bluuebunny/crossref_metadata_2025 huggingface dataset:
Pitfalls of using the ILO classification for silicosis compensation claims
Authors: Akgün Metin , Ozmen Ipek , Ozari Yildirim Elif , Tuzun Bahar , Nur Toreyin Zehra , Kayinova Atinc , Arbak Peri , Akkurt Ibrahim
Published: March 2022

Background

The International Labour Organization (ILO) Classification of Radiographs of Pneumoconioses is used as the primary tool to determine compensation for pneumoconiosis in Turkey.

Aims

We aimed to evaluate how the ILO classification applied, but obtaining chest radiographs in the workplace for screening until the completion of compensation claim files by the referral centres, based on the ILO reading.

Methods

The study included 320 digital chest radiographs previously taken for screening from eight different ceramic factories and having finalised claim files by referral centres. We used an expert reference panel consisting of five ILO readers to re-evaluate all the radiographs independently using ILO standard films and reached a conclusion based on the agreement among at least three readers. The evaluation primarily included technical quality and silicosis diagnosis with an ILO 1/0 or above small profusion. The results were compared with previous findings.

Results

Sixty-three (20%) chest radiographs were unacceptable for classification purposes according to the ILO technical quality grades. Among the remaining 257 chest radiographs, we diagnosed 103 with silicosis (40%), while the referral centres diagnosed 182 (71%). A discrepancy was found between our results and previous evaluations. We diagnosed silicosis in 50% and 17% of the previous silicosis and normal evaluations, respectively.

Conclusions

Our findings suggest that the use of the ILO classification for compensation claims may be problematic due to the way of its implementation in Turkey in addition to its subjectivity.
Access to Medications for Opioid Use Disorder for Persons With Human Immunodeficiency Virus in the United States: Gaps in Coverage by State AIDS Drug Assistance Programs
Authors: McManus Kathleen A , Davy-Mendez Thibaut , Killelea Amy , Schranz Asher J
Published: March 2022

Life-saving medications for opioid use disorder are inaccessible for people with human immunodeficiency virus relying on the AIDS Drug Assistance Programs (ADAP) in 40% of jurisdictions. Funding/policies should address this through increasing access through ADAP and the Ryan White HIV/AIDS Program (RWHAP), partnerships between RWHAP and substance use programs, and other state/federal initiatives.
Hepatosplenic Candidiasis in Patients With Hematological Malignancies: A 13-Year Retrospective Cohort Study
Authors: Boussen Inès , Lisan Quentin , Raffoux Emmanuel , Di Blasi Roberta , Boissel Nicolas , Oksenhendler Eric , Adès Lionel , Xhaard Aliénor , Bretagne Stéphane , Alanio Alexandre , Molina Jean-Michel , Denis Blandine
Published: March 2022

Background

Hepatosplenic candidiasis (HSC) used to be reported in patients with acute myeloid leukemia (AML) without antifungal prophylaxis. The aim was to describe the clinical features and outcomes of HSC over the last 13 years in a single French hematology center.

Methods

All patients diagnosed with HSC between 2008 and 2020 were included in a single-center retrospective cohort study. Data were collected from patient charts, and HSC was classified according to the 2020 European Organisation for Research and Treatment of Cancer/Mycoses Study Group definitions.

Results

Sixty patients were included, with 18.3% proven, 3.3% probable, and 78.3% possible HSC according to the 2020 European Organization for Research and Treatment of Cancer Mycoses Study Group classification. Among them, 19 patients were treated for acute myeloid leukemia (AML), 21 for lymphomas, and 14 for acute lymphoblastic leukemia. HSC occurred in 13 patients after autologous stem cell transplantation for lymphoma. At HSC diagnosis, 13 patients were receiving antifungal prophylaxis. Candida colonization was present in 84.2%, with prior candidemia in 36.7% of cases. β-D-glucans was positive in 55.8%, and 45.8% of tissue biopsies were contributive. First-line antifungal therapy was azoles in 61.7%, and steroids were associated in 45% of cases. At 3 months of follow-up, partial response to antifungal therapy was 94.2%. At last follow-up (mean, 22.6 months), 41 patients (68.3%) presented a complete hematological remission and 22 patients were deceased, none because of HSC.

Conclusions

The epidemiology of HSC has changed in the last decade, with fewer cases occurring in the AML setting. A better identification of patients at risk could lead to specific prophylaxis and improved diagnosis.
Reluctant Republicans, Eager Democrats?
Authors: Clinton Joshua D , Lapinski John S , Trussler Marc J
Published: March 2022

Using the registration-based samples and disposition codes of state-level pre-election telephone polls conducted by the National Election Pool as part of the National Exit Poll in 12 states, we test whether likely Democrats were more likely to cooperate with the National Exit Poll than likely Republicans and independents. Using information about both respondents and nonrespondents, we find that Democrats are more likely to cooperate with telephone interviewers than Republicans and independents by 3 and 6 percentage points, respectively, even after controlling for individual and geographic features plausibly related to nonresponse (e.g., age, gender, race, urban/rural, community support for President Trump, and effects of COVID-19). Equalizing the partisan cooperation rate when post-stratifying to account for the partisan differences in cooperation decreases the average polling error on the margin of victory by 4 percentage points in the polls we examine, but sizable errors remain in critical swing states because of within-party differences in who responds and/or errors in the available partisanship measures in the voter file.
Intermediate hypocretin-1 cerebrospinal fluid levels and typical cataplexy: their significance in the diagnosis of narcolepsy type 1
Authors: van der Hoeven Adrienne Elisabeth , Fronczek Rolf , Schinkelshoek Mink Sebastian , Roelandse Frederik Willem Cornelis , Bakker Jaap Adriaan , Overeem Sebastiaan , Bijlenga Denise , Lammers Gert Jan
Published: March 2022

Study Objectives

The diagnosis of narcolepsy type 1 (NT1) is based upon the presence of cataplexy and/or a cerebrospinal fluid (CSF) hypocretin-1/orexin-A level ≤ 110 pg/mL. We determined the clinical and diagnostic characteristics of patients with intermediate hypocretin-1 levels (111–200 pg/mL) and the diagnostic value of cataplexy characteristics in individuals with central disorders of hypersomnolence.

