An Observational Cohort Study
Authors: Resnik Linda J. , Borgia Matthew L. , Clark Melissa A.
Published: July 2023

Introduction

No prior studies have examined the prevalence of unmet prosthesis need among prosthesis nonusers.

Objectives

The aim of this study was to describe the prevalence of unmet need for an upper-limb prosthesis and identify independent covariates associated with unmet need for a prosthesis.

Study Design

This study is a telephone survey of 742 persons with upper-limb amputation (ULA).

Methods

Differences between users and nonusers and between nonusers with and without an unmet need were compared statistically. Covariates associated with unmet need P ≤ 0.2 in bivariate analyses were included in a multivariate logistic regression model predicting unmet need.

Results

Odds of unmet need were higher for those who stopped using a prosthesis within the past year compared with 20 years or more ago (odds ratio [OR], 4.30; 95% confidence interval [CI], 1.28–14.51) and those on disability (OR, 4.01; 95% CI, 0.95–16.85). Odds of unmet need were lower for those with higher upper-limb function scores (OR, 0.94; 95% CI, 0.96–1.00), who were unemployed versus employed/student (OR, 0.15; 95% CI, 0.02–0.98), and those who had abandoned a prior prosthesis because it was “too much fuss” (OR, 0.41; 95% CI, 0.18–0.92).

Conclusions

Unmet need was prevalent, impacting approximately 50% of persons with upper-limb amputation who were not using a device and 14% who reported never having used a prosthesis. Independent correlates of greater unmet included worse upper-limb function, prosthesis use within the prior year, and disability status. Correlates of lesser unmet need included being unemployed and having abandoned a prosthesis because it was perceived as an undue burden. Further studies are needed to understand barriers to prosthesis use among nonusers with an unmet need.

Clinical Relevance

Persons with ULA who do not use a prosthesis should be reevaluated regularly to identify unmet needs. Our findings suggest recent prosthesis users, those with poorer upper-limb function, and those who are employed or on disability are more likely to have unmet needs.
Consumer attitudes toward aging skin during the COVID-19 pandemic
Authors: Yang Lynna J. , Knoll Justin , Kundu Roopal V.
Published: July 2023

Background:

The impact of the novel coronavirus disease (COVID-19) pandemic on consumer attitudes toward their skin has not been well characterized.

Objective:

This study investigated how consumers’ attitudes toward their skin changed during the COVID-19 pandemic.

Methods:

A cross-sectional survey was conducted using REDCap. A total of 1,434 participants were recruited and consented to participate online through ResearchMatch. The survey gathered demographic information and assessed participants’ attitudes toward their skin using a Likert scale. An ordered logistic regression analysis was performed.

Results:

Nearly one-third of participants felt unhappy with their skin. Forty four percent feel less happy about their skin compared with 5 years earlier. The top skin concerns were eye puffiness (86.5%), loose skin (85.1%), uneven tone (84.9%), uneven texture (83.5%), and dry skin (81.4%). Video conferencing (31%), wearing masks (23%), and increased stress (21%) during the COVID-19 pandemic affected how participants felt about their skin. Compared with men, women were 1.6 to 1.8 times (P < .01) more likely to “strongly agree” that all 3 pandemic-related factors—video conferencing, wearing masks, and increased stress—affected how they felt about their skin. Younger age groups were 1.5 to 2.8 times (P < .01) more likely to answer in the top category for all 3 pandemic-related factors compared with the oldest age group.

Limitations:

Recruitment of participants was limited to English-speaking adults aged 18 years or older who were registered on ResearchMatch, which underrepresents minority populations. Further studies should be conducted to elucidate how the pandemic affected perceptions of skin.

