bluuebunny/crossref_metadata_2025 huggingface dataset:
Preliminary Data from Clinical Trial to Survey Results of Flourish Vaginal Care System for Recurrent BV [A80]
Authors: Chidawanyika Tamutenda , Cathy Yi Chung Hwa , Kelly-Martin Rachel , Cleland Joshua , DuPriest Elizabeth
Published: June 2022

INTRODUCTION:

Bacterial vaginosis (BV) is a vaginal dysbiosis causing pain, irritation, discharge, odor, and itching. Antibiotic treatment is standard of care, but BV recurs in up to 50% of patients in 1 year. We hypothesized that using the Flourish Vaginal Care (FVC) system (an over-the-counter kit by Good Clean Love), with iso-osmotic components to optimize vaginal pH and Lactobacillus levels would reduce BV recurrence.

METHODS:

Ten women with two or more BV episodes within the past 2 years were enrolled in the pilot study for 11 weeks. Participants were treated with metronidazole and simultaneously started on a daily external wash with pH<4.4; iso-osmolar intravaginal lactic acid-containing gel every other day, and vaginal homeopathic suppository in a probiotic base every 3 days. Outcomes were vaginal pH, BV, and yeast occurrence tested biweekly. Participants journaled associated symptoms daily. Patient satisfaction was determined via telephone interview 10-12 months post trial.

RESULTS:

During the trial, no participants had BV recurrence. Mean vaginal pH decreased from 4.54 to 4.08 at baseline to study end. Journals showed decreased frequencies of pain and irritation (∼2-fold) and itching (∼4-fold). All (100%) of subjects participating in telephone interviews were satisfied with their symptom resolution 10-12 months post trial.

CONCLUSION:

Our pilot study shows that consistent use of vaginal products that are iso-osmotic and support optimal vaginal pH with bio-matched lactic acid prevents BV recurrence and alleviates associated symptoms. This work has important implications for prevention of recurrent BV and is evidence for the importance of maintaining the vaginal microbiome.
How Surgeon Volume Predicts Rates of Minimally Invasive Myomectomy [A83]
Authors: Tierney Cassidy E. , Tutwiler Ameisha , Tucker Lue-Yen , Weintraub Miranda Ritterman , Zaritsky Eve
Published: June 2022

INTRODUCTION:

Creating high-volume surgeons improves perioperative outcomes and encourages surgeons to perform more minimally invasive gynecological procedures. Compared to open abdominal myomectomies (AM), minimally invasive myomectomies (MIM) for benign uterine leiomyomas have lower complication rates, costs, and recovery time. Despite this, approximately 40% of myomectomies nationally are performed via an abdominal approach. In 2011, Kaiser Permanente Northern California (KPNC) introduced a quality improvement initiative to increase the proportion of MIMs by developing a streamlined high-volume surgeon pool. This study examines the interplay between surgeon volume and route for myomectomy.

METHODS:

This was an institutional review board (IRB)-approved retrospective observational data-only cohort study of patients who received an AM or MIM for benign uterine leiomyomas between 2009 and 2019 within KPNC. Surgeon volume was categorized as low (20 cases/year).

RESULTS:

Over the 11-year study period, 4,033 adult women underwent a myomectomy. The proportion of MIMs went from 6.0% to 89.5%, a 15-fold increase. The number of MIM surgeons increased over time but remained below 50, even as MIM rates increased. Medium and high volume surgeons were significantly more likely to perform MIMs compared to their low volume peers. As the MIM surgeon pool decreased in size and experience increased, the likelihood of having a MIM increased significantly.

CONCLUSION:

Decreasing the number of obstetricians/gynecologists performing surgery by limiting the number of MIM-privileged surgeons effectively increased individual surgeon case volume and increased the rate of MIM over an 11-year period, even with a rise in overall myomectomy incidence.
Risk-Adapted Approach to Levonorgestrel-Containing Intrauterine Devices Placement for Heavy Menstrual Bleeding in Adolescents with Bleeding Disorders [A92]
Authors: Fiorillo Megan H. , Cygan Peter H. , Wright Tonya
Published: June 2022

INTRODUCTION:

Females with inherited bleeding disorders (IBD) are disproportionately affected by reproductive tract bleeding, and can suffer adverse physical, social, and emotional outcomes. Recent guidelines advise development of perioperative management protocols for women undergoing invasive procedures, but do not provide specific guidance and rely on provider-level expertise. Optimizing the care of these patients requires a multidisciplinary approach.

METHODS:

Patients with known/suspected bleeding disorders present to the women and girls’ bleeding disorder clinic for evaluation and counseling. A collaborative protocol is generated by hematologists and gynecologists for the patients who desire levonorgestrel-containing intrauterine devices (LNG-IUD). A periprocedural hemostatic treatment protocol is tailored to the patient’s bleeding disorder. Ultrasound is performed in advance for uterine size and device selection. Placement is performed under ultrasound guidance in an operative setting without the use of a tenaculum. In instances where patients have severe bleeding histories or ongoing vaginal bleeding at the time of LNG-IUD placement, they may elect to use anti-fibrinolytics or continue an additional form of menstrual management such as combined oral contraceptive pills (OCPs) for one to three menstrual cycles to decrease the risk of heavy bleeding and expulsion. Patients then have a short-interval follow-up for monitoring.

RESULTS:

Eighteen patients, ages 10-19 years, underwent LNG-IUD placement in the operating room without complications such as hemorrhage or uterine perforation. None of the patients required any further hematologic interventions that were outside the protocols as outlined preoperatively.