Methods

Retrospective cross-sectional study of 355 people with known CSF hypocretin-1 levels who visited specialized Sleep-Wake Centers in the Netherlands. For n = 271, we had full data on cataplexy type (“typical” or “atypical” cataplexy).

Results

Compared to those with normal hypocretin-1 levels (>200 pg/mL), a higher percentage of individuals with intermediate hypocretin-1 levels had typical cataplexy (75% or 12/16 vs 9% or 8/88, p < .05), and/or met the diagnostic polysomnographic (PSG) and Multiple Sleep Latency Test (MSLT) criteria for narcolepsy (50 vs 6%, p < .001). Of those with typical cataplexy, 88% had low, 7% intermediate, and 5% normal hypocretin-1 levels (p < .001). Atypical cataplexy was also associated with hypocretin deficiency but to a lesser extent. A hypocretin-1 cutoff of 150 pg/mL best predicted the presence of typical cataplexy and/or positive PSG and MSLT findings.

Conclusion

Individuals with intermediate hypocretin-1 levels or typical cataplexy more often have outcomes fitting the PSG and MSLT criteria for narcolepsy than those with normal levels or atypical cataplexy. In addition, typical cataplexy has a much stronger association with hypocretin-1 deficiency than atypical cataplexy. We suggest increasing the NT1 diagnostic hypocretin-1 cutoff and adding the presence of clearly defined typical cataplexy to the diagnostic criteria of NT1.

Clinical trial information: This study is not registered in a clinical trial register, as it has a retrospective database design.
Updating the phylogeny and taxonomy of pleurostomatid ciliates (Protista: Ciliophora) with establishment of a new family, a new genus and two new species
Authors: Zhang Gongaote , Zhao Yan , Chi Yong , Warren Alan , Pan Hongbo , Song Weibo
Published: March 2022

The order Pleurostomatida is one of the most confusing groups in the ciliate class Litostomatea. In the present study, two new species, Paralitonotus foissneri gen. & sp. nov. and Loxophyllum apochlorelligerum sp. nov., were investigated using an integrative approach. Paralitonotus foissneri differs from other pleurostomatids by its distinctive ciliary pattern (i.e. the anterior ends of the right somatic kineties are progressively shortened from the middle towards dorsal and perioral ones). Therefore, we place it in the new genus Paralitonotus. Loxophyllum apochlorelligerum is characterized by seven to nine left and 12–14 right somatic kineties, three to five anterior dorsal warts and a subterminal contractile vacuole. Phylogenetic analyses show that Pa. foissneri clusters with Apolitonotus lynni and Pseudolitonotus gracilis to form a deep-branching subclade that is basal to other core pleurostomatids. All three genera have distinctive anteriorly shortened right kineties, suggesting that this might be a familial character state. We therefore establish a new family, Paralitonotidae fam. nov., for pleurostomatids with this character and propose a new taxonomic scheme and a hypothetical evolutionary trajectory of the order Pleurostomatida. In addition, the generic diagnostic characters for pleurostomatids are updated, and a key to the identification of pleurostomatid genera is provided.
Development of PCR-Based Assays for Rapid and Reliable Detection and Identification of Canker-Causing Pathogens from Symptomatic Almond Trees
Authors: Avenot Herve F. , Jaime-Frias Rosa , Travadon Renaud , Holland Leslie A. , Lawrence Daniel P. , Trouillas Florent P.
Published: March 2022

Trunk and scaffold canker diseases (TSCDs) of almond cause significant yield and tree losses and reduce the lifespan of orchards. In California, several pathogens cause TSCDs, including Botryosphaeriaceae, Ceratocystis destructans, Eutypa lata, Collophorina hispanica, Pallidophorina paarla, Cytospora, Diaporthe, and Phytophthora spp. Field diagnosis of TSCDs is challenging because symptom delineation among the diseases is not clear. Accurate diagnosis of the causal species requires detailed examination of symptoms and subsequent isolation on medium and identification using morphological criteria and subsequent confirmation using molecular tools. The process is time-consuming and difficult, particularly as morphological characteristics are variable and overlap among species. To facilitate diagnosis of TSCD, we developed PCR assays using 23 species-specific primers designed by exploiting sequence differences in the translation elongation factor, β-tubulin, or internal transcribed spacer gene. Using genomic DNA from pure cultures of each fungal and oomycete species, each primer pair successfully amplified a single DNA fragment from the target pathogen but not from selected nontarget pathogens or common endophytes. Although 10-fold serial dilution of fungal DNA extracted from either pure cultures or infected wood samples detected as little as 0.1 pg of DNA sample, consistent detection required 10 ng of pathogen DNA from mycelial samples or from wood chips or drill shavings from artificially or naturally infected almond wood samples with visible symptoms. The new PCR assay represents an improved tool for diagnostic laboratories and will be critical to implement effective disease surveillance and control measures.
Research Priorities for Pediatric Intensive Care Nutrition Within the United Kingdom: A National Institute of Health Research James Lind Alliance Priority Setting Partnership
Authors: O’Connor Graeme , Marino Luise V. , Tume Lyvonne N. , Stewart Alexandra , Gates Simon , Lanigan Julie , Bangalore Harish , Kinsella Suzannah
Published: March 2022

OBJECTIVES:

To determine research priorities in PICU nutrition, which represent the shared priorities of patients, parents, carers, and PICU healthcare professionals within the United Kingdom.

