bluuebunny/crossref_metadata_2025 huggingface dataset:
381. PROGRESSIVE LOSS OF BONE DENSITY IN PATIENTS WITH ESOPHAGEAL CANCER
Authors: Cameron Miles E , Judge Sarah , Judge Andrew , Awad Ziad
Published: August 2023

Background

Changes in body composition are common in esophageal cancer (EC). A majority of patients, regardless of stage, display signs of cachexia, including weight loss, skeletal and cardiac muscle atrophy and fat wasting. Bone loss is also common in cancer, secondary to shared signaling pathways that contribute to lean body loss. In this study, we hypothesized that bone density decreases progressively in patients with EC and that the continued loss of bone associated with oncologic outcomes.

Methods

We performed a retrospective review of all patients that received esophagectomy between 2012 and 2020 at our facility. Body composition was measured using PET/CT scans, and patients were classified by muscle mass according to sex- and BMI-dependent cutoffs. Bone density was measured by determining the radiation attenuation of the lumbar (L1-L5) vertebral bodies. The change in bone density was normalized by time and compared to tumor pathologic variables. A p-value less than 0.05 was considered statistically significant.

Results

Bone density was significantly reduced in patients with cachexia relative to those with appropriate muscle mass (108 ± 37.2 HU v. 146 ± 55.0 HU, p = 0.003). Furthermore, bone density correlated with muscle mass (p < 0.00001, R = 0.5055) and muscle quality/radiodensity (p = 0.0002, R = 0.4736). Mean rate of bone loss was −12.0 ± 27.9 HU/100d. Patients with regional lymph node metastases at surgery had more bone loss than those with N0 disease (−26.6 ± 30.8 HU/100d v. -2.71 ± 22.1 HU/100d, p = 0.03). Similarly, patients with positive lymphovascular invasion (−41.8 ± 32.6 HU/100d v. -3.53 ± 20.1 HU/100d, p = 0.005) and positive perineural invasion (−29.8 ± 32.4 HU/100d v. -3.12 ± 21.1 HU/100d, p = 0.01) progressively lost more bone.

Conclusion

Reduced bone mineral density is a key component of cachexia in patients with EC. We demonstrate herein that osteopenia in EC patients associates with several cachexia measures and that progressive loss of bone may predict early metastasis. Bone density may serve as a strong predictor of survival and stratification tool for clinical trials. These findings further highlight the need to study mechanisms that lead to bone wasting in tumor bearing hosts.
386. ROLE OF RECURRENT NERVE LYMPHADENECTOMY THROUGH MINIMALLY INVASIVE SURGERY IN THE TREATMENT OF OESOPHAGEAL CANCER
Authors: Chicote Cristina Martínez , Navarro Fernando Mingol , Pardo Luis Hurtado , Sánchez Marta Nieto , Audí David Abelló , Olmo Nuria García , Esteban Marcos Bruna , Urbaneja Francisco Javier Vaqué
Published: August 2023

Background

With the development of neoadjuvant therapy protocols and the advances in minimally invasive surgery, an increasing number of patients are undergoing surgery of oesophageal cancer. Lymphatic involvement is one of the most important independent prognostic factors. There is enough evidence to support that the greater the lymphadenectomy, the better survival rates.

Our aim is to present the results of our series, in which partial or total recurrent nerve lymphadenectomy was performed during oncological oesophagectomies.

Methods

Retrospective observational study that includes all patients that were operated on for oesophageal cancer from January 2019 to January 2023. All surgeries were performed by the same specialized team. Quantitative variables are described as mean and standard deviation, and qualitative variables as absolute number and percentage. The univariate methods used were Pearson’s X2 or Student’s t test for independent samples. We used logistic regression models to study prognostic factors influencing survival. The IBM SPSS Statistics 22 programme was chosen for data analysis.

Results

59 patients were operated during this period through minimally invasive approach, including recurrent nerve lymphadenectomy. Anatomopathological results showed 6 (10.2%) patients with recurrent lymph node involvement, 2 (3.4%) with right-sided positive nodes, 3 (5.1%) with left-sided ones and 1 (1.7%) with bilateral invasion. Analysis by subgroups showed that 20% of tumours larger than T2 had recurrent nerve lymph node metastasis.

There were 18 (30.5%) recurrent nerve injuries, all of which were transient except for 3 (5.1%) that required scheduled surgery.

A statistically significant relationship was found between the number of affected nodes and disease-free survival time (p-value = 0.045).

Conclusions

Mediastinal and recurrent nerve lymphadenectomy in oesophageal cancer increases the number of total positive lymph nodes obtained after surgery, allowing for a better adequacy of adjuvant treatment and corelating positively with disease-free survival time. Complications derived from these procedures are similar in number to standard lymphadenectomy and most of them can be managed by conservative treatment.
404. A SYSTEMATIC REVIEW AND META-ANALYSIS ON THE ROLE OF RADIOMICS IN ESOPHAGEAL CANCER: DIAGNOSIS, TREATMENT RESPONSE AND SURVIVAL PREDICTION
Authors: Menon Nainika , Guidozzi Nadia , Chidambaram Swathikan , Markar Sheraz Rehan
Published: August 2023

Background

The use of artificial intelligence, in the form of radiomics, enables more detailed interpretation of radiological images in less time, when compared to the human eye. Some challenges in managing esophageal cancer, particularly those reliant of human factors, can be addressed by incorporating radiomics into image interpretation, thereby supporting diagnosis, treatment planning and predicting treatment response and survival. This systematic review and meta-analysis aims to summarize the evidence in this expanding field.