CONCLUSION:

Highly efficacious heavy menstrual bleeding (HMB) treatment can be offered to persons with IBD via a multidisciplinary approach to assure patient safety and satisfaction.
Endometriosis Management Patterns Among Women in the National Survey of Family Growth (2017-2019) [A98]
Authors: Cox Kaily , Sriprasert Intira , Nguyen Brian
Published: June 2022

INTRODUCTION:

Endometriosis is a common gynecologic condition among women of reproductive age. Optimal treatment should be utilized, especially among those who have not completed childbearing.

METHODS:

We described the prevalence of endometriosis and treatment patterns among reproductive-aged women from the National Survey of Family Growth (NSFG, 2017-2019), focusing on treatments received by individuals reporting a desire for future childbearing. We conducted weighted bivariate analyses using t-tests and chi-square tests as appropriate.

RESULTS:

Endometriosis was diagnosed in 5.7% (n=314/6,141) of reproductive-aged women, of whom 43.6% reported a current diagnosis. Women with endometriosis were aged 38 years, commonly identified as non-Hispanic White (7.3%), and nearly all (92.7%) had health insurance (65% from private insurance). Reported treatments included: non-narcotic medicines (58.5%), hormonal medicines (47.7%), narcotics (34.6%), hysterectomy (30.1%), and progesterone-releasing intrauterine devices (IUDs) (12.2%); 11.2% never received any treatment. Treatments received did not vary by race and ethnicity, education, income, marital status, or insurance coverage. Prior to hysterectomy among 74 women, 56.7% received non-narcotic medicines, 54.7% hormonal medicines, 47.0% narcotics, and 26.1% progesterone-releasing IUDs. Twenty women (15.5%) who underwent hysterectomy reported a desire for future childbearing. Among these, 81.8% received narcotics, 76.2% received hormonal medicines, 73.0% received non-narcotic medicines, and 23.1% received a progesterone-releasing IUD prior to hysterectomy.

CONCLUSION:

Nearly one-third of reproductive-age women with endometriosis underwent a hysterectomy, among whom approximately 16% had not completed childbearing. Narcotics are overutilized and progesterone-releasing IUDs underutilized among individuals receiving hysterectomy prior to completion of childbearing.
Neutrophilic Dermatoses in a Clinical Practice of Wound Care Professionals
Authors: Lapa Tatiana , Sibbald R. Gary , Coutts Patricia M. , Zhao Xiu Chang
Published: June 2022

Diagnosing and treating neutrophilic dermatoses (NDs) in clinical practice can be challenging because of various presentations and stubborn treatment responses. Establishing a diagnosis is necessary, though, because many NDs are associated with underlying conditions, including malignancy. In this article, the authors provide information about Sweet syndrome, pyoderma gangrenosum, and other NDs and describe their clinical presentation, pathophysiology, diagnostic criteria, and associated conditions. The authors also present a case report describing the coexistence of two NDs and hidradenitis suppurativa in one patient and review the treatment modalities for those conditions.
Impact of Initial Warfarin Dosing on Time in Therapeutic Range for Postoperative Left Ventricular Assist Device Patients
Authors: Olson Logan M. , Korkames Grace C. , Lyden Elizabeth R. , Ryan Timothy R. , Bowman Stephanie A.
Published: June 2022

Initial warfarin dosing and time in therapeutic range (TTR) are poorly characterized for early post-operative left ventricular assist device (LVAD) patients. This study evaluated TTR after LVAD implantation compared between patients receiving low-dose (<3 mg) and high-dose (≥3 mg) warfarin. This single-center, retrospective analysis included 234 LVAD patients who received warfarin within 5 days of implantation. The primary outcome was TTR during the 5 days following first international normalized ratio (INR) ≥2 compared between low-dose and high-dose groups. Secondary outcomes were hospital and intensive care unit length of stay, time to first INR ≥2, TTR after first INR ≥2, and reinitiation of parenteral anticoagulation. No difference in TTR was detected between warfarin groups (57.2% vs. 62.7%, P = 0.13). Multivariable analysis did not detect any factors predictive of TTR during the primary outcome timeframe, but age and body mass index were associated with the warfarin dose. The low-dose group received a mean warfarin dose of 1.9 mg (±0.64 mg), and the high dose group received 4.34 mg (±1.38 mg). Cohort TTR during the primary outcome timeframe was 60.5% and 56.5% for hospitalization. The low-dose group had longer intensive care unit length of stay, shorter time to therapeutic INR, and more frequently reinitiated parenteral anticoagulation. Patients with recent LVAD implantation are complex and have diverse warfarin sensitivity factors, which did not allow for optimal warfarin dose detection, although half of all patients received doses between 2.04 mg and 4.33 mg. Individualized dosing should be used, adjusting for patient-specific factors such as age, body mass index, and drug interactions.
Active Surveillance With Seroprevalence-based Infection Rates Indicates Racial Disparities With Pediatric SARS-CoV-2 Requiring Hospitalization in Mississippi, March 2020–February 2021
Authors: Hobbs Charlotte V. , Kim Sara S. , Vemula Preeti , Inagaki Kengo , Harrison Virginia A. , Malloch Lacy , Martin Lora M. , Singh Gurbaksh , Agana Urita , Williams John M. , Patterson Kayla , Kittle Theresa , Byers Paul , Palmer April , Santos Roberto P. , Dhanrajani Anita , Stephenson Meagan , Hung Leroy , Hankins Phillip , Thornburg Nathalie , Drobeniuc Jan , Flannery Brendan ,   on behalf of the CDC COVID-19 Response Team
Published: June 2022

Background:

Racial disparities in SARS-CoV-2 infection, hospitalization, and multisystem inflammatory syndrome in children (MIS-C) have been reported. However, these reports have been based on incomplete data relying on passive reporting, unknown catchment populations, and unknown infection prevalence. We aimed to characterize population-based incidence of MIS-C and COVID-19 hospitalizations among non-Hispanic Black and White children using active surveillance based on seroprevalence-based cumulative incidence of pediatric SARS-CoV-2 infection in a defined catchment 16-county area of Mississippi.

