bluuebunny/crossref_metadata_2025 huggingface dataset:
(113) SEXUAL ASPECTS OF PREGNANCY AND THE POSTPARTUM PERIOD IN LESBIAN WOMEN
Authors: Højgaard Dr Astrid D , Prof. Bente Dahl , Sam Geuens , Dr. Woet Gianotten
Published: July 2023

Objectives

The presentation aims at presenting knowledge on aspects on sexual function and relationship in lesbian women when reproduction is the matter.

Secondly, we demonstrate our opinion on necessary knowledge for midwives as presented in the chapter “Sexual aspects of pregnancy and the postpartum period in lesbian women” in the open access textbook ‘Sexuality & Midwifery’, published by Springer Nature. The presentation covers topics relevant in lesbian motherhood regarding fertility treatment, pregnancy, delivery, postpartum and period. It is our hope to integrate HCPs with recent knowledge and skills from sexology, providing an overview of the current scientific knowledge on sexuality and aspects related to midwifery when having a consultation with a lesbian couple and how to give good care to and communicate with the lesbian couple.

Methods

A review of current literature on lesbian motherhood, prevalence, marital and reproductive rights and treatments, the role of the co-mother and sexological counselling focusing on lesbians.

Results

Sexuality and sexual orientation should be an issue in all maternity care areas in midwifery and gyn/obs education. Health professionals should bear in mind that not all women are heterosexual – if you do not ask – patients probably do not tell. Particular attention to verbal and non-verbal language and asking direct questions to both partners is important to make the co-mother feeling acknowledged as parents and not overlooked or invisible. Many problems are common pregnancy or postpartum issues for heterosexual couples as well. Be also aware not to focus too much on the sexual orientation of the lesbian woman or couple. Not all minority women are victimised and oppressed, but many women are in some world regions.

Conclusions

All HCPs should be aware of their own assumptions, attitudes, and cultural bias. Meeting the minority woman/couple with an open mind and heart can be a most rewarding experience.

Conflicts of Interest

None
(190) URETHRAL RECONSTRUCTIVE SURGERY IN TRANSGENDER PATIENTS UNDERGOING PHALLOPLASTY: A CASE REPORT
Authors: Alonso-Bartolomé María B , Esaú Fernández , Andrea Rodríguez , Santiago Alonso-Bartolomé , Carlos Toribio-Vázquez
Published: July 2023

Objectives

Transgender patients are those whose sexual identity differs from the anatomical sex with which they were born. More and more patients are looking for medical and surgical treatment to achieve the desired sex. These surgeries may have some urethral complications that urologists must be aware of and be able to treat them. The aim of this study is to present the case of a patient with several urethral complications after phalloplasty surgery.

Methods

Phalloplasty consists of removing the female genital tract and creating neo-male genitalia with autologous grafts. In our center, phalloplasty is performed using a radial forearm microsurgical free-flap with double tunneling, in two stages.

The resulting urethra consists of a pars fixa, obtained from the tubulization of the labia minora, and a pars pendulans, formed by tubulized forearm skin.

The most common urethral complications are urethrocutaneous leaks and fistulas (15-70%), especially in the two anastomotic areas; the persistence of the vaginal cavity; and urethral strictures (up to 41%). Most of these complications can be resolved conservatively or surgically.

Results

We present the case of a trans male who, after the first stage of phalloplasty, developed a pars fixa fistula, successfully managed conservatively. After its resolution, the second time was performed with a radial forearm microsurgical free-flap. In the immediate postoperative period, the patient required several reinterventions due to flap congestion. He developed a fistula and stricture in the new urethral anastomosis, requiring a two-stage urethroplasty with a dorsal buccal mucosa graft. After this procedure, urethral integrity was achieved with spontaneous micturition through the phallus.

Conclusions

Phalloplasty must be carried out by a multidisciplinary team that involves plastic and urology services. It is an increasingly frequent surgery, so mastery of the anatomy of these reconstructions by the urologist is essential to solve any complications.

Conflicts of Interest

No.
Proportionality rhetoric and neoliberal rationality in the ‘fundamental social rights’ adjudication of the Court of Justice of the European Union
Authors: Garcia Blesa Juan J
Published: July 2023

This article studies the rhetorical construction of proportionality discourse in controversial social rights cases at the Court of Justice of the European Union. It argues that neoliberal rationality controls the Court’s proportionality discourse. That rationality operates through eliding social conflict and excluding egalitarian approaches to social rights, which are rhetorically re-imagined as subsidiary instruments of competition and business.
Recent oncolytic virotherapy clinical trials outline a roadmap for the treatment of high-grade glioma
Authors: Bernstock Joshua D , Blitz Sarah E , Hoffman Samantha E , Gerstl Jakob V E , Chiocca E Antonio , Friedman Gregory K
Published: July 2023

Adult and pediatric high-grade gliomas (HGGs) are aggressive cancers of the central nervous system that confer dismal clinical prognoses. Standard radiation and chemotherapy have demonstrated only limited efficacy in HGGs, motivating the accelerated investigation of novel modalities such as oncolytic virus (OV) therapies. OV centered therapies work through a mixed mechanism centered on oncolysis and the stimulation of an antitumor immune response. Three recent clinical trials utilizing herpes simplex virus-1 and adenovirus-based oncolytic virotherapy demonstrated not only the safety and efficacy of OVs but also novel dosing strategies that augment OV response potential. Considering these recent trials, herein we present a roadmap for future clinical trials of oncolytic immunovirotherapy in both adult and pediatric HGG, as well as persistent roadblocks related to the assessment of OV efficacy within and between trials.
Prevalence of pathogenic germline variants in adult-type diffuse glioma
Authors: McDonald Malcolm F , Prather Lyndsey L , Helfer Cassandra R , Ludmir Ethan B , Echeverria Alfredo E , Yust-Katz Shlomit , Patel Akash J , Deneen Benjamin , Rao Ganesh , Jalali Ali , Dhar Shweta U , Amos Chris I , Mandel Jacob J
Published: July 2023

Background

No consensus germline testing guidelines currently exist for glioma patients, so the prevalence of germline pathogenic variants remains unknown. This study aims to determine the prevalence and type of pathogenic germline variants in adult glioma.