Conclusion:

Skin aging is a significant concern among adults of all ages. The COVID-19 pandemic has exacerbated skin concerns. Women and young adults are more likely to be affected by the COVID-19 pandemic in their attitudes toward their skin.
A Cone Beam CT Bronchoscopy Study of the Ultrathin Cryoprobe for Biopsy of Peripheral Lung Lesions
Authors: Bhadra Krish , Setser Randolph M. , Condra William , Bader Brittany Amento , David Stephanie
Published: July 2023

Background:

Compared with the standard cryoprobe, the novel ultrathin 1.1 mm cryoprobe (UTCP) has improved ergonomics, shape memory, and flexibility. The performance of UTCP has demonstrated promising results in several small trials.

Methods:

In this single-center, retrospective review, we examine 200 (N=200) consecutive patients referred for cone beam CT bronchoscopic biopsy of peripheral lung lesions. We utilized an extended multimodality approach, including transbronchial needle aspirate, brush, traditional forces biopsies, UTCP biopsies, and BAL. We analyzed tool in lesion, tool touch lesion, center strike rates, and diagnostic yield. We assessed for molecular adequacy and analyzed safety.

Results:

A total of 222 lesions were biopsied. We achieved a tool in lesion or tool touch lesion confirmation for all biopsy attempts (100%) and a center strike rate of 68%. AQuIRE diagnostic yield was 90%, with 60% malignant, 30% benign lung nodules, and 10% nondiagnostic. UTCP was diagnostic in 3.6 % of peripheral lung lesions biopsies when all other modalities were nondiagnostic; thus, raising our overall diagnostic yield from 86.4% to 90.1%. Our analysis demonstrates superior adequacy for molecular analysis for histologic samples (TBBX or UTCP) versus cytologic samples (FNA) (P<0.001). Three patients (1.5%) had a pneumothorax, and 1 patient (0.5%) had moderate bleeding.

Conclusion:

UTCP was diagnostic in 3.6% of peripheral lung lesions when all other modalities were nondiagnostic. In the setting of CBCT guidance, UTCP has a similar safety profile to standard biopsy tools. Future trials are warranted to assess UTCP and its impact on peripheral lung lesion biopsies.
Exposure to organophosphorus compounds: best practice in managing timely, effective emergency responses
Authors: Dorandeu Frédéric , Singer Christopher , Chatfield Steven , Chilcott Robert P. , Hall Jonathan
Published: July 2023

Increasing indications, reports and studies demonstrate that threats from the deliberate use of chemical weapons remain high and are evolving. One of the deadliest classes of chemical weapons are the organophosphorus nerve agents. It is now clear that both state and non-state actors have the ability to deploy and use these types of weapons against individuals and the wider civilian population posing a real and significant threat. The objective of this article is to provide an overview of the issues impacting on a timely critical response to the accidental or deliberate release of Organophosphorus Nerve Agents in order to enhance the understanding of their effects and provide guidance on how first responders might better treat themselves or victims of exposure through a discussion of available evidence and best practices for rapid skin decontamination. The article also examines use of the current nomenclature of ‘wet’ and ‘dry’ to describe different forms of decontamination. One of the key conclusions of this article is that adequate preparedness is essential to ensuring that responders are trained to understand the threat posed by Organophosphorus Nerve Agents as well as how to approach a contaminated environment. A key aspect to achieving this will be to ensure that generic medical countermeasures are forward-deployed and available, preferably within minutes of a contamination and that first responders know how to use them.
A Comprehensive Review of the Newest World Health Organization (WHO) Cytopathology Reporting Systems
Authors: Nigam Jitendra Singh , Bharti Jyotsna Naresh , Rath Ashutosh , Pradeep Immanuel
Published: July 2023