Methods:

Active, population-based surveillance for MIS-C and acute COVID-19 hospitalizations meeting clinical and laboratory criteria was conducted by adjudicating clinicians at the major pediatric referral hospital for Mississippi, University of Mississippi Medical Center, from March 2020, to February 2021. Race-stratified SARS-CoV-2 seroprevalence was estimated using convenience samples from persons <18 years to calculate cumulative SARS-CoV-2 infections in the population.

Results:

Thirty-eight MIS-C cases and 74 pediatric acute COVID-19 hospitalizations were identified. Cumulative incidence of MIS-C was 4.7 times higher among Black compared with White children (40.7 versus 8.3 cases per 100,000 SARS-CoV-2 infections). Cumulative incidence of COVID-19 hospitalization was 62.3 among Black and 33.1 among White children per 100,000 SARS-CoV-2 infections.

Conclusions:

From the same catchment area, active surveillance, and cumulative incidence of infection estimated by seroprevalence, we show strikingly higher incidence of SARS-CoV-2-hospitalization and MIS-C in non-Hispanic Black children compared with White children before COVID-19 vaccination introduction in children. These disparities in SARS-CoV-2 manifestations cannot be accounted for by differences in exposure or testing. Targeted vaccine interventions will lessen disparities observed with SARS-CoV-2 manifestations in children.
Tacrolimus suppresses itch-related response in diet-induced atopic dermatitis model mice by reducing chloroquine-sensitive sensory neurons
Authors: Fujii Masanori , Imahori Shota , Nakayama Misao , Nabe Takeshi , Ohya Susumu
Published: June 2022

Introduction:

Itch (or pruritus) is a common symptom of atopic dermatitis (AD), which significantly decreases the patient’s quality of life. Tacrolimus ointment reduces pruritus in AD; however, the underlying mechanism is not fully understood.

Methods:

In the present study, we used a diet-induced AD mouse model to examine the antipruritic mechanism of tacrolimus. After induction of AD symptoms, the tacrolimus-containing ointment was applied once daily for 7 days. Responsiveness of isolated dorsal root ganglion (DRG) cells to various stimuli was examined by monitoring intracellular Ca2+ levels.

Results:

Repeated application of tacrolimus ointment attenuated spontaneous itch-related responses, even when skin barrier dysfunction, skin inflammation, and epidermal nerve sprouting were not ameliorated. Tacrolimus-treated mice also exhibited reduced scratching behavior induced by several pruritogens, such as histamine, SLIGRL-NH2, and chloroquine (CQ), although capsaicin-induced pain behavior was not affected. DRG cells from tacrolimus-treated mice showed significantly lower Ca2+ responses to CQ. Furthermore, a reduction in CQ-sensitive DRG neurons was observed after in vitro treatment with either tacrolimus or rapamycin.

Discussion:

CQ-sensitive (MrgprA3-expressing) DRG neurons are implicated as itch-specific sensory neurons. Therefore, topically applied tacrolimus may act directly on itch-signaling neurons, consequently suppressing various itch responses in AD mice.
Decompensated cornea with epithelial and stromal edema
Authors: Menapace Rupert , Neuhann Thomas , Schmidinger Gerald , Assia Ehud , Alió Jorge , Narang Priya , Agarwal Amar , Szurman Peter
Published: June 2022

A 66-year-old patient underwent surgery for congenital cataract in both eyes in her first year of life without implantation of an intraocular lens (IOL). In 1994, at the age of 39 years, both eyes received secondary Kelman multiflex-style angle-fixated anterior chamber IOLs (AC IOLs). The surgeries were followed by retinal detachments in both eyes, in the left eye in the same year and in the right eye 4 years later, which were successfully repaired.

The patient presented with a decompensated cornea with epithelial and stromal edema in the left eye. The AC IOL axis was oriented from 5- to 8-o'clock position with the haptic contacting the cornea. The distal portion of the inferior–nasal haptic was deeply buried and entrapped in a broad iridocorneal synechia extending between 6- and 8-o'clock positions. The synechia also caused adjacent pupillary distortion and pigment leaf eversion (Figure 1

JOURNAL/jcrs/04.03/02158034-202205000-00021/figure1/v/2023-08-19T002632Z/r/image-tiff

). The AC IOL in the right eye was well positioned, and the cornea was clear with an endothelial cell count (ECC) of 2160 cells/mm2 and central corneal thickness (CCT) of 650 μm. No ECC was obtainable in the left eye, and CCT was 775 μm (Figure 2

JOURNAL/jcrs/04.03/02158034-202205000-00021/figure2/v/2023-08-19T002632Z/r/image-tiff

). Visual acuity was 0.8 corrected in the right eye and hand motion in the left eye. Both eyes were normotonic.

On optical coherence tomography (OCT) imaging, a broad iridocorneal synechia was visible with a canal corresponding to the deeply buried haptic end of the AC IOL (Figure 3

JOURNAL/jcrs/04.03/02158034-202205000-00021/figure3/v/2023-08-19T002632Z/r/image-tiff

). Abundant condensed cortical material (Soemmerring's ring) was found behind the iris and above the ciliary body.

