bluuebunny/crossref_metadata_2025 huggingface dataset:
Frailty Status, Not Just Age, is Associated With Postoperative Opioid Consumption: A Retrospective, Population-based Analysis
Authors: Latack Kyle R. , Howard Ryan , Bicket Mark C. , Cooley Samantha , Gunaseelan Vidhya , Englesbe Michael , Waljee Jennifer
Published: October 2024

Objective:

To assess the relationship between postoperative opioid consumption and frailty status.

Background:

Physiologic reserve can be assessed through both chronologic age as well as measures of frailty. Although prior studies suggest that older individuals may require less opioid following surgery, chronologic age, and frailty do not always align, and little is known regarding postoperative opioid consumption patterns by frailty.

Methods:

We conducted a retrospective analysis of opioid-naïve adult patients undergoing common general, vascular, and gynecologic procedures across a statewide quality improvement program from November 6, 2017 to February 28, 2021. Our primary outcome was postoperative patient-reported opioid consumption within 30 days of surgery in oral morphine equivalents (OME). Our primary exposure was frailty status defined by the modified frailty index (mFi-5) criteria. Other covariates included patient demographic and clinical attributes, procedural factors, discharge opioid prescription size, and postoperative complications. Linear regression was performed to assess the association of frailty status and opioid consumption, stratified by age.

Results:

In this cohort of 34,854 patients, 10,596 had an mFi-5 score of ≤1 and 3,635 had a score of >1. A score of >1 was associated with increased patient-reported opioid consumption (OMEs 3.3 greater; 95% CI = 1.5–5.1). This held true for individuals over 65 (OMEs 2.7 greater; 95% CI = 0.2–5.1). Frailty status, regardless of score, was negatively associated with an opioid prescription at discharge.

Conclusions:

Frailty status is associated with increased opioid consumption after common operations. Future prescribing guidelines and outcomes analyses should consider this marker when reviewing opioid consumption data and related adverse outcomes.
Validating the Fluctuating Mental Status Evaluation in Neurocritically Ill Patients With Acute Stroke
Authors: Reznik Michael E. , Margolis Seth A. , Andrews Nicholas , Basso Colin , Mintz Noa , Varga Sean , Snitz Beth E. , Girard Timothy D. , Shutter Lori A. , Ely E. Wesley , Jones Richard N.
Published: October 2024

OBJECTIVES:

Neurocritically ill patients are at high risk for developing delirium, which can worsen the long-term outcomes of this vulnerable population. However, existing delirium assessment tools do not account for neurologic deficits that often interfere with conventional testing and are therefore unreliable in neurocritically ill patients. We aimed to determine the accuracy and predictive validity of the Fluctuating Mental Status Evaluation (FMSE), a novel delirium screening tool developed specifically for neurocritically ill patients.

DESIGN:

Prospective validation study.

SETTING:

Neurocritical care unit at an academic medical center.

PATIENTS:

One hundred thirty-nine neurocritically ill stroke patients (mean age, 63.9 [sd, 15.9], median National Institutes of Health Stroke Scale score 11 [interquartile range, 2–17]).

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

Expert raters performed daily Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-based delirium assessments, while paired FMSE assessments were performed by trained clinicians. We analyzed 717 total noncomatose days of paired assessments, of which 52% (n = 373) were rated by experts as days with delirium; 53% of subjects were delirious during one or more days. Compared with expert ratings, the overall accuracy of the FMSE was high (area under the curve [AUC], 0.85; 95% CI, 0.82–0.87). FMSE scores greater than or equal to 1 had 86% sensitivity and 74% specificity on a per-assessment basis, while scores greater than or equal to 2 had 70% sensitivity and 88% specificity. Accuracy remained high in patients with aphasia (FMSE ≥ 1: 82% sensitivity, 64% specificity; FMSE ≥ 2: 64% sensitivity, 84% specificity) and those with decreased arousal (FMSE ≥ 1: 87% sensitivity, 77% specificity; FMSE ≥ 2: 71% sensitivity, 90% specificity). Positive FMSE assessments also had excellent accuracy when predicting functional outcomes at discharge (AUC, 0.86 [95% CI, 0.79–0.93]) and 3 months (AUC, 0.85 [95% CI, 0.78–0.92]).

CONCLUSIONS:

In this validation study, we found that the FMSE was an accurate delirium screening tool in neurocritically ill stroke patients. FMSE scores greater than or equal to 1 indicate “possible” delirium and should be used when prioritizing sensitivity, whereas scores greater than or equal to 2 indicate “probable” delirium and should be used when prioritizing specificity.
Comparative Effectiveness of Baricitinib Versus Tocilizumab in Hospitalized Patients With COVID-19: A Retrospective Cohort Study of the National Covid Collaborative
Authors: Patanwala Asad E. , Xiao Xuya , Hills Thomas E. , Higgins Alisa M. , McArthur Colin J. , Alexander G. Caleb , Mehta Hemalkumar B. ,   on behalf of National Covid Cohort Collaborative (N3C) Consortium
Published: October 2024

OBJECTIVES:

COVID-19 treatment guidelines recommend baricitinib or tocilizumab for the management of hospitalized patients with COVID-19. We compared the effectiveness of baricitinib vs. tocilizumab on mortality and clinical outcomes among hospitalized patients with COVID-19.

DESIGN:

Multicenter, retrospective, propensity-weighted cohort study using a target trial emulation approach.