DESIGN:

A national multiphase priority setting methodology in partnership with the James Lind Alliance delivered over 16 months (June 2020–September 2021). Part 1: a national scoping survey asked respondents to submit their research uncertainties related to PICU nutrition. Part 2: summarizing and evidence-checking the submitted uncertainties. Part 3: interim prioritization survey. Part 4: consensus workshop.

SETTING:

PICU.

PARTICIPANTS:

Patients, parents, and carers of patients who had been admitted to PICU, and PICU healthcare professionals involved in the treatment of these patients within the United Kingdom.

INTERVENTIONS:

None.

MEASUREMENTS AND MAIN RESULTS:

A national scoping survey asked respondents to submit their research uncertainties related to PICU nutrition. In the first survey, 165 topic ideas were suggested (12% by parents/carers and 88% by PICU healthcare professionals). These were categorized into 57 summary questions. The existing evidence was searched to ensure that the proposed summary questions had not already been answered. Forty were judged to be true uncertainties following a systematic literature review. These 40 uncertainties were grouped into eight themes for the second interim survey, which asked respondents to prioritize their top research questions. One hundred and forty participants contributed to this second interim survey. A final shortlist of 25 questions was derived, with the top 18 questions taken to a multistakeholder workshop where a consensus was reached on the top 10 priorities.

CONCLUSIONS:

This research identified important research gaps in the management of patients in PICU. Areas that need to be addressed as a priority include energy requirements in ventilated neonates, nutritional supplementation of probiotics to manage and prevent sepsis, the impact of postintensive care syndrome on nutrition and growth, and when to commence parenteral (IV) nutrition. The challenge now is to refine and deliver answers to these research priorities.
Visit-to-visit glycated hemoglobin A1c variability in adults with type 2 diabetes: a systematic review and meta-analysis
Authors: Qu Furong , Shi Qingyang , Wang Yang , Shen Yanjiao , Zhou Kaixin , Pearson Ewan R. , Li Sheyu
Published: March 2022

Background:

Current practice uses the latest measure of glycated hemoglobin (HbAlc) to facilitate clinical decision-making. Studies have demonstrated that HbAlc variability links the risk of death and complications of diabetes. However, the role of HbAlc variability is unclear in clinical practice. This systematic review summarized the evidence of visit-to-visit HbAlc variability regarding different metrics in micro- and macro-vascular complications and death in people with type 2 diabetes.

Methods:

We searched PubMed, EMBASE (via OVID), and Cochrane Central Register (CENTRAL, via OVID) for studies investigating the association between HbAlc variability and adverse outcomes in patients with type 2 diabetes and performed random-effects meta-analysis stratified by HbAlc variability metrics in terms of standard deviation (SD), coefficient of variation (CV), and HbAlc variability score (HVS).

Results:

In people with type 2 diabetes, the highest quantile of all three HbAlc variability metrics (HbAlc-standard deviation [HbAlc-SD], HbAlc-coefficient of variance [HbAlc-CV], and HVS) is associated with increased risks of all-cause mortality, cardiovascular events, progression to chronic kidney disease, amputation, and peripheral neuropathy. For example, the hazard ratio of HbAlc-SD on all-cause mortality was l.89 with 95% confidence interval (95% CI) l.46–2.45 (HbAlc-CV l.47, 95% CI l.26–l.72; HVS l.67, 95% CI l.34–2.09).

Conclusions:

High HbAlc variability leads to micro- and macro-vascular complications of type 2 diabetes and related death. People with type 2 diabetes and high HbAlc variability need additional attention and care for the potential adverse outcomes.
Associations of insulin resistance and beta-cell function with abnormal lipid profile in newly diagnosed diabetes
Authors: Tang Xiaohan , Yan Xiang , Zhou Houde , Huang Gan , Niu Xiaohong , Jiang Hongwei , Su Heng , Yang Xilin , Li Xia , Zhou Zhiguang
Published: March 2022

Background:

Abnormal lipids are strong predictors of cardiovascular disease in type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM). However, the potential associations of insulin resistance (IR) and beta-cell function (BCF) with abnormal lipids in newly diagnosed T1DM or T2DM patients are not fully understood.

Methods:

A cross-sectional survey of 15,928 participants was conducted. Homeostasis model assessment and postprandial C-peptide levels were used to estimate IR and BCF. A restricted cubic spline (RCS) nested in binary logistic regression was used to examine the associations of IR and BCF with abnormal lipids.

Results:

High triglyceride (TG), low high-density lipoprotein cholesterol, and high low-density lipoprotein cholesterol (LDL-C) accounted for 49.7%, 47.8%, and 59.2% of the participants, respectively. In multivariable analysis, high IR was associated with an increased risk of high TGs (P for trend <0.001) in T1DM and is associated with an elevated risk of high TG and low HDL-C (all P for trend <0.01) in T2DM. Low BCF was not associated with risks of dyslipidemia in patients with T1DM or T2DM after adjustment for potential confounders.