What would be your surgical options to rehabilitate the patient's left eye considering corneal decompensation caused by haptic contact of an angle-fixated AC IOL and capture of 1 haptic within an iridocorneal synechia extending along 2 clock hours?
HIV Testing Patterns Among Recently Self-Tested Russian Men Who Have Sex With Men: A Qualitative Study
Authors: Meylakhs Peter , Davitadze Arsen , Meylakhs Anastasia , Rodionova Tatiana , Alieva Alisa
Published: June 2022

Most qualitative research to date on HIV self-testing (HIVST) has been devoted to questions related to perceptions of HIVST among various groups of men who have sex with men (MSM) in different countries. However, little is known about HIV testing patterns of HIVST testers. Thrity-two Russian MSM, 10 with HIV and 22 without, from five cities were interviewed about their HIV testing and risk behaviors. Five types of testers “maintenance testers,” “risk-based testers,” “convenience testers,” “test avoiders,” and “HIVST-only testers” were identified in the study. Three dimensions of HIV testing patterns—testing motive, frequency, and mode—were proposed to improve existing typifications. Almost all informants practiced condomless sex with their primary partners; HIV testing or condom negotiation in primary partnerships before proceeding to condomless sex was rare. Increase in HIVST availability at no cost for MSM and targeted prevention efforts for MSM on both individual and dyadic level are urgently needed.
Stuck Inside
Authors: Minor Kyle S. , Myers Evan J. , Abel Danielle B. , Mickens Jessica L. , Ayala Alexandra , Warren Kiara K. , Vohs Jenifer L.
Published: June 2022

Social distancing policies enacted during the COVID-19 pandemic altered our social interactions. People with schizophrenia, who already exhibit social deficits, may have been disproportionally impacted. In this pilot study, we a) compared prepandemic social functioning to functioning during the pandemic in people with schizophrenia (n = 21) who had data at both time points; and b) examined if patterns of decline in schizophrenia differed from healthy controls (n = 21) across a series of repeated-measures analyses of variance. We observed larger declines in social functioning in schizophrenia (η2 = 0.07, medium effect size) during the pandemic compared with the control group. Between-group declines did not extend to other domains, suggesting that declines are specific to social functioning. Our findings signal that treatments focusing on reconnecting people with schizophrenia to their social networks should be prioritized. Future studies should continue tracking social functioning after the pandemic to illustrate patterns of recovery.
Virtual Trainings Effectively Prepared the Public Health Workforce to Support Schools During the COVID-19 Pandemic in California in 2021
Authors: Kiernan Brianán , Alonis Amelia , Diala Jody A. , Willard-Grace Rachel , Welty Susie , White Karen , Dorian Alina , Dunn Caitlin , Peare Anna , Westfall Miranda , Shodahl Skye , Brickley Debbie Bain
Published: June 2022

Context:

School closures in California due to COVID-19 have had a negative impact on the learning advancement and social development of K-12 students. Since March 2020, the achievement gap has grown between high-income and low-income students and between White students and students of color.

Program:

In November 2020, a team from the California Department of Public Health, University of California, San Francisco, and University of California, Los Angeles, developed the School Specialist training for local health department and state employee redirected staff to the COVID-19 response to equip them to support schools as they reopen.

Implementation:

A pilot of the virtual School Specialist training was carried out in December 2020, which informed subsequent biweekly half-day virtual trainings. The training consisted of lectures from experts and skill development activities led by trained facilitators.

Evaluation:

The objectives of the evaluation of the training were to understand whether (1) knowledge of key concepts improved from pre- to posttraining; (2) confidence in skills central to the role of a School Specialist improved from pre- to posttraining; and (3) course learners who were activated to work as School Specialists felt the training adequately prepared them for the role. The School Specialist training team sent pre- and posttraining surveys to learners between February 8 and May 18, 2021. Of the 262 learners who responded, a significant improvement was seen in knowledge, with a mean score increase of 15.6%. Significant improvement was also observed for confidence, with a 20.1% score improvement seen posttraining.

Discussion:

Overall, the School Specialist training was shown to be effective in increasing knowledge and confidence in preparation for School Specialist deployment. Adequate training and partnerships for local health department and school staff are critical to keep K-12 students safe and to reduce the learning achievement gap during the ongoing COVID-19 pandemic.
Data Velocity in HIV-Related Implementation Research: Estimating Time From Funding to Publication
Authors: Schwartz Sheree R. , Chavez Ortiz Joel , Smith Justin D. , Beres Laura K. , Mody Aaloke , Eshun-Wilson Ingrid , Benbow Nanette , Mallela Deepthi P. , Tan Stephen , Baral Stefan , Geng Elvin
Published: June 2022

Background:

Given available effective biomedical and behavioral prevention and treatment interventions, HIV-related implementation research (IR) is expanding. The rapid generation and dissemination of IR to inform guidelines and practice has the potential to optimize the impact of the Ending the Epidemic Initiative and the HIV pandemic response more broadly.

Methods:

We leveraged a prior mapping review of NIH-funded awards in HIV and IR from January 2013 to March 2018 and identified all publications linked to those grants in NIH RePORTER through January 1, 2021 (n = 1509). Deduplication and screening of nonoriginal research reduced the count to 1032 articles, of which 952 were eligible and included in this review. Publication volume and timing were summarized; Kaplan–Meier plots estimated time to publication.

Results:

Among the 215 NIH-funded IR-related awards, 127 of 215 (59%) published original research directly related to the grant, averaging 2.0 articles (SD: 3.3) per award, largely in the early IR phases. Many articles (521 of 952, 55%) attributed to grants did not report grant-related data. Time from article submission to publication averaged 205 days (SD: 107). The median time-to-first publication from funding start was 4 years. Data dissemination velocity varied by award type, trending toward faster publication in recent years. Delays in data velocity included (1) time from funding to enrollment, (2) enrollment length, and (3) time from data collection completion to publication.