SETTING:

The National COVID Cohort Collaborative (N3C), which is the largest electronic health records data on COVID-19 in the United States. The setting included 75 hospitals.

PATIENTS:

Adults who were hospitalized for COVID-19.

INTERVENTIONS:

Newly initiated on baricitinib or tocilizumab.

MEASUREMENTS AND MAIN RESULTS:

Our primary outcome was 28-day mortality. We used propensity scores with inverse probability of treatment weights (IPTWs) to control bias and confounding while comparing treatments. Among 10,661 individuals included in the study, 6,229 (58.4%) received baricitinib and 4,432 (41.6%) tocilizumab. Overall, the mean age of the cohort was 60.0 ± 15.1 years, 6429 (60.3%) were male, and 19.2% received invasive mechanical ventilation. After IPTW adjustment, baricitinib use was associated with lower 28-day mortality (odds ratio [OR], 0.91; 95% CI, 0.85–0.98) and hospital (OR, 0.88; 95% CI, 0.82–0.94) mortality compared with tocilizumab. Baricitinib was also associated with shorter hospital length of stay (incident rate ratio, 0.92; 95% CI, 0.90–0.94) and lower rates of hospital-acquired infections (OR, 0.86; 95% CI, 0.75–0.99), although no difference in ICU length of stay was noted between the two groups.

CONCLUSIONS:

In this large, diverse cohort of U.S. hospitalized adults with COVID-19, baricitinib was associated with significantly lower 28-day mortality, hospital mortality, shorter hospital length of stay, and less hospital-acquired infections compared with tocilizumab.
Ultrasound-guided Deep Waist Fat Liposuction: Complement to a Narrow Waist
Authors: Flores González Emmanuel Armando , Manzaneda Cipriani Raúl Martin , Babaitis Ricardo , Durán Vega Héctor , Schneider Viaro Mauricio , Lobo Botelho Daniel , Danilla Enei Stefan , Ramirez Guerrero Oliver René
Published: October 2024

Background:

For body contouring, the waist plays an important role in both male and female body structure. Currently, there are procedures that aim to achieve a narrow waist as a result, to achieve an adequate waist-to-hip ratio. This study proposes a technique of ultrasound-guided deep liposuction of the lumbar triangle to achieve favorable and safe aesthetic results.

Methods:

The technique was applied in 142 patients who provided informed consent. During liposuction, ultrasound was used as a guide to avoid contact with vital organs, and in the postoperative stage, a satisfaction survey was administered on the aesthetic results obtained. In addition, patients had a preoperative waist measurement and a postoperative waist measurement at 3 months.

Results:

The deep liposuction technique in the lumbar triangle is safe, no serious complications were observed, and the results of the satisfaction survey regarding the aesthetic result after the third postoperative month showed 100% satisfaction. In addition, it was found that the body measurements of the waist before the operation and 3 months later showed a difference between 8 and 15 cm less in the diameter of the waist after the technique was applied.

Conclusions:

Deep liposuction of the lumbar region is a safe technique, due to the use of ultrasound for patient care, and enhances patient satisfaction with the aesthetic results.
Hug Flap and Hamdi Hammock: Two Innovative Techniques for Enhancing Aesthetic Outcomes in Deep Inferior Epigastric Artery Perforator Breast Reconstruction
Authors: Kyriazidis Ioannis , Georgiou Letizia , Hamdi Moustapha
Published: October 2024

Background:

Achieving optimal aesthetic outcomes in deep inferior epigastric artery perforator (DIEP) flap breast reconstruction remains a challenge, often necessitating additional procedures for refinement. This study presents two innovative techniques (the hug flap and Hamdi hammock) aimed at enhancing breast projection and inframammary fold (IMF) definition in DIEP flap reconstruction.

Methods:

The hug flap technique uses de-epithelialized caudal mastectomy skin to augment breast projection, whereas the Hamdi hammock uses a percutaneous purse-string suture to define the IMF. A retrospective review of 782 patients who underwent DIEP flap breast reconstruction between 2007 and 2023 was conducted.

Results:

The hug flap group required significantly less additional fat grafting compared to other techniques (11% versus 27% and 22%). No total flap losses occurred in the hug flap group, and fat necrosis rates were low. The Hamdi hammock was used in 405 patients with a mean of two lipofilling sessions. Complications were minor and no stitches required removal.

Conclusions:

The hug flap and Hamdi hammock techniques offer effective and safe methods for enhancing breast projection and IMF definition in DIEP flap reconstruction. These techniques may reduce the need for additional procedures and improve aesthetic outcomes.
A Unified Approach to Facial Contours and Volume Correction: The Role of the Cheek and the Chin
Authors: Moradi Amir , Montes Jose Raul , Humphrey Shannon , Grunebaum Lisa D. , Bertossi Dario , Dimitrijevic Elena , Sangha Sara
Published: October 2024

Background:

Facial proportions and contours influence perceptions of beauty and youthfulness. In particular, the shape and definition of the midface and lower face impact the overall appearance of the face.

Methods:

This review provides anatomical evidence to support a holistic approach to facial analysis and rejuvenation that starts with assessment and treatment of the midface and lower face to create an aesthetically desirable facial balance.