World Health Organization cytopathology reporting system systems have proposed for the pancreatobiliary tract, lung, lymph node, and soft tissue aligned with the updates in the World Health Organization classification of Tumor series. Among them, the pancreatobiliary tract and lung specimen reporting system have been published recently and are now a 7-tier and 5-tier category system, respectively, without any subcategorization. World Health Organization reporting systems also encourage the application of ancillary diagnostic tests like cell block preparation, immunocytochemistry, and rapid on-site evaluation for better categorization of specimens and further management, especially in indeterminate (atypical and suspicious for malignancy) and malignant cytology categories. In this brief review, we aim to provide a brief outline of both the systems and their clinical risk-based management strategies.
An open label randomized controlled trial of atorvastatin versus aspirin in elite controllers and antiretroviral-treated people with HIV
Authors: Mystakelis Harry A. , Wilson Eleanor , Laidlaw Elizabeth , Poole April , Krishnan Sonya , Rupert Adam , Welker Jorden L. , Gorelick Robert J. , Lisco Andrea , Manion Maura , Baker Jason V. , Migueles Stephen A. , Sereti Irini
Published: July 2023

Background:

Residual inflammation in people with HIV (PWH) despite suppression of HIV replication is associated with many comorbidities including cardiovascular disease. Targeting inflammation may decrease the risk of cardiovascular disease.

Methods:

An open label randomized study was conducted to evaluate the effect of nine months of 81 mg aspirin versus 40 mg atorvastatin in antiretroviral therapy (ART) treated PWH and elite controllers (EC), not on ART. Biomarkers associated with inflammation and virologic indices were measured and analyzed using non-parametric and linear mixed effect models.

Results:

53 participants were randomized and 44 were included in the final analysis. Median age was 54 years, 72% were male, 59% were Black. Median CD4 count was 595 cells/μL in the aspirin and 717 cells/μL in the atorvastatin arm. After 9 months of treatment, plasma soluble (s) CD14 was reduced in the aspirin group within both treated PWH and EC (P = 0.0229), yet only within treated PWH in the atorvastatin group (P = 0.0128). A 2.3% reduction from baseline in tissue factor levels was also observed in the aspirin arm, driven by the EC group. In the atorvastatin arm, there was a 4.3% reduction in IL-8 levels (P = 0.02) and a small decrease of activated CD4 T cells (P < 0.001). No statistically significant differences were observed in the plasma HIV viral load and cell-associated (CA) HIV DNA and RNA.

Conclusions:

Aspirin and atorvastatin could play a role in targeting HIV-associated inflammation. Elite controllers may warrant special consideration for anti-inflammatory strategies.
Extracutaneous Kaposi sarcoma risk remains higher in people with HIV in the post-ART era: a nation-wide population-based study
Authors: Dinh Sofia , Malmström Stina , Möller Isabela Killander , Yilmaz Aylin , Svedhem Veronica , Carlander Christina
Published: July 2023

Objective:

To assess Kaposi sarcoma (KS) by HIV-status in Sweden 1983–2017, with particular focus on extracutaneous KS.

Design:

Population-based study linking the Total Population Registry, the Swedish HIV Registry InfCareHIV, and the Swedish Cancer Registry.

Methods:

We included all Swedish residents, born in or outside Sweden between 1940 and 2000 (n = 8 587 829), assessing the annual incidence of KS, adjusted hazard ratios (adjHR), and odds ratios (adjOR) in the pre- and post-combination antiretroviral therapy (ART) eras.

Results:

KS was found in 324 individuals of whom 202 (62%) were people living with HIV (PLHIV). While the incidence of KS decreased in PLHIV, it remained higher compared to HIV-negative at end of follow-up (28 vs. 0.09 per 100 000 person-years, p < 0.001). In the post ART era PLHIV still had an increased risk of both cutaneous (adjHR 616, 95% confidence interval [CI] 410–926) and extracutaneous KS (adjHR 2068, 95% CI 757–5654), compared to HIV-negative individuals, although there were no cases of extracutaneous disease among virally suppressed PLHIV. In the post-ART era, the relative risk for KS remained higher in men, particularly MSM, and viral suppression was associated with lower odds of KS (adjOR 0.05, 95% CI 0.03–0.09).