Conclusion:

Research publication was high overall, and time-to-publication is accelerating; however, over 40% of grants have yet to publish findings from grant-related data. Addressing bottlenecks in the production and dissemination of HIV-related IR would reinforce its programmatic and policy relevance in the HIV response.
Implementing PrEP Services in Diverse Health Care Settings
Authors: Faro Elissa Z. , Mantell Joanne E. , Gonzalez-Argoti Tatiana , Hoffman Susie , Edelstein Zoe , Tsoi Benjamin , Bauman Laurie J.
Published: June 2022

Background:

Uptake of pre-exposure prophylaxis (PrEP) in the US has been limited. Evidence for why and how PrEP has been successfully integrated into some clinical settings, but not in others is minimal. To address this gap, we conducted a qualitative study to identify contextual factors that facilitated and challenged the implementation of PrEP services.

Setting:

In partnership with the NYC Department of Health, we convened a planning committee with expertise with groups highly affected by the HIV epidemic employed in diverse health care settings, to guide the project. Representatives from programs within New York were targeted for participation initially and subsequently expanded nationally to enhance diversity in program type.

Methods:

Using an interview guide informed by the Consolidated Framework for Implementation Research, we conducted 20 interviews with participants who successfully implemented PrEP programs in different settings (eg, primary care, emergency department, sexual health clinics), using different delivery models. We used template and matrix analysis to identify and characterize contextual determinants and implementation strategies.

Results:

Participants frequently described determinants and strategies fluidly and conceptualized them in context-specific terms. Commonly discussed Consolidated Framework for Implementation Research constructs included implementation climate (tension for change, compatibility, relatively priority), stakeholders' knowledge (or lack thereof) and beliefs about PrEP, and costs associated with PrEP implementation.

Conclusion:

Our work identifies patterns in PrEP program implementation, describing how organizations dealt with determinants in their own context. Our research points to the need to connect rigorous implementation research with how frontline implementers conceptualize their work to inform and improve PrEP implementation.
Using Microsimulation Modeling to Inform EHE Implementation Strategies in Los Angeles County
Authors: Drabo Emmanuel F. , Moucheraud Corrina , Nguyen Anthony , Garland Wendy H. , Holloway Ian W. , Leibowitz Arleen , Suen Sze-chuan
Published: June 2022

Background:

Pre-exposure prophylaxis (PrEP) is essential to ending HIV. Yet, uptake remains uneven across racial and ethnic groups. We aimed to estimate the impacts of alternative PrEP implementation strategies in Los Angeles County.

Setting:

Men who have sex with men, residing in Los Angeles County.

Methods:

We developed a microsimulation model of HIV transmission, with inputs from key local stakeholders. With this model, we estimated the 15-year (2021–2035) health and racial and ethnic equity impacts of 3 PrEP implementation strategies involving coverage with 9000 additional PrEP units annually, above the Status-quo coverage level. Strategies included PrEP allocation equally (strategy 1), proportionally to HIV prevalence (strategy 2), and proportionally to HIV diagnosis rates (strategy 3), across racial and ethnic groups. We measured the degree of relative equalities in the distribution of the health impacts using the Gini index (G) which ranges from 0 (perfect equality, with all individuals across all groups receiving equal health benefits) to 1 (total inequality).

Results:

HIV prevalence was 21.3% in 2021 [Black (BMSM), 31.1%; Latino (LMSM), 18.3%, and White (WMSM), 20.7%] with relatively equal to reasonable distribution across groups (G, 0.28; 95% confidence interval [CI], 0.26 to 0.34). During 2021–2035, cumulative incident infections were highest under Status-quo (n = 24,584) and lowest under strategy 3 (n = 22,080). Status-quo infection risk declined over time among all groups but remained higher in 2035 for BMSM (incidence rate ratio, 4.76; 95% CI: 4.58 to 4.95), and LMSM (incidence rate ratio, 1.74; 95% CI: 1.69 to 1.80), with the health benefits equally to reasonably distributed across groups (G, 0.32; 95% CI: 0.28 to 0.35). Relative to Status-quo, all other strategies reduced BMSM-WMSM and BMSM-LMSM disparities, but none reduced LMSM-WMSM disparities by 2035. Compared to Status-quo, strategy 3 reduced the most both incident infections (% infections averted: overall, 10.2%; BMSM, 32.4%; LMSM, 3.8%; WMSM, 3.5%) and HIV racial inequalities (G reduction, 0.08; 95% CI: 0.02 to 0.14).

Conclusions:

Microsimulation models developed with early, continuous stakeholder engagement and inputs yield powerful tools to guide policy implementation.
Preprocedure and Immediate Postoperative Changes to Genital Hiatus Following Minimally Invasive Sacrocolpopexy
Authors: Glass Clark Stephanie , Sassani Jessica C. , Zyczynski Halina M. , Bradley Megan S.
Published: June 2022

Importance

This study assesses resting genital hiatus (GH) measurements under anesthesia as compared with in-office measurements for intraoperative planning purposes.

Objectives

The aim of this study was to determine the influence of general anesthesia and apical suspension on GH measurements compared with office measurements.

Study Design

This was a retrospective cohort of women who underwent minimally invasive sacrocolpopexy within an academic urogynecology practice. Genital hiatus for each patient was measured at 4 time points: (1) preoperative office examination (baseline) at rest (GHrest) and with strain (GHstrain); (2) following anesthesia induction, at rest (GHinduction); (3) immediately after sacrocolpopexy, at rest (GHcolpopexy); and (4) 4- to 6-week postoperative visit, strain (GHpostop). Enlarged baseline GHstrain was defined as ≥4 cm. Paired statistics and analysis of variance were used for comparisons.