Methods

A retrospective review at a single institution with paired tumor/normal sequencing from August 2018–April 2022 was performed and corresponding clinical data were collected.

Results

We identified 152 glioma patients of which 15 (9.8%) had pathogenic germline variants. Pathogenic germline variants were seen in 11/84 (13.1%) of Glioblastoma, IDH wild type; 3/42 (7.1%) of Astrocytoma, IDH mutant; and 1/26 (3.8%) of Oligodendroglioma, IDH mutant, and 1p/19q co-deleted patients. Pathogenic variants in BRCA2, MUTYH, and CHEK2 were most common (3/15, 20% each). BRCA1 variants occurred in 2/15 (13%) patients, with variants in NF1, ATM, MSH2, and MSH3 occurring in one patient (7%) each. Prior cancer diagnosis was found in 5/15 patients (33%). Second-hit somatic variants were seen in 3/15 patients (20%) in NF1, MUTYH, and MSH2. Referral to genetics was performed in 6/15 (40%) patients with pathogenic germline variants. 14/15 (93%) of patients discovered their pathogenic variant as a result of their paired glioma sequencing.

Conclusions

These findings suggest a possible overlooked opportunity for determination of hereditary cancer syndromes with impact on surveillance as well as potential broader treatment options. Further studies that can determine the role of variants in gliomagenesis and confirm the occurrence and types of pathogenic germline variants in patients with IDH wild type compared to IDH mutant tumors are necessary.
Safety, Virology, Pharmacokinetics, and Clinical Experience of High-Dose Intravenous Sotrovimab for the Treatment of Mild to Moderate COVID-19: An Open-Label Clinical Trial
Authors: Moya Jaynier , Temech Marisol , Parra Sergio , Juarez Erick , Hernandez-Loy Reinaldo , Gutierrez Juan C Moises , Diaz Jorge , Hussain Rubaba , Segal Scott , Xu Claire , Skingsley Andrew , Schnell Gretja , El-Zailik Asma , Sager Jennifer E , Aldinger Melissa , Alexander Elizabeth L , Acloque Gerard
Published: July 2023

Background

Five hundred milligrams of intravenous (IV) sotrovimab has been shown to be well tolerated and efficacious against pre-Omicron strains in treating patients with mild to moderate coronavirus disease 2019 (COVID-19) at high risk for disease progression.

Methods

This was an open-label, single-arm substudy of phase 3 COMET-TAIL (NCT04913675) assessing the safety and tolerability of a 2000 mg IV dose of sotrovimab. Symptomatic patients (aged ≥18 years) with COVID-19 at high risk for progression were enrolled from June 30 through July 11, 2022, when Omicron BA.5, BA.2.12.1, and BA.4 were the predominant circulating variants in the United States. The primary end point was the occurrence of adverse events (AEs), serious AEs (SAEs), AEs of special interest, and COVID-19 disease-related events (DREs) through day 8. Safety, pharmacokinetics, viral load, and hospitalization >24 hours for acute management of illness or death through day 29 were assessed.

Results

All participants (n = 81) were Hispanic, 58% were female, and 51% were aged ≥55 years. Through day 8, no AEs, including infusion-related reactions or hypersensitivity, were reported; 2 participants reported DREs (mild cough, n = 2). One SAE (acute myocardial infarction), which was considered unrelated to sotrovimab or COVID-19 by the investigator, occurred on day 27 and was the only hospitalization reported. Maximum serum concentration (geometric mean) was 745.9 µg/mL. Viral load decreased from baseline through day 29; only 2 (3%) participants had a persistently high viral load (≥4.1 log10 copies/mL) at day 8.

Conclusions

Two thousand milligrams of IV sotrovimab was well tolerated, with no safety signals observed.

Trial registration

ClinicalTrials.gov Identifier: NCT04913675.
Safety, Tolerability, and Pharmacokinetics of Single and Multiple Ascending Intravenous Infusions of PF-07304814 (Lufotrelvir) in Participants Hospitalized With COVID-19
Authors: Robinson Philip , Toussi Sima S , Aggarwal Sudeepta , Bergman Arthur , Zhu Tong , Hackman Frances , Sathish Jean G , Updyke Lawrence , Loudon Peter , Krishna Ganesh , Clevenbergh Philippe , Hernandez-Mora Miguel Gorgolas , Cisneros Herreros Jose Miguel , Albertson Timothy E , Dougan Michael , Thacker Amber , Baniecki Mary Lynn , Soares Holly , Whitlock Mark , Nucci Gianluca , Menon Sandeep , Anderson Annaliesa S , Binks Michael
Published: July 2023

Background

An urgent need remains for antiviral therapies to treat patients hospitalized with COVID-19. PF-07304814—the prodrug (lufotrelvir) and its active moiety (PF-00835231)—is a potent inhibitor of the SARS-CoV-2 3CL protease.