Results:

The cheek and chin can be considered “anchors” or starting points within full-face treatment because of the noticeable impact of their treatment on the definition and contour of the entire face. Age-related changes in the cheek and chin affect overall facial appearance and can produce unintended facial emotional attributes such as looking tired, angry, or sad. Patients seek facial aesthetic treatment typically for a global improvement such as revitalization or genderization of facial features. Best practices in aesthetics have evolved from treatment of individual areas to a holistic paradigm that uses multimodal therapy to improve overall facial emotional attributes. Hyaluronic acid fillers are useful for volume replacement and smoothing abrupt transitions that develop with age throughout the midface, chin, and jaw. A combination of hyaluronic acid filler for volume restoration and sodium deoxycholate and/or onabotulinumtoxinA for volume reduction where appropriate may optimize lower facial contour.

Conclusions:

This review highlights the importance of facial angles and contours as well as the significance of panfacial assessments and treatment, focusing on the relationships within areas of the face, specifically the midface and lower face, to optimize results.
Breast Reconstruction in a Postbariatric Patient Using a Fleur-de-lis Free Deep Inferior Epigastric Artery Perforator Flap: A Mini-review
Authors: Berkane Yanis , Beaufils Tristan , Alabdulkareem Mohammad , Abu Qasida Alla , Scarabosio Anna , Girard Paul , Watier Eric , Bertheuil Nicolas
Published: October 2024

Breast reconstruction in postbariatric patients presents unique challenges due to substantial weight loss–induced body deformities. We present the case of a 51-year-old woman with massive lower abdominal deformities who underwent a mastectomy treatment followed by a temporary expander-based reconstruction. A year later, a fleur-de-lis-shaped free deep inferior epigastric artery perforator flap and abdominoplasty were performed for autologous reconstruction and abdominal contouring. This design addressed both purposes while allowing a voluminous flap to be harvested on periumbilical perforators. No postoperative complications were found, and the outcomes were favorable. Although deep inferior epigastric artery perforator flaps are standard in autologous breast reconstruction, our case demonstrates the utility of the fleur-de-lis design in massive weight loss patients for vascular safety and volume enhancement. Finally, we discuss this rarely described approach and compare it with other variants, showcasing versatility in addressing complex reconstruction needs in this particular patient population.
Electrographic flow mapping of atrial fibrillation
Authors: Castellano Steven , Kong Melissa H.
Published: October 2024

Purpose of review

A low ceiling of efficacy exists for the treatment of persistent atrial fibrillation via pulmonary vein isolation without adjunctive ablations, which is likely because they do not target an individual patient's specific underlying disease mechanisms. Electrographic flow (EGF) mapping is the first system that reliably displays wavefront propagation through the atria. It is a promising tool for localizing sources of atrial fibrillation, guiding targeted ablation, and visualizing conduction through the atrial substrate.

Recent findings

We describe EGF mapping with emphasis on contemporary studies examining map reproducibility and use cases in the preclinical and clinical environment. Animal experiments demonstrated that maps were interpretable across increasingly complex rhythms with pacing during spontaneously persistent atrial fibrillation reliably simulating EGF sources. The FLOW-AF randomized controlled trial showed that source ablation improved outcomes and that EGF map properties may be used to phenotype patients based on their atrial fibrillation mechanisms and recurrence likelihoods.

Targeted ablation strategies balance the risks of insufficiently ablating atrial fibrillation triggers with exacerbating disease through additional scar formation. EGF mapping leverages spatiotemporal relationships in voltage to localize sources and quantify substrate health. Further research is needed to optimize phenotyping and treatment efforts.
Paradigm Shift in Eye Banking: From Tissue Retrieval to Cellular Harvesting and Bioengineering
Authors: Deshmukh Rashmi , Dua Harminder S. , Mehta Jodhbir S. , Vajpayee Rasik B. , Jhanji Vishal , Basu Sayan
Published: October 2024

An integrated cell, tissue, and eye bank is vital to meet the evolving needs of ocular transplant therapies. In addition to traditional corneal transplant tissues, it encompasses processing and delivery of transplant materials for newer treatments like cell-based therapies and gene-modified products, adhering to rigorous standards, optimizing tissue utilization with comprehensive services for surgeons.
Effects of Stress and Strain on the Optic Nerve Head on the Progression of Glaucoma
Authors: Kang Edward , Park Ji-Hye , Yoo Chungkwon , Kim Yong Yeon
Published: October 2024

Précis:

In primary open angle glaucoma, the rate of retinal nerve fiber layer thickness decrease was negatively correlated with lamina cribrosa strain, which was associated with intraocular pressure and optic nerve head geometric factors.

Purpose:

We hypothesized that the biomechanical deformation of the optic nerve head (ONH) contributes to the progression of primary open angle glaucoma (POAG). This study investigated the biomechanical stress and strain on the ONH in patients with POAG using computer simulations based on finite element analysis and analyzed its association with disease progression.

Methods:

We conducted a retrospective analysis that included patients diagnosed with early-to-moderate stage POAG. The strains and stresses on the retinal nerve fiber layer (RNFL) surface, prelaminar region, and lamina cribrosa (LC) were calculated using computer simulations based on finite element analysis. The correlations between the rate of RNFL thickness decrease and biomechanical stress and strain were investigated in both the progression and nonprogression groups.

Results:

The study included 71 and 47 patients in the progression and nonprogression groups, respectively. In the progression group, the factors exhibiting negative correlations with the RNFL thickness decrease rate included the maximum and mean strain on the LC. In multivariate analysis, the mean strain on the LC was associated with optic disc radius, optic cup deepening, axial length, and mean intraocular pressure (IOP), whereas the maximum strain was only associated with mean IOP.