Conclusions:

KS remained increased in PLHIV in the post-ART era, with a particularly high risk for extracutaneous disease compared to HIV-negative individuals. Notably, there were no cases of extracutaneous disease among virally suppressed PLHIV, suggesting a less aggressive disease in this population. Further studies on KS in virally suppressed PLHIV are warranted.
Benign and Malignant Ovarian Teratomas: Multimodality Imaging Findings With Histopathologic Correlation
Authors: Laothamatas Indira , Fang Eric , Lee Justine , Abbas Syed Muhammad Hashim , Ding Juan , Kagen Alexander , Zakashansky Konstantin , Taouli Bachir , Kamath Amita , King Michael J.
Published: July 2023

The purpose of this article is to provide a comprehensive review of the imaging findings along with histopathologic correlation of mature (benign) teratomas and malignant ovarian teratomas, which include both immature teratomas and malignant degeneration of mature teratomas. The radiologist's ability to provide an accurate diagnosis plays an essential role in guiding the interdisciplinary care of patients with malignant teratomas and improving their outcomes.
An Unreported Variation of Origin of Posterior Tibial Artery Encountered During Free Fibula Flap Harvest
Authors: Karmakar Shilpi , Singla Priyanka
Published: July 2023

Variations in the division of popliteal artery and origin of the 3 vascular systems are well documented. Here, we report a case in which the posterior tibial artery originated from the peroneal artery, in lower leg and then followed the normal course. The anomaly was detected intraoperatively precluding the harvest of free fibula flap. The procedure was abandoned and fibula was fixed using plates and screws and a free radial forearm flap was done over 2 mini-plates, which spanned the bone gap. A second bone flap procedure was to be planned in another sitting.

The anomalous origin of posterior tibial artery from the peroneal artery in lower leg did not fall into any of the categories described previously by Kim et al (Ann Surg 1989;210:776–81.). In the event such atypical anatomy is encountered, it must be delineated, and the surgical plan adjusted accordingly. Flexibility in surgical approach can prevent vascular catastrophe.
Pemphigus Vulgaris
Authors: Ruiz Samuel , Puebla Brittany , Hernandez Noel , Rubio Viviana , Young Elizabeth , Mir Haaris
Published: July 2023

Introduction

Pemphigus is a group of autoimmune diseases of the skin and mucous membranes that is characterized by multiple bullae formation. It is caused by autoantibodies directed against the cell surface of keratinocytes, resulting in the loss of cell-cell adhesion of keratinocytes. This disease can be very debilitating and difficult to treat if large surface areas are involved.

Methods

We performed a retrospective review of a complex case of pemphigus vulgaris in a 24-year-old man who develop partial-thickness skin lesions distributed throughout the entire body with a total body surface of 80% short after an episode of strep throat treated with amoxicillin.

Results

The patient had a complicated hospital course in which the standard treatment of the disease led to adverse effects that were successfully managed at our busy burn center.

Conclusions

Pemphigus vulgaris is a complex skin disease in which treatment techniques carry their risk and must be tailored to the patient's specific needs. Treatment of this conditions at a burn center would be beneficial as demonstrated with conditions like Stevens-Johnson syndrome and toxic epidermal necrolysis.
Draft genome sequences for ten strains of Xanthomonas species that have phylogenomic importance
Authors: Harrison Jamie , Hussain Rana Muhammad Fraz , Greer Shannon F. , Ntoukakis Vardis , Aspin Andrew , Vicente Joana G. , Grant Murray , Studholme David J.
Published: July 2023

Here we report draft-quality genome sequences for pathotype strains of eight plant-pathogenic bacterial pathovars:

Xanthomonas campestris

pv. asclepiadis,

X. campestris

pv. cannae,

X. campestris

pv. esculenti,

X. campestris

pv. nigromaculans,

X. campestris

pv. parthenii,

X. campestris

pv. phormiicola,

X. campestris

pv. zinniae and

X. dyei

pv. eucalypti (=

X. campestris

pv. eucalypti). We also sequenced the type strain of species

X. melonis

and the unclassified

Xanthomonas

strain NCPPB 1067. These data will be useful for phylogenomic and taxonomic studies, filling some important gaps in sequence coverage of