Methods

The systematic review was carried out using Pubmed, MEDLINE and Ovid EMBASE databases—articles describing the use of radiomics in 18F-FDG PET/CT scans and CT scans in the esophageal cancer management were included. A meta-analysis was also performed.

Results

50 studies were included, most of which were single center cohort studies. For the assessment of treatment response using 18F-FDG PET/CT scans, 7 studies (443 patients) were included in the meta-analysis. The pooled sensitivity and specificity were 86.5% (81.1–90.6) and 87.1% (78.0–92.8). For the assessment of treatment response using CT scans, 5 studies (625 patients) were included in the meta-analysis, with a pooled sensitivity and specificity of 86.7% (81.4–90.7) and 76.1% (69.9–81.4). The remaining 38 studies discussed the benefits of radiomics in diagnosis, radiotherapy planning and survival prediction, often in less time and best when used in conjunction with radiologists.

Conclusion

This review explores the many possibilities of radiomics in esophageal cancer management. The sensitivities of 18F-FDG PET/CT scans and CT scans are comparable but 18F-FDG PET/CT scans have improved specificity for AI-based prediction of treatment response. Integrated clinical and radiomic models were the best at facilitating diagnosis and survival prediction, particularly when combined with radiologists. More multi-center studies are required to compare and externally validate models to build an evidence base.
406. A SYSTEMATIC REVIEW AND META-ANALYSIS ON THE USE OF ARTIFICIAL INTELLIGENCE IN THE ENDOSCOPIC DIAGNOSIS OF ESOPHAGEAL CANCER
Authors: Guidozzi Nadia , Menon Nainika , Chidambaram Swathikan , Markar Sheraz Rehan
Published: August 2023

Introduction

Endoscopy plays a key role in the surveillance of patients with Barrett’s esophagus and the diagnosis of esophageal cancer. The subtleties of endoscopic interpretation are subject to clinical expertise, diagnostic skill, and thus human error. Therefore, artificial intelligence (AI) is increasingly being incorporated into endoscopy in order to improve diagnostic accuracy and early detection. This systematic review and meta-analysis consolidates the evidence on the use of AI in the endoscopic diagnosis of esophageal cancer.

Methods

The systematic review was carried out using Pubmed, MEDLINE and Ovid EMBASE databases as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Studies which described the role of AI in supporting endoscopic video or image diagnosis of esophageal cancer were included. A meta-analysis was also performed.

Results

45 studies formed the qualitative and quantitative review. 14 studies with 1590 patients in total assessed the use of AI in endoscopic diagnosis of esophageal squamous cell carcinoma (ESCC)- the pooled sensitivity and specificity were 91.2% (84.3–95.2%) and 80% (64.3–89.9%). A further, 9 studies consisting of 478 patients overall explored the capabilities of AI in supporting the endoscopic diagnosis of esophageal adenocarcinoma (EAC), with a pooled sensitivity and specificity of 93.1% (86.8–96.4%) and 86.9% (81.7–90.7%). AI was often superior to endoscopists when diagnosing ESCC and improved the overall accuracy of both novice and expert endoscopists.

Conclusion

AI technology, as an adjunct to endoscopy has proven to be beneficial in early, accurate detection of esophageal malignancy. Multiple studies have shown superior diagnostic capabilities when comparing AI technology to endoscopists alone. Despite promising results, the application in real-time endoscopy is limited, and further multicenter trials are required to accurately assess its use in routine practice.
410. IMPACT ON BODY WEIGHT OF REMNANT STOMACH PRESERVING ESOPHAGECTOMY FOR THE PATIENTS WITH PAST MEDICAL HISTORY OF GASTRECTOMY
Authors: Momose Kota , Yamashita Kotaro , Saito Takuro , Tanaka Koji , Yamamoto Kazuyoshi , Makino Tomoki , Takahashi Tsuyoshi , Kurokawa Yukinori , Nakajima Kiyokazu , Eguchi Hidetoshi , Doki Yuichiro
Published: August 2023

Background

Esophagectomy has a great impact on patients’ nutritional status. Particularly for the patients with past medical history of gastrectomy, there is a concern that surgical procedure of esophagectomy accommpanying remnant gastrectomy may potentially deteriorate nutritional status more than standard esophagectomy, resulting in excessive body weight loss. In order to reduce such negative impact, we perform remnant stomach preserving esophagectomy. The purpose of this study is to assess the impact on body weight of this procedure.

Methods

The patients with past medical history of gastrectomy who underwent remnant stomach preserving esophagectomy in our institute from 2015 to 2022 were enrolled in this study. All the measured body weights were collected from the electronic medical record retrospectively and all data point were plotted as BMI over time to see any transitional trend. The day of esophagectomy was defined as day0. The enrolled patients were divided into two groups according to the median initial BMI; lower BMI group and higher BMI group. The BMI transitional trends were detected in each group.

Results

Totally 37 patients were eligible in this study. Median age was 72 (57–88), the number of female was 1 (36 male), cStage1/2/3/4 of esophageal cancer were 9/9/13/5, median time period from gastrectomy was 21.0 years (0–54.5), and median initial BMI was 20.7 (15.1–27.7). All BMI data points from every patient according to the higher/lower initial BMI groups were shown in the figure. The decreasing trend in BMI until about 3 months after the esophagectomy was seen in the higher BMI group whilst relatively plateau trend in such period was seen in the lower BMI group.