Method

Eligible participants were 18 to 79 years old and hospitalized with confirmed COVID-19. This first-in-human phase 1b study was designed with 2 groups: single ascending dose (SAD) and multiple ascending dose (MAD). Participants could receive local standard-of-care therapy. In SAD, participants were randomized to receive a 24-hour infusion of lufotrelvir/placebo. In MAD, participants were randomized to receive a 120-hour infusion of lufotrelvir/placebo. The primary endpoint was to assess the safety and tolerability of lufotrelvir. The secondary endpoint was to evaluate the pharmacokinetics of lufotrelvir and PF-00835231.

Results

In SAD, participants were randomized to receive 250 mg lufotrelvir (n = 2), 500 mg lufotrelvir (n = 2), or placebo (n = 4) by continuous 24-hour infusion. In MAD, participants were randomized to receive 250 mg lufotrelvir (n = 7), 500 mg lufotrelvir (n = 6), or placebo (n = 4) by continuous 120-hour infusion. No adverse events or serious adverse events were considered related to lufotrelvir. At doses of 250 and 500 mg, concentrations for the prodrug lufotrelvir and active moiety PF-00835231 increased in a dose-related manner. Unbound concentrations of the lufotrelvir active metabolite reached steady state approximately 2- and 4-fold that of in vitro EC90 following 250- and 500-mg doses, respectively.

Conclusions

These safety and pharmacokinetic findings support the continued evaluation of lufotrelvir in clinical studies.

Clinical Trials Registration. ClinicalTrials.gov NCT04535167.
Abundance, composition and distribution of carnivorous gelatinous zooplankton in the Northern Gulf of Alaska
Authors: Cotea Islas Heidi Michelle , Hopcroft Russell R
Published: July 2023

Abundance, biomass, size and distribution of macro-jellyfish were measured in the Northern Gulf of Alaska (NGA). Nearly 1000 kg dispersed among ~13 800 jellyfish were collected using a 5-m2 Methot net. We present length-weight regressions for seven most-common taxa. Catches were dominated by the hydrozoan Aequorea victoria and the scyphozoan Chrysaora melanaster. During 2018, epipelagic macro-jellyfish biomass averaged 1.46 ± 0.36 g WW m−3 for July and 1.14 ± 0.23 g WW m−3 for September, while during 2019 they averaged 0.86 ± 0.19 g WW m−3 for July and 0.72 ± 0.21 g WW m−3 by September. Despite similar biomass among seasons within a year, July abundances were fivefold greater than abundances in September, with July catches dominated by smaller-sized jellyfish over the inner shelf, while during September larger jellyfish were more prominent and most predominant at offshore stations. Comparison to 20 years of data from standard towed nets allowed determination of the relative magnitude of the dominant carnivorous zooplankton components: scyphozoans, hydrozoans and chaetognaths in the NGA. The biomass of these smaller epipelagic predators (5.4 mg WW m−3 for hydrozoans and 10.5 mg WW m−3 for chaetognaths) is a low percentage of the macro-jellyfish, despite their much higher numerical abundance.
Mitigation of Huanglongbing: Implications of a Biologically Enhanced Nutritional Program on Yield, Pathogen Localization, and Host Gene Expression Profiles
Authors: Makam Srinivas N. , Setamou Mamoudou , Alabi Olufemi J. , Day William , Cromey Douglas , Nwugo Chika
Published: July 2023

Huanglongbing (HLB, citrus greening disease), the most destructive disease affecting citrus production, is primarily linked to the gram-negative, insect-vectored, phloem-inhabiting α-proteobacterium ‘Candidatus Liberibacter asiaticus’ (CLas). With no effective treatment available, management strategies have largely focused on the use of insecticides in addition to the destruction of infected trees, which are environmentally hazardous and cost-prohibitive for growers, respectively. A major limitation to combating HLB is the inability to isolate CLas in axenic culture, which hinders in vitro studies and creates a need for robust in situ CLas detection and visualization methods. The aim of this study was to investigate the efficacy of a nutritional program-based approach for HLB treatment, and to explore the effectiveness of an enhanced immunodetection method to detect CLas-infected tissues. To achieve this, four different biologically enhanced nutritional programs (bENPs; P1, P2, P3, and P4) were tested on CLas-infected citrus trees. Structured illumination microscopy preceded by a modified immunolabeling process and transmission electron microscopy were used to show treatment-dependent reduction of CLas cells in phloem tissues. No sieve pore plugging was seen in the leaves of P2 trees. This was accompanied by an 80% annual increase in fruit number per tree and 1,503 (611 upregulated and 892 downregulated) differentially expressed genes. These included an MLRQ subunit gene, UDP-glucose transferase, and genes associated with the alpha-amino linolenic acid metabolism pathway in P2 trees. Taken together, the results highlight a major role for bENPs as a viable, sustainable, and cost effective option for HLB management.
Evaluating the Use of Postharvest Decomposition Treatments on Peanut Residues for Reducing Subsequent Infection by Nothopassalora personata
Authors: Renfroe-Becton H. , Ye R. , Anco D. J.
Published: July 2023

The late leaf spot (LLS) pathogen  Nothopassalora personata overwinters on peanut residues left in the field. In this study, decomposition treatments were evaluated for their potential use in increasing the rate of decomposition of residues and potentially reducing LLS incidence. Treatments including urea ammonium nitrate (UAN) only, UAN plus a microbial stubble digestor (SD25), or UAN plus an adjuvant (Bond Max, BM), as well as timing of application in fall or spring, were assessed. Fall applications were not effective in reducing or delaying subsequent LLS epidemics. Although there were differences observed among treatments in the spring 2019 test, with UAN plus Bond Max-treated plots having significantly less defoliation from LLS at the end of the growing season, these results were not consistent in the 2020 experiments. Using the litterbag method, no consistent increase in decomposition was observed from treated residues compared with the nontreated control. Based on these results, the examined decomposition treatments were not considered to be useful in increasing the decomposition of peanut residues and subsequently reducing or delaying LLS epidemics.