Conclusion:

High IR had different associations with the risk of dyslipidemia in newly diagnosed T1DM and T2DM patients, suggesting that early treatment that improves IR may benefit abnormal lipid metabolism.
Endoscopic sleeve gastroplasty: a narrative review on historical evolution, physiology, outcomes, and future standpoints
Authors: Brunaldi Vitor Ottoboni , Neto Manoel Galvao
Published: March 2022

Since its first description in 2013, robust evidence supporting the efficacy and safety of the endoscopic sleeve gastroplasty (ESG) has been on the rise. A large case series and meta-analysis report supported results up to 24 months, while some other studies already described 5-year data. If associated with pharmacotherapy, the ESG may help one to achieve weight loss similar to that of surgical sleeve gastrectomy. Though the results of the ongoing randomized trials on ESG are awaited, currently available data support the clinical use of the ESG, especially for patients who are refusing or unfit for bariatric surgery.
Influence of Body Position on Intraocular Pressure After Descemet Membrane Endothelial Keratoplasty: A Prospective Randomized Trial
Authors: Händel Alexander , Siebelmann Sebastian , Lüke Jan Niklas , Matthaei Mario , Cursiefen Claus , Bachmann Björn
Published: March 2022

Purpose:

The purpose of this study was to analyze the influence of patient positioning on intraocular pressure (IOP) after Descemet membrane endothelial keratoplasty (DMEK) in pseudophakic patients treated for Fuchs endothelial corneal dystrophy.

Methods:

Forty patients were included in this prospective, single-blinded, randomized controlled clinical trial. Patients received a YAG iridotomy 1 day before surgery and an 80% anterior chamber tamponade [20% concentration of sulfur hexafluoride (SF6)]. Postoperative positioning was either supine (group 1) or seated (group 2, at least 30 degrees upper-body high position). IOP was measured with iCare.

Results:

There was no statistically significant difference in IOP postoperatively [group 1 vs. group 2—after 1h: 13.9 mm Hg (±4.2 mm Hg) versus 13.6 mm Hg (±4.1 mm Hg) (P = 1.00); after 2h: 13.9 mm Hg (±5.4 mm Hg) versus 15.3 mm Hg (±4.6 mm Hg) (P = 0.370); after 4h: 13.8 mm Hg (±4.2 mm Hg) versus 15.2 mm Hg (±4.2 mm Hg) (P = 0.401]. In group 1, 10% of patients showed IOP decompensations well above 30 mm Hg, and in group 2, there were no IOP decompensations. Seated position led to relative risk reduction of 100% and absolute risk reduction of 10% regarding IOP decompensations. The number of patients needed to position seated to prevent 1 additional IOP decompensation was 10. Rebubbling rates, best spectacle–corrected visual acuity, and reduction of corneal thickness were comparable between the 2 groups in the follow-up period up to 1 month.

Conclusions:

After DMEK in pseudophakic eyes with 80% anterior chamber tamponade, positioning patients with at least 30 degrees elevation of the upper body up immediately after surgery until bedtime prevents IOP decompensations.
Long-Term Results of Postoperative Rescuing of Inverted DMEK Grafts: Two Case Reports
Authors: Ariño-Gutierrez Mayte , Moloney Gregory , Burgos-Blasco Barbara , Arriola-Villalobos Pedro , Cuiña-Sardiña Ricardo , Diaz-Valle David
Published: March 2022

Purpose:

The purpose of this study was to report the clinical outcomes of postoperative repositioning of 2 inverted Descemet membrane endothelial keratoplasty (DMEK) grafts in 2 patients with endothelial dysfunction.

Methods:

Two patients underwent DMEK surgery in a tertiary referral corneal clinic. Initial surgery was performed by 2 different corneal surgeons, and a third surgeon repositioned both cases. In the early postoperative period, partial and subtotal detachments were observed at slitlamp and inverted graft orientation was confirmed by anterior segment optical coherence tomography. In both cases, uneventful reposition of the inverted graft was performed by an experienced DMEK surgeon on days 2 and 9 after initial DMEK surgery.

Results:

Repositioning surgery was successful in both patients. The Moutsouris sign was used to confirm proper orientation. One patient had total graft adherence at day 1 postrepositioning. The second patient required a rebubbling procedure, despite the correct orientation confirmed by using anterior segment optical coherence tomography. Visual acuity and corneal thickness were stable in both cases (case 1: 20/30, 567 μm; case 2: 20/80, 543 μm). Both patients had clear corneas and functional cell counts 2 years after repositioning (451 cells/mm2 and 1052 cells/mm2).

Conclusions:

Postoperative repositioning of an inverted DMEK graft may be a viable procedure to delay or prevent regrafting.
Observational study of the clinical utility of sulfamethoxazole serum level monitoring in the treatment of brain abscesses due to Nocardia species
Authors: Corsini Campioli Cristina , Abu Saleh Omar , Mara Kristin C. , Rivera Christina G.
Published: March 2022

Although there is a lack of data in trimethoprim-sulfamethoxazole (TMP-SMX) serum monitoring utility for invasive nocardial infections, therapeutic drug monitoring is widely used to optimize dosing and avoid adverse reactions that may cause treatment interruption.

We retrospectively reviewed all adults who received TMP-SMX to treat nocardial brain abscess and had SMX serum level testing from 2010 to 2020.