Conclusions:

In early-to-moderate stage POAG, the rate of RNFL thickness decrease was influenced by both the mean and maximum strain on the LC. Strains on the LC were associated with mean IOP, optic disc radius, axial length, and optic cup deepening. These results suggest that not only IOP but also ONH geometric factors are important in the progression of glaucoma.
Spread of Neisseria gonorrhoeae FC428 Subclone MLST ST13871
Authors: Li Hao , Zhu Bang-Yong , Gan Quan , Nguyen Tam Thi , Chen Shao-Chun
Published: October 2024

The main objective of this study was to investigate the relationship between a ceftriaxone-resistant Neisseria gonorrhoeae strain GX211022, isolated from China, and MLST ST13871 strains reported internationally. In this study, we determined the susceptibility of the N. gonorrhoeae isolate to antibiotics using the agar dilution method. Genotyping was performed through N. gonorrhoeae sequence typing for antimicrobial resistance (NG-STAR), N. gonorrhoeae multiantigen sequence typing (NG-MAST), and multilocus sequence typing (MLST). Additionally, phylogenetic analysis was conducted to explore the genetic relatedness to other MLST ST13871 strains. Isolate GX211022 was identified to possess penA allele 60.001 with a ceftriaxone MIC = 1 mg/L and was classified as MLST ST13871 and NG-STAR ST233. Phylogenetic analysis indicated that GX211022 was clustered with isolates from Vietnam and confirmed that all MLST ST13871 strains are a subclone of the internationally disseminated high-level ceftriaxone-resistant FC428 clone. These findings highlight abundant regional spread of MLST ST13871 in Southeast Asia.
Race and Ethnicity Reporting in United States Limb-Loss Literature (2015–2020): A Scoping Review
Authors: Rosen Rachael E. , Morgan Sara J. , Hafner Brian J. , McDonald Cody L.
Published: October 2024

Introduction

Accurate and consistent reporting of demographic data in research, including race and ethnicity, is essential for identifying, studying, and addressing health disparities. Reporting race and ethnicity data is necessary because these constructs serve as proxies used to measure the impact of racism, bias, and discrimination, which are some of the underlying causes of health disparities.

Objective

The study was conducted to investigate the frequency and variability with which race and ethnicity are reported in recent peer-reviewed articles that present results of limb loss research in the United States.

Study Design

A scoping review was completed.

Methods

A comprehensive search of three bibliographic databases was conducted to identify original articles that described the results of research involving individuals with limb loss published between 2015 and 2020. Articles were screened for relevance, and key details, including publication year, study focus, study design, participant demographics, limb involvement, and etiology, were extracted. A total of 420 articles were included in this review.

Results

Few articles (15.9%) included participants’ race or ethnicity. Only 6.4% reported these characteristics using the categories recommended by the US federal government. Overall, race and ethnicity were reported with low frequency, limited specificity, and high variability.

Conclusions

Results of this review suggest that improved race and ethnicity reporting is needed for limb loss research. Recommendations include the following: collection and reporting of demographic data for all participants; use of standardized race and ethnicity categories; clear delineation of race groups in analyses; and implementation of editorial policies that mandate reporting.

Clinical Relevance

Improving the reporting of race and ethnicity data in limb loss research is crucial to address disparities and provide equitable care. Improved reporting methods will facilitate accurate assessment of representation, assist in targeted recruitment efforts, and contribute to development of tailored interventions to address the needs of racially and ethnically minoritized groups.
Universal screening for familial hypercholesterolaemia: how can we maximise benefits and minimise potential harm for children and their families?
Authors: Ramaswami Uma , Priestley-Barnham Lorraine , Humphries Steve E.
Published: October 2024

Purpose of review

Universal Screening programmes to identify subjects with familial hypercholesterolaemia (FH) have been the subject of much recent interest. However, any screening programme can cause harm as well as having potential benefits. Here we review recent papers using different ages and strategies to identify subjects with FH, and examine to what extent the publications provide quantitative or qualitative evidence of benefit or harm to children and adults.

Recent findings

Three studies have been published over the last 2 years where Universal Screening for FH has been carried out in infancy, at the time of routine vaccinations, or at preschool age. Next-generation sequencing of all known FH-causing genes has been used to determine the proportion of screened individuals, who have total or low-density lipoprotein cholesterol (LDL-C) concentrations above a predetermined threshold (such as >95th percentile), with genetically confirmed FH.

While we fully support the concept of Universal Screening for FH, which appears feasible and of potential clinical utility at all of the different ages examined, there is little data to document potential benefit or how to mitigate potential harms. Future study protocols should include collection of such data to strengthen the case of roll out of Universal Screening programmes.
Safety, efficacy, and side effects of sodium fluorescein-aided resection of glioblastoma: a quasi-experimental study
Authors: Ahmed Nazmin , Hossain Md. Nazrul , Ahmed Raju , Abbasi Md. Mahmud , Azab Mohammed A. , Alam Morshad , Nusrat Khan Nazia , Kazi Md. Raad , Ghafoor Nusrat , Siraj Nawshin , Chaurasia Bipin
Published: October 2024

Background:

The use of fluorescein sodium (FS) as a surgical adjunct in glioblastoma resection has shown promise in improving tumor visualization and resection outcomes. This study aimed to evaluate the safety, efficacy, and side effects of FS-aided resection in patients with glioblastoma.