[Formula: see text] Copyright © 2023 The Author(s). This is an open access article distributed under the CC BY-NC-ND 4.0 International license .
Trends in Cannabis-positive Urine Toxicology Test Results: US Veterans Health Administration Emergency Department Patients, 2008 to 2019
Authors: Fink David S. , Malte Carol , Cerdá Magdalena , Mannes Zachary L. , Livne Ofir , Martins Silvia S. , Keyhani Salomeh , Olfson Mark , McDowell Yoanna , Gradus Jaimie L. , Wall Melanie M. , Sherman Scott , Maynard Charles C. , Saxon Andrew J. , Hasin Deborah S.
Published: July 2023

Objectives

This study aimed to examine trends in cannabis-positive urine drug screens (UDSs) among emergency department (ED) patients from 2008 to 2019 using data from the Veterans Health Administration (VHA) health care system, and whether these trends differed by age group (18–34, 35–64, and 65–75 years), sex, and race, and ethnicity.

Method

VHA electronic health records from 2008 to 2019 were used to identify the percentage of unique VHA patients seen each year at an ED, received a UDS, and screened positive for cannabis. Trends in cannabis-positive UDS were examined by age, race and ethnicity, and sex within age groups.

Results

Of the VHA ED patients with a UDS, the annual prevalence positive for cannabis increased from 16.42% in 2008 to 27.2% in 2019. The largest increases in cannabis-positive UDS were observed in the younger age groups. Male and female ED patients tested positive for cannabis at similar levels. Although the prevalence of cannabis-positive UDS was consistently highest among non-Hispanic Black patients, cannabis-positive UDS increased in all race and ethnicity groups.

Discussion

The increasing prevalence of cannabis-positive UDS supports the validity of previously observed population-level increases in cannabis use and cannabis use disorder from survey and administrative records. Time trends via UDS results provide additional support that previously documented increases in self-reported cannabis use and disorder from surveys and claims data are not spuriously due to changes in patient willingness to report use as it becomes more legalized, or due to greater clinical attention over time.
Effects of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) Trial on Elective Induction and Obstetric Outcomes in Term Nulliparous Patients
Authors: Nethery Elizabeth , Levy Barbara , McLean Kate , Sitcov Kristin , Souter Vivienne L.
Published: July 2023

OBJECTIVE:

To evaluate the effect of publication of the ARRIVE (A Randomized Trial of Induction Versus Expectant Management) trial on perinatal outcomes in singleton, term, nulliparous patients.

METHODS:

An interrupted time series analysis was performed using clinical data for nulliparous singleton births at 39 weeks of gestation or later at 13 hospitals in the Northwest region of the United States (January 2016–December 2020). A modified Poisson regression was used to model time trends and changes after the ARRIVE trial (August 9, 2018). Outcomes of interest were elective induction, unplanned cesarean births, hypertensive disorders of pregnancy, a composite of perinatal adverse outcomes, and neonatal intensive care unit admissions.

RESULTS:

The analysis included 28,256 births (15,208 pre-ARRIVE and 13,048 post-ARRIVE). The rate of elective labor induction was 3.6% during the pre-ARRIVE period (January 2016–July 2018) and 10.8% post-ARRIVE (August 2018–December 2020). In the interrupted time series analysis, elective induction increased by 42% (relative risk [RR] 1.42; 95% CI 1.18–1.71) immediately after the ARRIVE trial publication. Thereafter, the trend was unchanged compared with the pre-ARRIVE period. There was no statistically significant change in cesarean birth (RR 0.96; 95% CI 0.89–1.04) or hypertensive disorders of pregnancy (RR 0.91; 95% CI 0.79–1.06) immediately after the trial, and no change in trend. After the ARRIVE trial, there was no immediate change in adverse perinatal outcomes, but a statistically significant increase in trend of adverse perinatal events (1.03; 95% CI 1.01–1.05) when compared with a declining trend observed in the pre-ARRIVE period.

CONCLUSION:

Publication of the ARRIVE trial was associated with an increase in elective induction, and no change in cesarean birth or hypertensive disorders of pregnancy in singleton nulliparous patients giving birth at 39 weeks or later. There was a flattening of the pre-ARRIVE decreasing trend in perinatal adverse events.
Closing the Diagnostic Gap in Adolescents and Young Adult Women With Bleeding Disorders
Authors: Wright Tonya S. , Cygan Peter H.
Published: July 2023

Approximately 2% of the general population have an underlying inherited bleeding disorder, which, for adolescents and young adult women, has both physical risks and adverse psychosocial effects. Heavy menstrual bleeding can be the first sign of an underlying bleeding disorder such as von Willebrand disease and the X-linked bleeding disorders hemophilia A and B. Connective tissue disorders such as Ehlers-Danlos syndrome, in particular the hypermobile subtype, are relatively frequent in the general population and can also cause bleeding symptoms from impaired hemostasis due to defective collagen. For more than 20 years, the American College of Obstetricians and Gynecologists (ACOG) has recommended screening adolescents and young adult women for bleeding disorders when they present with heavy menstrual bleeding. Despite this directive, there is a significant gap from symptom onset to time of diagnosis in this patient population. We must work to effectively close this diagnostic gap by consistently obtaining thorough bleeding histories, performing the appropriate laboratory evaluations, working collaboratively with hematologists, and using tools and materials promoted by ACOG. Improved screening and earlier diagnosis of these individuals can have far-reaching effects that are not limited to heavy menstrual bleeding management and extend to peripartum considerations and prenatal counseling.
Neovaginal Human Papillomavirus Prevalence in Transfeminine Individuals
Authors: Nandwana Devika , Hawes Kenna , Zuend Christina Farr , Pope Rachel
Published: July 2023

OBJECTIVE:

To assess the prevalence of high-risk human papillomavirus (hrHPV) and human papillomavirus (HPV)–associated abnormalities in the neovaginas of postvaginoplasty transfeminine patients to inform potential HPV-screening guidelines for this patient population.