Xanthomonas

phylogenetic diversity. We include representatives of previously under-sequenced pathovars and species-level clades. Furthermore, these genome sequences may be useful in elucidating the molecular basis for important phenotypes, such as biosynthesis of coronatine-related toxins and degradation of fungal toxin cercosporin.
Prokaryotic ammonium transporters: what has three decades of research revealed?
Authors: Bizior Adriana , Williamson Gordon , Harris Thomas , Hoskisson Paul A. , Javelle Arnaud
Published: July 2023

The exchange of ammonium across cellular membranes is a fundamental process in all domains of life. In plants, bacteria and fungi, ammonium represents a vital source of nitrogen, which is scavenged from the external environment. In contrast, in animal cells ammonium is a cytotoxic metabolic waste product and must be excreted to prevent cell death. Transport of ammonium is facilitated by the ubiquitous Amt/Mep/Rh transporter superfamily. In addition to their function as transporters, Amt/Mep/Rh proteins play roles in a diverse array of biological processes and human physiopathology. Despite this clear physiological importance and medical relevance, the molecular mechanism of Amt/Mep/Rh proteins has remained elusive. Crystal structures of bacterial Amt/Rh proteins suggest electroneutral transport, whilst functional evidence supports an electrogenic mechanism. Here, focusing on bacterial members of the family, we summarize the structure of Amt/Rh proteins and what three decades of research tells us concerning the general mechanisms of ammonium translocation, in particular the possibility that the transport mechanism might differ in various members of the Amt/Mep/Rh superfamily.
Examination of Influenza A Infection Rate, Its Determinants, and Seasonal Influenza Vaccine Effectiveness in the Post-COVID-19 Pandemic Era
Authors: Wagenhäuser Isabell , Mees Juliane , Reusch Julia , Lâm Thiên-Trí , Schubert-Unkmeir Alexandra , Krone Lukas B. , Frey Anna , Kurzai Oliver , Frantz Stefan , Dölken Lars , Liese Johannes , Gabel Alexander , Petri Nils , Krone Manuel
Published: July 2023

Background

In the context of the COVID-19 pandemic, a pronounced wave of Influenza A occurred in the 2022/23 winter season under generally relaxed post-pandemic non-pharmaceutical preventive measures.

Aim

This study aimed to investigate the Influenza A infection rate, factors influencing its occurrence and seasonal Influenza vaccine effectiveness on seroconversion in the post-COVID-19 pandemic era.

Methods

The seroconversion of Anti-Influenza-A-Nucleoprotein/Matrix IgG was investigated in 402 healthcare workers (HCWs) during the winter season of 2022/2023 (23 May 2022 to 11 May 2023). The participants provided a serum sample and completed a study questionnaire both before and after the seasonal Influenza A wave (24 October 2022 to 8 January 2023). The levels of a vaccine-independent Anti-Influenza-A-Nucleoprotein/Matrix IgG were measured using the SERION ELISAclassicInfluenza A IgG assay, with a 2-fold increase as indicative of seroconversion after asymptomatic or symptomatic influenza infection.

Results

Among the participants, 20.6% (95% CI 17.0-24.9%; 83/402) showed seroconversion. The multivariate logistic regression analysis revealed that the age category of ≥ 45 years (p=0.03) and regular patient contact (p=0.02) significantly influenced seroconversion. However, the factors male gender, BMI, smoking, household size, seasonal Influenza vaccination, and SARS-CoV-2 infection during the Influenza A season were not significantly associated with seroconversion. The effectiveness of the 2022/23 seasonal Influenza vaccine on seroconversion induced by Influenza infection was 22.6% (95% CI -17.1-50.6%).