Methods:

This is a prospective, single-center cohort study conducted at Ibrahim Cardiac Hospital and Research Institute from September 2021 to November 2023. Twelve patients with histologically confirmed glioblastoma underwent FS-guided resection. All participants received an intravenous dose of FS (5 mg/kg body weight) ~30 min before surgery. The study follows a quasi-experimental design, focusing on the outcomes of FS-aided surgery without a control group. Patients were selected based on specific inclusion and exclusion criteria, and all surgeries were performed by a single experienced neurosurgeon. The extent of tumor resection was classified as gross total resection (GTR), near-total resection (NTR), or partial resection (PR).

Results:

Gross total resection (GTR) was achieved in 66.6% of patients, near total resection (NTR) in 16.6%, and subtotal resection (STR) in 16.6%. No significant adverse effects were observed except for a single case of postoperative seizure, which was managed without long-term consequences. All patients showed normal liver and kidney function tests postoperatively. The low-dose FS protocol demonstrated both a high rate of GTR and a favorable safety profile, with only minor, transient side effects such as temporary yellow discoloration of the skin, sclera, and urine. No severe or long-term complications related to FS were observed during the follow-up period, which had a median duration of 13.4 months.

Conclusion:

FS appears to be a safe and effective aid in glioblastoma resection, achieving high rates of GTR with minimal side effects. The findings suggest that FS, particularly at a low dose, is a viable, cost-effective alternative to other fluorescent markers, especially in settings where resource constraints may limit the use of more expensive options like 5-ALA.
Racial and Ethnic Disparities in HIV Diagnosis Rates by Social Determinants of Health at the Census Tract Level Among Adults in the United States and Puerto Rico, 2021
Authors: Kota Krishna Kiran , Eppink Samuel , Gant Sumner Zanetta , Chesson Harrell , McCree Donna Hubbard
Published: October 2024

Background:

We compared racial and ethnic disparities in HIV diagnosis rates among adults in census tracts with the most disadvantaged vs. the most advantaged levels of social determinants of health.

Methods:

In this ecologic analysis, we used the National HIV Surveillance System data from 2021 and social determinants of health data from 2017–2021 American Community Survey. We measured racial and ethnic disparities stratified by sex in the most disadvantaged quartiles and advantaged quartiles for (1) poverty, (2) education level, (3) median household income, and (4) insurance coverage. We calculated 8 relative disparity measures [Black-to-White rate ratio, Hispanic/Latino-to-White rate ratio, index of disparity (ID), population-weighted ID, mean log deviation, Theil index, population attributable proportion, Gini coefficient] and 4 absolute disparity measures (Black-to-White rate difference, Hispanic/Latino-to-White rate difference, absolute ID, and population-weighted absolute ID).

Results:

Comparing the most disadvantaged quartiles with the most advantaged quartiles, all 4 absolute disparity measures decreased, but 7 of the 8 relative disparity measures increased: the median percentage decreases in the absolute measures for men and women, respectively, were 38.1% and 47.6% for poverty, 12.4% and 42.6% for education level, 43.6% and 44.0% for median household income, and 44.2% and 45.4% for insurance coverage. The median percentage increases in the relative measures for men and women, respectively, were 44.3% and 61.3% for poverty, 54.9% and 95.3% for education level, 19.6% and 90.0% for median household income, and 32.8% and 46.4% for insurance coverage.

Conclusions:

Racial and ethnic disparities in the most disadvantaged and the most advantaged quartiles highlight the need for strategies addressing the root causes of disparities.
Intersecting Structural and Psychosocial Conditions: Investigating Injection Drug Use and HIV Among Transgender Women
Authors: Burnett Janet , Olansky Evelyn , Baugher Amy R. , Lee Kathryn , Callens Steven , Wejnert Cyprian ,   for the NHBS-Trans Study Group
Published: October 2024

Background:

Transgender women continue to face a significant burden of health disparities with HIV infection as a critical public health concern. Substance use is higher among transgender women than among cisgender women. However, little is known about transgender women who inject drugs and risk for HIV in the United States. The objectives were to explore HIV prevalence, injection-related behaviors, and HIV prevention and care outcomes among transgender women who inject drugs and to compare transgender women with a general sample of persons who inject drugs.

Methods:

Participants from the National HIV Behavioral Surveillance were recruited through respondent-driven sampling, interviewed, and tested for HIV infection in 2019–2020. Log-linked Poisson regression models were used to test for associations between injection drug use and selected characteristics.

Results:

Among 1561 transgender women, 7% injected drugs in the past 12 months. HIV prevalence was higher among transgender women who inject (adjusted prevalence ratio = 1.5, 95% confidence interval: 1.2 to 1.8) than among those who do not. Multiple psychosocial conditions were associated with injection drug use. Among transgender women with HIV, those who inject were less likely to take antiretroviral therapy (adjusted prevalence ratio = 0.8, 95% confidence interval: 0.7 to 1.0) than those who do not. Methamphetamine was the most commonly injected drug (67%); most accessed a syringe services program (66%).