Conclusion

Efficacy of the remnant stomach preserving esophagectomy in terms of reducing body weight loss could be more apparent in lower BMI patients than higher BMI patients. When you see an esophageal cancer patient with past medical history of gastrectomy, the remnant stomach preserving procedure should be considered particularly when the BMI is low.
424. EXPRESSION OF KCNB1 AND ITS RELATION TO TUMOR PROGRESSION IN ESOPHAGEAL CANCER
Authors: Ota Atsuki , Shiozaki Atsushi , Nishibeppu Keiji , Kiuchi Jun , Ohashi Takuma , Shimizu Hiroki , Arita Tomohiro , Yamamoto Yusuke , Konishi Hirotaka , Morimura Ryo , Kuriu Yoshiaki , Ikoma Hisashi , Kubota Takeshi , Fujiwara Hitoshi , Otsuji Eigo
Published: August 2023

Background

KCNB1 is a member of voltage-gated potassium channels, which mediate transmembrane potassium transport. Previous studies have elucidated the roles of and the mechanisms by which KCNB1 is activated in various cancer type. However, the role of KCNB1 in esophageal cancer remains poorly understood. In the present study, we analyzed the relationship between KCNB1 expression and tumor progression in esophageal cancer.

Methods

Knockdown (KD) experiments were performed on human esophageal cancer cell lines using KCNB1 small interfering RNA. 129 primary tissue samples from esophageal cancer patients were examined immunohistochemistry (IHC), and its relationship with clinicopathological factors and prognosis were examined.

Results

KCNB1-KD suppressed the proliferation, migration and invasion of cells and enhanced apoptosis. Cell cycle analysis showed that KCNB1-KD suppressed the progression of G2/M phase. Survival analysis showed significantly poorer 5-year relapse-free survival (RFS) in the KCNB1 high expression group by IHC (high vs low; 28.5% vs 58.1%, p = 0.0016). The multivariate analysis identified the high expression of KCNB1 as an independent prognostic factor for 5-year RFS in esophageal cancer patients (p = 0.0197).

Conclusion

The present study may contribute to the identification of KCNB1 as a mediator in tumor progression, with it eventually being a promising prognostic biomarker or a novel therapeutic target of esophageal cancer.
466. ESOPHAGECTOMY AFTER NEOADJUVANT CHEMORADIATION THERAPY: DOES THE TIMING OF SURGERY INFLUENCE THE OUTCOME?
Authors: Giorgi Lorenzo , Pansa Andrea , Marano Salvatore , Perano Vittoria , Alfieri Rita , Basato Silvia , Castoro Carlo
Published: August 2023

Background

Multimodality treatment, either neoadjuvant chemoradiotherapy (nCRT) or perioperative chemotherapy (e.g., FLOT), and surgery, represents the standard of care for locally advanced, resectable cancer of the esophagus and esophago-gastric junction. The recommended interval between the ending of nCRT and surgery is between 6 and 8 weeks. A prolonged time to surgery (TTS) is associated with an increase in pathologic complete response (pCR) and survival in different malignancies, with a possible increase in surgical difficulty and postoperative complications.

Materials and methods: A retrospective analysis was conducted on 154 patients with cT2-4aN0-(+), cT1bN+, M0 squamous cell (SCC) and adenocarcinoma (AC) cancer of the esophagus and esophagogastric junction (Siewert type 1) treated with nCRT and surgery between August 2017 and January 2022. Three groups were identified: patients operated within 10 (n = 37), between 10 and 12 (n = 48) and beyond 12 weeks (n = 69). Minimum follow-up period was six months.

Results

Demographic and clinical characteristics were comparable. Mean length of stay was 13.1, 15.6 and 16.5 days (p = 0.06) respectively. Incidence of postoperative complications and their severity were not different between groups. No postoperative deaths were observed. No difference in pCR was found. When analyzed by histology, a slight increase was evident in patients with SCC (33.3%, 43.5%, 39.4%; vs ADC 16%, 16%, 16.7%), though not statistically significant. Similar results were obtained for tumor regression grade, with an increase in major responses for SCC over time (Mandard 1–2: SCC 50%, 61%, 62%; ADC 60%, 64%, 58%). No difference in overall survival was observed.

Conclusions

Esophagectomy performed more than 10 weeks after the end of chemoradiation therapy was not associated with an increase in postoperative morbidity. We observed, though, a trend towards longer hospital stays. The rate of major pathological response seems to increase over time after completion of chemoradiation therapy, but only for squamous histotype. Larger studies are required to corroborate these findings.
479. TRANSTHORACIC VERSUS TRANSABDOMINAL SURGICAL APPROACH FOR SIEWERT TYPE II ESOPHAGOGASTRIC JUNCTIONAL ADENOCARCINOMAS—A PROPENSITY SCORE-MATCHED ANALYSIS
Authors: Wong Claudia , Chan Desmond , Wong Ian , Law Betty , Chan Fion , Law Simon
Published: August 2023

Background

Esophagogastric junctional(EGJ) adenocarcinoma is a complex type of cancer that varies in etiology and disease pattern depending on the tumor level. There is increasing evidence on the need for different surgical approaches for different Siewert types. The optimal surgical approach for Siewert type II cancer remains controversial. This study aims to compare the oncological and surgical safety of transthoracic and transabdominal approaches for type II cancers.