Twenty-two patients received treatment with TMP-SMX for Nocardia species brain abscess and 16 (72.7%) had a reported SMX level, with a median patient age of 65.5 years (interquartile range, IQR 59.5–72.5). Compared to those who did not have a documented SMX serum level, patients with SMX levels had a shorter median course of TMP-SMX treatment (322 days [IQR 188–365] vs. 365 [IQR 224–365]; P = .31) and higher therapeutic induction dose (10 [62.5%] vs. 3 [50%]; P = .92). Similarly, they were more frequently on hemodialysis (3 [13.6%] vs. 1 [4.5%]; P = > .99). The median peak level was 158.5 (IQR 120–218) μg/mL, collected at 2 hours (75%) post-administration in the induction phase (81.3%). Patients with documented SMX levels had fewer reported drug toxicity (5 [31.3%] vs. 4 [66.7%]; P = .1) than those without SMX levels. Among the five patients who reported TMP-SMX-related toxicity, 4 (80%) had an SMX peak level >150 μg/mL. There was no difference in the cure, relapse, and death rates among the two groups.

While SMX level was not associated with Nocardia species brain abscess cure rates and mortality, most patients with SMX peak >150 μg/mL experienced drug toxicity.
Influence of hemoglobin concentration on the in-hospital outcomes in newly diagnosed heart failure patients with atrial fibrillation
Authors: Dong Mengya , Xu Chenbo , Zhou Juan , Yuan Zuyi
Published: March 2022

Atrial fibrillation (AF) and heart failure (HF) coexistence is common of clinical significance. Although anemia is a well-recognized risk factor for adverse outcomes, the prognostic value of hemoglobin is controversial in AF and HF. We aimed to determine whether hemoglobin is associated with in-hospital outcomes in such patients.

On the basis of the data from the CCC-AF (Improving Care for Cardiovascular Diseases in China-Atrial Fibrillation) project, 2367 inpatients with a definitive diagnosis of AF and HF and record of admission hemoglobin concentration were included. Logistic regression analysis was performed to investigate the relationship between hemoglobin and in-hospital outcomes.

All patients were divided into 4 groups according to quartiles of hemoglobin values. Compared with patients with higher hemoglobin, patients with lower hemoglobin had higher proportion of males, heart rate (HR), and diastolic blood pressure (DBP). On the contrary, they had lower age, medical history, left ventricular ejection fraction (LVEF), and brain natriuretic peptide (P < .05). Spearman correlation showed that hemoglobin was negatively correlated with age, LVEF, international normalized ratio, and serum creatinine but positively correlated with HR, DBP, and blood urea nitrogen (P < .05). Multivariable logistic regression analysis revealed that increasing hemoglobin was an independent protective factor for in-hospital outcomes (odds ratio = 0.989; 95% confidence interval: 0.979–1.000; P = .046).

Admission hemoglobin concentration was an independent protective factor for in-hospital outcomes in HF patients with AF. Our study indicated that increasing hemoglobin level and improving anemia degree might improve the prognosis of patients with AF and HF.
Clinical outcomes after elective double-embryo transfer in frozen cycles for women of advanced maternal age
Authors: Wang Zilian , Zhu Haiyan , Tong Xiaomei , Jiang Lingying , Wei Qun , Zhang Songying
Published: March 2022

We aimed to determine the clinical outcome of double cleavage-stage embryo transfers in frozen-thawed embryo transfer cycles for older women.

This study analyzed a total of 8189 cleavage-stage frozen-thawed embryo transfer cycles between January 2013 and December 2017 at Sir Run Run Shaw Hospital. All cycles were sorted into 3 groups based on patient age: ≤35 years (Group A), 36 to 37 years (Group B), and ≥38 years (Group C). The clinical pregnancy rate (CPR), implantation rate (IR), live birth rate (LBR), miscarriage rate, multiple pregnancy rate (MPR), preterm birth rate, and low-birth-weight rate were compared between the 3 groups.

Significant differences in CPR, IR, LBR, MPR, and premature birth rate were found among the 3 groups. The CPR, IR, LBR, and MPR in Group A were higher than those in Group C. Transfers of 2 high-quality embryos resulted in significant differences in CPR, IR, LBR, MPR, and neonatal weight among the 3 groups, but no differences in premature birth and abortion rates were observed. Transfers with 1 high-quality and 1 fair-quality embryo resulted in significant differences in CPR, IR, and LBR among the 3 groups. Comparison of transfers of 2 high-quality embryos with 1 high-quality and 1 fair-quality embryo showed that the CPR and LBR were significantly lower for the latter in Groups A and C, but Group B had no salient changes.

Higher IR and LBR and lower MPR may be achieved by selection of optimal embryo types for patients of different ages. Two high-quality embryos need to be transferred in women older than 38 years. For women aged 36 to 37 years, 1 high-quality embryo or 1 high-quality plus 1 fair-quality embryo should be singled out for transfer. For women younger than 35 years, a single high-quality embryo should be selected for transfer.
Effects of electroacupuncture for obesity
Authors: Kang Junhyuk , Kim Koh-Woon , Seo Yeonho , Song Mi-Yeon , Chung Won-Seok
Published: March 2022

Background:

Obesity—a public health problem that negatively affects the quality of life—is associated with various diseases, and its prevalence is on the rise. Although drugs and surgical interventions are used to treat obesity, they have adverse effects and limitations. Electroacupuncture is a widely used method for treating obesity in which electrical stimulation is transmitted to the body through acupuncture needles. This systematic review and meta-analysis will evaluate the efficacy of electroacupuncture in treating obesity.