Results

Fifty-one women were included, whose mean age was 61.3 ± 8.2 years; the majority had stage ≥3 prolapse (n = 39 [76.4%]). Concomitant procedures included hysterectomy (n = 33 [64.7%]) and posterior colporrhaphy or perineorrhaphy (n = 8 [15.7%]). The majority had an enlarged baseline GHstrain (n = 39 [76.4%]), and overall cohort mean was 4.7 ± 1.3 cm. Compared with baseline GHrest, mean GHinduction was larger (GHinduction: 4.6 ± 1.4 cm vs GHrest: 3.8 ± 1.2 cm, P < 0.01) but not different from baseline GHstrain (GHinduction: 4.6 ± 1.4 cm vs GHstrain: 4.7 ± 1.3 cm, P = 0.81). GHcolpopexy was decreased from baseline GHstrain with a mean difference of 1.1 ± 1.3 cm (P < 0.01). This difference was driven by women with enlarged baseline GHstrain who experienced a mean decrease of 1.5 ± 1.1 cm (P < 0.01).

Conclusions

Genital hiatus after induction of anesthesia does not significantly differ from preoperative straining GH. Apical suspension with sacrocolpopexy alone resulted in immediate reduction in GH measures, with greater decreases observed in women with enlarged preoperative GH.
Who’s Posting What? A Qualitative, Cross-Sectional Study Comparing Twitter and Instagram Patterns Between Health Care Professionals and Patients
Authors: Dzienny Alexa C. , Toal Coralee T. , Fitzgerald Jocelyn J. , Carter-Brooks Charelle M.
Published: June 2022

Importance

There is a paucity of evidence-based, physician-authored content available on social media. Data are lacking on physicians use of social media, including intended audience and content.

Objective

The aim of this study was to explore the patterns of Twitter and Instagram use for popular urogynecology hashtags between physicians, patients, and allied health professionals (AHPs).

Study Design

Twelve hashtags derived from the Urogynecology Tag Ontology project were used as search terms to select Twitter and Instagram posts. Up to 5 top posts per hashtag per author type (physician, patient, or AHP) were included. Posts were analyzed using Dedoose qualitative analytic software by author, hashtag, intended audience, and themes.

Results

On Twitter, 109 posts met inclusion criteria: 41% written by physicians, 40% patients, and 18.3% AHPs. For Instagram, 72 posts were included: 50% written by patients, 39% AHPs, and 11% physicians. Twitter physician posts were mainly intended for health professionals (64%) with only 18% for patients. Patients posted to the general public (57%) and patients (36%). Instagram physician posts were intended for health professionals (49%), whereas 62% of AHPs posted to patients. Most patient posts were directed to other patients (90%). Physicians posted about academic peer discussions, medical education, and advocacy. Patients posted about personal experiences, treatments, or dissatisfaction.

Conclusions

Physicians are more likely to post on Twitter than Instagram, with content focused primarily on their peer group, and physicians/patients are unlikely to engage with each other. There is an opportunity to improve social media interactions between physicians and the public while increasing high-quality patient education.
A case of septic arthritis caused by Capnocytophaga canimorsus in an HIV patient
Authors: Fernández Vecilla Domingo , Aspichueta Vivanco Cristina , Angulo López Itziar , Baraia-Etxaburu Artetxe Josu Mirena , Renzi Francesco , Díaz de Tuesta del Arco José Luis
Published: June 2022

Invasive infections caused by

Capnocytophaga canimorsus

, a Gram-negative rod found in the oral cavity of healthy dogs and cats, are rare but they are increasing worldwide. We report a case of septic arthritis in a native knee joint due to this micro-organism. A 57-year-old man, with a well-controlled chronic HIV infection, attended the Emergency Department because of left knee pain and shivering without measured fever. A knee arthrocentesis and a computed tomography scan were performed, revealing septic arthritis with collections in the left leg posterior musculature. He was admitted to the Infectious Diseases Department for antibiotic treatment. Initial synovial fluid was inoculated in blood culture bottles, and the anaerobic one was positive after 63 h. Gram stain revealed fusiform Gram-negative rods, identified as

C. canimorsus

by matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF) directly from the bottle. Identification was confirmed by 16S rRNA sequencing and serotyping was performed by PCR, with serovar A as the outcome. Due to an unfavourable clinical course, the patient required two surgical cleanings and after appropriate antibiotic treatment he was discharged 2 months later.
Sulphate repression of ssuD-dependent alkanesulphonate-sulphur assimilation in Escherichia coli
Authors: Nishikawa Masanobu , Noda Soichiro , Henmi Kenji , Ogawa Ken’ichi
Published: June 2022

Escherichia coli

cells utilize alkanesulphonates including taurine as the sulphur source. We previously reported that when