Methods

The study included patients who underwent resection for Siewert type II adenocarcinomas from 2003–2020 in a single tertiary center using transthoracic (TT) and transabdominal (TA) approaches with macroscopic tumor clearance. The TT approach referred to Lewis-Tanner esophagogastrectomy, while the TA approach included total gastrectomy and proximal gastrectomy. Data from a prospectively-managed database were analyzed to compare postoperative morbidity and mortality rates, lymph node harvest, completeness of resection and overall survival between the two groups. Propensity score matching (PSM) was used in further analyses.

Results

Excluding R2 resections, there were 54 patients in the TT and 45 (proximal gastrectomy:23) in the TA groups. cT stages were comparable. In TT group, median tumor length was 6 cm (vs. 3 cm,p = 0.000), 18.5% with esophageal extension of >4 cm above EGJ;75.9% had nodal metastases (vs. 47.7%, p = 0.004);20.4% underwent neoadjuvant therapy (vs. 6.8%, p = 0.057).

Anastomotic leak and cardiopulmonary complication rates, R0 resection rates, nodal yield and positive lymph node ratios were comparable. Proximal margin was involved in 15.9% for TA (vs. 5.6%, p = 0.092). Overall median survival times were similar (TT vs. TA: 42vs.65 months, p = 0.557).

PSM yielded 33 patients per group. Only one in TT group had >4 cm esophageal involvement. Cardiac complication rate in TT group was 23.6%(vs. 3.5%, p = 0.024).

Conclusion

After correcting for selection bias, positive lymph node ratio, resection margin and overall survival did not differ for the TT and TA approaches. Resection by the TT approach is associated with more cardiac complications. For Siewert type II tumors with limited thoracic esophageal extension, the TA approach is safe and should be sufficient.
489. COLON DIVERTICULUM IN THE CERVICAL REGION FOLLOWING COLON INTERPOSITION FOR CORROSIVE INJURY: A CASE REPORT
Authors: Maurice Karim , Elfiky Mohamed , Hawary Ramy , Elshayeb Amr , Elkholy Shaimaa
Published: August 2023

Background

Colon interposition is one of the traditional procedures for esophageal reconstruction following corrosive injury. While the colonic conduit has the potential to restore swallowing function in patients, yet the long term complications are not well documented. we, herby, present a case of colon diverticulum in the neck 17 years after bypass surgery.

Methods

a 22 years old female patient presented with a one year history of gradually progressive grade I dysphagia following a colon bypass surgery performed for esophageal reconstruction for corrosive stricture at the age of 5 years old. Clinical assessment revealed the presence of a swelling on the left side of her neck which increased in size upon swallowing. The patient reported that applying pressure on the swelling was associated with sensation of passage of the food bolus.

Endoscopic and Radiological assessment confirmed the presence of a neck diverticulum at the site of the anastomosis.

Results

Neck exploration was performed. The diverticulum was dissected from the surrounding tissues with particular care to preserve the colon mesentery. The esophago-colic anastomosis was identified. It was found that this anastomosis was performed in an end to side fashion. The diverticulum appeared to be the enlarged side of the colon which was enlarged causing compression on the esophagus (1). This part was resected using a stapler after intraoperative endoscopic assessment (2,3). A second layer of interrupted sutures was performed over the stapled part (4). The postoperative course was uneventful and was associated with improved dysphagia.

Conclusion

Symptomatic colon diverticulum in the neck is a rare long term complication following colon bypass and esophago-colic anastomosis. Particular care should be made when performing it in an end to side fashion. End to end esophago-colic anastomosis could potentially prevent such complication.
Cornelia de Lange Syndrome mutations in SMC1A cause cohesion defects in yeast
Authors: Chen Jingrong , Floyd Erin N , Dawson Dean S , Rankin Susannah
Published: August 2023

Cornelia de Lange Syndrome (CdLS) is a developmental disorder characterized by limb truncations, craniofacial abnormalities, and cognitive delays. CdLS is caused mainly by mutations in genes encoding subunits or regulators of the cohesin complex. Cohesin plays 2 distinct roles in chromosome dynamics as follows: it promotes looping, organization, and compaction of individual chromosomes, and it holds newly replicated sister chromatids together until cell division. CdLS-associated mutations result in altered gene expression likely by affecting chromosome architecture. Whether CdLS mutations cause phenotypes through impact on sister chromatid cohesion is less clear. Here, we show that CdLS-associated mutations introduced into the SMC1A gene of budding yeast had measurable impacts on sister chromatid cohesion, mitotic progression, and DNA damage sensitivity. These data suggest that sister chromatid cohesion-related defects may contribute to phenotypes seen in CdLS affected individuals.
Microbial and Metabolite Signatures of Stress Reactivity in Ulcerative Colitis Patients in Clinical Remission Predict Clinical Flare Risk
Authors: Jacobs Jonathan P , Sauk Jenny S , Ahdoot Aaron I , Liang Fengting , Katzka William , Ryu Hyo Jin , Khandadash Ariela , Lagishetty Venu , Labus Jennifer S , Naliboff Bruce D , Mayer Emeran A
Published: August 2023

Background

Stress reactivity (SR) is associated with increased risk of flares in ulcerative colitis (UC) patients. Because both preclinical and clinical data support that stress can influence gut microbiome composition and function, we investigated whether microbiome profiles of SR exist in UC.