DATA SOURCES:

MEDLINE, ClinicalTrials.gov, the Cochrane Library, Scopus, and Google Scholar were searched through September 30, 2022.

METHODS OF STUDY SELECTION:

The population included transfeminine individuals who had undergone vaginoplasty with an outcome of subsequent positive HPV diagnosis or HPV-related lesions. Randomized clinical trials, cohort studies, cross-sectional studies, and case reports available in English were included in the analysis. Identified articles were doubly screened, and accepted articles were doubly extracted.

TABULATION, INTEGRATION, AND RESULTS:

Of 59 abstracts identified, 30 were screened for eligibility, of which 15 met the criteria for review. Included studies were assessed for vaginoplasty procedure type, time elapsed between vaginoplasty and HPV testing, HPV type, location and manner of sample collection, method of HPV diagnosis, and classification and location of HPV-associated neovaginal lesions. Studies were assigned a grade of evidence of very low, low, moderate, or high based on study design, precision, directness, and risk of bias. Prevalence of neovaginal hrHPV ranged from 8.3% to 20% in identified studies, and per-study prevalence of HPV-related neovaginal abnormalities ranged from 0% to 8.3% in patients.

CONCLUSION:

The current body of research demonstrates that, after vaginoplasty, transfeminine individuals may develop neovaginal HPV infection with associated cytologic abnormalities or grossly apparent lesions. In some included studies, neovaginal HPV-associated lesions were highly advanced before they were identified. A small number of studies assessed neovaginal HPV prevalence in transfeminine individuals, with hrHPV prevalence ranging from 8.3% to 20%. However, broader conclusions about neovaginal HPV prevalence are limited by a lack of high-grade evidence in the existing literature. More rigorous prevalence research is needed to inform preventative care guidelines for transfeminine individuals at risk of developing HPV-related neovaginal complications.

SYSTEMATIC REVIEW REGISTRATION:

PROSPERO, CRD42022379977.
Weekday-dependent long-term outcomes in gastrointestinal cancer surgery: a german population-based retrospective cohort study
Authors: Maier Christopher Fabian , Schölch Caroline , Zhu Lei , Nzomo Martial Mboulla , L’hoest Helmut , Marschall Ursula , Reißfelder Christoph , Schölch Sebastian
Published: July 2023

Background:

For most solid cancers, surgery represents the mainstay of curative treatment. Several studies investigating the effects of the weekday of surgery (WOS) on patient outcomes have yielded conflicting results. Barmer, the second-largest health insurance company in Germany, serves roughly 10% of the German population. We have used the Barmer database to evaluate how the weekday on which the surgery is performed influences long-term oncologic outcomes.

Methods:

For this retrospective cohort study, the Barmer database was used to investigate the effect of the WOS (Monday–Friday) on outcomes following oncological resections of the colorectum (n=49,003), liver (n=1,302), stomach (n=5027), esophagus (n=1126), and pancreas (n=6,097). In total, 62,555 cases from 2008 to 2018 were included in the analysis. The endpoints were overall survival (OS), postoperative complications, and necessity for therapeutic interventions or re-operations. We furthermore examined whether the annual caseload or certification as a cancer center influenced the weekday effect.

Results:

We observed a significantly impaired OS for patients receiving gastric or colorectal resections on a Monday. Colorectal surgery performed on Mondays was associated with more postoperative complications and higher probability of re-operations. The annual caseload or a certification as a colorectal cancer center had no bearing on the observed weekday effect. There is evidence that hospitals schedule older patients with more comorbidities earlier in the week, possibly explaining these findings.

Conclusion:

This is the first study investigating the influence of the WOS on long-term survival in Germany. Our findings indicate that, in the German healthcare system, patients undergoing colorectal cancer surgery on Mondays have more postoperative complications and, therefore, require significantly more re-operations, ultimately lowering OS. This surprising finding appears to reflect an attempt to schedule patients with higher postoperative risk earlier in the week as well as semi-elective patients admitted on weekends scheduled for surgery on the next Monday.
Interstitial lung disease-associated pulmonary hypertension – what the future holds
Authors: Cottin Vincent , Diesler Rémi , Turquier Ségolène , Valenzuela Claudia
Published: July 2023

Purpose of review

Pulmonary hypertension associated with interstitial lung disease (ILD-PH) is associated with significant alteration of quality of life, exercise capacity, and survival. Over the past 2 years, there were changes in the guideline definition and classification of ILD-PH, and positive randomized controlled trials were published.

Recent findings

Pulmonary hypertension associated with chronic lung disease is now hemodynamically defined as a mean pulmonary artery pressure more than 20 mmHg, with pulmonary artery wedge pressure 15 mmHg or less, and pulmonary vascular resistance (PVR) at least 2 Wood units. Severe ILD-PH is defined by PVR more than 5 Wood units. In the INCREASE trial, patients receiving inhaled treprostinil had favorable significant changes in 6-min walk distance, NT-proBNP level, clinical worsening events, and forced vital capacity, which were maintained in the open label extension study. Promising results were obtained in a placebo-controlled pilot trial using escalated doses of inhaled nitric oxide. According to European guidelines, patients with ILD-PH should be referred to pulmonary hypertension centers, where inhaled treprostinil may be considered; phosphodiesterase type-5 inhibitors may also be considered in patients with severe ILD-PH.