Methods:

MEDLINE/PubMed, EMBASE, the Cochrane Central Register of Controlled Trials, 3 Korean databases (Oriental Medicine Advanced Searching Integrated System, ScienceON, and KoreaMed), 1 Japanese database (Citation Information by the National Institute of Informatics), and 1 Chinese database (Chinese National Knowledge Infrastructure) will be searched from their inception to December 2021. The primary outcome will be body mass index, and the secondary outcomes will be body weight, waist and hip circumference, waist-to-hip ratio, body fat percentage, body fat mass, and adverse effects.

Results and conclusion:

This systematic review and meta-analysis will provide evidence for efficacy of electroacupuncture as a treatment method for obesity.

Trial registration number:

DOI 10.17605/OSF.IO/YU5XR (https://osf.io/yu5xr).
Efficacy and safety of acupuncture combined with Chinese herbal medicine traditional Chinese medicine for poststroke cognitive impairment
Authors: Wang Ying , Guo Sha , Xiao Meng-Lu , Zhang Hong
Published: March 2022

Background:

Poststroke cognitive impairment (PSCI) is often secondary to poststroke, which is common in stroke patients, induced difficulty in rehabilitation and seriously affects their quality of life. Currently, effective treatments are still limited. Researches show that acupuncture combined with traditional Chinese medicine (TCM) has a good effect on PSCI. However, there is no consistent conclusion at present. Therefore, THE purpose of this study is to assess the effectiveness and safety of acupuncture combined with TCM in the treatment of PSCI.

Methods:

We will search the following databases from inception to January, 2022: the Cochrane Library, PubMed, Embase, Medline, Web of Science, China National Knowledge Infrastructure, China Biology Medicine, Wan Fang data, and the Chinese Science and Technology Periodical Database. All randomized controlled trials eligible for acupuncture combined with TCM for PSCI will be included in this study. Study selection, data extraction, and quality assessment will be performed by 2 reviewers independently. Bias risk assessment and data synthesis will be performed using the Review Manager software (RevMan, version 5.3) and R (version 3.6.1) software.

Results:

We will synthesize the current studies to evaluate the effectiveness and safety of acupuncture combined with TCM in the treatment of PSCI.

Conclusion:

The systematic review will provide a new paradigm for acupuncture combined with TCM in the intervention of PSCI, and further provide scientific evidence for the efficacy and safety of acupuncture combined with TCM in the treatment of PSCI.

Trial registration number:

INPLASY202220062.
Out-of-Network Care in Commercially Insured Pediatric Patients According to Medical Complexity
Authors: Xu Wendy Y. , Li Yiting , Song Chi , Bose-Brill Seuli , Retchin Sheldon M.
Published: March 2022

Background:

Commercial health plans establish networks and require much higher cost sharing for out-of-network (OON) care. Yet, the adequacy of health plan networks for access to pediatric specialists, especially for children with medical complexity, is largely unknown.

Objective:

To examine differences in OON care and associated cost-sharing payments for commercially insured children with different levels of medical complexity.

Design:

Cross-sectional study using a nationwide commercial claims database.

Subjects:

Enrollees 0–18 years old in employer-sponsored insurance plans. The Pediatric Medical Complexity Algorithm was used to classify individuals into 3 levels of medical complexity: children with no chronic disease, children with non-complex chronic diseases, and children with complex chronic diseases.

Main Outcomes:

OON care rates, cost-sharing payments for OON care and in-network care, OON cost sharing as a proportion of total health care spending, and OON cost sharing as a proportion of total cost sharing.

Results:

The study sample included 6,399,006 individuals with no chronic disease, 1,674,450 with noncomplex chronic diseases, and 603,237 with complex chronic diseases. Children with noncomplex chronic diseases were more likely to encounter OON care by 6.77 percentage points with higher cost-sharing by $288 for OON care, relative to those with no chronic disease. For those with complex chronic diseases, these differences rose to 16.08 percentage points and $599, respectively. Among children who saw behavioral health providers, rates of OON care were especially high.

Conclusions:

Commercially insured children with medical complexity experience higher rates of OON care with higher OON cost-sharing payments compared with those with no chronic disease.
The role of radiotherapy in oligometastatic hormone-sensitive prostate cancer
Authors: Abdel-Aty Hoda , James Nicholas D.
Published: March 2022

Purpose of review

The aim of this article is to review the role of radiotherapy in the management of oligometastatic hormone-sensitive prostate cancer (HSPC).

Recent findings

The M1|RT STAMPEDE trial showed a survival advantage to prostate radiotherapy in newly diagnosed oligometastatic HSPC. The combination of prostate radiotherapy with systemic treatment is now the recommended standard of care. Metastases-directed therapy (MDT) with stereotactic ablative radiotherapy (SABR) in the STOMP and ORIOLE trial reported excellent local control and a survival advantage in metachronous oligometastatic HSPC. Results were consistent with prostate cancer outcomes in the SABR-COMET trial and the NHS England Commissioning through Evaluation scheme (CtE). SABR in synchronous oligometastatic HSPC will be evaluated in a new comparison within the STAMPEDE trial. Current definition of oligometastatic HSPC is based on the number of metastatic lesions on conventional imaging (CT/MRI and Isotope bone scan). Novel imaging, such as PSMA PET/CT provide superior accuracy to conventional imaging. However, limited data exists on the role of novel imaging in determining subsequent clinical outcomes.