Methods

Ninety-one UC subjects in clinical and biochemical remission were classified into high and low SR groups by questionnaires. Baseline and longitudinal characterization of the intestinal microbiome was performed by 16S rRNA gene sequencing and fecal and plasma global untargeted metabolomics. Microbe, fecal metabolite, and plasma metabolite abundances were analyzed separately to create random forest classifiers for high SR and biomarker-derived SR scores.

Results

High SR reactivity was characterized by altered abundance of fecal microbes, primarily in the Ruminococcaceae and Lachnospiraceae families; fecal metabolites including reduced levels of monoacylglycerols (endocannabinoid-related) and bile acids; and plasma metabolites including increased 4-ethyl phenyl sulfate, 1-arachidonoylglycerol (endocannabinoid), and sphingomyelin. Classifiers generated from baseline microbe, fecal metabolite, and plasma metabolite abundance distinguished high vs low SR with area under the receiver operating characteristic curve of 0.81, 0.83, and 0.91, respectively. Stress reactivity scores derived from these classifiers were significantly associated with flare risk during 6 to 24 months of follow-up, with odds ratios of 3.8, 4.1, and 4.9. Clinical flare and intestinal inflammation did not alter fecal microbial abundances but attenuated fecal and plasma metabolite differences between high and low SR.

Conclusions

High SR in UC is characterized by microbial signatures that predict clinical flare risk, suggesting that the microbiome may contribute to stress-induced UC flares.
ACTIV-2: A Platform Trial for the Evaluation of Novel Therapeutics for the Treatment of Early COVID-19 in Outpatients
Authors: Currier Judith S , Moser Carlee , Eron Joseph J , Chew Kara W , Smith Davey M , Javan Arzhang Cyrus , Wohl David Alain , Daar Eric S , Hughes Michael D ,   for the ACTIV-2/A5401 Study Team, Hosey Lara , Roa Jhoanna , Patel Nilam , Science Frontier , Erhardt Bill , Waring Lorraine , Hessinger Diane , Adams Stacey
Published: August 2023

Clinical Trials Registration ClinicalTrials.gov Identifier: NCT04518410.
How Do Active and Passive Cigarette Smokers in Iran Evaluate Their Health? A Sex-Specific Analysis on the Full-Spectrum of Quality of Life
Authors: Cheraghi Leila , Niknam Mahdieh , Masihay-Akbar Hasti , Azizi Fereidoun , Amiri Parisa
Published: August 2023

Introduction

This study aimed to determine the sex-specific effects of active and passive cigarette smoking on the full spectrum of health-related quality of life (HRQoL) among a sizeable adult population.

Methods

This study was conducted within the Tehran Lipid and Glucose Study (TLGS) framework. Participants included 7478 adults in the last examination of the TLGS. We used a quantile regression model to compare sex-specific HRQoL distributions among non-, current, and passive smokers. Two-step cluster analysis was used to consider the synergic effects of confounder variables.

Results

In men, current smoking was negatively associated with only mental HRQoL in all percentiles of its distribution with a decrease in absolute estimation values from the lowest (5th: β = −6.59, p < .001) to the highest (90th: β=−0.93, p = .027). Also, passive smoking was negatively associated with men’s physical HRQoL in the upper percentiles of its distribution (75th: β = −1.12, p = .010; 90th: β = −1.26, p = .016). In women, the current (β = −4.17 to −4.45 for 25th to 90th percentiles) and passive smokers (β = −2.05 to −4.25 for 10th to 90th percentiles) had lower mental HRQoL in the mentioned percentiles. Also, the current smoking had a negative association with the 5th percentile (β = −2.04, p = .008), and a positive association with the 50th (β = 1.94, p < .008) and 75th percentile of physical HRQoL (β = 2.25, p = .004).

Conclusions

The present study showed the harmful effect of smoking on mental HRQol in all participants. In contrast, the physical effect of smoking was only observed in female active smokers and at the extreme levels of the physical HRQoL spectrum.

Implications

According to the harmful effect of smoking on HRQoL, understanding active and passive smokers’ perceptions of how smoking impacts their health is critical for tobacco control programs. Since most previous studies of smoking and HRQoL have mainly focused on the extreme parts or central values of the HRQoL distribution, the use of a multiple regression approach enables the evaluation of other parts of the conditional distribution of the outcome variable. This study demonstrated the prominent effect of smoking on the mental HRQoL as well as the more serious public health burden of passive smoking in women.
Preoperative Disability Influences Effectiveness of MCID and PASS in Predicting Patient Improvement Following Lumbar Spine Surgery
Authors: Shahi Pratyush , Subramanian Tejas , Maayan Omri , Araghi Kasra , Singh Nishtha , Singh Sumedha , Asada Tomoyuki , Tuma Olivia , Korsun Maximilian , Sheha Evan , Dowdell James , Qureshi Sheeraz A. , Iyer Sravisht
Published: August 2023

Study Design:

Retrospective cohort.

Summary of Background Data:

Although minimal clinically important difference (MCID) and patient acceptable symptom state (PASS) are utilized to interpret Oswestry Disability Index (ODI), it is unclear whether there is a clearly better metric between the two and if not, which metric should be utilized when.