Recent changes in the definitions and a new therapeutic option have an impact on the diagnosis and management of ILD-PH.
Spontaneous resolution of cryptogenic organizing pneumonia: Observational study
Authors: Shimoda Masafumi , Tanaka Yoshiaki , Morimoto Kozo , Yoshimori Kozo , Ohta Ken
Published: July 2023

Cryptogenic organizing pneumonia (COP) is an idiopathic interstitial pneumonia generally requiring steroid therapy, and spontaneous resolution has been reported in patients with mild disease. However, evidence supporting the need for COP treatment is poor. Therefore, we investigated the characteristics of patients with spontaneous resolution. We retrospectively collected data from 40 adult patients who were diagnosed with COP through bronchoscopic examination at Fukujuji Hospital from May 2016 to June 2022. Sixteen patients who improved without steroid therapy (the spontaneous resolution group) and 24 patients who required steroid therapy (the steroid therapy group) were compared. Patients in the spontaneous resolution group showed a lower C-reactive protein (CRP) concentration (median 0.93 mg/dL [interquartile range [IQR] 0.46–1.91] vs median 10.42 mg/dL [4.82–16.7], P < .001), a higher lymphocyte ratio (median 21.7% [18.2–25.2] vs median 13.3% [8.8–19.8], P = .002), and a longer duration from symptom onset to diagnosis of COP (median 51.5 days [24.5–65.3] vs 23.0 days [17.3–31.8], P = .009) than those in the steroid therapy group. Within 2 weeks, all patients in the spontaneous resolution group showed relief of symptoms and alleviated radiographic findings. The area under the receiver operating characteristic (ROC) curve was 0.859 (95% confidence interval [CI]: 0.741–0.978) in CRP. When we arbitrarily determined the cutoff values, including CRP levels of ≤3.79 mg/dL, the sensitivity, specificity, and odds ratio were 73.9%, 93.8%, and 39.8 (95% confidence interval: 4.51–1968.9), respectively. Only 1 patient in the spontaneous resolution group showed recurrence but did not require steroid therapy. Conversely, 4 patients in the steroid therapy group showed recurrence and were treated by an additional course of steroids. The characteristics of COP with spontaneous resolution and factors that determine the patients in whom steroid therapy might be avoided is detailed in this study.
The Effect of Aquatic Exercise on Balance in Ambulatory Individuals With Down Syndrome: An Interventional Feasibility Study
Authors: Michaels Natalie Norman , Darr Nancy , Alama Courtney , Callahan Kopplin Carly , Jacobs Taylor , Rungee Taylor Anna , Youngblood Madeleine
Published: July 2023

Background:

People with Down syndrome (DS) often present with ligamentous laxity, coordination difficulties, and decreased strength, which can lead to impaired balance. These impairments may contribute to delayed development of age-appropriate motor skills and can contribute to increased risk of falls. Although aquatic exercises have been found to improve balance in various populations, the effectiveness of aquatic exercise to improve balance for individuals with DS has not been thoroughly studied.

Methods:

Five participants with DS were tested using the second edition of the Pediatric Balance Scale (PBS-2), while their parents completed the Activities-specific Balance Confidence (ABC) scale. They then participated in an aquatic exercise intervention twice per week for 6 weeks. Following the 6-week intervention, the participants were tested again using the PBS-2 and the ABC scale.

Results:

Parents' ABC scores increased for 3 of the 5 participants, and there was a statistically significant difference between pre– and post–aquatic intervention PBS-2 total test scores for the group (P < .05).

Relevance:

The results of this small feasibility study support the practicality of aquatic exercise to improve balance for children and young adults with DS. Further research using a larger sample size is recommended.
Breakthrough HIV-1 infection in setting of cabotegravir for HIV pre-exposure prophylaxis
Authors: Hazra Aniruddha , Landovitz Raphael J. , Marzinke Mark A. , Quinby Connor , Creticos Catherine
Published: July 2023

Objective(s):

We describe the first case of HIV-1 infection in the setting of long-acting injectable cabotegravir (CAB-LA) for HIV pre-exposure prophylaxis (PrEP) to occur in the real world.

Design:

Case report

Methods:

Electronic medical records were reviewed to assess patient history and CABLA administration details. Plasma 4th generation HIV-1/2 Ag/Ab combination immunoassay and HIV-1 RNA quantitative PCR were performed at each injection visit.

Results:

We report a 28-year-old gender diverse person assigned male at birth who acquired HIV-1 infection 91 days after transitioning from tenofovir alafenamideemtricitabine (TAF/FTC) to CAB-LA despite on-time dosing and appropriate laboratory monitoring.

Conclusions:

This patient's history suggests HIV infection despite on-time and appropriate CAB-LA injections. To our knowledge, this is the first case of CAB-LA PrEP failure outside the setting of a clinical trial and highlights diagnostic and management challenges that may occur with such breakthrough infections.
Achieving the 3rd 95 in sub-saharan Africa: application of machine learning approaches to predict viral failure
Authors: Esber Allahna L. , Dear Nicole F. , King David , Francisco Leilani V. , Sing’oei Valentine , Owuoth John , Maswai Jonah , Iroezindu Michael , Bahemana Emmanuel , Kibuuka Hannah , Shah Neha , Polyak Christina S. , Ake Julie A. , Crowell Trevor A.
Published: July 2023

Objective:

Viral failure in people living with HIV (PLWH) may be influenced by multiple socio-behavioral, clinical, and context-specific factors, and supervised learning approaches may identify novel predictors. We compared the performance of two supervised learning algorithms to predict viral failure in four African countries.