Prostate radiotherapy improves survival and is standard of care with systemic treatment in newly diagnosed oligometastatic HSPC. The role of SABR in newly diagnosed oligometastatic HSPC is yet to be determined.
Secondary Tumors of the Kidney: A Comprehensive Clinicopathologic Analysis
Authors: Saeed Faisal , Osunkoya Adeboye O.
Published: March 2022

Metastases to the kidney are rare and were historically described in autopsy series, and the incidence ranged between 2.36% and 12.6%. However, in the contemporary literature with the improvements in imaging modalities (computed tomography scan and magnetic resonance imaging) and other health care screening services, metastatic tumors to the kidney are being diagnosed more frequently in surgical specimens. The utility of needle core biopsies in the primary evaluation of renal masses has also increased the number of sampled metastases, and as a result, only limited histologic material is available for evaluation in some cases and may potentially lead to diagnostic pitfalls. In the last decade, a few large clinical series have been published. In these series, the majority of metastatic tumors to the kidney are carcinomas, with the lung being the most common primary site. A significant number of the various tumor types with metastasis to the kidney are also associated with widespread metastases to other organs, and the renal metastasis may present several years after diagnosis of the primary tumor. The majority of secondary tumors of the kidney are asymptomatic, incidentally discovered, and solitary. There should be a high index of suspicion of metastasis to the kidney in patients with an associated enlarging renal lesion with minimal to no enhancement on imaging and tumor progression of a known high-grade nonrenal malignancy. Secondary tumors of the kidney can be accurately diagnosed by correlating histopathologic features with clinical and radiographic findings and the judicious use of ancillary studies.
Effective Treatment of Chronic Mastectomy Pain with Intercostal Sensory Neurectomy
Authors: Hart Sarah E. , Agarwal Shailesh , Hamill Jennifer B. , Brown David L.
Published: March 2022

Chronic postmastectomy pain affects up to 40 percent of patients and leads to diminished quality of life and increased risk of opioid dependence. The cause of this pain is incompletely understood; however, one hypothesis is that direct injury to cutaneous intercostal nerves at the time of mastectomy and/or reconstruction leads to chronic pain. As a result, proximal neurectomy of the involved sensory nerve(s) has been suggested to be effective for these patients. The purpose of this study was to determine whether chronic pain in postmastectomy patients can be diagnosed reliably in an office setting and pain reduced by intercostal sensory neurectomy. The authors performed a retrospective review of seven patients with a history of breast surgery and chronic pain who underwent intercostal neurectomy combined with muscle or dermal wrapping of the proximal end of the resected nerve. All patients were diagnosed by history and physical examination, and suspected nerves were further identified with local anesthetic nerve blocks. An average of 3.14 neurectomies were performed per patient (range, one to six). There was a significant reduction in visual analogue scale pain scores following surgery, from 9 preoperatively to 1 postoperatively (p = 0.02). Eighty-six percent of patients were pain-free or “considerably improved” at their latest follow-up appointment (average, 6.14 months). It is concluded that intercostal sensory nerve injury at the time of mastectomy and/or reconstruction can lead to chronic mastectomy pain, which can be easily diagnosed and effectively treated with intercostal neurectomy.

CLINICAL QUESTION/LEVEL OF EVIDENCE:

Therapeutic, IV.
Semantic Categorization of Naming Responses Based on Prearticulatory Electrical Brain Activity
Authors: Wilmskoetter Janina , Roth Rebecca , McDowell Konnor , Munsell Brent , Fontenot Skyler , Andrews Keeghan , Chang Allen , Johnson Lorelei P. , Sangtian Stacey , Behroozmand Roozbeh , van Mierlo Pieter , Fridriksson Julius , Bonilha Leonardo
Published: March 2022

Purpose:

Object naming requires visual decoding, conceptualization, semantic categorization, and phonological encoding, all within 400 to 600 ms of stimulus presentation and before a word is spoken. In this study, we sought to predict semantic categories of naming responses based on prearticulatory brain activity recorded with scalp EEG in healthy individuals.

Methods:

We assessed 19 healthy individuals who completed a naming task while undergoing EEG. The naming task consisted of 120 drawings of animate/inanimate objects or abstract drawings. We applied a one-dimensional, two-layer, neural network to predict the semantic categories of naming responses based on prearticulatory brain activity.

Results:

Classifications of animate, inanimate, and abstract responses had an average accuracy of 80%, sensitivity of 72%, and specificity of 87% across participants. Across participants, time points with the highest average weights were between 470 and 490 milliseconds after stimulus presentation, and electrodes with the highest weights were located over the left and right frontal brain areas.