Objective:

To compare the characteristics of MCID and PASS when interpreting ODI after lumbar spine surgery.

Methods:

Patients who underwent primary minimally invasive transforaminal lumbar interbody fusion or decompression were included. The ODI and global rating change data at 1 year were analyzed. The global rating change was collapsed to a dichotomous outcome variable—(a) improved, (b) not improved The sensitivity, specificity, positive predictive value and negative predictive value of MCID and PASS were calculated for the overall cohort and separately for patients with minimal, moderate, and severe preoperative disability. Two groups with patients who achieved PASS but not MCID and patients who achieved MCID but not PASS were analyzed.

Results:

Two hundred twenty patients (mean age 62 y, 57% males) were included. PASS (86% vs. 69%) and MCID (88% vs. 63%) had significantly greater sensitivity in patients with moderate and severe preoperative disability, respectively. Nineteen percent of patients achieved PASS but not MCID and 10% of patients achieved MCID but not PASS, with the preoperative ODI being significantly greater in the latter. Most of these patients still reported improvement with no significant difference between the 2 groups (93% vs. 86%).

Conclusion:

Significant postoperative clinical improvement is most effectively assessed by PASS in patients with minimal or moderate preoperative disability and by MCID in patients with severe preoperative disability. Adequate interpretation of ODI using the PASS and MCID metrics warrants individualized application as their utility is highly dependent on the degree of preoperative disability.
Emerging Treatment Options for Cervical Dysplasia and Early Cervical Cancer
Authors: Boisen Michelle , Guido Richard
Published: August 2023

Discussion

of treatment strategies for cervical cancer precursors, review of medical therapies and emerging therapeutics for treatment of cervical cancers, and updates on new approaches to treating early-stage cervical cancers.
Navigation of Prenatal Care With Sex Discordance Between Cell-free DNA and Ultrasound Findings
Authors: GRIFFIN LAURIE B. , MCCARTHY MEGHAN , RUSSO MELISSA L.
Published: August 2023

The utilization of cell-free DNA (cfDNA) screening has expanded rapidly across the age spectrum of pregnant persons. With cfDNA’s widespread adoption, genetic fetal sex is now often known before a phenotypic assessment on anatomic survey. CfDNA detects sex discordance in 1/1500 to 2000 pregnancies. Upon detection of sex discordance, lab error or other factors should first be assessed. Once other causes have been ruled out, this may indicate an underlying disorder/difference in sex development. A multidisciplinary team should coordinate diagnosis, treatment, and support for the family. This review discusses the diagnostic workup, emphasizing the multidisciplinary counseling and management of disorder/differences in sex development.
Physical influences on the skin barrier and pathogenesis of allergy
Authors: Hui-Beckman Jessica W. , Leung Donald Y.M.
Published: August 2023

Purpose of review

As the incidence of allergic conditions has increased in recent decades, the effects of climate change have been implicated. There is also increased knowledge on the effects of other physical influences, such as scratching and Staphylococcus aureus. The skin barrier is the first line of defense to the external environment, so understanding the ways that these factors influence skin barrier dysfunction is important.

Recent findings

Although the impact on environmental exposures has been well studied in asthma and other allergic disorders, there is now more literature on the effects of temperature, air pollution, and detergents on the skin barrier. Factors that cause skin barrier dysfunction include extreme temperatures, air pollution (including greenhouse gases and particulate matter), wildfire smoke, pollen, scratching, S. aureus, and detergents.

Understanding the ways that external insults affect the skin barrier is important to further understand the mechanisms in order to inform the medical community on treatment and prevention measures for atopic conditions.
Alternative inks for arbuscular mycorrhizal root staining
Authors: Wilkes Thomas I.
Published: August 2023

Alternative methods for arbuscular mycorrhizal (AM) fungal colonized root staining have recently gained more attention for the reduction of hazard exposure to the user. Sheaffer blue ink has been employed for such an identification and quantification, having shown an increased degree of image clarity. However, sourcing Sheaffer blue ink is becoming problematic, leading to the need to find alternative inks that are readily available. Parker ink is a well-known brand, providing comparable colour options to Sheaffer. Two Parker inks, blue and washable blue, were employed alongside Sheaffer blue for comparative AM fungal colonized root staining. From quantified AM fungal vesicles and arbuscles, along with the degree of stained image clarity under microscopy, none of the inks utilized for this comparison produce a significantly (P=0.97) different AM fungal quantification or change in image clarity. Therefore, the results of the present communication suggest that Parker blue and washable blue inks are alternative ink stains for the viewing and quantification of AM fungi in host cortical root tissues.
The importance of utilizing travel history metadata for informative phylogeographical inferences: a case study of early SARS-CoV-2 introductions into Australia
Authors: Porter Ashleigh F. , Featherstone Leo , Lane Courtney R. , Sherry Norelle L. , Nolan Monica L. , Lister David , Seemann Torsten , Duchene Sebastian , Howden Benjamin P.
Published: August 2023