Conclusions:

Transgender women who inject have substantial challenges related to health outcomes including high HIV prevalence and exposure to psychosocial conditions, such as homelessness, incarceration, and exchange sex, that may exacerbate risks associated with injection drug use. This population may benefit from increased access to nonjudgmental and culturally competent harm reduction services.
Esophageal Inflammatory Pseudotumor on Al18F-FAPI-74 and 18F-FDG PET/CT
Authors: Cheng Xin , Hou Guozhu , Zheng Rong , Li Yong , Wang Xuejuan
Published: October 2024

A 25-year-old woman experiencing dysphagia for 2 years underwent 18F-FDG and Al18F-FAPI-74 PET/CT. The scans showed local thickening of the cervical and upper thoracic esophageal wall with several calcifications, accompanied by increased and heterogeneous FDG uptake and more intense FAPI activity. Histopathological analysis following thoracoscopic esophagectomy confirmed the diagnosis of esophageal inflammatory pseudotumor.
Whole-Genome Sequencing assisted outbreak investigation of Salmonella Enteritidis, at a hospital in South Africa, September 2022
Authors: Brummer Brian , Smith Anthony Marius , Modise Motshabi , Thomas Juno , Mdose Hetani , Mokoena Ramasedi , Baleni Dikeledi
Published: October 2024

Health authorities were notified of a suspected outbreak of foodborne disease in a hospital in South Africa, where staff and patients reported acute onset of abdominal cramps, diarrhoea, fever, and rigors after eating a chicken pasta meal. The aim of this report is to discuss the use of whole-genome sequencing (WGS) analysis of bacterial isolates to support an epidemiological investigation. An epidemiological investigation led by the Infection Control Manager of the hospital and supported by an outbreak response team was conducted. Standard microbiological procedures were used to process stool samples and culture/identify diarrhoeal pathogens. Bacterial cultures were investigated using WGS performed using Illumina NextSeq technology, and WGS data were analysed using multiple bioinformatics tools, including those available at the Center for Genomic Epidemiology and EnteroBase. Core-genome multilocus sequence typing (cgMLST) was used to investigate the phylogeny of isolates. Forty-nine cases were identified, with stool samples collected from 21 cases, and nontyphoidal Salmonella isolated from 19/21 (90%) of the samples. All isolates were identified as Salmonella enterica serovar Enteritidis and differed from each other by ≤2 allele differences on cgMLST, indicating that isolates are highly genetically related. Delays in testing of food retention samples rendered the negative test results of limited value. A case control study was conducted; eating chicken pasta was strongly associated with developing gastroenteritis (OR=15.4, Chi-Square test with Yates correction p-value = 0.02). The epidemiological evidence suggests that the chicken pasta was the likely vehicle of transmission in this outbreak, although the source of Salmonella enterica serovar Enteritidis remains unknown.
LMP-TX: An AI-driven Integrated Longitudinal Multi-modal Platform for Early Prognosis of Late Onset Alzheimer’s Disease
Authors: Li Victor OK , Lam Jacqueline CK , Han Yang
Published: October 2024

Alzheimer’s Disease (AD) is the 7th leading cause of death worldwide. 95% of AD cases are late-onset Alzheimer’s disease (LOAD), which often takes decades to evolve and become symptomatic. Early prognosis of LOAD is critical for timely intervention before irreversible brain damage. This study proposes an Artificial Intelligence (AI)-driven longitudinal multi-modal platform with time-series transformer (LMP-TX) for the early prognosis of LOAD. It has two versions: LMP-TX utilizes full multi-modal data to provide more accurate prediction, while a lightweight version, LMP-TX-CL, only uses simple multi-modal and cognitive-linguistic (CL) data. Results on prognosis accuracy based on the AUC scores for subjects progressing from normal control (NC) to early mild cognitive impairment (eMCI) andeMCI to late MCI (lMCI) is respectively 89% maximum (predicted by LMP-TX) and 81% maximum (predicted by LMP-TX-CL). Moreover, results on the top biomarkers predicting different states of LOAD onsets have revealed key multi-modal (including CL-based) biomarkers indicative of early-stage LOAD progressions. Future work will develop a more fine-grained LMP-TX based on disease progression scores and identify the key multi-modal and CL-based biomarkers predictive of fast AD progression rates at early stages.
Health Exposure Records and Occupations (HERO) Summary: Development of Occupational Exposure Summary for clinical utility in Military Populations
Authors: Samuel Immanuel B.H. , Pollin Kamila , Tschida Sherri , Reck Lily , Powell Alan , Mefford Jessica , Lee Jamie , Dupriest Teresa , Prisco Michelle , Fischer Stephen , Ortiz Jose , Forsten Robert , Faselis Charles , Barrett John , Reinhard Matthew , Costanzo Michelle
Published: October 2024

Introduction

Military exposure summarization is critical for Veterans with complex environmental, occupational, or toxic exposures. Existing methods are limited by technical language, incompatible data formats, and difficulty in prioritizing information. Clinicians require concise, standardized, and easily interpretable exposure summaries to facilitate rapid assessment. This report is part of a broader programmatic effort to collate military exposure information from established, as well as new sources of data to improve VA exposure-informed healthcare.

Methods

In a collaborative effort, VA clinicians from multiple specialties participated in a structured clinical needs assessment interview to identify the most clinically useful information to be included in the Health Exposure Records and Occupations (HERO) summary. The interviews covered summary length, exposure prioritization, demographics, military occupational history, features characterizing exposure, resilience factors, health outcomes, and impact on clinical practice.

Results

Consensus recommendations prescribed a concise summary with clear language, basic military demographics, and critical military exposures that prioritize exposures that require further investigation. Based on recommendations, the HERO summary also includes types of exposure, proximity, route, symptoms at the time of exposure, exposure period, duration, frequency, and protective controls used.