Conclusions:

Scalp EEG can be successfully used in predicting naming responses through prearticulatory brain activity. Interparticipant variability in feature weights suggests that individualized models are necessary for highest accuracy. Our findings may inform future applications of EEG in reconstructing speech for individuals with and without speech impairments.
Uneven terrain treadmill walking in younger and older adults
Authors: Downey Ryan J. , Richer Natalie , Gupta Rohan , Liu Chang , Pliner Erika M. , Roy Arkaprava , Hwang Jungyun , Clark David J. , Hass Chris J. , Manini Todd M. , Seidler Rachael D. , Ferris Daniel P.
Published: March 2022

We developed a method for altering terrain unevenness on a treadmill to study gait kinematics. Terrain consisted of rigid polyurethane disks (12.7 cm diameter, 1.3-3.8 cm tall) which attached to the treadmill belt using hook-and-loop fasteners. Here, we tested four terrain unevenness conditions: Flat, Low, Medium, and High. The main objective was to test the hypothesis that increasing the unevenness of the terrain would result in greater gait kinematic variability. Seventeen younger adults (age 20-40 years), 25 higher-functioning older adults (age 65+ years), and 29 lower-functioning older adults (age 65+ years, Short Physical Performance Battery score < 10) participated. We customized the treadmill speed to each participant’s walking ability, keeping the speed constant across all four terrain conditions. Participants completed two 3-minute walking trials per condition. Using an inertial measurement unit placed over the sacrum and pressure sensors in the shoes, we calculated the stride-to-stride variability in step duration and sacral excursion (coefficient of variation; standard deviation expressed as percentage of the mean). Participants also self-reported their perceived stability for each condition. Terrain was a significant predictor of step duration variability, which roughly doubled from Flat to High terrain for all participant groups: younger adults (Flat 4.0%, High 8.2%), higher-functioning older adults (Flat 5.0%, High 8.9%), lower-functioning older adults (Flat 7.0%, High 14.1%). Similarly, all groups exhibited significant increases in sacral excursion variability for all three uneven terrain conditions compared to Flat. Participants were also significantly more likely to report feeling less stable walking over all three uneven terrain conditions compared to Flat. These findings support the hypothesis that altering terrain unevenness on a treadmill will increase gait kinematic variability and reduce perceived stability in younger and older adults.
A promoter-proximal silencer modifies the activity of a shared enhancer to mediate divergent expression of nub and pdm2 paralogs in wing development
Authors: Loker Ryan , Mann Richard S.
Published: March 2022

Duplication of genes and their associated cis-regulatory elements, or enhancers, is a key contributor to genome evolution and biological complexity. Moreover, many paralogs, particularly tandem duplicates, are fixed for long periods of time under the control of shared enhancers. However, in most cases the mechanism by which gene expression and function diverge following duplication is not known. Here we dissect the regulation and function of the paralogous nubbin/pdm2 genes during wing development in Drosophila melanogaster. We show that these paralogs play a redundant role in the wing and that their expression relies on a single shared wing enhancer. However, the two genes differ in their ability to respond to this enhancer, with nub responding in all wing progenitor cells and pdm2 only in a small subset. This divergence is a result of a pdm2-specific silencer element at the pdm2 promoter that receives repressive input from the transcription factor Rotund. Repression through this silencer also depends on nub, allowing pdm2 to fully respond to the wing enhancer when nub expression is perturbed and functional compensation to occur. Thus, expression divergence downstream of a shared enhancer arises as a consequence of silencing the promoter of one paralog.
Motion of the Cochlear Reticular Lamina Varies Radially Across Outer-Hair-Cell Rows
Authors: Cho Nam Hyun , Puria Sunil
Published: March 2022

The basilar membrane (BM) is connected to the reticular lamina (RL) through three rows of Y-shaped structures consisting of an outer hair cell (OHC) and a Deiters’ cell (DC) with a phalangeal process (PhP) that forms part of the RL mosaic surface. Morphological differences in the anatomy of the Y-shaped structures across the three OHC rows suggest differences in motion across the rows. Here we report OoC transverse motions measured across several radial locations for the gerbil basal region corresponding to ~45 kHz. Cross-sectional imaging and vibrometry measurements were made using a high-resolution (2.23 um axially in water) spectral-domain optical-coherence-tomography (SD-OCT) system. The stimuli were pure tones (2–63 kHz) at ear-canal sound pressure levels (SPLs) of 30–95 dB SPL in anesthetized gerbils (N=9) with healthy cochleae. We report displacements at the RL regions of OHC rows 1–3 (RL1–3), at the OHC-DC junctions of OHC rows 1–3 (OHC-DC-junction1–3), and at the arcuate zone, arcuate-pectinate junction, and pectinate zone of the BM (BMAZ, BMAPJ, and BMPZ, respectively). The in vivo BM displacements showed classic compressive nonlinearity and traveling-wave delays. The RL gain was similar to the BM gain at low frequencies (<20 kHz), but increased with frequency. Near the best frequency (BF), the RL gain was greater than the high-level BM gain by 40 ±5 dB (mean±std), and had greater compressive nonlinearity. RL motion varied radially, and the RL3gain was significantly greater than that of RL1by 10 ±1 dB (p<0.001). In contrast, the OHC-DC-junction gain varied little radially across OHCs. At low frequencies the OHC-DC-junction gain was constant across SPLs, and 14 ± 3 dB greater than the BM gain. As the frequency increased, the OHC-DC-junction gain decreased to a level similar to the BM gain at BF. The RL2, 3phase was advanced by 0.25–0.375 cycles relative to the BM phase at low frequencies, but the RL2, 3phase lead decreased as the frequency increased, became similar to the BM phase at BF, and lagged behind the BM phase by 0.25–0.5 cycles above BF. The OHC-DC-junction phases were mostly similar to the BM phase at low frequencies, but became delayed relative to the BM as the frequency increased, typically by 0.25–0.5 cycles near BF and by up to 1 cycle above BF. Our results show the most detailed picture of motion around the three OHC rows yet published, indicating that RL motion varied radially. Surprisingly, there was little motion difference across the three OHC rows in the OHC-DC-junction region, indicating that the tops of the DCs move in unison. Our data show a rich array of OoC amplitude and phase variations that are not explained by current theories.