Conclusion

During the initial Influenza A season following the COVID-19 pandemic, approximately 20% of HCWs contracted an Influenza A infection. This highlights a potential risk and a significant asymptomatic or symptomatic infection rate posing a theoretical risk for intrahospital transmission chains and nosocomial infections.
Posttraumatic reexperiencing and alcohol use: mediofrontal theta as a neural mechanism for negative reinforcement
Authors: Rawls Eric , Marquardt Craig A. , Fix Spencer T. , Bernat Edward , Sponheim Scott R.
Published: July 2023

Objective

Over half of US military veterans with posttraumatic stress disorder (PTSD) use alcohol heavily, potentially to cope with their symptoms. This study investigated the neural underpinnings of PTSD symptoms and heavy drinking in veterans. We focused on brain responses to salient outcomes within predictive coding theory. This framework suggests the brain generates prediction errors (PEs) when outcomes deviate from expectations. Alcohol use might provide negative reinforcement by reducing the salience of negatively-valenced PEs and dampening experiences like loss.

Methods

We analyzed electroencephalography (EEG) responses to unpredictable gain/loss feedback in veterans of Operations Enduring and Iraqi Freedom. We used time-frequency principal components analysis of event-related potentials to isolate neural responses indicative of PEs, identifying mediofrontal theta linked to losses (feedback-related negativity, FRN) and central delta associated with gains (reward positivity, RewP).

Results

Intrusive reexperiencing symptoms of PTSD were associated with intensified mediofrontal theta signaling during losses, suggesting heightened negative PE sensitivity. Conversely, increased hazardous alcohol use was associated with reduced theta responses, implying a dampening of these negative PEs. The separate delta-RewP component showed associations with alcohol use but not PTSD symptoms.

Conclusions

Findings suggest a common neural component of PTSD and hazardous alcohol use involving altered PE processing. We suggest that reexperiencing enhances the intensity of salient negative PEs, while chronic alcohol use may reduce their intensity, thereby providing negative reinforcement by muting emotional disruption from reexperienced trauma. Modifying the mediofrontal theta response could address the intertwined nature of PTSD symptoms and alcohol use, providing new avenues for treatment.
Selective reactivation of value- and place-dependent information during sharp-wave ripples in the intermediate and dorsal hippocampus
Authors: Jin Seung-Woo , Lee Inah
Published: July 2023

Reactivation of place cells during sharp-wave ripples in the hippocampus is important for memory consolidation. However, whether hippocampal reactivation is affected by the values of events experienced by the animal is largely unknown. Here, we investigated whether place cells in the dorsal (dHP) and intermediate (iHP) hippocampus of rats are differentially reactivated depending on the value associated with a place during the learning of places associated with higher-value rewards in a T-maze. Place cells in the iHP representing the high-value location were reactivated significantly more frequently than those representing the low-value location, characteristics not observed in the dHP. In contrast, the activities of place cells in the dHP coding the routes leading to high-value locations were replayed more than those in the iHP. Our findings suggest that value-based differential reactivation patterns along the septotemporal axis of the hippocampus may play essential roles in optimizing goal-directed spatial learning for maximal reward.

Teaser

Information carried by sharp-wave ripples differ qualitatively between the dorsal and intermediate hippocampal regions.
sciMET-cap: High-throughput single-cell methylation analysis with a reduced sequencing burden
Authors: Acharya Sonia N. , Nichols Ruth V. , Rylaarsdam Lauren E. , O’Connell Brendan L. , Braun Theodore P. , Adey Andrew C.
Published: July 2023

DNA methylation is a key component of the mammalian epigenome, playing a regulatory role in development, disease, and other processes. Robust, high-throughput single-cell DNA methylation assays are now possible (sciMET); however, the genome-wide nature of DNA methylation results in a high sequencing burden per cell. Here, we leverage target enrichment with sciMET to capture sufficient information per cell for cell type assignment using substantially fewer sequence reads (sciMET-cap). Sufficient off-target coverage further enables the production of near-complete methylomes for individual cell types. We characterize sciMET-cap on human PBMCs and brain (middle frontal gyrus).