Conclusion

This perspective piece not only assesses the clinical need for exposure summarization and the optimal format for the HERO summary, but also highlights its potential impact. The HERO summary, as a tool, offers improved time efficiency, consistency in exposure-informed care across the VA, enhances communication between Veterans and providers, and improves understanding of the association between military exposures and health outcomes, potentially transforming the VA healthcare system.
Short-term effect of repeat echocardiographic screening for detection or confirmation of hypertrophic cardiomyopathy
Authors: Movahed Mohammad Reza , Irannejad Kyvan , Sadin Fardokht , Keating Luke , Bates Sharon S.
Published: October 2024

Background

Diagnosis of Hypertrophic Cardiomyopathy (HCM) can be challenging. HCM can present later in life and the value of repeat echocardiogram for late presentation of HCM is not known. The goal of this study was to evaluate any changes in wall thickness occurring within 2 years using repeat screening echocardiography.

Method

The Anthony Bates Foundation has been performing screening echocardiography in high schools across the United States for the prevention of sudden death since 2001. A total of 206 subjects underwent baseline and repeat echocardiography within 2 years. We evaluated the prevalence of HCM before and after repeated echocardiography. Suspected HCM was defined as any wall thickness > 15 mm.

Results

The total prevalence of suspected HCM, defined by a cut-off value of 15 mm or more, was two from 206 (0.9%). Repeat echo within one year found one additional case of suspected HCM (wall thickness changed from 14 to 15 mm). However, the other two initial cases of suspected HCM showed regression of wall thickness to <15 mm not qualifying as HCM anymore as previously suspected after 2 years (one decreased wall thickness from 15 to 12 and the other one from 15 to 13 mm)

Conclusion

We found that repeat echocardiography is warranted in subjects with suspected HCM in order to prevent overdiagnosis. Furthermore, a new diagnosis of suspected cardiomyopathy was detected within 2 years of repeat screening. Larger studies are needed to evaluate the best timing and frequency of screening echocardiography for the detection and prevention of HCM.
Deep-learning and analytical models give distinct results for the brain structure-function relationship in health and in psychosis
Authors: Cai Qing , Thomas Hannah , Hyde Vanessa , Luque Laguna Pedro , McNabb Carolyn Beth , Singh Krish D , Jones Derek K , Messaritaki Eirini
Published: October 2024

Quantifying the intricate relationship between brain structure and function is of extreme importance in neuroscience. In this work, we present a comprehensive framework for mapping brain structural connectivity measured via diffusion-MRI to resting-state functional connectivity measured via magnetoencephalography, utilizing a deep-learning model based on a Graph Multi-Head Attention AutoEncoder. We compare the results to those from an analytical model that utilizes shortest-path- length and search-information communication mechanisms. The deep-learning model performed well at predicting healthy participant functional connectivity at individual-participant level, in particular in the alpha and beta frequency bands (mean correlation coefficient over 0.8), and better than the analytical model. The two models identified distinct differences in the structure-function relationship in people with psychosis compared to healthy participants, which were highly statistically significant (p < 2x10-4 for the deep-learning model, p < 3x10-3 in the delta band for the analytical model). Our results imply that human brain structural connectivity and electrophysiological functional connectivity are tightly coupled. They also show that simple analytical algorithms are very good models for communication between brain areas in people with psychosis in the delta and theta bands, while more sophisticated models are required for the alpha and beta bands.
Limiting hearing loss in transgenic mouse models
Authors: Babola Travis A. , Donovan Naomi , Darcy Sean S. , Spjut Catalina D. , Kanold Patrick O.
Published: October 2024

Transgenic mice provide unprecedented access to manipulate and visualize neural circuits, however, those on a C57BL/6 background develop progressive hearing loss, significantly confounding systems-level and behavioral analysis. While outbreeding can limit hearing loss, it introduces strain variability and complicates the generation of complex genotypes. Here, we propose an approach to preserve hearing by crossing transgenic mice with congenic B6.CAST-Cdh23Ahl+mice, which maintain low-threshold hearing into adulthood. Widefield and two-photon imaging of the auditory cortex revealed that 2.5-month-old C57BL/6 mice exhibit elevated thresholds to high frequency tones and widespread cortical reorganization, with most neurons responding best to lower frequencies. In contrast,Ahl+C57BL/6 mice exhibited robust neural responses across a range of frequencies and sound levels (4-64 kHz, 30-90 dB SPL) and retained low thresholds into adulthood. Our approach offers a cost-effective solution for generating complex genotypes and facilitates more interpretable systems neuroscience research by eliminating confounding effects from hearing loss.
Single and paired TMS pulses engage spatially distinct corticomotor representations in human pericentral cortex
Authors: Madsen Mads A.J. , Christiansen Lasse , Chung Chloe , Jønsson Morten G. , Siebner Hartwig R.
Published: October 2024

Single-pulse transcranial magnetic stimulation (TMS) of the primary motor hand area (M1-HAND) can assess corticomotor function in humans by evoking motor evoked potentials (MEP). Paired-pulse TMS at peri-threshold intensity elicits short-latency intracortical facilitation (SICF) with early peaks at inter-pulse intervals of 1.0-1.8ms (SICF1) and 2.4-3ms (SICF2). The similarity between the periodicity of SICF and indirect (I-)waves in the corticospinal volleys evoked by single-pulse TMS suggests that SICF originates from I-wave generating circuits. This study aimed to explore the mechanisms of MEP generation by mapping the corticomotor representations of single-pulse and paired-pulse TMS targeting SICF1and SICF2peaks in 14 participants (7 female). MEPs were recorded from two hand muscles and the spatial properties of each corticomotor map were analyzed. For both hand muscles, we found a consistent posterior shift of the center-of-gravity (CoG) for SICF maps compared to single-pulse maps, with a larger shift for SICF1. CoG displacement in the SICF1map correlated with individual SICF1latencies. Further, ADM maps consistently peaked more medially than FDI maps and paired-pulse TMS resulted in larger corticomotor maps than single-pulse TMS. This is the first study to show that circuits responsible for SICF have a more posterior representation in the precentral crown than those generating MEPs via single-pulse TMS. These findings indicate that paired-pulse TMS probing SICF1, SICF2, and single-pulse TMS engage overlapping but spatially distinct cortical circuits, adding further insights into the intricate organization of the human motor hand area.