E. coli

cells carrying a double deletion in tauD and cysN were inoculated into a taurine-containing minimal medium, they started to grow only after long-term incubation (Nishikawa et al. 2018, Microbiology 164: 1446–1456). We show here that cells that can induce ssuD-dependent alkanesulphonate–sulphur assimilation (SASSA) are essentially rare, but suppressors that can induce SASSA appear during long-term incubation. Mutant cells carrying ΔtauD and ΔcysN, ΔcysC or ΔcysH generated suppressor cells that can induce SASSA at a frequency of about 10−6 in a population. Whereas ΔtauD ΔcysN cells without prior SASSA did not express ssuD even when necessary, the cells with prior SASSA properly expressed ssuD. Whole-genome DNA sequencing of a clone isolated from ΔtauD ΔcysN cells with prior SASSA revealed that the influx of sulphate or thiosulphate may be related to the regulation of SASSA. To clarify whether sulphate or thiosulphate affects the induction of SASSA, the effect of mutations in sbp and cysP, which are responsible for sulphate and thiosulphate uptake with different preferences for substrates, was examined. Only the ΔtauD ΔcysN Δsbp mutant did not show repression of SASSA when no sulphate was added to the medium. When the concentration of the sulphate added was over 10 μM, the Δsbp mutant showed repression of SASSA. Therefore, it was considered that the influx of extracellular sulphate resulted in repression of SASSA.
SARS-CoV-2 RNA levels in Scotland’s wastewater
Authors: Scorza Livia C. T. , Cameron Graeme J. , Murray-Williams Roisin , Findlay David , Bolland Julie , Cerghizan Brindusa , Campbell Kirsty , Thomson David , Corbishley Alexander , Gally David , Fitzgerald Stephen , Low Alison , McAteer Sean , Roberts Adrian M. I. , Fang Zhou , Mayer Claus-Dieter , Frantsuzova Anastasia , Baby Sumy V. , Zieliński Tomasz , Millar Andrew J.
Published: June 2022

Nationwide, wastewater-based monitoring was newly established in Scotland to track the levels of SARS-CoV-2 viral RNA shed into the sewage network, during the COVID-19 pandemic. We present a curated, reference data set produced by this national programme, from May 2020 to February 2022. Viral levels were analysed by RT-qPCR assays of the N1 gene, on RNA extracted from wastewater sampled at 122 locations. Locations were sampled up to four times per week, typically once or twice per week, and in response to local needs. We report sampling site locations with geographical coordinates, the total population in the catchment for each site, and the information necessary for data normalisation, such as the incoming wastewater flow values and ammonia concentration, when these were available. The methodology for viral quantification and data analysis is briefly described, with links to detailed protocols online. These wastewater data are contributing to estimates of disease prevalence and the viral reproduction number (R) in Scotland and in the UK.
A wealth of novel cell-specific expressed SNVs from tumor and normal scRNA-seq datasets
Authors: Dillard Christian , Ulianova Evgenia , Prashant NM , Liu Hongyu , Edwards Nathan , Horvath Anelia
Published: June 2022

We demonstrate a novel variant calling strategy using barcode-stratified alignments on 25 tumor and normal 10XGenomics scRNA-seq datasets (>200,000 cells). Our approach identified 24,528 exonic non-dbSNP single cell expressed (sce)SNVs, a third of which are shared across multiple samples. The novel sceSNVs include unreported somatic and germline variants, as well as RNA-originating variants; some are expressed in up to 17% of the cells, and many are found in known cancer genes. Our findings suggest that there is an unacknowledged repertoire of expressed genetic variants, possibly recurrent and common across samples, in the normal and cancer transcriptome.
Melanopsin activates divergent phototransduction pathways in ipRGC subtypes
Authors: Contreras Ely , Sonoda Takuma , Birnbaumer Lutz , Schmidt Tiffany M.
Published: June 2022

Melanopsin signaling within ipRGC subtypes impacts a broad range of behaviors from circadian photoentrainment to conscious visual perception. Yet, how melanopsin phototransduction within M1-M6 ipRGC subtypes impacts cellular signaling to drive diverse behaviors is still largely unresolved. The identity of the phototransduction channels in each subtype is key to understanding this central question but has remained controversial. In this study, we resolve two opposing models of M4 phototransduction, demonstrating that hyperpolarization-activated cyclic nucleotide-gated (HCN) channels are dispensable for this process and providing support for a model involving melanopsin-dependent potassium channel closure and canonical transient receptor potential (TRPC) channel opening. Surprisingly, we find that HCN channels are likewise dispensable for M2 phototransduction, contradicting the current model. We instead show that in M2 phototransduction, TRPC channels act in conjunction with T-type voltage-gated calcium channels, a novel melanopsin phototransduction target. Collectively, this work resolves key discrepancies in our understanding of ipRGC phototransduction pathways in multiple subtypes and adds to mounting evidence that ipRGC subtypes employ diverse phototransduction cascades to fine-tune cellular responses for downstream behaviors.
Sensitive and specific miRNA in situ hybridization using partially methylated phosphotriester antisense DNA probes
Authors: Wang Po-Hsiang , Jia Tony Z. , Chang Ching-Wen , Tan Bertrand Chin-Ming , Chi Ya-Hui , Chen Wen-Yih
Published: June 2022

Neutralized DNA (nDNA) is an emerging class of DNA oligonucleotides chemically synthesized with site-specific internucleoside methyl phosphotriester linkages, changing the negatively charged DNA phosphodiester backbone to a neutral methyl phosphotriester backbone. The reduction of inter-strand charge repulsion of nucleotide duplexes results in stronger binding between nDNA and other nucleic acids, and as such, nDNA has been used as a sensitive antisense probe for sequencing nucleotides. From a thermodynamic perspective due to steric effects, a hybrid duplex between DNA and partially methylated nDNA should possess higher specificity than a duplex between DNA with fully methylated nDNA, while retaining binding affinity. However, the application of nDNA for ex vivo RNA hybridization at low transcript abundance remains completely unexplored. Here, we determined that partially methylated nDNA (N4 nDNA; with 4 methylated nucleotides) probes inhibited reverse transcription of oncogenic miRNA miR-21 more efficiently than canonical DNA probes or highly methylated nDNA probes (all probes share the same sequence) and with an efficiency rivaling LNA probes. Subsequently, we performed in situ hybridization analysis using a miR-21-expressing colorectal cancer cell line (HCT116). HCT116 stained with N4 nDNA probes revealed a greater detection intensity and specificity than HCT116 stained with canonical DNA probes. Consistently, enzyme-linked immunosorbent assays revealed that miRNA hybridization efficiency of N4 nDNA probes was greater than that of canonical DNA probes at cellular transcript levels. Given that N4 nDNA probe is immune-negative and DNase I-resistant, partially methylated nDNA could be further developed to have significant applications in biotechnology and medicine.
Structural basis for antibody recognition of vulnerable epitopes on Nipah virus F protein
Authors: Byrne Patrick O. , Fisher Brian E. , Ambrozak David R. , Blade Elizabeth G. , Tsybovsky Yaroslav , Graham Barney S. , McLellan Jason S. , Loomis Rebecca J.
Published: June 2022