Inferring the spatiotemporal spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) via Bayesian phylogeography has been complicated by the overwhelming sampling bias present in the global genomic dataset. Previous work has demonstrated the utility of metadata in addressing this bias. Specifically, the inclusion of recent travel history of SARS-CoV-2-positive individuals into extended phylogeographical models has demonstrated increased accuracy of estimates, along with proposing alternative hypotheses that were not apparent using only genomic and geographical data. However, as the availability of comprehensive epidemiological metadata is limited, many of the current estimates rely on sequence data and basic metadata (i.e. sample date and location). As the bias within the SARS-CoV-2 sequence dataset is extensive, the degree to which we can rely on results drawn from standard phylogeographical models (i.e. discrete trait analysis) that lack integrated metadata is of great concern. This is particularly important when estimates influence and inform public health policy. We compared results generated from the same dataset, using two discrete phylogeographical models: one including travel history metadata and one without. We utilized sequences from Victoria, Australia, in this case study for two unique properties. Firstly, the high proportion of cases sequenced throughout 2020 within Victoria and the rest of Australia. Secondly, individual travel history was collected from returning travellers in Victoria during the first wave (January to May) of the coronavirus disease 2019 (COVID-19) pandemic. We found that the implementation of individual travel history was essential for the estimation of SARS-CoV-2 movement via discrete phylogeography models. Without the additional information provided by the travel history metadata, the discrete trait analysis could not be fit to the data due to numerical instability. We also suggest that during the first wave of the COVID-19 pandemic in Australia, the primary driving force behind the spread of SARS-CoV-2 was viral importation from international locations. This case study demonstrates the necessity of robust genomic datasets supplemented with epidemiological metadata for generating accurate estimates from phylogeographical models in datasets that have significant sampling bias. For future work, we recommend the collection of metadata in conjunction with genomic data. Furthermore, we highlight the risk of applying phylogeographical models to biased datasets without incorporating appropriate metadata, especially when estimates influence public health policy decision making.
Genomic Profiling to Contextualize the Results of Intervention for High-Risk Smoldering Myeloma
Authors: Kazandjian Dickran , Diamond Benjamin , Papadimitriou Marios , Hill Elizabeth , Sklavenitis-Pistofidis Romanos , Ziccheddu Bachisio , Blaney Patrick , Chojnacka Monika , Durante Michael , Maclachlan Kylee , Young Ryan , Usmani Saad , Davies Faith , Getz Gad , Ghobrial Irene , Korde Neha , Morgan Gareth , Maura Francesco , Landgren Ola
Published: August 2023

Early intervention for High-Risk Smoldering Multiple Myeloma (HR-SMM) achieves deeper and more prolonged responses compared to Newly Diagnosed (ND) MM. It is unclear if beneficial outcomes of interventional studies in HR-SMM are due to treatment of less complex, susceptible disease or inaccuracy in clinical definition of cases entered. Here, to gain greater biologic insight into treatment outcomes, we performed the first whole genome sequencing analysis of treated HR-SMM for 27 patients treated with carfilzomib, lenalidomide, and dexamethasone and lenalidomide maintenance (NCT01572480). Genomic features were pooled with another contemporary HR-SMM interventional study (E-PRISM;NCT02279394) and compared to those of NDMM. We reveal that across interventional cohorts, the genomic landscape of HR-SMM is uniformly simple as compared to NDMM counterparts, with fewer inactivation events of tumor suppressor genes, fewer RAS pathway mutations, lower frequency ofMYCdisruption, and lower APOBEC contribution. The absence of these genomic events parallels that of indolent precursor conditions with low chance of progression, possibly explaining the overall superior outcomes across these trials. However, there remains a subgroup of patients harboring genomic complexity for whom early intervention with potent triplet therapy fails to sustain response and who experience resistant, progressive disease. Overall, these results suggest that clinical risk scores do not effectively discriminate between genomically indolent and aggressive disease. Furthermore, our study supports the use of genomics to contextualize the advantage of early intervention in SMM and to consider novel approaches for those with the most aggressive precursor states.

Key Points

Treated clinical high-risk smoldering multiple myeloma is genomically heterogeneous but is mostly less complex than multiple myeloma counterparts.

A small subgroup of high-risk genomic features is associated with disease progression despite early intervention with triplet therapy.
Misconceptions and misunderstandings: an exploration of the interplay of religion, culture and gender from Muslim scholars and clerics
Authors: Koburtay Tamer , Abualigah Ahmad , Syed Jawad , Ali Abbas J.
Published: August 2023

Purpose

This study seeks to offer a contextual, multilevel perspective on the impact of patriarchal culture and Islamic faith on issues facing women holding leadership positions in a Middle Eastern context.

Design/methodology/approach

Data were collected through 25 in-depth qualitative interviews along with open-ended questions in a paper-based survey. In view of the authors' research objectives, the authors purposively recruited participants who were identified as Muslim scholars (academics) and clerics (practitioners).

Findings

While the study challenges the prevailing stereotype that Islam holds women leaders back by referring to Islamic teachings that support gender equality, it also highlights the adverse impact of gender discriminatory misinterpretations of Islam for women leaders. The study identifies three interconnected, multilevel factors that lead to misinterpretations of Islamic teachings, i.e. (1) cultural factors (macro level – i.e. patriarchal and tribal culture), (2) organizational factors (meso level – i.e. organizational policies) and (3) individual factors (micro level – i.e. interpretations and practices of religion).

Research limitations/implications

This study contributes to the existing theory development of religion and women in leadership by presenting a novel model highlighting the interplay between religion, patriarchy and women in leadership.