Design:

Cohort study

Methods:

The African Cohort Study is an ongoing, longitudinal cohort enrolling PLWH at 12 sites in Uganda, Kenya, Tanzania, and Nigeria. Participants underwent physical examination, medical history-taking, medical record extraction, socio-behavioral interviews, and laboratory testing. In cross-sectional analyses of enrollment data, viral failure was defined as a viral load ≥1000 copies/mL among participants on antiretroviral therapy (ART) for at least six months. We compared the performance of lasso-type regularized regression and random forests by calculating area under the curve (AUC) and used each to identify factors associated with viral failure; 94 explanatory variables were considered.

Results:

Between January 2013 and December 2020, 2,941 PLWH were enrolled, 1,602 had been on ART for at least 6 months, and 1,571 participants with complete case data were included. At enrollment, 190 (12.0%) had viral failure. The lasso regression model was slightly superior to the random forest in its ability to identify PLWH with viral failure (AUC: 0.82 vs 0.75). Both models identified CD4 count, ART regimen, age, self-reported ART adherence and duration on ART as important factors associated with viral failure.

Conclusion:

These findings corroborate existing literature primarily based on hypothesis-testing statistical approaches and help to generate questions for future investigations that may impact viral failure.
Adherence to oral antiretroviral therapy in Canada, 2010–2020: A retrospective analysis of claims data
Authors: Angel Jonathan B. , Freilich Jonatan , Arthurs Erin , Ban Joann K. , Lachaine Jean , Chounta Vasiliki , Harris Marianne
Published: July 2023

Objective:

To assess antiretroviral therapy (ART) adherence among people living with HIV (PLHIV) in Canada and identify baseline characteristics associated with suboptimal adherence (<95%).

Design:

Retrospective observational study using data from the National Prescription Drug Utilization Information System and Régie de l’assurance maladie Quebec (RAMQ) Public Prescription Drug Insurance Plan.

Methods:

This analysis included PLHIV aged 18 years or older who initiated an ART regimen and were followed for at least 12 months (2010–2020). Patient characteristics were summarized using medical/pharmacy claims data from seven provinces (Alberta, Manitoba, New Brunswick, Newfoundland and Labrador, Ontario, Saskatchewan, and Quebec). ART regimen at index date (first dispensing of a regimen including a core agent) was defined as a single- or multi-tablet regimen. Adherence was calculated using a Proportion of Days Covered approach, based on ART dispensing, recorded between April 2010 and the last available date. Multivariate linear regression analysis was used to determine correlations between suboptimal adherence and baseline characteristics.

Results:

We identified 19,322 eligible PLHIV, 44.7% of whom had suboptimal adherence (<95%). Among 12,594 PLHIV with evaluable baseline data, 10,673 (84.8%) were ART naïve, 74.2% were male, mean age was 42.9 years, and 54.1% received a multi-tablet regimen as their ART. Based on multivariate regression analysis, suboptimal adherence was significantly associated with multi-tablet ART (p < 0.001) and younger age (p < 0.001), but not sex.

Conclusion:

Almost half of adult PLHIV in Canada had suboptimal adherence to ART. Better understanding of factors influencing adherence may help address gaps in current care practices that may impact adherence.
Computed Tomography–Based Deep Learning Model for Assessing the Severity of Patients With Connective Tissue Disease–Associated Interstitial Lung Disease
Authors: Su Ningling , Hou Fan , Zheng Wen , Wu Zhifeng , E Linning
Published: July 2023

Objectives

This study aimed to develop a computed tomography (CT)–based deep learning model for assessing the severity of patients with connective tissue disease (CTD)–associated interstitial lung disease (ILD).

Methods

The retrospective study included 298 CTD-ILD patients between January 2018 and May 2022. A deep learning–based RDNet model was established (1610 fully annotated CT images for training and 402 images for validation). The model was used to automatically classify and quantify 3 radiologic features (ground glass opacities [GGOs], reticulation, and honeycombing), along with a volumetric sum of 3 areas (ILD%). As a control, we used 4 previously defined CT threshold methods to calculate the ILD assessment index. The Spearman rank correlation coefficient (r) evaluated the correlation between various indicators and the lung function index in the remaining 184 CTD-ILD patients who were staged according to the gender-age-physiology (GAP) system.

Results

The RDNet model accurately identified GGOs, reticulation, and honeycombing, with corresponding Dice indexes of 0.784, 0.782, and 0.747, respectively. A total of 137 patients were at GAP1 (73.9%), 36 patients at GAP2 (19.6%), and 11 patients at GAP3 (6.0%). The percentages of reticulation and honeycombing at GAP2 and GAP3 were markedly elevated compared with those at GAP1 (P < 0.001). The percentage of GGOs was not significantly different among the GAP stages (P = 0.62). As the GAP stage increased, all lung function indicators tended to decrease, and the composite physiologic index (CPI) indicated an upward tendency. The percentage of honeycombs moderately correlated with the percentage of diffusing capacity of the lung for carbon monoxide (DLco%) (r = −0.58, P < 0.001) and CPI (r = 0.63, P < 0.001). The ILD assessment index calculated by the CT threshold method (−260 to −600 Hounsfield units) had a low correlation with DLco% and CPI (DLco%: r = −0.42, P < 0.001; CPI: r = 0.45, P < 0.001).