New & Noteworthy

Single- and paired-pulse transcranial magnetic stimulation (TMS) is widely used to study corticomotor physiology in humans, but do they engage the same intracortical circuits? We compared the spatial properties of corticomotor maps elicited by single-pulse TMS to those elicited by paired-pulse short-latency intracortical facilitation (SICF). SICF maps consistently showed a posterior shift in center of gravity compared to single-pulse maps, suggesting that paired-pulse TMS engages cortical circuits that are spatially distinct from single-pulse TMS.
Forward Simulations of Walking on Surfaces with Asymmetric Mechanical Impedance: Insights for Gait Rehabilitation
Authors: Abdikadirova Banu , Price Mark , Hoogkamer Wouter , Huber Meghan E.
Published: October 2024

Gait asymmetry, prevalent in stroke survivors and various other neurological and musculoskeletal conditions, leads to abnormal joint loading, increased fall risk, and reduced walking efficiency. Traditional rehabilitation methods often fail to consistently reduce weight-bearing gait asymmetry, necessitating innovative approaches. This study explores the potential of an adjustable mechanical impedance treadmill to amplify weight-bearing asymmetries, leveraging the “error amplification” technique akin to split-belt treadmill training. We developed a 2D optimal control gait model in OpenSim to simulate walking on a rigid platform with one leg and a compliant platform, with adjustable stiffness and damping, with the other. We simulated 112 unique mechanical impedance conditions of the compliant platform and analyzed the effects of these conditions on stance time, ground reaction forces (GRFs), and muscle activations. Our results identified specific impedance parameters that can be utilized to amplify propulsion asymmetries, providing a potential new approach for gait rehabilitation post-stroke. Future work should validate these results in experimental settings and further explore optimal impedance parameters for effective gait therapy of various gait impairments.
Risk of Ischemic Heart Disease in Women with Dysmenorrhea: A Longitudinal Analysis of 251,264 Patients Across Three Diverse Cohorts
Authors: Alleva Eugenia , Khalil Susan , Glazer Kimberly , Stone Joanne , Viganò Paola , Somigliana Edgardo , Konigorski Stefan , Landi Isotta , Shengja Chen , Verma Ruchika , Jagminat Jannes , Danieletto Matteo , Hirten Robert , Böttinger Erwin , Ensari Ipek , Fuchs Thomas J. , Shaw Leslee J.
Published: October 2024

This study explores the role of dysmenorrhea as a sex-specific ischemic heart disease (IHD) risk enhancing factor across three large cohorts of 251,264 individuals, two retrospective electronic health records cohorts, i.e., the Mount Sinai Health System, All of Us, and one prospective cohort, the Australian Longitudinal Survey on Women’s Health. Considering traditional and nontraditional young female-specific cardiovascular risk factors, hazard ratios for IHD were estimated through Cox regression models and propensity score matching, and dysmenorrhea was found to be significantly associated, with a 40% to 225% increase in the hazard of developing IHD. The risk was found to be higher in women of color and those with persistent dysmenorrhea beginning in adolescence. The addition of dysmenorrhea as a predictor beyond traditional cardiovascular risk scores improved risk stratification (AUROC 0.786 vs 0.798, p-value 0.02). Within the Mount Sinai’s electronic health records, we also found dysmenorrhea diagnostic codes to have a 37.3% false negative rate. To overcome the under-coding of the diagnosis, we implemented a large language model EHR-phenotyping algorithm which led to higher hazard ratios, together with self-reporting within the ALSWH (HR 2.5 and 3.3, respectively), compared to diagnostic code-only cohort definition (HR 1.5). These findings highlight the need to recognize dysmenorrhea’s impact beyond reproduction and call for greater clinical and research awareness.
The Duan-Kimble cavity-atom quantum memory loading scheme revisited
Authors: Raymer Michael G. , Embleton Clark , Shapiro Jeffrey H.
Published: October 2024

We reexamine the well-known Duan-Kimble entanglement scheme, wherein the state of a single-photon qubit is entangled with a quantum memory consisting of a single-atom qubit in a strongly coupled optical cavity, providing the capability to load the photon’s state into the memory. We correct a common error appearing in some subsequent papers regarding the validity of the single-photon reflectivity function that characterizes the essential phase shift at the heart of the protocol. Using the validated analytical solution, we introduce an improved scheme—the configuration—where the photon and cavity are tuned at the midpoint between atomic resonances and show that it can outperform the original configuration in which the photon and cavity are tuned exactly to one of the atomic resonances. The performance metric used is the final memory-state fidelity versus the heralding probability, which determines the memory-loading rate. The results should play a role in optimizing future quantum repeater schemes based on the Duan-Kimble protocol.

Published by the American Physical Society
2024