SUMMARY/ABSTRACT

Nipah virus (NiV) is a pathogenic paramyxovirus that causes fatal encephalitis in humans. Two envelope glycoproteins, the attachment protein (G) and fusion protein (F), facilitate entry into host cells. Due to its vital role, NiV F presents an attractive target for developing vaccines and therapeutics. Several neutralization-sensitive epitopes on the NiV F apex have been described, however the antigenicity of most of the F protein’s surface remains uncharacterized. Here, we immunize mice with prefusion-stabilized NiV F and isolate ten monoclonal antibodies that neutralize pseudotyped virus. Cryo-electron microscopy reveals eight neutralization-sensitive epitopes on NiV F, four of which have not previously been described. Novel sites span the lateral and basal faces of NiV F, expanding the known library of vulnerable epitopes. This work identifies new epitopes as targets for therapeutics, provides a molecular basis for NiV neutralization, and lays a foundation for development of new antibodies targeting NiV F.
The Hdc GC box is critical for Hdc gene transcription and histamine-mediated anaphylaxis
Authors: Li Yapeng , Gao Junfeng , Zhao Dianzheng , Guan Xiaoyu , Morris Suzanne C. , Finkelman Fred D. , Huang Hua
Published: June 2022

Background: Histamine is a critical mediator of anaphylaxis, a neurotransmitter, and a regulator of gastric acid secretion. Histidine decarboxylase is a rate-limiting enzyme for histamine synthesis. However, in vivo regulation of Hdc, the gene that encodes histidine decarboxylase is poorly understood. Objective: We sought to investigate how enhancers regulate Hdc gene transcription and histamine synthesis in resting conditions and in a mouse model of anaphylaxis. Methods: H3K27 acetylation histone modification and chromatin accessibility were used to identify candidate enhancers; The enhancer activity of candidate enhancers was measured in a reporter gene assay; and the function enhancers were validated using CRISPR deletion. Results: Deletion of the GC box, which binds to zinc finger transcription factors, in the proximal Hdc enhancer, reduced Hdc gene transcription and histamine synthesis in the mouse and human mast cell lines. Mast cells, basophils, brain cells, and stomach cells from GC box-deficient mice transcribed the Hdc gene much less than similar cells from wild-type mice and Hdc GC box-deficient mice failed to develop anaphylaxis. Conclusion: Our results demonstrate that the HDC GC box within the proximal enhancer in the mouse and human HDC gene is essential for Hdc gene transcription, histamine synthesis, and histamine-mediated anaphylaxis in vitro and in vivo.
The role of auxiliary domains in modulating CHD4 activity suggests mechanistic commonality between enzyme families
Authors: Zhong Yichen , Sani Hakimeh Moghaddas , Paudel Bishnu Prasad , Low Jason K. K. , Silva Ana P. G. , Mueller Stefan , Deshpande Chandrika , Panjikar Santosh , Reid Xavier J. , Bedward Max J. , van Oijen Antoine M. , Mackay Joel P.
Published: June 2022

CHD4 is an essential, widely conserved ATP-dependent translocase that is also a broad tumour dependency. In common with other SF2-family chromatin remodelling enzymes, it alters chromatin accessibility by repositioning histone octamers. Besides the helicase and adjacent tandem chromodomains and PHD domains, CHD4 features 1000 residues of N- and C-terminal sequence with unknown structure and function. We demonstrate that these regions regulate CHD4 activity through different mechanisms. An N-terminal intrinsically disordered region (IDR) promotes remodelling integrity in a manner that depends on the composition but not sequence of the IDR. The C-terminal region harbours an auto-inhibitory region that contacts the helicase domain. Auto-inhibition is relieved by a previously unrecognized C-terminal SANT-SLIDE domain split by ∼150 residues of disordered sequence, most likely by binding of this domain to substrate DNA. Our data shed light on CHD4 regulation and reveal strong mechanistic commonality between CHD family members, as well as with ISWI-family remodellers.
Dominant constraints on the evolution of rhythmic gene expression
Authors: Cheng Yang , Chi Yuhao , Sun Linying , Wang Guang-Zhong
Published: June 2022

Although the individual transcriptional regulators of the core circadian clock are distinct amongst different organisms, the autoregulatory feedback loops they form are conserved. This unified design principle explains how daily physiological activities oscillate across species. However, whether analogous design principles govern the gene expression output of circadian clocks is unknown. Herein, we performed a comparative analysis of rhythmic gene expression in eight diverse species and captured four common distribution patterns of cycling gene expression across these species. We hypothesized that maintenance of reduced energetic costs constrains the evolution of rhythmic gene expression. Our large-scale computational simulations support this hypothesis by showing that selection against high-energy expenditure completely regenerates all cycling gene patterns. Moreover, we find that the late- and early-phase peaks of rhythmic expression have been subjected to this type of selective pressure. Therefore, energetic costs have constricted the cycling transcriptome throughout evolutionary history.