Conclusions

The RDNet model can quantify GGOs, reticulation, and honeycombing of chest CT images in CTD-ILD patients, among which honeycombing had the most significant effect on lung function indicators. In addition, this model provided good clinical utility for evaluating the severity of CTD-ILD.
C-Arm Computed Tomographic Image Fusion for Repetitive Transarterial Chemoembolization of Hepatocellular Carcinoma
Authors: Choi Yelim , Jeong Yun Soo , Hwang Jang Soon , Kim Hyo-Cheol , Chung Jin Wook , Choi Jin Woo
Published: July 2023

Objective

The aim of this study was to evaluate the potential implications of fusion imaging with C-arm computed tomography (CACT) scans for repetitive conventional transarterial chemoembolization (cTACE) for hepatocellular carcinoma.

Materials and Methods

Fifty-six cTACE sessions were performed using fusion CACT images from September 2020 to June 2021 in a tertiary referral center, and the data were retrospectively analyzed. Fusion of unenhanced and enhanced CACT images was considered when previously accumulated iodized oil hampered the identification of local tumor progression or intrahepatic distant metastasis (indication A), when a tumor was supplied by multiple arteries with different origins from the aorta and missing tumor enhancement was suspected (indication B), or when iodized oil distribution on immediate post-cTACE CACT images needed to be precisely compared with the pre-cTACE images (indication C). Fusion image quality, initial tumor response, time to local progression (TTLP) of index tumors, and time to progression (TTP) were evaluated.

Results

The fusion quality was satisfactory with a mean misregistration distance of 1.4 mm. For the 40 patients with indication A, the initial tumor responses at 3 months were nonviable, equivocal, and viable in 27 (67.5%), 4 (10.0%), and 9 (22.5%) index tumors, respectively. The median TTLP and TTP were 14.8 months and 4.5 months, respectively. For 10 patients with indication B, the median TTLP and TTP were 8.3 months and 2.6 months, respectively. Among the 6 patients with indication C, 2 patients were additionally treated at the same cTACE session after confirming incomplete iodized oil uptake on fusion imaging.

Conclusions

Fusion CACT images are useful in patients with hepatocellular carcinoma undergoing repetitive cTACE.
Glossopharyngeal Neuralgia Characterized by Otalgia: A Retrospective Study
Authors: Fan Haonan , Wang Linkai , Xia Siqi , Xu Xiaohui , Su Sheng , Feng Weijian , Wu Chunlai , Lou Chengjian , Chen Yili
Published: July 2023

Glossopharyngeal neuralgia (GPN) is an uncommon facial pain syndrome and is characterized by paroxysms of excruciating pain in the distributions of the auricular and pharyngeal branches of cranial nerves IX and X. Glossopharyngeal neuralgia characterized by otalgia alone is rare. Herein, the authors analyzed 2 patients with GPN with otalgia as the main clinical manifestation. The clinical features and prognosis of this rare group of patients with GPN were discussed. They both presented with paroxysmal pain in the external auditory meatus and preoperative magnetic resonance imaging suggested the vertebral artery were closely related to the glossopharyngeal nerves. In both patients, compression of the glossopharyngeal nerve was confirmed during microvascular decompression, and the symptoms were relieved immediately after surgery. At 11 to 15 months follow-up, there was no recurrence of pain. A variety of reasons can cause otalgia. The possibility of GPN is a clinical concern in patients with otalgia as the main complaint. The authors think the involvement of the glossopharyngeal nerve fibers in the tympanic plexus via Jacobson nerve may provide an important anatomic basis for GPN with predominant otalgia. Surface anesthesia test of the pharynx and preoperative magnetic resonance imaging is helpful for diagnosis. Microvascular decompression is effective in the treatment of GPN with predominant otalgia.
Does Adjuvant Gamma Knife Stereotactic Radiosurgery Have a Role in Treating Optic Nerve Sheath Meningiomas?
Authors: Wei Zhishuo , Taori Suchet , Song Shanshan , Deng Hansen , Niranjan Ajay , Lunsford L. Dade
Published: July 2023

Background:

Meningiomas arising from or adjacent to the optic nerve sheath meningioma (ONSM) are management challenges because of their risk of visual loss. Stereotactic radiosurgery (SRS) is a minimally invasive modality that can be added as adjuvant treatment for patients whose tumor has progressed or recurred after initial resection.

Methods:

The authors retrospectively reviewed 2,030 meningioma patients who underwent SRS between 1987 and 2022. In total, 7 patients (4 females; median age = 49) were found with tumors originating from the optic nerve sheath. None of the patients had tumors that engulfed the optic nerve as such tumors typically undergo fractionated radiation therapy (FRT) to preserve vision. The clinical history, visual function, and radiographic and neurological findings were characterized. Outcome measures included visual status, tumor control, and the need for additional management.

Results:

All patients underwent either initial gross total (n = 1) or partial surgical resection (n = 6) before SRS. Two patients with progressive tumor growth also had SRS after failing additional fractionated radiation after surgery (54 Gy, 30 fractions for both patients). The median time between the date of surgery and the SRS procedure date was 38 months. The Leksell Gamma Knife was used to deliver a margin dose of 12 Gy (range: 8–14 Gy) to a median cumulative tumor volume of 3.3 cc (range: 1.2–18 cc). The median maximal optic nerve radiation dose was 6.5 Gy (range: 1.9–8.1 Gy). After SRS, the median follow-up time was 130 months (range: 26–169 months). Two patients showed local tumor progression at 20 and 55 months after SRS. Four had stable visual function, 2 experienced improved visual acuity, and 1 patient had visual deterioration.

Conclusions:

Meningiomas arising from (but not engulfing the optic nerve) represent management quandaries after failed initial surgical removal. In this experience, salvage SRS was associated with tumor control and vision preservation in 5 of 7 patients. Additional experience with this strategy may further define the role of SRS both as a salvage and primary option.