Practical implications

The study recommends the application of a gender egalitarian system that enables full utilization of women's skills and capabilities by (1) reducing the discriminatory function of tribal culture and (2) identifying steps to reform inegalitarian gender practices in the Arab region.

Originality/value

The research is unique as it is the first time that a study has incorporated Muslim academic scholars' and clerics' views into gender and organization research. The study is thus contextually relevant and offers fresh multilevel insights on the interplay among religion, culture and gender.
Pricing information asymmetry in healthcare: stakeholder analysis and research insights
Authors: Mishra Akanksha , Pandey Neeraj
Published: August 2023

Purpose

This study aims to map and analyze health-care pricing information research. This work highlights current gap in pricing information research in health care and proposes future research avenues to academia and industry professionals.

Design/methodology/approach

A bibliometric method was adopted to analyze extant literature on pricing information asymmetry. Semistructured interviews were conducted with key stakeholders in health care to triangulate the findings.

Findings

Pricing information is crucial for all stakeholders including health-care consumers, providers and regulators. The popular research areas were the rising health-care cost, cost-saving, outcome-based pricing, price based on service supply and demand, insurance and out-of-pocket spending. Cost–quality perceived linkages, cost–demand correlation in health-care service and cost–price interlinked drivers were the dominant themes in extant literature. The study highlighted that pricing information asymmetry pushed patients from weaker sections into a debt trap due to unplanned out-of-pocket health-care expenses. The study suggests areas of research to minimize this pricing information asymmetry.

Practical implications

The emerging themes in health pricing asymmetry will help key stakeholders to identify areas for improvement and take remedial actions in the health-care domain.

Originality/value

This study is a pioneering effort to summarize extant literature published in the health-care information pricing domain and analyze it from a bibliometric perspective. The study also triangulates the finding with primary data from key stakeholders and highlights emerging research areas.
English version of Japanese guidance for biologics in treating atopic dermatitis
Authors: Saeki Hidehisa , Akiyama Masashi , Abe Masatoshi , Igarashi Atsuyuki , Imafuku Shinichi , Ohya Yukihiro , Katoh Norito , Kameda Hideto , Kabashima Kenji , Tsunemi Yuichiro , Hide Michihiro , Ohtsuki Mamitaro ,   Committee for reviewing the safety of atopic dermatitis/urticaria treatment, Japanese Dermatological Association
Published: August 2023

This is the English version of the Japanese guidance for biologics in treating atopic dermatitis (AD). The signaling pathway mediated by interleukin (IL)‐4 and IL‐13 contributes to type 2 inflammatory responses and plays an important role in the pathogenesis of AD. IL‐31 is a cytokine mainly produced by activated T cells and is known to be involved in the pruritus of AD. Biologics for AD have been approved, including dupilumab, an anti‐IL‐4 receptor α antibody that was approved for expanded use in AD in 2018. In 2022, nemolizumab, an anti‐IL‐31 receptor α antibody, was approved for pruritus of AD, and tralokinumab, an anti‐IL‐13 antibody, was approved for AD. Physicians who intend to use these drugs should sufficiently understand and comply with the contents of the guidelines prepared by the Japanese Ministry of Health, Labour, and Welfare to promote the optimal use of the drugs. In treatment with biologics, it is important to consider disease factors (activity and severity), treatment factors (dosage and administration as well as the efficacy and safety), and patients’ background characteristics (age and comorbidities) and share this information with patients when choosing treatment options. This guidance was developed for board‐certified dermatologists who specialize in treating AD, and for promoting the proper use of biologics, taking into account the variety of factors in individual patients.
The role of thermal tolerance in determining elevational distributions of four arthropod taxa in mountain ranges of southern Asia
Authors: Khaliq Imran , Shahid Muhammad Junaid , Kamran Haseeb , Sheraz Muhammad , Awais Muhammad , Shabir Mehtab , Asghar Muhammad , Rehman Abdul , Riaz Maria , Braschler Brigitte , Sanders Nathan J. , Hof Christian
Published: August 2023

Understanding the role of thermal tolerances in determining species distributions is important for assessing species responses to climate change. Two hypotheses linking physiology with species distributions have been put forward—the climatic variability hypothesis and the climatic extreme hypothesis. The climatic variability hypothesis predicts the selection of individuals with broad thermal tolerance in more variable climatic conditions and the climatic extreme hypothesis predicts the selection of individuals with extreme thermal tolerance values under extreme climatic conditions. However, no study has tested the predictions of these hypotheses simultaneously for several taxonomic groups along elevational gradients.

Here, we related experimentally measured critical thermal maxima, critical thermal minima and thermal tolerance breadths for 15,187 individuals belonging to 116 species of ants, beetles, grasshoppers, and spiders from mountain ranges in central and northern Pakistan to the limits and breadths of their geographic and temperature range.

Across all species and taxonomic groups, we found strong relationships between thermal traits and elevational distributions both in terms of geography and temperature. The relationships were robust when repeating the analyses for ants, grasshoppers, and spiders but not for beetles. These results indicate a strong role of physiology in determining elevational distributions of arthropods in Southern Asia.

Overall, we found strong support for the climatic variability hypothesis and the climatic extreme hypothesis. A close association between species' distributional limits and their thermal tolerances suggest that in case of a failure to adapt or acclimate to novel climatic conditions, species may be under pressure to track their preferred climatic conditions, potentially facing serious consequences under current and future climate change.